Utilization and Economic Contribution of Psychiatric Mental Health Nurse Practitioners in Public Behavioral Health Services.

PubMed

Chapman, Susan A; Phoenix, Bethany J; Hahn, Talia E; Strod, Deborah C

2018-06-01

Expanded insurance coverage through the Affordable Care Act and parity in behavioral health coverage have increased demand for services. Yet there is a persistent shortage in the behavioral health workforce. Psychiatric Mental Health Nurse Practitioners (PMHNPs) may be part of the solution to shortages but are not yet fully utilized. The purpose of this study was to describe how PMHNPs are utilized, identify barriers to full utilization, and assess PMHNPs' economic contribution in public behavioral health systems. This study used a mixed methods approach, selecting counties for use of PMHNPs, geography, population size, rural/urban, and availability of financial data. The authors conducted 1- to 2-day site visits in 2014-2015 including semi-structured interviews with management and clinical leaders and collected PMHNP staffing and billing data. Thematic analysis of interview data was conducted and aggregate staffing and billing data were analyzed to determine net PMHNP financial contribution. The primary billed service for PMHNPs is medication management. Barriers to full utilization included system-level barriers to hiring PMHNPs, lack of role-appropriate job descriptions, confusion related to scope of practice/supervision requirements, and challenges in recruitment and retention. Fiscal analysis showed a positive net contribution from PMHNP services. PMHNPs can make a significant contribution to behavioral healthcare delivery, particularly in public mental health settings, yet greater understanding of their role and addressing barriers to practice is needed. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

PubMed

Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

2015-01-01

To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p < .01) when compared to control. There were no significant interactions between financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p < .05) with a conditional payment. Compared to lower-income participants, higher-income participants had lower odds of behavior change (OR: 0.46; p = .01) with a regret lottery. Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

Behavioral Economics

PubMed Central

Niileksela, Christopher R.; Kaplan, Brent A.

2013-01-01

In recent years, behavioral economics has gained much attention in psychology and public policy. Despite increased interest and continued basic experimental studies, the application of behavioral economics to therapeutic settings remains relatively sparse. Using examples from both basic and applied studies, we provide an overview of the principles comprising behavioral economic perspectives and discuss implications for behavior analysts in practice. A call for further translational research is provided. PMID:25729506

Using Insights From Behavioral Economics to Strengthen Disaster Preparedness and Response.

PubMed

Linnemayr, Sebastian; O'Hanlon, Claire; Uscher-Pines, Lori; Van Abel, Kristin; Nelson, Christopher

2016-10-01

Behavioral economics is based on the idea that individuals' decisions are affected by systematic and predictable cognitive biases and that these same biases can be leveraged to change behavior and improve decision-making. Insights from behavioral economics have been used to encourage a range of desired behaviors but have rarely been used in disaster preparedness and response, though traditional efforts by public health practitioners have failed to increase adoption of key preparedness behaviors. In this work, we aim to show how some of the key concepts in the behavioral economics literature are applicable to behaviors related to disaster preparedness and response, and we present ideas for behavioral economics-based interventions that we vetted with public health officials. Two of the best-received interventions were applications of social norms approaches, which leverage social influence bias, and commitment devices, which leverage present bias and loss aversion. Although the current evidence base for the applications of concepts from behavioral economics in disaster preparedness and response is weak, behavioral economics has achieved positive results in similar decision-making contexts. The low cost and potentially high impact of behavioral economics-based interventions warrant further investigation and testing. (Disaster Med Public Health Preparedness. 2016;page 1 of 7).

Behavioral economics

PubMed Central

Hursh, Steven R.

1984-01-01

Economics, like behavioral psychology, is a science of behavior, albeit highly organized human behavior. The value of economic concepts for behavioral psychology rests on (1) their empirical validity when tested in the laboratory with individual subjects and (2) their uniqueness when compared to established behavioral concepts. Several fundamental concepts are introduced and illustrated by reference to experimental data: open and closed economies, elastic and inelastic demand, and substitution versus complementarity. Changes in absolute response rate are analyzed in relation to elasticity and intensity of demand. The economic concepts of substitution and complementarity are related to traditional behavioral studies of choice and to the matching relation. The economic approach has many implications for the future of behavioral research and theory. In general, economic concepts are grounded on a dynamic view of reinforcement. The closed-economy methodology extends the generality of behavioral principles to situations in which response rate and obtained rate of reinforcement are interdependent. Analysis of results in terms of elasticity and intensity of demand promises to provide a more direct method for characterizing the effects of “motivational” variables. Future studies of choice should arrange heterogeneous reinforcers with varying elasticities, use closed economies, and modulate scarcity or income. The economic analysis can be extended to the study of performances that involve subtle discriminations or skilled movements that vary in accuracy or quality as opposed to rate or quantity, and thus permit examination of time/accuracy trade-offs. PMID:16812401

Low Self-Esteem during Adolescence Predicts Poor Health, Criminal Behavior, and Limited Economic Prospects during Adulthood

ERIC Educational Resources Information Center

Trzesniewski, Kali H.; Donnellan, M. Brent; Moffitt, Terrie E.; Robins, Richard W.; Poulton, Richie; Caspi, Avshalom

2006-01-01

Using prospective data from the Dunedin Multidisciplinary Health and Development Study birth cohort, the authors found that adolescents with low self-esteem had poorer mental and physical health, worse economic prospects, and higher levels of criminal behavior during adulthood, compared with adolescents with high self-esteem. The long-term…

The Behavioral Economics of Young Adult Substance Abuse

PubMed Central

Murphy, James G.; Dennhardt, Ashley A.

2016-01-01

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes. PMID:27151545

The behavioral economics of young adult substance abuse.

PubMed

Murphy, James G; Dennhardt, Ashley A

2016-11-01

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews of available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Using behavioral economics to promote healthy behavior toward sun exposure in adolescents and young adults.

PubMed

García-Romero, Maria T; Geller, Alan C; Kawachi, Ichiro

2015-12-01

Skin cancer represents an important public health problem, and it is associated with ultraviolet radiation exposure, particularly at early ages. Unhealthy sun exposure and intentional tanning continue to be the trend among young people. Multiple interventions to raise awareness of the risks of sun exposure have been implemented, without necessarily translating into decreased unhealthy behaviors or skin cancer incidence rates. Behavioral economics adds a set of concepts and tools to potentially boost the efficacy of existing approaches to decrease unhealthy sun exposure. This paper reviews public health interventions that have been based in behavioral economics concepts and their results, and provides examples of new and creative ways physicians and health professionals can actively apply insights from behavioral economics to counsel teenagers and young adults about skin cancer prevention. Copyright © 2015 Elsevier Inc. All rights reserved.

The Role of Incentives in Changing the Behavior of Spinal Care Providers: A Primer on Behavioral Economics in Health Care.

PubMed

Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

2016-12-01

As spinal care transitions from individual practitioners working in a volume-based reimbursement system toward multidisciplinary health care organizations working in a population-based model with value-based reimbursement, it is critical that insurance companies, administrators, and spine care provider have a clear understanding of how incentives change physician behavior. This article will introduce the concept of behavior economics, and discuss 9 principles relevant to physician decision-making.

The health effects of economic insecurity.

PubMed Central

Catalano, R

1991-01-01

BACKGROUND. Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. METHODS. The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. RESULTS. Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. CONCLUSIONS. The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms. PMID:1951825

Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

PubMed

Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

2017-08-22

Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

Behavioral economics strategies for promoting adherence to sleep interventions.

PubMed

Stevens, Jack

2015-10-01

Cognitive-behavioral treatment for insomnia and continuous positive airway pressure therapy for obstructive sleep apnea are among the most efficacious sleep interventions. Unfortunately, adherence levels are disappointingly low for these interventions. Behavioral economics offers a promising framework for promoting adherence, often through relatively brief and straightforward strategies. The assumptions, goals, and key strategies of behavioral economics will be introduced. These strategies include providing social norms information, changing defaults, using the compromise effect, utilizing commitment devices, and establishing lottery-based systems. Then, this review will highlight specific behavioral economic approaches to promote patient adherence for three major sleep interventions: 1) behavioral treatment for pediatric insomnia, 2) cognitive-behavioral treatment for adult insomnia, and 3) continuous positive airway pressure for obstructive sleep apnea. Next, behavioral economic strategies will be discussed as ways to improve health care provider adherence to clinical practice guidelines regarding appropriate prescribing of hypnotics and ordering sleep-promoting practices for hospitalized inpatients. Finally, possible concerns that readers may have about behavioral economics strategies, including their efficacy, feasibility, and sustainability, will be addressed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transplantation at the nexus of behavioral economics and health care delivery.

PubMed

Schnier, K E; Cox, J C; McIntyre, C; Ruhil, R; Sadiraj, V; Turgeon, N

2013-01-01

The transplant surgeon's decision to accept and utilize an organ typically is made within a constrained time window, explicitly cognizant of numerous health-related risks and under the potential influence of considerable regulatory and institutional pressures. This decision affects the health of two distinct populations, those patients receiving organ transplants and those waiting to receive a transplant; it also influences the physician's life and their institute's productivity. The numerous, at times nonaligned, incentives established by the complex clinical and regulatory environment, have been derived specifically to influence physicians' behaviors, and though well intended, may lead to responses that are nonoptimal when considering the myriad stakeholders being influenced. This may compromise the quality of care provided to the population at risk, and has potential to influence the physician-patient relationship. A synergistic collaboration between transplant physicians and economists that is focused on this decision environment may help to alleviate these strains. This viewpoint discusses behavioral economic principles and how they might be applied to transplantation. Specifically, the previous medical decision-making literature on transplantation will be reviewed and a discussion on how a behavioral model of physician decision making can be utilized will be explored. To date this approach has not been integrated into transplantation decision making. No claim to original US government works Journal compilation © 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

The business cycle and health behaviors.

PubMed

Xu, Xin

2013-01-01

While it is well documented that economic expansions provide widespread and immediate financial benefits, the evidence on how an economic downturn affects individual's health behaviors is surprisingly mixed. In this paper, we take a structural approach to investigate the effects of wages and working hours on health behaviors of low-educated persons using variations in wages and hours caused by changes in local economic activity. In the empirical analysis, we adopt a two-sample instrumental variables approach to combine the data on individual health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) with the data on individual employment from the Current Population Survey (CPS). The total sample size of the combined CPS-BRFSS data for the time period of 1984-2005 is 967,594, while that of the combined CPS-NHIS data for the time period of 1976-2001 is 364,078. We find that increases in wages caused by economic expansions are associated with greater consumption of cigarettes in the United States. We also find that increases in hours of work caused by economic expansions are associated with more cigarette consumption, but less physical activity and physician visits. More importantly, the evidence suggests that most of such effects associated with changes in hours of work can be attributed to the changes at the extensive margin of employment, meaning the changes in employment status, rather than the changes at the intensive margin, meaning changes in hours of work conditional on being employed. These findings imply that changes in employment may have heterogeneous impacts on time-intensive and less time-intensive health behaviors and also provide additional evidence on the importance of time in health production, particularly for time-intensive activities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Behavioral Economic Laboratory Research in Tobacco Regulatory Science.

PubMed

Tidey, Jennifer W; Cassidy, Rachel N; Miller, Mollie E; Smith, Tracy T

2016-10-01

Research that can provide a scientific foundation for the United States Food and Drug Administration (FDA) tobacco policy decisions is needed to inform tobacco regulatory policy. One factor that affects the impact of a tobacco product on public health is its intensity of use, which is determined, in part, by its abuse liability or reinforcing efficacy. Behavioral economic tasks have considerable utility for assessing the reinforcing efficacy of current and emerging tobacco products. This paper provides a narrative review of several behavioral economic laboratory tasks and identifies important applications to tobacco regulatory science. Behavioral economic laboratory assessments, including operant self-administration, choice tasks and purchase tasks, can be used generate behavioral economic data on the effect of price and other constraints on tobacco product consumption. These tasks could provide an expedited simulation of the effects of various tobacco control policies across populations of interest to the FDA. Tobacco regulatory research questions that can be addressed with behavioral economic tasks include assessments of the impact of product characteristics on product demand, assessments of the abuse liability of novel and potential modified risk tobacco products (MRTPs), and assessments of the impact of conventional and novel products in vulnerable populations.

Behavioral economics without anomalies.

PubMed Central

Rachlin, H

1995-01-01

Behavioral economics is often conceived as the study of anomalies superimposed on a rational system. As research has progressed, anomalies have multiplied until little is left of rationality. Another conception of behavioral economics is based on the axiom that value is always maximized. It incorporates so-called anomalies either as conflicts between temporal patterns of behavior and the individual acts comprising those patterns or as outcomes of nonexponential time discounting. This second conception of behavioral economics is both empirically based and internally consistent. PMID:8551195

Behavioral economics and regulatory analysis.

PubMed

Robinson, Lisa A; Hammitt, James K

2011-09-01

Behavioral economics has captured the interest of scholars and the general public by demonstrating ways in which individuals make decisions that appear irrational. While increasing attention is being focused on the implications of this research for the design of risk-reducing policies, less attention has been paid to how it affects the economic valuation of policy consequences. This article considers the latter issue, reviewing the behavioral economics literature and discussing its implications for the conduct of benefit-cost analysis, particularly in the context of environmental, health, and safety regulations. We explore three concerns: using estimates of willingness to pay or willingness to accept compensation for valuation, considering the psychological aspects of risk when valuing mortality-risk reductions, and discounting future consequences. In each case, we take the perspective that analysts should avoid making judgments about whether values are "rational" or "irrational." Instead, they should make every effort to rely on well-designed studies, using ranges, sensitivity analysis, or probabilistic modeling to reflect uncertainty. More generally, behavioral research has led some to argue for a more paternalistic approach to policy analysis. We argue instead for continued focus on describing the preferences of those affected, while working to ensure that these preferences are based on knowledge and careful reflection. © 2011 Society for Risk Analysis.

Locating Economic Risks for Adolescent Mental and Behavioral Health: Poverty and Affluence in Families, Neighborhoods, and Schools

ERIC Educational Resources Information Center

Coley, Rebekah Levine; Sims, Jacqueline; Dearing, Eric; Spielvogel, Bryn

2018-01-01

Research has identified risks of both poverty and affluence for adolescents. This study sought to clarify associations between income and youth mental and behavioral health by delineating economic risks derived from family, neighborhood, and school contexts within a nationally representative sample of high school students (N = 13,179, average age…

Conditional Economic Incentives for Reducing HIV Risk Behaviors: Integration of Psychology and Behavioral Economics

PubMed Central

Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar

2014-01-01

Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243

Conditional economic incentives for reducing HIV risk behaviors: integration of psychology and behavioral economics.

PubMed

Operario, Don; Kuo, Caroline; Sosa-Rubí, Sandra G; Gálarraga, Omar

2013-09-01

This article reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories and behavioral economics can be combined into new approaches for HIV prevention. Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and sexually transmitted infection (STI) prevalence, HIV testing, HIV medication adherence, and drug use. CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Health economics in public health.

PubMed

Ammerman, Alice S; Farrelly, Matthew A; Cavallo, David N; Ickes, Scott B; Hoerger, Thomas J

2009-03-01

Economic analysis is an important tool in deciding how to allocate scarce public health resources; however, there is currently a dearth of such analysis by public health researchers. Public health researchers and practitioners were surveyed to determine their current use of health economics and to identify barriers to use as well as potential strategies to decrease those barriers in order to allow them to more effectively incorporate economic analyses into their work. Data collected from five focus groups informed survey development. The survey included a demographic section and 14 multi-part questions. Participants were recruited in 2006 from three national public health organizations through e-mail; 294 academicians, practitioners, and community representatives answered the survey. Survey data were analyzed in 2007. Despite an expressed belief in the importance of health economics, more than half of the respondents reported very little or no current use of health economics in their work. Of those using health economics, cost-benefit and cost-effectiveness analysis and determination of public health costs were cited as the measures used most frequently. The most important barriers were lack of expertise, funding, time, tools, and data, as well as discomfort with economic theory. The resource deemed most important to using health economics was collaboration with economists or those with economic training. Respondents indicated a desire to learn more about health economics and tools for performing economic analysis. Given the importance of incorporating economic analysis into public health interventions, and the desire of survey respondents for more collaboration with health economists, opportunities for such collaborations should be increased.

Internet-Based Cognitive Behavioral Therapy for Insomnia: A Health Economic Evaluation

PubMed Central

Thiart, Hanne; Ebert, David Daniel; Lehr, Dirk; Nobis, Stephanie; Buntrock, Claudia; Berking, Matthias; Smit, Filip; Riper, Heleen

2016-01-01

Study Objectives: Lost productivity caused by insomnia is a common and costly problem for employers. Although evidence for the efficacy of Internet-based cognitive behavioral therapy for insomnia (iCBT-I) already exists, little is known about its economic effects. This study aims to evaluate the cost-effectiveness and cost-benefit of providing iCBT-I to symptomatic employees from the employer's perspective. Methods: School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a waitlist-control-group, both with access to treatment as usual. Economic data were collected at baseline and 6-mo follow-up. We conducted (1) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and (2) a cost-benefit analysis. Because both analyses were performed from the employer's perspective, we focused specifically on absenteeism and presenteeism costs. Statistical uncertainty was estimated using bootstrapping. Results: Assuming intervention costs of €200 ($245), cost-effectiveness analyses showed that at a willingness-to-pay of €0 for each positive treatment response, there is an 87% probability that the intervention is more cost effective than treatment as usual alone. Cost-benefit analyses led to a net benefit of €418 (95% confidence interval: −593.03 to 1,488.70) ($512) per participant and a return on investment of 208% (95% confidence interval: −296.52 to 744.35). The reduction in costs was mainly driven by the effects of the intervention on presenteeism and to a lesser degree by reduced absenteeism. Conclusions: Focusing on sleep improvement using iCBT-I may be a cost-effective strategy in occupational health care. Clinical Trials Registration: Title: Online Recovery Training for Better Sleep in Teachers with High Psychological Strain. German Clinical Trial Register (DRKS), URL: https

Behavioral economics: areas of cooperative research between economics and applied behavioral analysis1

PubMed Central

Kagel, John H.; Winkler, Robin C.

1972-01-01

The current research methods of behavioral economics are characterized by inadequate empirical foundations. Psychologists involved in the experimental analysis of behavior with their research strategies and their experimental technology, particularly that of the Token Economy, can assist in providing empirical foundations for behavioral economics. Cooperative research between economists and psychologists to this end should be immediately fruitful and mutually beneficial. PMID:16795356

Applied economics: The use of monetary incentives to modulate behavior.

PubMed

Strang, S; Park, S Q; Strombach, T; Kenning, P

2016-01-01

According to standard economic theory higher monetary incentives will lead to higher performance and higher effort independent of task, context, or individual. In many contexts this standard economic advice is implemented. Monetary incentives are, for example, used to enhance performance at workplace or to increase health-related behavior. However, the fundamental positive impact of monetary incentives has been questioned by psychologists as well as behavioral economists during the last decade, arguing that monetary incentives can sometimes even backfire. In this chapter, studies from proponents as well as opponents of monetary incentives will be presented. Specifically, the impact of monetary incentives on performance, prosocial, and health behavior will be discussed. Furthermore, variables determining whether incentives have a positive or negative impact will be identified. © 2016 Elsevier B.V. All rights reserved.

Substitution of healthy for unhealthy beverages among college students. A health-concerns and behavioral-economics perspective.

PubMed

Yang, Chao-Chin; Chiou, Wen-Bin

2010-06-01

Excessive intake of sugar-sweetened beverages by undergraduates is closely related to the increasing prevalence of obesity, making investigations of the substitution of healthy for unhealthy beverages imperative. According to the concept of price elasticity in behavioral economics, the choice of healthy over unhealthy behaviors is facilitated by increasing the cost of less-healthy alternatives or reducing the cost of healthier alternatives. Furthermore, evoking health concerns by using health claims may induce substitution of healthy for unhealthy beverages. A total of 108 18-22-year-old undergraduates participated in a laboratory experiment and were given a certain amount of money and allowed to purchase a healthy beverage and a less-healthy beverage with or without receiving health claims. Increasing the price of a type of beverage was shown to reduce purchases of that beverage type and lead to substitution with the alternative type. Moreover, the effect of price elasticity on healthy beverage substitution was more pronounced when participants' health concerns were evoked. The results suggest that lowering the cost of alternative commodities and evoking health concerns by health-related claims would foster the substitution of healthier for unhealthy beverages among college students. Copyright 2010 Elsevier Ltd. All rights reserved.

What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions.

PubMed

Iribarren, Sarah J; Cato, Kenrick; Falzon, Louise; Stone, Patricia W

2017-01-01

Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62-100, STD 14.18) and the top quartile reported 91.3-100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of intervention effectiveness of a health

Understanding consumer decisions using behavioral economics.

PubMed

Zandstra, Elizabeth H; Miyapuram, Krishna P; Tobler, Philippe N

2013-01-01

Consumers make many decisions in everyday life involving finances, food, and health. It is known from behavioral economics research that people are often driven by short-term gratification, that is, people tend to choose the immediate, albeit smaller reward. But choosing the delayed reward, that is, delaying the gratification, can actually be beneficial. How can we motivate consumers to resist the "now" and invest in their future, leading to sustainable or healthy habits? We review recent developments from behavioral and neuroimaging studies that are relevant for understanding consumer decisions. Further, we present results from our field research that examined whether we can increase the perceived value of a (delayed) environmental benefit using tailored communication, that is, change the way it is framed. More specifically, we investigated whether we can boost the value of an abstract, long-term "green" claim of a product by expressing it as a concrete, short-term benefit. This is a new application area for behavioral economics. Copyright © 2013 Elsevier B.V. All rights reserved.

THE HEALTH EFFECTS OF ECONOMIC DECLINE

PubMed Central

Catalano, Ralph; Goldman-Mellor, Sidra; Saxton, Katherine; Margerison-Zilko, Claire; Subbaraman, Meenakshi; LeWinn, Kaja; Anderson, Elizabeth

2013-01-01

The recent recession and lingering high unemployment will likely lead to a burst of research studying the health effects of economic decline. We aim to inform that work by summarizing empirical research concerned with those effects. We separate the studies into groups defined by questions asked, mechanisms invoked, and outcomes studied. We conclude that although much research shows that undesirable job and financial experiences increase the risk of psychological and behavioral disorder, many other suspected associations remain poorly studied or unsupported. The intuition that mortality increases when the economy declines, for example, appears wrong. We note that the research informs public health programming by identifying risk factors, such as job loss, made more frequent by economic decline. The promise that the research would identify health costs and benefits of economic policy choices, however, remains unfulfilled and will likely remain so without stronger theory and greater methodological agreement. PMID:21054175

Presenting quality data to vulnerable groups: charts, summaries or behavioral economic nudges?

PubMed

Elbel, Brian; Gillespie, Colleen; Raven, Maria C

2014-07-01

Despite the increased focus on health care consumers' active choice, not enough is known about how to best facilitate the choice process. We sought to assess methods of improving this process for vulnerable consumers in the United States by testing alternatives that emphasize insights from behavioral economics, or 'nudges'. We performed a hypothetical choice experiment where subjects were randomized to one of five experimental conditions and asked to choose a health center (location where they would receive all their care). The conditions presented the same information about health centers in different ways, including graphically as a chart, via written summary and using behavioral economics, 'nudging' consumers toward particular choices. We hypothesized that these 'nudges' might help simplify the choice process. Our primary outcomes focused on the health center chosen and whether consumers were willing to accept 'nudges'. We found that consumer choice was influenced by the method of presentation and the majority of consumers accepted the health center they were 'nudged' towards. Consumers were accepting of choices grounded in insights from behavioral economics and further consideration should be given to their role in patient choice. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Health economic choices in old age: interdisciplinary perspectives on economic decisions and the aging mind.

PubMed

Nielsen, Lisbeth; Phillips, John W R

2008-01-01

This chapter offers an integrative review of psychological and neurobiological differences between younger and older adults that might impact economic behavior. Focusing on key health economic challenges facing the elderly, it offers perspectives on how these psychological and neurobiological factors may influence decision-making over the life course and considers future interdisciplinary research directions. We review relevant literature from three domains that are essential for developing a comprehensive science of decision-making and economic behavior in aging (psychology, neuroscience, and economics), consider implications for prescription drug coverage and long-term care (LTC) insurance, and highlight future research directions. Older adults face many complex economic decisions that directly affect their health and well-being, including LTC insurance, prescription drug plans, and end of life care. Economic research suggests that many older Americans are not making cost-effective and economically rational decisions. While economic models provide insight into some of the financial incentives associated with these decisions, they typically do not consider the roles of cognition and affect in decision-making. Research has established that older age is associated with predictable declines in many cognitive functions and evidence is accumulating that distinct social motives and affect-processing profiles emerge in older age. It is unknown how these age differences impact the economic behaviors of older people and implies opportunities for path-breaking interdisciplinary research. Our chapter looks to develop interdisciplinary research to better understand the causes and consequences of age-related changes in economic decision-making and guide interventions to improve public programs and overall social welfare.

Socioeconomic Disparities in Health Behaviors

PubMed Central

Pampel, Fred C.; Krueger, Patrick M.; Denney, Justin T.

2011-01-01

The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms. PMID:21909182

What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

PubMed Central

Cato, Kenrick; Falzon, Louise; Stone, Patricia W.

2017-01-01

Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of

HIT: time to end behavioral health discrimination.

PubMed

Rosenberg, Linda

2012-10-01

While the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009, provided $20.6 billion for incentive payments to support the adoption and meaningful use of health information technology (HIT), behavioral health organizations were not eligible to receive facility payments. The consequences of excluding behavioral health from HIT incentive payments are found in the results of the "HIT Adoption and Meaningful Use Readiness in Community Behavioral Health" survey. The survey found that only 2% of community behavioral health organizations are able to meet federal meaningful use (MU) requirements-compare this to the 27% of Federally Qualified Health Centers and 20% of hospitals that already meet some level of MU requirements. Behavioral health organizations, serving more than eight million adults, children, and families with mental illnesses and addiction disorders, are ready and eager to adopt HIT to meet the goals of better healthcare, better health, and lower costs. But reaching these goals may prove impossible unless behavioral health achieves "parity" within healthcare and receives resources for the adoption of HIT.

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations

PubMed Central

Hommel, Kevin A.

2016-01-01

Objective Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. Methods A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. Results All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Conclusions Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. PMID:26359311

Low self-esteem during adolescence predicts poor health, criminal behavior, and limited economic prospects during adulthood.

PubMed

Trzesniewski, Kali H; Donnellan, M Brent; Moffitt, Terrie E; Robins, Richard W; Poulton, Richie; Caspi, Avshalom

2006-03-01

Using prospective data from the Dunedin Multidisciplinary Health and Development Study birth cohort, the authors found that adolescents with low self-esteem had poorer mental and physical health, worse economic prospects, and higher levels of criminal behavior during adulthood, compared with adolescents with high self-esteem. The long-term consequences of self-esteem could not be explained by adolescent depression, gender, or socioeconomic status. Moreover, the findings held when the outcome variables were assessed using objective measures and informant reports; therefore, the findings cannot be explained by shared method variance in self-report data. The findings suggest that low self-esteem during adolescence predicts negative real-world consequences during adulthood. Copyright (c) 2006 APA, all rights reserved.

