53 research outputs found
Physician dispensing and the choice between generic and brand-name drugs – Do margins affect choice?
No full textMany politicians blame physician dispensing (PD) to increase health care expenditure and to undermine independence of drug prescription and income leading to a suboptimal medication. Therefore, PD is not allowed in most OECD countries. In Switzerland, PD is allowed in some regions depending on the density of pharmacies. This enables to investigate the difference in prescribing behavior between physician which gain income from prescribing a specific drug and their colleagues which prescribe the drug but do not sell it. Because the considered drugs are bioequivalent we focus on the economic consequence of PD. We analyze the prescribing behavior of Swiss physicians using cross-sectional data between 2005 and 2007 for three important agents. The results support our hypothesis that dispensing physicians have a higher probability of prescribing the drug with the (most likely) higher margin compared to non-dispensing physicians. Further, generic drugs are prescribed more often to patients with higher cost-sharing while patients' cost-sharing is less influential with PD. High-income patients face a much higher probability to receive the brand-name drug due to their lower marginal utility of income. Today's administered reimbursement prices for generics seem to be high enough to gain physicians for prescribing generics because of their high margins.Physician dispensing, prescribing behavior, generics, brand-name drugs
An argument against the current methodology of presenting and educating about quilts made in North America
No full textArt history research paper.AR 592.1987 Spring
Demand-side strategies to deal with moral hazard in public insurance for long-term care
No full textMoral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) are described, highlighting the pros and cons of each strategy. Patient-oriented strategies to counteract moral hazard are used in all four countries but their impact on efficiency is unclear and crucially depends on their design. Strategies targeted at insurers are much less popular: Belgium and Switzerland have introduced elements of managed competition for some types of long-term care, as has the Netherlands in 2015. As only some elements of managed competition have been introduced, it is unclear whether it improves efficiency. Its effect will depend on the feasibility of setting appropriate financial incentives for insurers using risk equalization and the willingness of governments to provide insurers with instruments to manage long-term care
Information asymmetries and incentives in health care markets
No full textThe health care market deviates from other markets in at least two important ways: First, in addition to the usual buyers and sellers, important market players include third party payers and government agencies. Second, information asymmetries exist between all market players. This dissertation analyzes some information assymetries and their consequences on incentives. Chapter 2 analyzes a market where the regulator wishes to offset private insurers’ incentives to select good risks by paying out risk-adjusted premium subsidies. However, the regulator can neither perfectly observe an insurer’s risk pool nor does he know the cost of offering coverage efficiently. Nevertheless, our calculations show how risk adjustment schemes can be designed in a way to substantially reduce incentives for risk selection. Chapter 3 contains an estimation of how demand-side and supply-side cost sharing can be used as a corrective for moral hazard. It is found that both types of cost sharing can reduce health care expenditure. However, when the trade-off between moral hazard reduction and risk selection effects is considered, supply-side cost sharing is somewhat more effective. Chapters 4 and 5 analyze the impact of financial incentives on physician decision making and physician agency using the fact that some Swiss physicians have the right to dispense drugs on their own account, while other physicians prescribe drugs only. The former group has financial interests attached to the type and quantities of drugs sold, while the latter group does not. In Chapter 4, a prescribing physician’s dispensing status is related to her choice of generic versus brand-name drugs. It is found that physicians who dispense on their own account are more likely to prescribe generic drugs compared to physicians who do not. In Chapter 5, a general practitioner’s (GP) dispensing status is related to her incentives (1) to prescribe drugs, (2) to provide treatments, or (3) to make referrals to hospitals. From a theoretical model, it is expected that a dispensing GP would prescribe more drugs, but provide less GP services and make less referrals than a non-dispensing GP. In the empirical estimation, only the last hypothesis could be confirmed.
Der Gesundheitsmarkt unterscheidet sich von anderen Märkten in mindestens zwei wichtigen Aspekten: Erstens, es treten neben den Käufern und Verkäufern, auch externe Zahler (Versicherer) und staatliche Institutionen (Regulatoren) als wichtige Marktteilnehmer auf. Zweitens, es existieren beachtliche Informationsasymmetrien zwischen den Marktteilnehmern. In dieser Arbeit werden wichtige Informationsasymmetrien und ihre Konsequenzen auf die Marktteilnehmer untersucht. In Kapitel 2 wird ein Versicherungswettbewerb analysiert. Der Regulator will die Anreize zur Risikoselektion mindern, in dem er risikoadjustierte Subventionen an die Versicherer ausbezahlt. Er kann jedoch das vom Versicherer getragene Risiko nur unvollständig beobachten. Trotz dieser fehlenden Information können Risikoausgleichsformeln so gestaltet werden, dass der Anreiz zur Selektion substantiell reduziert wird. Kapitel 3 untersucht die Wirkung von nachfrage- und angebotsseitiger Kostenbeteiligung auf die Gesundheitsausgaben. Beide Formen von Kostenbeteiligung führen auch nach Risikobereinigung zu reduzierten Ausgaben, wobei die nachfrageseitige Kostenbeteiligung gleichzeitig zu erheblicher