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Greve J, Kristensen SR, Lydiksen N. Patient and peer: Guideline design and expert response. JOURNAL OF HEALTH ECONOMICS 2023; 92:102806. [PMID: 37729841 DOI: 10.1016/j.jhealeco.2023.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/16/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
We examine how patients' medical expertise influences adherence to clinical guidelines for a treatment that is common, costly, and rationed by the clinical guidelines. Using administrative data on prenatal diagnostic testing (PDT), we compare the testing rates of medically trained patients (experts) and non-medically trained patients (non-experts) on the margin of eligibility thresholds in clinical guidelines. We find that experts are 9 percentage points more likely to receive PDT than non-experts when they are not eligible for testing and that more than 80% of the difference can be attributed to medical expertise. Our results suggest that the design of clinical guidelines is important for adherence and that having medical expertise as a patient affects treatment, when there is room for a deviation from the guideline.
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Affiliation(s)
- Jane Greve
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, DK-1052, Copenhagen K, Denmark.
| | - Søren Rud Kristensen
- Danish Center for Health Economics, University of Southern Denmark, J.B. Winsløws Vej 9B, 1st st floor, DK-5000, Odense C, Denmark.
| | - Nis Lydiksen
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, DK-1052, Copenhagen K, Denmark; Department of Economics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.
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Daniels L, Marneffe W. Does patient behaviour drive physicians to practice defensive medicine? Evidence from a video experiment. HEALTH ECONOMICS REVIEW 2023; 13:45. [PMID: 37737503 PMCID: PMC10515032 DOI: 10.1186/s13561-023-00458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 08/20/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE By manipulating patients' critical attitude in a video experiment, we examined whether physicians are more intended to perform defensive acts because of a higher perceived liability risk in Belgium. METHODS We assigned 85 practicing gynaecologists/obstetricians and orthopaedists randomly to four hypothetical video consultations, in which the patients show either a critical attitude (i.e., getting ahead of the facts, showing distrust) or a non-critical attitude (i.e., displaying more neutral questions and expressions). We asked the physicians about the care they would administer in the presented cases and the expected likelihood that the patient would sue the physician in case of a medical incident. RESULTS By manipulating patients' verbal critical attitude (which indicates patients' intention to take further steps), while keeping constant physician's communication, patients' clinical situation, preferences, and non-verbal behaviour in the videos, we were able to discover differential treatment styles driven by physicians' perceived liability risk among patients with a different critical attitude. We found that physicians perform 17 percentage points more defensive acts (e.g., surgeries and diagnostic tests that are not medically necessary) when experiencing a high liability risk. CONCLUSIONS Our results show that patients' critical attitude drives physicians' perceived liability risk and consequent defensive behaviour among obstetricians/gynaecologists and orthopaedists.
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Affiliation(s)
- Lotte Daniels
- Faculty of Business Economics, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
| | - Wim Marneffe
- Faculty of Business Economics, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
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Hoxha I, Lama A, Bunjaku G, Grezda K, Agahi R, Beqiri P, Goodman DC. Office hours and caesarean section: systematic review and Meta-analysis. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:4. [PMID: 39177807 PMCID: PMC11264882 DOI: 10.1007/s43999-022-00002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/05/2022] [Indexed: 08/24/2024]
Abstract
BACKGROUND Unnecessary caesarean births may be affected by physician factors, such as preferences, incentives and convenience. Delivery during office hours can be a valuable proxy for measuring such effects. OBJECTIVE To determine the effect of office hours on the decision for caesarean delivery by assessing the odds of caesarean during office hours compared to out-of-office hours. SEARCH STRATEGY We searched CINAHL, ClinicalTrials.gov , The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021. DATA COLLECTION AND ANALYSIS Search results were screened by three researchers. First, we selected studies that reported odds ratios of caesareans, or data allowing their calculation, for office and out-of-office hours. We extracted data on the study population, study design, data sources, setting, type of caesarean section, statistical analysis, and outcome measures. For groups reporting the same outcome, we performed a standard inverse-variance random-effects meta-analysis, which enabled us to calculate the overall odds ratios for each group. For groups reporting varying outcomes, we performed descriptive analysis. MAIN RESULTS Meta-analysis of weekday vs weekend for any caesarean section showed higher odds of caesarean during weekdays in adjusted analysis 1.40 (95%CI 1.13, 1.72 from 1,952,691 births). A similar effect was observed in the weekday vs Sunday comparison (1.39, 95%CI 1.10, 1.75, 150,932 births). A lower effect was observed for emergency CS, with a slight increase in adjusted analysis (1.06, 95%CI 0.90, 1.26, 2,622,772 births) and a slightly higher increase in unadjusted analysis (1.15, 95%CI 1.03, 1.29, 12,591,485 births). Similar trends were observed in subgroup analyses and descriptive synthesis of studies examining other office hours outcomes. CONCLUSIONS Delivery during office hours is associated with higher odds for overall caesarean sections and little to no effect for emergency caesarean. Non-clinical factors associated with office hours may influence the decision to deliver by caesarean section. Further detailed investigation of the "office hours effect" in delivery care is necessary and could lead to improvements in care systems. FUNDING The authors received no direct funding for this study.