Health economics education in undergraduate medical training: introducing the health economics education (HEe) website.

PubMed

Oppong, Raymond; Mistry, Hema; Frew, Emma

2013-09-13

In the UK, the General Medical Council clearly stipulates that upon completion of training, medical students should be able to discuss the principles underlying the development of health and health service policy, including issues relating to health economics. In response, researchers from the UK and other countries have called for a need to incorporate health economics training into the undergraduate medical curricula. The Health Economics education website was developed to encourage and support teaching and learning in health economics for medical students. It was designed to function both as a forum for teachers of health economics to communicate and to share resources and also to provide instantaneous access to supporting literature and teaching materials on health economics. The website provides a range of free online material that can be used by both health economists and non-health economists to teach the basic principles of the discipline. The Health Economics education website is the only online education resource that exists for teaching health economics to medical undergraduate students and it provides teachers of health economics with a range of comprehensive basic and advanced teaching materials that are freely available. This article presents the website as a tool to encourage the incorporation of health economics training into the undergraduate medical curricula.

Health economics education in undergraduate medical training: introducing the health economics education (HEe) website

PubMed Central

2013-01-01

In the UK, the General Medical Council clearly stipulates that upon completion of training, medical students should be able to discuss the principles underlying the development of health and health service policy, including issues relating to health economics. In response, researchers from the UK and other countries have called for a need to incorporate health economics training into the undergraduate medical curricula. The Health Economics education website was developed to encourage and support teaching and learning in health economics for medical students. It was designed to function both as a forum for teachers of health economics to communicate and to share resources and also to provide instantaneous access to supporting literature and teaching materials on health economics. The website provides a range of free online material that can be used by both health economists and non-health economists to teach the basic principles of the discipline. The Health Economics education website is the only online education resource that exists for teaching health economics to medical undergraduate students and it provides teachers of health economics with a range of comprehensive basic and advanced teaching materials that are freely available. This article presents the website as a tool to encourage the incorporation of health economics training into the undergraduate medical curricula. PMID:24034906

Behavioral economics and empirical public policy.

PubMed

Hursh, Steven R; Roma, Peter G

2013-01-01

The application of economics principles to the analysis of behavior has yielded novel insights on value and choice across contexts ranging from laboratory animal research to clinical populations to national trends of global impact. Recent innovations in demand curve methods provide a credible means of quantitatively comparing qualitatively different reinforcers as well as quantifying the choice relations between concurrently available reinforcers. The potential of the behavioral economic approach to inform public policy is illustrated with examples from basic research, pre-clinical behavioral pharmacology, and clinical drug abuse research as well as emerging applications to public transportation and social behavior. Behavioral Economics can serve as a broadly applicable conceptual, methodological, and analytical framework for the development and evaluation of empirical public policy. © Society for the Experimental Analysis of Behavior.

Adolescent Health Problems: Behavioral Perspectives. Advances in Pediatric Psychology.

ERIC Educational Resources Information Center

Wallander, Jan L., Ed.; Siegel, Lawrence J., Ed.

This book examines the relationship between adolescent risk-taking behaviors and health. The health-related problems of adolescents frequently are manifestations of social, economic, or behavioral factors. Following an overview (Siegal), the chapters in the first section of the book explore general and conceptual issues: (1) "Epidemiology of…

Family Economic Security Policies and Child and Family Health.

PubMed

Spencer, Rachael A; Komro, Kelli A

2017-03-01

In this review, we examine the effects of family economic security policies (i.e., minimum wage, earned income tax credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the USA, and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies, and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child well-being. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and well-being.

Family Economic Security Policies and Child and Family Health

PubMed Central

Spencer, Rachael A.; Komro, Kelli A.

2017-01-01

In this review we examine the effects of family economic security policies (i.e., minimum wage, Earned Income Tax Credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the U.S., and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child wellbeing. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and wellbeing. PMID:28176020

Evaluating Behavioral Economic Models of Heavy Drinking Among College Students.

PubMed

Acuff, Samuel F; Soltis, Kathryn E; Dennhardt, Ashley A; Berlin, Kristoffer S; Murphy, James G

2018-05-14

Heavy drinking among college students is a significant public health concern that can lead to profound social and health consequences, including alcohol use disorder. Behavioral economics posits that low future orientation and high valuation of alcohol (alcohol demand) combined with deficits in alternative reinforcement increase the likelihood of alcohol misuse (Bickel et al., 2011). Despite this, no study has examined the incremental utility of all three variables simultaneously in a comprehensive model METHOD: The current study uses structural equation modeling to test the associations between behavioral economic variables - alcohol demand (latent), future orientation (measured with a delay discounting task and the Consideration of Future Consequences (CFC) scale), and proportionate substance-related reinforcement - and alcohol consumption and problems among 393 heavy drinking college students. Two models are tested: 1) an iteration of the reinforcer pathology model that includes an interaction between future orientation and alcohol demand; and 2) an alternative model evaluating the interconnectedness of behavioral economic variables in predicting problematic alcohol use RESULTS: The interaction effects in model 1 were nonsignificant. Model 2 suggests that greater alcohol demand and proportionate substance-related reinforcement is associated with greater alcohol consumption and problems. Further, CFC was associated with alcohol-related problems and lower proportionate substance-related reinforcement but was not significantly associated with alcohol consumption or alcohol demand. Finally, greater proportionate substance-related reinforcement was associated with greater alcohol demand CONCLUSIONS: Our results support the validity of the behavioral economic reinforcer pathology model as applied to young adult heavy drinking. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Work stress and health risk behavior.

PubMed

Siegrist, Johannes; Rödel, Andreas

2006-12-01

This contribution discusses current knowledge of associations between psychosocial stress at work and health risk behavior, in particular cigarette smoking, alcohol consumption and overweight, by reviewing findings from major studies in the field published between 1989 and 2006. Psychosocial stress at work is measured by the demand-control model and the effort-reward imbalance model. Health risk behavior was analyzed in the broader context of a health-related Western lifestyle with socially and economically patterned practices of consumption. Overall, the review, based on 46 studies, only modestly supports the hypothesis of a consistent association between work stress and health risk behavior. The relatively strongest relationships have been found with regard to heavy alcohol consumption among men, overweight, and the co-manifestation of several risks. Suggestions for further research are given, and the need to reduce stressful experience in the framework of worksite health promotion programs is emphasized.

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

PubMed

Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

2016-01-19

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

Links between Socio-Economic Circumstances and Changes in Smoking Behavior in the Mexican Population: 2002–2010

PubMed Central

Beltrán-Sánchez, HIRAM; Thomas, DUNCAN; Teruel, GRACIELA; Wheaton, FELICIA; Crimmins, EILEEN M.

2013-01-01

While deleterious consequences of smoking on health have been widely publicized, in many developing countries, smoking prevalence is high and increasing. Little is known about the dynamics underlying changes in smoking behavior. This paper examines socio-economic and demographic characteristics associated with smoking initiation and quitting in Mexico between 2002 and 2010. In addition to the influences of age, gender, education, household economic resources and location of residence, changes in marital status, living arrangements and health status are examined. Drawing data from the Mexican Family Life Survey, a rich population-based longitudinal study of individuals, smoking behavior of individuals in 2002 is compared with their behavior in 2010. Logistic models are used to examine socio-demographic and health factors that are associated with initiating and quitting smoking. There are three main findings. First, part of the relationship between education and smoking reflects the role of economic resources. Second, associations of smoking with education and economic resources differ for females and males. Third, there is considerable heterogeneity in the factors linked to smoking behavior in Mexico indicating that the smoking epidemic may be at different stages in different population subgroups. Mexico has recently implemented fiscal policies and public health campaigns aimed at reducing smoking prevalence and discouraging smoking initiation. These programs are likely to be more effective if they target particular socio-economic and demographic sub-groups. PMID:23888371

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations.

PubMed

McGrady, Meghan E; Hommel, Kevin A

2016-09-01

Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs. A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted. All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs. Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Economic Holobiont: Influence of Parasites, Microbiota and Chemosignals on Economic Behavior

PubMed Central

Houdek, Petr

2018-01-01

The article is a perspective on utilization of microorganisms and chemosignals in studying human economic behavior. Research in biological roots of economic development has already confirmed that parasitic pressure influenced the creation and development of cultural norms and institutions. However, other effects of microorganisms on human groups and individual decision-making and behavior are heavily understudied. The perspective discusses how parasitic infections, sexually transmitted organisms and microbiota (i.e., “human holobiont”) could causally influence risk-seeking behavior, impulsivity, social dominance, empathy, political views and gender differences. As a case study, the parasite Toxoplasma gondii and its influence on economic preferences, personal characteristics and human appearance are examined. I also briefly review how chemosignals influence decision-making, particularly in the social preferences domain. I mention some predictions that arise from the paradigm of economic holobiont for the economic science. The conclusion summarizes limitations of the discussed findings and the stated speculations. PMID:29765310

[Fostering of health economics in Germany].

PubMed

Ulrich, V

2012-05-01

Health economics is now well established in Germany with the aim to apply economic tools to answer problems in health and health care. After a short review of the international development of health economics and the development in Germany in particular, the article looks at selected recent topics of health economic analysis in Germany (economic evaluation, industrial economics, health and education).

Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review.

PubMed

McGill, Bronwyn; O'Hara, Blythe J; Bauman, Adrian; Grunseit, Anne C; Phongsavan, Philayrath

2018-01-01

To identify the behavioral economics (BE) conceptual underpinnings of lifestyle financial incentive (FI) interventions. A mapping review of peer-reviewed literature was conducted by searching electronic databases. Inclusion criteria were real-world FI interventions explicitly mentioning BE, targeting individuals, or populations with lifestyle-related behavioral outcomes. Exclusion criteria were hypothetical studies, health professional focus, clinically oriented interventions. Study characteristics were tabulated according to purpose, categorization of BE concepts and FI types, design, outcome measures, study quality, and findings. Data Synthesis and Analysis: Financial incentives were categorized according to type and payment structure. Behavioral economics concepts explicitly used in the intervention design were grouped based on common patterns of thinking. The interplay between FI types, BE concepts, and outcome was assessed. Seventeen studies were identified from 1452 unique records. Analysis showed 76.5% (n = 13) of studies explicitly incorporated BE concepts. Six studies provided clear theoretical justification for the inclusion of BE. No pattern in the type of FI and BE concepts used was apparent. Not all FI interventions claiming BE inclusion did so. For interventions that explicitly included BE, the degree to which this was portrayed and woven into the design varied. This review identified BE concepts common to FI interventions, a first step in providing emergent and pragmatic information to public health and health promotion program planners.

Empathy promotes altruistic behavior in economic interactions

PubMed Central

Klimecki, Olga M.; Mayer, Sarah V.; Jusyte, Aiste; Scheeff , Jonathan; Schönenberg, Michael

2016-01-01

What are the determinants of altruism? While economists assume that altruism is mainly driven by fairness norms, social psychologists consider empathy to be a key motivator for altruistic behavior. To unite these two theories, we conducted an experiment in which we compared behavior in a standard economic game that assesses altruism (the so-called Dictator Game) with a Dictator Game in which participants’ behavioral choices were preceded either by an empathy induction or by a control condition without empathy induction. The results of this within-subject manipulation show that the empathy induction substantially increased altruistic behavior. Moreover, the increase in experienced empathy predicted over 40% of the increase in sharing behavior. These data extend standard economic theories that altruism is based on fairness considerations, by showing that empathic feelings can be a key motivator for altruistic behavior in economic interactions. PMID:27578563

Health economics and health policy: experiences from New Zealand.

PubMed

Cumming, Jacqueline

2015-06-01

Health economics has had a significant impact on the New Zealand health system over the past 30 years. In this paper, I set out a framework for thinking about health economics, give some historical background to New Zealand and the New Zealand health system, and discuss examples of how health economics has influenced thinking about the organisation of the health sector and priority setting. I conclude the paper with overall observations about the role of health economics in health policy in New Zealand, also identifying where health economics has not made the contribution it could and where further influence might be beneficial.

The role of behavioral economics and behavioral decision making in Americans' retirement savings decisions.

PubMed

Knoll, Melissa A Z

2010-01-01

Traditional economic theory posits that people make decisions by maximizing a utility function in which all of the relevant constraints and preferences are included and weighed appropriately. Behavioral economists and decision-making researchers, however, are interested in how people make decisions in the face of incomplete information, limited cognitive resources, and decision biases. Empirical findings in the areas of behavioral economics and judgment and decision making (JDM) demonstrate departures from the notion that man is economically rational, illustrating instead that people often act in ways that are economically suboptimal. This article outlines findings from the JDM and behavioral-economics literatures that highlight the many behavioral impediments to saving that individuals may encounter on their way to financial security. I discuss how behavioral and psychological issues, such as self-control, emotions, and choice architecture can help policymakers understand what factors, aside from purely economic ones, may affect individuals' savings behavior.

Nutrition economics - characterising the economic and health impact of nutrition.

PubMed

Lenoir-Wijnkoop, I; Dapoigny, M; Dubois, D; van Ganse, E; Gutiérrez-Ibarluzea, I; Hutton, J; Jones, P; Mittendorf, T; Poley, M J; Salminen, S; Nuijten, M J C

2011-01-01

There is a new merging of health economics and nutrition disciplines to assess the impact of diet on health and disease prevention and to characterise the health and economic aspects of specific changes in nutritional behaviour and nutrition recommendations. A rationale exists for developing the field of nutrition economics which could offer a better understanding of both nutrition, in the context of having a significant influence on health outcomes, and economics, in order to estimate the absolute and relative monetary impact of health measures. For this purpose, an expert meeting assessed questions aimed at clarifying the scope and identifying the key issues that should be taken into consideration in developing nutrition economics as a discipline that could potentially address important questions. We propose a first multidisciplinary outline for understanding the principles and particular characteristics of this emerging field. We summarise here the concepts and the observations of workshop participants and propose a basic setting for nutrition economics and health outcomes research as a novel discipline to support nutrition, health economics and health policy development in an evidence and health-benefit-based manner.

Behavioral Economics Applied to Energy Demand Analysis: A Foundation

EIA Publications

2014-01-01

Neoclassical economics has shaped our understanding of human behavior for several decades. While still an important starting point for economic studies, neoclassical frameworks have generally imposed strong assumptions, for example regarding utility maximization, information, and foresight, while treating consumer preferences as given or external to the framework. In real life, however, such strong assumptions tend to be less than fully valid. Behavioral economics refers to the study and formalizing of theories regarding deviations from traditionally-modeled economic decision-making in the behavior of individuals. The U.S. Energy Information Administration (EIA) has an interest in behavioral economics as one influence on energy demand.

The behavioral economics of violence.

PubMed

Rachlin, Howard

2004-12-01

From the viewpoint of teleological behaviorism the first question to ask in attempting to understand any behavior, including violent behavior, is: What are its contingencies of reward and punishment? Or, to put the question in economic terms: What are the short-term and long-term costs and benefits that such behavior entails? Let us therefore consider the costs and benefits of youth violence. Among the short-term costs of violent behavior are the physical effort of the act, the possibility of immediate physical retaliation, immediate social disapproval, and the opportunity cost of other social acts that the violent behavior takes the place of (you can't be affectionate and violent at the same time, for instance). Among the immediate benefits of violent behavior are the intrinsic satisfaction of the violent act itself and any extrinsic benefit; if A violently appropriates B's new sneakers then obtaining the sneakers reinforces A's violence. These immediate benefits may well outweigh the costs in many contexts. Among the long-term costs of violent behavior are delayed retaliation, possible social disapproval and loss of social support, rejection from a social group, job loss, and health risks associated with a violent lifestyle. Among the long-term benefits are long-term intimidation of others (your neighbor is less likely to build a fence on your property if you have a reputation for violence), and a possibly exciting lifestyle. These long-term benefits may well be outweighed by the long-term costs. Opposition of long-term net costs to short-term net benefits, where it exists, creates a personal self-control trap: Overall satisfaction may decrease monotonically with rate of the target behavior but, regardless of its rate, the immediate satisfaction of doing it is always higher than that of not doing it. In the case of violent behavior, this trap is exacerbated by the fact that as a person's violence increases, net immediate reinforcement also increases (due to

Behavioral Economic Factors Related to Pediatric Obesity

PubMed Central

Greenwald, Mark K.

2016-01-01

Summary The field of behavioral economics suggests that food and activity choices are governed by costs, available alternatives, and reinforcement. Here, we review basic and translational research using a behavioral economic (BE) framework with overweight or obese children up to age 18. We address BE concepts and methods, discuss developmental issues, the continuum of BE intervention approaches, findings of studies focused on increasing the cost of unwanted behaviors (i.e., energy-dense food intake and sedentary behavior) and decreasing the cost of desired behaviors (i.e., healthy food intake and PA), and our team's recent basic behavioral studies using BE approaches with minority adolescents. PMID:27261543

[Clinical and health economic challenges of personalized medicine].

PubMed

Brüggenjürgen, B; Kornbluth, L; Ferrara, J V; Willich, S N

2012-05-01

Healthcare systems across the globe are currently challenged by aging populations, increases in chronic diseases and the difficult task of managing a healthcare budget. In this health economic climate, personalized medicine promises not only an improvement in healthcare delivery but also the possibility of more cost-effective therapies. It is important to remember, however, that personalized medicine has the potential to both increase and decrease costs. Each targeted therapy must be evaluated individually. However, standard clinical trial design is not suitable for personalized therapies. Therefore, both scientists and regulatory authorities will need to accept innovative study designs in order to validate personalized therapies. Hence correct economic evaluations are difficult to carry out due to lack of clear clinical evidence, longitudinal accounting and experience with patient/clinician behavior in the context of personalized medicine. In terms of reimbursement, payers, pharmaceutical companies and companion diagnostic manufacturers will also need to explore creative risk-sharing concepts. Germany is no exception to the challenges that face personalized medicine and for personalized medicine to really become the future of medicine many health economic challenges first need to be overcome. The health economic implications of personalized medicine remain unclear but it is certain that the expansion of targeted therapies in current healthcare systems will create a host of challenges.

Health economics--concepts and conceptual problems.

PubMed

Satpathy, S K; Bansal, R D

1982-01-01

Awareness of the economic manifestation of health and diseases and the limited resources allocated to health care services has brought to the focus a new discipline - health economics. Cost accounting, cost benefit, cost effectiveness methods etc. are increasingly becoming an integral part of the health management and evaluation of health programmes. Various concepts and problems relating to health economics are discussed in the present paper. More efforts should be made to conduct health economic studies in hospitals and health centres by which the process of standardisation of the concepts, would be easier. Health economics should also find its due place in the medical curriculum.

Economic Evaluation of Pharmaco- and Behavioral Therapies for Smoking Cessation: A Critical and Systematic Review of Empirical Research

PubMed Central

Ruger, Jennifer Prah; Lazar, Christina M.

2014-01-01

Economic evaluations are an important tool to improve our understanding of the costs and effects of health care services and to create sustainable health care systems. This article critically assesses empirical evidence from economic evaluations of pharmaco- and behavioral therapies for smoking cessation. A comprehensive literature review of PubMed and the British National Health Service Economic Evaluation Database was conducted. The search identified 15 articles on nicotine-based pharmacotherapies, 12 articles on nonnicotine based pharmacotherapies, no articles on selegiline, and 10 articles on brief counseling for smoking cessation treatment. Results show that both pharmaco- and behavioral therapies for smoking cessation are cost-effective or even cost-saving. The review highlights several shortcomings in methodology and a lack of standardization of current economic evaluations. Efforts to improve methodology will help make future studies more comparable and increase the evidence base so that such evaluations can be more useful to public health practitioners and policy makers. PMID:22224889

Economic Recession and Obesity-Related Internet Search Behavior in Taiwan: Analysis of Google Trends Data.

PubMed

Wang, Ho-Wei; Chen, Duan-Rung

2018-04-06

Obesity is highly correlated with the development of chronic diseases and has become a critical public health issue that must be countered by aggressive action. This study determined whether data from Google Trends could provide insight into trends in obesity-related search behaviors in Taiwan. Using Google Trends, we examined how changes in economic conditions-using business cycle indicators as a proxy-were associated with people's internet search behaviors related to obesity awareness, health behaviors, and fast food restaurants. Monthly business cycle indicators were obtained from the Taiwan National Development Council. Weekly Taiwan Stock Exchange (TWSE) weighted index data were accessed and downloaded from Yahoo Finance. The weekly relative search volumes (RSV) of obesity-related terms were downloaded from Google Trends. RSVs of obesity-related terms and the TWSE from January 2007 to December 2011 (60 months) were analyzed using correlation analysis. During an economic recession, the RSV of obesity awareness and health behaviors declined (r=.441, P<.001; r=.593, P<.001, respectively); however, the RSV for fast food restaurants increased (r=-.437, P<.001). Findings indicated that when the economy was faltering, people tended to be less likely to search for information related to health behaviors and obesity awareness; moreover, they were more likely to search for fast food restaurants. Macroeconomic conditions can have an impact on people's health-related internet searches. ©Ho-Wei Wang, Duan-Rung Chen. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 06.04.2018.

Socio-economic Aspects of Health-Related Behaviors and Their Dynamics: A Case Study for the Netherlands

PubMed Central

Rezayatmand, Reza; Pavlova, Milena; Groot, Wim

2016-01-01

Background: Previous studies have mostly focused on socio-demographic and health-related determinants of health-related behaviors. Although comprehensive health insurance coverage could discourage individual lifestyle improvement due to the ex-ante moral hazard problem, few studies have examined such effects. This study examines the association of a comprehensive set of factors including socio-demographic, health status, health insurance, and perceived change in health insurance coverage with health-related behaviors and their dynamics (ie, changes in behavior). Methods: Using Survey of Health, Aging, and Retirement in Europe (SHARE) data (a European aging survey among 50+ years old) for the Netherlands in 2004 and 2007 (sample size: 1745), binary and multinomial logit models are employed to study health-related behaviors (daily smoking, excessive alcohol use, and physical inactivity in 2004) and their corresponding changes (stopping or starting unhealthy behavior between 2004 and 2007). Results: Our findings show that being older, being female, having higher education and living with a partner increase the likelihood not to be a daily smoker or to stop daily smoking. At the same time, being older (OR = 3.02 [1.31, 6.95]) and being female (OR = 1.77 [1.05, 2.96]) increases the likelihood to be or to become physically inactive. We also find that worse perceived health insurance coverage in 2007 is associated with a lower likelihood (OR = 0.19 [0.06, 0.57]) of stopping excessive alcohol use in that year. However, we do not find a strong association between the type of health insurance and health behavior. Conclusion: Our findings show that all above mentioned factors (ie, socio-demographic and health status factors) are associated with health-related behavior but not in a consistent way across all behaviors. Moreover, the dynamics of each behavior (positive or negative change) is not necessarily determined by the same factors that determine the state of that behavior

Predictors of the Health-Promoting Behaviors of Nepalese Migrant Workers.

PubMed

Bhandari, Pratibha; Kim, MiYoung

2016-09-01

Health-promoting behaviors assist individuals to prevent disease, promote health, increase longevity, and enjoy a better quality of life. A number of interpersonal, social, and environmental factors have been shown to influence health-promoting behaviors. Little empirical evidence exists about the predictors of health-promoting behaviors among migrant workers. This study uses Pender's health promotion model to describe and identify the predictors of health-promoting behaviors in Nepalese migrant workers in Korea. A cross-sectional research design was used. Nepalese migrants who had been working in South Korea (n = 169) for over 6 months were surveyed between July and December 2012. Self-efficacy was measured using the Perceived Health Competence Scale, the Health-Promoting Lifestyle Profile II was used to measure health-promoting lifestyle behaviors, and perceived health status was measured using a single-item question. Descriptive statistics, correlation analysis, and multiple regression analysis were used to analyze data. Spiritual activity was the highest reported health-promoting behavior, whereas physical activity was the least practiced behavior. Self-efficacy was the only significant predictor of health-promoting behavior. The results of this study suggest that future health-promoting interventions should enhance the self-efficacy of target populations for individual health behaviors. Factors such as working conditions, culture, and economic background that may affect the health-promoting behaviors of migrant workers must be considered when planning nursing interventions. Multicultural nursing structures and policies are needed to reach out proactively to all adult migrant groups.

Maximization, learning, and economic behavior

PubMed Central

Erev, Ido; Roth, Alvin E.

2014-01-01

The rationality assumption that underlies mainstream economic theory has proved to be a useful approximation, despite the fact that systematic violations to its predictions can be found. That is, the assumption of rational behavior is useful in understanding the ways in which many successful economic institutions function, although it is also true that actual human behavior falls systematically short of perfect rationality. We consider a possible explanation of this apparent inconsistency, suggesting that mechanisms that rest on the rationality assumption are likely to be successful when they create an environment in which the behavior they try to facilitate leads to the best payoff for all agents on average, and most of the time. Review of basic learning research suggests that, under these conditions, people quickly learn to maximize expected return. This review also shows that there are many situations in which experience does not increase maximization. In many cases, experience leads people to underweight rare events. In addition, the current paper suggests that it is convenient to distinguish between two behavioral approaches to improve economic analyses. The first, and more conventional approach among behavioral economists and psychologists interested in judgment and decision making, highlights violations of the rational model and proposes descriptive models that capture these violations. The second approach studies human learning to clarify the conditions under which people quickly learn to maximize expected return. The current review highlights one set of conditions of this type and shows how the understanding of these conditions can facilitate market design. PMID:25024182

Maximization, learning, and economic behavior.

PubMed

Erev, Ido; Roth, Alvin E

2014-07-22

The rationality assumption that underlies mainstream economic theory has proved to be a useful approximation, despite the fact that systematic violations to its predictions can be found. That is, the assumption of rational behavior is useful in understanding the ways in which many successful economic institutions function, although it is also true that actual human behavior falls systematically short of perfect rationality. We consider a possible explanation of this apparent inconsistency, suggesting that mechanisms that rest on the rationality assumption are likely to be successful when they create an environment in which the behavior they try to facilitate leads to the best payoff for all agents on average, and most of the time. Review of basic learning research suggests that, under these conditions, people quickly learn to maximize expected return. This review also shows that there are many situations in which experience does not increase maximization. In many cases, experience leads people to underweight rare events. In addition, the current paper suggests that it is convenient to distinguish between two behavioral approaches to improve economic analyses. The first, and more conventional approach among behavioral economists and psychologists interested in judgment and decision making, highlights violations of the rational model and proposes descriptive models that capture these violations. The second approach studies human learning to clarify the conditions under which people quickly learn to maximize expected return. The current review highlights one set of conditions of this type and shows how the understanding of these conditions can facilitate market design.

A review of economic evaluations of behavior change interventions: setting an agenda for research methods and practice.

