Designing and Undertaking a Health Economics Study of Digital Health Interventions.

This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.This paper is one of the outputs of two workshops, one supported by the Medical Research Council (MRC)/National Institute for Health Research (NIHR) Methodology Research Programme (PI Susan Michie) and the Robert Wood Johnson Foundation (PI Kevin Patrick), and the other by the National Science Foundation (PI Donna Spruitj-Metz, proposal # 1539846). The Health Economics Research Unit is funded in part by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier

impact of housing code enforcement upon house operating firm decision-making

In the field of planning and policy-making, there is often insufficient concern for the nature and patterns of decision-making in the private sector. It is felt that improved knowledge of these patterns would provide an additional significant input to aid policy-makers in the difficult task of assembling the most appropriate program from a host of available alternatives. To develop this theme, this thesis has focused upon private sector response to housing code enforcement as a tool for eliminating substandard housing and increasing the supply of standard housing for low income tenants. Two models of rehabilitation decision-making by absentee owners of multiple rental housing (i.e., house operating firms) are presented and operationalized. The first model assumes that a community does not enforce a set of minimum housing standards. Consequently, house operating firms are free to adjust their operating, replacement and remodelling expenditures, thereby raising or lowering the position occupied by their buildings in a distribution of rental housing quality. Since each position in this quality distribution generates a different level of rent, the firm must choose that position which maximizes profit from its building. In the case where minimum housing regulations are not enforced, this pattern of decision-making often implies the existence of a significant quantity of profitable substandard rental housing. Since firms in this instance are free to decide to operate their buildings at substandard levels without fear of prosecution, we have termed this the "unrestricted decision-making model." The second model, which we have described as the "restricted decision-making model," assumes that a housing code has been enacted and is strictly enforced. In this case, house operating firms owning substandard buildings have certain restrictions placed on their decision-making. These restrictions require that the firm either increase its expenditures on its building to raise the level of quality to a certain minimum standard or withdraw the building from occupancy. The result is that such firms face a potential loss in profit which they will attempt to minimize in their decision-making. An examination of the housing code enforcement experience of selected communities points toward a number of serious issues which must be resolved if such programs are to succeed in restricting house operating firm decision-making. These issues include administration, inspection, staffing, legal, land use and vacancy problems. All but the latter problem appear to be soluble, given the appropriate steps. However, under conditions of low vacancy rates in non-luxury rental housing, the strict enforcement of a housing code threatens to dislocate significant numbers of low income tenants. This undesirable outcome is to be expected according to the restricted decision-making model; however, it is contrary to the stated aims of code enforcement. To alter this outcome, it is contended that communities should concentrate on manipulating the important variables in the house operating firm decision-making process by introducing a range of policies into their code enforcement programs. In the final chapter of this thesis, then, certain policy alternatives are considered with respect to their potential impact upon the decisions of house operating firms, with the emphasis placed on stimulating rehabilitation where it might otherwise not occur.Applied Science, Faculty ofCommunity and Regional Planning (SCARP), School ofGraduat

The Resurgence of India

Recent economic growth in India has raised its potential to be an economic giant, along with the United States and China. One unique aspect of the Indian economy is that tremendous economic growth has been achieved despite weak infrastructure, resource shortages, and other travails that restrict growth in emerging economies. Recent economic explanations suggest that institutions supporting the economy and economic development are vital to sustained economic growth and may even be more important than infrastructure development. Examining the historic context of the Indian economy, we contend that vital market institutions were always present in India and that economic reforms have unleashed the full potential of these institutions. Using some industry examples, the authors argue that economic policies that strengthen market institutions may be more important compared to conventional policies geared toward infrastructure development