50 research outputs found
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Adaptation to Health States: A Micro-Econometric Approach
Health care funding decisions in the UK are based on valuations of the general public. However, it has been shown that there is a disparity between a hypothetical valuation of the impact of a specific condition on health and the effect of that health state by someone who experiences it. This paper examines the issue of adaptation to health states, which partially may explain the discrepancy between hypothetical and experienced health state valuations. We use the British Cohort Study (BCS70) which is a longitudinal dataset that tracks a sample of British individuals since their birth in 1970. We use four BCS70 waves containing information on self-assessed health (SAH), morbidity as well as a number of socio-economic characteristics. To estimate the issue of adaptation, we implement a dynamic ordered probit model that controls for (health) state dependence. The empirical specification controls for morbidity and also includes a variable for the duration of the illness. We find that, for most chronic conditions, duration has a positive impact on self-assessed health, while for some conditions-such as diabetes- this does not occur. We interpret our results as evidence in support of the hypothesis that adaptation to chronic diseases exists and may explain at least in part the differences between general public and patientsâ health state valuations
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Exploring the Impact of New Medical Technology on Workforce Planning
This paper considers the manner in which technology is diffused, with a particular emphasis on the impact on workforce composition as it matures. The lack of quantitative evidence of technology on the medical labour-force limits our knowledge of the full impact of technological change in the healthcare sector. We examine the diffusion of PTCA as it replaces CABG in the treatment of cardiovascular disease in England, estimating the degree to which the workforce reacts to the introduction of the newer technology, through calculating elasticity of supply measures. Using administrative data we trace the complementarity between CABG and PTCA during the mature phase of technology adoption, mapped against an increasing employment of cardiologists over cardiothoracic surgeons. Our findings show evidence of indication creep as PTCA is increasingly expanded to older and sicker patients, and that cardiothoracic surgery, other than CABG, increases in a manner consistent with replacement activity and cardiothoracic employment
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Better Health in Times of Hardship?
This paper examines the impact that the Great Recession had on individualsâ health behaviours and risk factors such as diet choices, smoking, alcohol consumption, and Body Mass Index, as well as on intermediate health outcomes in England. We exploit data from the Health Survey for England for the period 2001-2013 and capture the change in macroeconomic conditions using regional Unemployment Rates (URs) and an indicator variable for the onset of the recession. We observe an overall tendency towards moderation in smoking and alcohol intake. Interestingly, the recession indicator itself is associated to a decrease in fruit intake, a shift of the BMI distribution towards obesity, an increase in medicines consumption, and the likelihood of suffering diabetes, heart and mental health problems. These associations are more intense for the less educated and for women. When it exists, the association with UR tends to weaken after 2008. Our findings indicate that some of the health risks and intermediate health outcomes changes are associated with mechanisms not captured solely by worsened URs. We hypothesize that the uncertainty and the negative expectations generated by the recession may have influenced individual health outcomes and behaviours beyond the adjustments induced by the worsened macroeconomic conditions. The net effect translated in the erosion of the propensity to undertake several health risky behaviours but an exacerbation of some morbidity indicators
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The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England
This paper examines the impact that the Great Recession had on individuals' health behaviours and risk factors such as diet choices, smoking, alcohol consumption, and Body Mass Index, as well as on intermediate health outcomes in England. We exploit data on about 9000 households from the Health Survey for England for the period 2001-2013 and capture the change in macroeconomic conditions using regional unemployment rates and an indicator variable for the onset of the recession. Our findings indicate that the recession is associated with a decrease in the number of cigarettes smoked - which translated into a moderation in smoking intensity - and a reduction in alcohol intake. The recession indicator itself is associated with a decrease in fruit intake, a shift of the BMI distribution towards obesity, an increase in medicines consumption, and the likelihood of suffering from diabetes and mental health problems. These associations are often stronger for the less educated and for women. When they exist, the associations with the unemployment rate (UR) are nevertheless similar before and after 2008. Our results suggest that some of the health risks and intermediate health outcomes changes may be due to mechanisms not captured by worsened URs. We hypothesize that the uncertainty and the negative expectations generated by the recession may have influenced individual health outcomes and behaviours beyond the adjustments induced by the worsened macroeconomic conditions. The net effect translated into the erosion of the propensity to undertake several health risky behaviours but an exacerbation of some morbidity indicators. Overall, we find that the recession led to a moderation in risky behaviours but also to worsening of some risk factors and health outcomes
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The suitability of a DRG casemix system in the Maltese hospital setting
