Equity in the finance of health care: some further international comparisons.

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.     

Costs and quality of life of multiple sclerosis in Switzerland

This cost-of-illness analysis, based on information from 1101 patients in Switzerland, is part of a Europe-wide cost-of-illness study in multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients registered with the Swiss MS patient organization were asked to participate in a mail survey and 44% responded. The questionnaire asked for details on the disease (type of disease, relapses, level of functional disability), information on all medical and non-medical resource consumption, informal care and work capacity (sick leave and early retirement). In addition, patients were asked about their current QOL (measured as utility) and the level of fatigue. The mean age of respondents was 53 years, and 21% were 65 years or older. Almost one-quarter of patients in the sample (23%) had severe disease (Expanded Disability Status Scale [EDSS] score ≥7), while 36% had moderate disease (EDSS score 4–6.5) and 38% had mild disease (EDSS score 0–3). The median EDSS score was 5.0, with a mean of 4.5. Mean utility was 0.53 (range, 0 = death to 1 = full health), while mean fatigue was rated as 5.4 (range, 1 = not tired to 10 = extremely tired). Utility and fatigue were worse for patients with a recent relapse. Costs and utility are highly correlated with disease severity. Workforce participation decreases from greater than 80% in early disease to less than 10% in the very late stages, while total costs increase more than fivefold between an EDSS score of 0–1 and an EDSS of 7, and by more than 40% from an EDSS score of 7 to worse states. Most cost types increase steadily until patients reach an EDSS score of 7, after which there is a sharp increase due to home care, home services and informal care. The mean annual cost per patient in the sample (65.000 Swiss francs, € 42.000) corresponds to costs for a patient at the median EDSS score of 5. Utility decreases from 0.89 to 0.1 as the disease becomes severe, but the loss compared to the age- and gender-matched general population can be observed at all levels of the disease (～0.1 at an EDSS score of 2 to ～0.3 at an EDSS score of 5-6), leading to an estimated annual loss of 0.3 quality-adjusted life-years (QALY) per patient in the sample. Relapses for patients with an EDSS score <5 were associated with a utility loss of 0.08 and an incremental cost of 5500 Swiss francs (€ 3.500) during the quarter in which they occurred. Health-care costs are to a large extent covered by insurances, and a substantial amount of services such as home care and home help are available to patients with severe disease. These services represent approximately 15% of total societal costs and are largely covered, resulting in almost 30% of total costs to different payers. Despite this, a large amount of costs falls on families providing care, in particular for patients with severe disease.     

Nonparametric bounds on the effect of deductibles in health care insurance on doctor visits - Swiss evidence

We evaluate the effect of the size of deductibles in the basic health insurance in Switzerland on the probability of a doctor visit. We employ nonparametric bounding techniques to minimise statistical assumptions. In order to tighten the bounds we consider two further assumptions: mean independence of an instrument and monotone treatment response. Under these two assumption we are able to bound the causal effect of high deductibles compared to low deductibles below zero. We conclude that the difference in health care utilisation is partly due to a reduction of moral hazard effects.     

Equity in the finance of health care: some international comparisons

This paper presents the results of a ten-country comparative study of health care financing systems and their progressivity characteristics. It distinguishes between the tax-financed systems of Denmark, Portugal and the U.K., the social insurance systems of France, the Netherlands and Spain, and the predominantly private systems of Switzerland and the U.S. It concludes that tax-financed systems tend to be proportional or mildly progressive, that social insurance systems are regressive and that private systems are even more regressive. Out-of-pocket payments are in most countries an especially regressive means of raising health care revenues.     

High-throughput nuclear magnetic resonance-based screening.

A high-throughput screening strategy is described that involves the acquisition of two-dimensional 15N/1H correlation spectra in less than 10 min on 50 microM protein samples using cryogenic NMR probe technology. By screening at these concentrations, small organic molecules can be tested in mixtures of 100, which dramatically increases the throughput of the NMR-based assay. Using this strategy, libraries of more than 200 000 compounds can be tested in less than 1 month. There are many advantages of high-throughput NMR-based screening compared to conventional assays, such as the ability to identify high-affinity ligands for protein targets with no known function. This suggests that the method will be extremely useful for screening the large number of targets derived from genomics research.     

Equity in the delivery of health care in Europe and the US

This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.     

Sensitivity to delta9-tetrahydrocannabinol is selectively enhanced in beta-arrestin2 -/- mice

Little is known about the roles of beta-arrestins in the regulation of brain CB1 cannabinoid receptors. This study investigated the role of beta-arrestin2 in cannabinoid behavioral effects using beta-arrestin2 -/- mice and their wild-type counterparts. A variety of cannabinoid ligands from different chemical classes that exhibit a variety of efficacies for activation of CB1 receptors were investigated, including Delta-tetrahydrocannabinol, CP55940, methanandamide, JWH-073, and O-1812. Delta-tetrahydrocannabinol produced both greater antinociception and greater decreases in body temperature in beta-arrestin2 -/- compared with beta-arrestin2 +/+ mice. No significant differences were, however, present in either assay for the other CB1 agonists. Antagonist radioligand binding indicated no difference in the density of cannabinoid CB1 receptors in the cerebellum, cortex, or hippocampus of beta-arrestin2 +/+ and -/- mice. These data demonstrate that beta-arrestin2 may regulate cannabinoid CB1 receptor sensitivity in an agonist-specific manner.     

A method for anterograde axonal tracing of chemically specified circuits in the central nervous system: combinedPhaseolus vulgaris-leucoagglutinin (PHA-L) tract tracing and immunohistochemistry

A method is described for combining anterograde axonal tract tracing using concurrent double immunohistochemical localization of axonally transportedPhaseolus vulgaris-leucoagglutinin (PHA-L) and endogenous neural antigens. With this technique, some projections of the substantia nigra and the paraventricular hypothalamic nucleus are examined to demonstrate advantages offered by this approach for tracing chemically specified circuits in the central nervous system.     

Income-related inequalities in health: some international comparisons

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.