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Jung E. Coûts de la santé : réflexions d’une médecin généraliste au front. Rev Med Suisse 2024; 20:996-997. [PMID: 38756038 DOI: 10.53738/revmed.2024.20.874.996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Emmanuelle Jung
- Médecine interne FMH, Attestation de Formation continue en médecine psychosomatique et psychosociale
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2
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Larkin HD. One-third of English GPs Plan to Quit Within 5 Years. JAMA 2022; 327:1859. [PMID: 35579635 DOI: 10.1001/jama.2022.7732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Olm M, Donnachie E, Tauscher M, Gerlach R, Linde K, Maier W, Schwettmann L, Schneider A. Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis. PLoS One 2021; 16:e0253919. [PMID: 34181693 PMCID: PMC8238183 DOI: 10.1371/journal.pone.0253919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011–2012 (with copayment) and 2013–2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.
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Affiliation(s)
- Michaela Olm
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
- * E-mail:
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Martin Tauscher
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Roman Gerlach
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Klaus Linde
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle an der Saale, Saxony-Anhalt, Germany
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
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Cassou M, Mousquès J, Franc C. General practitioners' income and activity: the impact of multi-professional group practice in France. Eur J Health Econ 2020; 21:1295-1315. [PMID: 33057977 DOI: 10.1007/s10198-020-01226-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
France has first experimented, in 2009, and then generalized a practice level add-on payment to promote Multi-Professional Primary Care Groups (MPCGs). Team-based practices are intended to improve both the efficiency of outpatient care supply and the attractiveness of medically underserved areas for healthcare professionals. To evaluate its financial attractiveness and thus the sustainability of MPCGs, we analyzed the evolution of incomes (self-employed income and wages) of General Practitioners (GPs) enrolled in a MPCG, compared with other GPs. We also studied the impacts of working in a MPCG on GPs' activity through both the quantity of medical services provided and the number of patients encountered. Our analyses were based on a quasi-experimental design, with a panel dataset over the period 2008-2014. We accounted for the selection into MPCG by using together coarsened exact matching and difference-in-differences (DID) design with panel-data regression models to account for unobserved heterogeneity. We show that GPs enrolled in MPCGs during the period exhibited an increase in income 2.5% higher than that of other GPs; there was a greater increase in the number of patients seen by the GPs' (88 more) without involving a greater increase in the quantity of medical services provided. A complementary cross-sectional analysis for 2014 showed that these changes were not detrimental to quality in terms of bonuses related to the French pay-for-performance program for the year 2014. Hence, our results suggest that labor and income concerns should not be a barrier to the development of MPCGs, and that MPCGs may improve patient access to primary care services.
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Affiliation(s)
- Matthieu Cassou
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex, Villejuif, France.
- Institute for Research and Information in Health Economics (IRDES), Paris, France.
| | - Julien Mousquès
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Carine Franc
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex, Villejuif, France
- Institute for Research and Information in Health Economics (IRDES), Paris, France
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Ballard PJ, Rhoades L, Fuller L. What sets the conditions for success in community-partnered evaluation work? Multiple perspectives on a small-scale research-practice partnership evaluation. J Community Psychol 2020; 48:1811-1824. [PMID: 32390239 PMCID: PMC10179206 DOI: 10.1002/jcop.22372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 05/14/2023]
Abstract
The goals of this study are: (a) to share reflections from multiple stakeholders involved in a foundation-funded community-partnered evaluation project, (b) to share information that might be useful to researchers, practitioners, and funders considering the merits of researcher/practitioner evaluation projects, and (c) to make specific suggestions for funders and researcher/practitioner teams starting an evaluation project. Three stakeholders in a small-scale research-practice partnership (RPP) reflected on the evaluation project by responding to three prompts. A researcher, community organization leader, and funder at a small foundation share specific tips for those considering a small-scale RPP. Engaging in a small-scale RPPs can be a very meaningful experience for individual researchers and smaller organizations and funders. The benefits and challenges align and differ in many ways with those encountered in larger projects.