Risikoselektion führt. In Kapitel 4 und 5 werden finanzielle Anreize für Ärzte untersucht. Dabei wird die Tatsache analysiert, dass gewisse Schweizer Ärzte selbst Medikamente verkaufen, während andere Ärzte lediglich verschreiben. Erstere haben daher finanzielle Interessen an der Medikamentenverschreibung. In Kapitel 4 wird gezeigt, dass Ärzte mit dem Recht zum Medikamentenverkauf erheblich mehr Generikas abgeben als Apotheken. Dies wird einerseits auf die höhere Marge für Generikas, andererseits auf Rücksicht auf den (teil-)selbstzahlenden Patienten zurückgeführt. In Kapitel 5 werden die Auswirkungen des Medikamentenverkaufs auf die Anreize des Arztes untersucht, Medikamente zu verschreiben, Behandlungen vorzunehmen und Überweisungen zu tätigen. Aus einem theoretischen Modell wird hergeleitet, dass die Medikamentenausgaben ansteigen, während medizinische Leistungen und Überweisungen eher zurückgehen. In der empirischen Überprüfung wird nur eine Reduktion der Krankenhauseinweisungen bestätigt
Bernard de Clairvaux et la pensée des cisterciens
No full textProgramme des journées d'études organisées par Christian Trottmann, Jean Leclercq, Theo Kobusch, Guy Lobrichon, Lambros Couloubaritsis, Raffaele Fassetta, Claudio Stercal, Gilbert Dahan, Laurence Mellerin, D. Cazes, Annie Noblesse-Rocher, Dominique Bertrand, Cédric Giraud, Alessia Trivellone, Christophe Grellard, Maria Borriello, Jean Devriendt, Jacopo Costa, Simon Icard, Jean Leclercq, Pierre Gandil, José Goncalves. Colloque organisé par la Communauté de l'agglomération troyenne, le CNRS, le Centre d'études supérieures de la Renaissance de Tours, le Centre d'études supérieures de civilisation médiévale de Poitiers, l'École pratique des hautes études (sciences religieuses), la Faculté de théologie Protes tante de l'université de Strasbourg, avec le soutien de l'Association solidarité cistercienne
Union mystique et béatitude dans le De calculo de Ruusbroec
No full textDo the last chapters of The Ring or the Shining Stone show an effort by the author to justify his orthodoxy just after the Constitution Benedictus Deus? Does Gerson’s critique rather have the decretal of 1311 in mind, as Andr. Combes claims? This article takes up the question afresh and shows that it is rather an amalgam of the two bulls, which in no way affects the Brabant master’s conception of mystical union, which is perfectly orthodox and subtly Trinitarian. He by the way criticised the Begards, to whom Gerson and Combes tried to assimilate him, as well as their Eckhartian source. The indistinction of enjoyment in no way reduces the difference of essences, nor that of the divine persons. Each blessed creature thus receives in the union without confusion its true identity inscribed on the calculus, in the eternal face to face
Physician dispensing and the choice between generic and brand-name drugs: Do margins affect choice?
No full textMany politicians blame physician dispensing (PD) to increase health care expenditure and to undermine independence of drug prescription and income leading to a suboptimal medication. Therefore, PD is not allowed in most OECD countries. In Switzerland, PD is allowed in some regions depending on the density of pharmacies. This enables to investigate the difference in prescribing behavior between physician which gain income from prescribing a specific drug and their colleagues which prescribe the drug but do not sell it. Because the considered drugs are bioequivalent we focus on the economic consequence of PD. We analyze the prescribing behavior of Swiss physicians using cross-sectional data between 2005 and 2007 for three important agents. The results support our hypothesis that dispensing physicians have a higher probability of prescribing the drug with the (most likely) higher margin compared to non-dispensing physicians. Further, generic drugs are prescribed more often to patients with higher cost-sharing while patients' cost-sharing is less influential with PD. High-income patients face a much higher probability to receive the brand-name drug due to their lower marginal utility of income. Today's administered reimbursement prices for generics seem to be high enough to gain physicians for prescribing generics because of their high margins
Impact of a diabetes disease management program on guideline-adherent care, hospitalization risk and health care costs: a propensity score matching study using real-world data.
No full textOBJECTIVE
To evaluate the impact of a DMP for patients with diabetes mellitus in a Swiss primary care setting.
METHODS
In a prospective observational study, we compared diabetes patients in a DMP (intervention group; N = 538) with diabetes patients receiving usual care (control group; N = 5050) using propensity score matching with entropy balancing. Using a difference-in-difference (DiD) approach, we compared changes in outcomes from baseline (2017) to 1-year (2017/18) and to 2-year follow-up (2017/19). Outcomes included four measures for guideline-adherent diabetes care, hospitalization risk, and health care costs.
RESULTS
We identified a positive impact of the DMP on the share of patients fulfilling all measures for guideline-adherent care [DiD 2017/18: 7.2 percentage-points, p < 0.01; 2017/19: 8.4 percentage-points, p < 0.001]. The hospitalization risk was lower in the intervention group in both years, but only statistically significant in the 1-year follow-up [DiD 2017/18: - 5.7 percentage-points, p < 0.05; 2017/19: - 3.9 percentage points, n.s.]. The increase in health care costs was smaller in the intervention than in the control group [DiD 2017/18: CHF - 852; 2017/19: CHF - 909], but this effect was not statistically significant.
CONCLUSION
The DMP under evaluation seems to exert a positive impact on the quality of diabetes care, reflected in the increase in the measures for guideline-adherent care and in a reduction of the hospitalization risk in the intervention group. It also might reduce health care costs, but only a longer follow-up will show whether the observed effect persists over time
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