1,721,192 research outputs found
HTA around the world: broadening our understanding of cross-country differences
No full textThe editorial discuss the attitudes toward the use of health technology assessment (HTA) in healthcare decision making vary widely between the United States and Europe and often even within Europ
Expanding the role of early health economic modelling in evaluation of health technologies. Comment on "Problems and promises of health technologies: the role of early health economic modeling"
No full textCommentary on the role of health economic modelling for manufacturers and HT
Inpatient reimbursement system in Italy: how do tariffs relate to costs?
No full textIn 1995 the Italian National Health Service begun to fund its hospitals on a per case basis, classified according to a DRGs system. Five out of 21 Italian regions developed a regional DRG tariff system, while the majority adopted the system set at national level. The article presents how tariffs are set by the national government and by the Lombardy Region. Production cost (mainly assessed according to a top-down, gross-costing approach) is only one of the variables used for setting tariffs. Microcosting is not used and, apparently, is not deemed as an appropriate methodology. After 10 years since their introduction national and regional tariffs are still not derived from explicit algorithms
Financing medical devices: The case of implantable cardioverter defibrillators and coronary stents in Italy
No full textIn the recent years, the financing of medical devices has gained increasing attention from health policy makers in Italy at both regional and national level. The article investigates the current modalities of procurement and reimbursement of cardiovascular medical devices in Italy, as well as their diffusion across the country. Both implantable cardioverter defibrillators and coronary stents are purchased by the health care providers using Diagnosis Related Group tariffs. Empirical data suggest that these technologies have increasingly been used in recent years in Italy
Investigating the relationship between health and gender equality: what role do maternal, reproductive, and sexual health services play?
Full text linkExamining the causal nexus between health services and gender equality is of paramount significance in policy formulation and academic inquiry. This paper concentrates on maternal, sexual, and reproductive health, offering a critical narrative review of empirical research exploring the causal relationship between enhanced women's health, stemming from either overall healthcare amelioration or specific interventions, and broader gender equality objectives. A conceptual framework is devised to elucidate the causal pathways between health and gender equality across various dimensions. The final review encompasses 30 empirical papers, revealing both direct and indirect effects of improved maternal, reproductive, and sexual health outcomes on labour participation and educational investment, with fertility decisions and autonomy serving as primary intermediary factors. Evidence predominantly indicates that interventions like contraception, family planning, and abortion policies yield enduring effects beyond health, influencing reproductive choices. Specific medical procedures, such as caesarean deliveries and sterilization, also impact fertility and labour market outcomes. Furthermore, public healthcare infrastructure contributes to combating gender-based violence by facilitating incident reporting and access to protection. Recognizing, documenting, and monitoring these co-benefits arising from improved women's health are pivotal for delineating future health sector priorities and advancing the global gender equality and sustainable development agenda
Economic Evaluation in Health Care: The Point of View of Informed Physicians
No full textAbstractObjectivesWe investigated health professionals with a solid background in health-care management and economics to get their opinion and attitude on the use of economic evaluation at the policy, organizational, and professional levels of decision-making.MethodsA 12-item questionnaire was sent to 374 Italian health-care professionals who received training in economic evaluation of health-care programs in the last 10 years at the Bocconi School of Management, Milan, Italy.ResultsThe response rate was 46.8% (175 questionnaires). All respondents stated that the basics of economic evaluation analysis must be part of the overall knowledge of health-care professionals. The usefulness of economic evaluation for professional activities was rated 3.83 (scale 1–5). Respondents stated that economic evaluation is used more for managerial decisions than for clinical ones (mean 2.89 vs. 2.74, P = 0.09). “Decisions are taken according to a short-term perspective” was the most frequently reported barrier for the actual use of economic evaluation studies, particularly by managers (76.7%). “More training in health economics” was indicated as the incentive to expand its use by the majority of both clinicians and managers (64.6%). Significantly more managers than clinicians (74.4% vs. 54.1%, P = 0.005) considered that the maximum benefits of economic evaluation are reaped at organizational level.ConclusionsInformed Italian health professionals have a positive attitude toward the principles and the techniques of economic evaluation. They show appreciation of their potential role and report making some use of them in actual decision making
Sustainability of Universal Health Coverage: Five Continents, Four Perspectives
No full textThis supplement of Value in Health contains a selection of contributions that were originally presented at the SDA Bocconi School of Management global conference on Sustaining and Implementing Universal Health Coverage. Four Perspectives for Five Continents in Milan, in February 2012. The conference was hosted by MIHMEP – the Master of International Healthcare Management, Economics and Policy, an education programme of 13-years standing with a broad network of +400 Alumni in 70 different countries. The conference represented a major milestone in the life of this network. It’s main objectives were to present evidence and discuss the major challenges of universal health coverage (UHC) in high- and low-income countries, from different perspectives: healthcare management, health economics, health policy, public and global health. The aim was to facilitate a liberal dialogue between all actors essential to healthcare provision in order to learn from the experiences of professionals in other sectors and countries, and to address the policies behind the implementation of UHC. By including all areas of healthcare in the debate – global and public health, healthcare systems and policy, healthcare management, and health economics – we gained a more complete understanding of the different elements required to achieve a truly universal coverage and stimulated the healthcare community to believe that instead of passively reacting to changes, they should be driving the changes
Uptake and diffusion of medical technology innovation in Europe: what role for funding and procurement policies?
