The value of a QALY towards the end of life and its determinants: Experimental evidence.

Objectives: Individual and societal willingness to pay (WTP) for end-of-life medical interventions continue to be subject to considerable uncertainty. This study aims at deriving both types of WTP estimates for an extension of survival time and an improvement of quality of life amounting to a QALY.

Methods: A discrete choice experiment (DCE) involving a hypothetical novel drug for the treatment of terminal cancer involving 1529 Swiss residents was performed in 2014.

The 'Red Herring' Hypothesis: Some Theory and New Evidence.

The 'red herring' hypothesis (RHH) claims that apart from income and medical technology, proximity to death rather than age constitutes the main determinant of healthcare expenditure (HCE). This paper seeks to underpin the RHH with some theory to derive new predictions also for a rationed setting, and to test them against published empirical evidence. One set comprising ten predictions uses women's longer life expectancy as an indicator of the difference in time to death in their favor.

A Reconstruction Algorithm for Temporally Aliased Seismic Signals Recorded by the InSight Mars Lander.

In December 2018, the NASA InSight lander successfully placed a seismometer on the surface of Mars. Alongside, a hammering device was deployed at the landing site that penetrated into the ground to attempt the first measurements of the planetary heat flow of Mars. The hammering of the heat probe generated repeated seismic signals that were registered by the seismometer and can potentially be used to image the shallow subsurface just below the lander.

Innovation in health care through information technology (IT): The role of incentives.

For several years now, information technology (IT) has been hailed as an innovation that will revolutionize medicine and health care more generally. Yet adoption of new IT in the healthcare sector has been slow, possibly reflecting a lack of interest. In economic terms, the incentives of the major players in health care may work against new IT, which fosters process and organizational innovation much more than product innovation.

Mental health: The burden of social stigma.

The burden of mental health has two facets, social and psychological. Social stigma causes individuals who suspect to be suffering from a mental condition to conceal it, importantly by seeking care from a nonspecialist provider willing to diagnose it as physical disease. In this way, social stigma adds to both the direct and indirect cost of mental health.

Buying efficiency: optimal hospital payment in the presence of double upcoding.

Background: With DRG payments, hospitals can game the system by 'upcoding' true patient's severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent of the distortion depending on hospital's internal decision-making process. The internal decision making can be of the principal-agent type with the management as the principal and the chief physician as the agent, but the chief physicians may be able to engage in negotiations with management resulting in a bargaining solution.

Mental health: A Particular Challenge Confronting Policy Makers and Economists.

The first objective of this paper is to expound the particular challenge posed by the occurrence of inconsistency in the expression of preferences by mental health patients to both economists and policy makers. Since this difficulty cannot be resolved, the second aim of the paper is to identify agents who may be counted upon to identify the true patient preferences. A decision rule is developed to help identify these agents who may be family members or judges in court, who have the ability and incentive to make these decisions.

End-of-life healthcare expenditure: Testing economic explanations using a discrete choice experiment.

Healthcare expenditure (HCE) spent during an individual's last year of life accounts for a high share of lifetime HCE. This finding is puzzling because an investment in health is unlikely to have a sufficiently long payback period. However, Becker et al.

Choice of reserve capacity by hospitals: a problem for prospective payment.

This contribution analyzes the impact of prospective payment on hospital decisions with regard to reserve capacity, using Swiss hospital data covering the years 2004-2009. This data set is unique because it permits distinguishing of institutional characteristics (e.g.

Overcoming resistance against managed care - insights from a bargaining model.

Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed.

Medical ethics: enhanced or undermined by modes of payment?

Background: In the medical literature [1, 2, 7], the view prevails that any change away from fee-for-service (FFS) jeopardizes medical ethics, defined as motivational preference in this article. The objective of this contribution is to test this hypothesis by first developing two theoretical models of behavior, building on the pioneering works of Ellis and McGuire [4] and Pauly and Redisch [11]. Medical ethics is reflected by a parameter α, which indicates how much importance the physician attributes to patient well-being relative to his or her own income.

