Psychometric evaluation of the Mental Health Quality of Life (MHQoL) instrument in seven European countries

Introduction: To make efficient use of available resources, decision-makers in healthcare may assess the costs and (health) benefits of health interventions. For interventions aimed at improving mental health capturing the full health benefits is an important challenge. The Mental Health Quality of Life (MHQoL) instrument was recently developed to meet this challenge. Evaluating the pyschometric properties of this instrument in different contexts remains important. Methods: A psychometric evaluation of the MHQoL was performed using existing international, cross-sectional data with 7155 respondents from seven European countries (Denmark, France, Germany, Italy, Portugal, The Netherlands, Portugal and the United Kingdom). Reliability was examined by calculating Cronbach’s alpha, a measure of internal consistency of the seven MHQoL dimensions, and by examining the association of the MHQoL sum scores with the MHQoL-VAS scores. Construct validity was examined by calculating Spearman’s rank correlation coefficients between the MHQoL sum scores and EQ-5D index scores, EQ-VAS scores, EQ-5D anxiety/depression dimension scores, ICECAP-A index scores and PHQ-4 sum scores. Results: The MHQoL was found to have good internal consistency for all seven countries. The MHQoL sum score and the MHQoL-VAS had a high correlation. Spearman’s rank correlation coefficients were moderate to very high for all outcomes. Conclusion: Our results, based on data gathered in seven European countries, suggest that the MHQoL shows favourable psychometrical characteristics. While further validation remains important, the MHQoL may be a useful instrument in measuring mental health-related quality of life in the Western European context

Demographic Development and Moral Hazard: Health Insurance with Medical Savings Accounts

In times of ever-rising health expenditures it is becoming more and more obvious that conventional models for funding health care are increasingly experiencing difficulties in meeting this challenge. The concept of Medical Savings Accounts (“MSAs”) represents an innovative and so far rarely analysed alternative for the funding of health care systems. In this concept an anticipated amount of money needed is saved up ex ante by each individual in a special account set aside to cover health care expenses. Since, however, health care expenses for certain kinds of treatment frequently exceed the financial capacity of the individual, Medical Savings Accounts are normally introduced in combination with health insurance covering defined services with higher financial risk. From a theoretical point of view the MSA concept helps to counteract the phenomenon of moral hazard in health insurance systems, at the same time coping with the future challenges posed by demographic development. This paper also examines experience gained so far in the implementation and use of Medical Savings Accounts in different countries. It draws a mixed but positive picture of the results. Therefore it could be feasible to integrate certain elements of this concept into health care systems of European countries. The Geneva Papers on Risk and Insurance (2004) 29, 689–704. doi:10.1111/j.1468-0440.2004.00311.x

The Irish ‘health basket’: a basket case?

Health basket, Health system, Health structure, Entitlement, Complex system, Ireland, I10, I18,