Is current institutional quality linked to legal origins and disease endowments? Evidence from Africa

This paper empirically assesses if and to what extent cross-country differences in institutions inherited from the past affect current institutional quality in Africa. Specifically, the work evaluates if legal origins and disease endowments explain cross-country differences in the quality of contemporary institutions that are widely considered to be important for financial system development and other economic outcomes, such as those related to creditor rights protection and the credit information infrastructure, as well as the judicial, legal property and insolvency systems. Empirical tests are carried out on a sample of 46 African former European colonies with data on current institutional quality from 2004 to 2013. The findings reveal that the legal origins hypothesis receives strong support in the data: historical factors, rooted in legal origins, have long-lasting effects on current institutional quality in the African context. Mixed evidence is instead found for the endowment view.     

Medical resource utilisation and healthcare costs in patients with chronic hepatitis C viral infection and thrombocytopenia

Abstract

Background:

Thrombocytopenia is a significant risk for patients with chronic HCV infection and a common side-effect of treatment with pegylated (PEG) interferon (IFN). Thrombocytopenia predisposes patients to bleeding and requirements for platelet transfusions, and may thus place an increased burden on patients and on medical resource utilisation.

Scope:

In a retrospective analysis of an integrated, longitudinal database of medical and pharmacy claims and laboratory results in a US commercial health (insurance) plan, patients with chronic hepatitis C viral (HCV) infection were identified by reviewing ICD-9-CM HCV-, chronic liver disease-, and cirrhosis-related diagnoses. Medical resource utilisation and laboratory results were evaluated during the year following the HCV diagnosis index date as well as during the baseline year prior to that index date. Medical resource utilisation was determined by comparing outpatient visits, emergency department (ER) visits, and inpatient hospital stays for HCV patients with or without thrombocytopenia.

Findings:

HCV patients diagnosed with thrombocytopenia had a greater incidence of bleeding events (27.3 vs. 9.9%), platelet transfusions (8.5 vs. <1%), liver disease-related ambulatory visits (10.4 vs. 4.4; odds ratio [OR]?=?2.3; p?<?0.001), ER visits (OR?=?8.6; p?<?0.01), and inpatient hospital stays (OR?=?17.7; p?<?0.01) during the study period compared with HCV patients without a thrombocytopenia diagnosis. HCV patients with thrombocytopenia had significantly higher overall healthcare costs ($37,924 vs. $12,174; p?<?0.001) and liver disease-related costs ($14,569 vs. $4107; p?<?0.001) than patients without thrombocytopenia.

Limitations:

Administrative claims data are subject to coding errors; additionally, the patient population may not be completely representative of the general chronic HCV population.

Conclusions:

Diagnosis of thrombocytopenia in patients with HCV is associated with increased incidence of certain comorbidities, complications, and medical interventions, and significantly increased medical resource utilisation.     

Superhighway patrolman

This fictional prototype explores two of the future's major societal challenges: the delivery of healthcare to an increasingly ageing society; and the policing of a society, in which digital surveillance may predominate. It contrasts the author's vision of what life could be like in the United Kingdom in a decade's time (just as he contemplates retirement) with the simpler values of the 1980s, when he began his postgraduate career. The lyrics of the poignant 1982 Bruce Springsteen song, “Highway Patrolman” are used to bridge the epochs¹. The prototype relocates the two main ‘middle-America’ characters, brothers Joe and Frank Roberts, in London in the year 2025. Much has already changed politically and socially in ‘Western societies’ in the intervening period up to 2012, driven by the inexorable advances of technology. As further scientific advances drive us to an anticipated paradigm change,² one can only speculate on how society will advance, posing serious ethical dilemmas. Many of the changes will be positive. However, the story explores the potential negative consequences to the ageing population, in what appears to be a successful economy. Although somewhat pessimistic in outlook, a hopeful conclusion is that the ‘ties that bind’ will still predominate.     

英美两国疾病管理模式比较

本文结合英美两国医疗卫生体制的特点，总结了疾病管理在两国的发展情况，全面分析了疾病管理模式中的相关利益主体，对我国学习国外疾病管理模式中的先进经验具有重要的启示作用。     

Implications of Real-world Adherence on Cost-effectiveness Analysis in Multiple Sclerosis

Abstract

Objectives:

Adherence to medication is essential for optimal outcomes, especially for chronic diseases such as multiple sclerosis (MS). Studies in MS indicate that lower adherence is associated with an increased risk of relapse, hospitalization or emergency room (ER) visits, and higher medical costs. A previous investigation assessed the cost per relapse avoided for patients with MS receiving first-line disease modifying therapies (DMTs); however, the model assumed 100% adherence.

