Suchergebnisse

Recent political events have thrust the bulk negotiation of drug prices by Medicare and Medicaid back into the spotlight. Yet, even if politically feasible, there is no clear framework for negotiating prices of new drugs with uncertain target populations—for example, due to imprecise estimates or off-label use—or uncertain clinical effects—for example, due to heterogeneous patient response. We create such a framework using two-price programs developed in the economics of procurement literature. This framework delivers new payment strategies, and unifying them with theoretical advances in pharmaceutical reimbursement like capitation and value-based pricing. Two-price programs substantially reduce uncertainty for both payers and pharmaceutical companies, while still creating financial incentives for those companies that innovate and create value for patients.

Der Anteil der Ausgaben der Gesetzlichen Krankenversicherung am Bruttonationaleinkommen ist zwar seit der Wiedervereinigung von 5,9 auf 6,9 Prozent gestiegen. Abgesehen von dem Niveausprung nach der Finanzmarktkrise im Jahr 2009 blieb die Quote aber weitgehend stabil. Ein anderes Bild ergibt sich, sobald die GKV-Ausgaben pro Kopf betrachtet werden: Seit 1991 sind die Ausgaben je Versicherten jedes Jahr um durchschnittlich rund 1 Prozentpunkt stärker gestiegen als die beitragspflichtigen Einkommen pro Kopf. Diese Differenz bleibt bestehen, wenn beide Größen auf die beitragszahlenden Mitglieder bezogen werden. Auch im Vergleich zu den Konsummöglichkeiten der Gesellschaft, deren Entwicklung über das Bruttonationaleinkommen je Einwohner beschrieben wird, wachsen die GKV-Ausgaben pro Kopf überproportional stark. Dagegen ist die Finanzierungsbasis der Gesetzlichen Krankenversicherung nicht erodiert. Je GKV-Mitglied haben sich die beitragspflichtigen Einkommen mit annähernd gleicher Dynamik entwickelt wie die durchschnittlichen Arbeitnehmerentgelte. Allerdings ist das Volkseinkommen je Einwohner etwas stärker gewachsen. Für die Diskussion um den Vorrang einer einnahmen- oder ausgabenorientierten Gesundheitspolitik gibt der Befund deshalb deutliche Orientierung: Eine Reform der Beitragsfinanzierung mag aus verteilungspolitischen Erwägungen opportun erscheinen, die drängenden Probleme auf der Ausgabenseite werden damit aber nicht behoben. ; Since Reunification in 1990, expenditure by Germany's statutory health insurance (SHI) system has increased from 5.9 to 6.9 per cent of gross national income. However, apart from a steep rise following the financial market crisis in 2009, this proportion has remained broadly stable. Per capita spending, though, reveals a different picture. Every year since 1991, expenditure per insured person has risen by an average of around 1 percentage point more than per capita income on which SHI contributions are payable. This difference remains even when both values are related to the SHI members paying those contributions. Per capita SHI expenditure has also been growing disproportionately fast compared with potential consumption, described by gross national income per head of population. On the other hand, there has been no erosion of the statutory health insurance's financial footing. Income subject to contributions per SHI member has developed approximately in line with employees' average pay. However, per capita national income has grown somewhat more steeply. These findings thus provide clear guidance on whether to give preference to a revenue- or an expenditure-based health policy. A reform of contribution financing may seem opportune in terms of distribution policy, but would not solve the urgent problems on the expenditure side.

Fang and Gong (2017) develop a procedure to detect potential over-billing of Medicare by physicians. In their empirical analysis, they use aggregated claims data that can overstate the number of services performed due to features of Medicare billing. In this comment, I show how auditors can use detailed claims-level data to better target improper overbilling. (JEL H51, I13, I18, J22, J44)

Abstract. Bangladesh is a developing country where providing sufficient and affordable health-care is a challenge due to the high population density and poor healthcare infrastructure. Considering this reality, the Government of Bangladesh is going to implement telemedicine in public hospitals of Bangladesh. In order to introduce telemedicine in public hospitals in Bangladesh itis important to identify and address issues and challenges that may affect successful implementation. So, the aim of our project was to identify the challenges to implement telemedicine in public hospitals of Bangladesh. A Qualitative exploratory research approach has been used to conduct the study. The model of Khalifehsoltani & Gerami (2010) was used to investigate the six areas of expected challenges to implement telemedicine in public hospitals of Bangladesh in our study. After analysing the collected data in the light of a conceptual mode it was found that the expected challenges to implement telemedicine in public hospitals of Bangladesh are related to a lack of sufficient funds, the anxieties of patients about telemedicine, the lack of widespread and continuous education for public use of e-health services, a weakness of the software to deal with increasing workloads, shortage of technologically skilled manpower, the lack of a comprehensive legal framework about telemedicine, lack of telemedicine related policy and lack of telecommunication network in some areas of the country. Before being able to successfully implement the telemedicine project in public hospitals the government of Bangladesh needs to take some serious initiatives to solve these challenges.Keywords. E-health, Telemedicine, Challenges, Implement, Public hospitals.JEL. H51, H70, I10.