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Affiliation(s)
- Ilir Hoxha
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA.
- Kolegji Heimerer, 10000, Prishtina, Kosovo.
- Evidence Synthesis Group, 10000, Prishtina, Kosovo.
| | - Arber Lama
- Kolegji Heimerer, 10000, Prishtina, Kosovo
- Evidence Synthesis Group, 10000, Prishtina, Kosovo
| | | | | | - Riaz Agahi
- Kolegji Heimerer, 10000, Prishtina, Kosovo
| | | | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA
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Abstract
OBJECTIVE To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo. DESIGN Cross-sectional survey. SETTING Five largest public hospitals in Kosovo. PARTICIPANTS 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. OUTCOME MEASURES The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital. RESULTS Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90). CONCLUSIONS We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
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Affiliation(s)
- Ilir Hoxha
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
- Action for Mother and Children, Prishtina, Kosovo
| | | | - Mrika Aliu
- Action for Mother and Children, Prishtina, Kosovo
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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Grytten J, Skau I, Sørensen R, Eskild A. Does the Use of Diagnostic Technology Reduce Fetal Mortality? Health Serv Res 2018; 53:4437-4459. [PMID: 29349772 PMCID: PMC6232411 DOI: 10.1111/1475-6773.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the effect that the introduction of new diagnostic technology in obstetric care has had on fetal death. DATA SOURCE The Medical Birth Registry of Norway provided detailed medical information for approximately 1.2 million deliveries from 1967 to 1995. Information about diagnostic technology was collected directly from the maternity units, using a questionnaire. STUDY DESIGN The data were analyzed using a hospital fixed-effects regression with fetal mortality as the outcome measure. The key independent variables were the introduction of ultrasound and electronic fetal monitoring at each maternity ward. Hospital-specific trends and risk factors of the mother were included as control variables. The richness of the data allowed us to perform several robustness tests. PRINCIPAL FINDING The introduction of ultrasound caused a significant drop in fetal mortality rate, while the introduction of electronic fetal monitoring had no effect on the rate. In the population as a whole, ultrasound contributed to a reduction in fetal deaths of nearly 20 percent. For post-term deliveries, the reduction was well over 50 percent. CONCLUSION The introduction of ultrasound made a major contribution to the decline in fetal mortality at the end of the last century.
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Affiliation(s)
- Jostein Grytten
- Department of Community DentistryUniversity of OsloOsloNorway
- Department of Obstetrics and GynecologyInstitute of Clinical MedicineAkershus University HospitalLørenskogNorway
| | - Irene Skau
- Department of Community DentistryUniversity of OsloOsloNorway
| | | | - Anne Eskild
- Department of Obstetrics and GynecologyInstitute of Clinical MedicineAkershus University HospitalLørenskogNorway
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Grytten J, Skau I, Sørensen R. The impact of the mass media on obstetricians’ behavior in Norway. Health Policy 2017; 121:986-993. [DOI: 10.1016/j.healthpol.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
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Grytten J, Monkerud L, Skau I, Eskild A, Sørensen RJ, Saugstad OD. Saving Newborn Babies - The Benefits of Interventions in Neonatal Care in Norway over More Than 40 Years. HEALTH ECONOMICS 2017; 26:352-370. [PMID: 26842217 DOI: 10.1002/hec.3314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 11/30/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to examine the effect that the introduction of new medical interventions at birth has had on mortality among newborn babies in Norway during the period 1967-2011. During this period, there has been a significant decline in mortality, in particular for low birth weight infants. We identified four interventions that together explained about 50% of the decline in early neonatal and infant mortality: ventilators, antenatal steroids, surfactant and insure. The analyses were performed on a large set of data, encompassing more than 1.6 million deliveries (Medical Birth Registry of Norway). The richness of the data allowed us to perform several robustness tests. Our study indicates that the introduction of new medical interventions has been a very important channel through which the decline in mortality among newborn babies occurred during the second half of the last century. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Lars Monkerud
- Department of Community Dentistry, University of Oslo, Oslo, Norway
- Norwegian Institute for Urban and Regional Research, Oslo, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | | | - Ola Didrik Saugstad
- Department of Pediatric Research, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway
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Sahlin M, Andolf E, Edman G, Wiklund I. Mode of delivery among Swedish midwives and obstetricians and their attitudes towards caesarean section. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 11:112-116. [PMID: 28159121 DOI: 10.1016/j.srhc.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery. OBJECTIVES The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated. MATERIAL AND METHOD Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses. RESULTS The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred. No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement "the proportion of caesarean section is too high" where midwives to a greater extent agreed with the statement (p = 0.033). There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p < 0.05). CONCLUSIONS Over the years, the indications for caesarean section have increased. The increase is shown in both the textbooks read during the different time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975.