PubMed

Alayli-Goebbels, Adrienne F G; Evers, Silvia M A A; Alexeeva, Daria; Ament, André J H A; de Vries, Nanne K; Tilly, Jan C; Severens, Johan L

2014-06-01

The objective of this study was to review methodological quality of economic evaluations of lifestyle behavior change interventions (LBCIs) and to examine how they address methodological challenges for public health economic evaluation identified in the literature. Pubmed and the NHS economic evaluation database were searched for published studies in six key areas for behavior change: smoking, physical activity, dietary behavior, (illegal) drug use, alcohol use and sexual behavior. From included studies (n = 142), we extracted data on general study characteristics, characteristics of the LBCIs, methodological quality and handling of methodological challenges. Economic evaluation evidence for LBCIs showed a number of weaknesses: methods, study design and characteristics of evaluated interventions were not well reported; methodological quality showed several shortcomings and progress with addressing methodological challenges remained limited. Based on the findings of this review we propose an agenda for improving future evidence to support decision-making. Recommendations for practice include improving reporting of essential study details and increasing adherence with good practice standards. Recommendations for research methods focus on mapping out complex causal pathways for modeling, developing measures to capture broader domains of wellbeing and community outcomes, testing methods for considering equity, identifying relevant non-health sector costs and advancing methods for evidence synthesis. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Editorial: 3rd Special Issue on behavior change, health, and health disparities.

PubMed

Higgins, Stephen T

2016-11-01

This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of the Exclusion of Behavioral Health from Health Information Technology (HIT) Legislation on the Future of Integrated Health Care.

PubMed

Cohen, Deborah

2015-10-01

Past research has shown abundant comorbidity between physical chronic health conditions and mental illness. The focal point of the conversation to reduce cost is better care coordination through the implementation of health information technology (HIT). At the policy level, the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act) was implemented as a way to increase the implementation of HIT. However, behavioral health providers have been largely excluded from obtaining access to the funds provided by the HITECH Act. Without further intervention, disjointed care coordination between physical and behavioral health providers will continue.

Economic Recession and Obesity-Related Internet Search Behavior in Taiwan: Analysis of Google Trends Data

PubMed Central

2018-01-01

Background Obesity is highly correlated with the development of chronic diseases and has become a critical public health issue that must be countered by aggressive action. This study determined whether data from Google Trends could provide insight into trends in obesity-related search behaviors in Taiwan. Objective Using Google Trends, we examined how changes in economic conditions—using business cycle indicators as a proxy—were associated with people’s internet search behaviors related to obesity awareness, health behaviors, and fast food restaurants. Methods Monthly business cycle indicators were obtained from the Taiwan National Development Council. Weekly Taiwan Stock Exchange (TWSE) weighted index data were accessed and downloaded from Yahoo Finance. The weekly relative search volumes (RSV) of obesity-related terms were downloaded from Google Trends. RSVs of obesity-related terms and the TWSE from January 2007 to December 2011 (60 months) were analyzed using correlation analysis. Results During an economic recession, the RSV of obesity awareness and health behaviors declined (r=.441, P<.001; r=.593, P<.001, respectively); however, the RSV for fast food restaurants increased (r=−.437, P<.001). Findings indicated that when the economy was faltering, people tended to be less likely to search for information related to health behaviors and obesity awareness; moreover, they were more likely to search for fast food restaurants. Conclusions Macroeconomic conditions can have an impact on people’s health-related internet searches. PMID:29625958

[The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014].

PubMed

Cortès-Franch, Imma; González López-Valcárcel, Beatriz

2014-06-01

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Behavioral economics: "nudging" underserved populations to be screened for cancer.

PubMed

Purnell, Jason Q; Thompson, Tess; Kreuter, Matthew W; McBride, Timothy D

2015-01-15

Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice.

Systematic overview of economic evaluations of health-related rehabilitation.

PubMed

Howard-Wilsher, Stephanie; Irvine, Lisa; Fan, Hong; Shakespeare, Tom; Suhrcke, Marc; Horton, Simon; Poland, Fiona; Hooper, Lee; Song, Fujian

2016-01-01

Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered. To provide an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation. We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist. We included 64 SRs, most of which included economic evaluations alongside randomized controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n = 14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n = 24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioral, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4). Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study.

PubMed

Busch, Vincent; Van Stel, Henk F; Schrijvers, Augustinus J P; de Leeuw, Johannes R J

2013-12-04

Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial and physical health. These findings have

Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study

PubMed Central

2013-01-01

Background Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. Methods Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. Results Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. Conclusions The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial

Nutrition economics – characterising the economic and health impact of nutrition

PubMed Central

Lenoir-Wijnkoop, I.; Dapoigny, M.; Dubois, D.; van Ganse, E.; Gutiérrez-Ibarluzea, I.; Hutton, J.; Jones, P.; Mittendorf, T.; Poley, M. J.; Salminen, S.; Nuijten, M. J. C.

2011-01-01

There is a new merging of health economics and nutrition disciplines to assess the impact of diet on health and disease prevention and to characterise the health and economic aspects of specific changes in nutritional behaviour and nutrition recommendations. A rationale exists for developing the field of nutrition economics which could offer a better understanding of both nutrition, in the context of having a significant influence on health outcomes, and economics, in order to estimate the absolute and relative monetary impact of health measures. For this purpose, an expert meeting assessed questions aimed at clarifying the scope and identifying the key issues that should be taken into consideration in developing nutrition economics as a discipline that could potentially address important questions. We propose a first multidisciplinary outline for understanding the principles and particular characteristics of this emerging field. We summarise here the concepts and the observations of workshop participants and propose a basic setting for nutrition economics and health outcomes research as a novel discipline to support nutrition, health economics and health policy development in an evidence and health-benefit-based manner. PMID:20797310

Health economic assessment: a methodological primer.

PubMed

Simoens, Steven

2009-12-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments.

Health Economic Assessment: A Methodological Primer

PubMed Central

Simoens, Steven

2009-01-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments. PMID:20049237

Behavioral economics holds potential to deliver better results for patients, insurers, and employers.

PubMed

Loewenstein, George; Asch, David A; Volpp, Kevin G

2013-07-01

Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health. We show how these programs could be made more effective through the use of insights from behavioral economics. For example, incentive programs that offer patients small and frequent payments for behavior that would benefit the patients, such as medication adherence, can be more effective than programs with incentives that are far less visible because they are folded into a paycheck or used to reduce a monthly premium. Deploying more-nuanced insights from behavioral economics can lead to policies with the potential to increase patient engagement and deliver dividends for patients and favorable cost-effectiveness ratios for insurers, employers, and other relevant commercial entities.

Economic concepts for the analysis of behavior

PubMed Central

Hursh, Steven R.

1980-01-01

A review of the relationship between schedule of reinforcement, response rate, and choice suggests that certain unifying concepts from economics can contribute to a more complete science of behavior. Four points are made: 1) a behavioral experiment is an economic system and its characteristics—open or closed—can strongly determine the results; 2) reinforcers can be distinguished by a functional property called elasticity; 3) reinforcers may interact as complements as well as substitutes; 4) no simple choice rule, such as strict matching, can account for all choice behavior. PMID:16812188

Economic evaluations of eHealth technologies: A systematic review.

PubMed

Sanyal, Chiranjeev; Stolee, Paul; Juzwishin, Don; Husereau, Don

2018-01-01

Innovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults. We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors. This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.

When do financial incentives reduce intrinsic motivation? comparing behaviors studied in psychological and economic literatures.

PubMed

Promberger, Marianne; Marteau, Theresa M

2013-09-01

To review existing evidence on the potential of incentives to undermine or "crowd out" intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PsycINFO Database Record (c) 2013 APA, all rights reserved.

When Do Financial Incentives Reduce Intrinsic Motivation? Comparing Behaviors Studied in Psychological and Economic Literatures

PubMed Central

2013-01-01

Objective: To review existing evidence on the potential of incentives to undermine or “crowd out” intrinsic motivation, in order to establish whether and when it predicts financial incentives to crowd out motivation for health-related behaviors. Method: We conducted a conceptual analysis to compare definitions and operationalizations of the effect, and reviewed existing evidence to identify potential moderators of the effect. Results: In the psychological literature, we find strong evidence for an undermining effect of tangible rewards on intrinsic motivation for simple tasks when motivation manifest in behavior is initially high. In the economic literature, evidence for undermining effects exists for a broader variety of behaviors, in settings that involve a conflict of interest between parties. By contrast, for health related behaviors, baseline levels of incentivized behaviors are usually low, and only a subset involve an interpersonal conflict of interest. Correspondingly, we find no evidence for crowding out of incentivized health behaviors. Conclusion: The existing evidence does not warrant a priori predictions that an undermining effect would be found for health-related behaviors. Health-related behaviors and incentives schemes differ greatly in moderating characteristics, which should be the focus of future research. PMID:24001245

Economic Evaluation of Health IT.

PubMed

Luzi, Daniela; Pecoraro, Fabrizio; Tamburis, Oscar

2016-01-01

Economic evaluation in health care supports decision makers in prioritizing interventions and maximizing the available limited resources for social benefits. Health Information Technology (health IT) constitutes a promising strategy to improve the quality and delivery of health care. However, to determine whether the appropriate health IT solution has been selected in a specific health context, its impact on the clinical and organizational process, on costs, on user satisfaction as well as on patient outcomes, a rigorous and multidimensional evaluation analysis is necessary. Starting from the principles of evaluation introduced since the mid-1980s within the Health Technology Assessment (HTA) guidelines, this contribution provides an overview of the main challenging issues related to the complex task of performing an economic evaluation of health IT. A set of necessary key principles to deliver a proper design and implementation of a multidimensional economic evaluation study is described, focusing in particular on the classification of costs and outcomes as well as on the type of economic analysis to be performed. A case study is eventually described to show how the key principles introduced are applied.

Behavioral Economics and the Public Acceptance of Synthetic Biology.

PubMed

Oliver, Adam

2018-01-01

Different applications of synthetic biology are alike in that their possible negative consequences are highly uncertain, potentially catastrophic, and perhaps irreversible; therefore, they are also alike in that public attitudes about them are fertile ground for behavioral economic phenomena. Findings from behavioral economics suggest that people may not respond to such applications according to the normal rules of economic evaluation, by which the value of an outcome is multiplied by the mathematical probability that the outcome will occur. Possibly, then, synthetic biology applications challenge the normative postulates of the standard approach, too. I want to first consider how some of the phenomena described by behavioral economists-and behavioral scientists more broadly-might affect people's perceptions of the uncertainties associated with synthetic biology. My analysis will be far from complete, however, because behavioral economics is essentially the study of human behavior, and thus its reach is potentially vast and its development longstanding and ongoing. Nonetheless, I hope to give an indicative perspective on how some aspects of behavioral economics might affect the assessment and perceived acceptability of synthetic biology. I will then consider the issue of agency. Should policy-makers respect people's reactions to synthetic biology when those reactions are known to be driven by behavioral economic phenomena rather than following the normative postulates of rational choice theory? Or should policy-makers dismiss these reactions as inherently biased? I will argue that the normative force of these human reactions (probably) depends on phenomenon and context. © 2018 The Hastings Center.

Overutilization and underutilization of operating rooms - insights from behavioral health care operations management.

PubMed

Fügener, Andreas; Schiffels, Sebastian; Kolisch, Rainer

2017-03-01

The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons' behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

Editorial: 2nd Special Issue on behavior change, health, and health disparities.

PubMed

Higgins, Stephen T

2015-11-01

This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. Copyright © 2015 Elsevier Inc. All rights reserved.

When does "economic man" dominate social behavior?

PubMed

Camerer, Colin F; Fehr, Ernst

2006-01-06

The canonical model in economics considers people to be rational and self-regarding. However, much evidence challenges this view, raising the question of when "Economic Man" dominates the outcome of social interactions, and when bounded rationality or other-regarding preferences dominate. Here we show that strategic incentives are the key to answering this question. A minority of self-regarding individuals can trigger a "noncooperative" aggregate outcome if their behavior generates incentives for the majority of other-regarding individuals to mimic the minority's behavior. Likewise, a minority of other-regarding individuals can generate a "cooperative" aggregate outcome if their behavior generates incentives for a majority of self-regarding people to behave cooperatively. Similarly, in strategic games, aggregate outcomes can be either far from or close to Nash equilibrium if players with high degrees of strategic thinking mimic or erase the effects of others who do very little strategic thinking. Recently developed theories of other-regarding preferences and bounded rationality explain these findings and provide better predictions of actual aggregate behavior than does traditional economic theory.

Behavioral Economics: A New Lens for Understanding Genomic Decision Making.

PubMed

Moore, Scott Emory; Ulbrich, Holley H; Hepburn, Kenneth; Holaday, Bonnie; Mayo, Rachel; Sharp, Julia; Pruitt, Rosanne H

2018-05-01

This article seeks to take the next step in examining the insights that nurses and other healthcare providers can derive from applying behavioral economic concepts to support genomic decision making. As genomic science continues to permeate clinical practice, nurses must continue to adapt practice to meet new challenges. Decisions associated with genomics are often not simple and dichotomous in nature. They can be complex and challenging for all involved. This article offers an introduction to behavioral economics as a possible tool to help support patients', families', and caregivers' decision making related to genomics. Using current writings from nursing, ethics, behavioral economic, and other healthcare scholars, we review key concepts of behavioral economics and discuss their relevance to supporting genomic decision making. Behavioral economic concepts-particularly relativity, deliberation, and choice architecture-are specifically examined as new ways to view the complexities of genomic decision making. Each concept is explored through patient decision making and clinical practice examples. This article also discusses next steps and practice implications for further development of the behavioral economic lens in nursing. Behavioral economics provides valuable insight into the unique nature of genetic decision-making practices. Nurses are often a source of information and support for patients during clinical decision making. This article seeks to offer behavioral economic concepts as a framework for understanding and examining the unique nature of genomic decision making. As genetic and genomic testing become more common in practice, it will continue to grow in importance for nurses to be able to support the autonomous decision making of patients, their families, and caregivers. © 2018 Sigma Theta Tau International.

Economic globalization and oral health.

PubMed

Hobdell, M H

2001-05-01

To briefly review the origins of economic globalization and examine the evidence available concerning its possible impact on oral health. Based on Medline searches 1966-1999 and review of Health Wrights: Politics of Health database. SPECIFIC ORAL DISEASES: Dental caries, destructive periodontal diseases, cancrum oris and oral cancer. The reported growing disparity between rich and poor populations, both internationally and nationally, is arguably being exacerbated by economic globalization. Increasing levels of the above specific oral diseases might be attributed, in part, to this economic phenomenon.

Economic crisis and mental health.

PubMed

Uutela, Antti

2010-03-01

Literature from the past year was examined to learn whether economic recessions have an effect on mental disorders including depression and suicides. Economic recessions and crises have a context-dependent negative impact on mental health disorders. These appear in low-income and middle-income countries whereas some affluent countries are offering provisions that help unemployed persons to escape the detrimental consequences. The Asian economic crisis led to a sharp unemployment-related increase in suicide mortality in east Asian countries. In European Union countries rising unemployment was associated with significant short-term increases in premature deaths from intentional violence including suicides. It seems that active labour market programmes existing in some Organization for Economic Cooperation and Development countries can prevent some adverse health effects of economic downturns. As mental health consequences of economic crises are context dependent, the current situation needs monitoring. Enough services for those in need should be provided and advocacy for societal support measures is of great importance.

Economic theory and evidence on smoking behavior of adults.

PubMed

Sloan, Frank A; Wang, Yang

2008-11-01

To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework. A systematic review and appraisal of important theoretical and empirical economic studies on smoking. There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking. Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

[Advances and challenges in health economics].

PubMed

Pena, P H; Arredondo, A; Ortiz, C; Rosenthal, G

1995-08-01

Health economics is a specialized field of economic science that applies the economic perspective to the fields of health, the medical-industrial complex and health services. A brief review of the evolution of this speciality by subject, as well as the level achieved assessed in terms of generation, diffusion, reproduction and application of its specialized knowledge, is presented.

HIV Testing, Subjective Beliefs and Economic Behavior

PubMed Central

Thornton, Rebecca L.

2013-01-01

This paper examines the effects of learning HIV status on economic behavior among rural Malawians. According to economic life-cycle models, if learning HIV results is informative about additional years of life, being diagnosed HIV-positive or negative should predict changes in consumption, investment and savings behavior with important micro and macro-economic implications. Using an experiment that randomly assigned incentives to learn HIV results, I find that while learning HIV results had short term effects on subjective belief of HIV infection, these differences did not persist after two years. Consistent with this, there were relatively few differences two years later in savings, income, expenditures, and employment between those who learned and did not learn their status. PMID:24369439

Health-related economic costs of the Three-Mile Island accident.

PubMed

Hu, T W; Slaysman, K S

1984-01-01

On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident.

[Health and health-related behaviors according to sexual attraction and behavior].

PubMed

Pérez, Glòria; Martí-Pastor, Marc; Gotsens, Mercè; Bartoll, Xavier; Diez, Elia; Borrell, Carme

2015-01-01

to Describe perceived health, mental health and certain health-related behaviors according to sexual attraction and behavior in the population residing in Barcelona in 2011. Perceived health, mental health, chronic conditions and health-related behaviors were analyzed in 2675 people aged 15 to 64 years. The Barcelona Health Survey for 2011 was used, which included questions on sexual attraction and behavior. Multivariate robust Poisson regression models were fitted to obtain adjusted prevalence ratios. People feeling same-sex attraction reported a higher prevalence of worse perceived and mental health. These people and those who had had sex with persons of the same sex more frequently reported harmful health-related behaviors. Lesbian, gay, transgender and bisexual people may have health problems that should be explored in depth, prevented, and attended. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Exploring Outcomes to Consider in Economic Evaluations of Health Promotion Programs: What Broader Non-Health Outcomes Matter Most?

PubMed

Benning, Tim M; Alayli-Goebbels, Adrienne F G; Aarts, Marie-Jeanne; Stolk, Elly; de Wit, G Ardine; Prenger, Rilana; Braakman-Jansen, Louise M A; Evers, Silvia M A A

2015-07-14

Attention is increasing on the consideration of broader non-health outcomes in economic evaluations. It is unknown which non-health outcomes are valued as most relevant in the context of health promotion. The present study fills this gap by investigating the relative importance of non-health outcomes in a health promotion context. We investigated the relative importance of ten non-health outcomes of health promotion programs not commonly captured in QALYs. Preferences were elicited from a sample of the Dutch general public (N = 549) by means of a ranking task. These preferences were analyzed using Borda scores and rank-ordered logit models. The relative order of preference (from most to least important) was: self-confidence, insights into own (un)healthy behavior, perceived life control, knowledge about a certain health problem, social support, relaxation, better educational achievements, increased labor participation and work productivity, social participation, and a reduction in criminal behavior. The weight given to a particular non-health outcome was affected by the demographic variables age, gender, income, and education. Furthermore, in an open question, respondents mentioned a number of other relevant non-health outcomes, which we classified into outcomes relevant for the individual, the direct social environment, and for society as a whole. The study provides valuable insights in the non-health outcomes that are considered as most important by the Dutch general population. Ideally, researchers should include the most important non-health outcomes in economic evaluations of health promotion.

The economic impact of adolescent health promotion policies and programs.

PubMed

Aratani, Yumiko; Schwarz, Susan Wile; Skinner, Curtis

2011-12-01

Adolescence is a critical period in the human lifecycle, a time of rapid physical and socioemotional growth and a time when individuals establish lifestyle habits and health behaviors that often endure into and have lasting effects in adulthood. Adolescent health promotion programs play a critical role in helping youth establish healthy lifestyles. In this article, we present a socio-ecological model as a framework for identifying effective policy and program areas that have a positive impact on adolescent health behaviors. Our discussion focuses on 4 key areas: reproductive health; obesity prevention; mental health and substance use, including smoking; and injury and violence prevention. We proceed with an overview of the current status of state-led adolescent health promotion policies and programs from a newly created policy database and then examine the evidence on the cost of preventable adolescent health problems and the cost-effectiveness of health promotion programs and policies. We conclude by discussing the threat posed to adolescent health promotion services and state-led policy initiatives by proposed and implemented federal and state-level budget cuts and examine the possible health and economic repercussions of reducing or eliminating these programs.

Introduction to health economics and decision-making: Is economics relevant for the frontline clinician?

PubMed

Goeree, Ron; Diaby, Vakaramoko

2013-12-01

In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.

The contention within health economics: a micro-economic foundation using a macro-economic analysis.

PubMed

Yaxley, I L

1998-03-01

Health economists claim to use market economics combined with the micro-economic concepts of opportunity cost and the margin to advise on priority setting. However, they are advising on setting priorities through a macro-economic analysis using the costs of the supplier, thus prioritising the producer and not the consumer as the dynamic of economic activity. For health economists any contention within priority setting is due to lack of data not their confusion over fundamental concepts.

Economic rationality in choosing between short-term bad-health choices and longer-term good-health choices.

PubMed

Campbell, David

2013-11-08

Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance.

Obesity: can behavioral economics help?

PubMed

Just, David R; Payne, Collin R

2009-12-01

Consumers regularly and predictably behave in ways that contradict standard assumptions of economic analysis such that they make decisions that prevent them from reaching rationally intended goals. These contradictions play a significant role with respect to consumers' food decisions and the effect these decisions have on their health. Food decisions that are rationally derived include those that trade short-term gains of sensory pleasure (hedonic) for longer term gains of health and wellness (utilitarian). However, extra-rational food decisions are much more common. They can occur because of the contexts in which they are made--such as being distracted or pressed for time. In these contexts, heuristics (or rules of thumb) are used. Because food decisions are made with little cognitive involvement, food policies designed to appeal to highly cognitive thought (e.g., fat taxes, detailed information labels) are likely to have little impact. Furthermore, food marketing environments influence not only what foods consumers buy but also how much. As a general principle, when individuals do not behave in their own interest, markets will feed perverse and sub-optimal behaviors. Given the limited ability of individuals to retain and use accurate health information coupled with varying levels of self control, profit motivations of marketers can become predatory--though not necessarily malicious. Alternative policy options that do not restrict choice are outlined, which enable consumers to make better decisions. These options allow for profit motivations of marketers to align with the long-term well being of the consumer.

Behavioral Economic Measures of Alcohol Reward Value as Problem Severity Indicators in College Students

PubMed Central

Skidmore, Jessica R.; Murphy, James G.; Martens, Matthew P.

2014-01-01

The aims of the current study were to examine the associations among behavioral economic measures of alcohol value derived from three distinct measurement approaches, and to evaluate their respective relations with traditional indicators of alcohol problem severity in college drinkers. Five behavioral economic metrics were derived from hypothetical demand curves that quantify reward value by plotting consumption and expenditures as a function of price, another metric measured proportional behavioral allocation and enjoyment related to alcohol versus other activities, and a final metric measured relative discretionary expenditures on alcohol. The sample included 207 heavy drinking college students (53% female) who were recruited through an on-campus health center or university courses. Factor analysis revealed that the alcohol valuation construct comprises two factors: one factor that reflects participants’ levels of alcohol price sensitivity (demand persistence), and a second factor that reflects participants’ maximum consumption and monetary and behavioral allocation towards alcohol (amplitude of demand). The demand persistence and behavioral allocation metrics demonstrated the strongest and most consistent multivariate relations with alcohol-related problems, even when controlling for other well-established predictors. The results suggest that behavioral economic indices of reward value show meaningful relations with alcohol problem severity in young adults. Despite the presence of some gender differences, these measures appear to be useful problem indicators for men and women. PMID:24749779

Health economic evaluation: important principles and methodology.

PubMed

Rudmik, Luke; Drummond, Michael

2013-06-01

To discuss health economic evaluation and improve the understanding of common methodology. This article discusses the methodology for the following types of economic evaluations: cost-minimization, cost-effectiveness, cost-utility, cost-benefit, and economic modeling. Topics include health-state utility measures, the quality-adjusted life year (QALY), uncertainty analysis, discounting, decision tree analysis, and Markov modeling. Economic evaluation is the comparative analysis of alternative courses of action in terms of both their costs and consequences. With increasing health care expenditure and limited resources, it is important for physicians to consider the economic impact of their interventions. Understanding common methodology involved in health economic evaluation will improve critical appraisal of the literature and optimize future economic evaluations. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

Behavioral Economics: “Nudging” Underserved Populations to Be Screened for Cancer

PubMed Central

Thompson, Tess; Kreuter, Matthew W.; McBride, Timothy D.

2015-01-01

Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice. PMID:25590600

Health and safety economics: limitations of economic appraisal of occupational health services activities in Poland.

PubMed

Rydlewska-Liszkowska, Izabela

2002-01-01

Methods of economic appraisal developed for evaluating activities in health care system may as well be successfully used for evaluating occupational health service activities. This involves the problem of resources management and cost containment not only at the company level, but also at different managerial and institutional levels. The decision makers have to know what resources are spent on occupational health, what is the effectiveness and efficiency of investing in employees health. The key issue of good understanding of the theory and practice of economic appraisal is a precise definition of costs, effectiveness and benefits. Another important area is the identification of information sources and barriers of economic appraisal. The results of the project carried out by the Nofer Institute of Occupational Medicine have provided evidence that defining costs, effectiveness and benefits of preventive activities need to be developed. It becomes even more clear after an analysis of existing limitations of economic appraisal in Polish enterprises.

Awareness and Performance of Iranian Nurses with Regard to Health Economics: A Cross-Sectional Study.

PubMed

Heydari, Abbas; Mazloom, Reza; Najar, Ali Vafaee; Bakhshi, Mahmoud

2015-09-01

Health costs have risen everywhere, worldwide, and nurses play a pivotal role in cost savings and in contributing to the financial stability of hospitals. This study evaluated the awareness and performance of Iranian nursing staff, with regard to health economics. A total of 175 nurses who worked in three teaching hospitals in Mashhad (Iran) were selected for this descriptive cross-sectional study, and data were gathered via a 27-item questionnaire. Statistical analysis was performed using one-way analysis of variance, multiple regression analysis, and Pearson's correlation coefficient. A total of 78% (n = 39) of nurses did not have a good awareness of health economics. The overall mean score for economic awareness was 5.9 ± 2.1 (possible range, 0-16), and for economic performance was 26.6 ± 4 (possible range, 0-44). There was a significant relationship between the economic awareness and performance of nurses, and nurses in higher positions had a greater awareness of health economics. Considering the inadequacy of the health economics awareness and performance of nurses, it is essential that efforts are made to enhance their knowledge and behavior with regard to economic issues and cost saving in all the fields of nursing, through the use of continuing education courses and workshops.

Study Guide in Health Economics.

ERIC Educational Resources Information Center

Dawson, George; Jablon, Bert

Prepared to assist students at Empire State College in developing learning contracts for the study of the economics of health care delivery, this study guide discusses various aspects of the topic, suggests student projects, and provides an extensive bibliography. First, introductory material discusses the relationship of economics to health care…

Helping patients make better decisions: how to apply behavioral economics in clinical practice

PubMed Central

Courtney, Maureen Reni; Spivey, Christy; Daniel, Kathy M

2014-01-01

Clinicians are committed to effectively educating patients and helping them to make sound decisions concerning their own health care. However, how do clinicians determine what is effective education? How do they present information clearly and in a manner that patients understand and can use to make informed decisions? Behavioral economics (BE) is a subfield of economics that can assist clinicians to better understand how individuals actually make decisions. BE research can help guide interactions with patients so that information is presented and discussed in a more deliberate and impactful way. We can be more effective providers of care when we understand the factors that influence how our patients make decisions, factors of which we may have been largely unaware. BE research that focuses on health care and medical decision making is becoming more widely known, and what has been reported suggests that BE interventions can be effective in the medical realm. The purpose of this article is to provide clinicians with an overview of BE decision science and derived practice strategies to promote more effective behavior change in patients. PMID:25378915

Reinforcer Pathology: The Behavioral Economics of Abuse Liability Testing.

