Dissertations / Theses: 'Medical economics. Medical policy'

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Amporfu, Eugenia. "Three essays in health economics /." Burnaby B.C. : Simon Fraser University, 2004. http://ir.lib.sfu.ca/handle/1892/2297.

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Stiffler, Peter B. 1976. "Health economics: Policy outcomes, individual choice, and adolescent behavior." Thesis, University of Oregon, 2010. http://hdl.handle.net/1794/10533.

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xiii, 123 p. : ill. (some col.) A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.
To complement a varied and growing literature in health economics, this dissertation is conducted in three substantive parts. First, I investigate the effect of public policy on health use and health outcomes, exploiting variation in the generosity of Medicaid eligibility to low income pregnant women across states and over time to identify an effect on common, yet costly, pregnancy complications. I provide new evidence on this important question from a nationally representative sample of hospital discharges for 12 states between 1989 and 2001. Second, I explore heterogeneity in individual demand for health risk reductions. Utilizing individual stated-preference data from matching surveys conducted in both Canada and the United States, I employ the Value of a Statistical Illness Profile framework to investigate differences in average willingness-to-pay (WTP) for health risk reductions across the two different cultures. Although existing literature has allowed for systematic variation in age to explain differences in health care demand, the differences in WTP have not been explained through systematic variation across other socio-demographic characteristics, subjective risks of the diseases in question, or differences between the Canadian and U.S. health care systems. I extend the literature by controlling for an expanded set of observable individual heterogeneity and comment on the degree to which estimates can be applied across cultures to inform varying policy decisions. The third paper studies factors affecting adolescent health risk behavior. Previous study finds that community size and the degree to which social networks are interconnected affect three economically significant outcomes: the frequency of adolescent misbehavior in school, degree of perceived safety in school, and grade performance. Other research has suggested peer effects on smoking behavior and drinking behavior. I investigate the degree to which social connectedness impacts adolescent health, specifically looking at outcomes for drinking and smoking, and the degree to which these effects can be disentangled from more commonly studied "peer effects" in health behavior.
Committee in charge: Trudy Cameron, Co-Chairperson, Economics; Glen Waddell, Co-Chairperson, Economics; Anne van den Nouweland, Member, Economics; Jessica Greene, Member, Planning Public Policy & Mgmt; David Levin, Outside Member, Mathematics

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Stern, Ariel Dora. "Essays in the Economics of Health Care and the Regulation of Medical Technology." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11678.

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The first chapter of this dissertation explores how the regulatory approval process affects innovation incentives in medical technologies. While prior studies of medical innovation under regulation have found an early mover regulatory advantage for drugs, I find the opposite to be true for medical devices. Using detailed data on over three decades of high-risk medical device approval times in the United States, I show pioneer entrants spend approximately 34 percent (7.2 months) longer in the approval process than the first follow-on innovator. Back-of-the-envelope calculations suggest that the opportunity cost of capital of a delay of this length is upwards of 7 percent of the total cost of bringing a new device to market. I consider how different types of regulatory uncertainty affect approval times and find that a product's technological novelty is largely unrelated to time spent under review. In contrast, uncertainty about application content and format appears to play a large role: when objective guidelines for evaluation are published, approval times quicken for subsequent entrants. Finally, I consider how the regulatory process affects firms’ market entry strategies and find that financially constrained firms are less likely to enter new device markets as pioneers.

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Van, den Heever Alexander Marius. "The distribution and redistribution of health resources in South Africa." Master's thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/18291.

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This thesis is intended as a broad examination of the distribution of health resources in South Africa. Issues both macro and micro in nature have been covered to provide a perspective that would be Jacking in a narrower study. Although the title refers to a redistribution of resources, the intention of this thesis is to stress the importance of providing appropriate health measures rather than merely apportioning existing facilities evenly. This realization is insufficient, however, if it is not accompanied by the introduction and utilization of analytical approaches for identifying resource selection priorities. The influences on health status are many. In defining appropriate measures to improve health status it is important to be aware of the limitations of medical-care. Chapter three involves a cross-sectional regression analysis of various countries in order to examine the influences certain variables have on health status. This study suggests the need for an integrated approach to improving the health of a population. Merely focusing on medical care will only have a limited affect. However, this does not mean that medical-care is not important. It must just be provided in an appropriate manner. The rest of the thesis evaluates health-care resource distribution in South Africa. The existing distribution of health-care resources in South Africa is ill-suited to the existing health status of the population. There is a bias toward urban based curative facilities. Furthermore, the location of facilities has been based on racial criteria, whereby some areas have sufficient resources for their needs while others do not. Two methods of identifying how these issues should be dealt with are produced in this thesis. The first deals with a method for adjusting the broad distribution of funds toward those areas where need is greatest. The suggestion put forward by this thesis is that a formula be developed that would be able both to define need on a geographical basis, and to allocate resources based on that need. The formula would be used to allocate government health expenditure. This section is based on a formula that was developed in the United Kingdom. The second deals with a method for defining appropriate medical interventions on the micro level. It is called cost-effectiveness analysis (CEA). CEA is used for micro-economic decision-making where a choice has to be made between at least two alternatives for attaining a particular objective. Furthermore, CEA evaluates projects or programmes that are on-going in nature. It should be noted that CEA can also evaluate non-medical interventions to solve a particular health problem. In order to indicate the type of information that a CEA can provide, an investigation into cervical cancer procedures used on black females was produced. The entire black female population of South Africa was examined. A computer simulation of incidence and mortality rates of the disease was used to evaluate various scenarios. The results indicate that significant gains can be made by introducing cervical cancer screening on a large scale in South Africa. A major priority of this thesis was to stress the importance of using economic criteria to assist in making decisions concerning health-care resource allocations. Very little work of this nature is produced in South Africa. Hopefully this will not always be the case.

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Nordyke, Robert. "Privatization of health care provision in a transition economy : lessons from the Republic of Macedonia /." Santa Monica, CA : RAND, 2000. http://www.rand.org/pubs/rgs%5Fdissertations/RGSD155/.