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Affiliation(s)
- Parissa J. Ballard
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Wollersheim BM, van Asselt KM, van der Poel HG, van Weert HCPM, Hauptmann M, Retèl VP, Aaronson NK, van de Poll-Franse LV, Boekhout AH. Design of the PROstate cancer follow-up care in Secondary and Primary hEalth Care study (PROSPEC): a randomized controlled trial to evaluate the effectiveness of primary care-based follow-up of localized prostate cancer survivors. BMC Cancer 2020; 20:635. [PMID: 32641023 PMCID: PMC7346492 DOI: 10.1186/s12885-020-07112-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In its 2006 report, From cancer patient to cancer survivor: lost in transition, the U.S. Institute of Medicine raised the need for a more coordinated and comprehensive care model for cancer survivors. Given the ever increasing number of cancer survivors, in general, and prostate cancer survivors, in particular, there is a need for a more sustainable model of follow-up care. Currently, patients who have completed primary treatment for localized prostate cancer are often included in a specialist-based follow-up care program. General practitioners already play a key role in providing continuous and comprehensive health care. Studies in breast and colorectal cancer suggest that general practitioners could also consider to provide survivorship care in prostate cancer. However, empirical data are needed to determine whether follow-up care of localized prostate cancer survivors by the general practitioner is a feasible alternative. METHODS This multicenter, randomized, non-inferiority study will compare specialist-based (usual care) versus general practitioner-based (intervention) follow-up care of prostate cancer survivors who have completed primary treatment (prostatectomy or radiotherapy) for localized prostate cancer. Patients are being recruited from hospitals in the Netherlands, and randomly (1:1) allocated to specialist-based (N = 195) or general practitioner-based (N = 195) follow-up care. This trial will evaluate the effectiveness of primary care-based follow-up, in comparison to usual care, in terms of adherence to the prostate cancer surveillance guideline for the timing and frequency of prostate-specific antigen assessments, the time from a biochemical recurrence to retreatment decision-making, the management of treatment-related side effects, health-related quality of life, prostate cancer-related anxiety, continuity of care, and cost-effectiveness. The outcome measures will be assessed at randomization (≤6 months after treatment), and 12, 18, and 24 months after treatment. DISCUSSION This multicenter, prospective, randomized study will provide empirical evidence regarding the (cost-) effectiveness of specialist-based follow-up care compared to general practitioner-based follow-up care for localized prostate cancer survivors. TRIAL REGISTRATION Netherlands Trial Registry, Trial NL7068 (NTR7266). Prospectively registered on 11 June 2018.
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Affiliation(s)
- Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - Michael Hauptmann
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Annelies H Boekhout
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands.
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Engels A, Reber KC, Magaard JL, Härter M, Hawighorst-Knapstein S, Chaudhuri A, Brettschneider C, König HH. How does the integration of collaborative care elements in a gatekeeping system affect the costs for mental health care in Germany? Eur J Health Econ 2020; 21:751-761. [PMID: 32185524 DOI: 10.1007/s10198-020-01170-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
Mental disorders are widespread, debilitating and associated with high costs. In Germany, usual care (UC) for mental disorders is afflicted by poor coordination between providers and long waiting times. Recently, the primary alternative to UC-the gatekeeping-based general practitioners (GP) program-was extended by the collaborative Psychiatry-Neurology-Psychotherapy (PNP) program, which is a selective contract designed to improve mental health care and the allocation of resources. Here, we assess the effects of the GP program and the PNP program on costs for mental health care. We analyzed claims data from 2014 to 2016 of 55,472 adults with a disorder addressed by PNP to compare costs and sick leave days between PNP, the GP program and UC. The individuals were grouped and balanced via entropy balancing to adjust for potentially confounding covariates. We employed a negative binomial model to compare sick leave days and two-part models to compare sick pay, outpatient, inpatient and medication costs over a 12-month period. The PNP program significantly reduced sick pay by 164€, compared to UC, and by 177€, compared to the GP program. Consistently, sick leave days were lower in PNP. We found lower inpatient costs in PNP than in UC (-194€) and in the GP program (-177€), but no reduction in those shares of inpatient costs that accrued in psychiatric or neurological departments. Our results suggest that integrating collaborative care elements in a gatekeeping system can favourably impact costs. In contrast, we found no evidence that the widely implemented GP program reduces costs for mental health care.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Katrin Christiane Reber
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julia Luise Magaard
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | | | - Ariane Chaudhuri
- AOK Baden-Württemberg, Presselstraße 19, 70176, Stuttgart, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Goupil B, Balusson F, Naudet F, Esvan M, Bastian B, Chapron A, Frouard P. Association between gifts from pharmaceutical companies to French general practitioners and their drug prescribing patterns in 2016: retrospective study using the French Transparency in Healthcare and National Health Data System databases. BMJ 2019; 367:l6015. [PMID: 31690553 PMCID: PMC6830500 DOI: 10.1136/bmj.l6015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING Primary care, France. PARTICIPANTS 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION OSF register OSF.IO/8M3QR.
