Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines

Objective: To develop cases of preference-sensitive care and analyze the individualized cost-effectiveness of respecting patient preference compared to guidelines.

Methods: Four cases were analyzed comparing patient preference to guidelines: (a) high-risk cancer patient preferring to forgo colonoscopy; (b) decubitus patient preferring to forgo air-fluidized bed use; (c) anemic patient preferring to forgo transfusion; (d) end-of-life patient requesting all resuscitative measures. Decision trees were modeled to analyze cost-effectiveness of alternative treatments that respect preference compared to guidelines in USD per quality-adjusted life year (QALY) at a $100,000/QALY willingness-to-pay threshold from patient, provider and societal perspectives.

Results: Forgoing colonoscopy dominates colonoscopy from patient, provider, and societal perspectives. Forgoing transfusion and air-fluidized bed are cost-effective from all three perspectives. Palliative care is cost-effective from provider and societal perspectives, but not from the patient perspective.

Conclusion: Prioritizing incorporation of patient preferences within guidelines holds good value and should be prioritized when developing new guidelines.     

Availability of Long‐term Care Facilities and Middle‐aged People's Labor Supply in Japan

This paper estimates the effect of the availability of long‐term care facilities in the prefecture or medical district where middle‐aged men and women reside on their labor supply. Prefecture‐ and medical district‐ level panel datasets of the capacity of long‐term care facilities are merged with individual level employment data, and each individual's employment status is regressed on the capacities of long‐term care facilities. I find no evidence for a positive impact of the long‐term care availability on labor supply, although the estimates are unstable in sign and not estimated precisely enough to draw any strong conclusions.     

An Economic Analysis of Yard Care and Synthetic Chemical Use: The Case of San Francisco

Yard care is an economically important household production activity that also has potentially significant environmental or health impacts. Of particular concern are the possible negative impacts of using synthetic pesticides and fertilizers. But economic models and empirical analyses of yard care and chemical use are rare. We develop a simple model of household production and consumption to analyze yard care and chemical use. We then estimate a multinomial logit model of these behavioral choices with household data from San Francisco. Attitudes towards the quality of one's outdoor residential environment and time scarcity are important determinants of the odds of chemical use whereas financial variables play the major role in determining the odds that people have and care for yards. These results could help to improve educational or marketing campaigns that aim to reduce potential or actual problems associated with yard chemical use. Better data for models similar to this one are needed for future research.     

论人人享有基本卫生保健之改革

本文通过分析"看病贵、看病难"原因而导致的阻碍人人享有初级卫生保健的主要因素,提出必须深化卫生体制改革,发展基层社区卫生服务、建立覆盖全民的基本医疗保障制度以及实行均等化的公共卫生服务和基本药物制度,以实现人人享有初级卫生保健的目标。     

韩国老人长期看护保险法评介

为了应对人口高龄化带来的老人看护问题,韩国制定了《老人长期看护保险法》,通过该法创设了老人看护保险制度。该法的实施预示着韩国逐渐由家庭养老方式向社会化养老方式进行转变。尽管老人看护保险制度还面临一些新的问题,但韩国已经在解决高龄者看护问题的道路上迈出了坚实的一步。     

MEASUREMENT AND HEALTH CARE MANAGEMENT

Over recent decades many health care organisations have 'modernised' their management accounting systems by using the balanced scorecard (BSC). However, public health care involves multi-dimensional goals and resolving conflicts of interest. The question is whether a management control system based on measurements is suitable in a health care context. Light can be shed on this question using a study of the application of a BSC over a ten-year period at Högland Hospital. The study shows that the BSC and measurements of output and behaviour became a way of approaching unanswered questions about processes and quality development. Medical professionals with management responsibility, in co-operation with medical professionals responsible for different specialities, determined measures and targets and the measurements were integrated into activity processes and affected activities.     

公共卫生投资与区域经济增长关系的实证研究

本文利用1990年以来我国公共卫生投资的Pool数据,通过引入公共卫生投资变量的经济增长模型,对公共卫生投资与区域经济增长的关系进行了实证研究。本文的研究结果表明,一方面公共卫生投资与区域经济增长密不可分;另一方面公共卫生投资对区域经济增长的影响呈现出阶段性特征,目前西部地区的公共卫生投资对区域经济增长的贡献最大。     

基本医疗卫生制度公共提供的经济学分析——对“新医改方案”基本医疗卫生制度公共提供的政策解读

我国城乡居民普遍存在＂看病难、看病贵＂的现象,造成这种现象的一个重要原因是基本医疗卫生制度的提供过度市场化。基本医疗卫生制度具有公共产品的属性,应该采用公共提供的方式。2009年4月7日我国出台了＂医药卫生体制改革近期重点实施方案（2009-2011年）＂,＂新医改方案＂要求把基本医疗卫生制度作为公共产品向全民提供。在对基本医疗卫生制度的公共产品属性进行了分析之后,探讨了＂新医改方案＂对于缓解我国城乡居民＂看病难、看病贵＂的积极作用。     

长期照护保险对农村家庭消费水平的影响——基于CHARLS数据的实证分析

基于预防性储蓄等理论,运用双重差分法,依据中国健康与养老追踪调查(CHARLS)2011—2018年四期面板数据,考量长期照护保险政策对农村家庭消费水平的影响效应。结果显示,长期照护保险使得农村家庭消费水平总体提高了5.2%,这种消费促进效应突出地体现在食品消费、日用品消费、通信消费中,对文化娱乐消费和衣着消费影响不明显。异质性分析显示,非独生子女、收入高以及过去一年内有住院经历的农村家庭受长期照护保险政策的影响程度更大。机制分析表明,预防性储蓄、居民健康和代际经济支持是长期照护保险影响农村家庭消费的重要途径。鉴于此,应通过扩大城乡试点范围、建立多元筹资渠道、构建服务供给体系等方式,推动长期照护保险实现城乡全覆盖。     

A measurement model of strategic planning

While strategic planning is a key concept in management research, there has been little consistency in its conceptualization or measurement. Our review of prior studies also identifies reliability and validity, dimensionality, crude levels of measurement, and lack of parsimony as additional problems associated with prior use of this variable. Such problems substantially limit our ability to compare results across studies, or to make appropriate normative recommendations. We address these concerns by developing and validating a multiple indicator measure of strategic planning, using two independent samples. Implications for future research are then discussed. © 1998 John Wiley & Sons, Ltd.