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Bosworth, Ryan Cole. "Demand for public health policies /." view abstract or download file of text, 2006. http://proquest.umi.com/pqdweb?index=0&did=1192186841&SrchMode=1&sid=1&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1176749188&clientId=11238.

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Thesis (Ph. D.)--University of Oregon, 2006.
Typescript. Includes vita and abstract. Includes bibliographical references (leaves 127-130). Also available for download via the World Wide Web; free to University of Oregon users.

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Yamada, Go. "Input-output analysis on the economic impact of medical care in Japan." 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215218.

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Briggs, Adam. "Estimating and comparing the cost-effectiveness of primary prevention policies affecting diet and physical activity in England." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:31a057d1-c15c-4edb-ba26-c51217049ba0.

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Health and public health services in England are under increasing financial pressure. At the same time, nearly 40% of the total disease burden is potentially amenable to known causes with two of the leading behavioural risk factors being unhealthy diets and physical inactivity. To better inform decision makers and improve health in England, this thesis aims to develop a cost-effectiveness model that can directly compare diet and physical activity interventions. Published public health economic models were reviewed and the strengths and weaknesses of the modelling structures were explored. A pre-existing multistate life table model, PRIMEtime, was developed into PRIMEtime Cost Effectiveness (PRIMEtime CE). Disease specific NHS England costs were derived from NHS England Programme Budgeting Data and unrelated disease costs from NHS cost curves. Social care costs were quantified using a Department of Health tool for estimating wider societal costs. Disease specific utility decrements were adopted from a catalogue of EuroQoL five dimensions questionnaire scores. The cost effectiveness of reformulating food to have less salt and of expanding access to leisure centres in England were modelled from an NHS and social care perspective over a 10 year time horizon, including government and industry costs. Salt reformulation was dominant with an estimated cost per quality adjusted life year (QALY) of -Â£17,000 (95% uncertainty interval, -Â£40,000 to Â£39,000), compared with Â£727,000 (Â£514,000 to Â£1,064,000) for increasing access to leisure centres. Sensitivity analyses and cross validation testing of outcomes demonstrated how cost per QALY estimates were sensitive to the choice of model scope, parameters, and structure. PRIMEtime CE is a tool for decision makers to compare interventions affecting diet and physical activity, enabling them to make better informed choices about how to spend finite resources. Future work will focus on making the model freely available and expanding its risk factors to enable comparisons of other public health interventions.

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Walker, Lauryn. "Patient-Centered Medical Homes and Hospital Value-Based Purchasing: Investigating Provider Responses to Incentives." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5796.

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Provider incentives are a commonly used policy tool to mold provider behaviors.1 However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program. Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic surveys to member experience with care in order to evaluate characteristics key to patient-centered medical homes. I find that patient-perceived patient-centeredness of a practice is not related to the number of PCMH attributes a practice reports. However, some characteristics do play specific and significant roles in patient perception and outcomes. For instance, case management is not only associated with increased patient perception of after-hours access to care, but overall costs were reduced. Interestingly, having after hours clinic hours was more common with practices highly consistent with PCMH criteria, but these hours did not result in decreased emergency department use or cost of care. Chapter 2: The second provider incentive studied is the Medicare Hospital Value-Based Purchasing Program (HVBP). This program assigns payment adjustments based on performance on a series of rotating quality metrics. To date, changes in patient outcomes cannot be attributed to the program; however, it should not be concluded that hospitals are not responding at all. I identify changes in staffing by provider type as an early indicator of hospital response to payment incentives. Data come from the Virginia Health Information (VHI) Hospital Cost Report, 2010-2017. Using a generalized linear model, I find that when receiving a penalty, hospitals reduce staffing among the most and least expensive personnel (physicians and nursing aides). Hospitals increase nursing and administrative staff following a bonus. These findings are consistent with hospitals responding to incentives both by aiming to improve efficient use of resources and maintain or improve quality of care. Chapter 3: Finally, I assess potential unintended consequences of the HVBP program, specifically the provision of charity care. Using the VHI cost reports for year 2013 to 2017 with a regression discontinuity model, I find that hospitals receiving a bonus decrease their charity care among the lowest income patients (under 100% federal poverty level (FPL)). Hospitals receiving a penalty tend to reduce charity care among higher income patients (100%-200% FPL). These findings are consistent with two separate responses to the incentives. Hospitals receiving bonuses appear to be cream-skimming healthier, wealthier individuals while hospitals receiving penalties appear to be shifting the focus of their charity care to the most needy, likely in an effort to reduce cost of care levels overall while maintaining their community benefit programs, potentially as a result of goal gradient cognitive bias.

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Choi, Chung Ho. "Patient journey shortening using a multi-agent approach." HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1228.

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Wikler, Elizabeth McCarthy. "Transformations in Health Policy: An Analysis of Alzheimer's Disease Testing, Medicaid Enrollment, and Insurance Market Concentration." Thesis, Harvard University, 2013. http://dissertations.umi.com/gsas.harvard:10866.

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This dissertation consists of three quantitative papers addressing contemporary issues in health policy. The first paper draws on a survey of 2,678 adults from the United States and four European countries to assess demand for a hypothetical early medical test for Alzheimer's disease (AD). Overall, 67% of respondents reported that they would be "very" or "somewhat" likely to get the test if it were available. Through logistic regression analysis, we find that interest was higher among those worried about developing AD, with an immediate blood relative with AD, and who have provided care for AD patients. Knowing that AD is fatal did not influence demand, except among those with an affected blood relative. We expect that a test becoming available could precipitate the creation of a large constituency of asymptomatic, diagnosed adults, affecting a range of health policy decisions. The second paper utilizes Current Population Survey data to explore state-level Medicaid enrollment rates among eligible parents between 2003 and 2010, focusing on the interaction of race and ethnicity and political ideology. Using logistic regression analysis, we find that average take-up for Hispanics in conservative states was 23%, whereas take-up was 38% for both whites and blacks in those states, adjusting for state and individual demographics. These differences abated in liberal and moderate states. Among eligible Hispanics, enrollment rates were less than half as high in conservative states than in liberal states (23% versus 61%). Adjusting for differences in state Medicaid policies narrowed these disparities significantly, highlighting the importance of new provisions aimed at streamlining enrollment procedures across all states. The last paper draws on public and private data from 2007 to 2010 to analyze how administrative spending by health insurers and providers varied across states with different levels of insurance and hospital market concentration. Using regression analysis, we find that in provider offices, high levels of insurance concentration were associated with lower administrative costs. If all states were as concentrated as the most concentrated state in our sample, we would expect nationwide savings of $3.6 billion in administrative expenses. However, market concentration did not reduce administrative spending by insurers or hospitals.

