Cost of breast cancer in Sweden in 2002

Breast cancer is the most common cancer among Swedish women and an important cause of illness and death. The aim of this study was to estimate the total cost of breast cancer in Sweden in 2002, using a top-down prevalence-based cost-of-illness approach. The total cost of breast cancer in Sweden in 2002 was estimated at 3.0 billion SEK (1 € = 9.4 SEK). The direct costs were estimated at 895 million SEK and constituted 30% of the total cost. Indirect costs were estimated at 2.1 billion SEK and constituted 70% of the total cost. The main cost driver was production losses caused by premature mortality, amounting to 52% of the indirect costs. The reason that indirect costs were the dominant cost is because most newly detected breast cancers occur in patients aged below 65, thus causing significant production losses due to sick leave, early retirement, and premature mortality.

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).

Ungleichheit in der Mundgesundheit

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Editorial

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The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002

This article estimates the societal cost of alcohol consumption in Sweden in 2002, as well as the effects on health and quality of life. The estimation includes direct costs, indirect costs and intangible costs. Relevant cost-of-illness methods are applied using the human capital method and prevalence-based estimates, as suggested in existing international guidelines, allowing cautious comparison with prior studies. The results show that the net cost (i.e. including protective effects of alcohol consumption) is 20.3 billion Swedish kronor (SEK) and the gross cost (counting only detrimental effects) is 29.4 billon (0.9 and 1.3% of GDP). Alcohol consumption is estimated to cause a net loss of 121,800 QALYs. The results are within the range found in prior studies, although at the low end. A large number of sensitivity analyses are performed, indicating a sensitivity range of 50%.

Editorial

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

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

Editorial

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Cohort effects in physical inactivity

Marked age-dependent physical inactivity is generally assumed in the health science literature. On the basis of cross-sectional studies it is assumed that the probable physical inactivity increases linearly with increasing age. Health economical analyses based on this assumption result automatically in the conclusion that an aging society and the associated increasing inactivity will lead to higher health-care costs. The object of this paper was to check the validity of this underlying assumption. The data records of the German Socio-Economic Panel Study (GSOEP) for the years 1985–2001 served as a basis. With the aid of longitudinal and cohort sequence analyses, it was shown that not only the effects of age, but also those of period and cohort effects always influence health behaviour. The effects of age can be absolutely compensated for, or in part even overcompensated, by the period and cohort effects. For this reason, the aging of society itself does not necessarily lead to higher health-care costs owing to certain parameters of health behaviour, even if cross-sectional studies show an increasing incidence with age.

Emergency department visits: the cost of trauma centers

Crowded emergency departments (EDs) have become a serious problem in the current U.S. healthcare system. Patient wait times and periods of ED diversion have increased, raising concerns about the timeliness, efficiency, and quality of ED treatment. This study addresses the question of whether there are economies of scale (EOS) in ED care, and the extent to which such economies vary across different types of EDs. A hospital cost function approach is taken to evaluate average and marginal costs of EDs designated as trauma centers. Data comes from acute care hospitals in Texas for the period 1998–2004. Cost functions corresponding to four different levels of ED trauma care are estimated using a translog panel data model with hospital fixed effects. The marginal costs (in 2004 dollars) of each trauma center level are: $53 (Level I), $177 (Level II), $119 (Level III), and $258 (Level IV). Average cost per ED visit for trauma centers exceeds marginal cost at all Levels, indicating the presence of EOS. The results support a possible expansion of ED size policy in order to improve the cost efficiency of ED services.

The quality of life of Palestinians living in chronic conflict: assessment and determinants

This study assessed the quality of life (QoL) of Palestinians living in conditions of chronic conflict and examined its determinants. An adapted World Health Organization quality of life (WHOQoL-Bref) instrument was used in a representative sample of 1,008 adults. Factor analysis and multiple regression were conducted to determine associations between demographic and socioeconomic characteristics and scores of extracted principal determinants, and estimated overall and domain-specific QoL scores. Men, older persons and those less educated reported lower QoL than their counterparts. Negative associations were also found with higher distress and fear levels, and lower financial and freedom status. The chronic and entrenched conflict over generations resulted in lower QoL for the population of the Occupied Palestinian Territory.

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.

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.

The income distributive implications of recent private health insurance policy reforms in Australia

The Australian government implemented a series of private health insurance (PHI) policy reforms between 1997 and 2000. As a result, the proportion of the population with PHI coverage increased by more than 35%. However, this study found significant evidence that the policy reform disproportionately favours high-income earners. In particular, the 30% premium subsidy represents a windfall gain for households which would have purchased PHI even without the rebate. The amount of such gain is estimated to be around $900 million per year, a large proportion of which went to higher income households.

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.

Assessing Cultural Life Skills of American Indian Youth

While the global United States society emphasizes independence and emancipation from parents and families as appropriate transition tasks for adolescents in foster care, American Indian communities tend to stress interdependence and continuing youth, family, and community connections. The purpose of this naturalistic collective case study is to describe cultural life skills needed by American Indian youth to leave foster care and successfully transition into adulthood. Three Northern Plains Native reservations and two urban Indian communities participated. The research team partnered with the American Indian gatekeepers, elders, youth, and professional staff in efforts to embrace qualitative methods, considered the best way to legitimate and liberate Native ways of knowing. Findings take into account the subtleties of vast diversities among America’s First Nations’ people and support the importance of positive cultural influences in youth identity development.

Emotional exhaustion and mental health problems among employees doing “people work”: the impact of job demands,job resources and family-to-work conflict

Objective  This study investigates the relationship between four job characteristics and family-to-work conflict on emotional exhaustion and mental health problems. Methods  Multiple regression analyses were performed using data from 1,008 mental health care employees. Separate regression analyses were computed for high and low patient interaction jobs. Results  Different job characteristics as well as family-to-work conflict were associated with emotional exhaustion and mental health problems in each job type. The relationship between family-to-work conflict and emotional exhaustion was mitigated by social support from colleagues for those who worked in low patient interaction jobs. Conclusion  In addition to general and specific stressors, it is worthwhile to include home-related stressors that interfere with the work domain in stress research.

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.

An extended DEA model for hospital performance evaluation and improvement

This paper presents an extended data envelopment analysis (DEA) model which includes a new benchmark filtering measure to identify the decision making units (DMUs) which consistently have the best performance. Additionally, window analysis is utilized over multiple time periods in order to consider the time dependent nature of hospital data. The proposed approach, termed Panel-based Benchmarking, is applied to the data from previous research to demonstrate its effectiveness and benefits. Next, the proposed approach is applied to a real-world data set spanning a five year period supplied by the Iowa Hospital Association. Finally, the Malmquist method is used to compliment the proposed approach to verify temporal productivity performance of DMUs. The results indicate that the proposed model can generate benchmarks which consistently perform well over multiple time periods.

Best Interests,the Power of the Medical Profession,and the Power of the Judiciary

This paper is a response to a paper by John Coggon ‘Best Interests, Public Interest, and the Power of the Medical Profession'. It argues that certain legal judgements in relation to best interests seek to change and curtail the role of the medical profession in this arena while simultaneously extending the jurisdiction of the courts. It also argues that we must guard against replacing one professional standard, that of the medical profession, with another, that of the judiciary in this area.