The response to nutritional labels: Evidence from a quasi-experiment

This paper evaluates a UK policy that aimed to improve dietary information provision by introducing nutrition labelling on retailers’ store-brand products. Exploiting the differential timing of the introduction of Front-of-Pack nutrition labels as a quasi-experiment, our findings suggest that labelling led to a reduction in the quantity purchased of labelled store-brand foods, and an improvement in their nutritional composition. More specifically, we find that households reduced the total monthly calories from labelled store-brand foods by 588 kcal, saturated fats by 14 g, sugars by 7 g, and sodium by 0.8 mg.     

The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments

Objectives:

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits.

Methods:

We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions.

Results:

The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes.

Conclusions:

A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.     

The impact of school exclusion zone planning guidance on the number and type of food outlets in an English local authority: A longitudinal analysis

The use of planning policy to manage and create a healthy food environment has become a popular policy tool for local governments in England. To date there has been no evaluation of their short-term impact on the built environment. We assess if planning guidance restricting new fast food outlets within 400 m of a secondary school, influences the food environment in the local authority of Newcastle Upon Tyne, UK. We have administrative data on all food outlets in Newcastle 3 years pre-intervention 2012–2015, the intervention year 2016, and three years’ post-intervention 2016–2019. We employ a difference-in-difference approach comparing postcodes within the school fast food outlet exclusion zone to those outside the fast-food exclusion zones. In the short term (3 years), planning guidance to limit the number of new fast-food outlets in a school exclusion zone did not have a statistically significant impact on the food environment when compared with a control zone.     

城镇居民基本医疗保险制度对医疗及预防保健服务利用的影响研究

目的:研究城镇居民基本医疗保险制度对居民医疗和预防保健服务利用的影响,定量评估城镇居民基本医疗保险制度的实施效果。方法:采用中国健康与营养调查(CHNS)2006年和2011年参加城镇居民基本医疗保险制度数据,以2011年未参保居民为对照组,以2011年参保居民为处理组。通过倍差法(DID模型)和Probit模型比较两组在城镇居民基本医疗保险制度实施前(2006年)和实施后(2011年)的医疗和预防保健服务利用情况和差异。结果:参加城镇居民基本医疗保险制度的城镇居民医疗和预防保健服务的利用情况均高于未参保的城镇居民。年龄、教育程度、家庭人均年收入和有无高血压对城镇居民医疗服务的利用情况有影响,其中家庭人均年收入为保护因素。年龄和教育程度对城镇居民预防保健服务的利用有影响。结论:城镇居民基本医疗保险制度对医疗和预防保健服务利用有提升作用,在完成覆盖率的同时,需要不断增强人均收入对医疗卫生服务利用的保护作用。     

An extension in eligibility for free primary care and avoidable hospitalisations: a natural experiment

In the Republic of Ireland, approximately 30 per cent of the population ('medical card patients') are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population ('private patients') must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999-2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified.     

Additional reimbursement for outpatient physicians treating nursing home residents reduces avoidable hospital admissions: Results of a reimbursement change in Germany

Potentially avoidable hospitalizations of nursing home residents are costly and may even be harmful for the residents concerned. This study analyzes whether the introduction, in Germany in 2016, of an additional reimbursement for outpatient care physicians treating nursing home residents has led to a reduction in hospital admissions. This analysis exploits the introduction of the additional reimbursement in a difference-in-difference approach, using recipients of professional home care as a control. The analysis is based on claims data from the largest German sickness fund, which provide complete information on health care and long-term care utilization for each insured person. Our analysis highlights a 5-percent reduction in overall hospital stays and an 8-percent reduction in ambulatory care-sensitive admissions as a result of the additional reimbursements. However, we found no effect for short-term hospital admissions or for admissions at night or at the weekend. We conclude that the overall health care utilization for nursing home patients seems to have improved due to an increased presence of physicians in nursing homes during daytime working hours. Thus, an additional reimbursement for outpatient care physicians seems to be an effective tool to reduce potentially avoidable hospital admissions in the nursing home sector. However, it does not appear to improve emergency care utilization, especially out-of-hour.     

The impact of paid family leave on the timely vaccination of infants

Time constraints parents face can affect whether infant children are vaccinated on time. Using the National Immunization Survey, we employ a synthetic control difference-in-difference estimation technique to establish a causal relationship arising from California’s implementation of Paid Parental Leave Program as a natural experiment. We find California Paid Family Leave reduced late vaccinations by up to 5 percentage points or approximately 10% for children born to parents in California after the policy was implemented. Further, the policy had a stronger impact on families below the poverty line. Thus access to paid family leave can improve on-time immunization of infants.     

Inclusion of quasi-experimental studies in systematic reviews of health systems research

Systematic reviews of health systems research commonly limit studies for evidence synthesis to randomized controlled trials. However, well-conducted quasi-experimental studies can provide strong evidence for causal inference. With this article, we aim to stimulate and inform discussions on including quasi-experiments in systematic reviews of health systems research. We define quasi-experimental studies as those that estimate causal effect sizes using exogenous variation in the exposure of interest that is not directly controlled by the researcher. We incorporate this definition into a non-hierarchical three-class taxonomy of study designs – experiments, quasi-experiments, and non-experiments. Based on a review of practice in three disciplines related to health systems research (epidemiology, economics, and political science), we discuss five commonly used study designs that fit our definition of quasi-experiments: natural experiments, instrumental variable analyses, regression discontinuity analyses, interrupted times series studies, and difference studies including controlled before-and-after designs, difference-in-difference designs and fixed effects analyses of panel data. We further review current practices regarding quasi-experimental studies in three non-health fields that utilize systematic reviews (education, development, and environment studies) to inform the design of approaches for synthesizing quasi-experimental evidence in health systems research. Ultimately, the aim of any review is practical: to provide useful information for policymakers, practitioners, and researchers. Future work should focus on building a consensus among users and producers of systematic reviews regarding the inclusion of quasi-experiments.