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Al-Hashmi, Sultan Muhammad. "The dependence of elderly people in Omani society : social, economic and medical dependence of elderly people in a changing society - Oman 1970-1996." Thesis, University of Exeter, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264604.

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Antioch, Kathryn M. "Improving cost effectiveness, distributional justice and allocative efficiency in hospital funding and service delivery in Australia and internationally." Monash University, Dept. of Epidemiology and Preventive Medicine, 2004. http://arrow.monash.edu.au/hdl/1959.1/5296.

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Dell'Aera, Anthony D. "Prescription drug regulation and the art of the possible : reconciling private interest and public good in American health care policy." View abstract/electronic edition; access limited to Brown University users, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3318305.

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Muir, Lauretta, and n/a. "The impact of economic theory on the art of clinical practice : a study of science, meaning, and health." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20060911.160405.

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In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy. This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms. The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity. In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.

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Zhang, Lei. "Uncompensated Care Provision and the Economic Behavior of Hospitals: the Influence of the Regulatory Environment." Diss., unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-02242009-152847/.

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Thesis (Ph. D.)--Georgia State University, 2008.
Title from file title page. Paul G. Farnham, committee chair; Patricia G. Ketsche , Douglas S. Noonan (Ga. Tech.), Shiferaw Gurmu, Karen J. Minyard, William S. Custer, committee members. Description based on contents viewed June 11, 2009. Includes bibliographical references (p. 146-153).

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Chukmaitova, Dariga. "Sector-Switching in Transition Economies: A Case Study of Kazakhstan's Health Care Sector." Scholarship @ Claremont, 2011. http://scholarship.claremont.edu/cgu_etd/20.

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The dissertation examines the economic and behavioral factors influencing 'sector-switching' in Kazakhstan's health care industry. Sector-switching involves doctors moving from the national to the private system, which is not well established, thereby raising questions about why the switch occurs. It addresses the question: why health care professionals in Kazakhstan switch from the public sector to similar jobs in the private or nonprofit sectors? This study addresses a key issue in public management (sector switching) and also offers insights into the dynamics of the transition from a centralized economy to a market economy. As such, its findings have `real-world' applications beyond the particular case being studied i.e. Kazakhstan. This study is based on two simple claims. First, fundamental to the reforms that characterize transitional economies is effectively moving public sector employees to a nascent private sector. Second, such switches are unique because the risks related to transitioning to the private sector are different in transitional economies than in established market economies. Thus, the study considers: the degree to which economic and behavioral factors interact with different perceptions of sectoral risk, and subsequently shape the decision to move from the public sector to the private sector; in particular in Kazakhstan's health industry. The data supporting this study come from a survey covering approximately 1,000 health care professionals (practicing physicians working in both the public and private health care sectors) from nine regions of Kazakhstan. The data includes information about individual incentives physicians have for switching sections and their perceptions of perceived risks and uncertainties given the economic transition currently underway in Kazakhstan. The findings of the research suggest the strong support for the proposed hypotheses and have revealed some of the dynamics of sector switching behavior and the characteristics of "sector switchers" in Kazakhstan. The results demonstrate that physicians' overall job dissatisfaction, relative salary compared to physicians in a different sector, their risk-taking behavior, the national health care system's deterioration compared to previous years, as well as problems with providing medical services in the country affect physicians in making their decision to change their employment sector.

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Eckermann, Simon Economics Australian School of Business UNSW. "Hospital performance including quality: creating economic incentives consistent with evidence-based medicine." Awarded by:University of New South Wales. School of Economics, 2004. http://handle.unsw.edu.au/1959.4/22011.

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This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

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Rosomoff, Sara Stephanie. "Promote the General Welfare: A Political Economy Analysis of Medicare & Medicaid." Miami University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=miami1574263717055768.

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Nsarhaza, Bishikwabo Kizito. "La restructuration du secteur de santé et le marché informel: cas de la République Démocratique du Congo." Doctoral thesis, Universite Libre de Bruxelles, 1997. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/212128.

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Aznar, Lou Ignacio. "El problema de la no iniciación del tratamiento farmacológico: evaluación con métodos cuantitativos." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/404327.

