The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization

Response variables that are scored as counts and that present a large number of zeros often arise in quantitative health care analysis. We define a zero-in flated Poisson model with fixed-effects in both of its equations to identify respondent and health-related characteristics associated with health care demand. This is a new model that is proposed to model count measures of health care utilization and account for the panel structure of the data. Parameter estimation is achieved by conditional maximum likelihood. An application of the new model is implemented using micro level data from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE), and compared to existing panel data models for count data. Results show that separately controlling for whether outcomes are zero or positive in one of the two years does make a difference for counts with a larger number of zeros.Count Data;Zero-In ated Poisson Model;Fixed-effects;SHARE

A microeconometric analysis of health care utilization in Europe.

By analyzing the relationship between socio-economic status, health, and health care use for a variety of developed countries (with a main focus on Europe), this thesis attempts to address several questions: • What are the socio-economic factors driving the use of health care services: income, wealth and/or education? • Does the relationship between socio-economic factors and health care use vary with different types of health care services, such as primary care, specialist care, or in- and outpatient care in a hospital? • How is preventive clinical service utilization related to socio-economic status in the population aged 50 and over? • Are there different socio-economic factors driving the use of preventive care services than those driving usual care? • How should the empirical analysis be modified when dealing with count data with excess zeros? The data that are used in the thesis are micro-level data, which provide crucial information for the evaluation of health systems, including harmonized information on a variety of dimensions such as health, health care use, and socio-economic conditions at the individual level.

A microeconometric analysis of health care utilization in Europe

By analyzing the relationship between socio-economic status, health, and health care use for a variety of developed countries (with a main focus on Europe), this thesis attempts to address several questions: • What are the socio-economic factors driving the use of health care services: income, wealth and/or education? • Does the relationship between socio-economic factors and health care use vary with different types of health care services, such as primary care, specialist care, or in- and outpatient care in a hospital? • How is preventive clinical service utilization related to socio-economic status in the population aged 50 and over? • Are there different socio-economic factors driving the use of preventive care services than those driving usual care? • How should the empirical analysis be modified when dealing with count data with excess zeros? The data that are used in the thesis are micro-level data, which provide crucial information for the evaluation of health systems, including harmonized information on a variety of dimensions such as health, health care use, and socio-economic conditions at the individual level

A microeconometric analysis of health care utilization in Europe

By analyzing the relationship between socio-economic status, health, and health care use for a variety of developed countries (with a main focus on Europe), this thesis attempts to address several questions: • What are the socio-economic factors driving the use of health care services: income, wealth and/or education? • Does the relationship between socio-economic factors and health care use vary with different types of health care services, such as primary care, specialist care, or in- and outpatient care in a hospital? • How is preventive clinical service utilization related to socio-economic status in the population aged 50 and over? • Are there different socio-economic factors driving the use of preventive care services than those driving usual care? • How should the empirical analysis be modified when dealing with count data with excess zeros? The data that are used in the thesis are micro-level data, which provide crucial information for the evaluation of health systems, including harmonized information on a variety of dimensions such as health, health care use, and socio-economic conditions at the individual level.

The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization

Response variables that are scored as counts and that present a large number of zeros often arise in quantitative health care analysis. We define a zero-in flated Poisson model with fixed-effects in both of its equations to identify respondent and health-related characteristics associated with health care demand. This is a new model that is proposed to model count measures of health care utilization and account for the panel structure of the data. Parameter estimation is achieved by conditional maximum likelihood. An application of the new model is implemented using micro level data from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE), and compared to existing panel data models for count data. Results show that separately controlling for whether outcomes are zero or positive in one of the two years does make a difference for counts with a larger number of zeros

Income and health care utilization among the 50+ in Europe and the US

This study addresses the question how income affects health care utilization by the population aged 50 and over in the United States and a number of European countries with varying health care systems. The probabilities that individuals receive several medical services (visits to general practitioner, specialist, dentist, inpatient, or outpatient services) are analyzed separately using probit models. In addition to controls for income and demographic characteristics, controls for health status (both subjective and objective measures of health) are used. We analyze how the relationship between income and health care utilization varies across countries and relate these cross country differences to characteristics of the health care system, i. e., per capita total and public expenditure on health care, gate-keeping for specialist are, and copayments

Cost-effectiveness of life-review for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial

Purpose: Life-review has been established as an evidence-based treatment of depression in later life. This study investigates the cost-effectiveness of life-review compared to care-as-usual. Methods: An economic evaluation alongside a randomized controlled trial was carried out, comparing life-review (. n=. 100) to care-as-usual (. n=. 102). Individuals of 55. years and over, with moderate depressive symptomatology, were included. Treatment response was defined as a statistically reliable reduction of depressive symptoms on the Center for Epidemiologic Studies Depression scale. Total per-participant costs encompassed intervention costs, costs of receiving other treatments, participants' out-of-pocket expenses, and costs stemming from production losses, and were expressed in (2009) euros (€). Results: At 6-month follow-up, treatment response was 54.0% and 27.5% in the life-review and usual-care conditions, respectively. The difference in effectiveness was statistically significant at p=. .001 (2-tailed). In the respective conditions the costs were €5550 and €3162, with the higher costs in the intervention arm of the trial. The incremental cost-effectiveness was €8675 (US$10,227) per improved participant. Conclusion: The findings suggest that offering life-review rather than care-as-usual almost doubles the likelihood of a favorable outcome. However, the better clinical outcomes are achieved at greater costs. The conclusion that life-review offers good value for money is sensitive to the willingness to pay for a favorable treatment response. It is recommended that life-review is delivered by a single therapist and in larger groups as this may improve the cost-effectiveness of this intervention

Reducing suicidal ideation: cost-effectiveness analysis of a randomized controlled trial of unguided web-based self-help.

Background: Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective: To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods: A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants' out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results: At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 - 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were -€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be -€5039/0.15 = -€34,727 after rounding (US -$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions: This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended

La sociologie du sport en France

1- Retards, obstacles et avancées. 2- Des données nombreuses mais peu précises. 3- Une approche des positions théoriques : à chacun des 3 niveaux d'une définition construite du sport (Le sport est 'l'ensemble des situations motrices codifiées sous forme de compétitions et institutionnalisées', Parlebas, 1981), présence du corps, présence des règles, constitution comme institution, correspondent soit des discours normatifs, positifs ou négatifs, soit de véritables analyses sociologiques