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Affiliation(s)
- Bruno Goupil
- Department of General Medicine, University of Rennes 1, Rennes, France
| | - Frédéric Balusson
- EA 7449 (Pharmaco-epidemiology and Health Services Research) REPERES, Univ Rennes, Rennes University Hospital, Rennes, France
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
- Department of Adult Psychiatry, Rennes University Hospital, Rennes, France
| | - Maxime Esvan
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Benjamin Bastian
- Department of General Medicine, University of Rennes 1, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Anthony Chapron
- Department of General Medicine, University of Rennes 1, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Pierre Frouard
- Department of General Medicine, University of Rennes 1, Rennes, France
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Bayati M, Rashidian A, Sarikhani Y, Lohivash S. Income inequality among general practitioners in Iran: a decomposition approach. BMC Health Serv Res 2019; 19:620. [PMID: 31477097 PMCID: PMC6721336 DOI: 10.1186/s12913-019-4473-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND General practitioners (GPs) are among the most important resources of healthcare system and public health is considerably influenced by the function of this group. Income inequality among GPs considerably affects the motivation and performance of this group. The present study aims to examine the income inequality among Iranian GPs in order to provide the necessary evidence for health human resource policy. METHODS In this cross-sectional study, the distribution of income and wage inequality among GPs was investigated using income quintiles. We also used the Dagum's model to analyze the inequality between different groups of GPs through the decomposition of the Gini coefficient. Moreover, a regression model was used to determine the effective factors on GPs' income. RESULTS The results of this study indicated that income and wages of GPs in the highest quintile were eight times more than those of doctors at the lowest quintile. Regression estimates showed that factors such as gender, practice setting, and activity as the family physician (P < 0.001) were effective on income of GPs; and also male and self-employed GPs had significantly more wage (P < 0.001). Total Gini coefficient of GPs' income and wage were estimated at 0.403 and 0.412, respectively. Highest monthly income was found in GPs with 16-20 years practice experience ($8358) based on Purchasing Power Parity (PPP), male ($8339 PPP), and self-employed GPs ($8134 PPP) subgroup. However, the female ($5389 PPP) and single ($5438 PPP) GPs had the lowest income. Population share; income/wage share; income/wage mean; Gini coefficient; and within, between and overlap decomposed components of Gini coefficient are also reported for each GPs subgroups. CONCLUSIONS We found significant inequalities in income and wages among Iranian GPs. Adjustment of income based on working hours indicated that one of the most common causes of income inequality among GPs in Iran was different workloads among different groups. Since the motivation and function of physicians can be influenced by income inequality, policymakers in the health system should consider factors increasing such inequalities.
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Affiliation(s)
- Mohsen Bayati
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran
- Director of Information, Evidence and Research, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt
| | - Yaser Sarikhani
- Student Research Committee, School of Management & Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, Iran.
| | - Saeed Lohivash
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Biezen R, Roberts C, Buising K, Thursky K, Boyle D, Lau P, Clark M, Manski-Nankervis JA. How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study. BMJ Open 2019; 9:e028329. [PMID: 31383702 PMCID: PMC6687052 DOI: 10.1136/bmjopen-2018-028329] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia. DESIGN This is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework. SETTING This study was conducted in general practice in Victoria, Australia. PARTICIPANTS Twenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018. RESULTS GPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients' expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use. CONCLUSIONS Current barriers to the use of antibiotic guidelines include GPs' experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Cassandra Roberts
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Serivce, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Malcolm Clark
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
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McIsaac M, Scott A, Kalb G. The role of financial factors in the mobility and location choices of General Practitioners in Australia. Hum Resour Health 2019; 17:34. [PMID: 31126294 PMCID: PMC6534889 DOI: 10.1186/s12960-019-0374-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The geographic distribution of health workers is a pervasive policy concern. Many governments are responding by introducing financial incentives to attract health care workers to locate in areas that are underserved. However, clear evidence of the effectiveness of such financial incentives is lacking. METHODS This paper examines General Practitioners' (GPs) relocation choices in Australia and proposes a dynamic location choice model accounting for both source and destination factors associated with a choice to relocate, thereby accounting for push and pull factors associated with job separation. The model is used to simulate financial incentive policies and assess potential for such policies to redistribute GPs. This paper examines the role of financial factors in relocating established GPs into neighbourhoods with relatively low socioeconomic status. The paper uses a discrete choice model and panel data on GPs' actual changes in location from one year to the next. RESULTS This paper finds that established GPs are not very mobile, even when a financial incentive is offered. Policy simulation predicts that 93.2% of GPs would remain at their current practice and that an additional 0.8% would be retained or would relocate in a low-socioeconomic status (SES) neighbourhood in response to a hypothetical financial incentive of a 10% increase in the earnings of all metropolitan GPs practising in low-SES neighbourhoods. CONCLUSION With current evidence on the effectiveness of redistribution programmes limited to newly entering GPs, the policy simulations in this paper provide an insight into the potential effectiveness of financial incentives as a redistribution policy targeting the entire GP population. Overall, the results suggest that financial considerations are part of many factors influencing the location choice of GPs. For instance, GP practice ownership played almost as important a role in mobility as earnings.
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Affiliation(s)
- Michelle McIsaac
- World Health Organization, Avenue Appia 20, 1293 Geneva, Switzerland
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, 111 Barry Street, Carlton, VIC 3053 Australia
| | - Guyonne Kalb
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, 111 Barry Street, Carlton, VIC 3053 Australia
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Affiliation(s)
- Kenji Shibuya
- Department of Global Health Policy, University of Tokyo, Tokyo 113-0033, Japan.