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La no iniciación es un comportamiento que se caracteriza por no empezar aquellos tratamientos farmacológicos prescritos por primera vez. Este comportamiento puede estar influenciado por distintos factores y parámetros contextuales y sus consecuencias se pueden enmarcar dentro del ámbito sanitario y económico. Este fenómeno ha sido escasamente estudiado a nivel mundial, de hecho, en España no se ha evaluado. Los sistemas de información presentes en Cataluña permiten una evaluación global de este comportamiento. Objetivos 1. Describir la prevalencia de no iniciación del tratamiento farmacológico en el sistema público de Atención Primaria (AP) en Cataluña. 2. Estimar los factores de paciente, médico y centro de AP que se asocian a la no iniciación. 3. Estimar la el impacto de la no inicaición en los costes para el sistema público. 4. Estimar el impacto de las políticas de copago en la no iniciación para niveles de aportación económica de los pacientes en distintos perfiles farmacológicos y. Métodos Estudio basados en registros sanitarios del Instituto Catalán de Salud. La variable no iniciación fue creada con datos de prescripción y facturación y se definió como la no dispensación de un fármaco el mes siguiente al de prescripción. Se incluyeron las nuevas prescripciones (sin prescripción de un fármaco del mismo grupo los 3 meses previos) realizadas en AP de los 13 grupos farmacológicos más prescritos y/o costosos. Los datos faltantes fueron imputados mediante imputación simple multivariante. Objetivos 1 y 2: se utilizaron datos de los pacientes que recibieron una nueva prescripción entre julio del 2013 y junio del 2014. Se calcularon las prevalencias de no iniciación para cada grupo farmacoterapéutico y se identificaron los factores predictores de la no iniciación mediante regresión logística multivariante multinivel. Objetivo 3: se siguió una cohorte retrospectiva (3 años) de pacientes con nuevas prescripciones en 2012. Los usos de servicios sanitarios y las bajas laborales de los iniciadores y no iniciadores se compararon mediante regresión lineal multinivel ajustada. Objetivo 4: experimento natural de la prevalencia semanal de no iniciación (enero 2011–junio 2014). Este periodo incluye cinco escenarios distintos relacionados con el copago farmacéutico. Mediante regresión logística segmentada ajustada se calculó la variación de nivel y tendencia de no iniciación en cada periodo. Resultados La prevalencia anual de no iniciación fue de 17.6%. Los grupos farmacológicos con prevalencias más altas y bajas fueron las anilidas (22.6%) y los IECAs (7.4%), respectivamente. Los factores de riesgo de no iniciación fueron ser joven, la nacionalidad americana, tener una patología mental o que curse con dolor, que el médico prescriptor sea substituto o residente y que la prescripción haya sido emitida en un centro docente. Los pacientes iniciadores hicieron un mayor uso de fármacos y de la mayoría de servicios sanitarios que los pacientes no iniciadores o parcialmente iniciadores. Sin embargo, los pacientes iniciadores estuvieron menos días de baja, lo que produjo un retorno económico neto. La no iniciación produjo una mayor carga económica para el sistema a corto-medio plazo. La publicación de noticias sobre el copago provocó una disminución de la no iniciación en todos los grupos poblacionales. La entrada en vigor del copago fijo aumentó la no iniciación en todos los grupos poblacionales. La adhesión del co-seguro pudo aumentar ligeramente la no iniciación, con respecto al período antes del cambio de políticas aunque se observa un efecto protector en los pacientes excluidos de pago. El grupo más afectado fueron los pensionistas con rentas medias y bajas. Conclusiones Esta tesis ha demostrado que la no iniciación es un comportamiento prevalente y que presenta un mayor riesgo en determinadas poblaciones. La no iniciación aumenta las bajas, produciendo costes para el sistema público. Además, podría estar impactando negativamente en la salud por lo que deberían desarrollarse estrategias para minimizarla. Las políticas de copago farmacéutico han impactado en la no iniciación, especialmente en grupos vulnerables (rentas bajas o muy bajas) por lo que se recomienda una revisión de los tramos de copago. Consecuencias Los resultados de esta tesis permitirán afrontar con mayores garantías el diseño de una estrategia que permita minimizar el problema estudiado.
Objectives 1. To estimate the prevalence of Initial Medication Non-Adherence (IMNA). 2. To determine IMNA risk factors related to patient, general practitioner and primary care (PC) center. 3. To estimate the impact of IMNA on costs. 4. To estimate the impact of copayment measures on IMNA. Methods The study is retrospective registries-based on the public PC system of Catalonia (Spain). IMNA was defined as not obtaining a newly prescribed medication (no prescription in the previous three months) in the month following the prescription. The 13 most prescribed and/or costly treatments were included. Missing data was imputed with multivariate simple imputation. Multilevel multivariate logistic and lineal regressions were used to assess risk factors and costs. Segmented logistic regression was used to evaluate copayment policies. Results IMNA prevalence was 17.6%, ranging from 7.4% (ACEIs) and 22.65% (anilides). Being young or American, having a mental or a pain-related disorder or receiving the prescription by a substitute/resident general practitioner and/or in a resident-training center were risk factors of IMNA. Although initially adherent patients made a higher use of medicines and some healthcare services than non-adherent and partially adherent patients, they had lower productivity losses, producing a net economic return. IMNA produced higher economic burden to the system in the short-middle term. The release of news on pharmaceutical copayment caused a decrease in IMNA which was reverted and increased after the establishment of the fixed copayment. The co-insurance copayment also increased IMNA but from this point it began to decrease until the end of the study, having a protective effect in vulnerable populations. The most affected population groups were low and middle-income pensioners. Conclusions This thesis shows that IMNA is a prevalent behavior and that there is a high-risk profile of patient. IMNA increases costs and could have a negative impact on health. Interventions should be implemented to reduce IMNA. Copayment policies affect IMNA, especially in vulnerable populations. The coinsurance thresholds should be revised.

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April, Michael David. "Human immunodeficiency virus testing and linkage-to-care in South Africa : an epidemiological and economic evaluation of expansion." Thesis, University of Oxford, 2008. http://ora.ox.ac.uk/objects/uuid:0fb860b2-14cb-40b5-a080-48a95b4874b1.

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This thesis evaluates the cost-effectiveness of eight policies expanding human immunodeficiency virus (HIV) testing in South Africa. All policies entail provider-initiated test offers for primary healthcare users and one of two options across three policy components: (i) consent method, opt-in or opt-out; (ii) test protocol, rapid only or rapid plus acute infection testing; and (iii) linkage-to-care, standard or enhanced. This thesis highlights four methodological issues. First is the challenge of conducting a population-level analysis, projecting the cost-effectiveness of expanded testing for each member of South Africa’s adult African population. To this end, I conducted a retrospective, descriptive study to measure current population-level testing rates and epidemic descriptors in an African community near Cape Town, South Africa. Second, the effects of testing expansion on current testing uptake were estimated by distinguishing testing in the study community likely to cease after testing expansion (baseline testing) from that likely to continue (background testing). Third, because testing alone is an outcome of less interest than health benefits following treatment, study community linkage-to-care probabilities were estimated and models utilized to estimate the efficacy of treatment. Fourth, the methods to convert the study community testing data into inputs for these models’ parameters are outlined. The enhanced linkage-to-care policies proved the most cost-effective, with opt-in testing and a rapid-only test protocol the least expensive cost-effective option at $848 per life year gained (LYG). Adding an opt-out consent method or acute infection test protocol to this policy increased the LYGs, but at higher cost-effectiveness ratios.

