Evidence of comparative efficacy should have a formal role in European drug approvals

Despite methodological concerns, comparative efficacy evidence should be required at the time of drug approval, says Corinna Sorenson and colleagues, to allow patients, clinicians, and other healthcare decision makers to determine whether a new drug is superior, equivalent, or inferior to its existing alternatives

The challenges of using cross-national comparisons of efficiency to inform health policy

Many comparative efficiency metrics focus on scrutinising the operation of specific parts of a single health system. This article reviews the key issues involved in international comparisons of various aspects of efficiency. It examines data sources and analytic techniques used to create comparative indicators, and discusses approaches to interpreting variations. It also highlights key challenges and promising new initiatives, such as the consistent use of international definitions and technical developments, such as data linkages, which hold the potential to enhance work in this area

Perceptions of health care access in Europe: How universal is universal coverage?

The past decade has witnessed a growing interest in the ability of health systems to protect citizens from the financial consequences associated with ill health and the use of medical care. In order to improve financial protection and access to care the WHO World Health Report 2010 firmly emphasizes that health systems move towards universal coverage of their populations. Of all regions, Europe has shown the most commitment to the goal of universal coverage. However, not all Europeans may feel as though they are able to access care if in fact they should need it. It is therefore important to investigate how the citizens of different European countries perceive their access to health care in order to better understand who these individuals are and what role different systems can play in providing better access to care

An analysis of perceived access to health care in Europe: how universal is universal coverage?

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N = 51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals’ perceptions of access and important barriers to accessing health care

The value of healthy ageing: estimating the economic value of health using time use data

Introduction Economic arguments in favour of investing in health and health care are important for policy making, yet demonstrating the potential economic gains associated with health at older ages can be empirically challenging due to older peoples’ limited attachment to the labour market. Methods We develop a novel method to quantify the economic value of health through time use data. Using data on people aged 65 years-old and older from the United Kingdom Time Use Survey (UKTUS) 2014–15, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities conditional on characteristics including age and self-perceived health. We weight these estimates of predicted minutes spent in each activity using household satellite accounts to quantify the monetary value of time spent engaging in non-market productive activities according to health status and simulate the monetary impact of health gains at older ages. Results Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Summing the monetized predictions of minutes spent across all types of activities indicates that being in “very good” instead of “very bad” self-perceived health is associated with an additional production of 439£, 629£ and 598£ (in real 2015 GBP) per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old and 85 years-old and older, respectively. Using our simulation model, if 10% of older people in “very bad” health in the United Kingdom were to transition to “very good” health it could lead to an increase of up to 278£ million through the production of non-market activities. Conclusions Health at older ages creates considerable economic value which is not observed using standard national accounting measures. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing

Catastrophic health spending in Europe: equity and policy implications of different calculation methods

Objective To investigate the equity and policy implications of different methods of calculating catastrophic health spending. Methods We used routinely collected data from recent household budget surveys in 14 European countries. We calculated the incidence of catastrophic health spending and its distribution across consumption quintiles using four methods. We compared the budget share method, which is used to monitor universal health coverage (UHC) in the sustainable development goals (SDGs), with three other well established methods: actual food spending; partial normative food spending; and normative spending on food, housing and utilities. Findings Country estimates of the incidence of catastrophic health spending were generally similar using the normative spending on food, housing and utilities method and the budget share method at the 10% threshold of a household’s ability to pay. The former method found that catastrophic spending was concentrated in the poorest quintile in all countries, whereas with the budget share method catastrophic spending was largely experienced by richer households. This is because the threshold for catastrophic health spending in the budget share method is the same for all households, while the other methods generated effective thresholds that varied across households. The normative spending on food, housing and utilities method was the only one that produced an effective threshold that rose smoothly with total household expenditure. Conclusion The budget share method used in the SDGs overestimates financial hardship among rich households and underestimates hardship among poor households. This raises concerns about the ability of the SDG process to generate appropriate guidance for policy on UHC

Kaitse suurte ravikulude eest Tšehhis, Eestis ja Lätis: kolm kõrge sissetulekutasemega riiki – kolm erinevat kogemust

Eesti Arst 2018; 97(6):301–304 &nbsp

Kaitse suurte ravikulude eest Tšehhis, Eestis ja Lätis: kolm kõrge sissetulekutasemega riiki – kolm erinevat kogemust

Eesti Arst 2018; 97(6):301–304 &nbsp

Health, an ageing labour force, and the economy: does health moderate the relationship between population age-structure and economic growth?

Research often suggests that population ageing will be detrimental for the economy due to increased labour market exits and lost productivity, however the role of population health and disability at older ages is not well established. We estimate the relationship between the size of the older working age population and economic growth across 180 countries from 1990 to 2017 to explore whether a healthy older working age population, as measured by age-specific Years Lived with Disability (YLDs), can moderate the relationship between an ageing labour force and real per capita GDP growth. Using country and year fixed effects models, we find that although an increase in the 55–69 year old share of the total population is associated with a reduction in real per capita GDP growth, the decline in economic growth is moderated if the population at that age is in good health. To demonstrate the magnitude of effects, we present model predicted real per capita GDP growth for a selection of countries from 2020 through 2100 comparing the 2017 country-specific baseline YLD rate to a simulated 5% improvement in YLDs. Our findings demonstrate that economic slowdowns attributable to population ageing are avoidable through policy interventions supporting healthy and active ageing