PubMed

Bickel, W K; Snider, S E; Quisenberry, A J; Stein, J S

2017-02-01

Understanding the abuse liability of novel drugs is critical to understanding the risk these new compounds pose to society. Behavioral economics, the integration of psychology and economics, can be used to predict abuse liability of novel substances. Here, we describe the behavioral economic concept of reinforcer pathology and how it may predict the use of novel drugs in existing drug-users and initiation of use in the drug-naive. © 2016 American Society for Clinical Pharmacology and Therapeutics.

The impact of economic globalisation on health.

PubMed

Koivusalo, Meri

2006-01-01

The analysis of the impact of economic globalisation on health depends on how it is defined and should consider how it shapes both health and health policies. I first discuss the ways in which economic globalisation can and has been defined and then why it is important to analyse its impact both in terms of health and health policies. I then explore the ways in which economic globalisation influences health and health policies and how this relates to equity, social justice, and the role of values and social rights in societies. Finally, I argue that the process of economic globalisation provides a common challenge for all health systems across the globe and requires a broader debate on values, accountability, and policy approaches.

Health economics in clinical research.

PubMed

Manns, Braden J

2015-01-01

The pressure for health care systems to provide more resource intensive health care and newer, more costly, therapies is significant, despite limited health care budgets. As such, demonstration that a new therapy is effective is no longer sufficient to ensure that it is funded within publicly funded health care systems. The impact of a therapy on health care costs is also an important consideration for decision-makers who must allocate scarce resources. The clinical benefits and costs of a new therapy can be estimated simultaneously using economic evaluation, the strengths and limitations of which are discussed herein. In addition, this chapter includes discussion of the important economic outcomes that can be collected within a clinical trial (alongside the clinical outcome data) enabling consideration of the impact of the therapy on overall resource use, thus enabling performance of an economic evaluation, if the therapy is shown to be effective.

Toward quantifying the abuse liability of ultraviolet tanning: A behavioral economic approach to tanning addiction.

PubMed

Reed, Derek D; Kaplan, Brent A; Becirevic, Amel; Roma, Peter G; Hursh, Steven R

2016-07-01

Many adults engage in ultraviolet indoor tanning despite evidence of its association with skin cancer. The constellation of behaviors associated with ultraviolet indoor tanning is analogous to that in other behavioral addictions. Despite a growing literature on ultraviolet indoor tanning as an addiction, there remains no consensus on how to identify ultraviolet indoor tanning addictive tendencies. The purpose of the present study was to translate a behavioral economic task more commonly used in substance abuse to quantify the "abuse liability" of ultraviolet indoor tanning, establish construct validity, and determine convergent validity with the most commonly used diagnostic tools for ultraviolet indoor tanning addiction (i.e., mCAGE and mDSM-IV-TR). We conducted a between-groups study using a novel hypothetical Tanning Purchase Task to quantify intensity and elasticity of ultraviolet indoor tanning demand and permit statistical comparisons with the mCAGE and mDSM-IV-TR. Results suggest that behavioral economic demand is related to ultraviolet indoor tanning addiction status and adequately discriminates between potential addicted individuals from nonaddicted individuals. Moreover, we provide evidence that the Tanning Purchase Task renders behavioral economic indicators that are relevant to public health research. The present findings are limited to two ultraviolet indoor tanning addiction tools and a relatively small sample of high-risk ultraviolet indoor tanning users; however, these pilot data demonstrate the potential for behavioral economic assessment tools as diagnostic and research aids in ultraviolet indoor tanning addiction studies. © 2016 Society for the Experimental Analysis of Behavior.

Factors associated with health risk behaviors among Brazilian adolescents: an integrative review.

PubMed

Moura, Luciana Ramos de; Torres, Lilian Machado; Cadete, Matilde Meire Miranda; Cunha, Cristiane de Freitas

2018-01-01

Identifying knowledge about factors associated with health risk behaviors among Brazilian adolescents. An integrative review of the literature conducted in the Cochrane, IBECS, LILACS, MEDLINE and SciELO databases in relation to risk behaviors recommended by the Centers for Disease Control and Prevention. Thirty-seven (37) studies were analyzed, with a predominance of risky sexual behavior, tobacco use and violent behavior. Advancing age favored unprotected sex, alcohol and tobacco use. Family and friends influence was related to smoking and alcoholism. Males were more involved in situations of violence and the female gender was associated with physical inactivity. Belonging to a lower economic class was related to unprotected sex, physical inactivity, unhealthy dietary behaviors and violence. Studying in private school was related to unhealthy dietary behavior. Risk behaviors were related to social, economic and family factors and they tend to agglomerate.

Behavioral Economics Matters for HIV Research: The Impact of Behavioral Biases on Adherence to Antiretrovirals (ARVs)

PubMed Central

Stecher, Chad

2016-01-01

Behavioral economics (BE) has been used to study a number of health behaviors such as smoking and drug use, but there is little knowledge of how these insights relate to HIV prevention and care. We present novel evidence on the prevalence of the common behavioral decision-making errors of present-bias, overoptimism, and information salience among 155 Ugandan HIV patients, and analyze their association with subsequent medication adherence. 36 % of study participants are classified as present-biased, 21 % as overoptimistic, and 34 % as having salient HIV information. Patients displaying present-bias were 13 % points (p = 0.006) less likely to have adherence rates above 90 %, overoptimistic clients were 9 % points (p = 0.04) less likely, and those not having salient HIV information were 17 % points (p < 0.001) less likely. These findings indicate that BE may be used to screen for future adherence problems and to better design and target interventions addressing these behavioral biases and the associated suboptimal adherence. PMID:25987190

Global health funding and economic development.

PubMed

Martin, Greg; Grant, Alexandra; D'Agostino, Mark

2012-04-10

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.

Global health funding and economic development

PubMed Central

2012-01-01

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries. PMID:22490207

Rewarding Healthy Food Choices in SNAP: Behavioral Economic Applications

PubMed Central

Richards, Michael R; Sindelar, Jody L

2013-01-01

Context American obesity rates continue to escalate, but an effective policy response remains elusive. Specific changes to the Supplemental Nutrition Assistance Program (SNAP) have been proposed as one way to improve nutrition and combat obesity among lower-income populations. While current SNAP proposals hold promise, some important challenges still remain. Methods We discuss the four most common recommendations for changes to SNAP and their benefits and limitations. We then propose three new delivery options for SNAP that take advantage of behavioral economic insights and encourage the selection of healthy foods. Findings Although the existing proposals could help SNAP recipients, they often do not address some important behavioral impediments to buying healthy foods. We believe that behavioral economics can be used to design alternative policies with several advantages, although we recognize and discuss some of their limitations. The first proposal rewards healthy purchases with more SNAP funds and provides an additional incentive to maintain healthier shopping patterns. The second proposal uses the opportunity to win prizes to reward healthy food choices, and the prizes further support healthier habits. The final proposal simplifies healthy food purchases by allowing individuals to commit their SNAP benefits to more nutritious selections in advance. Conclusions Reforming the delivery structure of SNAP's benefits could help improve nutrition, weight, and overall health of lower-income individuals. We advocate for more and diverse SNAP proposals, which should be tested and, possibly, combined. Their implementation, however, would require political will, administrative capacity, and funding. PMID:23758515

Health Disparity Still Exists in an Economically Well-Developed Society in Asia.

PubMed

Lee, Albert; Chua, Hoi-wai; Chan, Mariana; Leung, Patrick W L; Wong, Jasmine W S; Chuh, Antonio A T

2015-01-01

The socioeconomic inequalities in child health continue to widen despite improved economy. To investigate the correlation between socio-economic factors and health risk behaviors and psychosocial well-being of children in Hong Kong. The null hypothesis is that for this particular developed region, there exists little or no correlation between social-economic factors and health risk behaviors and psychosocial well-being of children. Cross sectional territory wide survey. Caregivers of 7,000 children in kindergartens in Hong Kong. Youth Risk Behavior Surveillance questionnaire, health-related knowledge and hygienic practice questionnaire, and Children Behavior Checklist (CBCL). Children were less likely to have somatic complaints and anxiety/depression as reflected by CBCL scores coming from families of higher income, not being recipients of social assistance, with fathers in employment, and with higher parental education. Children with only mother or father as caretakers had lower odds ratios (ORs) 0.71 (95% CI 0.58-0.89) and 0.53 (95% CI 0.33-0.84) respectively to have the habit of eating breakfast, whilst parental education at post-secondary level and higher family income had higher ORs 1.91 (95% CI 1.31-2.78), and 1.63 (95% CI 1.11-2.39). Fathers unemployed, relatives as main caretakers and living in districts with low median household inome incurred higher ORs, as 1.46 (95% CI 1.10-1.94),1.52 (95% CI 1.27-1.83) and 1.17 (95% CI 1.02-1.34) respectively, of watching television over two hours daily, whilst children with parental education at secondary level or above incurred lower OR 0.33 (95% CI 0.24-0.45). Children with parental education at post-secondary level and higher family income had lower ORs of 0.32 (95% CI 0.48-0.97) and 0.52 (95% CI 0.34-0.79) respectively, with regard to exposing to passive smoking, and reversed for those living in districts with lower median household income, lower family income and recipient of CSSA with ORs 1.24 (95% CI 1

Health Disparity Still Exists in an Economically Well-Developed Society in Asia

PubMed Central

Lee, Albert; Chua, Hoi-wai; Chan, Mariana; Leung, Patrick W. L.; Wong, Jasmine W. S.; Chuh, Antonio A. T.

2015-01-01

Background The socioeconomic inequalities in child health continue to widen despite improved economy. Objective To investigate the correlation between socio-economic factors and health risk behaviors and psychosocial well-being of children in Hong Kong. Hypothesis The null hypothesis is that for this particular developed region, there exists little or no correlation between social-economic factors and health risk behaviors and psychosocial well-being of children. Design Cross sectional territory wide survey. Participants Caregivers of 7,000 children in kindergartens in Hong Kong. Measuring tools Youth Risk Behavior Surveillance questionnaire, health-related knowledge and hygienic practice questionnaire, and Children Behavior Checklist (CBCL). Results Children were less likely to have somatic complaints and anxiety/depression as reflected by CBCL scores coming from families of higher income, not being recipients of social assistance, with fathers in employment, and with higher parental education. Children with only mother or father as caretakers had lower odds ratios (ORs) 0.71 (95% CI 0.58-0.89) and 0.53 (95% CI 0.33-0.84) respectively to have the habit of eating breakfast, whilst parental education at post-secondary level and higher family income had higher ORs 1.91 (95% CI 1.31-2.78), and 1.63 (95% CI 1.11-2.39). Fathers unemployed, relatives as main caretakers and living in districts with low median household inome incurred higher ORs, as 1.46 (95% CI 1.10-1.94),1.52 (95% CI 1.27-1.83) and 1.17 (95% CI 1.02-1.34) respectively, of watching television over two hours daily, whilst children with parental education at secondary level or above incurred lower OR 0.33 (95% CI 0.24-0.45). Children with parental education at post-secondary level and higher family income had lower ORs of 0.32 (95% CI 0.48-0.97) and 0.52 (95% CI 0.34-0.79) respectively, with regard to exposing to passive smoking, and reversed for those living in districts with lower median household income

HEALTH CARE ECONOMICS IN ROMANIA--DYNAMICS AND EVOLUTION.

PubMed

Tamba, B I; Azoicăi, Doina; Druguş, Daniela

2016-01-01

Health economics refers to the analysis of medical institutions considering their economic and social efficacy, but also the regularity and the relationships that govern the phenomena and the processes from the field of health with the final purpose of achieving better results with the minimum of resources; it represents the study of health price in its complexity. The economics of the population's health needs and in particular the health needs in case of the poor groups of the population, consider health to be the main component of global human vulnerability. Health economics tries to change the simple interpretation of health price and disease cost into a wider consideration of a system administration similar to educational and social economics and the study of health in the context of the multiple specializations of the macro economy of the national group, as it is an instrument in the country's great economics symphony.

Mental health economics: insights from Brazil.

PubMed

Cruz, Luciane; Lima, Ana Flavia Da Silva; Graeff-Martins, Ana; Maia, Carlos Renato Moreira; Ziegelmann, Patricia; Miguel, Sandoro; Fleck, Marcelo; Polanczyk, Carisi

2013-04-01

As the responsibility and demand on health care grows and resources do not increase at the same pace, the healthcare system has been forced to reconsider the benefits and costs of their actions, to ensure a rational and effective decision-making process regarding the adoption of interventions and allocation of resources. Cost-effectiveness (CE) studies represent one of the basic tools to achieve this goal. To present the current state of Health Technology Assessment (HTA) and health economics in mental health in Brazil and its importance to the decision-making process. Descriptive paper on HTA and health economics in Brazil. Databases from government and universities as well as some scientific databases to assess the information are presented. Economic analysis to evaluate interventions in mental health care is a relatively recent addition to the field of health economics; in Brazil, it is also considered a topic within Epidemiology research area. There have been an increased number of studies developed in high-income countries. However, there are fewer CE studies in low- and middle-income ones. Psychiatric disorders represent a significant burden in developing countries, where resources devoted to health care are even scarcer.

Metro Nature, Environmental Health, and Economic Value

PubMed Central

Robbins, Alicia S.T.

2015-01-01

Background Nearly 40 years of research provides an extensive body of evidence about human health, well-being, and improved function benefits associated with experiences of nearby nature in cities. Objectives We demonstrate the numerous opportunities for future research efforts that link metro nature, human health and well-being outcomes, and economic values. Methods We reviewed the literature on urban nature-based health and well-being benefits. In this review, we provide a classification schematic and propose potential economic values associated with metro nature services. Discussion Economic valuation of benefits derived from urban green systems has largely been undertaken in the fields of environmental and natural resource economics, but studies have not typically addressed health outcomes. Urban trees, parks, gardens, open spaces, and other nearby nature elements—collectively termed metro nature—generate many positive externalities that have been largely overlooked in urban economics and policy. Here, we present a range of health benefits, including benefit context and beneficiaries. Although the understanding of these benefits is not yet consistently expressed, and although it is likely that attempts to link urban ecosystem services and economic values will not include all expressions of cultural or social value, the development of new interdisciplinary approaches that integrate environmental health and economic disciplines are greatly needed. Conclusions Metro nature provides diverse and substantial benefits to human populations in cities. In this review, we begin to address the need for development of valuation methodologies and new approaches to understanding the potential economic outcomes of these benefits. Citation Wolf KL, Robbins AS. 2015. Metro nature, environmental health, and economic value. Environ Health Perspect 123:390–398; http://dx.doi.org/10.1289/ehp.1408216 PMID:25626137

Health, "illth," and economic growth: medicine, environment, and economics at the crossroads.

PubMed

Egger, Garry

2009-07-01

Economic growth has been the single biggest contributor to population health since the Industrial Revolution. The growth paradigm, by definition, is dynamic, implying similar diminishing returns on investment at both the macro- and the micro-economic levels. Changes in patterns of health in developing countries, from predominantly microbial-related infectious diseases to lifestyle-related chronic diseases (e.g., obesity, type 2 diabetes) beyond a point of economic growth described as the epidemiologic transition, suggest the start of certain declining benefits from further investment in the growth model. These changes are reflected in slowing improvements in some health indices (e.g., mortality, infant mortality) and deterioration in others (e.g., disability-associated life years, obesity, chronic diseases). Adverse environmental consequences, such as climate change from economic development, are also related to disease outcomes through the development of inflammatory processes due to an immune reaction to new environmental and lifestyle-related inducers. Both increases in chronic disease and climate change can be seen as growth problems with a similar economic cause and potential economic and public health-rather than personal health-solutions. Some common approaches for dealing with both are discussed, with a plea for greater involvement by health scientists in the economic and environmental debates in order to deal effectively with issues like obesity and chronic disease.

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus.

PubMed

Kullgren, Jeffrey T; Hafez, Dina; Fedewa, Allison; Heisler, Michele

2017-09-01

The purpose of this paper was to review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggested such approaches have the potential to improve patient behaviors and such approaches should be tested more broadly.

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

PubMed Central

Kullgren, Jeffrey T.; Hafez, Dina; Fedewa, Allison; Heisler, Michele

2017-01-01

Purpose of review To review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. Recent findings We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Summary Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggest such approaches have potential to improve patient behaviors and should be tested more broadly. PMID:28755061

Health and economic development: introduction to the symposium.

PubMed

Clay, Joy A; Mirvis, David M

2008-01-01

This symposium explores the role of health as an 'economic engine' in the lower Mississippi River Delta region of the United States. The health as an economic engine model proposes that health is an important and perhaps critical determinant of economic growth and development. This model is the reverse of the more commonly considered paradigm in which economic conditions are major determinants of health status. This reframing of the conventional pathway draws upon an existing and extensive internationally-based body of knowledge, predominantly from research done in Africa and Asia. We suggest, in this symposium, that the health as an economic engine model can also be applied within the United States, particularly in regions that are economically underdeveloped and have poor health. This reframing has significant implications for population health policy as public health advancement can be legitimately argued to be an investment rather than just an expense. Viewing health as an economic engine supports a call to community-based participatory action on the part of policy makers, researchers, and educators to further both public and private investment in health, particularly for children and the poor.

Unpaid work in health economic evaluations.

PubMed

Krol, Marieke; Brouwer, Werner

2015-11-01

Given its societal importance, unpaid work should be included in economic evaluations of health care technology aiming to take a societal perspective. However, in practice this does not often appear to be the case. This paper provides an overview of the current place of unpaid work in economic evaluations in theory and in practice. It does so first by summarizing recommendations regarding the inclusion of unpaid labor reported in health economic textbooks and national guidelines for economic evaluations. In total, three prominent health economic text-books were studied and 28 national health economic guidelines. The paper, moreover, provides an overview of the instruments available to measure lost unpaid labor and reports on a review of the place of unpaid labor in applied economic evaluations in the area of rheumatoid arthritis. The review was conducted by examining methodology of evaluations published between 1 March 2008 and 1 March 2013. The results of this study show that little guidance is offered regarding the inclusion of unpaid labor in economic evaluations in textbooks and guidelines. The review identified five productivity costs instruments including questions about unpaid work and 33 economic evaluations of treatments for rheumatoid arthritis of which only one included unpaid work. The results indicate that unpaid work is rarely included in applied economic evaluations of treatments for rheumatoid arthritis, despite this disease expecting to be associated with lost unpaid work. Given the strong effects of certain diseases and treatments on the ability to perform unpaid work, unpaid work currently receives less attention in economic evaluations than it deserves. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving utilization of and retention in PMTCT services: can behavioral economics help?

PubMed

Taylor, Nicholas Kenji; Buttenheim, Alison M

2013-10-10

The most recent strategic call to action of the World Health Organization sets the elimination of pediatric HIV as a goal. While recent efforts have focused on building infrastructure and ensuring access to high-quality treatment, we must now turn our focus to the behavior change needed to eliminate vertical transmission. We make the case for the application of concepts from the field of behavioral economics to prevention of mother-to-child transmission (PMTCT) programs to more effectively address demand-side issues of uptake and retention. We introduce five concepts from the field of behavioral economics and discuss their application to PMTCT programs: 1) Mentor mothers who come from similar circumstances as PMTCT patients can serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment. 2) Economic incentives, like cell phone minutes or food vouchers, that reward adherence to PMTCT protocols leverage present bias, the observation that people are generally biased toward immediate versus future awards. 3) Default bias, our preference for the default option, is already being used in many countries in the form of opt-out testing, and could be expanded to all PMTCT programs. 4) We are hardwired to avoid loss more than to pursue an equivalent gain. PMTCT programs can take advantage of loss aversion through the use of commitment contracts that incentivize mothers to return to the clinic in order to avoid both reputational and financial loss. Eliminating vertical transmission of HIV is an ambitious goal. To close the remaining gap, innovations are needed to address demand for PMTCT services. Behavioral economics offers a set of tools that can be engineered into PMTCT programs to increase uptake and improve retention with minimal investment.

Improving utilization of and retention in PMTCT services: Can behavioral economics help?

PubMed Central

2013-01-01

Background The most recent strategic call to action of the World Health Organization sets the elimination of pediatric HIV as a goal. While recent efforts have focused on building infrastructure and ensuring access to high-quality treatment, we must now turn our focus to the behavior change needed to eliminate vertical transmission. We make the case for the application of concepts from the field of behavioral economics to prevention of mother-to-child transmission (PMTCT) programs to more effectively address demand-side issues of uptake and retention. Discussion We introduce five concepts from the field of behavioral economics and discuss their application to PMTCT programs: 1) Mentor mothers who come from similar circumstances as PMTCT patients can serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment. 2) Economic incentives, like cell phone minutes or food vouchers, that reward adherence to PMTCT protocols leverage present bias, the observation that people are generally biased toward immediate versus future awards. 3) Default bias, our preference for the default option, is already being used in many countries in the form of opt-out testing, and could be expanded to all PMTCT programs. 4) We are hardwired to avoid loss more than to pursue an equivalent gain. PMTCT programs can take advantage of loss aversion through the use of commitment contracts that incentivize mothers to return to the clinic in order to avoid both reputational and financial loss. Summary Eliminating vertical transmission of HIV is an ambitious goal. To close the remaining gap, innovations are needed to address demand for PMTCT services. Behavioral economics offers a set of tools that can be engineered into PMTCT programs to increase uptake and improve retention with minimal investment. PMID:24112440

Applying economic principles to health care.

PubMed Central

Scott, R. D.; Solomon, S. L.; McGowan, J. E.

2001-01-01

Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control. PMID:11294724

Economic preferences and fast food consumption in US adults: Insights from behavioral economics.

PubMed

Shuval, Kerem; Stoklosa, Michal; Pachucki, Mark C; Yaroch, Amy L; Drope, Jeffrey; Harding, Matthew

2016-12-01

To examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults. Participants included 5871U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics). Multivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend <0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR=0.74, 95%CI: 0.62-0.89; and 60-day: OR=0.86, 95%CI: 0.74-1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend=0.73; 60-day: p for linear trend=0.83). Higher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies. Copyright © 2016 Elsevier Inc. All rights reserved.

The Dow is Killing Me: Risky Health Behaviors and the Stock Market.

PubMed

Cotti, Chad; Dunn, Richard A; Tefft, Nathan

2015-07-01

We investigate how risky health behaviors and self-reported health vary with the Dow Jones Industrial Average (DJIA) and during stock market crashes. Because stock market indices are leading indicators of economic performance, this research contributes to our understanding of the macroeconomic determinants of health. Existing studies typically rely on the unemployment rate to proxy for economic performance, but this measure captures only one of many channels through which the economic environment may influence individual health decisions. We find that large, negative monthly DJIA returns, decreases in the level of the DJIA, and stock market crashes are widely associated with worsening self-reported mental health and more cigarette smoking, binge drinking, and fatal car accidents involving alcohol. These results are consistent with predictions from rational addiction models and have implications for research on the association between consumption and stock prices. Copyright © 2014 John Wiley & Sons, Ltd.

Health behavior models and oral health: a review.

PubMed

Hollister, M Catherine; Anema, Marion G

2004-01-01

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Effects of Targeted Subsidies Policy on Health Behavior in Iranian Households: A Qualitative Study

PubMed Central

DOSHMANGIR, Leila; DOSHMANGIR, Parinaz; ABOLHASSANI, Nazanin; MOSHIRI, Esmaeil; JAFARI, Mehdi

2015-01-01

Background: This study aimed to explore the effects of national targeted subsidies policy on health behavior of Iranian households. Methods: In this qualitative study, data were collected between January 2012 and December 2013 through face-to-face interviews (23 experts in national and provincial levels of health system and 18 household heads) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method (inductive-deductive) and assisted by Atlas-ti software. Results: Rising health care costs, removing some food subsidies and the increase in price of most goods and services due to the implementation of economic policy of targeted subsidies have led to significant changes in the demand for health services, changes in the consumption trends of goods and services affecting health as well as changes in the health habits of households. Conclusion: Targeted subsidies and the cash subsidy policy have some negative effects on population health behavior especially among poor people. Hence, maintaining or increasing the cash subsidy is not an efficient allocation of resources toward health care system. So, it is necessary to identify appropriate strategies and policies and apply interventions in order to moderate negative effects and enhance positive effects resulted from implementing this economic reform on population health behavior. PMID:26056676

Socioeconomic Status, Health Behaviors, Obesity and Self-Rated Health among Older Arabs in Israel.

PubMed

Khalaila, R N Rabia

2017-03-01

Socioeconomic inequalities in health are well documented. Recently, researchers have shown interest in exploring the mechanisms by which measures of SES operate through it to impact SRH, such as material, psychosocial and behavioral factors. To examine the relationships between SES indicators and self-rated health (SRH); and to determine whether health behaviors and obesity mediate the association between SES indicators and SRH. A secondary analysis of data previously collected through the third survey of socioeconomic and health status of the Arab population in Israel, in which the SRH of 878 Arab-Israelis age 50 or older were analyzed using logistic regression. The results showed that higher education level and current employment in old age are associated with better SRH. However, neither subjective economic status nor family income was associated with SRH. Greater physical activity was found to be related to good\\very good SRH, while obesity was associated with less than good SRH. Finally, health behaviors (physical activity) and obesity were revealed as mediators between SES indicators (education and employment status) and SRH. The results highlight the importance of high education level and employment status in old age to reduce health inequalities. The findings also show that the relationship between SES and SRH can operate through behavioral mechanisms (i.e., physical activity) and their consequences (i.e., obesity), that can, however, be changed in old age.

Social capital and risk and protective behaviors: a global health perspective

PubMed Central

Kaljee, Linda M; Chen, Xinguang

2011-01-01

Social capital and health research has emerged as a focus of contemporary behavioral epidemiology, while intervention research is seeking more effective measures to increase health protective behaviors and decrease health-risk behaviors. In this review we explored current literature on social capital and health outcomes at the micro-, mesa-, and macro-levels with a particular emphasis on research that incorporates a social capital framework, and adolescent and young adult engagement in risk behaviors. These data indicate that across a broad range of socio-cultural and economic contexts, social capital can affect individuals’ risk for negative health outcomes and their engagement in risk behaviors. Further research is needed which should focus on differentiating and measuring positive and negative social capital within both mainstream and alternative social networks, assessing how social constructions of gender, ethnicity, and race – within specific cultural contexts – mediate the relationship between social capital and risk and/or protective behaviors. This new research should integrate the existing research within historical socioeconomic and political conditions. In addition, social capital scales need to be developed to be both culturally and developmentally appropriate for use with adolescents living in a diversity of settings. Despite the proliferation of social capital research, the concept remains underutilized in both assessment and intervention development for adolescents’ and young adults’ engagement in risk behaviors and their associated short- and long-term poor health outcomes. PMID:23243387

Early-Childhood Poverty and Adult Attainment, Behavior, and Health

ERIC Educational Resources Information Center

Duncan, Greg J.; Ziol-Guest, Kathleen M.; Kalil, Ariel

2010-01-01

This article assesses the consequences of poverty between a child's prenatal year and 5th birthday for several adult achievement, health, and behavior outcomes, measured as late as age 37. Using data from the Panel Study of Income Dynamics (1,589) and controlling for economic conditions in middle childhood and adolescence, as well as demographic…

[Health economics and antibiotic therapy].

