Análisis Coste-beneflcio del Programa de Detección Precoz de Enfermedades Metabólicas en la Comunidad Autónoma Vasca

ResumenSe estudia la rentabilidad social del Programa de Detección Precoz y Tratamiento de dos enfermedades metabólicas, la fenilcetonuria y el hipotiroidismo congènito, en la Comunidad Autónoma Vasca, en vigor desde noviembre de 1982.La técnica utilizada es el análisis coste-beneficio. Los costes sociales de detección y tratamiento se comparan con los beneficios sociales de la prevención del retardo mental (1984 y 1985). Los Índices beneficio-coste (BC) y el valor actual neto (VAN) muestran que el programa es rentable excepto cuando los valores futuros de costes y beneficios son descontados a tasas elevadas. Los resultados del estudio son consistentes con los obtenidos por otras evaluaciones económicas de este tipo de programas.En términos de coste-efectividad, el coste de prevenir un caso de subnormalidad se estimó en 3.300.000 ptas., lo que podría interpretarse como un limite inferior a la valoración social de la prevención de la deficiencia mental.SummaryThe efficiency of an early screening and treatment Programme for two Metabolic disorders, phenylketonuria and congenita! hypothyroidism running since November 1982 in the Basque Country, is analysed.The cost-benelit analysis technique is used. The social costs of screening and treatment are compared with the social benefits for the prevention of mental handicap (1984-1985). Benefit-cost ratios and the net present value shows the social efficiency of the programme except when high discount rates have been used for discounting future costs and benefits. That conclusion is consistent with the results of other cost-benefit studies.In terms of cost-effectiveness the cost per child with mental handicap prevented was estimated on 3.300.000 ptas. That could be seen as the lowest social value for the prevention of a child with mental handicap

Dealing with the health state ‘dead’ when using discrete choice experiments to obtain values for EQ-5D-5L heath states - Springer

__Abstract__ __Objective__ : To evaluate two different methods to obtain a dead (0)—full health (1) scale for EQ-5D-5L valuation studies when using discrete choice (DC) modeling. __Method__ : The study was carried out among 400 respondents from Barcelona who were representative of the Spanish population in terms of age, sex, and level of education. The DC design included 50 pairs of health states in five blocks. Participants were forced to choose between two EQ-5D-5L states (A and B). Two extra questions concerned whether A and B were considered worse than dead. Each participant performed ten choice exercises. In addition, values were collected using lead-time trade-off (lead-time TTO), for which 100 states in ten blocks were selected. Each participant performed five lead-time TTO exercises. These consisted of DC models offering the health state ‘dead’ as one of the choices—for which all participants’ responses were used (DCdead)—and a model that included only the responses of participants who chose at least one state as worse than dead (WTD) (DCWTD). The study also estimated DC models rescaled with lead-time TTO data and a lead-time TTO linear model. __Results__ : The DCdead and DCWTD models produced relatively similar results, although the coefficients in the DCdead model were slightly lower. The DC model rescaled with lead-time TTO data produced higher utility decrements. Lead-time TTO produced the highest utility decrements. __Conclusions__: The incorporation of the state ‘dead’ in the DC models produces results in concordance with DC models that do not include ‘dead’

Incentives Beyond the Money and Motivational Capital in Health Care Organizations.

This paper explores the conditions that characterize the optimality for a principal (health manager) to undertake investments to motivate agents (doctors). In the model, doctors are intrinsically motivated and can have different identities. We develop a principal agent dynamical model with moral hazard, which captures the possibility of affecting doctors’ intrinsic motivation and identity through contracts offered by the health manager. Identity and intrinsic motivation of the doctor can be undermined (crowding-out) or enhanced (crowding-in) by incentive policies and monetary rewards. When motivations beyond the money play a role in the agents behaviour, the optimality of the equilibrium outcomes may be altered. Intrinsic motivation is defined as doctor’s experienced enjoyment from doing her work and commit toward a mission. By “full” identity we mean a situation in which the doctor shares the organizational objectives and views herself as a part of the organization. We assume that “full” identity can be achieved when health managers include mission supportive investments in contracts. This also crowds in intrinsic motivation. However, crowding out occurs when the health manager uses only pure monetary rewards to incentivize doctors with the goal of drive their actions in his own interest. Solving the model, we are allowed to make comparative statics and discuss the conditions under which spending resources to invest in motivational capital, is optimal for the health organization’s manager. Our results may help to inform policy-makers about optimal policy design and optimal management of health organizations. For instance, we conclude that investing in motivational capital is more likely to be profitable in the long run whereas mere monetary incentives are more likely to be optimal in the short run.contracts, moral hazard, intrinsic motivation, crowding effects, mission, motivational capital

Uso de índices de necesidad relativa para estimar opciones de financiación sanitaria en las regiones venezolanas.

Objetivo: Estimar necesidades relativas de gasto de las regiones venezolanas, basadas en técnicas estadísticas de análisis multivariante. Material y Métodos: Se utilizan datos del año 1997 referidos a variables demográficas (Pob 5años y 65 años); de estado de salud (mortalidad infantil, mortalidad general, y como proxy de morbilidad se ha calculado la razón de mortalidad estandarizada, tanto infantil como general); variables socioeconómicas ( índice de desarrollo humano y índice de pobreza), para las 23 regiones venezolanas. Se aplicaron las técnicas de análisis de componentes principales (ACP), análisis cluster (AC) y regresión; para hacer una estimación de las necesidades relativas de gasto sanitario público venezolano; con la finalidad de obtener un conjunto de indicadores fiables que permitan conocer cuáles son los factores que las determinan en mayor medida y qué relación guardan con los criterios que se han venido utilizando en el reparto final de los recursos sanitarios. Resultados: al aplicar el ACP se seleccionaron las tres primeras componentes que explican el 97,381% de la variabilidad conjunta interpretando que estas variables son las que tienen mayor influencia, el análisis cluster permitió organizar a las regiones en cuatro grupos relativos a la necesidad de financiación de salud; así mismo se construyó la ecuación para calcular los índices de necesidad relativa de gasto, obteniéndose unos valores de necesidades relativas de las regiones venezolanas. El análisis de regresión contrasta necesidades relativas de gasto con respecto al gasto per cápita en salud; obteniéndose un R2 = 0,27; esto significa que durante el año analizado los gastos realizados en sanidad sólo responden en un 27% de los gastos necesarios; la regresión entre necesidades de gasto relativas y el índice de desarrollo humano obtiene un R2 = 0,49; lo que muestra que las necesidades responden en un 49% a los gastos necesarios. Conclusiones: El uso de índices de necesidad relativa puede ser una alternativa muy útil para distinguir regiones con mayores necesidades de gasto en sanidad, y por tanto, ser una herramienta para asignar recursos en salud en el ámbito regional basado en criterios de equidad.

Attitudes towards blood and living organ donations.

We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.altruism, uncertainty, blood donations, living organ donations