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1.
Health Policy ; 126(12): 1283-1290, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36384736

RESUMEN

Public policies fostering the freedom of choice of provider in the healthcare sector are increasingly common in many countries and regions, where policymakers wish to empower patients and improve health service performance. However, in the literature there is not clear consensus about the impact of expanded patient choice on healthcare quality yet. This study investigates whether increasing patients' freedom of choice influences health system outcomes in terms of various non-clinical aspects of care, a dimension often overlooked by researchers in this field. Our study considers a "natural experiment" that took place within the Spanish National Health System in 2009 under which citizens of the Community (region) of Madrid were allowed to freely choose among any GP and/or specialist in their region. The empirical analysis was conducted by using Spanish microdata for the period 2002-2016 and used synthetic control estimation techniques. The key findings show the reform had a strong and long-lasting impact, reducing average waiting times and increasing patients' satisfaction with the specialist attention received. We did not detect any statistically significant impact of the reform on the other responsiveness domains analysed. Our analysis shows that freedom of choice policies could improve health system performance if they are combined with appropriate economic incentives for health providers.


Asunto(s)
Conducta de Elección , Servicios de Salud , Humanos , Calidad de la Atención de Salud , Satisfacción del Paciente , Libertad
2.
Health Econ ; 27(2): 266-281, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28660624

RESUMEN

Studies of health system responsiveness mostly focus on the demand side by investigating the association between sociodemographic characteristics of patients and their reported level of responsiveness. However, little is known about the influence of supply-side factors. This paper addresses that research gap by analysing the role of hospital-specialty characteristics in explaining variations in patients' evaluation of responsiveness from a sample of about 38,700 in-patients treated in public hospitals within the Italian Region of Emilia-Romagna. The analysis is carried out by adopting a 2-step procedure. First, we use patients' self-reported data to derive 5 measures of responsiveness at the hospital-specialty level. By estimating a generalised ordered probit model, we are able to correct for variations in individual reporting behaviour due to the health status of patients and their experience of being in pain. Second, we run cross-sectional regressions to investigate the association between patients' responsiveness and potential supply-side drivers, including waiting times, staff workload, the level of spending on non-clinical facilities, the level of spending on staff education and training, and the proportion of staff expenditure between nursing and administrative staff. Results suggest that responsiveness is to some extent influenced by the supply-side drivers considered.


Asunto(s)
Atención a la Salud , Estado de Salud , Hospitales Públicos/organización & administración , Pacientes Internos/estadística & datos numéricos , Medicina , Estudios Transversales , Femenino , Costos de Hospital , Humanos , Italia , Masculino , Satisfacción del Paciente , Indicadores de Calidad de la Atención de Salud , Encuestas y Cuestionarios
4.
Soc Sci Med ; 144: 48-58, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26387079

RESUMEN

In recent years, the concept of responsiveness has been put forward as one desirable measure of the performance of health systems. Responsiveness can be defined as a system's ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care. However, since responsiveness is evaluated by patients on a categorical scale, their self-evaluation can be affected by the phenomenon of reporting heterogeneity. A few studies have investigated how standard socio-demographic characteristics influence the reporting style of patients with regard to responsiveness. However, we are not aware of studies that focus explicitly on the influence that both the patients' state of health and their experiencing of pain have on their reporting style on responsiveness. This paper tries to bridge this gap by using data regarding a sample of about 2500 patients hospitalized in four Local Health Authorities (LHA) in Italy's Emilia-Romagna region between 2010 and 2012. These patients have evaluated 27 different aspects of the quality of care, concerning five domains of responsiveness (communication, privacy, dignity, waiting times and quality of facilities). Data have been stratified into five sub-samples, according to these domains. We estimate a generalized ordered probit model, an extension of the standard ordered probit model which permits the reporting behaviour of respondents to be modelled as a function of certain respondents' characteristics, which in our analysis are represented by the variables "state of health" and "pain". Our results suggest that unhealthier patients and patients experiencing pain are more likely to report a lower level of responsiveness, all other things being equal.