PubMed

Leclercq, P; Bigdéli, M

1995-01-01

In the field of antibiotic therapy, particularly the methods of economic evaluation hold one's attention within the wide range of health economics' applications. Several tools allow a comparison of the outcomes of alternative strategies and thereby guide choices to the most appropriate solutions. After a brief recall of the methods classically used to evaluate health care strategy, the authors stress the importance and difficulty of fixing and applying a correct and satisfactory procedure for evaluation. An evaluation example of antibiotic therapy allows to illustrate the application of the principles confronting a field in which competition is intense and economic stakes stay large--a fact which naturally yields to seek after objective decision making criteria. The health care policies drawn by public authorities as well as the marketing strategies of the health sector trade are partly based on such evaluations. If these techniques are not intended for the practitioner in the first place, they should not be indifferent to him since they influence health authorities and thereby indirectly affect the therapeutic freedom of the physician.

Q methodology in health economics.

PubMed

Baker, Rachel; Thompson, Carl; Mannion, Russell

2006-01-01

The recognition that health economists need to understand the meaning of data if they are to adequately understand research findings which challenge conventional economic theory has led to the growth of qualitative modes of enquiry in health economics. The use of qualitative methods of exploration and description alongside quantitative techniques gives rise to a number of epistemological, ontological and methodological challenges: difficulties in accounting for subjectivity in choices, the need for rigour and transparency in method, and problems of disciplinary acceptability to health economists. Q methodology is introduced as a means of overcoming some of these challenges. We argue that Q offers a means of exploring subjectivity, beliefs and values while retaining the transparency, rigour and mathematical underpinnings of quantitative techniques. The various stages of Q methodological enquiry are outlined alongside potential areas of application in health economics, before discussing the strengths and limitations of the approach. We conclude that Q methodology is a useful addition to economists' methodological armoury and one that merits further consideration and evaluation in the study of health services.

[Health knowledge, health promoting behavior and factors influencing health promoting behavior of north korean defectors in South Korea].

PubMed

Choe, Myoung Ae; Yi, Myungsun; Choi, Jung An; Shin, Gisoo

2012-10-01

The purpose of this study was to identify health knowledge, health promoting behavior and factors influencing health promoting behavior of North Korean defectors in South Korea. Participants in this study were 410 North Korean defectors, over 20 years of age residing in Seoul. They were recruited by snowball sampling. Data were collected from April to June, 2010. Health knowledge, health promoting behavior, self-efficacy, perceived barriers to health promoting behavior and social support were measured by structured questionnaires, and perceived physical and mental health status were measured by one item with 10-point numeric rating scale. The data were analyzed using t-test, ANOVA, and multiple regression. Health knowledge, health promoting behavior, and perceived barriers to health promoting behavior were moderate while self-efficacy and social support were high. Factors influencing health promoting behavior of the participants were found to be self-efficacy, social support and perceived barrier to health promoting behavior. The results of this study indicate that nursing intervention programs enhancing self-efficacy, social support and reducing perceived barriers to health promoting behavior need to be developed for North Korean defectors in South Korea.

Use of psychology and behavioral economics to promote healthy eating.

PubMed

Roberto, Christina A; Kawachi, Ichiro

2014-12-01

Understanding the psychology of how people make decisions can shed light on important factors contributing to the cause and maintenance of public health problems like obesity. This knowledge can and should inform the design of government and private-sector public health interventions. Several insights from psychology and behavioral economics that help explain why people are particularly vulnerable to the current food environment are discussed. These insights fall into the following categories: the influence of starting points (status quo bias and anchoring effects); communicating health information (simplicity and framing); and unintended consequences of policy interventions (compensation, substitution, and the peanuts effect). The paper discusses opportunities for improving the design of food policies and interventions by altering default options, providing the public with simple and meaningful nutrition information, carefully constructing the framing of public health messages, and designing food policies to minimize unintended consequences, such as compensation and substitution. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

[Ethics versus economics in public health? On the integration of economic rationality in a discourse of public health ethics].

PubMed

Rothgang, H; Staber, J

2009-05-01

In the course of establishing the discourse of public health ethics in Germany, we discuss whether economic efficiency should be part of public health ethics and, if necessary, how efficiency should be conceptualized. Based on the welfare economics theory, we build a theoretical framework that demands an integration of economic rationality in public health ethics. Furthermore, we consider the possible implementation of welfare efficiency against the background of current practice in an economic evaluation of health care in Germany. The indifference of the welfare efficiency criterion with respect to distribution leads to the conclusion that efficiency must not be the only criteria of public health ethics. Therefore, an ethical approach of principles should be chosen for public health ethics. Possible conflicts between principles of such an approach are outlined.

Metro nature, environmental health, and economic value.

PubMed

Wolf, Kathleen L; Robbins, Alicia S T

2015-05-01

Nearly 40 years of research provides an extensive body of evidence about human health, well-being, and improved function benefits associated with experiences of nearby nature in cities. We demonstrate the numerous opportunities for future research efforts that link metro nature, human health and well-being outcomes, and economic values. We reviewed the literature on urban nature-based health and well-being benefits. In this review, we provide a classification schematic and propose potential economic values associated with metro nature services. Economic valuation of benefits derived from urban green systems has largely been undertaken in the fields of environmental and natural resource economics, but studies have not typically addressed health outcomes. Urban trees, parks, gardens, open spaces, and other nearby nature elements-collectively termed metro nature-generate many positive externalities that have been largely overlooked in urban economics and policy. Here, we present a range of health benefits, including benefit context and beneficiaries. Although the understanding of these benefits is not yet consistently expressed, and although it is likely that attempts to link urban ecosystem services and economic values will not include all expressions of cultural or social value, the development of new interdisciplinary approaches that integrate environmental health and economic disciplines are greatly needed. Metro nature provides diverse and substantial benefits to human populations in cities. In this review, we begin to address the need for development of valuation methodologies and new approaches to understanding the potential economic outcomes of these benefits.

A Framework for Developing the Structure of Public Health Economic Models.

PubMed

Squires, Hazel; Chilcott, James; Akehurst, Ronald; Burr, Jennifer; Kelly, Michael P

2016-01-01

A conceptual modeling framework is a methodology that assists modelers through the process of developing a model structure. Public health interventions tend to operate in dynamically complex systems. Modeling public health interventions requires broader considerations than clinical ones. Inappropriately simple models may lead to poor validity and credibility, resulting in suboptimal allocation of resources. This article presents the first conceptual modeling framework for public health economic evaluation. The framework presented here was informed by literature reviews of the key challenges in public health economic modeling and existing conceptual modeling frameworks; qualitative research to understand the experiences of modelers when developing public health economic models; and piloting a draft version of the framework. The conceptual modeling framework comprises four key principles of good practice and a proposed methodology. The key principles are that 1) a systems approach to modeling should be taken; 2) a documented understanding of the problem is imperative before and alongside developing and justifying the model structure; 3) strong communication with stakeholders and members of the team throughout model development is essential; and 4) a systematic consideration of the determinants of health is central to identifying the key impacts of public health interventions. The methodology consists of four phases: phase A, aligning the framework with the decision-making process; phase B, identifying relevant stakeholders; phase C, understanding the problem; and phase D, developing and justifying the model structure. Key areas for further research involve evaluation of the framework in diverse case studies and the development of methods for modeling individual and social behavior. This approach could improve the quality of Public Health economic models, supporting efficient allocation of scarce resources. Copyright © 2016 International Society for Pharmacoeconomics

The Behavioral Economics and Neuroeconomics of Alcohol Use Disorders

PubMed Central

MacKillop, James

2016-01-01

Background Behavioral economics and neuroeconomics bring together perspectives and methods from psychology, economics, and cognitive neuroscience to understand decision making and choice behavior. Extending an operant behavioral theoretical framework, these perspectives have increasingly been applied to understanding alcohol use disorders (AUDs) and this review surveys the theory, methods, and findings from this approach. The focus is on three key behavioral economic concepts: delay discounting (i.e., preferences for smaller immediate rewards relative to larger delayed rewards), alcohol demand (i.e., alcohol reinforcing value), and proportionate alcohol-related reinforcement (i.e., relative amount of psychosocial reinforcement associated with alcohol use). Findings Delay discounting has been linked to AUDs in both cross-sectional and longitudinal studies, and has been investigated cross-sectionally using neuroimaging. Alcohol demand and proportionate alcohol-related reinforcement have both been robustly associated with drinking and alcohol misuse cross-sectionally, but not over time. Both have also been found to predict treatment response to brief interventions. Alcohol demand has also been used to enhance the measurement of acute motivation for alcohol in laboratory studies. Interventions that focus on reducing the value of alcohol by increasing alternative reinforcement and response cost have been found to be efficacious, albeit in relatively small numbers of randomized controlled trials (RCTs). Mediators and moderators of response to these interventions have not been extensively investigated. Future Directions The application of behavioral economics and neuroeconomics to AUDs has given rise to an extensive body of empirical work, although significant gaps in knowledge remain. In particular, there is a need for more longitudinal investigations to clarify the etiological roles of these behavioral economic processes, especially alcohol demand and proportionate

75 FR 50783 - Committee for Social, Behavioral, and Economic Sciences Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-17

... NATIONAL SCIENCE FOUNDATION ADVISORY Committee for Social, Behavioral, and Economic Sciences..., Behavioral, and Economic Sciences ( 1171). Date/Time: September 7, 2010; 8:30 a.m. to 6 p.m. September 8... Assistant Director, Directorate for Social, Behavioral, and Economic Sciences, National Science Foundation...

Lateral Orbitofrontal Inactivation Dissociates Devaluation-Sensitive Behavior and Economic Choice.

PubMed

Gardner, Matthew P H; Conroy, Jessica S; Shaham, Michael H; Styer, Clay V; Schoenbaum, Geoffrey

2017-12-06

How do we choose between goods that have different subjective values, like apples and oranges? Neuroeconomics proposes that this is done by reducing complex goods to a single unitary value to allow comparison. This value is computed "on the fly" from the underlying model of the goods space, allowing decisions to meet current needs. This is termed "model-based" behavior to distinguish it from pre-determined, habitual, or "model-free" behavior. The lateral orbitofrontal cortex (OFC) supports model-based behavior in rats and primates, but whether the OFC is necessary for economic choice is less clear. Here we tested this question by optogenetically inactivating the lateral OFC in rats in a classic model-based task and during economic choice. Contrary to predictions, inactivation disrupted model-based behavior without affecting economic choice. Published by Elsevier Inc.

Crowdfunding our health: Economic risks and benefits.

PubMed

Renwick, Matthew J; Mossialos, Elias

2017-10-01

Crowdfunding is an expanding form of alternative financing that is gaining traction in the health sector. This article presents a typology for crowdfunded health projects and a review of the main economic benefits and risks of crowdfunding in the health market. We use evidence from a literature review, complimented by expert interviews, to extend the fundamental principles and established theories of crowdfunding to a health market context. Crowdfunded health projects can be classified into four types according to the venture's purpose and funding method. These are projects covering health expenses, fundraising health initiatives, supporting health research, or financing commercial health innovation. Crowdfunding could economically benefit the health sector by expanding market participation, drawing money and awareness to neglected health issues, improving access to funding, and fostering project accountability and social engagement. However, the economic risks of health-related crowdfunding include inefficient priority setting, heightened financial risk, inconsistent regulatory policies, intellectual property rights concerns, and fraud. Theorized crowdfunding behaviours such as signalling and herding can be observed in the market for health-related crowdfunding. Broader threats of market failure stemming from adverse selection and moral hazard also apply. Many of the discussed economic benefits and risks of crowdfunding health campaigns are shared more broadly with those of crowdfunding projects in other sectors. Where crowdfunding health care appears to diverge from theory is the negative externality inefficient priority setting may have towards achieving broader public health goals. Therefore, the market for crowdfunding health care must be economically stable, as well as designed to optimally and equitably improve public health. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues.

PubMed

Edwards, Rhiannon Tudor; Charles, Joanna Mary; Lloyd-Williams, Huw

2013-10-24

If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Electronic databases and organisation websites were searched using a 22 year time horizon (1990-2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader

Behavioral economic analysis of cue-elicited craving for alcohol.

PubMed

MacKillop, James; O'Hagen, Sean; Lisman, Stephen A; Murphy, James G; Ray, Lara A; Tidey, Jennifer W; McGeary, John E; Monti, Peter M

2010-09-01

Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug's value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure. One-way within-subjects design. Human laboratory environment. Heavy drinkers (n = 92) underwent exposures to neutral (water) cues followed by personalized alcohol cues. Participants were assessed for craving, alcohol demand, affect, and salivation following each exposure. Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (O(max)), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized P(max)). Craving was significantly correlated with demand measures at levels ranging from 0.21-0.43. These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol-related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.

Relationship of socioeconomic status with health behaviors and self-perceived health in the elderly: A community-based study, Turkey.

PubMed

Simsek, Hatice; Doganay, Sinem; Budak, Refik; Ucku, Reyhan

2014-10-01

The purpose of the present study was to determine the effects of socioeconomic status on health behaviors and perceived health. The present cross-sectional study included 2947 community-dwelling older adults aged 65 years and older. Dependent variables were health behaviors and self-perceived health. The independent variable was socioeconomic status. In men, the risk of unhealthy diet was higher among the uneducated group (OR 4.48) and among those with poor/very poor economic status (OR 3.31). Additionally, in men, having poor/very poor self-perceived health was found to be 3.50-fold significantly higher among the uneducated group than the secondary school and higher-educated group. Lower education level and lower social class were found to be protective factors for smoking in women. In women, the risk of unhealthy diet was found to be 1.54- and 2.18-fold significantly higher, respectively, among those who graduated from primary school and uneducated. There was also a relationship between poor/very poor economic status and unhealthy diet among elderly women (OR 2.80). In women, the risk of physical inactivity was found to be 1.98-fold significantly higher in the uneducated group and 1.79-fold significantly higher in those with poor/very poor economic status, 0.33-fold significantly lower in skilled employees/white collar workers. With regard to self-perceived health status, education level and perceived economic status were significantly related to poor/very poor health status in women (OR 2.09 and OR 4.08, respectively). In older men and women, lower socioeconomic status increases the risk of unhealthy diet and poor health perception. In older women, lower socioeconomic status is a protective factor for smoking, but it also increases physical inactivity. © 2013 Japan Geriatrics Society.

Issues surrounding the health economic evaluation of genomic technologies

PubMed Central

Buchanan, James; Wordsworth, Sarah; Schuh, Anna

2014-01-01

Aim Genomic interventions could enable improved disease stratification and individually tailored therapies. However, they have had a limited impact on clinical practice to date due to a lack of evidence, particularly economic evidence. This is partly because health economists are yet to reach consensus on whether existing methods are sufficient to evaluate genomic technologies. As different approaches may produce conflicting adoption decisions, clarification is urgently required. This article summarizes the methodological issues associated with conducting economic evaluations of genomic interventions. Materials & methods A structured literature review was conducted to identify references that considered the methodological challenges faced when conducting economic evaluations of genomic interventions. Results Methodological challenges related to the analytical approach included the choice of comparator, perspective and timeframe. Challenges in costing centered around the need to collect a broad range of costs, frequently, in a data-limited environment. Measuring outcomes is problematic as standard measures have limited applicability, however, alternative metrics (e.g., personal utility) are underdeveloped and alternative approaches (e.g., cost–benefit analysis) underused. Effectiveness data quality is weak and challenging to incorporate into standard economic analyses, while little is known about patient and clinician behavior in this context. Comprehensive value of information analyses are likely to be helpful. Conclusion Economic evaluations of genomic technologies present a particular challenge for health economists. New methods may be required to resolve these issues, but the evidence to justify alternative approaches is yet to be produced. This should be the focus of future work in this field. PMID:24236483

[Economic crisis and mental health. SESPAS report 2014].

PubMed

Gili, Margalida; García Campayo, Javier; Roca, Miquel

2014-06-01

Studies published before the financial crisis of 2008 suggest that economic difficulties contribute to poorer mental health. The IMPACT study conducted in primary health care centers in Spain found a significant increase in common mental disorders. Between 2006 and 2010, mood disorders increased by 19%, anxiety disorders by 8% and alcohol abuse disorders by 5%. There were also gender differences, with increased alcohol dependence in women during the crisis period. The most important risk factor for this increase was unemployment. In parallel, antidepressant consumption has increased in recent years, although there has not been a significant inrease in the number of suicides. Finally, the study offers some proposals to reduce the impact of the crisis on mental health: increased community services, employment activation measures, and active policies to reduce alcohol consumption and prevent suicidal behavior, particularly among young people. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Economic models of the family and the relationship between economic status and health.

PubMed

Tipper, Adam

2010-05-01

Empirical evidence strongly suggests that there is a positive relationship between economic status and health, and that married persons are healthier than their single counterparts. There are, however, a number of economic explanations for why economic status is related to health in the family context that are often overlooked in empirical studies. This paper provides a comparative introduction to three main economic approaches to the family in order to understand further why married persons are often observed to be healthier than single persons. The models discussed are the unitary model, the collective labour supply model, and the institutional economics approach. In discussing the different approaches to health formation in a family context, issues pertaining to gender, intra-household inequality, and resource transfers are also explored to highlight the advantages of considering various economic perspectives. Each of these models, it is suggested, provides an alternative view of the mechanisms for relating economic status to health, and may thus affect the interpretation of empirical results. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Systematic review of employer-sponsored wellness strategies and their economic and health-related outcomes.

PubMed

Kaspin, Lisa C; Gorman, Kathleen M; Miller, Ross M

2013-02-01

This review determines the characteristics and health-related and economic outcomes of employer-sponsored wellness programs and identifies possible reasons for their success. PubMed, ABI/Inform, and Business Source Premier databases, and Corporate Wellness Magazine were searched. English-language articles published from 2005 to 2011 that reported characteristics of employer-sponsored wellness programs and their impact on health-related and economic outcomes among US employees were accepted. Data were abstracted, synthesized, and interpreted. Twenty references were accepted. Wellness interventions were classified into health assessments, lifestyle management, and behavioral health. Improved economic outcomes were reported (health care costs, return on investment, absenteeism, productivity, workers' compensation, utilization) as well as decreased health risks. Programs associated with favorable outcomes had several characteristics in common. First, the corporate culture encouraged wellness to improve employees' lives, not only to reduce costs. Second, employees and leadership were strongly motivated to support the wellness programs and to improve their health in general. Third, employees were motivated by a participation-friendly corporate policy and physical environment. Fourth, successful programs adapted to the changing needs of the employees. Fifth, community health organizations provided support, education, and treatment. Sixth, successful wellness programs utilized technology to facilitate health risk assessments and wellness education. Improved health-related and economic outcomes were associated with employer-sponsored wellness programs. Companies with successful programs tended to include wellness as part of their corporate culture and supported employee participation in several key ways.

Associations between media use and health information-seeking behavior on vaccinations in South Korea.

PubMed

Kim, Jiyeon; Jung, Minsoo

2017-09-11

Although vaccinations are critical for preventing emerging infectious diseases, scant research has been conducted on risk communication. With socio-economic characteristics, health behavior, and underlying diseases under control, we investigated associations between media use, health information-seeking behavior, health information type, and vaccination in the population. This study relied on a national survey of Korean adults (n = 1367). Participants were adult males and females age 20 and older. Web and face-to-face surveys were conducted throughout July 2014. The main outcome was vaccination (categorized as yes or no). Independent variables were time spent on media, frequency of health information-seeking behavior, and types of health information sought. Controlling for co-variates, logistic regression analysis was conducted to identify factors that influence Korean adults being vaccinated. Results revealed that accessible information about emerging infectious diseases, listening to the radio, and reading the newspaper were associated with increased odds of being vaccinated. Active seeking health information as well as being female and of higher socio-economic status were positively correlated with Korean adults being vaccinated. It is critical to promote health information-seeking behavior and use diverse media channels to increase acceptance and awareness of emerging infectious diseases and vaccinations. Because there are differences in vaccination awareness depending on social class, it is critical to reduce communication inequality, strengthen accessibility to vaccinations, and devise appropriate risk communication strategies that ensure Korean adults receive vaccinations.

Economic values, ethics, and ecosystem health

Treesearch

Thomas P. Holmes; Randall A. Kramer

1995-01-01

Economic valuations of changes in ecosystem health can provide quantitative information for social decisions. However, willingness to pay for ecosystem health may be motivated by an environmental ethic regarding the right thing to do. Counterpreferential choices based on an environmental ethic are inconsistent with the normative basis of welfare economics. In this...

Health economics in developing countries.

PubMed

Abel-Smith, B

1989-08-01

The interpretation of health economics chosen for this paper is broad. It includes the relation between economic and other factors in health development. This interpretation has been chosen lest the acceptance of a disciplinary approach in the commissioning of papers should have the unintended effect of excluding some key areas of research which require the consideration of crucial interrelationships between disciplines. The only justification for covering this area in a paper on economics rather than, for example, epidemiology is that increasingly there is and indeed has to be a heavy focus on costs in considering alternative paths to health development. The word 'research' is loosely interpreted and not restricted to the type of activity which could lead to the award of a PhD. The compilation of experience in many areas is, in the view of the author, a priority need, to plan where further research and experiment is needed.

Relationships Between Health Behaviors, Self-Efficacy, and Health Locus of Control of Students at the Universities of the Third Age

PubMed Central

Zielińska-Więczkowska, Halina

2016-01-01

Background This study aimed to determine the relationship of health behaviors with the health locus of control and the sense of self-efficacy against the background of socio-economic factors and self-rated health among students of the Universities of the Third Age (U3As). Material/Methods The study included 320 U3A students, with mean age of 67.5 years. The following research tools were used: Health Behavior Inventory (HBI), Multidimensional Health Locus of Control Scale (MHLC), Generalized Self-Efficacy Scale (GSES), and an original survey of the author’s own design. Results Mean total HBI and GSES scores were 90.63 and 30.12, respectively. These results are satisfactory. A slight predominance of internal health locus of control was documented. A number of significant correlations were found between the HBI, GSES, and MHLC scores, except for the MHLC subscale expressing the influence of chance. Educational attainment was shown to have a significant impact on the scores for the positive attitude and proper dietary habits subscales of HBI, as well as on the GSES scores. Economic status of the participants influenced the levels of positive attitude, internal health locus of control, and self-efficacy. Furthermore, internal health locus of control was found to be modulated by subjective health of the respondents. The scores for external health locus of control and the influence of chance increased significantly with age. Conclusions The currently noticeable emphasis placed on lifelong education should serve as a good prognostic factor for health behaviors and personal health resources for years to come. PMID:26879981

Relationships Between Health Behaviors, Self-Efficacy, and Health Locus of Control of Students at the Universities of the Third Age.

PubMed

Zielińska-Więczkowska, Halina

2016-02-16

BACKGROUND This study aimed to determine the relationship of health behaviors with the health locus of control and the sense of self-efficacy against the background of socio-economic factors and self-rated health among students of the Universities of the Third Age (U3As). MATERIAL AND METHODS The study included 320 U3A students, with mean age of 67.5 years. The following research tools were used: Health Behavior Inventory (HBI), Multidimensional Health Locus of Control Scale (MHLC), Generalized Self-Efficacy Scale (GSES), and an original survey of the author's own design. RESULTS Mean total HBI and GSES scores were 90.63 and 30.12, respectively. These results are satisfactory. A slight predominance of internal health locus of control was documented. A number of significant correlations were found between the HBI, GSES, and MHLC scores, except for the MHLC subscale expressing the influence of chance. Educational attainment was shown to have a significant impact on the scores for the positive attitude and proper dietary habits subscales of HBI, as well as on the GSES scores. Economic status of the participants influenced the levels of positive attitude, internal health locus of control, and self-efficacy. Furthermore, internal health locus of control was found to be modulated by subjective health of the respondents. The scores for external health locus of control and the influence of chance increased significantly with age. CONCLUSIONS The currently noticeable emphasis placed on lifelong education should serve as a good prognostic factor for health behaviors and personal health resources for years to come.

Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues

PubMed Central

2013-01-01

Background If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Methods Electronic databases and organisation websites were searched using a 22 year time horizon (1990–2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. Results We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. Conclusions In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may

Linking human health and livestock health: a "one-health" platform for integrated analysis of human health, livestock health, and economic welfare in livestock dependent communities.

PubMed

Thumbi, S M; Njenga, M Kariuki; Marsh, Thomas L; Noh, Susan; Otiang, Elkanah; Munyua, Peninah; Ochieng, Linus; Ogola, Eric; Yoder, Jonathan; Audi, Allan; Montgomery, Joel M; Bigogo, Godfrey; Breiman, Robert F; Palmer, Guy H; McElwain, Terry F

2015-01-01

For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status. We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households. Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the

Evaluating Behavioral Health Surveillance Systems.

PubMed

Azofeifa, Alejandro; Stroup, Donna F; Lyerla, Rob; Largo, Thomas; Gabella, Barbara A; Smith, C Kay; Truman, Benedict I; Brewer, Robert D; Brener, Nancy D

2018-05-10

In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health-related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems.

[Occupational health protection in business economics--business plan for health intervention].

PubMed

Rydlewska-Liszkowska, Izabela

2011-01-01

One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees

Evaluating Behavioral Health Surveillance Systems

PubMed Central

Azofeifa, Alejandro; Lyerla, Rob; Largo, Thomas; Gabella, Barbara A.; Smith, C. Kay; Truman, Benedict I.; Brewer, Robert D.; Brener, Nancy D.

2018-01-01

In 2015, more than 27 million people in the United States reported that they currently used illicit drugs or misused prescription drugs, and more than 66 million reported binge drinking during the previous month. Data from public health surveillance systems on drug and alcohol abuse are crucial for developing and evaluating interventions to prevent and control such behavior. However, public health surveillance for behavioral health in the United States has been hindered by organizational issues and other factors. For example, existing guidelines for surveillance evaluation do not distinguish between data systems that characterize behavioral health problems and those that assess other public health problems (eg, infectious diseases). To address this gap in behavioral health surveillance, we present a revised framework for evaluating behavioral health surveillance systems. This system framework builds on published frameworks and incorporates additional attributes (informatics capabilities and population coverage) that we deemed necessary for evaluating behavioral health–related surveillance. This revised surveillance evaluation framework can support ongoing improvements to behavioral health surveillance systems and ensure their continued usefulness for detecting, preventing, and managing behavioral health problems. PMID:29752804

Behavioral Economics and Empirical Public Policy

ERIC Educational Resources Information Center

Hursh, Steven R.; Roma, Peter G.

2013-01-01

The application of economics principles to the analysis of behavior has yielded novel insights on value and choice across contexts ranging from laboratory animal research to clinical populations to national trends of global impact. Recent innovations in demand curve methods provide a credible means of quantitatively comparing qualitatively…

Health capabilities and diabetes self-management: the impact of economic, social, and cultural resources.

PubMed

Weaver, Robert R; Lemonde, Manon; Payman, Naghmeh; Goodman, William M

2014-02-01

While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic

Relationships between youth sport participation and selected health risk behaviors from 1999 to 2007.