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Laokri, Samia. "Assessing cost-of-illness in a user's perspective: two bottom-up micro-costing studies towards evidence informed policy-making for tuberculosis control in Sub-saharan Africa." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209273.

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Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.

To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.

This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge.

National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.

Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.

The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.

Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage

Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Shiu, Wan-yee Ruby, and 邵韻儀. "An evaluation on 2007 obstetric service policy in Hong Kong: a solution to the service-seeking behaviourof Mainland pregnant women?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B38598358.

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Phuong, Tran Thi Thanh. "Application of economic analysis to evaluate various infectious diseases in Vietnam." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:2452971c-e5eb-4661-8675-d76f0eca9774.

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This thesis is composed of two economic evaluations: one trial-based study and one model-based study. In a recent study published in Clinical Infectious Diseases in 2011, a team of OUCRU investigators found that immediate antiretroviral therapy (ART) was not associated with improved 9-month survival in HIV-associated TBM patients (HR, 1.12; 95% CI, .81 toâ1.55; P = .50). An economic evaluation of this clinical trial was conducted to examine the cost-effectiveness of immediate ART (initiate ART within 1 week of study entry) versus deferred ART (initiate ART after 2 months of TB treatment) in HIV-associated TBM patients. Over 9 months, immediate ART was not different from deferred ART in terms of costs and QALYs gained. Late initiation of ART during TB and HIV treatment for HIV-positive TBM patients proved to be the most cost-effective strategy. Increasing resistance of Plasmodium falciparum malaria to artemisinin is posing a major threat to the global effort to eliminate malaria. Artesmisinin combination therapies (ACT) are currently known as the most efficacious first-line therapies to treat uncomplicated malaria. However, resistance to both artemisinin and partner drugs is developing and this could result in increasing morbidity, mortality, and economic costs. One strategy advocated for delaying the development of resistance to the ACTs is the wide-scale deployment of multiple first-line therapies. A previous modeling study examined that the use of multiple first-line therapies (MFT) reduced the long-term treatment failures compared with strategies in which a single first-line ACT was recommended. Motivated by observed results of the published modelling study in the Lancet, the cost-effectiveness of the MFT versus the single first-line therapies was assessed in settings of different transmission intensities, treatment coverages and fitness cost of resistance using a previously developed model of the dynamics of malaria and a literature âbased cost estimate of changing antimalarial drug policy at national level. This study demonstrates that the MFT strategies outperform the single first-line strategies in terms of costs and benefits across the wide range of epidemiological and economic scenarios considered. The second analysis of the thesis is not only internationally relevant but also with a focus towards healthcare practice in Vietnam. These two studies add significant new cost-effectiveness evidence in Vietnam. This thesis presents the first trial-based economic evaluation in Vietnam considers patient-health outcome measures as the participants have cognitive limitations (tuberculous meningitis), dealing with missing data along with the potential ways to handle this common problem by the use of multiple imputation, and the issues of censored costs data. Having identified these issues would support the decision makers or stakeholders including the pharmaceutical industry to devise a new guideline on how to implement a well-design trial-based economic evaluation in Vietnam in the future. Another novelty of this thesis is the introduction of the detailed of costing of drug regimens change in which the economic evaluations considering the drug policy change often do not include. This cost could be substantial to the healthcare system for retraining the staff and publishing the new guidelines. This thesis will document the costs incurred by the Vietnamese government by changing the first-line treatment of malaria, from single first-line therapy (ACT) to multiple first-line therapies.

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Palmedo, P. Christopher. "Equality, Trust and Universalism in Europe, Canada and the United States: Implications for Health Care Policy." PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1929.

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A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

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Ott, Kenneth Brad. "The Closure of New Orleans' Charity Hospital After Hurricane Katrina: A Case of Disaster Capitalism." ScholarWorks@UNO, 2012. http://scholarworks.uno.edu/td/1472.

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Abstract Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.

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Backhouse, Peter. "Medical knowledge, medical power : doctors and health policy in Australia /." Title page, contents and abstract only, 1994. http://web4.library.adelaide.edu.au/theses/09PH/09phb126.pdf.

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Johnson, Mark Lawrence. "Contre-mesures médicales contre les risques NRBC : quelles solutions pour un développement facilité dans une économie de marché ?" Thesis, Paris 2, 2018. http://www.theses.fr/2018PA020014/document.

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Pour certaines maladies causées par des agents chimiques, biologiques, radiologiques et nucléaires (CBRN), il n’existe pas de contre-mesures médicales (MedCM) et bon nombre de celles qui existent pourraient ne pas être disponibles en cas de besoin. En cas d’accident CBRN, des efforts inadéquats de financement de la R&D et de mise à disposition par les gouvernements peuvent avoir de graves conséquences économiques nettement supérieures aux coûts d’initiatives préventives. Compte-tenu des contraintes budgétaires auxquelles de nombreux gouvernements sont confrontés, il est nécessaire de définir des priorités. Parallèlement à la mise en place d’indicateurs de décision de santé efficaces qui identifient et mesurent les effets de causalité de l’impact négatif sur la santé, le processus de décision doit également prendre en considération le rapport coût-efficacité pour rendre le financement durable.Cette thèse a pour objectif de définir une voie vers une politique économique de santé publique visant à renforcer la disponibilité des MedCM pour les agents CBRN. Dans la première partie, les causes des défaillances du marché sont identifiées (lorsque les opportunités de profit ne compensent pas l’effort de R&D nécessaire). Dans la deuxième partie, des études de cas illustrent les caractéristiques et les conséquences économiques d’exemples d’accidents CBRN et des scénarios sont analysés afin de mettre en évidence comment la disponibilité de MedCM pourrait potentiellement devenir rentable. Enfin, la troisième partie propose des approches plus complètes pour mesurer et compenser les facteurs contribuant à la défaillance du marché en appliquant des modèles économiques spécifiques
For some diseases caused by chemical, biological, radiological, and nuclear (CBRN) agents, innovative medical countermeasures (MedCMs) do not exist while many of those that do might not be readily available. In case of a CBRN event, inappropriate medical research and development (R&D) funding and government procurement efforts can result in adverse economic consequences (e.g. lost income) far exceeding the costs of strong and comprehensive preparedness initiatives. Given the budgetary constraints many governments face, priorities must be defined. Parallel to determining effective health decision metrics that identify and weigh the causal effects of negative health impact, decision making must also consider cost-effectiveness to make funding sustainable. Moreover, international cooperation is necessary since the risks increasingly transcend borders due to global travel and the global threat of terrorism. This dissertation ultimately seeks to define a path to public health economic policy to enhance the international availability of CBRN MedCMs. In Part I, the root causes of market failure are identified and depicted (i.e., where rewards for supply do not adequately compensate for the R&D effort). In Part II, case study examples illustrate the characteristics and economic consequences of CBRN incidents. Scenarios for each case are outlined to show where the availability of MedCMs in these situations could potentially be cost-effective. Finally, Part III construes more comprehensive approaches for gauging and offsetting the deterrence factors of market supply and demand by compiling and applying additional economic models and frameworks

