The visual analog rating scale of health-related quality of life: an examination of end-digit preferences

BACKGROUND: The Visual Analog Scale (VAS) has been extensively used in the valuation of health-related quality of life (HRQL). The objective of this paper is to examine the measurement error (rounding) explanation for the higher prevalence of VAS scores ending with a zero, and to provide an alternative interpretation. METHODS: The analysis is based on more than 4,500 reported VAS valuations of own HRQL, included in two Israeli health surveys (1993 and 2000). Bivariate and logistic regression analyses are used. RESULTS: The results show that reporting VAS scores ending with a 0 (...-20, ..0,10,20.....) decreases and scores ending with a 5 (...-15,-5,5,15,25,...) and with any other integer (...-12, -11,...1,2,...,92,..99) increases as VAS scores depart from 50, particularly when increasing up to 100. This pattern remains after controlling for personal characteristics determining the level of VAS. DISCUSSION: Rounding true HRQL to the nearest 10's or 5's cannot explain the specific pattern found. It is suggested that this pattern corresponds to a S-shaped value function, where individuals tend to evaluate their HRQL as "gains" or "losses" relative to a reference point evaluated at 50. This particular reference score originates from being a traditional "passing threshold" and the scale's midpoint. Several implications of this interpretation to the measurement of HRQL are discussed

Are Users of Complementary and Alternative Medicine Sicker than Non-Users?

Higher utilization of complementary and alternative medicine (CAM), both in cross-sections and over time, is commonly related to better socioeconomic status and to increased dissatisfaction with conventional medicine and its values. Little is known about health differences between users and non-users of CAM. The objective of the paper is to explore the difference in health measured by the SF-36 instrument between users and non-users of CAM, and to estimate the relative importance of the SF-36 health domains scales to the likelihood of consulting CAM providers. Interviews were used to collect information from a sample of 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and logistic regression analyses were used to explore the above associations. The results show that while users of CAM enjoy higher socioeconomic status and younger age, they tend to report worse health than non-users on the eight SF-36 health domains scales in both years. However, controlling for personal characteristics, lower scores on the bodily pain, role-emotional and vitality scales are related to greater likelihood of CAM use in 2000. In 1993, no scale had a significant adjusted association with the use of CAM. The conclusions are that CAM users tend to report worse health. With CAM becoming a mainstream, though somewhat luxurious, medical practice, pain and affective-emotional distress are the main drivers of CAM use

Satisfaction with Family Physicians and Specialists and the use of Complementary and Alternative Medicine in Israel

Higher utilization of complementary and alternative medicine (CAM) is commonly explained by dissatisfaction or disappointment with conventional medical treatment. To explore, at two points in time in Israel, the associations between six domains of satisfaction (attitude, length of visits, availability, information sharing, perceived quality of care and overall) with conventional family physicians' and specialists' services and the likelihood of consulting CAM providers. This is a secondary analysis of interviews, which were conducted with 2000 persons in 1993 and 2500 persons in 2000, representing the Israeli Jewish urban population aged 45–75 in those years. Bivariate and multivariate analyses were used in the investigation. In 1993, users of CAM were less satisfied than non-users with both family physicians' and specialists' care. Lower satisfaction with the attitude of, the amount of information sharing by and in general with family physicians, and with the length of visits and perceived quality of care of specialists were significantly associated with CAM use. In 2000, lower satisfaction with specialists' attitude, length of visits, availability and in general was significantly related to the use of CAM. Lower satisfaction with family physicians and specialists is significantly associated with consulting CAM providers. However, with CAM becoming a mainstream medical care specialty in its own, lower satisfaction with conventional medicine specialists becomes the most important factor

Acceptable costs and risk adjustment: policy choices and ethical trade-offs

The main objective of risk adjustment in systems of regulated competition on health insurance markets is the removal of incentives for undesirable risk selection. We introduce a simple conceptual framework to clarify how the definition of "acceptable costs" and the distinction between legitimate and illegitimate risk adjusters imply difficult ethical trade-offs between equity, avoidance of undesirable risk selection and cost-effectiveness. Focusing on the situation in Belgium, Germany, Israel, the Netherlands and Switzerland, we show how differences in the importance attached to solidarity and in the beliefs about market efficiency, have led to different decisions with respect to the definition of the basic benefits package, the choice of risk-adjusters, the possibilities of managed care, the degree of consumer choice and the relative importance of income-related financing sources in the overall system.