PubMed

Taliaferro, Lindsay A; Rienzo, Barbara A; Donovan, Kristine A

2010-08-01

How adolescents spend their out-of-school time represents one of the most important factors for predicting positive youth development. Sport participation relates to many beneficial outcomes. However, current economic conditions threaten high school sport programs around the United States. This investigation examined relationships by year between sport participation and numerous health risk behaviors among high school students. Data were derived from the Centers for Disease Control and Prevention's Youth Risk Behavior Surveys administered every 2 years from 1999 through 2007. Items assessed were sport participation, vigorous physical activity, dietary habits, weight loss, sexual activity, interpersonal violence and suicidality, and substance use. Multiple logistic regression analyses were used to examine relationships between sport participation and each health behavior. Interaction effects tested whether relationships varied by year, sex, age, and/or race/ethnicity. Analyses revealed some consistencies across years in relationships between sport participation and health risk behaviors for both sexes. However, most relationships varied by race/ethnicity. Among White students, sport participation related to multiple positive health behaviors. Conversely, African American, Hispanic, and Other athletes showed fewer positive health behaviors and some negative behaviors. Findings suggest that participation in organized sports affords many health benefits to most adolescents, but relates to some negative health behaviors in certain subgroups. Information regarding sport participation and health risk behaviors among subgroups across years can inform school policy, practice, and future research.

[Aspects of economic responsibility in health care].

PubMed

Hauke, Eugen

2007-01-01

According to the final consensus of a panel of intense discussions, the health care system should/can not be excluded from the economic laws of efficiency. Appropriate adaptation of various methods and instruments of economics make these tools applicable for use in the health care system. Due to errors in the implementation of economic methods, though, the question arises who is economically responsible in the health care system. The answer is found at three different levels of the health care system. The physician plays a leading role, both personally and professionally, in being primarily responsible for the direct medical treatment of the patient. The physician's dependence, however, on the health care system reduces his independence, which markedly affects his decision-making and treatment. Management of and in health care institutions is largely independent of the profession learned. Managers and physicians acting as managers must be appropriately and duly educated in the necessary specific talents and knowledge. The organisation of a health care system should also be reserved for trained specialists where the physicians as well as other professionals are obliged to acquire the skills necessary.

[Basic principles and methodological considerations of health economic evaluations].

PubMed

Loza, Cesar; Castillo-Portilla, Manuel; Rojas, José Luis; Huayanay, Leandro

2011-01-01

Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.

Mental health economics, health service provision, and the practice of geriatric psychiatry.

PubMed

Suh, Guk-Hee; Han, Changsu

2008-11-01

Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed. Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries. Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments.

77 FR 62538 - Advisory Committee for Social, Behavioral and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

... NATIONAL SCIENCE FOUNDATION Advisory Committee for Social, Behavioral and Economic Sciences..., Behavioral and Economic Sciences ( 1171). Date/Time: November 15, 2012; 8:00 a.m. to 5:00 p.m. Place..., Behavioral and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard, Room 905, Arlington...

Risk factors in road crossing among elderly pedestrians and readiness to adopt safe behavior in socio-economic comparison.

PubMed

Rosenbloom, Tova; Sapir-Lavid, Yael; Perlman, Amotz

2016-08-01

This research examines the Health Promotion Behavior (HPB) models regarding elderly pedestrians' behaviors and attitudes. We studied cognitive-psychological variables, such as risk estimation, self-efficacy and demographic variables and compared elderly pedestrians' attitudes and behaviors in a city with higher socio-economic level (Tel Aviv) versus a city with low socio-economic level (Beer Sheva). We expected to find more problematic behaviors among elderly pedestrians in the low socio-economic city compared to the high socio-economic city, and also less feeling of self-efficacy, and lessened awareness of the risks, that leads to lessened willingness to adopt preventive behaviors. The research was conducted in two studies. The first study was based on observations on 2591 pedestrians in six similar crosswalks in both cities. It revealed that pedestrians in the high socio-economic city demonstrated safer road crossing patterns than in the low socio-economic city and that elderly pedestrians reveal safer crossing patterns than younger pedestrians. We found an interaction of location and age due to greater gap of safe behaviors of elderly and young pedestrians in the high socio-economic city than in the low socio-economic city. In Tel Aviv elderly adhere to the crossing rules much more than the young while in Beer Sheva elderly and young people are almost similar in their crossing patterns. The second study used questionnaires that have been completed by 143 elderly in both cities. The questionnaires referred to (a) demographic variables such as gender, age, marital status, education, socio-economic level, (b) variables related to the affiliation to the main culture such as migration, date of migration, knowledge in Hebrew (local language) and connectivity to media and (c) cognitive as well as psychological variables related to the decline to adopt healthy behaviors based on Schwarzer and Fuchs (1995). This part also indicated that elderly in Tel Aviv have higher

The economic effect of Planet Health on preventing bulimia nervosa.

PubMed

Wang, Li Yan; Nichols, Lauren P; Austin, S Bryn

2011-08-01

To assess the economic effect of the school-based obesity prevention program Planet Health on preventing disordered weight control behaviors and to determine the cost-effectiveness of the intervention in terms of its combined effect on prevention of obesity and disordered weight control behaviors. On the basis of the intervention's short-term effect on disordered weight control behaviors prevention, we projected the number of girls who were prevented from developing bulimia nervosa by age 17 years. We further estimated medical costs saved and quality-adjusted life years gained by the intervention over 10 years. As a final step, we compared the intervention costs with the combined intervention benefits from both obesity prevention (reported previously) and prevention of disordered weight control behaviors to determine the overall cost-effectiveness of the intervention. Middle schools. A sample of 254 intervention girls aged 10 to 14 years. The Planet Health program was implemented during the school years from 1995 to 1997 and was designed to promote healthful nutrition and physical activity among youth. Intervention costs, medical costs saved, quality-adjusted life years gained, and cost-effectiveness ratio. An estimated 1 case of bulimia nervosa would have been prevented. As a result, an estimated $33 999 in medical costs and 0.7 quality-adjusted life years would be saved. At an intervention cost of $46 803, the combined prevention of obesity and disordered weight control behaviors would yield a net savings of $14 238 and a gain of 4.8 quality-adjusted life years. Primary prevention programs, such as Planet Health, warrant careful consideration by policy makers and program planners. The findings of this study provide additional argument for integrated prevention of obesity and eating disorders.

76 FR 65219 - Advisory Committee for Social, Behavioral and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-20

... NATIONAL SCIENCE FOUNDATION Advisory Committee for Social, Behavioral and Economic Sciences..., Behavioral and Economic Sciences ( 1171) Date/Time: November 3, 2011; 1 p.m. to 5:30 p.m. November 4, 2011; 8..., Directorate for Social, Behavioral and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard...

Tests of Behavioral-Economic Assessments of Relative Reinforcer Efficacy: Economic Substitutes

ERIC Educational Resources Information Center

Madden, Gregory J.; Smethells, John R.; Ewan, Eric E.; Hursh, Steven R.

2007-01-01

This experiment was conducted to test predictions of two behavioral-economic approaches to quantifying relative reinforcer efficacy. According to the first of these approaches, characteristics of averaged normalized demand curves may be used to predict progressive-ratio breakpoints and peak responding. The second approach, the demand analysis,…

International behavioral responses to a health hazard: AIDS.

PubMed

Earickson, R J

1990-01-01

This paper expands on Jonathan Mann's third wave of the AIDS pandemic: the epidemic of economic, social, political, and cultural reaction and response to the HIV infection and to AIDS. This worldwide epidemic is a major economic challenge, especially in Third World countries, which can ill afford additional health care costs. AIDS is also a harbinger of political and cultural conflicts between and among nations, states, institutions, and people everywhere. It may ultimately transform law as radically as it has health care practices. In terms of management, it is possible to approach AIDS much as we do natural and technological hazards. The biology and epidemiology of AIDS require a coordinated attack, involving research on vaccines and drugs, modification of human behavior and education of populations to arrest the disease. All of these require money, of which the United States was the major contributor before the Reagan years. Funding to the United Nations and WHO has since languished, jeopardizing the AIDS efforts of those two organizations.

Economy Over Security: Why Crises Fail to Impact Economic Behavior in East Asia

DTIC Science & Technology

2017-12-01

SECURITY: WHY CRISES FAIL TO IMPACT ECONOMIC BEHAVIOR IN EAST ASIA by Aaron R. Sipos December 2017 Thesis Advisor: Michael Glosny Second...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE ECONOMY OVER SECURITY: WHY CRISES FAIL TO IMPACT ECONOMIC BEHAVIOR IN EAST...release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) This study examines changes in economic behavior in

Early Adolescent Health Risk Behaviors, Conflict Resolution Strategies, and School Climate

ERIC Educational Resources Information Center

LaRusso, Maria; Selman, Robert

2011-01-01

Drawing upon an ethnically and socio-economically diverse sample of 323 7th grade students from twelve urban schools within one school district, this mixed method study examined early adolescents' self-reported health risk behaviors as related to their conflict resolution strategies and their school's conflict resolution climate. Survey data…

Interplay of politics and law to promote health: improving economic equality and health: the case of postwar Japan.

PubMed

Bezruchka, Stephen; Namekata, Tsukasa; Sistrom, Maria Gilson

2008-04-01

The health situation in Japan after World War II was extremely poor. However, in less than 35 years the country's life expectancy was the highest in the world. Japan's continuing health gains are linked to policies established at the end of World War II by the Allied occupation force that established a democratic government. The Confucian principles that existed in Japan long before the occupation but were preempted during the war years were reestablished after the war, facilitating subsequent health improvements. Japan's good health status today is not primarily the result of individual health behaviors or the country's health care system; rather, it is the result of the continuing economic equality that is the legacy of dismantling the prewar hierarchy.

76 FR 24062 - Advisory Committee for Social, Behavioral and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

... NATIONAL SCIENCE FOUNDATION Advisory Committee for Social, Behavioral and Economic Sciences..., Behavioral and Economic Sciences ( 1171) Date/Time: May 19, 2011; 9 a.m. to 5:30 p.m. May 20, 2011; 9 a.m. to..., Directorate for Social, Behavioral and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard...

77 FR 25207 - Advisory Committee for Social, Behavioral and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

... NATIONAL SCIENCE FOUNDATION Advisory Committee for Social, Behavioral and Economic Sciences..., Behavioral and Economic Sciences ( 1171). Date/Time: May 17, 2012; 8:30 a.m. to 5:30 p.m.; May 18, 2012; 8:30..., Directorate for Social, Behavioral and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard...

75 FR 25886 - Advisory Committee for Social, Behavioral, and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-10

... NATIONAL SCIENCE FOUNDATION Advisory Committee for Social, Behavioral, and Economic Sciences..., Behavioral, and Economic Sciences ( 1171). Date/Time: May 20, 2010; 8:30 a.m. to 5:30 p.m. May 21, 2010; 8:30..., Directorate for Social, Behavioral, and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard...

78 FR 25309 - Advisory Committee for Social, Behavioral and Economic Sciences; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-30

... NATIONAL SCIENCE FOUNDATION ADVISORY Advisory Committee for Social, Behavioral and Economic..., Behavioral and Economic Sciences ( 1171) Date/Time: May 20, 2013; 9:00 a.m. to 5:15 p.m. May 21, 2013; 9:00 a..., Directorate for Social, Behavioral and Economic Sciences, National Science Foundation, 4201 Wilson Boulevard...

Behavioral health referrals in pediatric epilepsy.

PubMed

Wagner, Janelle L; Ferguson, Pamela L; Kellermann, Tanja; Smith, Gigi; Brooks, Byron

2016-11-01

The purpose of this study was to examine the feasibility of a behavioral health referral protocol and barriers to behavioral health care in a pediatric epilepsy clinic. A sample of 93 youth with epilepsy ages 10-17 and caregivers completed behavioral health and seizure severity measures during a routine epilepsy clinic visit. Key findings are that 47 (50.5%) of the youth screened positive for a behavioral health referral, and 35 of these youth were referred for behavioral health services. However, only 20% made and presented for the behavioral health appointment. The most commonly cited barrier for accessing and utilizing behavioral health care was stigma related- a mental health label for the child. The significance of this study lies in the revelation that solely screening for and educating caregivers about behavioral health symptoms and providing behavioral health referral information is not an ideal model. Instead, stigma related barriers point to the necessity of continued integrated physical and behavioral health care within the pediatric epilepsy visit. Copyright © 2016 Elsevier B.V. All rights reserved.

How health plans promote health IT to improve behavioral health care.

PubMed

Quinn, Amity E; Reif, Sharon; Evans, Brooke; Creedon, Timothy B; Stewart, Maureen T; Garnick, Deborah W; Horgan, Constance M

2016-12-01

Given the large numbers of providers and enrollees with which they interact, health plans can encourage the use of health information technology (IT) to advance behavioral health care. The manner and extent to which commercial health plans promote health IT to improve behavioral health care is unknown. This study aims to address that gap. Cross-sectional study. Data are from a nationally representative survey of commercial health plans regarding administrative and clinical dimensions of behavioral health services in 2010. Data are weighted to be representative of commercial managed care products in the United States (n = 8427; 88% response rate). Approaches within the domains of provider support, access to care, and assessment and treatment were investigated as examples of how health plans can promote health IT to improve behavioral health care delivery. Health plans were using health IT approaches in each domain. About a quarter of products offered financial support for electronic health records, but technical assistance was rare. Primary care providers could bill for e-mail contact with patients for behavioral health in about a quarter of products. Few products offered member-provider e-mail, and none offered online appointment scheduling. However, online referral systems and online provider directories were common, and nearly all offered an online self-assessment tool; most offered online counseling and online personalized responses to questions or problems. In 2010, commercial health plans encouraged the use of health IT strategies for behavioral health care. Health plans have an important role to play for increasing health IT as a tool for behavioral health care.

Cost collection and analysis for health economic evaluation.

PubMed

Smith, Kristine A; Rudmik, Luke

2013-08-01

To improve the understanding of common health care cost collection, estimation, analysis, and reporting methodologies. Ovid MEDLINE (1947 to December 2012), Cochrane Central register of Controlled Trials, Database of Systematic Reviews, Health Technology Assessment, and National Health Service Economic Evaluation Database. This article discusses the following cost collection methods: defining relevant resources, quantification of consumed resources, and resource valuation. It outlines the recommendations for cost reporting in economic evaluations and reviews the techniques on how to handle cost data uncertainty. Last, it discusses the controversial topics of future costs and patient productivity losses. Health care cost collection and estimation can be challenging, and an organized approach is required to optimize accuracy of economic evaluation outcomes. Understanding health care cost collection and estimation techniques will improve both critical appraisal and development of future economic evaluations.

Ethics, economics, and public financing of health care

PubMed Central

Hurley, J.

2001-01-01

There is a wide variety of ethical arguments for public financing of health care that share a common structure built on a series of four logically related propositions regarding: (1) the ultimate purpose of a human life or human society; (2) the role of health and its distribution in society in advancing this ultimate purpose; (3) the role of access to or utilisation of health care in maintaining or improving the desired level and distribution of health among members of society, and (4) the role of public financing in ensuring the ethically justified access to and utilisation of health care by members of society. This paper argues that economics has much to contribute to the development of the ethical foundations for publicly financed health care. It focuses in particular on recent economic work to clarify the concepts of access and need and their role in analyses of the just distribution of health care resources, and on the importance of economic analysis of health care and health care insurance markets in demonstrating why public financing is necessary to achieve broad access to and utilisation of health care services. Key Words: Ethics • economics • health care financing PMID:11479353

Covariations of eating behaviors with other health-related behaviors among adolescents.

PubMed

Neumark-Sztainer, D; Story, M; Toporoff, E; Himes, J H; Resnick, M D; Blum, R W

1997-06-01

The study objectives are: (1) to examine and compare patterns of covariation of a wide range of health behaviors among adolescent boys and girls; (2) to determine whether eating behaviors are part of a larger construct of health-related behaviors and to identify the behaviors with which they share underlying similarities; and (3) to determine whether youth engaging in other health-compromising behaviors are at risk for unhealthy eating. Data were analyzed from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, completed by 36,284 adolescents, in grades 7-12 from 1986-87. Among boys, factor analysis revealed five factors: (1) risk-taking behaviors, (2) school-related behaviors, (3) "quietly" disturbed behaviors (e.g., frequent dieting, self-induced vomiting, suicide attempts), (4) health-promoting behaviors; and (5) exercise. Eating behaviors loaded on the construct of health-promoting behaviors with brushing teeth and seat belt use. Among girls, four similar factors emerged; however, exercise loaded on the construct of health-promoting behaviors. Therefore, eating behaviors loaded with brushing teeth, seat belt use, and exercise among girls. Logistic regression analyses, controlling for sociodemographic and personal variables, revealed that boys and girls engaging in health-promoting behaviors were less likely to have unhealthy eating behaviors, while those engaging in quietly disturbed behaviors, risk-taking behaviors, and problematic school behaviors were more likely to have unhealthy eating behaviors. Eating behaviors appear to be part of a health-promoting behavioral construct and should not be viewed in isolation from other behaviors. Although eating behaviors do not appear to be part of the "problem behavior syndrome," youth engaging in a wide range of health-compromising behaviors are at risk for unhealthy eating; emphasizing the need to target high-risk youth with health promotion programs.

Poverty dynamics in Germany: Evidence on the relationship between persistent poverty and health behavior.

PubMed

Aue, Katja; Roosen, Jutta; Jensen, Helen H

2016-03-01

Previous studies have found poverty to be related to lower levels of health due to poor health behavior such as unhealthy eating, smoking or less physical activity. Longer periods of poverty seem to be especially harmful for individual health behavior. Studies have shown that poverty has a dynamic character. Moreover, poverty is increasingly regarded as being a multidimensional construct and one that considers more aspects than income alone. Against this background this paper analyzes the relationship between health behavior and persistent spells of income poverty as well as a combined poverty indicator using data of the German Socio-Economic Panel (2000-2010). Next to cross-sectional logistic regression models we estimate fixed-effects models to analyze the effect of persistent poverty on dietary behavior, tobacco consumption, and physical activity. Cross-sectional results suggest that persistent poverty is related to poor health behavior, particularly regarding tobacco consumption and physical activity. Results also show that multidimensional and dynamic aspects of poverty matter. Complementary panel analyses reveal negative effects for the combined poverty indicator only for dietary behavior in the total sample. However, by analyzing the sample by gender we identify further effects of persistent poverty on health behavior. The analyses show that not only do individuals in poverty but also those in precarious situations show health-damaging behavior more often. Copyright © 2016 Elsevier Ltd. All rights reserved.

Benford's law and the FSD distribution of economic behavioral micro data

NASA Astrophysics Data System (ADS)

Villas-Boas, Sofia B.; Fu, Qiuzi; Judge, George

2017-11-01

In this paper, we focus on the first significant digit (FSD) distribution of European micro income data and use information theoretic-entropy based methods to investigate the degree to which Benford's FSD law is consistent with the nature of these economic behavioral systems. We demonstrate that Benford's law is not an empirical phenomenon that occurs only in important distributions in physical statistics, but that it also arises in self-organizing dynamic economic behavioral systems. The empirical likelihood member of the minimum divergence-entropy family, is used to recover country based income FSD probability density functions and to demonstrate the implications of using a Benford prior reference distribution in economic behavioral system information recovery.

On the costs of self-interested economic behavior: how does stinginess get under the skin?

PubMed

Dunn, Elizabeth W; Ashton-James, Claire E; Hanson, Margaret D; Aknin, Lara B

2010-05-01

The present study examined how financial decisions 'get under the skin'. Participants played an economic game in which they could donate some of their payment to another student. Affect was measured afterward and salivary cortisol was measured before and afterward. Participants who kept more money for themselves reported less positive affect, more negative affect, and more shame. Shame predicted higher levels of post-game cortisol, controlling for pre-game cortisol; stingy economic behavior therefore produced a significant indirect effect on cortisol via shame. Thus, shame and cortisol represent plausible emotional and biological pathways linking everyday decisions with downstream consequences for health.

Economic and social dimensions of environmental behavior: balancing conservation and development in Bhutan.

PubMed

Brooks, Jeremy S

2010-12-01

One of the primary approaches to environmental conservation emphasizes economic development. This conservation-and-development approach often ignores how development affects sociocultural characteristics that may motivate environmental behaviors (actions that actively benefit or limit one's negative impacts on the environment). Evolutionary anthropologists espouse a theoretical perspective that supports the conservation-and-development approach. Others believe sociocultural factors are the foundation of environmental behavior and worry that development will erode the values and norms that may shape such behavior. My research assistants and I surveyed 170 individuals from eight villages in two communities in Bhutan to explore whether economic (wealth, market integration) or social (religious behaviors, environmental values, social capital) factors are better indicators of environmental behavior. I used multilevel modeling to analyze use of fuelwood, use of agricultural chemicals, and tree planting, and to determine whether social norms were associated with these behaviors. Although economic factors were more often associated with these behaviors than social factors, local conditions and control variables were the best indicators of behaviors. Furthermore, economic factors were not always associated with positive environmental outcomes. Instead, farmers attempted to make the best economic decisions given their circumstances rather than seeking to conserve resources. Although religion was not a strong predictor of any of the behaviors I examined, I found evidence that the understanding of Buddhist philosophy is growing, which suggests that social factors may play a more prominent role as Bhutan's development progresses. My results highlight the need for conservation planners to be aware of local conditions when planning and implementing policies aimed at motivating environmental behaviors and that economic and social motivations for conservation may not be mutually

A behavioral economics perspective on tobacco taxation.

PubMed

Cherukupalli, Rajeev

2010-04-01

Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco's hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country's circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

PubMed Central

2013-01-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (http://www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years. PMID:23531108

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

PubMed Central

2013-01-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (http://www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years. PMID:23531194

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-03-25

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (http://www.ispor.org/TaskForces/EconomicPubGuidelines.asp).We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-01-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website: (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years. Copyright © 2013. Published by Elsevier Inc.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-04-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website: (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years. Copyright © 2013. Published by EM Inc USA.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-06-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website ( www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-04-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-01-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user-friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user-friendly, 24-item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). The hope is that CHEERS will lead to better reporting and, ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. Other journals and groups are encouraged to endorse CHEERS. The author team plans to review the checklist for an update in 5 years.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-05-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website ( www.ispor.org/TaskForces/EconomicPubGuidelines.asp ).We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

2013-03-25

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Behavioral Health Program Element

NASA Technical Reports Server (NTRS)

Leveton, Lauren B.

2006-01-01

The project goal is to develop behavioral health prevention and maintenance system for continued crew health, safety, and performance for exploration missions. The basic scope includes a) Operationally-relevant research related to clinical cognitive and behavioral health of crewmembers; b) Ground-based studies using analog environments (Antarctic, NEEMO, simulations, and other testbeds; c) ISS studies (ISSMP) focusing on operational issues related to behavioral health outcomes and standards; d) Technology development activities for monitoring and diagnostic tools; and e) Cross-disciplinary research (e.g., human factors and habitability research, skeletal muscle, radiation).

Autoshaped choice in artificial neural networks: implications for behavioral economics and neuroeconomics.

PubMed

Burgos, José E; García-Leal, Óscar

2015-05-01

An existing neural network model of conditioning was used to simulate autoshaped choice. In this phenomenon, pigeons first receive an autoshaping procedure with two keylight stimuli X and Y separately paired with food in a forward-delay manner, intermittently for X and continuously for Y. Then pigeons receive unreinforced choice test trials of X and Y concurrently present. Most pigeons choose Y. This preference for a more valuable response alternative is a form of economic behavior that makes the phenomenon relevant to behavioral economics. The phenomenon also suggests a role for Pavlovian contingencies in economic behavior. The model used, in contrast to others, predicts autoshaping and automaintenance, so it is uniquely positioned to predict autoshaped choice. The model also contemplates neural substrates of economic behavior in neuroeconomics, such as dopaminergic and hippocampal systems. A feedforward neural network architecture was designed to simulate a neuroanatomical differentiation between two environment-behavior relations X-R1 and Y-R2, [corrected] where R1 and R2 denote two different emitted responses (not unconditionally elicited by the reward). Networks with this architecture received a training protocol that simulated an autoshaped-choice procedure. Most networks simulated the phenomenon. Implications for behavioral economics and neuroeconomics, limitations, and the issue of model appraisal are discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

Managing Air Quality - Human Health, Environmental and Economic Assessments

EPA Pesticide Factsheets

Human health and environmental assessments characterize health and environmental risks associated with exposure to pollution. Economic assessments evaluate the cost and economic impact of a policy or regulation & can estimate economic benefits.

Health Economics as Rhetoric: The Limited Impact of Health Economics on Funding Decisions in Four European Countries.

PubMed

Franken, Margreet; Heintz, Emelie; Gerber-Grote, Andreas; Raftery, James

2016-12-01

A response to the challenge of high-cost treatments in health care has been economic evaluation. Cost-effectiveness analysis presented as cost per quality-adjusted life-years gained has been controversial, raising heated support and opposition. To assess the impact of economic evaluation in decisions on what to fund in four European countries and discuss the implications of our findings. We used a protocol to review the key features of the application of economic evaluation in reimbursement decision making in England, Germany, the Netherlands, and Sweden, reporting country-specific highlights. Although the institutions and processes vary by country, health economic evaluation has had limited impact on restricting access of controversial high-cost drugs. Even in those countries that have gone the furthest, ways have been found to avoid refusing to fund high-cost drugs for particular diseases including cancer, multiple sclerosis, and orphan diseases. Economic evaluation may, however, have helped some countries to negotiate price reductions for some drugs. It has also extended to the discussion of clinical effectiveness to include cost. The differences in approaches but similarities in outcomes suggest that health economic evaluation be viewed largely as rhetoric (in D.N. McCloskey's terms in The Rhetoric of Economics, 1985). This is not to imply that economics had no impact: rather that it usually contributed to the discourse in ways that differed by country. The reasons for this no doubt vary by perspective, from political science to ethics. Economic evaluation may have less to do with rationing or denial of medical treatments than to do with expanding the discourse used to discuss such issues. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Organizational economics and health care markets.

PubMed

Robinson, J C

2001-04-01

As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership.

Economic evaluation in the field of mental health: conceptual basis.

PubMed

Lima, Ana Flávia Barros da Silva; Cruz, Luciane Nascimento; Polanczyk, Carisi Anne; Maia, Carlos Renato Moreira

2013-01-01

Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies.

A qualitative investigation of the health economic impacts of bariatric surgery for obesity and implications for improved practice in health economics.

PubMed

Campbell, Julie A; Ezzy, Douglas; Neil, Amanda; Hensher, Martin; Venn, Alison; Sharman, Melanie J; Palmer, Andrew J

2018-06-01

Obesity is an economic problem. Bariatric surgery is cost-effective for severe and resistant obesity. Most economic evaluations of bariatric surgery use administrative data and narrowly defined direct medical costs in their quantitative analyses. Demand far outstrips supply for bariatric surgery. Further allocation of health care resources to bariatric surgery (particularly public) could be stimulated by new health economic evidence that supports the provision of bariatric surgery. We postulated that qualitative research methods would elicit important health economic dimensions of bariatric surgery that would typically be omitted from the current economic evaluation framework, nor be reported and therefore not considered by policymakers with sufficient priority. We listened to patients: Focus group data were analysed thematically with software assistance. Key themes were identified inductively through a dialogue between the qualitative data and pre-existing economic theory (perspective, externalities, and emotional capital). We identified the concept of emotional capital where participants described life-changing desires to be productive and participate in their communities postoperatively. After self-funding bariatric surgery, some participants experienced financial distress. We recommend a mixed-methods approach to the economic evaluation of bariatric surgery. This could be operationalised in health economic model conceptualisation and construction, through to the separate reporting of qualitative results to supplement quantitative results. Copyright © 2018 John Wiley & Sons, Ltd.