Experimental measurement of preferences in health care using best-worst scaling (BWS): theoretical and statistical issues.

For optimal solutions in health care, decision makers inevitably must evaluate trade-offs, which call for multi-attribute valuation methods. Researchers have proposed using best-worst scaling (BWS) methods which seek to extract information from respondents by asking them to identify the best and worst items in each choice set. While a companion paper describes the different types of BWS, application and their advantages and downsides, this contribution expounds their relationships with microeconomic theory, which also have implications for statistical inference.

Experimental measurement of preferences in health and healthcare using best-worst scaling: an overview.

Best-worst scaling (BWS), also known as maximum-difference scaling, is a multiattribute approach to measuring preferences. BWS aims at the analysis of preferences regarding a set of attributes, their levels or alternatives. It is a stated-preference method based on the assumption that respondents are capable of making judgments regarding the best and the worst (or the most and least important, respectively) out of three or more elements of a choice-set.

Cost-Effectiveness Analysis of Universal Human Papillomavirus Vaccination Using a Dynamic Bayesian Methodology: The BEST II Study.

Background: Human papillomavirus (HPV) plays a role in the development of benign and malign neoplasms in both sexes. The Italian recommendations for HPV vaccines consider only females. The BEST II study (Bayesian modelling to assess the Effectiveness of a vaccination Strategy to prevent HPV-related diseases) evaluates 1) the cost-effectiveness of immunization strategies targeting universal vaccination compared with cervical cancer screening and female-only vaccination and 2) the economic impact of immunization on various HPV-induced diseases.

Why 'Optimal' Payment for Healthcare Providers Can Never be Optimal Under Community Rating.

This article extends the existing literature on optimal provider payment by accounting for consumer heterogeneity in preferences for health insurance and healthcare. This heterogeneity breaks down the separation of the relationship between providers and the health insurer and the relationship between consumers and the insurer. Both experimental and market evidence for a high degree of heterogeneity are presented.

Rationing of health care: is there an economic rationality to it?

The point of departure of this Editorial is the fact that we all are engaged in self-rationing in our everyday lives. We would like to spend more money on all sorts of nice things and devote more time to our cherished activities. Imposed rationing is characteristic of wartime governments, who seek to prevent the rich from gobbling up the resources left by the army.

Preferences for health insurance in Germany and the Netherlands - a tale of two countries.

Background: This contribution seeks to measure preferences for health insurance in Germany and the Netherlands, using two Discrete Choice Experiments (DCE). Since the Dutch DCE was carried out right after the 2006 health reform, which made citizens explicitly choose a health insurance contract, two research questions naturally arise. First, are the preferences with regard to contract attributes (such as Managed Care-type restrictions of physician choice), incentives (such as bonus options for no claims, deductibles, and a bonus for preventive behavior), and extra services provided by the health insurer (such as patient counseling) similar between the two countries? Second, was the requirement to explicitly choose imposed by the Dutch government in the context of the reform effective in reducing status quo bias with respect to future reforms?

Results: Based on random-effects Probit estimates, these two questions can be answered as follows.

Mutual altruism: evidence from Alzheimer patients and their spouse caregivers.

Purpose: Preferences of both Alzheimer patients and their spouse caregivers are related to a willingness-to-pay (WTP) measure which is used to test for the presence of mutual (rather than conventional unilateral) altruism.

Methodology: Contingent valuation experiments were conducted in 2000-2002, involving 126 Alzheimer patients and their caregiving spouses living in the Zurich metropolitan area (Switzerland). WTP values for three hypothetical treatments of the demented patient were elicited.

Generic substitution, financial interests, and imperfect agency.

Policy makers around the world seek to encourage generic substitution. In this paper, the importance of prescribing physicians' imperfect agency is tested using the fact that some Swiss jurisdictions allow physicians to dispense drugs on their own account (physician dispensing, PD) while others disallow it. We estimate a model of physician drug choice with the help of drug claim data, finding a significant positive association between PD and the use of generics.