The EXCELC project in Finland : The main descriptive findings from surveys using the Adult Social Care Outcomes Toolkit (ASCOT)

Exploring Comparative Effectiveness and Efficiency in Long-term Care (EXCELC), an international research project, started in 2015 to explore the comparative effectiveness and efficiency of non-institutional long-term care in Austria, England and Finland. The EXCELC project has applied the Adult Social Care Outcomes Toolkit (ASCOT) to measure social care-related quality of life of old service users, their carers and the effectiveness of non-institutional long-term care (www.pssru.ac.uk/ascot/tools). This methodological report describes the process of translating the ASCOT quality of life measures from English into Finnish, the methods of collecting survey data in 12 Finnish regions, and the main descriptive findings from the surveys

Pricing the Pharmaceuticals when the Ability to Pay Differs

A non-trivial fraction of people cannot afford to buy pharmaceutical products at unregulated market prices. This paper analyses the public insurance of a patent-protected pharmaceutical product in terms of price controls and socially optimal third-degree price discrimination. First, the paper characterizes the Ramsey pricing rule in the case where the producer price has to cover the R&D costs of the firm and patients’ pharmaceutical expenditures are not covered by health insurance. Subsequently, conditions for a welfare increasing departure from the Ramsey pricing rule are stated in terms of price regulation and health insurance coverage. Unlike the earlier views expressed, the increased consumption of the pharmaceutical is shown to be welfare increasing. In the spirit of the Rawlsian view, a criterion for vertical equity is examined as an optimal means-tested health insurance. In this scheme, the regulator chooses a higher insurance coverage for individuals whose income is below an endogenously determined income threshold. The means-tested insurance scheme improves social welfare but also yields very equal market outcomes

Physician altruism and moral hazard: (no) evidence from Finnish national prescriptions data

We test the physicians’ altruism and moral hazard hypotheses using a national panel register containing all 2003-2010 statins prescriptions in Finland. We estimate the likelihood that physicians prescribe generic versus branded versions of statins as a function of the shares of the difference between what patients have to pay out of their pocket and what is covered by the insurance, controlling for patient, physician, and drug characteristics. We find that the estimated coefficients and the average marginal effects associated with moral hazard and altruism are nearly zero, and are orders of magnitude smaller than the ones associated with other explanatory factors such as the prescriptions’ year and the physician specialization. When the analysis distinctly accounts for both the patient and the insurer shares of expenditure, the estimated coefficients directly reject the altruism and moral hazard hypotheses. Instead, we find strong and robust evidence of habits persistence in prescribing branded drugs

Tutkimus vuoden 2009 vammaispalvelulain muutosten vaikutuksista asiakasmääriin ja kustannuksiin

Henkilökohtaisen avun muuttuminen subjektiiviseksi oikeudeksi vaikeavammaisille henkilöille on lisännyt heidän yhdenvertaisuutta ja osallisuutta yhteiskunnan toimintoihin. Henkilökohtaisen avun asiakasmäärä onkin kasvanut selvästi viime vuosina johtuen erityisesti vuoden 2009 lakimuutoksesta. Tässä raportissa tarkastellaan lakimuutoksen vaikutuksia vammaispalvelujen, erityisesti henkilökohtaisen avun asiakasmääriin ja kustannuksiin. Lisäksi luodaan kuvaa myös muissa vammaispalveluissa viime vuosina tapahtuneisiin muutoksiin. Tulokset osoittavat, että asiakasmäärät ovat kasvaneet jopa odotettua enemmän. Tuloksista nähdään myös, että henkilökohtaista apua tarjotaan yhä vanhemmille asiakkaille. Vaikka henkilökohtaista apua tarjotaan yhä laajemmalle joukolle, on uusien asiakkaiden tarve pienempi kuin aiemmin. Tästä syystä myönnettyjen tuntien keskimääräinen määrä on laskenut. Raportin tulokset osoittavat kuitenkin, että lakimuutoksen aiheuttamat kokonaiskustannukset ovat kasvaneet ennakoitua enemmän, lähes 40 miljoonaa euroa. Tämä raportti on tarkoitettu päätöksentekijöille, asiantuntijoille ja tutkijoille sekä kaikille vammaispalveluista ja vammaispolitiikasta kiinnostuneille

Population-based preference weights for the Adult Social Care Outcomes Toolkit (ASCOT) for Service Users for Austria: findings from a best-worst experiment

Background: The Adult Social Care Outcomes Toolkit (ASCOT) measures quality-of-life (QoL) outcomes of long-term care (LTC) service provision. Country-specific preference weights are required to calculate ASCOT scores. ASCOT has been translated into German, but lacks preference weights for German-speaking countries. Objectives: This paper aims to establish Austrian preference weights for the German version of the ASCOT service user measure, using best-worst scaling (BWS). Methods: Data were collected using an online BWS-experiment from a general population sample (n=1,000) of Austrian adults. We use a scaleadjusted multinomial logit model (S-MNL) accounting for positioning effects to estimate preference weights. Results: Austrians value the top attribute-levels in the ASCOT domains 'being meaningfully occupied during the day' and 'having control over daily life' most highly, whereas high needs were the least preferred in the domains 'dignity' and 'social participation'. From a methods perspective, we found significant positioning effects only for 'best' choices, with statements at the top of a list being picked more often than those further down in the list. Factors related to survey completion (self-assessed understanding of the tasks and survey completion time) were shown to have the greatest effect on individual choice consistency. Discussion: The paper provides Austrian preference weights for the German version of ASCOT for service users. The weights also provide insight into how Austrians value different LTC-QoL states. Future research may investigate how values for different LTC-QoL states differ between socioeconomic groups