The behavioral economics of will in recovery from addiction.

PubMed

Monterosso, John; Ainslie, George

2007-09-01

Behavioral economic studies demonstrate that rewards are discounted proportionally with their delay (hyperbolic discounting). Hyperbolic discounting implies temporary preference for smaller rewards when they are imminent, and this concept has been widely considered by researchers interested in the causes of addictive behavior. Far less consideration has been given to the fact that systematic preference reversal also predicts various self-control phenomena, which may also be analyzed from a behavioral economic perspective. Here we summarize self-control phenomena predicted by hyperbolic discounting, particularly with application to the field of addiction. Of greatest interest is the phenomenon of choice bundling, an increase in motivation to wait for delayed rewards that can be expected to result from making choices in whole categories. Specifically, when a person's expectations about her own future behavior are conditional upon her current behavior, the value of these expectations is added to the contingencies for the current behavior, resulting in reduced impulsivity. Hyperbolic discounting provides a bottom-up basis for the intuitive learning of choice bundling, the properties of which match common descriptions of willpower. We suggest that the bundling effect can also be discerned in the advice of 12-step programs.

The behavioral economics of will in recovery from addiction

PubMed Central

Monterosso, John; Ainslie, George

2007-01-01

Behavioral economic studies demonstrate that rewards are discounted proportionally with their delay (hyperbolic discounting). Hyperbolic discounting implies temporary preference for smaller rewards when they are imminent, and this concept has been widely considered by researchers interested in the causes of addictive behavior. Far less consideration has been given to the fact that systematic preference reversal also predicts various self-control phenomena, which may also be analyzed from a behavioral economic perspective. Here we summarize self-control phenomena predicted by hyperbolic discounting, particularly with application to the field of addiction. Of greatest interest is the phenomenon of choice bundling, an increase in motivation to wait for delayed rewards that can be expected to result from making choices in whole categories. Specifically, when a person’s expectations about her own future behavior are conditional upon her current behavior, the value of these expectations is added to the contingencies for the current behavior, resulting in reduced impulsivity. Hyperbolic discounting provides a bottom-up basis for the intuitive learning of choice bundling, the properties of which match common descriptions of willpower. We suggest that the bundling effect can also be discerned in the advice of 12-step programs. PMID:17034958

Risky music-listening behaviors and associated health-risk behaviors.

PubMed

Vogel, Ineke; van de Looij-Jansen, Petra M; Mieloo, Cathelijne L; Burdorf, Alex; de Waart, Frouwkje

2012-06-01

To examine, among adolescents and emerging adults attending inner-city lower education, associations between risky music-listening behaviors (from MP3 players and in discotheques and at pop concerts) and more traditional health-risk behaviors: substance use (cigarettes, alcohol, cannabis, and hard drugs) and unsafe sexual intercourse. A total of 944 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their music-listening and traditional health-risk behaviors. Multiple logistic regression analyses were used to examine associations between music-listening and traditional health-risk behaviors. Risky MP3-player listeners used cannabis more often during the past 4 weeks. Students exposed to risky sound levels during discotheque and pop concert attendance used cannabis less often during the past 4 weeks, were more often binge drinkers, and reported inconsistent condom use during sexual intercourse. The coexistence of risky music-listening behaviors with other health-risk behaviors provides evidence in support of the integration of risky music-listening behaviors within research on and programs aimed at reducing more traditional health-risk behaviors, such as substance abuse and unsafe sexual intercourse.

Health Behavior in Hypochondriasis.

PubMed

Schwind, Julia; Neng, Julia M B; Höfling, Volkmar; Weck, Florian

2015-07-01

The relationship between health behavior and hypochondriasis has not yet been sufficiently examined, as previous studies investigated only individual dimensions of health behavior. In the present study, we extend current literature by examining multiple dimensions of health behavior. One hundred twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and other measures for the evaluation of general psychopathology, illness anxiety, depression, and general anxiety. Patients with hypochondriasis revealed a less active way of life (d = 0.89) and lower hygiene (d = 0.60) than healthy controls, but did not differ from healthy controls regarding their compliance to medical recommendations. No differences were found in substance avoidance, security orientation, and diet. Hypochondriasis-specific behavior should be monitored in the treatment of the disorder.

[Economics of health care in Mali].

PubMed

Coulibaly, S O; Keita, M

1996-01-01

From the results obtained regarding the financing of health care in Mali, we emphasize two important points. First, there is a lack of criteria for the distribution of finding in the health care sector, resulting in a waste of resources. Secondly, there is an absence of adequate pharmaceutical policies. The field studies led in 1987 provided the following observations. The rate of occupation of the beds is very low. Also, the numerous new investments are not yet put into service because of the lack of necessary equipment of qualified personnel. In addition, this does not consider the excessive investments occurring in certain localities where neither the rate of frequentation nor the economic conditions will ever allow the use of the capacity created. Among the possible solutions for the crisis of health care funding in Mali, the following should be priority: first, to fight against the complete lack of organization of the activities at the health care centers; secondly, to fight against the waste and misappropriation of money resulting from the behavior of the medical and paramedical personnel: and thirdly, to clarify the management of the resources coming from the charges for each service. The pharmaceutical policies adopted and implemented in recent years Largely contributed to, first, the creation of competition between essential generic medications and nongeneric medications that can be replaced, and then, the destruction of the public network of drug distribution. These conditions considerably limited the distribution of essential medications; yet, this is the only manner of reducing the pharmaceutical expenses and accordingly, allowing more funding for other medical services. As the distribution network is disorganized, the only alternative for the population to obtain the medications at the lowest price was to create centers of purchasing and distribution and to multiply the number of retailers of essential medications. Extensive work has been conducted in

Economic demand predicts addiction-like behavior and therapeutic efficacy of oxytocin in the rat.

PubMed

Bentzley, Brandon S; Jhou, Thomas C; Aston-Jones, Gary

2014-08-12

Development of new treatments for drug addiction will depend on high-throughput screening in animal models. However, an addiction biomarker fit for rapid testing, and useful in both humans and animals, is not currently available. Economic models are promising candidates. They offer a structured quantitative approach to modeling behavior that is mathematically identical across species, and accruing evidence indicates economic-based descriptors of human behavior may be particularly useful biomarkers of addiction severity. However, economic demand has not yet been established as a biomarker of addiction-like behavior in animals, an essential final step in linking animal and human studies of addiction through economic models. We recently developed a mathematical approach for rapidly modeling economic demand in rats trained to self-administer cocaine. We show here that economic demand, as both a spontaneous trait and induced state, predicts addiction-like behavior, including relapse propensity, drug seeking in abstinence, and compulsive (punished) drug taking. These findings confirm economic demand as a biomarker of addiction-like behavior in rats. They also support the view that excessive motivation plays an important role in addiction while extending the idea that drug dependence represents a shift from initially recreational to compulsive drug use. Finally, we found that economic demand for cocaine predicted the efficacy of a promising pharmacotherapy (oxytocin) in attenuating cocaine-seeking behaviors across individuals, demonstrating that economic measures may be used to rapidly identify the clinical utility of prospective addiction treatments.

Economic demand predicts addiction-like behavior and therapeutic efficacy of oxytocin in the rat

PubMed Central

Bentzley, Brandon S.; Jhou, Thomas C.; Aston-Jones, Gary

2014-01-01

Development of new treatments for drug addiction will depend on high-throughput screening in animal models. However, an addiction biomarker fit for rapid testing, and useful in both humans and animals, is not currently available. Economic models are promising candidates. They offer a structured quantitative approach to modeling behavior that is mathematically identical across species, and accruing evidence indicates economic-based descriptors of human behavior may be particularly useful biomarkers of addiction severity. However, economic demand has not yet been established as a biomarker of addiction-like behavior in animals, an essential final step in linking animal and human studies of addiction through economic models. We recently developed a mathematical approach for rapidly modeling economic demand in rats trained to self-administer cocaine. We show here that economic demand, as both a spontaneous trait and induced state, predicts addiction-like behavior, including relapse propensity, drug seeking in abstinence, and compulsive (punished) drug taking. These findings confirm economic demand as a biomarker of addiction-like behavior in rats. They also support the view that excessive motivation plays an important role in addiction while extending the idea that drug dependence represents a shift from initially recreational to compulsive drug use. Finally, we found that economic demand for cocaine predicted the efficacy of a promising pharmacotherapy (oxytocin) in attenuating cocaine-seeking behaviors across individuals, demonstrating that economic measures may be used to rapidly identify the clinical utility of prospective addiction treatments. PMID:25071176

Behavioral economics.

PubMed

Chambers, David W

2009-01-01

It is human nature to overestimate how rational we are, both in general and even when we are trying to be. Such irrationality is not random, and the search for and explanation of patterns of fuzzy thinking is the basis for a new academic discipline known as behavioral economics. Examples are given of some of the best understood of our foibles, including prospect theory, framing, anchoring, salience, confirmation bias, superstition, and ownership. Humans have two cognitive systems: one conscious, deliberate, slow, and rational; the other fast, pattern-based, emotionally tinged, and intuitive. Each is subject to its own kind of error. In the case of rational thought, we tend to exaggerate our capacity; for intuition, we fail to train it or recognize contexts where it is inappropriate. Humans are especially poor at estimating probabilities, or even understanding what they are. It is a common human failing to reason backwards from random outcomes that are favorable to beliefs about our power to predict the future. Five suggestions are offered for thinking within our means.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

PubMed

Husereau, D; Drummond, M; Petrou, S; Carswell, C; Moher, D; Greenberg, D; Augustovski, F; Briggs, A H; Mauskopf, J; Loder, E

2013-05-01

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance.The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in 5 years. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

Tests of Behavioral-Economic Assessments of Relative Reinforcer Efficacy II: Economic Complements

ERIC Educational Resources Information Center

Madden, Gregory J.; Smethells, John R.; Ewan, Eric E.; Hursh, Steven R.

2007-01-01

This experiment was conducted to test the predictions of two behavioral-economic approaches to quantifying relative reinforcer efficacy. The normalized demand analysis suggests that characteristics of averaged normalized demand curves may be used to predict progressive-ratio breakpoints and peak responding. By contrast, the demand analysis holds…

[Economic evaluation of health technologies: theory and practice].

PubMed

Abadi-Korek, Ifat; Shemer, Joshua

2008-06-01

Health care systems are committed to maintain and improve the health of their citizens in an effective, fair and accessible way. New medical technologies that offer improvement upon existing alternatives are progressing at a rapid pace. These new sophisticated health technologies are high priced and have been viewed as a significant factor in increasing the cost of healthcare expenditures. The abundance of new medical alternatives, combined with scarcity of resources, has led to the need for priority setting in a way that maximizes the health benefit of those insured. Economic evaluation of medical technologies is the analysis which compares the costs and consequences of alternative healthcare interventions. Economic evaluation of medical technologies can be used by policy makers as a tool to aid in resource allocation decisions. The inclusion of an economic perspective in the evaluation of health and health care has become an increasingly accepted component of health policy and planning. The health care system in Israel has come to acknowledge the advantages of this method. There is still a need for more suitable and structured guidelines to conducting economic evaluation in order to make this emergent and welcome process and its products useable.

A Behavioral Economics Perspective on Tobacco Taxation

PubMed Central

2010-01-01

Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco's hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country's circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally. PMID:20220113

[Agreement between guidelines for pharmaco-economic research and never-before-published health-economics evaluations].

PubMed

Postma, M J; Kwik, J J; Rutten, W J M J; de Jong-van den Berg, L T W; Brouwers, J R B J

2002-06-08

To investigate whether the health-economics research published in Dutch journals is in agreement with the guidelines for pharmaco-economic research as published in 1999 by the Dutch 'College voor zorgverzekeringen' [Healthcare Insurance Board]. Descriptive. A literature search was performed for health-economic evaluations published during 1990-1999 in Dutch journals such as Nederlands Tijdschrift voor Geneeskunde (NTvG), Pharmaceutisch Weekblad and Tijdschrift voor Gezondheidswetenschappen. The resulting 19 studies, primarily published in the NTvG, were compared with the pharmaco-economic guidelines, summarised in 9 criteria. The social perspective was taken in 5 studies (26%), non-related medical costs were excluded in 19 (100%), relevant subgroup analyses were performed in 16 (84%), effectiveness was explicitly differentiated from efficacy in 15 (79%), incremental analysis was performed in 18 (95%), an adequate period of analysis was chosen in 16 (84%), costs, benefits and health gains were discounted in 13 (68%), sensitivity analysis was included in the investigation in 10 (53%), and estimated cost prices were used in 9 (47%). The methodology in recently published Dutch health-economics research was partly in agreement with the later official guidelines for pharmaco-economic studies in the Netherlands.

Health Care Waste Segregation Behavior among Health Workers in Uganda: An Application of the Theory of Planned Behavior.

PubMed

Akulume, Martha; Kiwanuka, Suzanne N

2016-01-01

Objective . The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology . One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation). Results . For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers' segregation behavior, but intention emerged as the strongest and most significant ( r = 0.524, P < 0.001). The theory of planned behavior model explained 52.5% of the variance in health workers' segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion . Generally, health workers' health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers' health care waste segregation behaviors.

Organizational economics and health care markets.

PubMed Central

Robinson, J C

2001-01-01

As health policy emphasizes the use of private sector mechanisms to pursue public sector goals, health services research needs to develop stronger conceptual frameworks for the interpretation of empirical studies of health care markets and organizations. Organizational relationships should not be interpreted exclusively in terms of competition among providers of similar services but also in terms of relationships among providers of substitute and complementary services and in terms of upstream suppliers and downstream distributors. This article illustrates the potential applicability of transactions cost economics, agency theory, and organizational economics more broadly to horizontal and vertical markets in health care. Examples are derived from organizational integration between physicians and hospitals and organizational conversions from nonprofit to for-profit ownership. PMID:11327173

Contemporary health care economics: an overview.

PubMed

McLaughlin, Nancy; Ong, Michael K; Tabbush, Victor; Hagigi, Farhad; Martin, Neil A

2014-11-01

Economic evaluations provide a decision-making framework in which outcomes (benefits) and costs are assessed for various alternative options. Although the interest in complete and partial economic evaluations has increased over the past 2 decades, the quality of studies has been marginal due to methodological challenges or incomplete cost determination. This paper provides an overview of the main types of complete and partial economic evaluations, reviews key methodological elements to be considered for any economic evaluation, and reviews concepts of cost determination. The goal is to provide the clinician neurosurgeon with the knowledge and tools needed to appraise published economic evaluations and to direct high-quality health economic evaluations.

Market fallacies in health economics.

PubMed

Grant, R J

1991-12-07

Serious methodological errors that plague studies in health economics are examined with the focus on misconceptions about the nature and functions of markets. The belief that market economics do not apply to the medical marketplace involves circular reasoning that treats man-made laws and regulations as though they were unchangeable laws of nature. Arguments against the market provision of health care are questioned and the 'information gap' problem is shown to be aggravated, if not caused, by regulations that prevent normal information flows in the market. Similarly, the contention that health care insurance pushes up costs is criticised on the basis of both theory and empirical evidence. The apparent failure to contain costs may be blamed on legal restrictions, government spending and pressure from medical associations. Confusion between normative theory and positive theory is also examined.

Women Empowerment and Its Relation with Health Seeking Behavior in Bangladesh

PubMed Central

Mainuddin, AKM; Ara Begum, Housne; Rawal, Lal B.; Islam, Anwar; Shariful Islam, SM

2015-01-01

Objective: Over the last few decades, Bangladesh has made significant progress towards achieving targets for the Millennium Development Goals (MDGs) and women empowerment. This study is aimed at identifying the levels and patterns of women empowerment in relation to health seeking behavior in Bangladesh. Materials and methods: We conducted a cross-sectional study among 200 rural married women in Cox’s Bazar district in Bangladesh using multi stage sampling technique and face-to-face interview. Data was collected on socio-economic characteristics, proxy indicators for women empowerment in mobility and health seeking behavior related decision making. Bivariate and multivariate regression analyses were performed to identify associations between women empowerment in relation to health seeking behavior on mobility and decision making, controlling the effect of other independent variables. Results: The results showed that only 12% women were empowered to decide on their own about seeking healthcare and 8.5% in healthcare seeking for their children. In multivariate analysis women empowerment in health seeking behavior was higher among age group 25-34 years (OR 1.76, [CI = 0.82-3.21]), women’s education, husband’s education, age at marriage > 18 years (OR 6.38, [CI = 0.98-4.21]) and women’s working status (OR 16.44, [CI = 0.79-2.71]). Conclusion: Women empowerment enhances their decision-making authority regarding health seeking behavior. Acknowledging and adopting the implications of these findings are essential for an integrated health and development strategy for Bangladesh and achieving the MDGs. PMID:26175761

Linking Human Health and Livestock Health: A “One-Health” Platform for Integrated Analysis of Human Health, Livestock Health, and Economic Welfare in Livestock Dependent Communities

PubMed Central

Thumbi, S. M.; Njenga, M. Kariuki; Marsh, Thomas L.; Noh, Susan; Otiang, Elkanah; Munyua, Peninah; Ochieng, Linus; Ogola, Eric; Yoder, Jonathan; Audi, Allan; Montgomery, Joel M.; Bigogo, Godfrey; Breiman, Robert F.; Palmer, Guy H.; McElwain, Terry F.

2015-01-01

Background For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status. Method We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households. Findings Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling

Adolescents’ expectations for the future predict health behaviors in early adulthood

PubMed Central

McDade, Thomas W.; Chyu, Laura; Duncan, Greg J.; Hoyt, Lindsay T.; Doane, Leah D.; Adam, Emma K.

2011-01-01

Health-related behaviors in adolescence establish trajectories of risk for obesity and chronic degenerative diseases, and they represent an important pathway through which socio-economic environments shape patterns of morbidity and mortality. Most behaviors that promote health involve making choices that may not pay off until the future, but the factors that predict an individual's investment in future health are not known. In this paper we consider whether expectations for the future in two domains relevant to adolescents in the U.S.—perceived chances of living to middle age and perceived chances of attending college—are associated with an individual's engagement in behaviors that protect health in the long run. We focus on adolescence as an important life stage during which habits formed may shape trajectories of disease risk later in life. We use data from a large, nationally representative sample of American youth (the US National Longitudinal Study of Adolescent Health) to predict levels of physical activity, fast food consumption, and cigarette smoking in young adulthood in relation to perceived life chances in adolescence, controlling for baseline health behaviors and a wide range of potentially confounding factors. We found that adolescents who rated their chances of attending college more highly exercised more frequently and smoked fewer cigarettes in young adulthood. Adolescents with higher expectations of living to age 35 smoked fewer cigarettes as young adults. Parental education was a significant predictor of perceived life chances, as well as health behaviors, but for each outcome the effects of perceived life chances were independent of, and often stronger than, parental education. Perceived life chances in adolescence may therefore play an important role in establishing individual trajectories of health, and in contributing to social gradients in population health. PMID:21764487

Adolescents' expectations for the future predict health behaviors in early adulthood.

PubMed

McDade, Thomas W; Chyu, Laura; Duncan, Greg J; Hoyt, Lindsay T; Doane, Leah D; Adam, Emma K

2011-08-01

Health-related behaviors in adolescence establish trajectories of risk for obesity and chronic degenerative diseases, and they represent an important pathway through which socio-economic environments shape patterns of morbidity and mortality. Most behaviors that promote health involve making choices that may not pay off until the future, but the factors that predict an individual's investment in future health are not known. In this paper we consider whether expectations for the future in two domains relevant to adolescents in the U.S.-perceived chances of living to middle age and perceived chances of attending college-are associated with an individual's engagement in behaviors that protect health in the long run. We focus on adolescence as an important life stage during which habits formed may shape trajectories of disease risk later in life. We use data from a large, nationally representative sample of American youth (the US National Longitudinal Study of Adolescent Health) to predict levels of physical activity, fast food consumption, and cigarette smoking in young adulthood in relation to perceived life chances in adolescence, controlling for baseline health behaviors and a wide range of potentially confounding factors. We found that adolescents who rated their chances of attending college more highly exercised more frequently and smoked fewer cigarettes in young adulthood. Adolescents with higher expectations of living to age 35 smoked fewer cigarettes as young adults. Parental education was a significant predictor of perceived life chances, as well as health behaviors, but for each outcome the effects of perceived life chances were independent of, and often stronger than, parental education. Perceived life chances in adolescence may therefore play an important role in establishing individual trajectories of health, and in contributing to social gradients in population health. Copyright © 2011 Elsevier Ltd. All rights reserved.

Kids, Cash and Sustainability: Economic Knowledge and Behaviors among Preschool Children

ERIC Educational Resources Information Center

Borg, Farhana

2017-01-01

Although young children are often involved in economic transactions of various kinds in their daily activities, research on their knowledge and behaviors in relation to sustainable economics is limited. Sustainable economics deals with, among others, equity, corporate responsibility and poverty reduction. This study explored preschool children's…

[Public health in major socio-economic crisis].

PubMed

Cosmacini, G

2014-01-01

The term "crisis" in different cultures (such as ancient Greece or China) can have a positive meaning, since it indicates a time of growth, change and opportunity. Over the centuries there have been times of severe economic and social crisis that led to the implementation of major reforms and improved population health. Nowadays, despite the new economic crisis which has also affected health care for its rising costs, health economics does not hesitate to affirm the importance of key objectives such as prevention and medical assistance. Prevention is not prediction. Prevention means "going upstream" and fixing a problem at the source; the goal is to reduce diseases' effects, causes and risk factors, thereby reducing the prevalence of costly medical conditions.

Fiscal incentives, behavior change and health promotion: what place in the health-in-all-policies toolkit?

PubMed

Sassi, Franco; Belloni, Annalisa

2014-06-01

Taxes, subsidies and welfare benefits may provide financial incentives to encourage healthy behaviors or discourage less healthy ones. Historically, taxes have been used in many countries to deter behaviors like tobacco smoking or harmful alcohol use. More recently, an increasing number of governments have sought to expand the scope for the use of fiscal measures in health promotion to foods and beverages high in fat, salt or sugar. A strong public health rationale, supported by a growing body of evidence of the health impacts of taxes and other fiscal measures, adds to the more traditional rationale for the use of commodity taxes, which hinges on their revenue-generating potential and their ability to address the costs imposed by consumers of health-related commodities on other individuals. Despite limitations in the existing evidence base, reviewed in this paper, taxes have been shown to generate significant health gains when applied to tobacco products and alcoholic beverages. In the case of foods and non-alcoholic beverages, the effects tend to build up over time and are stronger in people with lower socio-economic status. However, a number of potentially undesirable effects suggest that governments should exercise caution in planning and implementing taxes on health-related commodities. In particular, commodity taxes are generally regressive, and this is especially the case for taxes on tobacco, foods and non-alcoholic beverages, although the actual size of the tax burden involved is relatively modest. In addition, taxes may negatively impact on economic efficiency and social welfare, and may incentivize illicit activities. © OECD (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Valuation of health-related quality of life and utilities in health economics].

PubMed

Greiner, Wolfgang; Klose, Kristina

2014-01-01

Measuring health-related quality of life is an important aspect in economic evaluation of health programmes. The development of utility-based (preference-based) measures is advanced by the discipline of health economics. Different preference measures are applied for valuing health states to produce a weighted health state index. Those preference weights should be derived from a general population sample in case of resource allocation on a collective level (as in current valuation studies of the EuroQol group). Copyright © 2014. Published by Elsevier GmbH.

Changing Health Behavior in Youth

ERIC Educational Resources Information Center

Hochbaum, Godfrey M.

2010-01-01

In this article, the author considers the need for changing health behavior in youth. The author begins by discussing how people learn health behavior which could help educators in understanding the reasons why it is often difficult to effect changes--and how educators may succeed. If the aim of health educators is to change behavior, the author…

Importance of Economic Evaluation in Health Care: An Indian Perspective.

PubMed

Dang, Amit; Likhar, Nishkarsh; Alok, Utkarsh

2016-05-01

Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. Economic evaluation is one part of health economics, and it is a tool for comparing costs and consequences of different interventions. Health technology assessment is a technique for economic evaluation that is well adapted by developed countries. The traditional classification of economic evaluation includes cost-minimization, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. There has been uncertainty in the conduct of such economic evaluations in India, due to some hesitancy with respect to the adoption of their guidelines. The biggest challenge in this evolutionary method is lack of understanding of methods in current use by all those involved in the provision and purchasing of health care. In some countries, different methods of economic evaluation have been adopted for decision making, most commonly to address the question of public subsidies for the purchase of medicines. There is limited evidence on the impact of health insurance on the health and economic well-being of beneficiaries in developing countries. India is currently pursuing several strategies to improve health services for its population, including investing in government-provided services as well as purchasing services from public and private providers through various schemes. Prospects for future growth and development in this field are required in India because rapid health care inflation, increasing rates of chronic conditions, aging population, and increasing technology diffusion will require greater economic efficiency into health care systems. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Return to work, economic hardship, and women's postpartum health.

PubMed

Tucker, Jenna N; Grzywacz, Joseph G; Leng, Iris; Clinch, C Randall; Arcury, Thomas A

2010-10-01

This study followed a sample of 217 new mothers in a North Carolina county as they returned to work full-time, measuring their mental and physical health-related quality of life through 16 months postpartum. In general, working mothers of infants had mental health scores that were comparable to the general population of U.S. women, and physical health that was slightly better than women in general. Using ANCOVA and controlling for important demographic characteristics, health-related quality of life was compared between mothers experiencing low and high levels of economic hardship. Across the study period, women with high economic hardship, who constituted 30.7% of the sample, had levels of mental and physical health below those of women with low economic hardship. Mothers with high economic hardship also had less stable health trajectories than mothers with low economic hardship. The findings highlight the importance of reconsidering the traditionally accepted postpartum recovery period of six weeks and extending benefits, such as paid maternity and sick leave, as well as stable yet flexible work schedules.

Economics and Health Reform: Academic Research and Public Policy.

PubMed

Glied, Sherry A; Miller, Erin A

2015-08-01

Two prior studies, conducted in 1966 and in 1979, examined the role of economic research in health policy development. Both concluded that health economics had not been an important contributor to policy. Passage of the Affordable Care Act offers an opportunity to reassess this question. We find that the evolution of health economics research has given it an increasingly important role in policy. Research in the field has followed three related paths over the past century-institutionalist research that described problems; theoretical research, which proposed relationships that might extend beyond existing institutions; and empirical assessments of structural parameters identified in the theoretical research. These three strands operating in concert allowed economic research to be used to predict the fiscal and coverage consequences of alternative policy paths. This ability made economic research a powerful policy force. Key conclusions of health economics research are clearly evident in the Affordable Care Act. © The Author(s) 2015.

