The Usefulness of the Discrete Choice Experiment in Providing Effective Healthcare

Given that in times of crisis the burden of chronic disease is increasing, preventive interventions are becoming more important as they affect the maintenance and improvement of the population’s health, therefore reducing government spending on the sick leave and disability benefits. As public healthcare is characterized by administrative decision-making and relying on non-market mechanisms in the resource allocation, it requires the implementation of economic evaluations. This discussion shows that because the specifics of public healthcare complicate the data collection of revealed (market) preferences, it is necessary to rely on stated preferences of respondents in order to evaluate the economic value of health interventions as well to improve public health care interventions and make them more patients oriented. Also, this article explores the method of discrete choice experiment along with its applications in healthcare, which seeks to identify the marginal rate of substitution between relevant attributes of public healthcare intervention and its impact on the patients’ choice, hence enabling a broad application of the method

Using stated preference methods to inform public health decision making: Evidence from Croatia

Croatia has recognised the importance of prevention programmes in the field of public health, although their effectiveness is not satisfactory due to the low population response, which has a negative impact on the rationalisation of public spending. One of the possible solutions is to consider the stated preferences of the target population. Therefore, the main objective of this study is to evaluate the use of stated preference methods in improving public health prevention programmes. For the purpose of the study, a questionnaire was designed using three different methods - Discrete Choice Experiment (DCE), Contingent Rating method (CR) and Best-Worst Scaling method (BWS). This study shows that the attributes of the Croatian cervical cancer screening programme are significantly associated with the respondents\u27 utility level, which in turn is related to women\u27s response. Since BWS, DCE, and CR measure the same construct - utility - we can say that convergent validity partially confirms the external validity of the methods. The author concludes that it is necessary to implement market principles, i.e. the demand-side analysis using stated preference methods, in the planning, implementation and re-evaluation of public health programmes

Balancing Between Efficiency and Equity in Publicly Funded Health Systems

The purpose of this paper is to provide a theoretical overview of efficiency and equity and give insights in the Croatian health system. Using selected indicators, a basic descriptive review of efficiency and equity in the Croatian health system was made, with an added comparison to other countries of the European Union. Observed at the macro level, Croatia shows relatively good efficiency of its health system, even above the average of the comparable countries by health expenditure per capita, but still significantly below the most developed EU countries. Still, Croatia requires further reforms that would enhance the efficiency of its health system (especially at the hospital level), without sacrificing equity which is a fundamental right of all citizens in need of health care. Although in total only small proportion of the population perceived an unmet need for health care, Croatia reported much larger inequalities in unmet need among different socio-economic groups, between high and low educated population, between women and men and among different age groups

THE IMPACT OF OWNERSHIP AND CAPITAL STRUCTURE ON THE FLUCTUATION OF AGENCY COSTS: CASE STUDY OF LOW CONCENTRATED OWNERSHIP COMPANIES OF THE REPUBLIC OF CROATIA

Matematički model izračuna agencijskih troškova postavljen u radu potvrdio je postavke agencijske teorije o utjecaju vlasničke strukture na zaduživanje te negativnoj korelaciji između financijske poluge i agencijskih troškova. Model je razvijen na uzorku skupine poduzeća Velike Britanije te, unatoč njegovim nedostatcima, od kojih je najočitiji stavljanje u uzorak poduzeća s velikom razlikom u prosječnim agencijskim troškovima, isti je predložak korišten i kod izračuna agencijskih troškova u poduzećima Republike Hrvatske. Zbog istaknutog ograničenja model je u jednom svom dijelu modificiran, a u analizu je uvedena bazna i ciljana skupina poduzeća. Pretpostavka da bazna skupina poduzeća nema agencijskih troškova jer su u vlasništvu malog broja vlasnika trebala je omogućiti procjenu istih kod ciljane skupine poduzeća. Nakon provedenog izračuna izabranih varijabli uključenih u model te ocjene ovisnosti nezavisnih varijabli modela sa zavisnom, potvrđene su hipoteze agencijskih troškova o utjecaju kapitalne strukture na agencijske troškove poduzeća, kao i postojanje agencijskih troškova u poduzećima kod kojih je vlasnička struktura raspršena na više vlasnika i interesnih skupina.The mathematical model of calculating agency costs, as presented in this paper, confirmed the hypothesis of agency theory on the impact of ownership structure on borrowing, and on a negative correlation between financial leverage and agency costs. Model was developed on a sample of companies in Great Britain, and despite its shortcomings out of which the most obvious is including those companies with a large difference in average agency costs, the same template was used to calculate the agency costs in Croatian companies. Because of the noticeable limitation, the model was partly modified, and the basic and target group of companies was introduced in the analysis. The assumption that the base group of companies has no agency costs, because they are owned by a small number of owners, should provide the estimate of the same within the target group. After the calculation of selected variables of the model, and after the dependency evaluation of independent variables of a model with the dependent one, the hypotheses about agency costs on the impact of capital structure on agency costs of companies, as well as the existence of agency costs in companies where the ownership structure is dispersed on multiple owners and interest groups were confirmed