Abstract. The paper undertakes a detailed analysis of health and economic outcomes of COVID 19 pandemic. The paper explains the need for governments to implement steps like partial lock downs in major metropolitans of the world to safe guard the public and contain the outbreak. The paper discusses the economic risks and opportunities for both developed and developing countries due to this ongoing pandemic. There is a risk of a recession and thus the author presents few steps that the governments and institutions of international governance can take to prevent a steep trough in business cycle. For a country like Pakistan, economic response to the pandemic may also include improvement of regional ties, especially with neighboring India; creating thriving domestic economy by promoting entrepreneurship and further strengthening domestic and regional commerce.Keywords. Health economics, Pandemic, Economic outcomes, Covid-19.JEL. H51, H75, I00, I30.

Abstract
This special volume is dedicated to David H. Dean who passed away on August 11th, 2013. This dedication describes David's impact on the academic research on disability and, most notably, the vital interaction between research and policy. It discusses his influence in shaping perspectives on evaluating the effectiveness of programs to increase employment. Finally, it describes David as a person and why he was influential as a researcher and college professor.

JEL codes

H51, I13, J24

Health care system in Georgia appears to be one of the important priority of the country during last decade and varies within 9-11%. With regard to health care costs, mental health sector, share its funds within 2%. Although mental health financing and resource distribution are characterized by a growing tendency in Georgia, effective allocation of funds directed for psychiatric treatment remains underestimated. Evidence based government policies imply to offer differentiated services for people with mental health problems and are based on cost-effectiveness analysis. Contemporary studies with the cost/benefit/effectiveness analysis, confirm the effectiveness of community services intervention. In particular, under the same expenditures, community services can make far more positive results by improving the quality of life of people with mental disorders rather than ordinary hospital services. Nowadays, costs for the inpatient services are three times higher compared to the ambulance treatments in Georgia. Taking into view the fact that the country spends 100 times less funds in financing of mental healthcare policies then developed countries and 12 times less than Eastern European countries, choosing appropriate policy which remains adequate ratio between treatment approaches on the bases of cost-effective studies arises in the political agenda. Investing funds in community services means taking out the same amount of funds from in patient, which is already scarce and significantly lower in comparison with the similar indicators in other countries. Thus, giving preferences to inpatient or outpatient services seems to be problematic without analyzing appropriate data and comparing benefit received from funding one treatment policy to the losses of another treatment policy as a result of finance reducing.

Medicaid is a government program that also provides health insurance to the old who have little assets and either low income or catastrophic health care expenses. We ask how the Medicaid rules map into the reality of Medicaid recipiency and what other observable characteristics are important to determine who ends up on Medicaid. The data show that both singles and couples with high retirement income can end up on Medicaid at very advanced ages. We find that, conditioning on a large number of observable characteristics, including those that directly relate to Medicaid eligibility criteria, single women are more likely to end up on Medicaid. So are non-whites, but, surprisingly, their higher recipiency is concentrated in the higher income percentiles. We also find that low-income people with a high school diploma or higher are much less likely to end up on Medicaid than their less educated counterparts. All of these effects are large and depend on retirement income in a very non-linear way.

Abctract. Since independence, oil imports in Kenya have been rising mainly to sustain the nascent transport, manufacturing, energy, agriculture and maritime sectors among other uses in the country. The growth in the country's oil import bill has however been closely related to public spending in the health and education sectors which experienced shocks owing to the growth in expenditures apportioned to the rising volume of oil imports. Given the significance of the social pillar of the Kenya Vision 2030 and the inconsistency in the progress towards achieving the Sustainable Development Goals, which is inherent in the Kenya Vision 2030, understanding the linkages between the aforementioned trends in expenditures can help in explaining the progress towards attaining the education and health facets of the social pillar. The purpose of this study was to analyze the relationship between aggregate expenditure on oil imports and public spending on health and education. The data used was time series data sourced from Kenya National Bureau of Statistics, Central Bank of Kenya and World Bank. The study employed granger causality and correlation analysis. Based on standard Chi-square tests and F-tests, the findings of the study revealed that there exists bi-directional causality between government expenditure on health and aggregate expenditure on oil imports on one hand; and a unidirectional causality running from government spending on education to aggregate expenditure on oil imports on the other hand, both in the long-run and short-run. It is therefore recommended that the government should define what is deemed economically sustainable in regard to government expenditure on health as a proportion of the exchequer budget. It should also put in place policies that will institute reasonable margins for government expenditures on health and education to adjust as a measure to keep the rising oil import bill in check.Keywords. Public spending, Causality, Oil price shock.JEL. D61, H12, H51, H52, Q48.