Asunto(s)
Autoevaluación Diagnóstica , Estado de Salud , Dolor/psicología , Indicadores de Calidad de la Atención de Salud , Femenino , Humanos , Italia , Masculino , Satisfacción del Paciente , Calidad de la Atención de Salud
5.
Health Serv Res ; 46(6pt2): 2079-100, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21762144

RESUMEN

OBJECTIVES. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants. Our objective is to investigate the potential country-level drivers of health system responsiveness. DATA SOURCE. Data on responsiveness are taken from the World Health Survey. Information on country-level characteristics is obtained from a variety of sources including the United Nations Development Program (UNDP). STUDY DESIGN. A two-step procedure. First, using survey data we derive a country-level measure of system responsiveness purged of differences in individual reporting behavior. Secondly, we run cross-sectional country-level regressions of responsiveness on potential drivers. PRINCIPAL FINDINGS. Health care expenditures per capita are positively associated with responsiveness, after controlling for the influence of potential confounding factors. Aspects of responsiveness are also associated with public sector spending (negatively) and educational development (positively). CONCLUSIONS. From a policy perspective, improvements in responsiveness may require higher spending levels. The expansion of nonpublic sector provision, perhaps in the form of increased patient choice, may also serve to improve responsiveness. However, these inferences are tentative and require further study.


Asunto(s)
Atención a la Salud/economía , Países Desarrollados/estadística & datos numéricos , Sector de Atención de Salud/economía , Gastos en Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Salud Pública/economía , Estudios Transversales , Atención a la Salud/tendencias , Europa (Continente) , Salud Global , Sector de Atención de Salud/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Investigación sobre Servicios de Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Salud Pública/tendencias
6.
J Health Econ ; 30(4): 616-25, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21696839

RESUMEN

The World Health Report 2000 proposed three fundamental goals for health systems encompassing population health, health care finance and health systems responsiveness. The goals incorporate both an efficiency and equity dimension. While inequalities in population health and health care finance have motivated two important strands of research, inequalities in responsiveness have received less attention in health economics. This paper examines inequality and polarisation in responsiveness, bridging this gap in the literature and contributing towards an integrated analysis of health systems performance. It uses data from the World Health Survey to measure and compare inequalities in responsiveness across 25 European countries. In order to respect the inherently ordinal nature of the responsiveness data, median-based measures of inequality and polarisation are employed. The results suggest that, in the face of wide differences in the health systems analysed, there exists large variability in inequality in responsiveness across countries.


Asunto(s)
Atención a la Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud , Europa (Continente) , Salud Global , Investigación sobre Servicios de Salud , Encuestas Epidemiológicas , Humanos
7.
Mayo Clin Proc ; 86(2): 113-9, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21282485

RESUMEN

OBJECTIVE: To investigate the influence of socioeconomic status (SES) on Breslow thickness, disease-free survival, and overall survival in patients with stage I-II primary cutaneous melanoma (PCM). PATIENTS AND METHODS: The study consists of all consecutive patients who were diagnosed as having PCM and were treated and followed up at our hospital between November 1, 1998, and July 31, 2009. Pathologic and sociodemographic characteristics of the patients were obtained. We categorized SES into 3 levels: low (manual employees and skilled/unskilled workers, including farmers, with primary education level), middle (nonmanual employees and clerks with middle education level), and high (professionals, executives, administrators, and entrepreneurs with tertiary education). RESULTS: A total of 1443 consecutive patients were evaluated. In a multivariate logistic regression analysis, sex (female vs male: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.08-1.75), SES (high vs middle: OR, 1.27; 95% CI, 0.96-1.69; high vs low: OR, 1.73; 95% CI, 1.26-2.38), age (<60 vs ≥60 years: OR, 1.35; 95% CI, 1.03-1.78), and family context (single vs living with relatives: OR, 1.37; 95% CI, 0.97-1.94) were the strongest correlates of Breslow thickness. Compared with high SES, the risk of melanoma-related death, adjusted for age and sex, was 7 times higher (hazard ratio, 7.44; 95% CI, 3.27-16.93) and almost 2 times higher (hazard ratio, 1.88; 95% CI, 1.04-3.39) in patients with low SES living alone or living with relatives, respectively. CONCLUSION: In patients with PCM, low SES is associated with thicker melanoma and a poorer clinical outcome.


Asunto(s)
Melanoma/mortalidad , Melanoma/patología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Clase Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Italia/epidemiología , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Tasa de Supervivencia
8.
Eur J Health Econ ; 12(2): 141-62, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20349262

RESUMEN

Despite the growing popularity of the vignette methodology to deal with self-reported, categorical data, the formal evaluation of the validity of this methodology is still a topic of research. Some critical assumptions need to hold in order for this method to be valid. In this paper we analyse the assumption of "vignette equivalence" using data on health system responsiveness contained within the World Health Survey. We perform several tests to check the assumption of vignette equivalence. First, we use a test based on the global ordering of the vignettes. A minimal condition for the assumption of vignette equivalence to hold is that individual responses are consistent with the global ordering of vignettes. Secondly, using the hierarchical ordered probit model (HOPIT) model on the pool of countries, we undertake sensitivity analyses, stratifying countries according to the Inglehart-Welzel scale and the Human Development Index. The results of this analysis are robust, suggesting that the vignette equivalence assumption is not contradicted. Thirdly, we model the reporting behaviour of the respondents through a two-step regression procedure to evaluate whether the vignettes construct is perceived by respondents in different ways. Overall, across the analyses the results do not contradict the assumption of vignette equivalence and accordingly lend support to the use of the vignette methodology when analysing self-reported data and health system responsiveness.


Asunto(s)
Comparación Transcultural , Personas con Discapacidad , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Autoinforme , Comunicación , Confidencialidad , Estado de Salud , Humanos , Satisfacción en el Trabajo , Autonomía Personal , Reproducibilidad de los Resultados , Apoyo Social , Factores Socioeconómicos , Estadísticas no Paramétricas
9.
Eur J Health Econ ; 12(5): 429-44, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20499127

RESUMEN

Given changes in the labour market in past decades, it is of interest to evaluate whether and how contractual and working conditions affect health and psychological well-being in society today. We consider the effects of contractual and working conditions on self-assessed health and psychological well-being using twelve waves (1991/1992-2002/2003) of the British Household Panel Survey. For self-assessed health, the dependent variable is categorical, and we estimate non-linear dynamic panel ordered probit models, while for psychological well-being, we estimate a dynamic linear specification. The results show that both contractual and working conditions have an influence on health and psychological well-being and that the impact is different for men and women.


Asunto(s)
Contratos , Estado de Salud , Salud Laboral , Satisfacción Personal , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Encuestas y Cuestionarios , Reino Unido , Tolerancia al Trabajo Programado/psicología
10.
Health Econ ; 19(9): 1029-47, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20648520

RESUMEN

Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for 'trade' in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enrollees for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool.


Asunto(s)
Relaciones Paciente-Hospital , Hospitales/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Conducta de Elección , Geografía , Humanos , Italia , Funciones de Verosimilitud , Modelos Econométricos , Distribución de Poisson , Viaje/estadística & datos numéricos
11.
Int J Health Care Finance Econ ; 6(3): 215-36, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-17103308

RESUMEN

Sutton (1991, Sunk costs and market structure. Cambridge: MIT Press; 1998, Technology and market structure. Cambridge: MIT Press) theorised that industries evolve into distinct market configurations in terms of concentration, depending upon product homogeneity and whether R&D or advertising are relevant relative to set-up costs. This paper tests the existence of such a relationship between technological profiles and market structure empirically, using the health care services provided by the Italian National Health Service as the specific economic framework. Our results support the empirical predictions made by Sutton. In particular, in markets where the technological intensity is low the lower bound to concentration converges monotonically to zero when the market size increases, for any level of product homogeneity. Conversely, in markets where the technological intensity is high the lower bound of concentration converges to some positive (non-zero) value when market size increases, while the lower bound increases (from zero) when the level of product homogeneity increases.


Asunto(s)
Tecnología Biomédica/economía , Sector de Atención de Salud , Programas Nacionales de Salud/economía , Humanos , Italia , Modelos Econométricos
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