No full textThe producers of medical technology constantly strive to innovate and to improve their products for the benefit of patients. With each new generation of devices enabling less invasive techniques, better clinical outcomes and reduced recovery times, patients are direct beneficiaries of this commitment to innovation. Innovation and patient access to technology are inseparably linked with each national health system's respective coverage, procurement and reimbursement policies. If a particular innovation is not included in the basket of services covered by public resources, there may be a time lag before it enters the system and reaches patients. If the procurement criteria focus primarily on price, it is likely that the quality and innovativeness will be penalised. Finally, if the use of an innovative technology leads to higher costs for the health-care provider, it has to bear the cost until the reimbursement mechanism is updated to include the new technology. Today there are substantial regional differences relative to the financial incentives for introducing new technology and in some cases, it can take years before the new technologies are recognised, which can inhibit the roll-out of innovation within the health system. In addition to utilising different policy choices for funding and procurement, the decision-making criteria used to inform policies vary greatly in European countries. Increasingly, health-care policymakers want scientific, technological and economic evidence before classifying a new technology as reimbursable. Although it is important to ensure that new medical devices are superior to conventional treatments, due to short-sightedness in certain assessment mechanisms and limited availability of clinical trial information, the reliability of estimates of the efficacy and cost-effectiveness can be questioned. As health technology assessment procedures are centralised, it becomes ever more important that coverage decisions regarding new medical devices are made on sound, robust criteria and that they include the full economic benefits – to the patient, to the health-care system and to society – of innovative new technology. As pressure on health-care funding mounts, reimbursement policy, in particular, is being refocused to target the contrasting objectives of healthcare expenditure containment and support of innovation. Looking forward, the successful balancing of technological adoption and affordability will require a judicious use of policy levers and will probably be accompanied by more regulatory action
Understanding the impact of economic evidence on clinical decision making: a discrete choice experiment in cardiology
No full textThe present study aims to evaluate the impact of cost-effectiveness information on clinical decision making using discrete choice experiment (DCE) methodology. Data were collected through a self-completed questionnaire administered to Italian cardiologists in June 2007 (n = 129 respondents, 1143 observations). The questionnaire asked clinicians to make choices between paired scenarios, across which three key dimensions were identified and varied: (1) quality of clinical evidence, (2) size of health gain (reduction of relative and absolute risk), and (3) economic impact (incremental cost-effectiveness ratio). A random effects probit model was used to estimate clinicians’ preferences for the different dimensions, while the heterogeneity of preferences was tested in a model with interaction terms. Dominance tests were used to assess the consistency of responses. The results indicate that Italian cardiologists regard economic impact (cost-effectiveness) as an important factor in their decision making. Economic evidence is valued more highly among clinicians with a higher self-assessed level of knowledge regarding economic evaluation techniques, as well as among younger professionals (age <45). While relevant study limitations should be acknowledged, our results suggest that DCEs can be used to elicit clinicians’ decision-making criteria and to inform the allocation of resources for future research in a logical manner. Italian cardiologists appear to take cost-effectiveness information into account when deciding whether to use new treatments
Equità territoriale: definizioni, evidenze empiriche e politiche appropriate
No full textIl tema dell’equità dei sistemi sanitari non riceve una dovuta attenzione da parte delle istituzioni sociali e delle discipline economiche. In questo capitolo ci proponiamo di sottolineare questa mancanza nel contesto italiano, suggerendo che, in linea con i principi ispiratori della L. 833/78 e delle seguenti riforme, è necessario un sforzo vigoroso per mettere a punto strumenti adeguati di policy al fine di mantenere la vocazioni universale, solidaristica ed egalitaria del Servizio sanitario nazionale (Ssn), anche e soprattutto in una fase storica caratterizzata da politiche di contenimento della spesa e di decentramento istituzionale e fiscale. L’obiettivo del capitolo è presentare il tema dell’equità territoriale nel contesto del Ssn, illustrando alcune definizioni e proponendone una che, a nostro avviso, è la più coerente con i principi della nostra legislazione e con il dispositivo dei Livelli Essenziali di Assistenza (LEA)
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