Editorial

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Ungleichheit in der Mundgesundheit

Ohne Zusammenfassung

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Editorial

Ohne Zusammenfassung

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Editorial

Ohne Zusammenfassung

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The timing of adoption of positron emission tomography: a real options approach

This paper presents the economic evaluation from a hospital’s perspective of the investment in positron emission tomography, adopting a real options approach. The installation of this equipment requires a major capital outlay, while uncertainty on several key variables is substantial. The value of several timing strategies, including sequential investment, is determined taking into account that future decisions will be based on the information available at that time. The results show that adopting this approach may have an impact on the timing of investment, because postponing the investment may be optimal even when the Expected Net Present Value of the project is positive.

Why the econometrician is in good spirits: a workshop through the looking glass

Vita brevis, ars longa (or...life is too short for abstracts).

Well-Being and Health

One way of evaluating health is in terms of its impact on well-being. It has been shown, however, that evaluating health this way runs into difficulties, since health and other aspects of well-being are not separable. At the same time, the practical implications of the inseparability problem remain unclear. This paper assesses these implications by considering the relations between theories, components, and indicators of well-being.

Do quality-adjusted life years take account of lost income? Evidence from an Australian survey

The procedures used in cost utility analysis for eliciting quality of life weights have generally omitted any instruction concerning the level of consumption in a health state, despite the fact that some health states preclude the possibility of normal employment. This introduces ambiguity into the interpretation of quality of life (QoL) scores, and project ranking is sensitive to the subsequent treatment of consumption in the analysis. This article reports the results of a study that questioned 131 respondents to a time trade-off (TTO) interview about their assumptions concerning consumption and the amount of thought given to consumption. Results indicate that, without prompting, most assumed unchanged consumption, implying little bias in existing studies.

The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant problem in many healthcare systems. In Germany, few data are available on its economic consequences and, so far, no study has been performed using a large sample of real-life data from several hospitals. We present a retrospective matched-pairs analysis of mortality, length of stay, and cost of MRSA patients based mainly on routine administrative data from 11 German hospitals. Our results show that MRSA patients stay in hospital 11 days longer, exhibit 7% higher mortality, are 7% more likely to undergo mechanical ventilation, and cause significantly higher total costs (€ 8,198).

Total costs of injury from accidents in the home and during education, sports and leisure activities: estimates for Norway with assessment of uncertainty

Injury accidents occurring in the home, during educational, sports or leisure activities were estimated from samples of hospital data, combined with fatality data from vital statistics. Uncertainty of estimated figures was assessed in simulation-based analysis. Total economic costs to society from injuries and fatalities due to such accidents were estimated at approximately NOK 150 billion per year. The estimated costs reveal the scale of the public health problem and lead to arguments for the establishment of a proper injury register for the identification of preventive measures to reduce the costs to society.

Can Mediterranean diet really influence obesity? Evidence from propensity score matching

Worldwide obesity rates have stimulated interest in healthy dietary patterns. One well-known dietary pattern is the Mediterranean diet, which has been linked with several beneficial health effects. However, concerns have also been raised regarding the Mediterranean diet’s role in promoting weight gain. We explored the effect of the Mediterranean diet on body mass index using the propensity score matching approach. We found no statistically significant average treatment effect on the treated and therefore cannot confirm that a causal link exists between Mediterranean diet and body mass index.

Choice determinants of the mobility in the Dutch health insurance market

We estimate a Logit model for the choice determinants of the mobility in the Dutch market for health insurance in 2006. The results highlight that socio-economic, geographical, and health-related factors matter in the decision to switch health care insurer. Moreover, previous contact with the insurer and the former type of health policy are also of influence.

Conducting multilevel analyses in medical education

A significant body of education literature has begun using multilevel statistical models to examine data that reside at multiple levels of analysis. In order to provide a primer for medical education researchers, the current work gives a brief overview of some issues associated with multilevel statistical modeling. To provide an example of this technique, we then present a multilevel analysis examining the relationship between two individual-level variables and the “cross-level” interaction between this relationship and a school-level variable. In offering this discussion and example of multilevel modeling, we hope to provide medical educators with a basic introduction to multilevel statistics, including the advantages of utilizing these techniques.