Deutschland hat sich das Ziel gesetzt, bis zum 21. September 2021 70 % der erwachsenen Bevölkerung ein Impfangebot zu unterbreiten. Der Fortschritt der Impfkampagne hängt dabei wesentlich von drei Determinanten ab: der Impfstoffverfügbarkeit, den Impfkapazitäten sowie der Impfbereitschaft. Auf Basis von Szenarienrechnungen wird aufgezeigt, wie das Ziel der Bundesregierung zu erreichen ist und welche Anforderungen an die Organisation der Impfkampagne dabei gestellt werden müssen. Abschließend werden langfristige Perspektiven und Herausforderungen angesprochen, etwa mit Blick auf die Impfung von Kindern und Jugendlichen oder den weltweiten Impffortschritt. ; The success of the vaccination campaign in Germany depends decisively on the availability of vaccines, vaccination capacities and the willingness to vaccinate. On the basis of model calculations, this article presents the possible scenarios of the vaccination progress and discusses requirements for the organisation of the vaccination campaign. It also addresses the long-term perspectives and challenges, e. g. with regard to the vaccination of children and adolescents or the global vaccination progress.

With most African economies experiencing adverse economic misalignment in recent times, the need of enhancing the growth process cannot be overemphasized. Using a typical Savings-Trade-Fiscal Gap Model, the paper employed panel data estimation method to examine the impact of savings, trade and fiscal gap on economic growth of 15 West African countries. The paper finds a negative relationship between net trade and economic growth, while savings and government expenditure impacts positively on economic performance. The paper thus, among recommended that it is appropriate for all countries to eliminate fiscal dominance from monetary policy-making, reduce public debt and establish institutions that promote and encourage counter-cyclical fiscal policy, develop their financial systems, establish credibility in fiscal and monetary policy-making as well as encourage trade.

The global framework for financing development, adopted in 2015, places great emphasis on mobilizing domestic resources to finance the Sustainable Development Goals, which include universal healthcare. In a recent paper Reeves et al. (2015) attribute progress towards universal healthcare to higher levels of taxation, but report a negative association between taxes on goods and services (indirect taxes) and health outcomes, which they hypothesise arises from the impact such taxes have on the real incomes of the poor. This paper revisits the relationship between tax types and health outcomes using the ICTD Government Revenue Dataset, which, crucially, isolates taxes from resource industries. As expected, we confirm increases in revenue are associated with increased public health expenditure; we find some weak evidence that greater reliance on direct taxes is associated with higher health spending and better outcomes, but no evidence that indirect taxes are deleterious to health. We argue these relationships cannot bear the weight of causal interpretation but that they offer some guidance on what to expect from increased domestic revenue mobilization.

Activity-based financing of Norwegian hospitals was implemented in 1997. An earlier study shows that when the activity-based component increases, the average length of stay for the elderly is reduced. If this reduction entails premature discharge, an increased activity-based component may have the undesirable side effect of increasing readmission rates. Yearly the Norwegian government decides the size of the activity-based component, and all hospitals face the same size. In this paper, we investigate whether the level of activity-based financing is associated with the readmission rates for acute-care patients above 70 years of age. The sample consisted of 468 010 hospital admissions among elderly patients in the period from 2000 to 2007. Using repeated cross-sectional data extracted from the Norwegian Patient Registry, a Cox regression model was used to estimate factors that may influence the hazard rate of a readmission within 30 days. The overall 30-day readmission rate was 6.6%. The results demonstrate that the activity-based component had no significant effect on the readmission rate. Patient-specific factors such as age, gender, diagnoses, comorbidities, as well as the time trend, were important predictors of readmission rates. We also found a statistically significant random effect of hospitals, although this effect was less substantial than the impact of patient characteristics. Our results show that the effect of the activity-based component on the readmission rate was negligible when it varied between 40% and 60%.Published: Online May 2016. In print August 2016.