The healthcare system in Malta is financed through global budgets and healthcare is provided free at the point of use. This paper is a first attempt to examine the feasibility of introducing a Diagnosis Related Groups casemix system for Malta, not necessarily for payment and funding purposes, but as a tool to help describe, manage and measure resource use. This is particularly challenging in view of the constraints and characteristics of a small state country. The study evaluates the applicability of the MS-DRG (Version 27.0) Grouper to describe acute hospital activity on the island. The classification of 151,615 admissions between 2009-2011 resulted in 636 DRG categories. Around half of these DRGs accounted for 99% of the total activity at the hospital, while 296 DRG categories had fewer than 15 cases over the period. Patient length of stay is used to explain resource use and the Coefficient of Multiple Determination obtained was of 0.19 (improving to 0.25 when a number of trimming algorithms were applied). A good proportion of the resulting DRGs had a Coefficient of Variation, which indicates a low degree of variability within the obtained DRG groups. This presents good evidence to support the introduction of a DRG system in Malta particularly in view of the recent drive towards more public-private partnerships and legislation on cross-border patient treatment
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The Blow of Domestic Violence on Children's Health Outcomes
This article unravels the effect of Domestic Violence on childrenâs health production function. Drawing results from the UK Millennium Cohort Study, we find that there is a strong negative externality of household violence on childrenâs health outcomes. Simultaneity between child health and Domestic Violence makes it difficult to identify a causal effect, so we use an instrumental approach to address the potential bias. Children living in a household in which there is Domestic Violence appear to be between 55% and 61% less likely to have their health rated as Excellent. Our results are robust and statistically significant across all specifications. Our paper not only sheds light on the negative impact of DV on childrenâs health but provides a robust quantification of this effect
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Adaptation to Health States: Sick yet better off?
Healthcare funding decisions in the UK rely on health state valuations of the general public. However, it has been shown that there is disparity between the valuation of the impact of hypothetical conditions on health and the reported health by those experiencing them. Patients' adaptation to health states is among the most common explanations for this discrepancy. Being diagnosed with a disease appears to affect individual perception of health over time so that better subjective health may be reported over a disease trajectory. This paper examines adaptation to health states using a longitudinal dataset. We use four waves of the British Cohort Study (BCS70), which tracks a sample of British individuals since birth in 1970 and contains information on self-assessed health (SAH), morbidity, and socioeconomic characteristics. We implement a dynamic ordered probit model controlling for health state dependence. Results are supportive of the existence of adaptation: Time since diagnosis has a positive impact on SAH. Moreover, adaptation happens over relatively long durations. We do not find significant results proving different adaptation paths for patients reporting prior better SAH. The analysis by specific conditions generally supports the existence of adaptation, but results are statistically significant only for a subset of conditions
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Efficiency and productivity gains of robotic surgery: The case of the English National Health Service
This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high onâgoing maintenance costs. Using data from Hospital Episode Statistics for the period 2000â2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in roboticâassisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered differenceâinâdifference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in postâLoS and 44% and 46% decrease in postoperative visits after 1Â year and 2Â years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the largeâscale hospital investments in such costly technology
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Intimate partner violence and children's health outcomes
A growing body of literature has established that childhood health is a crucial determinant of human capital formation. Shocks experienced in utero and during early life may have far-reaching consequences that extend well into adulthood. Nevertheless, there is relatively little evidence regarding the effects of parental behaviour on child health. This paper contributes to the literature by examining the impact of intimate partner violence (IPV) on the child's health production function. Using data from the UK's Millennium Cohort Study and leveraging information on both child health and IPV, our analysis reveals that exposure to IPV is negatively associated to child's health. Children witnessing IPV in their household see their probability of being in excellent health reduced by 7 percentage points. Our results also suggest that children exposed to IPV are subject to increased morbidity, manifested in elevated risks of hearing and respiratory problems, as well as long-term health conditions and are less likely to get fully immunised
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The diffusion of robotic surgery: Examining technology use in the English NHS
This paper examines the adoption and diffusion of medical technology as associated with the dramatic recent increase in the surgical use of robots. We consider specifically the sequential adoption and diffusion patterns of three interrelated surgical technologies within a single healthcare system (the English NHS): robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar patient benefits, but the newer robotic technique requires a high initial investment cost to purchase the robot and carries high maintenance costs over time. Using data from a large UK administrative database, Hospital Episodes Statistics, for the period 2000-2018, we analyse 173 hospitals performing radical prostatectomy, the most prevalent and earliest surgical area of adoption of robotic surgery. Our empirical analysis first identifies substitution effects, with robotic surgery replacing the incumbent technology, including the recently diffused laparoscopic technology. We then quantify the spillover of robotic surgery as it diffuses to other surgical specialties. Finally, we perform time-to-event analysis at the hospital level to quantitatively examine the adoption. Results show that a higher number of urologists and a wealthier referral area favor robot adoption