A queueing network model to analyze the impact of parallelization of care on patient cycle time

The total time a patient spends in an outpatient facility, called the patient cycle time, is a major contributor to overall patient satisfaction. A frequently recommended strategy to reduce the total time is to perform some activities in parallel thereby shortening patient cycle time. To analyze patient cycle time this paper extends and improves upon existing multi-class open queueing network model (MOQN) so that the patient flow in an urgent care center can be modeled. Results of the model are analyzed using data from an urgent care center contemplating greater parallelization of patient care activities. The results indicate that parallelization can reduce the cycle time for those patient classes which require more than one diagnostic and/or treatment intervention. However, for many patient classes there would be little if any improvement, indicating the importance of tools to analyze business process reengineering rules. The paper makes contributions by implementing an approximation for fork/join queues in the network and by improving the approximation for multiple server queues in both low traffic and high traffic conditions. We demonstrate the accuracy of the MOQN results through comparisons to simulation results.

Feasibility and Integrity of a Parent–Teacher Consultation Intervention for ADHD Students

This study examined the feasibility and integrity of a daily report card (DRC) intervention in a small sample of randomly assigned elementary students with previously diagnosed ADHD and classroom impairment. In order to enhance implementation, a conjoint behavioral consultation approach was used in which parents were engaged as active participants in the treatment. Intervention parents and teachers maintained moderately high levels of adherence over 4 months based on multiple methods of implementation assessment, and acceptability ratings were all very favorable. Intervention participants demonstrated significant improvement in academic skills and productivity at post-test as compared to control participants, with moderately large effect sizes. Results suggest that a DRC intervention implemented within conjoint parent–teacher consultation may help to reduce the research to practice gap in evidence-based school interventions.

Pesticides and farmer health in Nicaragua: a willingness-to-pay approach to evaluation

A contingent valuation approach to assess the health effects of chemical pesticides among Nicaraguan vegetable farmers is presented. Farmers’ valuation of health is measured as their willingness to pay (WTP) for low-toxicity pesticides. Results show that farmers are willing to spend an additional amount of about 28% of current pesticide expenditure for avoiding health risks. The validity of results is established in scope tests and with a two-step regression model. WTP depends on farmers’ experience with poisoning, income variables, and current exposure to pesticides. The results can help in designing rural health policies and in the formulation of programmes aiming to reduce the negative effects of pesticides.

Improving patient flow at an outpatient clinic: study of sources of variability and improvement factors

This paper focuses on analyzing and improving patient flow at an outpatient clinic of the Indiana University Medical Group. A structured process analysis and improvement approach was used to identify sources of variability and improvement factors. A process map, that matched the flow process at the clinic, was developed and validated. Key sources of variability that had potential to contribute to congestion in flow were identified. Data on task times were collected by observing the process with stopwatch or from historical records. A simulation model corresponding to the process map was developed, and the output was validated. Several ideas to modify clinic operations were tested on the validated simulation model. The overall result was an improvement in both the mean and the standard deviation of patient wait time, as well as higher utilization of physicians’ time. The clinic has implemented several of our recommendations and experienced significant improvements.

Contractual design and PPPs for hospitals: lessons for the Portuguese model

Recently the Portuguese Government announced the launching of public–private partnerships (PPPs) to build hospitals with the distinctive feature that infrastructure construction and clinical activities management will be awarded to separate private parties. Also, one of the parties will be in charge of providing soft facilities. We explore alternative configurations of contracts and assess whether the equilibrium allocations attain the first-best solution.

Epidemiology and causation

Epidemiologists’ discussions on causation are not always very enlightening with regard to the notion of ‘cause’ in epidemiology. Epidemiologists rightly work from a science-based approach to causation in epidemiology, but largely disagree about the matter. Disagreement may be partly due to confusion of the question of useful concepts for causal inference in epidemiological practice with the question of the metaphysical presuppositions of causal concepts used in epidemiology. In other words, epidemiologists seem to confuse the practical results of epidemiological research at the population level with the metaphysical views about the reality of disease causation at the individual level in their writings on causation.