1,720,963 research outputs found
Lead me not into temptation: drug price regulation and dispensing physicians in Switzerland
Get PDFWhile most countries separate drug prescription and dispensation to ensure independent drug choice, some allow this combination to increase pharmaceutical access in rural areas or to increase the utilization of pharmacist skills. A drawback of this approach is that dispensing physicians or prescribing pharmacists may be incentivized to increase their own profits through the prescription of cost-inefficient drug packages, leading to an increase in pharmaceutical spending. Switzerland constitutes an interesting example of where dispensing and non-dispensing physicians coexist, permitting a comparison of their prescribing behavior. The present study shows that drug margin optimization is possible under the current drug price regulation scheme in Switzerland. Using drug claims data, empirical findings indicate a 5-10% higher margin per dose for dispensing physicians compared to pharmacists. Cost per dose is 3-5% higher when dispensed by physicians instead of pharmacists
Provider and consumer preferences in health care markets
Get PDFThis dissertation investigates provider and consumer preferences in health care markets as they pertain to policy decisions and shows that, if placing priority on a nation’s welfare, policy makers would do well to design reforms that not only address, but also, are largely informed by, provider and consumer feedback. For example, if citizens’ preferences point to a willingness to pay high insurance premiums (or taxes) for health care consumption, reforms to cut cost through rationing health care provision may actually decrease a nation’s welfare. Each chapter of this dissertation can be considered as self-contained. Following a brief discussion of the relevance of preference measurement, this dissertation first analyzes what it is that physicians dislike about Managed Care (MC). Supported by evidence drawn from a discrete choice experiment conducted with Swiss ambulatory care physicians, findings demonstrate that private health insurers must be able to achieve substantial savings in order to create sufficient incentives for physicians to participate voluntarily in MC. The same is true for accepting budgetary co-responsibility investigated in Chapter 3. The results show that, as long as the alternative of conventional private practice exists, physicians are less likely to join physician networks and accept budgetary responsibility unless they are highly compensated for the additional financial risk. Chapter 4 compares consumer preferences for health insurance in Germany and the Netherlands. Using two discrete choice experiments, this chapter compares consumer willingness to pay for health insurance attributes. While the two populations agree in their resistance against MC-type attributes, German respondents required much higher compensation in order to give up free physician choice and instead accept a physician list. Chapters 5 and 6 examine physicians’ preferences for drug versions and package sizes. Chapter 5 tests physicians’ imperfect agency and reveals a significant positive association between physician dispensing and the use of generic drugs. Chapter 6 explores whether or not dispensing physicians optimize their own drug margins by prescribing margin-optimizing package sizes. Findings suggest that dispensing physicians achieve higher drug margins than pharmacies, which results in higher drug costs and inefficient package choices for patients
Simulating WTP Values from Random-Coefficient Models
Get PDFDiscrete Choice Experiments (DCEs) designed to estimate willingness-to-pay (WTP) values are very popular in health economics. With increased computation power and advanced simulation techniques, random-coefficient models have gained an increasing importance in applied work as they allow for taste heterogeneity. This paper discusses the parametrical derivation of WTP values from estimated random-coefficient models and shows how these values can be simulated in cases where they do not have a known distribution
Lead me not into temptation: drug price regulation and dispensing physicians in Switzerland
Get PDFWhile most countries separate drug prescription and dispensation to ensure independent drug choice, some allow this combination to increase pharmaceutical access in rural areas or to increase the utilization of pharmacist skills. A drawback of this approach is that dispensing physicians or prescribing pharmacists may be incentivized to increase their own profits through the prescription of cost-inefficient drug packages, leading to an increase in pharmaceutical spending. Switzerland constitutes an interesting example of where dispensing and non-dispensing physicians coexist, permitting a comparison of their prescribing behavior. The present study shows that drug margin optimization is possible under the current drug price regulation scheme in Switzerland. Using drug claims data, empirical findings indicate a 5-10% higher margin per dose for dispensing physicians compared to pharmacists. Cost per dose is 3-5% higher when dispensed by physicians instead of pharmacists
What do physicians dislike about managed care? Evidence from a choice experiment
Get PDFManaged care (MC) imposes restrictions on physician behavior, but also holds promises, especially in terms of cost savings and improvements in treatment quality. This contribution reports on private-practice physicians' willingness to accept (WTA, compensation asked, respectively) for several MC features. In 2011, 1,088 Swiss ambulatory care physicians participated in a discrete choice experiment, which permits putting WTA values on MC attributes. With the exception of shared decision making and up to six quality circle meetings per year, all attributes are associated with non-zero WTA values. Thus, health insurers must be able to achieve substantial savings in order to create sufficient incentives for Swiss physicians to participate voluntarily in MC plan
Physician dispensing and the choice between generic and brand-name drugs: Do margins affect choice?
Get PDFMany 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
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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