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Ng, Suk-han Christina. "The health policy network and policy community in Hong Kong : from concertation to pressure pluralism /." View the Table of Contents & Abstract, 1998. http://sunzi.lib.hku.hk/hkuto/record/B36628979.

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McClellan, Mark B. "The economics of medical treatment intensity." Thesis, Massachusetts Institute of Technology, 1993. http://hdl.handle.net/1721.1/12703.

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Suen, Yuk-lam Kelvin. "A comparative study of the health care policies in Hong Kong and Singapore." Click to view the E-thesis via HKUTO, 2002. http://sunzi.lib.hku.hk/hkuto/record/B42576350.

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Hollis, Brett F. "Medical emergencies on commercial airlines| An Analysis of Onboard Medical Incidents, Treatment versus Prevention." Thesis, Brandman University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10181770.

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The occurrence of inflight medical incidents on commercial airlines is documented in medical and aviation journals to occur at a rate of approximately 1 in 11,000 – 50,000 passengers (Lyznicki, 2013; Prout, 2013; Johanson, 2013; and Peterson, 2013) but these numbers can vary. As there are no requirements to report medical incidents to any governing body worldwide (Ruskin, 2009), (Walters, 2008), (Liao, 2010) it is very difficult to obtain an accurate accounting of inflight incidents. The literature reveals that most of the inflight incidents are occurring among passengers with pre-existing conditions (Grounder, 2011) and that issues were not being properly addressed by their primary care providers. The purpose of this study was to show the depth of discrepancy between the currently reported rate of inflight medical incidents and the actual rate of inflight incidents and to gain a better understanding of the general public knowledge base regarding flying with medical conditions and practice of medical providers addressing their patient’s acute & chronic conditions as it pertains to flying on commercial airlines. This study surveyed the general public and revealed the majority of respondents had no knowledge of medical guidelines for passengers and a lack of discussion with their providers regarding safety of flying as it relates to their medical conditions. This study also conducted a survey of medical providers which revealed a lack of understanding of how aircraft cabin pressurization affects their patients with acute and chronic illness. These findings support the need for improvement in developing and implementing a unified method of calculating and reporting inflight medical incidents, along with patient and provider flight education.

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Rudin, Robert (Robert Samuel). "Making medical records more resilient." Thesis, Massachusetts Institute of Technology, 2007. http://hdl.handle.net/1721.1/41567.

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Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2007.
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Includes bibliographical references (p. 72-77).
Hurricane Katrina showed that the current methods for handling medical records are minimally resilient to large scale disasters. This research presents a preliminary model for measuring the resilience of medical records systems against public policy goals and uses the model to illuminate the current state of medical record resilience. From this analysis, three recommendations for how to make medical records more resilient are presented. The recommendations are: 1) Federal and state governments should use the preliminary resilience model introduced here as the basis for compliance requirements for electronic medical record technical architectures. 2) Regional Health Information Organizations (RHIOs) should consider offering services in disaster management to healthcare organizations. This will help RHIOs create sustainable business models. 3) Storage companies should consider developing distributed storage solutions based on Distributed Hash Table (DHT) technology for medical record storage. Distributed storage would alleviate public concerns over privacy with centralized storage of medical records. Empirical evidence is presented demonstrating the performance of DHT technology using a prototype medical record system.
by Robert Rudin.
S.M.

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Chace, Meredith Joy. "Evaluating Intended and Unintended Consequences of Health Policy and Regulation in Vulnerable Populations." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10725.

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The objective of this dissertation is to evaluate whether two different types of policy interventions in the United States are associated with health service utilization and economic outcomes. Paper 1: The number of government lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. We use Medicare and Medicaid claims data to evaluate how an off-label marketing lawsuit and its accompanying media coverage affected utilization and spending on gabapentin as well as other anticonvulsant medications. In this interrupted time series analysis of dual eligible patients with bipolar disorder, we found that the lawsuit and accompanying media coverage corresponded with a decrease in market share of gabapentin, a substitution of newer and expensive anticonvulsants, and a substantial increase in overall spending on anticonvulsants. Paper 2: Medicare Part D was a major expansion of Medicare benefits to cover pharmaceuticals. There were initial concerns about how the dually eligible population who previously had drug coverage through Medicaid would fare after transitioning to Part D plans. Using a nationally representative longitudinal panel survey of Medicare Beneficiaries that are dually eligible for Medicaid, we investigated whether differences in generosity of Medicaid drug benefits were associated with differential changes in drug utilization and out-of-pocket spending for duals after they transitioned to Part D. Our finding suggest that those who previously encountered a monthly drug cap prior to Part D implementation experienced a differentially higher increase in annual prescription drug fills compared with those who did not face a cap.

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Eichner, Matthew Jason. "Medical expenditures and major risk health insurance." Thesis, Massachusetts Institute of Technology, 1997. http://hdl.handle.net/1721.1/10316.

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Koivukangas, T. (Tapani). "The medical device industry market development analysis." Master's thesis, University of Oulu, 2014. http://urn.fi/URN:NBN:fi:oulu-201406241776.