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Affiliation(s)
- Maria Sahlin
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Edman
- Department of Psychiatry, R&D Section, Tiohundra AB, Norrtälje, Sweden
| | - Ingela Wiklund
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Atinga RA, Bawole JN, Nang-Beifubah A. 'Some patients are more equal than others': Patient-centred care differential in two-tier inpatient ward hospitals in Ghana. PATIENT EDUCATION AND COUNSELING 2016; 99:370-377. [PMID: 26475729 DOI: 10.1016/j.pec.2015.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine differences in patient-centred care among private and public inpatients in public hospitals and whether satisfaction with patient-centred care differ between the patient groups. METHOD Cross-sectional data collected from inpatients in private wards (n=300) and public wards (n=520) in Ghana, using a structured questionnaire modelled on four dimensions of patient-centred care: respect and dignity, emotional support, interpersonal relations and information sharing. RESULTS Patient-centred care differed significantly among private and public patients (p<0.001), with an effect size ranging from medium to large. Private patients rated patient-centred care higher than public patients in all the items of the four dimensions. Satisfaction with patient-centred care discriminated between the patient groups. Satisfaction was significantly high for private patients who are aged 50+ (p<0.001), had high education (p<0.05) and high income (p<0.001) compared to the same category of public patients. CONCLUSION Physicians behaviour is stereotyping and less favourable to public patients, suggesting inequitable access to patient-centred care for inpatients from high and low socioeconomic backgrounds. PRACTICE IMPLICATIONS Hospitals with private and public wards should be compelled to properly coordinate and regulate the activities of physicians to avoid fragmented care for inpatients.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana.
| | - Justice N Bawole
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Fiva JH, Hægeland T, Rønning M, Syse A. Access to treatment and educational inequalities in cancer survival. JOURNAL OF HEALTH ECONOMICS 2014; 36:98-111. [PMID: 24780404 DOI: 10.1016/j.jhealeco.2014.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 12/13/2013] [Accepted: 04/01/2014] [Indexed: 05/08/2023]
Abstract
The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that (i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and (ii) the use of such treatment improved these patients' survival.
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Affiliation(s)
- Jon H Fiva
- Department of Economics, BI Norwegian Business School, Norway.
| | | | | | - Astri Syse
- Statistics Norway, Research Department, Norway.
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Grytten J, Monkerud L, Skau I, Sørensen R. Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality. Health Serv Res 2014; 49:1184-204. [PMID: 24476021 DOI: 10.1111/1475-6773.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. DATA The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. STUDY DESIGN Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. PRINCIPAL FINDING Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. CONCLUSION A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries.
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Affiliation(s)
- Jostein Grytten
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
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Eskild A, Grytten J. The reduction in fetal death rates; a result of improved identification of high-risk pregnancies? Acta Obstet Gynecol Scand 2013; 92:1123-4. [DOI: 10.1111/aogs.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Eskild
- Department of Obstetrics and Gynecology; Institute of Clinical Medicine; Akershus University Hospital; Lørenskog Norway
| | - Jostein Grytten
- Department of Obstetrics and Gynecology; Institute of Clinical Medicine; Akershus University Hospital; Lørenskog Norway
- Institute of Community Dentistry; Faculty of Odontology; University of Oslo; Oslo Norway
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Carlsen F, Grytten J, Eskild A. Maternal education and risk of offspring death; changing patterns from 16 weeks of gestation until one year after birth. Eur J Public Health 2013; 24:157-62. [PMID: 23782981 DOI: 10.1093/eurpub/ckt065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The social disparity in perinatal mortality may vary by the age of the offspring. We studied offspring mortality from pregnancy week 16 until 1 year after birth by maternal educational level. METHODS We included all births in Norwegian women during the years 1999-2004 (n = 297 663). The Medical Birth Registry of Norway was linked to the Norwegian Education Registry to obtain individual information on maternal education at the time of delivery. Information on infant mortality was obtained by linkage to the Norwegian Central Person Registry. RESULTS In pregnancy weeks 37 through 43 and in the first week after birth, there was little difference in offspring mortality by maternal education. Before pregnancy week 37, the excess offspring mortality associated with compulsory school only was >60% using university/college education as the reference. During the 2nd through 12th month after birth, the excess mortality was 132% in offspring of mothers with compulsory school only. CONCLUSION The social disparity in offspring mortality was lowest in pregnancies at term and in the first week after birth. In this period, all women living in Norway and their infants use the public health care service extensively. Our results may suggest that health care that is equally available to all citizens, reduces social disparities in mortality.
