Quality choice in a health care market: a mixed duopoly approach

We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating mean–variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients affects the true quality of medical care provided by hospitals. In addition, we show that a case exists in which the quality of the partially privatized hospital becomes higher than that of the private hospital when the patient’s preference for quality is relatively high.

Editorial

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Ungleichheit in der Mundgesundheit

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Editorial

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Editorial

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Building a Meaningful Future for Young People with Mental Illness

Transitioning to adulthood is challenging for young people who have a mental illness or substance use disorder, especially those who are transitioning from institutional care. For young people with serious mental illnesses to succeed in the adult world, they need more than treatment.These youth need to be truly integrated into their communities. They need jobs that offer skills, dignity, independence, and peers. They need a responsible and caring older adult who can help them to make better choices, learn from their mistakes, and applaud their successes, no matter how small. Community providers can create these opportunities through their own programs or appropriate community collaborations.

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

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

Indirect Effects of Acute Alcohol Intoxication on Sexual Risk-taking: The Roles of Subjective and Physiological Sexual Arousal

Three experiments supported the idea that alcohol fosters sexual risk-taking in men and women, in part, through its effects on sexual arousal. In Experiment 1, increasing alcohol dosage (target blood alcohol levels of .00, .04, .08%) heightened men’s and women’s risk-taking intentions. Alcohol’s effect was indirect via increased subjective sexual arousal; also, men exhibited greater risk-taking than women. In Experiment 2, an extended dosage range (target blood alcohol levels of .00, .06, .08, .10%) heightened men’s risk-taking intentions. Alcohol’s effect again was indirect via subjective arousal. Physiological sexual arousal, which was unaffected by alcohol, increased risk-taking via increased subjective arousal. In Experiment 3, alcohol increased women’s risk-taking indirectly via subjective arousal, but alcohol-attenuated physiological arousal had no effect on risk-taking. Implications for alcohol myopia theory and prevention interventions are discussed.

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%.

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.

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.

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.

Update of WHO air quality guidelines

Based on a systematic review of literature on adverse health effects of air pollution, the World Health Organization has updated its Air Quality Guidelines in 2005. The current update is intended to be relevant and applicable worldwide and takes into consideration large regional inequalities in exposures to air pollution. It recommends guideline levels for particulate matter, ozone, nitrogen dioxide and sulfur dioxide, as well as the set of interim targets for these pollutants’ concentrations, encouraging gradual improvement of air quality and reduction of health impacts of the pollution.

A Naturalistic Study of MST Dissemination in 13 Ohio Communities

The diffusion of evidence-based practices (EBPs) to child-serving human service organizations often occurs within the context of a comprehensive system-of-care in which a coordinated network of service providers collaborate to meet the needs of children and adolescents with serious behavioral and emotional disturbances. To the extent that inter-organizational networks influence the choices of organizational decision makers, it is necessary to understand interactions among participating organizations within the system when studying diffusion processes associated with EBP adoption and implementation. The present study analyzes decision making about the adoption and implementation of an EBP within the ecological context of system-of-care collaboration. Findings suggest that several factors impact the adoption decision, including system-of-care infrastructure planning and development activities before the decision process, the perception of adequate start-up and ongoing implementation resources among key players in the system-of-care, the range of motivations to participate in collaborative decision making, and the presence of entrepreneurial leadership.

Modelling healthcare systems with phase-type distributions

Phase-type distributions constitute a very versatile class of distributions. They have been used in a wide range of stochastic modelling applications in areas as diverse as telecommunications, finance, biostatistics, queueing theory, drug kinetics, and survival analysis. Their use in modelling systems in the healthcare industry, however, has so far been limited. In this paper we introduce phase-type distributions, give a survey of where they have been used in the healthcare industry, and propose some ideas on how they could be further utilized.

Individual and Contextual Effects of School Adjustment on Adolescent Alcohol Use

This paper examines the effect of a student’s own school adjustment as well as the contextual level of school adjustment (the normative level of school adjustment among students in a school) on students’ self-reported use of alcohol. Using a dataset of 43,465 male and female 8th grade students from 349 schools across the contiguous United States who participated in a national study of substance use in rural communities between 1996 and 2000, multilevel latent covariate models were utilized to disentangle the individual-level and contextual effects of three school adjustment variables (i.e., school bonding, behavior at school, and friend’s school bonding) on alcohol use. All three school adjustment factors were significant predictors of alcohol use both within and between schools. Furthermore, this study demonstrated a strong contextual effect: Students who attended schools where the overall level of school adjustment was higher reported lower levels of alcohol use even after taking their own school adjustment into account. The results demonstrate the importance of both a student’s own level of school adjustment and the normative level of school adjustment among students in the school on an adolescent’s use of alcohol. Differences in school adjustment across schools were quite strongly related to an adolescent’s own alcohol use, indicating that school adjustment is an important aspect of school climate. Initiatives aimed at improving school climate may have beneficial effects on students’ alcohol use.

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.

Redistributive effects in public health care financing

This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.