THE IMPACT OF OWNERSHIP AND CAPITAL STRUCTURE ON THE FLUCTUATION OF AGENCY COSTS: CASE STUDY OF LOW CONCENTRATED OWNERSHIP COMPANIES OF THE REPUBLIC OF CROATIA

Matematički model izračuna agencijskih troškova postavljen u radu potvrdio je postavke agencijske teorije o utjecaju vlasničke strukture na zaduživanje te negativnoj korelaciji između financijske poluge i agencijskih troškova. Model je razvijen na uzorku skupine poduzeća Velike Britanije te, unatoč njegovim nedostatcima, od kojih je najočitiji stavljanje u uzorak poduzeća s velikom razlikom u prosječnim agencijskim troškovima, isti je predložak korišten i kod izračuna agencijskih troškova u poduzećima Republike Hrvatske. Zbog istaknutog ograničenja model je u jednom svom dijelu modificiran, a u analizu je uvedena bazna i ciljana skupina poduzeća. Pretpostavka da bazna skupina poduzeća nema agencijskih troškova jer su u vlasništvu malog broja vlasnika trebala je omogućiti procjenu istih kod ciljane skupine poduzeća. Nakon provedenog izračuna izabranih varijabli uključenih u model te ocjene ovisnosti nezavisnih varijabli modela sa zavisnom, potvrđene su hipoteze agencijskih troškova o utjecaju kapitalne strukture na agencijske troškove poduzeća, kao i postojanje agencijskih troškova u poduzećima kod kojih je vlasnička struktura raspršena na više vlasnika i interesnih skupina.The mathematical model of calculating agency costs, as presented in this paper, confirmed the hypothesis of agency theory on the impact of ownership structure on borrowing, and on a negative correlation between financial leverage and agency costs. Model was developed on a sample of companies in Great Britain, and despite its shortcomings out of which the most obvious is including those companies with a large difference in average agency costs, the same template was used to calculate the agency costs in Croatian companies. Because of the noticeable limitation, the model was partly modified, and the basic and target group of companies was introduced in the analysis. The assumption that the base group of companies has no agency costs, because they are owned by a small number of owners, should provide the estimate of the same within the target group. After the calculation of selected variables of the model, and after the dependency evaluation of independent variables of a model with the dependent one, the hypotheses about agency costs on the impact of capital structure on agency costs of companies, as well as the existence of agency costs in companies where the ownership structure is dispersed on multiple owners and interest groups were confirmed

Health literacy in Croatia

Istraživanja pokazuju da niska razina zdravstvene pismenosti ima negativne posljedice za zdravlje pojedinca i zajednice. Cilj istraživanja je utvrditi prosječnu razinu zdravstvene pismenosti u Republici Hrvatskoj na nacionalno reprezentativnom uzorku te identificirati obilježja koja se mogu dovesti u vezu s posebno niskom razinom pismenosti. Rezultati pokazuju da se razina zdravstvene pismenosti u Hrvatskoj, u prosjeku, nalazi na samoj granici između problematične i adekvatne. Unutar populacije, međutim, postoje značajne razlike u razini zdravstvene pismenosti povezane s klasnim, ekonomskim i socijalnim obilježjima pojedinaca. Niža zdravstvena pismenost odražava se u nevoljkosti pojedinca da se odazove na preventivne preglede, da zadrži težinu ispod razine pretilosti ili da redovito vježba. Naši rezultati sugeriraju da se podizanje razine zdravstvene pismenosti u Hrvatskoj ne bi smjelo oslanjati primarno na medijske kampanje jer je informacije o zdravlju iz medija građanima teško razumjeti i upotrijebiti u svrhu zaštitite od bolesti.Research shows that low levels of health literacy have negative consequences for the health of the individual and the community. The aim of the research is to establish the average level of health literacy in Croatia on a nationally representative sample and to identify characteristics that can be linked to particularly low levels of health literacy. The results show that the level of health literacy in Croatia, on average, is at the very border between problematic and adequate. Within the population, however, there are significant differences in the level of health literacy associated with the class, economic and social characteristics of individuals. Lower health literacy reflects in an individual\u27s reluctance to respond to preventive screenings, keep weight below obesity levels, or exercise regularly. Our results suggest that raising the level of health literacy in Croatia should not rely primarily on media campaigns, because health information from the media is difficult for citizens to understand and use for the purpose of protection against diseases

VALUATION OF SUPPLY AND DEMAND - KEY TO PUBLIC HEALTH CARE RESOURCE ALLOCATION

Zdravstvo je sastavnica socijalne infrastrukture te je kao takvo podložno državnim intervencijama i administrativnom donošenju odluka. Osim što je temeljna ljudska potreba, zdravlje ostvaruje i mnogobrojne ekonomske implikacije, a efektivno korištenje zdravstvene prevencije utječe na smanjenje korištenja medicinskih usluga i povezanih visokih troškova zdravstva. Javno zdravstvo podrazumijeva administrativno donošenje odluka te je, stoga, potrebno eksplicitno vrednovati troškove i koristi od zdravstvenih intervencija, odnosno potrebno je voditi računa o njihovoj troškovnoj efikasnosti. Kako tržišna ravnoteža podrazumijeva usklađenost ponude i potražnje, cilj ovog rada je naglasiti važnost i potrebitost ne samo vrednovanja na strani ponude (provođenje ekonomskih evaluacija), već i vrednovanja čimbenika na strani potražnje (preferencija korisnika zdravstvenih usluga) koristeći se metodom izrečenih preferencija.Health care is a component of social infrastructure and thus it is subject to government intervention and administrative decision-making. In addition to being a basic human need, it contributes to numerous economic implications. An effective use of health care prevention programs contributes to a reduction in the use of medical services and the associated high cost of health care. Administrative decision-making is an integral part of the public health care and hence it becomes necessary to explicitly evaluate the costs and benefi ts of medical interventions, i.e. it is necessary to take into account their cost effectiveness. Since the market equilibrium implies a balance between the supply and demand, our goal is to emphasize the importance and the necessity of not only evaluating the supply side, but also the demand side factors (preferences of the health services users), by using the stated preferences method

SOCIO DEMOGRAPHIC DETERMINANTS OF FINANCIAL LITERACY OF THE CITIZENS OF THE REPUBLIC OF CROATIA

Svrha rada je empirijska analiza financijske pismenosti pojedinaca istraživanjem odnosa između financijske pismenosti i socio-demografskih obilježja građana Republike Hrvatske. Rezultati istraživanja mogu poslužiti kao osnova za razvoj i poboljšanje strategija osobnih financija i nacionalnih mjera financijske politike s posebnim naglaskom na obrazovanje. Empirijski model rada testiran je pomoću binarne logističke regresije. Utvrđena su četiri temeljena istraživačka pitanja, a u modelu čine zavisne varijable, dok šest socio-ekonomskih obilježja ispitanika predstavljaju nezavisne varijable. Rezultati istraživanja dovode do zaključka da starost, razina obrazovanja i razine dohotka statistički signifikantno utječu na financijsku pismenost.Scientific purpose of this paper is empirical assessment of financial literacy (FL) of individuals by examining relationship between FL and sociodemographic characteristics of the Croatian citizens. Research results could serve as a basis for development and improvement of personal finance strategies and national financial policy measures with special attention put on education. Empirical model has been tested by using binary logistic regression; four fundamental survey questions have been defined, set as dependent variables while six socio-demographic characteristics of respondents have been set as independent variables. Research results show that age, level of education and income levels statistically significantly influence FL

VALUATION OF SUPPLY AND DEMAND - KEY TO PUBLIC HEALTH CARE RESOURCE ALLOCATION

Zdravstvo je sastavnica socijalne infrastrukture te je kao takvo podložno državnim intervencijama i administrativnom donošenju odluka. Osim što je temeljna ljudska potreba, zdravlje ostvaruje i mnogobrojne ekonomske implikacije, a efektivno korištenje zdravstvene prevencije utječe na smanjenje korištenja medicinskih usluga i povezanih visokih troškova zdravstva. Javno zdravstvo podrazumijeva administrativno donošenje odluka te je, stoga, potrebno eksplicitno vrednovati troškove i koristi od zdravstvenih intervencija, odnosno potrebno je voditi računa o njihovoj troškovnoj efikasnosti. Kako tržišna ravnoteža podrazumijeva usklađenost ponude i potražnje, cilj ovog rada je naglasiti važnost i potrebitost ne samo vrednovanja na strani ponude (provođenje ekonomskih evaluacija), već i vrednovanja čimbenika na strani potražnje (preferencija korisnika zdravstvenih usluga) koristeći se metodom izrečenih preferencija.Health care is a component of social infrastructure and thus it is subject to government intervention and administrative decision-making. In addition to being a basic human need, it contributes to numerous economic implications. An effective use of health care prevention programs contributes to a reduction in the use of medical services and the associated high cost of health care. Administrative decision-making is an integral part of the public health care and hence it becomes necessary to explicitly evaluate the costs and benefi ts of medical interventions, i.e. it is necessary to take into account their cost effectiveness. Since the market equilibrium implies a balance between the supply and demand, our goal is to emphasize the importance and the necessity of not only evaluating the supply side, but also the demand side factors (preferences of the health services users), by using the stated preferences method

THE PARADIGM OF PATIENT-CENTERED CARE IN THE PUBLIC HEALTH DECISION-MAKING

Equitable provision of health care has been a longstanding goal in many European countries. Provision of such universal coverage comes with the problem of growing health expenditures that is recognized globally. This article argues that patient-centered care (PCC), which has become a new promising paradigm for cost-effective provision of health care, should also become the new paradigm in the public health decision-making. PCC relates to the notion that patients’ preferences, objectives and values should be considered in the process of decision-making and delivery of health care. If we apply the PCC paradigm to the public health issue, it can be argued that any public health program or health policy should be created and evaluated considering patients’ preferences. Therefore, the aim of this paper is to elaborate the importance of preference elicitation in health care decision-making as a part of PCC