Inequality in treatment use among elderly patients with acute myocardial infarction: USA, Belgium and Quebec

<p>Abstract</p> <p>Background</p> <p>Previous research has provided evidence that socioeconomic status has an impact on invasive treatments use after acute myocardial infarction. In this paper, we compare the socioeconomic inequality in the use of high-technology diagnosis and treatment after acute myocardial infarction between the US, Quebec and Belgium paying special attention to financial incentives and regulations as explanatory factors.</p> <p>Methods</p> <p>We examined hospital-discharge abstracts for all patients older than 65 who were admitted to hospitals during the 1993–1998 period in the US, Quebec and Belgium with a primary diagnosis of acute myocardial infarction. Patients' income data were imputed from the median incomes of their residential area. For each country, we compared the risk-adjusted probability of undergoing each procedure between socioeconomic categories measured by the patient's area median income.</p> <p>Results</p> <p>Our findings indicate that income-related inequality exists in the use of high-technology treatment and diagnosis techniques that is not justified by differences in patients' health characteristics. Those inequalities are largely explained, in the US and Quebec, by inequalities in distances to hospitals with on-site cardiac facilities. However, in both Belgium and the US, inequalities persist among patients admitted to hospitals with on-site cardiac facilities, rejecting the hospital location effect as the single explanation for inequalities. Meanwhile, inequality levels diverge across countries (higher in the US and in Belgium, extremely low in Quebec).</p> <p>Conclusion</p> <p>The findings support the hypothesis that income-related inequality in treatment for AMI exists and is likely to be affected by a country's system of health care.</p

Risk adjustment and risk selection on the sickness fund insurance market in five European countries

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds. [Authors]]]> Health Care Reform ; Insurance Selection Bias ; Managed Competition ; National Health Programs ; Risk Adjustment eng oai:serval.unil.ch:BIB_C1056E4EB1E1 2022-05-07T01:26:22Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_C1056E4EB1E1 Accurate Estimation of Running Temporal Parameters Using Foot-Worn Inertial Sensors info:doi:10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/doi/10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/pmid/29946263 Falbriard, M. Meyer, F. Mariani, B. Millet, G.P. Aminian, K. info:eu-repo/semantics/article article 2018 Frontiers in physiology, vol. 9, pp. NA info:eu-repo/semantics/altIdentifier/pissn/1664-042X urn:issn:1664-042X <![CDATA[The aim of this study was to assess the performance of different kinematic features measured by foot-worn inertial sensors for detecting running gait temporal events (e.g., initial contact, terminal contact) in order to estimate inner-stride phases duration (e.g., contact time, flight time, swing time, step time). Forty-one healthy adults ran multiple trials on an instrumented treadmill while wearing one inertial measurement unit on the dorsum of each foot. Different algorithms for the detection of initial contact and terminal contact were proposed, evaluated and compared with a reference-threshold on the vertical ground reaction force. The minimum of the pitch angular velocity within the first and second half of a mid-swing to mid-swing cycle were identified as the most precise features for initial and terminal contact detection with an inter-trial median ± IQR precision of 2 ± 1 ms and 4 ± 2 ms respectively. Using these initial and terminal contact features, this study showed that the ground contact time, flight time, step and swing time can be estimated with an inter-trial median ± IQR bias less than 12 ± 10 ms and the a precision less than 4 ± 3 ms. Finally, this study showed that the running speed can significantly affect the biases of the estimations, suggesting that a speed-dependent correction should be applied to improve the system's accuracy

Do the equity-efficiency preferences of the Israeli Basket Committee match those of Israeli health policy makers?

Abstract Background Prioritization of medical technologies requires a multi-dimensional view. Often, conflicting equity and efficiency criteria should be reconciled. The most dramatic manifestation of such conflict is in the prioritization of new medical technologies asking for public finance performed yearly by the Israeli Basket Committee. The aim of this paper is to compare the revealed preferences of the 2006/7 Basket Committee’s members with the declared preferences of health policy-makers in Israel. Methods We compared the ranking of a sample of 18 accepted and 16 rejected technologies evaluated by the 2006/7 Basket Committee with the ranking of these technologies as predicted based on the preferences of Israeli health policy-makers. These preferences were elicited by a recent Discrete Choice Experiment (DCE) which estimated the relative weights of four equity and three efficiency criteria. The candidate technologies were characterized by these seven criteria, and their ranking was determined. A third comparative ranking of these technologies was the efficiency ranking, which is based on international data on cost per QALY gained. Results The Committee’s ranking of all technologies show no correspondence with the policy-makers’ ranking. The correlation between the two is negative when only accepted technologies are ranked. The Committee’s ranking is positively correlated with the efficiency ranking, while the health policy-makers’ ranking is not. Discussion The Committee appeared to assign to efficiency considerations a higher weight than assigned by health policy-makers. The main explanation is that while policy-makers’ ranking is based on stated preferences, that of the Committee reflects revealed preferences. Real life prioritization, made under a budget constraint, enhances the importance of efficiency considerations at the expense of equity ones. Conclusions In order for Israeli health policy to be consistent and well coordinated across policy-makers, some discussions and exchanges are needed, to arrive at a common set of preferences with respect to equity and efficiency considerations