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The basis and interest for this thesis is the global economic situation of especially the high technology industry. In the traditional fields of high technology and more recently, in the field of ICT, there is a clear transition of work and markets toward the continents with lower development and production costs and those that are in the need of new technologies. This transition has evidently hit the developed countries (i.e. Western Europe and the USA) the hardest. Even though the other fields of technologies are clearly in transition, the statistics show that the medical device industry is in its highest growth in history. In fact, in 2012 the field grew at a pace of over 25 % annually in Finland and at double digits globally. In Finland, the medical device industry currently accounts for nearly 40 % of the total high technology market exports. This is remarkable to note, as this industry is relatively compact in size in comparison to the other high technologies. The objective of this research was to define the medical device technologies, to analyze the medical device technology market and, finally, to analyze reasons for its predicted continuous growth. This thesis covers the driving factors of this field of technology that predict the current trend in its market growth. This thesis also covers the aspects of medical devices and the medical device development processes, including the main differentiating factors compared to other fields of high technology products, especially those in the consumer markets. Finally, this study estimates the future economic growth of the medical device industry globally with special reference to Finland. The economic methods in this research are based on regression analysis of the medical device industry in the BRIC nations (Brazil, India, Russian Federation and P. R. China) and selected OECD countries. The variables used in the research include the trade balance, age structure, medical device technology status and GDP related factors, i.e. GDP in current USD and total health expenditure as percentage of GDP. Technology-wise, the research is based on the global trends in the medical device industry and the growing needs for new medical devices in general. The results and analyses indicate that the driving factors behind the predicted market growth can be explained by the science-push and demand-pull models. The time series and panel analyses indicate that the medical device industry could also serve as a global market opening technology. Furthermore, the results show that the growth of this industry is highly affected by population growth and age structure that increase the demand for new technologies to prevent and treat illnesses. Also, it was found that the medical device industry is not so greatly affected by global financial disruptions. Finally, the results show that the increase of medical device technologies clearly shortens the length of hospital stay which has been previously found to be a major factor in the rise of healthcare costs especially in the developed countries. This industry is thus evidently both a technology-push and a demand-pull based industry which is expected to grow due to the demand for higher quality healthcare while being less affected by general economic situations.

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Forlines, Grayson L. "ESSAYS ON THE ROLE OF GOVERNMENT REGULATION AND POLICY IN HEALTH CARE MARKETS." UKnowledge, 2018. https://uknowledge.uky.edu/economics_etds/35.

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Understanding how health care markets function is important not only because competition has a direct influence on the price and utilization of health care services, but also because the proper functioning, or lack thereof, of health care markets has a very real impact on patients who depend on health care markets and providers for their personal well-being. In this dissertation, I examine the role of government policies and regulation in health care markets, with a focus on the response of health care providers. In Chapter 1, I analyze the impact of Medicare payment rules on hospital ownership of physician practices. Since the mid-2000’s, there has been a rapid increase in hospital ownership of physician practices, however, there is little empirical research which addresses the causes of this recent wave of integration. Medicare’s “provider-based” billing policy allows hospital-owned physician practices to charge higher reimbursement rates for services provided compared to a freestanding, independent physician practice, without altering how or where services are provided. This “site-based” differential creates a premium for physicians to integrate with hospitals, and the size of this differential varies with the types of health care services provided. I find that Medicare payment rules have contributed to hospital ownership of physician practices and that the response varies across physician specialties. A 10 percent increase in the relative reimbursement rate paid to integrated physicians leads to a 1.9 percentage point increase in the probability of hospital ownership for Medical Care specialties, including cardiology, neurology, and dermatology, which explains about one-third of observed integration of these specialties from 2005 through 2015. Magnitudes for Surgical Care specialties are similar, but more sensitive across specifications. There is no significant response for Primary Care physicians. In combination with other empirical literature which finds that integration between physicians and hospitals typically results in higher prices with no impact on costs or quality of care, I cautiously interpret this responsiveness as evidence that Medicare’s provider-based billing policy overcompensates integrated physician practices and leads to an inefficiently high level of vertical integration between physician and hospitals. In Chapter 2, I analyze the effect of anti-fraud enforcement activity on Medicaid spending, with a particular focus on the False Claims Act. The False Claims Act (FCA) is a federal statute which protects the government from making undeserved payments to contractors and suppliers. Individual states have chosen to enact their own versions of the federal FCA, and these statutes have increasingly been used to target health care fraud. FCA statutes commonly include substantial monetary penalties such as “per-violation” monetary fines and tripled damages, as well as a “whistleblower” provision which allows private plaintiffs to initiate a lawsuit and collect a portion of recoveries as a reward. Using variation in statelevel FCA legislation, I find state FCAs reduce Medicaid prescription drug spending by 21 percent, while other spending categories - which are less lucrative for FCA lawsuits - are unresponsive. Within the prescription drug category, drugs prone to off-label use show larger declines in response to the whistleblower laws, consistent with FCA lawsuits being used to prosecute pharmaceutical manufacturers for off-label marketing and promotion. Spending and prescription volume for drugs prone to off-label use fall by up to 14 percent. This effect could be driven by pharmaceutical manufacturers’ changes in physician detailing for drugs prone to off-label use and/or physicians’ changes in prescribing behavior.

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Eckerlund, Ingemar. "Essays on the economics of medical practice variations." Doctoral thesis, Stockholm : Economic Research Institute, Stockholm School of Economics [Ekonomiska forskningsinstitutet vid Handelshögsk.] (EFI), 2001. http://www.hhs.se/efi/summary/583.htm.

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Johnstone, John G. "Medical concepts and penal policy : a study of the use of 'medical' concepts in penal discourses." Thesis, University of Edinburgh, 1990. http://hdl.handle.net/1842/24027.

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This thesis examines the ways in which 'medical' concepts have been used in penal discourse since the middle of the nineteenth century. By doing this I have tried to contribute to our understanding of modern methods of penal control and modern penal rationalities. The thesis contains two case studies. The first study examines the uses which have been made of the terms 'inebriety' and 'alcoholism' within penal discourse and also examines what is meant by the term 'treatment' when it is used in the context of 'the "treatment" of inebriates'. The second study looks at various ways in which the terms 'moral insanity', 'moral imbecility' and 'psychopathy' have been employed in penal discourses.