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Affiliation(s)
- Fredrik Carlsen
- 1 Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
AbstractThe collection and analysis of observational and experimental data represent the main tools for assessing the presence, the extent, the nature, and the trend of discrimination phenomena. Data analysis techniques have been proposed in the last 50 years in the economic, legal, statistical, and, recently, in the data mining literature. This is not surprising, since discrimination analysis is a multidisciplinary problem, involving sociological causes, legal argumentations, economic models, statistical techniques, and computational issues. The objective of this survey is to provide a guidance and a glue for researchers and anti-discrimination data analysts on concepts, problems, application areas, datasets, methods, and approaches from a multidisciplinary perspective. We organize the approaches according to their method of data collection as observational, quasi-experimental, and experimental studies. A fourth line of recently blooming research on knowledge discovery based methods is also covered. Observational methods are further categorized on the basis of their application context: labor economics, social profiling, consumer markets, and others.
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Grytten J, Monkerud L, Sørensen R. Adoption of diagnostic technology and variation in caesarean section rates: a test of the practice style hypothesis in Norway. Health Serv Res 2012; 47:2169-89. [PMID: 22594486 PMCID: PMC3523370 DOI: 10.1111/j.1475-6773.2012.01419.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine whether the introduction of advanced diagnostic technology in maternity care has led to less variation in type of delivery between hospitals in Norway. DATA SOURCES The Medical Birth Registry of Norway provided detailed medical information for 1.7 million deliveries from 1967 to 2005. Information about diagnostic technology was collected directly from the maternity units. STUDY DESIGN The data were analyzed using a two-level binary logistic model with Caesarean section as the outcome measure. Level one contained variables that characterized the health status of the mother and child. Hospitals are level two. A heterogeneous variance structure was specified for the hospital level, where the error variance was allowed to vary according to the following types of diagnostic technology: two-dimensional ultrasound, cardiotocography, ST waveform analysis, and fetal blood analyses. PRINCIPAL FINDING There was a marked variation in Caesarean section rates between hospitals up to 1973. After this the variation diminished markedly. This was due to the introduction of ultrasound and cardiotocography. CONCLUSION Diagnostic technology reduced clinical uncertainty about the diagnosis of risk factors of the mother and child during delivery, and variation in type of delivery between hospitals was reduced accordingly. The results support the practice style hypothesis.
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Affiliation(s)
- Jostein Grytten
- Section of Community Dentistry, University of Oslo and Akershus University Hospital, Blindern, Oslo, Norway.
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Grytten J, Monkerud L, Hagen TP, Sørensen R, Eskild A, Skau I. The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005. BMC Health Serv Res 2011; 11:267. [PMID: 21992174 PMCID: PMC3210106 DOI: 10.1186/1472-6963-11-267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There has been a marked increase in the number of Caesarean sections in many countries during the last decades. In several countries, Caesarean sections are carried out in more than 20 per cent of births. These high Caesarean section rates give cause for concern, both from an economic and a medical perspective. A general opinion among epidemiologists is that the increase in the number of Caesarean sections during the last decade has been greater than could be expected in relation to medical risk factors. Therefore, other explanations must be sought. We studied one potential explanation; the effect that the increase in hospital revenue per bed during the period 1976-2005 has had on the Caesarean section rate in Norway. During this period, hospital revenue increased by about 260% (adjusted for inflation). METHODS The analyses were carried out using data from the Medical Birth Registry 1976-2005 from Norway. The data were merged with data about hospital revenue, which were obtained from Statistics Norway. The analyses were carried out using annual data from 46 hospitals. A fixed effect regression model was estimated. Relevant medical control variables were included. RESULTS The elasticity of the Caesarean section rate with respect to hospital revenue per bed was 0.13 (p < 0.05). This represents an increase in the Caesarean section rate from the basis year 1976 to the final year 2005 of about 35 per cent. Most of the variables measuring characteristics of the health status of the mother and child had the expected effects. CONCLUSION The increase in hospital revenue explains only a small part of the increase in the Caesarean section rate in Norway during the last three decades. The increase in the Caesarean section rate is considerably greater than could be expected, based on the increase in hospital revenue alone. The strength of our study is that we have estimated a cause and effect relationship. This was done by using fixed effects for hospitals, a lagged revenue variable and by including an extensive set of control variables for the risk factors of the mother and the baby.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
| | - Lars Monkerud
- Department of Economics, BI Norwegian Business School, Oslo, Norway
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
| | - Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Rune Sørensen
- Department of Economics, BI Norwegian Business School, Oslo, Norway
| | - Anne Eskild
- Department of Gynecology and Obstetrics, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Oslo, Norway
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