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Parkinson B, Gumbie M, Cutler H, Gauld N, Mumford V, Haywood P. Cost-Effectiveness of Reclassifying Triptans in Australia: Application of an Economic Evaluation Approach to Regulatory Decisions. Value Health 2019; 22:293-302. [PMID: 30832967 DOI: 10.1016/j.jval.2018.09.2840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Migraine is a common, chronic, disabling headache disorder. Triptans, used as an acute treatment for migraine, are available via prescription in Australia. An Australian Therapeutic Goods Administration (TGA) committee rejected reclassifying sumatriptan and zolmitriptan from prescription medicine to pharmacist-only between 2005 and 2009, largely on the basis of concerns about patient risk. Nevertheless, pharmacist-only triptans may reduce migraine duration and free up healthcare resources. OBJECTIVES To estimate the cost-effectiveness of reclassifying triptans from prescription-only to pharmacist-only in Australia. METHODS The study design included decision-analytic modeling combining data from various sources. Behavior before and after reclassification was estimated using medical practitioner and patient surveys and also administrative data. Health outcomes included migraine frequency and duration as well as adverse events (AEs) discussed by the TGA committee. Efficacy and AEs were estimated using randomized controlled trials and observational studies. RESULTS Reclassifying triptans will reduce migraine duration but increase AEs. This will result in 337 quality-adjusted life-years gained at an increased cost of A$5.9 million over 10 years for all Australian adults older than 15 years (19.6 million). The incremental cost-effectiveness ratio was estimated to be A$17 412/quality-adjusted life-year gained. CONCLUSIONS The incremental cost-effectiveness ratio is likely to be considered cost-effective by Australian decision makers. Serotonin syndrome, a key concern of the TGA committee, had little impact on the results. Further research is needed regarding pharmacist-only triptan use by migraineurs currently using over-the-counter medicines and by nonmigraineurs, the efficacy of triptans, and the risk of cardiovascular and cerebrovascular AEs and chronic headaches with triptans.
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Affiliation(s)
- Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia.
| | - Mutsa Gumbie
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Virginia Mumford
- Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
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Panca M, Buszewicz M, Strydom A, Hassiotis A, Welch CA, Hunter RM. Resource use and cost of annual health checks in primary care for people with intellectual disabilities. J Intellect Disabil Res 2019; 63:233-243. [PMID: 30461105 PMCID: PMC6451619 DOI: 10.1111/jir.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The annual health check (AHC) programme, as part of a Directed Enhanced Service, offers an incentive to general practitioners in England to conduct health checks for people with intellectual disabilities (IDs). The aim of this analysis was to estimate the impact on health care costs of AHCs in primary care to the National Health Service in England by comparing adults with ID who did or did not have AHCs using data obtained from The Health Improvement Network. METHODS Two hundred eight records of people with ID from The Health Improvement Network database were analysed. Baseline health care resource use was captured at the time the first AHC was recorded (i.e. index date), or the earliest date after 1 April 2008 for those without an AHC. We examined the volume of resource use and associated costs that occurred at the time AHCs were performed, as well as before and after the index date. We then estimated the impact of AHCs on health care costs. RESULTS The average cost of AHC was estimated at £142.57 (95%CI £135.41 to £149.74). Primary, community and secondary health care costs increased significantly after the index date in the no AHC group owing to higher increase in resource utilisation. Regression analysis showed that the expected health care cost for those who have an AHC is 56% higher than for those who did not have an AHC. Age and gender were also associated with increase in expected health care cost. CONCLUSION The level of resource utilisation increased in both (AHC and no AHC) groups after the index date. Although the level of resource use before index date was lower in the no AHC group, it increased after the index date up to almost reaching the level of resource utilisation in the AHC group. Further research is needed to explore if the AHCs are effective in reducing health inequalities.
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Affiliation(s)
- Monica Panca
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - Marta Buszewicz
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - André Strydom
- Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF
| | - Angela Hassiotis
- UCL Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF
| | - Catherine A Welch
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE3 9QP
| | - Rachael M Hunter
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
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Black N, Hughes R, Jones AM. The health care costs of childhood obesity in Australia: An instrumental variables approach. Econ Hum Biol 2018; 31:1-13. [PMID: 30064082 DOI: 10.1016/j.ehb.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 05/27/2023]
Abstract
The effect of childhood obesity on medical costs incurred by the Australian Government is estimated using five waves of panel data from the Longitudinal Study of Australian Children, which is linked to public health insurance administrative records from Medicare Australia. Instrumental variables estimators are used to address concerns about measurement error and selection bias. The additional annual medical costs due to overweight and obesity among 6 to 13 year olds is about $43 million (in 2015 AUD). This is driven by a higher utilisation of general practitioner and specialist doctors. The results suggest that the economic consequences of childhood obesity are much larger than previously estimated.
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Affiliation(s)
- Nicole Black
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Robert Hughes
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Andrew M Jones
- Centre for Health Economics, Monash Business School, Monash University, Australia; Department of Economics and Related Studies, University of York, United Kingdom
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17
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Lymer S, Schofield D, Cunich M, Lee CMY, Fuller N, Caterson I, Colagiuri S. The Population Cost-Effectiveness of Weight Watchers with General Practitioner Referral Compared with Standard Care. Obesity (Silver Spring) 2018; 26:1261-1269. [PMID: 30138545 DOI: 10.1002/oby.22216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 04/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to assess population-level cost-effectiveness of the Weight Watchers (WW) program with doctor referral compared with standard care (SC) for Australian adults with overweight and obesity. METHODS The target population was Australian adults ≥ 20 years old with BMI ≥ 27 kg/m2 , whose obesity status was subsequently modeled for 2015 to 2025. A microsimulation model (noncommunicable disease model [NCDMod]) was used to assess the incremental cost-effectiveness of WW compared with SC. A health system perspective was taken, and outcomes were measured by obesity cases averted in 2025, BMI units averted for 2015 to 2025, and quality-adjusted life years for 2015 to 2025. Univariate sensitivity testing was used to measure variations in the model parameters. RESULTS The WW intervention resulted in 60,445 averted cases of obesity in 2025 (2,311 more cases than for SC), extra intervention costs of A$219 million, and cost savings within the health system of A$17,248 million (A$82 million more than for SC) for 2015 to 2025 compared with doing nothing. The modeled WW had an incremental cost-effectiveness ratio of A$35,195 in savings per case of obesity averted in 2025. WW remained dominant over SC for the different scenarios in the sensitivity analysis. CONCLUSIONS The WW intervention represents good value for money. The WW intervention needs serious consideration in a national package of obesity health services.
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Affiliation(s)
- Sharyn Lymer
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Ryde, New South Wales, Australia
- Department of Economics, Macquarie University, Ryde, New South Wales, Australia
| | - Michelle Cunich
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Crystal Man Ying Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Fuller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- WHO Collaborating Centre on Physical Activity, Nutrition & Obesity, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Kalb G, Kuehnle D, Scott A, Cheng TC, Jeon SH. What factors affect physicians' labour supply: Comparing structural discrete choice and reduced-form approaches. Health Econ 2018; 27:e101-e119. [PMID: 28980358 DOI: 10.1002/hec.3572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 05/29/2017] [Accepted: 07/04/2017] [Indexed: 06/07/2023]
Abstract
Little is known about the response of physicians to changes in compensation: Do increases in compensation increase or decrease labour supply? In this paper, we estimate wage elasticities for physicians. We apply both a structural discrete choice approach and a reduced-form approach to examine how these different approaches affect wage elasticities at the intensive margin. Using uniquely rich data collected from a large sample of general practitioners (GPs) and specialists in Australia, we estimate 3 alternative utility specifications (quadratic, translog, and box-cox utility functions) in the structural approach, as well as a reduced-form specification, separately for men and women. Australian data is particularly suited for this analysis due to a lack of regulation of physicians' fees leading to variation in earnings. All models predict small negative wage elasticities for male and female GPs and specialists passing several sensitivity checks. For this high-income and long-working-hours population, the translog and box-cox utility functions outperform the quadratic utility function. Simulating the effects of 5% and 10% wage increases at the intensive margin slightly reduces the full-time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs.
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Affiliation(s)
- Guyonne Kalb
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
- Institute for the Study of Labor, Bonn, Germany
| | - Daniel Kuehnle
- School of Business and Economics, FAU Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
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Broadway B, Kalb G, Li J, Scott A. Do Financial Incentives Influence GPs' Decisions to Do After-hours Work? A Discrete Choice Labour Supply Model. Health Econ 2017; 26:e52-e66. [PMID: 28217847 DOI: 10.1002/hec.3476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/14/2016] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
This paper analyses doctors' supply of after-hours care (AHC), and how it is affected by personal and family circumstances as well as the earnings structure. We use detailed survey data from a large sample of Australian General Practitioners (GPs) to estimate a structural, discrete choice model of labour supply and AHC. This allows us to jointly model GPs' decisions on the number of daytime-weekday working hours and the probability of providing AHC. We simulate GPs' labour supply responses to an increase in hourly earnings, both in a daytime-weekday setting and for AHC. GPs increase their daytime-weekday working hours if their hourly earnings in this setting increase, but only to a very small extent. GPs are somewhat more likely to provide AHC if their hourly earnings in that setting increase, but again, the effect is very small and only evident in some subgroups. Moreover, higher earnings in weekday-daytime practice reduce the probability of providing AHC, particularly for men. Increasing GPs' earnings appears to be at best relatively ineffective in encouraging increased provision of AHC and may even prove harmful if incentives are not well targeted. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Barbara Broadway
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, VIC, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Indooroopilly, QLD, Australia
| | - Guyonne Kalb
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, VIC, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Indooroopilly, QLD, Australia
- Institute for the Study of Labor (IZA), Bonn, Germany
| | - Jinhu Li
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, VIC, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Indooroopilly, QLD, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, VIC, Australia
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Farbmacher H, Ihle P, Schubert I, Winter J, Wuppermann A. Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care. Health Econ 2017; 26:1234-1248. [PMID: 27492210 DOI: 10.1002/hec.3395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/08/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Nonlinear price schedules generally have heterogeneous effects on health-care demand. We develop and apply a finite mixture bivariate probit model to analyze whether there are heterogeneous reactions to the introduction of a nonlinear price schedule in the German statutory health insurance system. In administrative insurance claims data from the largest German health insurance plan, we find that some individuals strongly react to the new price schedule while a second group of individuals does not react. Post-estimation analyses reveal that the group of the individuals who do not react to the reform includes the relatively sick. These results are in line with forward-looking behavior: Individuals who are already sick expect that they will hit the kink in the price schedule and thus are less sensitive to the co-payment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Helmut Farbmacher
- Munich Center for the Economics of Aging (MEA), Max Planck Society, Munich, Germany
| | - Peter Ihle
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Joachim Winter
- Department of Economics, University of Munich, Munich, Germany
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Limb M. "No convincing evidence" that QOF improves care of patients with long term illness. BMJ 2017; 358:j4493. [PMID: 28954727 DOI: 10.1136/bmj.j4493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
In many countries, general practitioners (GPs) are assigned the task of controlling the validity of their own patients' insurance claims. At the same time, they operate in a market where patients are customers free to choose their GP. Are these roles compatible? Can we trust that the gatekeeping decisions are untainted by private economic interests? Based on administrative registers from Norway with records on sick pay certification and GP-patient relationships, we present evidence to the contrary: GPs are more lenient gatekeepers the more competitive is the physician market, and a reputation for lenient gatekeeping increases the demand for their services.
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Affiliation(s)
| | - Knut Røed
- The Ragnar Frisch Centre for Economic Research, Norway
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Gulland A. NHS plans to spend £100m on recruiting overseas GPs. BMJ 2017; 358:j4077. [PMID: 28860224 DOI: 10.1136/bmj.j4077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hollingworth SA, Donald M, Zhang J, Vaikuntam BP, Russell A, Jackson C. Impact of a general practitioner-led integrated model of care on the cost of potentially preventable diabetes-related hospitalisations. Prim Care Diabetes 2017; 11:344-347. [PMID: 28442341 DOI: 10.1016/j.pcd.2017.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
Abstract
AIM To estimate potential savings for Australia's health care system through the implementation of an innovative Beacon model of care for patients with complex diabetes. METHODS A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. We extracted patient hospitalisation data from the Queensland Hospital Admitted Patient Data Collection and used Australian Refined Diagnosis Related Groups to assign costs to potentially preventable hospitalisations for diabetes. RESULTS 327 patients with complex diabetes referred by their general practitioner for specialist outpatient care were included in the analysis. The integrated model of care had potential for national cost savings of $132.5 million per year. CONCLUSIONS The differences in hospitalisations attributable to better integrated primary/secondary care can yield large cost savings. Models such as the Beacon are highly relevant to current national health care reform initiatives to improve the continuity and efficiency of care for those with complex chronic disease in primary care.
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Affiliation(s)
- Samantha A Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall St., Woolloongabba, QLD 4102, Australia.
| | - Maria Donald
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia.
| | - Jianzhen Zhang
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia.
| | | | - Anthony Russell
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia; Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Claire Jackson
- School of Medicine, The University of Queensland, Herston, QLD 4006, Australia.
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Dutta SS. Doctors in India meet to condemn practice of paying referral kickbacks to GPs. BMJ 2017; 358:j3202. [PMID: 28674088 DOI: 10.1136/bmj.j3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sicsic J, Franc C. Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. Eur J Health Econ 2017; 18:609-621. [PMID: 27329654 DOI: 10.1007/s10198-016-0813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. OBJECTIVE Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. METHODS Based on an administrative database of 50,752 women aged 50-74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). RESULTS Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41-2.35 %)], but the effect was not significantly different following the implementation of the contract. CONCLUSION The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.
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Affiliation(s)
- Jonathan Sicsic
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France.
| | - Carine Franc
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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Limb M. Change to collecting data makes counting GPs impossible, says royal college. BMJ 2017; 357:j2594. [PMID: 28546452 DOI: 10.1136/bmj.j2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rimmer A. Next government must tackle GP indemnity costs, royal college says. BMJ 2017; 357:j2429. [PMID: 28533291 DOI: 10.1136/bmj.j2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Iacobucci G. Delays in GP rescue package are "unacceptable," says BMA. BMJ 2017; 357:j2027. [PMID: 28442487 DOI: 10.1136/bmj.j2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Spanish doctors are still leaving the country to look for quality work. Ireland is not a country with many Spanish professionals but it is interesting to know its particular Health care system. Ireland is one of the countries with a national health care system, although it has a mixture of private health care insurance schemes. People have a right to health care if they have been living in Ireland at least for a year. Access to the primary care health system depends on age and income: free of charge for Category 1 and co-payments for the rest. This division generates great inequalities among the population. Primary Care doctors are self-employed, and they work independently. However, since 2001 they have tended to work in multidisciplinary teams in order to strengthen the Primary Care practice. Salary is gained from a combination of public and private incomes which are not differentiated. The role of the General Practitioner consists in the treatment of acute and chronic diseases, minor surgery, child care, etc. There is no coordination between Primary and Secondary care. Access to specialised medicine is regulated by the price of consultation. Primary Care doctors are not gatekeepers. To be able to work here, doctors must have three years of training after medical school. After that, Continuing Medical Education is compulsory, and the college of general practitioners monitors it annually. The Irish health care system does not fit into the European model. Lack of a clear separation between public and private health care generates great inequalities. The non-existence of coordination between primary and specialised care leads to inefficiencies, which Ireland cannot allow itself after a decade of economic crisis.
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Affiliation(s)
- T Sánchez-Sagrado
- Delegación territorial de Sanidad y Bienestar Social, Segovia, España.
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Iacobucci G. STP plans to cut GP numbers are "alarming," says royal college. BMJ 2017; 356:j598. [PMID: 28153833 DOI: 10.1136/bmj.j598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Iacobucci G. GP leaders in Northern Ireland to begin collecting resignation letters from practices. BMJ 2017; 356:j503. [PMID: 28130244 DOI: 10.1136/bmj.j503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Since the 1990s, Germany has introduced a number of competitive elements into its public health care system. Sickness funds were given some freedom to sign selective contracts with providers. Competition between ambulatory care providers and hospitals was introduced for certain diseases and services. As competition has become more intense, the importance of competition law has increased. This paper reviews these areas of competition policy. The problems of introducing competition into a corporatist system are discussed. Based on the scientific evidence on the effects of competition, key lessons and implications for future policy are formulated.
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Konnopka A, König HH, Kaufmann C, Egger N, Wild B, Szecsenyi J, Herzog W, Schellberg D, Schaefert R. Cost-utility of a specific collaborative group intervention for patients with functional somatic syndromes. J Psychosom Res 2016; 90:43-50. [PMID: 27772558 DOI: 10.1016/j.jpsychores.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life. OBJECTIVE To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS. METHODS An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves. RESULTS Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15). CONCLUSION CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity.
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Affiliation(s)
- Alexander Konnopka
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Claudia Kaufmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Nina Egger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
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Affiliation(s)
- Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
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McCartney M. Margaret McCartney: General practice is going the way of NHS dentistry. BMJ 2016; 354:i4817. [PMID: 27613428 DOI: 10.1136/bmj.i4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Holte JH, Sivey P, Abelsen B, Olsen JA. Modelling Nonlinearities and Reference Dependence in General Practitioners' Income Preferences. Health Econ 2016; 25:1020-38. [PMID: 26095526 DOI: 10.1002/hec.3208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/06/2015] [Accepted: 05/07/2015] [Indexed: 05/07/2023]
Abstract
This paper tests for the existence of nonlinearity and reference dependence in income preferences for general practitioners. Confirming the theory of reference dependent utility within the context of a discrete choice experiment, we find that losses loom larger than gains in income for Norwegian general practitioners, i.e. they value losses from their current income level around three times higher than the equivalent gains. Our results are validated by comparison with equivalent contingent valuation values for marginal willingness to pay and marginal willingness to accept compensation for changes in job characteristics. Physicians' income preferences determine the effectiveness of 'pay for performance' and other incentive schemes. Our results may explain the relative ineffectiveness of financial incentive schemes that rely on increasing physicians' incomes. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jon Helgheim Holte
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Peter Sivey
- Department of Economics and Finance, La Trobe Business School, La Trobe University, Melbourne, Victoria, Australia
| | - Birgit Abelsen
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Jan Abel Olsen
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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McCartney M. Margaret McCartney: We need more openness on GPs' pay. BMJ 2016; 353:i2729. [PMID: 27183960 DOI: 10.1136/bmj.i2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lublóy Á, Keresztúri JL, Benedek G. Formal Professional Relationships Between General Practitioners and Specialists in Shared Care: Possible Associations with Patient Health and Pharmacy Costs. Appl Health Econ Health Policy 2016; 14:217-227. [PMID: 26476734 DOI: 10.1007/s40258-015-0206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Shared care in chronic disease management aims at improving service delivery and patient outcomes, and reducing healthcare costs. The introduction of shared-care models is coupled with mixed evidence in relation to both patient health status and cost of care. Professional interactions among health providers are critical to a successful and efficient shared-care model. OBJECTIVE This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) in shared care affects either the health status of patients or their pharmacy costs. In strong GP-SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. METHODS This article measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. To test the hypotheses and compare the characteristics of the strongest GP-SP connections with those of the weakest, this article concentrates on diabetes-a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest frequency of specialist medication prescriptions. RESULTS This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health status. CONCLUSION Overall drug expenditure may be reduced by lowering patient care fragmentation through channelling a GP's patients to a small number of SPs.
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Affiliation(s)
- Ágnes Lublóy
- Department of Finance, Institute of Finance and Accounting, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Judit Lilla Keresztúri
- Department of Finance, Institute of Finance and Accounting, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Gábor Benedek
- Thesys SEA Pte Ltd, 89 Neil Road, Singapore, 088849, Singapore
- Department of Mathematical Economics and Economic Analyses, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
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Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes. J Hosp Med 2016; 11:245-50. [PMID: 26588825 PMCID: PMC5242336 DOI: 10.1002/jhm.2515] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/18/2015] [Accepted: 10/19/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prior work suggests interhospital transfer (IHT) may be a risky event. Outcomes for patients transferred from another acute care institution and discharged by hospitalists and general internists at academic health systems are not well described. OBJECTIVE Investigate the characteristics and outcomes of IHT patients compared with patients admitted from the emergency department (ED) to academic health systems. DESIGN Retrospective cohort study. SETTING/PATIENTS A total of 885,392 adult inpatients discharged by hospitalists or general internal medicine physicians from 158 academic medical centers and affiliated hospitals participating in the University HealthSystem Consortium Clinical Database and Resource Manager from April 1, 2011 to March 31, 2012. METHODS Patient cohorts were defined by admission source: those from another acute care institution were IHTs, and those coming through the ED whose source of origination was not another hospital or ambulatory surgery site were ED admissions. In-hospital mortality was our primary outcome. We analyzed our data using descriptive statistics, t tests, χ(2) tests, and logistic regression. RESULTS Compared with ED admissions, IHT patients had a longer average length of stay, higher proportion of time spent in the intensive care unit, higher costs per hospital day, lower frequency of discharges home, and higher inpatient mortality (4.1% vs 1.8%, P < 0.01). After adjusting for patient characteristics and risk of mortality measures, IHT patients had a higher risk of in-hospital death (odds ratio: 1.36, 95% confidence interval: 1.29-1.43). CONCLUSIONS In this large national sample, IHT status is independently associated with inpatient mortality.
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Affiliation(s)
- Lauge Sokol-Hessner
- Hospital Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew A White
- Hospital Medicine, University of Washington Medical Center, Seattle, Washington
| | | | - Shoshana J. Herzig
- Hospital Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Cheng TC, Trivedi PK. Attrition Bias in Panel Data: A Sheep in Wolf's Clothing? A Case Study Based on the Mabel Survey. Health Econ 2015; 24:1101-1117. [PMID: 26033504 DOI: 10.1002/hec.3206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 04/23/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Abstract
This paper investigates the nature and consequences of sample attrition in a unique longitudinal survey of medical doctors. We describe the patterns of non-response and examine if attrition affects the econometric analysis of medical labour market outcomes using the estimation of physician earnings equations as a case study. We compare the econometric gestimates obtained from a number of different modelling strategies, which are as follows: balanced versus unbalanced samples; an attrition model for panel data based on the classic sample selection model; and a recently developed copula-based selection model. Descriptive evidence shows that doctors who work longer hours, have lower years of experience, are overseas trained and have changed their work location are more likely to drop out. Our analysis suggests that the impact of attrition on inference about the earnings of general practitioners is small. For specialists, there appears to be some evidence for an economically significant bias. Finally, we discuss how the top-up samples in the Medicine in Australia: Balancing Employment and Life survey can be used to address the problem of panel attrition.
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Affiliation(s)
| | - Pravin K Trivedi
- University of Queensland, Brisbane, Australia
- Indiana University - Bloomington, USA
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GP tax scrapped but Medicare still under threat. Aust Nurs Midwifery J 2015; 22:5. [PMID: 26451428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Ekelius L. [Speaking! Physician shortage in primary care--Higher salary to general practitioners, where needed]. Lakartidningen 2015; 112:DEED. [PMID: 25803528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Rischatsch M. Who joins the network? Physicians' resistance to take budgetary co-responsibility. J Health Econ 2015; 40:109-121. [PMID: 25637711 DOI: 10.1016/j.jhealeco.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 06/04/2023]
Abstract
Managed Care (MC) is expected to provide health care at a lower cost than conventional provision. Therefore, Switzerland intends to promote MC by forcing health insurers to write MC contracts and introducing budgetary co-responsibility for ambulatory care physicians. A discrete choice experiment conducted in 2011 including 872 physicians reveals a strong preference heterogeneity with respect to network participation and alternative remuneration schemes. The number of physicians working in networks is unlikely to rise on a voluntary basis, while general practitioners are more likely to join networks than specialists with surgical activities. For physicians considering joining networks, cost savings are predicted to be higher than the estimated willingness-to-accept payments.
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Affiliation(s)
- Simon Bell
- Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | | | | | - Daniel Blackburn
- Sheffield Teaching Hospital NHS Trust, Sheffield, UK University of Sheffield, Sheffield, UK
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