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Cornelio, Deogracia. "Is the alternative traditional? tracing boundaries of medicines in the Dominican Republic /." [Gainesville, Fla.] : University of Florida, 2003. http://purl.fcla.edu/fcla/etd/UFE0001430.

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Crawford, Seth. "The Political Economy of Medical Marijuana." Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/12986.

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This study aims to shed light on several vexing questions surrounding marijuana at various levels of analysis. Why have some states adopted medical laws when others have not, and what are the implications of these adoptions for elites at the federal level? Why are certain areas within states hotbeds of marijuana use and production? Why, in the face of serious penalties, do certain individuals continue to use, produce, and sell this particular drug? How is the marijuana market structured and how much economic impact does it have? Possible sociopolitical factors responsible for passage (or failure) of marijuana-related voter initiatives and legislation in states are examined and the process of policy diffusion occurring between states that adopt such measures is detailed. An analysis of geographic variations in medical cardholder rates in Oregon is conducted using longitudinal data. Using a Respondent-Driven Sample and a detailed survey of legal and illegal marijuana users in Oregon, I identify differences between the two groups, elucidate differences between marijuana users and the general population, and estimate the economic impact of marijuana on Oregon's informal economy. Overall, the study finds that innovative, Democratically dominated states tend to pass medical marijuana laws and are the most at risk of doing so in the future. Within Oregon, county-level participation in the medical marijuana program is associated with Democratic party members, unemployment rates, and timber harvest levels. The Oregon marijuana market consists of a robust network of small producers, with individual users primarily managing distribution of the drug. Economic estimates indicate that the legalization of marijuana could generate between $37 million and $153 million per year in taxes for the state. Finally, historical evidence suggests that legalization of this drug could lead to its control; however, doing so could structurally transition the market from a robust network of small producers into tight oligopolic control by a limited number of producers, thereby disenfranchising small, artisan growers, communities traditionally reliant on marijuana for revenue, consumers who seek variety, and the plant's genetic diversity.

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Sigurgeirsdóttir, Sigurbjörg. "Health policy and hospital mergers : how the impossible became possible /." Reykjavik : Háskólaútgáfan [u.a.], 2006. http://www.loc.gov/catdir/toc/fy0802/2007462881.html.

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Chan, Yee-ying Michelle. "The formulation and implementation of healthcare reform in Hong Kong." Hong Kong : University of Hong Kong, 2001. http://sunzi.lib.hku.hk:8888/cgi-bin/hkuto%5Ftoc%5Fpdf?B2329470x.

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James, Batuka. "Factors influencing the price of medical services : a survey of the pricing behaviour of private medical providers in Kampala, Uganda." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/8629.

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Includes bibliographical references (leaves 84-90).
Understanding the pricing behaviour of medical providers in private clinics is important for the effective regulation of the private sector and ensuring that there is no extortion of patients. There is a global trend to encourage delivery of health services by the private sector reducing the public role to stewardship. Understanding the factors that inﬂuence the price of medical services in an out of pocket setting is important in designing strategies necessary to control the price of medical care. The study investigated the factors that inﬂuenced the price of medical services in Kampala district, Uganda. The respondents reported cost of drugs given to patients (type and dose of drug), other overhead expenditures, type of disease, income status of the patient and need to make proﬁt as factors which influence the price of medical services. On regression analysis, it was found that rent was a signiﬁcant factor on the price of medical services across all disease conditions. It was concluded that governments need to put in place effective regulatory mechanisms to ensure proper functioning of the private health sector.

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Cornstubble, Morgan Miller. "Dynamics of a US military theater medical evacuation policy." Thesis, Georgia Institute of Technology, 1992. http://hdl.handle.net/1853/25634.

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Vanhook, Patricia M., Trish Aniol, Rachel Clifton, and John Orzechowski. "Changing State Policy through Nurse-Led Medical-Legal Partnership." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7424.

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Sandham, John Dafydd. "Achieving a model for improving medical devices management policy." Thesis, Middlesex University, 2014. http://eprints.mdx.ac.uk/19157/.

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Hospitals have always faced fundamental questions of patient safety, care, and budgetary concerns. There has been increasing recognition recently of the serious issue of medical devices management, covering the areas of procurement, training, maintenance, and governance. This issue, documented by the National Audit Office, National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency, National Health Service Litigation Authority, and World Health Organisation, impacts on healthcare costs and patient safety. It has led to new Health and Social Care Act Regulations, enforced by the Care Quality Commission. As a result of my work as a consultant in the field of medical devices management, I constructed a policy model based on my own specialist experience and knowledge. This research sought to improve that model through participatory research conducted at an NHS Hospital in London. It took the form of a case study that specifically explored the core policy areas, but this time in collaboration with participants with expertise in one or more of the four interrelated policy areas of procurement, training, maintenance, and governance. This collaboration involved researching and analysing the external demands from regulatory agencies and internal demands from the organisation, centred on procurement, budgetary, and policy issues. The action research informed changes in policy, especially around procurement, leading to improvements in practice. The challenge of keeping policy up to date, and consistent with the external regulations and internal operational demands, is discussed in the case study. The Hospital’s internal politics and culture were found to be a help when starting up the case study, but a hindrance when it came to getting agreement and approvals to change the policy content, because of multiple committees and competing interests. The overall outcome of the project was an organisationally approved best practice policy model for medical devices management within a governance framework that meets the needs of the external regulators, and the management of the organisation. More specifically it was discovered that the use, maintenance, and governance of medical equipment were all reliant on a central issue, namely procurement practice. Procurement conduct for the organisation was redefined within the Hospital policy, and is making training, maintenance, and governance easier to achieve, thereby reducing risk and cost. A major consequence is that all budget holders need to be trained in procurement itself. Moreover, it is anticipated that the model could be used at similar healthcare organisations, ultimately leading to a contribution to knowledge and practice which assists in patient safety and meeting budgets.

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Paschane, David Michael. "A theoretical framework for the medical geography of health service politics /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/5649.

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Kiatpongsan, Sorapop. "Decision Making for Medical Innovations." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11386.

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Dissertations / Theses on the topic 'Medical economics. Medical policy'

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