Methods:

Because real-world utilization patterns influence the actual effectiveness of medications, this analysis assessed the impact of real-world adherence from a US commercial payer perspective, using updated costs.

Results:

As was seen in the original study, in this revised model, fingolimod was associated with the lowest cost per relapse avoided ($90,566), followed by SC IFN β-1b (Extavia: $127,024), SC IFN β-1b (Betaseron: $137,492), SC IFN β-1a ($144,016), glatiramer acetate ($160,314), and IM IFN β-1a ($312,629). The model inputs that had the greatest impact on the results were adherence-adjusted relative relapse rate reduction (RRR) of fingolimod, the wholesale acquisition costs of fingolimod, and the average number of relapses in untreated patients with MS.

Limitations:

The estimates of DMT adherence are from a single claims database study of a large national pharmacy benefit manager that only measured adherence, not actual relapses, and the model does not incorporate manufacturer discounts and rebates, which are not publicly available.

Conclusion:

These results suggest that economic analyses of MS therapies should incorporate real-world adherence rates where available, rather than relying exclusively on trial-based efficacy estimates when considering the economic value of treatment alternatives, and that highly efficacious therapies with low adherence may yield real-world efficacy that is substantially lower than that observed in closely monitored clinical trials.     

A CGE model of 'Dutch disease' economics in Taiwan

A computable general equilibrium (CGE) model of Dutch disease economics in Taiwan's economy is established in order to examine the impacts of the imbalanced growth in output, endogenous learning effects from imports and exports and the import tariff reduction. Twenty-nine industry sectors and five quintiles of households are taken to measure the changes in industry structure and functional distribution of income. An imbalanced growth, either from output or exports, contributes to the reduction in the share of manufacturing industry, but the deterioration in the functional distribution of income only happens to an imbalanced growth in intersectoral output. A widespread trade liberalization policy helps to mitigate the Dutch disease phenomenon in the sense that de-industrialization and deterioration of the distribution of income by an imbalanced growth in manufacturing industry are not so severe.     

Disease management programs: program intervention, behavior modification, and dosage effect

Disease management programs provide highly personalized self- management support to consumers afflicted with chronic illnesses. Program interventions include the provision of health information, ongoing motivation, and support for behavior change, adherence to pharmacotherapy, development of self-efficacy, and the distribution of self-care tools. Interactions between program and patients are structured and repetitive over time. Consumer behavior change can result in measurable improvements in quality and medical cost savings from postponement or avoidance of preventable complications. We evaluated the impact on cost and quality of a comprehensive Diabetes Disease Management Program (DDMP) across ten US urban markets. A staggered implementation allowed for ten pre–post and five pair-wise comparisons. The DDMP demonstrated significant improvements in six diabetes-related quality indicators, lower cost, and a dose-response with greater than 6 months participation. We conclude that a DDMP improves quality of care and reduce overall medical costs.     

Administrative cooperation and disease control in cross-border pork production

In recent years, the continuous structural change in the value chain of modern food production has been characterised by an increasing international division of labour among manufacturing companies. A regional specialisation of primary agricultural production is especially apparent in meat production. Thus, the German–Dutch border area has developed into a region of unprecedented intensive pork production. While The Netherlands specialises in piglet production, the production of fattened pigs continues to grow in northwest Germany. As a result of this increasing transnational value chain development, German imports of Dutch piglets have risen continuously since 2000. However, this structural interweaving of pork production between The Netherlands and Germany has resulted in many new challenges for the cooperation between the various participants and in particular for the administrative authorities in the field of food and feed safety as well as efficient animal disease control. The motivation for this exploratory study stems from the lack of scientific work on this topic to date. The aim of this research is to illustrate the relevance of functioning cross-border cooperation in the food sector, using commodity flow structures and disease spread analysis. Results indicate that cross-border cooperation between authorities during a CSF epidemic can reduce the risk of recurrence and the duration by 50%.     

Wellness tourism and spatial stigma: A case study of Bama,China

This study focused on the stigmatisation of an emerging wellness tourism destination due to patient travel for tourism. The concept of spatial stigma was adopted to explore how local residents perceive, experience and manage the particular negative effects of wellness tourism. The study investigated Bama Yao Autonomous County, colloquially known as ‘Bama’, in China, to which many tourists with cancer and other chronic diseases travel. The results showed that the influx of wellness tourists brought significant challenges in this area. The residents reported ambivalent experiences of and feelings about wellness tourism in local communities, and disagreed with the vilification of wellness tourists. However, they were concerned about the potential consequences of wellness tourism. To manage and resist spatial stigma, the residents deliberately separated themselves from the places occupied by wellness tourists. The theoretical contributions and managerial implications of the study are discussed.