Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria

Magnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question

Policy implications of heterogeneous demand reactions to changes in cost-sharing: patient-level evidence from Austria

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients’ (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool

Using Geographically Referenced Data on Environmental Exposures for Public Health Research: A Feasibility Study Based on the German Socio-Economic Panel Study (SOEP)

Background: In panel datasets information on environmental exposures is scarce. Thus, our goal was to probe the use of area-wide geographically referenced data for air pollution from an external data source in the analysis of physical health. Methods: The study population comprised SOEP respondents in 2004 merged with exposures for NO2, PM10 and O3 based on a multi-year reanalysis of the EURopean Air pollution Dispersion-Inverse Model (EURAD-IM). Apart from bivariate analyses with subjective air pollution we estimated cross-sectional multilevel regression models for physical health as assessed by the SF-12. Results: The variation of average exposure to NO2, PM10 and O3 was small with the interquartile range being less than 10µg/m3 for all pollutants. There was no correlation between subjective air pollution and average exposure to PM10 and O3, while there was a very small positive correlation between the first and NO2. Inclusion of objective air pollution in regression models did not improve the model fit. Conclusions: It is feasible to merge environmental exposures to a nationally representative panel study like the SOEP. However, in our study the spatial resolution of the specific air pollutants has been too little, yet.SOEP, Geographically Referenced Data, Feasibility Study, Air Pollution, EURAD-IM, Physical Health

Selbstbehalte in der Sozialversicherung. Einsatz als Steuerungs- und Finanzierungsinstrument. Teilbericht Modul I: Qualitative Analyse

In vielen Gesundheitssystemen spielen Selbstbehalte eine wichtige Rolle. So werden sie dazu genutzt die Inanspruchnahme von Gesundheitsleistungen der PatientInnen zu steuern, oder einfach als Mechanismus für das Lukrieren zusätzlicher finanzieller Mittel eingesetzt. Aus Sicht der ökonomischen Theorie gibt es sowohl Gründe, die für den Einsatz von Selbstbehalten, aber auch Gründe, die dagegen sprechen. Der vorliegende Projektbericht fasst die wichtigsten theoretischen Argumente und aktuelle empirische Erkenntnisse zusammen. Damit können der aktuelle Einsatz von Selbstbehalten im österreichischen Gesundheitssystem bewertet, und mögliche Perspektiven für Reformen in Richtung höher Effektivität benannt werden. Vor allem der Umstand, dass in Österreich mehrere unterschiedliche Selbstbehalteregime über die Sozialversicherungsträger hinweg bestehen, ist aus dem Blickwinkel des gleichen Zugangs zu medizinischen Leistungen kritisch zu sehen. Verbesserungen können durch eine gestaffelte und evidenzbasierte Ausgestaltung von Selbstbehalten erreicht werden. Dadurch können sozial schwächere PatientInnen besser vor negativen Auswirkungen von Selbstbehalten geschützt, und PatientInnen allgemein in Richtung notwendiger (evidenzbasierter) Gesundheitsleistungen gelenkt werden. In many healthcare systems around the globe, cost sharing maintains a key role. It can be used as a tool to influence patients’ patterns of healthcare service consumption, or simply as a revenue raising mechanism. From an economic point of view, there are both arguments in favour, but also against applying cost sharing in practice. This project report summarises the major economic arguments and recent empirical evidence. This is used to assess the current state of cost sharing in the Austrian healthcare system and to highlight possibilities for policy action to steer the use of cost sharing towards higher effectivity. We find that the multitude of different cost sharing schemes across social health insurance provides in Austria is problematic in terms of equity in access to care. Improvements can be made along the lines of staggered cost sharing to more effectively protect vulnerable patients, and value-based cost sharing to nudge patients towards evidence-based medical service and thus reduce the gap between necessary and merely desired treatment

Experimental and Numerical Investigation of Tire Tread Wear on Block Level

Tread wear appears as a consequence of friction, which mainly depends on surface charac-teristics, contact pressure, slip velocity, temperature and dissipative material properties of the tread material itself. The subsequent description introduces a wear model as a function of the frictional energy rate. A post-processing as well as an adaptive re-meshing algorithm are implemented into a finite element code in order to predict wear loss in terms of mass. The geometry of block models is generated by image processing tools using photographs of the rubber samples in the laboratory. In addition, the worn block shape after the wear test is compared to simulation results

InterFlowCeption: Foundations for Technological Enhancement of Interoception to Foster Flow States during Mental Work: About the potential of technologically supported body awareness to promote flow experiences during mental work

Conducting mental work by interacting with digital technology increases productivity, but strains attentional capacities and mental well-being. In consequence, many mental workers try to cultivate their fow experience. However, this is complex and difcult to achieve. Nevertheless, current technological systems do not yet provide this support in mental work. As interoception, the individual bodily awareness is an underlying mechanism of numerous fow correlates, it might ofer a new approach for fow-supporting systems in these scenarios. Results from a survey study with 176 digital workers show that adaptive regulation of interoceptive sensations correlates with higher levels of fow and engagement. Additionally, regular mindfulness practices improved workers’ adaptive regulation of bodily signals. Based on these results and integrating the current literature, this work conceptualizes three future technological support systems, such as interoceptive biofeedback, and electrical or auditory stimulation to enhance interoceptive awareness and foster fow in mental work

Complementarity of Resonant and Nonresonant Strong WWWW Scattering at the LHC

We exhibit a complementary relationship between resonant $WZ$ and nonresonant $W^+W^+$ scattering in a chiral Lagrangian model of the electroweak symmetry breaking sector with a dominant ``$\rho$'' meson. We use the model to estimate the minimum luminosity for the LHC to ensure a ``no-lose'' capability to observe the symmetry breaking sector.Comment: 13 pages, LateX with uuencoded postcript figures (figures available by mail to the technologically challenged), LBL-3484

Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists.

BACKGROUND According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings