查看更多>>摘要：Abstract Non‐preference‐based patient‐reported outcome measures (PROMs) are popular in health outcomes research. These measures, however, cannot be used to estimate health state utilities, limiting their usefulness for economic evaluations. Mapping PROMs to a multi‐attribute utility instrument is one solution. While mapping is commonly conducted using econometric techniques, failing to specify the complex interactions between variables may lead to inaccurate prediction of utilities, resulting in inaccurate estimates of cost‐effectiveness and suboptimal funding decisions. These issues can be addressed using machine learning. This paper evaluates the use of machine learning as a mapping tool. We adopt a comprehensive approach to compare six machine learning techniques with eight econometric techniques to map the Patient‐Reported Outcomes Measurement Information System Global Health 10 (PROMIS‐GH10) to the EuroQol five dimensions (EQ‐5D‐5L). Using data collected from 2015 Australians, we find the least absolute shrinkage and selection operator (LASSO) model out‐performed all machine learning techniques and the adjusted limited dependent variable mixture model (ALDVMM) out‐performed all econometric techniques, with the LASSO performing better than ALDVMM. The variable selection feature of LASSO was then used to enhance the performance of the ALDVMM in a hybrid model. Our analysis identifies the potential benefits and challenges of using machine learning techniques for mapping and offers important insights for future research.
查看更多>>摘要：Abstract In this study, we find that children in Vietnam who were born in December of a given year have better health outcomes than those born in January of the following year. Children born in December are taller, heavier, and less likely to be underweight and suffer from stunted growth than those born in January of the following year, though these two groups of children differ in age by only 1?month. We argue that the effect of being born in December compared to January on children's health is translated through early preschool attendance. In Vietnam, children born in December are more likely to start preschool as well as primary school 1?year earlier than those born in January of the following year. Thus, the health benefit for a child born in December would come from earlier and longer exposure to preschool. Importantly, we find that the positive effect of preschool persists over time as children grow. A possible major reason why preschool attendance improves health is the nutrition provided for children in preschools.
查看更多>>摘要：Abstract We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic damages for health care services. Small chain and unaffiliated nursing homes enjoyed “judgment proof standing” and were less apt to be sued, prior to reform. We find that the managers of such homes were relatively unresponsive to the implementation of state caps on noneconomic damages. Large “deep‐pocketed” chain‐affiliated homes lacked judgment proof standing and implemented greater reductions in their nursing inputs in the aftermath of tort relief. However, we find little evidence of service quality erosion across four measured dimensions of care outcomes. Our findings are consistent with a “defensive care” model in which large chain homes employ unproductive inputs in an effort to meet a negligence standard of care.
查看更多>>摘要：Abstract Many countries limit public and private reimbursement for nursing care costs for social or financial reasons. Still, quality varies across nursing homes. We explore the causal link between case‐mix adjusted nurse staffing ratios as an indicator of care quality and different price components in Swiss nursing homes. The Swiss reimbursement system limits and subsidizes the care price at the cantonal level, which implicitly limits staffing ratios, while the residents cover the nursing home‐specific lodging price privately. To estimate causal effects, we exploit (i) the exogeneity of the Swiss care price regulation, (ii) nursing‐home fixed effects estimations and (iii) instrumental variables for the lodging price. Our estimates show a positive impact of prices on certified staffing ratios. We find that a 10% increase in care prices increases certified staffing ratios by 3–4%. A comparable 10% increase in lodging prices raises certified staffing ratios by 1.5–10% (depending on the model). Our findings highlight that price limits for nursing care impose a limit on staffing ratios. Furthermore, our results indicate that providers circumvent price limits by increasing lodging prices that are privately covered. Thus, this cost shifting implicitly shifts the financial burden to the residents.
Stefan A. LipmanArthur E. AttemaMatthijs M. Versteegh
16页
查看更多>>摘要：Abstract Time trade‐off utilities have been suggested to be biased upwards. This bias is a result of the method being applied assuming linear utility of life duration, which is violated when individuals discount future life years or are loss averse for health. Applying a “corrective approach”, that is, measuring individuals' discount function and loss aversion and correcting time trade‐off utilities for these individual characteristics, may reduce this bias in utilities. Earlier work has developed this approach for time trade‐off in a student sample. In this study, the corrective approach was extended to composite time trade‐off (cTTO) methodology, which enabled correcting utilities for health states worse than dead. In digital interviews a sample of 150 members of the general public completed cTTO tasks for six health states, and afterward they completed measurements of loss aversion and discounting. cTTO utilities were corrected using these measurements under multiple specifications. Respondents were also asked to reflect on and adjust their cTTO utilities directly. Our results show considerable loss aversion and both positive and negative discounting were prevalent. As predicted, correction generally resulted in lower utilities. This was in accordance with the direction of adjustments made by respondents themselves.
查看更多>>摘要：Abstract This paper documents how substance abuse treatment (SAT) providers and services respond to increases in population‐level opioid addiction. I do this by exploiting the implementation of Medicare Part D as an exogenous increase in the availability of prescription opioids. Starting in 2006, states with higher shares of the population eligible for Medicare Part D experienced increases in residential and hospital inpatient SAT facilities, beds dedicated to SAT, and SAT facilities offering medication‐assisted treatment, relative to states with lower shares. These results suggest that the supply of SAT in the United States is capable of responding significantly to changes in demand.
查看更多>>摘要：Abstract Health care in China suffers from substantial allocative inefficiency in the delivery system and technical inefficiency within hospitals. To ameliorate this problem in rural areas, the Analysis of Provider Payment Reforms on Advancing China's Health (APPROACH) project shifted the payment method of China's rural health insurance scheme for county hospitals from fee‐for‐service to a novel global budget. In particular, APPROACH global budget incentivized system‐level allocative efficiency by reimbursing county hospitals at higher tariffs for gatekeeping and averting out‐of‐county (OOC) admissions among local patients they could treat. APPROACH conducted a large‐scale randomized controlled trial of the global budget in 56 counties (22 million enrollees) of Guizhou province during 2016–2017. Applying randomization inference to claims data, we find a significant shift of inpatient utilization and expenditure from OOC hospitals to county hospitals. At county hospitals, average expenditure per admission and length of stay decreased, though not significantly. Effects on readmissions show no clear sign of compromised quality. We further find limited effect heterogeneity with respect to treatment and hospital characteristics. Overall, APPROACH global budget may offer a framework for improving health care efficiency without sacrificing quality.
查看更多>>摘要：Abstract Non‐pecuniary sources of motivation are a strong feature of the health care sector and the impact of competitive incentives on behavior may be lower where pecuniary motivation is low. This paper measures the marginal utility of income (MUY) of physicians from a stated‐choice experiment, and examines whether this measure influences the association between competition faced by physicians and the prices they charge. We find that physicians are more likely to exploit a lack of competition with higher prices if they have a high MUY.
查看更多>>摘要：Abstract We study whether primary care physicians (PCPs) exercise left digit bias with respect to patients' age. Relying on a comprehensive administrative visit level data from a large Israeli HMO, we measure the intensity of patients' medical examination in visits that take place around a decadal birthday—a birthday that ends with zero—within a regression discontinuity framework. We find that in standard settings with clear patient information there is no evidence that PCPs exhibit left digit bias. However, when PCPs meet unfamiliar patients seeking immediate care, they are more likely to use basic diagnostic tests just above the decadal birthday threshold, indicating that under these circumstances, PCPs do use left digit bias.
NSTL
Wiley