486 research outputs found
The impact of pharmaceutical policy measures: a structural-break approach
Pharmaceutical spending in many other countries has had a steep increase in the
last decade. The Portuguese Government has adopted several measures to reduce
pharmaceutical expenditure growth, ranging from increased co-payments to price
decreases determined administratively. Promotion of generic consumption has also
ranked high in political priorities. We assess the overall impact of the several
policy measures on total pharmaceutical spending, using monthly data over the
period January 1995 – August 2008. Endogenous structural breaks (time-series)
methods were employed. Our findings suggest that policy measures aimed at
controlling pharmaceutical expenditure have been, in general, unsuccessful. Two
breaks were identified. Both coincide with administratively determined price
decreases. Measures aimed at increasing competition in the market had no visible
effect on the dynamics of Government spending in pharmaceutical products. In
particular, the introduction of reference pricing had only a transitory effect
of less than one year, with historical growth resuming quickly. The consequence
of it is a transfer of financial burden from the Government to the patients,
with no apparent effect on the dynamics of pharmaceutical spending. This
strongly suggests that pharmaceutical companies have been able to adjust to
policy measures, in order to sustain their sales. It remains a challenge for the
future to identify firms’ strategies that supported continued growth of sales,
despite the several policy measures ado
Double coverage and demand for health care: Evidence from quantile regression
An individual experiences double coverage when he bene ts from more than one
health insurance plan at the same time. This paper examines the impact of such
supplementary insurance on the demand for health care services. Its novelty is
that within the context of count data modelling and without imposing restrictive
parametric assumptions, the analysis is carried out for di¤erent points of the
conditional distribution, not only for its mean location. Results indicate that
moral hazard is present across the whole outcome distribution for both public
and private second layers of health insurance coverage but with greater
magnitude in the latter group. By looking at di¤erent points we unveil that
stronger double coverage e¤ects are smaller for high levels of usage. We use
data for Portugal, taking advantage of particular features of the public and
private protection schemes on top of the statutory National Health Service. By
exploring the last Portuguese Health Survey, we were able to evaluate their
impacts on the consumption of doctor vis
Does a Tougher Competition Policy Reduce or Promote Investment?
The question of how interventions from the Competition Authority (CA) affect
investment is not a straightforward one: a tougher competition policy might, by
reducing the ability to exert market power, either stimulate firms to invest
more to counter the restrictions on their actions, or make firms invest less
because of the reduced ability to have a return on investment. This tension is
illustrated using two models. In one model investment is own-cost-reducing
whereas in the other investment is anti-competitive. Anti-competitive
investments are defined as investments that increase competitors’ costs. In both
models the optimal level of investment is reduced with a tougher competition
policy. Furthermore, while in the case of an anti-competitive investment a
tougher authority necessarily leads to lower prices, in the case of a cost-
reducing investment the opposite may happen when the impact of the investment on
cost is sufficiently high. Results for total welfare are ambiguous in the cost-
reducing investment model, whereas in the anti-competitive investment model
welfare unambiguously increases due to a tougher competition poli
Waiting time distribution in public health care: empirics and theory
Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997–2005. We observe important differences on the ‘scale’ and on the ‘shape’ of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently
Survivorship of Anopheles darlingi (Diptera: Culicidae) in Relation with Malaria Incidence in the Brazilian Amazon
We performed a longitudinal study of adult survival of Anopheles darlingi, the most important vector in the Amazon, in a malarigenous frontier zone of Brazil. Survival rates were determined from both parous rates and multiparous dissections. Anopheles darlingi human biting rates, daily survival rates and expectation of life where higher in the dry season, as compared to the rainy season, and were correlated with malaria incidence. The biting density of mosquitoes that had survived long enough for completing at least one sporogonic cycle was related with the number of malaria cases by linear regression. Survival rates were the limiting factor explaining longitudinal variations in Plasmodium vivax malaria incidence and the association between adult mosquito survival and malaria was statistically significant by logistic regression (P<0.05). Survival rates were better correlated with malaria incidence than adult mosquito biting density. Mathematical modeling showed that P. falciparum and P. malariae were more vulnerable to changes in mosquito survival rates because of longer sporogonic cycle duration, as compared to P. vivax, which could account for the low prevalence of the former parasites observed in the study area. Population modeling also showed that the observed decreases in human biting rates in the wet season could be entirely explained by decreases in survival rates, suggesting that decreased breeding did not occur in the wet season, at the sites where adult mosquitoes were collected. For the first time in the literature, multivariate methods detected a statistically significant inverse relation (P<0.05) between the number of rainy days per month and daily survival rates, suggesting that rainfall may cause adult mortality
Tissue Doppler echocardiography – A case of right tool, wrong use
BACKGROUND: The developments in echocardiography or ultrasound cardiography (UCG) have improved our clinical capabilities. However, advanced hardware and software capabilities have resulted in UCG facilities of dubious clinical benefits. Is tissue Doppler echocardiography (TDE) is one such example? PRESENTATION OF THE HYPOTHESIS: TDE has been touted as advancement in the field of echocardiography. The striking play of colors, impressive waveforms and the seemingly accurate velocity values could be deceptive. TDE is a clear case of inappropriate use of technology. TESTING THE HYPOTHESIS: To understand this, a comparison between flow Doppler and tissue Doppler is made. To make clinically meaningful velocity measurements with Doppler, we need prior knowledge of the line of motion. This is possible in blood flow but impossible in the complex myocardial motion. The qualitative comparison makes it evident that Doppler is best suited for flow studies. IMPLICATIONS OF THE HYPOTHESIS: As of now TDE is going backwards using an indirect method when direct methods are better. The work on TDE at present is only debatable 'research and publication' material and do not translate into tangible clinical benefits. There are several advances like curved M-mode, strain rate imaging and tissue tracking in TDE. However these have been disappointing. This is due to the basic flaw in the application of the principles of Doppler. Doppler is best suited for flow studies and applying it to tissue motion is illogical. All data obtained by TDE is scientifically incorrect. This makes all the published papers on the subject flawed. Making diagnostic decisions based on this faulty application of technology would be unacceptable to the scientific cardiologist
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