Violent behavior in Chinese adolescents with an economic disadvantage. Psychological, family and interpersonal correlates.

PubMed

Shek, Daniel T; Tang, Vera

2003-01-01

Two studies investigating the psychological, family and interpersonal correlates of adolescent violent behavior are reported in this paper. In Study 1, secondary school students (N = 1,519) responded to established scales assessing their psychological attributes, family functioning, parenting qualities and psychosocial support and conflict. Results of Study 1 showed that: a) adolescents who showed higher levels of perceived stress and psychological symptoms displayed more signs of adolescent violence; b) adolescents who had a higher sense of mastery and existential mental health displayed less signs of violence; c) adolescents' attitudes towards poverty and traditional Chinese beliefs about adversity were significantly related to adolescent violence; d) higher levels of family functioning, positive parenting styles as well as interpersonal support and lower levels of interpersonal conflicts were associated with a lower level of adolescent violence. Results further showed that some of the above factors were more strongly related to adolescent violence in adolescents experiencing economic disadvantage than in adolescents who did not experience economic disadvantage. Some of the findings of Study 1 were replicated in Study 2, where adolescents from 229 families (either families on welfare or low income families) were recruited. These studies suggested that several psychological, family and interpersonal factors are related to adolescent violent behavior, particularly in adolescents with economic disadvantage.

Diets and Health: How Food Decisions Are Shaped by Biology, Economics, Geography, and Social Interactions.

PubMed

Drewnowski, Adam; Kawachi, Ichiro

2015-09-01

Health is shaped by both personal choices and features of the food environment. Food-choice decisions depend on complex interactions between biology and behavior, and are further modulated by the built environment and community structure. That lower-income families have lower-quality diets is well established. Yet, diet quality also varies across small geographic neighborhoods and can be influenced by transportation, retail, and ease of access to healthy foods, as well as by attitudes, beliefs, and social interactions. The learnings from the Seattle Obesity Study (SOS II) can be usefully applied to the much larger, more complex, and far more socially and ethnically diverse urban environment of New York City. The Kavli HUMAN Project (KHP) is ideally positioned to advance the understanding of health disparities by exploring the multiple underpinnings of food decision making. By combining geo-localized food shopping and consumption data with health behaviors, diet quality measures, and biomarkers, also coded by geographic location, the KHP will create the first-of-its-kind bio-behavioral, economic, and cultural atlas of diet quality and health for New York City.

How behavioral science can advance digital health.

PubMed

Pagoto, Sherry; Bennett, Gary G

2013-09-01

The field of behavioral science has produced myriad data on health behavior change strategies and leveraged such data into effective human-delivered interventions to improve health. Unfortunately, the impact of traditional health behavior change interventions has been heavily constrained by patient and provider burden, limited ability to measure and intervene upon behavior in real time, variable adherence, low rates of implementation, and poor third-party coverage. Digital health technologies, including mobile phones, sensors, and online social networks, by being available in real time, are being explored as tools to increase our understanding of health behavior and to enhance the impact of behavioral interventions. The recent explosion of industry attention to the development of novel health technologies is exciting but has far outpaced research. This Special Section of Translational Behavioral Medicine, Smartphones, Sensors, and Social Networks: A New Age of Health Behavior Change features a collection of studies that leverage health technologies to measure, change, and/or understand health behavior. We propose five key areas in which behavioral science can improve the impact of digital health technologies on public health. First, research is needed to identify which health technologies actually impact behavior and health outcomes. Second, we need to understand how online social networks can be leveraged to impact health behavior on a large scale. Third, a team science approach is needed in the developmental process of health technologies. Fourth, behavioral scientists should identify how a balance can be struck between the fast pace of innovation and the much slower pace of research. Fifth, behavioral scientists have an integral role in informing the development of health technologies and facilitating the movement of health technologies into the healthcare system.

How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review.

PubMed

de Goeij, Moniek C M; Suhrcke, Marc; Toffolutti, Veronica; van de Mheen, Dike; Schoenmakers, Tim M; Kunst, Anton E

2015-04-01

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful

[Intelligence and the explanation for socio-economic inequalities in health].

PubMed

Huisman, M; Mackenbach, J P

2007-05-12

Attention is increasingly being paid to the role of cognitive ability to explain socio-economic inequalities in health. The universal socio-economic gradient in health, where each rung lower on the socio-economic ladder implies worse health, has still not been satisfactorily explained scientifically. Because cognitive ability is related to a multitude of social outcomes in a similarly graded manner, hypothesising that cognitive ability plays a major role in health inequalities by socio-economic status is appealing. Recent empirical studies have shown that at least part of socio-economic health inequalities can indeed be explained by differences in cognitive ability. However, this does not imply that we should be pessimistic about future attempts to break the chain that links socio-economic status and cognitive ability with health. During some life stages, environmental factors may be able to influence cognitive ability. Interventions may therefore be targeted in order to optimize these effects. In addition, there is evidence that cognitive ability is correlated with health-related behaviours such as smoking, excessive alcohol consumption and obesity. Therefore, another opportunity for reducing health inequalities related to cognitive ability and socio-economic status would be to develop tailored interventions to improve health-related behaviours in disadvantaged groups. However, the first priority is to further investigate the role of cognitive ability in health inequalities by examining various health outcomes, different age groups and variations across the life course.

Economic Evidence on the Health Impacts of Climate Change in Europe

PubMed Central

Hutton, Guy; Menne, Bettina

2014-01-01

BACKGROUND In responding to the health impacts of climate change, economic evidence and tools inform decision makers of the efficiency of alternative health policies and interventions. In a time when sweeping budget cuts are affecting all tiers of government, economic evidence on health protection from climate change spending enables comparison with other public spending. METHODS The review included 53 countries of the World Health Organization (WHO) European Region. Literature was obtained using a Medline and Internet search of key terms in published reports and peer-reviewed literature, and from institutions working on health and climate change. Articles were included if they provided economic estimation of the health impacts of climate change or adaptation measures to protect health from climate change in the WHO European Region. Economic studies are classified under health impact cost, health adaptation cost, and health economic evaluation (comparing both costs and impacts). RESULTS A total of 40 relevant studies from Europe were identified, covering the health damage or adaptation costs related to the health effects of climate change and response measures to climate-sensitive diseases. No economic evaluation studies were identified of response measures specific to the impacts of climate change. Existing studies vary in terms of the economic outcomes measured and the methods for evaluation of health benefits. The lack of robust health impact data underlying economic studies significantly affects the availability and precision of economic studies. CONCLUSIONS Economic evidence in European countries on the costs of and response to climate-sensitive diseases is extremely limited and fragmented. Further studies are urgently needed that examine health impacts and the costs and efficiency of alternative responses to climate-sensitive health conditions, in particular extreme weather events (other than heat) and potential emerging diseases and other conditions

Economic evidence on the health impacts of climate change in europe.

PubMed

Hutton, Guy; Menne, Bettina

2014-01-01

In responding to the health impacts of climate change, economic evidence and tools inform decision makers of the efficiency of alternative health policies and interventions. In a time when sweeping budget cuts are affecting all tiers of government, economic evidence on health protection from climate change spending enables comparison with other public spending. The review included 53 countries of the World Health Organization (WHO) European Region. Literature was obtained using a Medline and Internet search of key terms in published reports and peer-reviewed literature, and from institutions working on health and climate change. Articles were included if they provided economic estimation of the health impacts of climate change or adaptation measures to protect health from climate change in the WHO European Region. Economic studies are classified under health impact cost, health adaptation cost, and health economic evaluation (comparing both costs and impacts). A total of 40 relevant studies from Europe were identified, covering the health damage or adaptation costs related to the health effects of climate change and response measures to climate-sensitive diseases. No economic evaluation studies were identified of response measures specific to the impacts of climate change. Existing studies vary in terms of the economic outcomes measured and the methods for evaluation of health benefits. The lack of robust health impact data underlying economic studies significantly affects the availability and precision of economic studies. Economic evidence in European countries on the costs of and response to climate-sensitive diseases is extremely limited and fragmented. Further studies are urgently needed that examine health impacts and the costs and efficiency of alternative responses to climate-sensitive health conditions, in particular extreme weather events (other than heat) and potential emerging diseases and other conditions threatening Europe.

Health care economic analyses and value-based medicine.

PubMed

Brown, Melissa M; Brown, Gary C; Sharma, Sanjay; Landy, Jennifer

2003-01-01

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect health). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.

Economics as a factor in models of behavioral motivation and change.

PubMed

Montoya, I D; Atkinson, J S; Trevino, R A

2000-02-01

This note first presents a summary of four main behavioral models that are used to explain behavioral motivation and change. Three models are based on psychosocial theory. They are: 1) the Theory of Reasoned Action, 2) the Theory of Planned Behavior, and 3) the Theory of Stages-of-Change. The fourth model is based on economic theory and is known as the Rational Addiction Model. Each model is analyzed for its strengths and weaknesses. The note concludes by arguing for the usefulness of integrating the economic and the psychosocial models to study drug use. Specific examples and suggestions are presented.

The future of hospital economic health.

PubMed

Gerber, David R; Bekes, Carolyn E; Parrillo, Joseph E

2006-03-01

To evaluate factors which may influence the economic future of academic medical centers (AMCs). A literature search was performed to identify publications which reviewed the areas of revenue sources for AMCs, costs and expenses incurred by these institutions, and mechanisms for optimizing institutional economic stability. Data were reviewed and evaluated in two primary contexts: hospital revenues and organizational and administrative factors influencing hospital economic health. Increasing economic stress will require AMCs to make efforts both to increase revenue through a variety of mechanisms and to minimize expenses without compromising their mission or impairing worker morale.

Bringing the patient back in: behavioral decision-making and choice in medical economics.

PubMed

Mendoza, Roger Lee

2018-04-01

We explore the behavioral methodology and "revolution" in economics through the lens of medical economics. We address two questions: (1) Are mainstream economic assumptions of utility-maximization realistic approximations of people's actual behavior? (2) Do people maximize subjective expected utility, particularly in choosing from among the available options? In doing so, we illustrate-in terms of a hypothetical experimental sample of patients with dry eye diagnosis-why and how utility in pharmacoeconomic assessments might be valued differently by patients when subjective psychological, social, cognitive, and emotional factors are considered. While experimentally-observed or surveyed behavior yields stated (rather than revealed) preferences, behaviorism offers a robust toolset in understanding drug, medical device, and treatment-related decisions compared to the optimizing calculus assumed by mainstream economists. It might also do so more perilously than economists have previously understood, in light of the intractable uncertainties, information asymmetries, insulated third-party agents, entry barriers, and externalities that characterize healthcare. Behavioral work has been carried out in many sub-fields of economics. Only recently has it been extended to healthcare. This offers medical economists both the challenge and opportunity of balancing efficiency presumptions with relatively autonomous patient choices, notwithstanding their predictable, yet seemingly consistent, irrationality. Despite its comparative youth and limitations, the scientific contributions of behaviorism are secure and its future in medical economics appears to be promising.

Health Literacy and Women's Health-Related Behaviors in Taiwan

ERIC Educational Resources Information Center

Lee, Shoou-Yih D.; Tsai, Tzu-I; Tsai, Yi-Wen; Kuo, Ken N.

2012-01-01

Extant health literacy research is unclear about the contribution of health literacy to health behaviors and is limited regarding women's health issues. The primary purpose of this study is to investigate the association between health literacy and five health behaviors (Pap smear screening, annual physical checkup, smoking, checking food…

Behavioral Health Services in the Changing Landscape of Private Health Plans.

PubMed

Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

2016-06-01

Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

Recessions and seniors' health, health behaviors, and healthcare use: analysis of the Medicare Current Beneficiary Survey.

PubMed

McInerney, Melissa; Mellor, Jennifer M

2012-09-01

A number of studies report that U.S. state mortality rates, particularly for the elderly, decline during economic downturns. Further, several prior studies use microdata to show that as state unemployment rates rise, physical health improves, unhealthy behaviors decrease, and medical care use declines. We use data on elderly mortality rates and data from the Medicare Current Beneficiary Survey from a time period that encompasses the start of the Great Recession. We find that elderly mortality is countercyclical during most of the 1994-2008 period. Further, as unemployment rates rise, seniors report worse mental health and are no more likely to engage in healthier behaviors. We find suggestive evidence that inpatient utilization increases perhaps because of an increased physician willingness to accept Medicare patients. Our findings suggest that either elderly individuals respond differently to recessions than do working age adults, or that the relationship between unemployment and health has changed. Copyright © 2012 Elsevier B.V. All rights reserved.

[What can medicine expect from health economics?].

PubMed

Bismarck, E; Schmitz-Dräger, B J; Schöffski, O

2012-04-01

Medicine has changed dramatically in the past ten decades thanks to the introduction of innovative diagnostic and therapeutic procedures. However, besides the unmistakable advances achieved in medicine, the costs of all health care systems have risen dramatically. In contrast to the escalation in expenditures, only moderate gains in proceeds have been accomplished. This situation requires that future financial resources be judiciously expended. The field of health economics has set as its goal the analysis of medical measures in terms of costs and benefits to be able to provide information on these parameters to those involved in the public health sector. The emerging problems are diverse and extend from assessment of effects and side effects to difficulties in standardizing analytical procedures and comparing results between different health care systems.In the context of this manuscript an attempt has been made to illustrate the methodological approaches to health economics based on current issues in the diagnosis and treatment of prostate cancer. This contribution intends to motivate stakeholders to view health economics as a tool to promote improvements in medical care and not as a means to regulating and rationing medical measures.

[Knowledge of medical doctors about health economics].

PubMed

Rodríguez-Ledesma, María de Los Angeles; Constantino-Casas, Patricia; García-Contreras, Fernando; Garduño-Espinosa, Juan

2007-01-01

To identify the level of knowledge about health economics of physicians with different academic degree, working place and medical activities. A questionnaire with 24 items about commonly used health economics concepts was applied. Face validity, content, construct, and consistency of the questionnaire were assessed. 523 Mexican physicians from public and private health institutions in Sinaloa and Distrito Federal were interviewed. The average general score was 4.1 +/- 2.1 (0 to 10 scale), for physicians at the IMSS was 4.1 +/- 2.1, SSA 4.3 +/- 2.5, ISSSTE 3.3 +/- 2; SEDENA 3.9 +/- 2.3 and in private medical services 4.4 +/- 2.2 (p = 0.001). Interns scored 3.7 +/- 2.1; physicians with specialties different from family medicine 4.3 +/- 2.2 and family physicians 4 +/- 2 (p = 0.05). The question that got the most correct answers was the definition of direct costs (82%) and the one with fewest was the percentage of the gross national product recommended by the World Health Organization for the health sector (11%). Interviewed physicians had poor knowledge about health economics. Academic degree and institutional work were factors related to that knowledge.

Some reciprocal roles between behavior analysis and institutional economics in post-darwinian science

PubMed Central

Glenn, Sigrid S.

1985-01-01

Behavior analysis and institutional economics are viewed as having common origins in the early 20th century effort to benefit from the conceptual revolution spurred by Darwin's synthesis. Institutional economics, initiated by Thorstein Veblen, appears to have failed to develop a progressive scientific technology, while behavior analysis has done so. It is suggested that institutional economics has been held back by lack of a synthesizing scientific mechanism that elucidates the relation between technological and ceremonial processes, the two cultural forces described by Veblen. The theory of institutional economist C. E. Ayres, built on Veblen's distinction, is used to clarify the concepts of technological and ceremonial processes for the reader. An analysis of the behavioral processes that might underlie the cultural processes described by Veblen/Ayres suggests that the experimental analysis of behavior has provided concepts that might function as a synthesizing mechanism for the social sciences and, in particular, institutional economics. The Veblen/Ayres dichotomy, now seen in terms of underlying behavioral processes, is used to examine the field of behavior analysis in terms of its origins, its relation to psychology and its current state. The paper concludes with a few practical suggestions as to how behavior analysts might work to enhance survival. PMID:22478617

A theory-based online health behavior intervention for new university students: study protocol

PubMed Central

2013-01-01

Background Too few young people engage in behaviors that reduce the risk of morbidity and premature mortality, such as eating healthily, being physically active, drinking sensibly and not smoking. The present research developed an online intervention to target these health behaviors during the significant life transition from school to university when health beliefs and behaviors may be more open to change. This paper describes the intervention and the proposed approach to its evaluation. Methods/design Potential participants (all undergraduates about to enter the University of Sheffield) will be emailed an online questionnaire two weeks before starting university. On completion of the questionnaire, respondents will be randomly assigned to receive either an online health behavior intervention (U@Uni) or a control condition. The intervention employs three behavior change techniques (self-affirmation, theory-based messages, and implementation intentions) to target four heath behaviors (alcohol consumption, physical activity, fruit and vegetable intake, and smoking). Subsequently, all participants will be emailed follow-up questionnaires approximately one and six months after starting university. The questionnaires will assess the four targeted behaviors and associated cognitions (e.g., intentions, self-efficacy) as well as socio-demographic variables, health status, Body Mass Index (BMI), health service use and recreational drug use. A sub-sample of participants will provide a sample of hair to assess changes in biochemical markers of health behavior. A health economic evaluation of the cost effectiveness of the intervention will also be conducted. Discussion The findings will provide evidence on the effectiveness of online interventions as well as the potential for intervening during significant life transitions, such as the move from school to university. If successful, the intervention could be employed at other universities to promote healthy behaviors among new

Designing and Undertaking a Health Economics Study of Digital Health Interventions.

PubMed

McNamee, Paul; Murray, Elizabeth; Kelly, Michael P; Bojke, Laura; Chilcott, Jim; Fischer, Alastair; West, Robert; Yardley, Lucy

2016-11-01

This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Application of economic impact analysis to a local public health agency and its "Academic Health Department".

PubMed

Livingood, Wiliiam C; Coughlin, Susan; Bowman, Walter; Bryant, Thomas; Goldhagen, Jeffrey

2007-01-01

Public health systems are stressed by increasing demands and inadequate resources. This study was designed to demonstrate how economic impact analysis can estimate the economic value of a local public health system's infrastructure as well as the economic assets of an "Academic Health Department" model. This study involved the secondary analysis of publicly available data on health department finances and employment using proprietary software specifically designed to assess economic impacts. The health department's impact on the local community was estimated at over 100 million dollars, exceeding the economic impact of other recently studied local industries with no additional costs to local taxpayers.

Socio-economic disparities in health system responsiveness in India.

PubMed

Malhotra, Chetna; Do, Young Kyung

2013-03-01

To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth). Data from Wave 1 of the Study on Global Ageing and Adult Health (2007-2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent's last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities. Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report 'very good' on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities. Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level.

Working toward financial sustainability of integrated behavioral health services in a public health care system.

PubMed

Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O

2012-06-01

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

Health Economics Research: An Annotated Bibliography.

ERIC Educational Resources Information Center

Dillard, Carole D.; And Others

This annotated bibliography lists books and journal articles published since 1976 which deal with health economics and which are based on health services research supported by the National Center for Health Services Research (NCHSR). Articles prepared by NCHSR staff are listed as intramural. All other articles cite the NCHSR grant or contract…

Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making

PubMed Central

Evers-Casey, Sarah; Graden, Sarah; Schnoll, Robert

2015-01-01

Rationale: Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in “next steps” consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Objective: Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Methods: Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of “success” probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Measurements and Main Results: Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Conclusions: Important presuppositions regarding the potential “success” of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors. PMID:25664676

Behavioral economic insights into physician tobacco treatment decision-making.

PubMed

Leone, Frank T; Evers-Casey, Sarah; Graden, Sarah; Schnoll, Robert

2015-03-01

Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in "next steps" consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of "success" probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Important presuppositions regarding the potential "success" of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors.

Paediatric health economic evaluations: a world view.

PubMed

Ungar, Wendy J

2007-01-01

As economic evaluation methods evolve, their applicability to special populations, such as children, has received increased scrutiny. The objective was to review paediatric health economic evaluations published over the last quarter century, comment on trends, discuss gaps between developed and developing nations, and point to future directions for research. Data compiled for the Paediatric Economic Database Evaluation (PEDE) project to 2003 were used to describe temporal and geographic trends and evaluate the frequency of intervention categories and conditions studied. The volume of paediatric health economic evaluations rose rapidly since 1980. Studies of infective/parasitic diseases, congenital anomalies and complications of pregnancy accounted for the majority. Prevention rather than treatment was emphasized. Most evaluations performed since 1998 (78%) were cost-effectiveness analyses. Cost-utility analyses were rare. The US produced half of all publications, with the U.K. contributing 12%. Economic evaluations from developing countries were uncommon, despite an urgent need for evidence-based decision-making in these regions. The interventions studied reflected local health priorities; HIV and malaria prevention were more commonly studied in developing nations, whereas treatments for asthma and birth malformations were more often evaluated in developed nations. Despite global initiatives to combat disease, developing nations rely on foreign research to inform implementation of local health programs. There is a need for better methods for data transfer and extrapolation. Future research must focus on paediatric models of costs and consequences and the development of tools to measure long-term effects.

Four decades of health economics through a bibliometric lens.

PubMed

Wagstaff, Adam; Culyer, Anthony J

2012-03-01

In this paper, we take a bibliometric tour of the last forty years of health economics using bibliographic "metadata" from EconLit supplemented by citation data from Google Scholar and our own topical classifications. We report the growth of health economics (we find 33,000 publications since 1969-12,000 more than in the economics of education) and list the 300 most-cited publications broken down by topic. We report the changing topical and geographic focus of health economics (the topics 'Determinants of health and ill-health' and 'Health statistics and econometrics' both show an upward trend, and the field has expanded appreciably into the developing world). We also compare authors, countries, institutions and journals in terms of the volume of publications and their influence as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at the top on a variety of measures). Copyright © 2012 World Bank. Published by Elsevier B.V. All rights reserved.

Does inequality in health impede economic growth?

PubMed

Grimm, Michael

2011-01-01

This paper investigates the effects of inequality in health on economic growth in low and middle income countries. The empirical part of the paper uses an original cross-national panel data set covering 62 low and middle income countries over the period 1985 to 2007. I find a substantial and relatively robust negative effect of health inequality on income levels and income growth controlling for life expectancy, country and time fixed-effects and a large number of other effects that have been shown to matter for growth. The effect also holds if health inequality is instrumented to circumvent a potential problem of reverse causality. Hence, reducing inequality in the access to health care and to health-related information can make a substantial contribution to economic growth.

Ethics, economics, and public financing of health care.

PubMed

Hurley, J

2001-08-01

There is a wide variety of ethical arguments for public financing of health care that share a common structure built on a series of four logically related propositions regarding: (1) the ultimate purpose of a human life or human society; (2) the role of health and its distribution in society in advancing this ultimate purpose; (3) the role of access to or utilisation of health care in maintaining or improving the desired level and distribution of health among members of society, and (4) the role of public financing in ensuring the ethically justified access to and utilisation of health care by members of society. This paper argues that economics has much to contribute to the development of the ethical foundations for publicly financed health care. It focuses in particular on recent economic work to clarify the concepts of access and need and their role in analyses of the just distribution of health care resources, and on the importance of economic analysis of health care and health care insurance markets in demonstrating why public financing is necessary to achieve broad access to and utilisation of health care services.

Trial-Based Economic Evaluations in Occupational Health

PubMed Central

van Wier, Marieke F.; Tompa, Emile; Bongers, Paulien M.; van der Beek, Allard J.; van Tulder, Maurits W.; Bosmans, Judith E.

2014-01-01

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions. PMID:24854249

Environmental Effects on Public Health: An Economic Perspective

PubMed Central

Remoundou, Kyriaki; Koundouri, Phoebe

2009-01-01

In this article we critically review the economic literature on the effects of environmental changes on public health, in both the developed and the developing world. We first focus on the economic methodologies that are available for the evaluation of the effects (social costs and benefits) of environmental changes (degradation/preservation) on public health. Then, we explain how the monetary valuations of these effects can feed back in the construction of economic policy for creating agent-specific incentives for more efficient public health management, which is also equitable and environmentally sustainable. Our exposition is accompanied by a synthesis of the available quantitative empirical results. PMID:19742153

Environmental effects on public health: an economic perspective.

PubMed

Remoundou, Kyriaki; Koundouri, Phoebe

2009-08-01

In this article we critically review the economic literature on the effects of environmental changes on public health, in both the developed and the developing world. We first focus on the economic methodologies that are available for the evaluation of the effects (social costs and benefits) of environmental changes (degradation/preservation) on public health. Then, we explain how the monetary evaluations of these effects can feed back in the construction of economic policy for creating agent-specific incentives for more efficient public health management, which is also equitable and environmentally sustainable. Our exposition is accompanied by a synthesis of the available quantitative empirical results.

One Health Economics to confront disease threats

PubMed Central

Machalaba, Catherine; Smith, Kristine M; Awada, Lina; Berry, Kevin; Berthe, Franck; Bouley, Timothy A; Bruce, Mieghan; Cortiñas Abrahantes, Jose; El Turabi, Anas; Feferholtz, Yasha; Flynn, Louise; Fournié, Giullaume; Andre, Amanda; Grace, Delia; Jonas, Olga; Kimani, Tabitha; Le Gall, François; Miranda, Juan Jose; Peyre, Marisa; Pinto, Julio; Ross, Noam; Rüegg, Simon R; Salerno, Robert H; Seifman, Richard; Zambrana-Torrelio, Carlos; Karesh, William B

2017-01-01

Abstract Global economic impacts of epidemics suggest high return on investment in prevention and One Health capacity. However, such investments remain limited, contributing to persistent endemic diseases and vulnerability to emerging ones. An interdisciplinary workshop explored methods for country-level analysis of added value of One Health approaches to disease control. Key recommendations include: 1. systems thinking to identify risks and mitigation options for decision-making under uncertainty; 2. multisectoral economic impact assessment to identify wider relevance and possible resource-sharing, and 3. consistent integration of environmental considerations. Economic analysis offers a congruent measure of value complementing diverse impact metrics among sectors and contexts. PMID:29044367

Inclusiveness in the health economic evaluation space.

PubMed

Ryan, Mandy; Gerard, Karen

2014-05-01

This paper presents an overview of Gavin Mooney's contributions to broadening the evaluative space in health economics. It outlines how Mooney's ideas have encouraged many, including ourselves, to expand the conventional QALYs/health gain approach and look more broadly at what it is that is of value from health services. We reflect on Mooney's contributions to debates around cost-effectiveness analysis, Quality Adjusted Life Years (QALYs) and cost-utility analysis as well as his contribution to the development and application of contingent valuation and discrete choice experiments in health economics. We conclude by suggesting important avenues for future research to take forward Mooney's work. Copyright © 2014 Elsevier Ltd. All rights reserved.

Social and economic attitudes shaping American health policy.

PubMed

Fein, R

1980-01-01

The Health Clark Lectures (University of London) explore the development of American health care policy in a social and economic context; the probability of transatlantic relevance is substantial. I. American Health Care: Selected Policy Issues. The U.S. economy is beset with difficulties, and social policy bends to these realities and to perceptions of them. In the climate of growing neoconservatism, efforts to develop a coherent and cohesive national health policy are discontinuous and even inconsistent. II. Efficiency and Equity in Medicine: The Role of the Economist. The critical issue for economic policy is the amount spent for health care in society; for social policy it is the way that amount is shared. Certainly, there is an interplay between the two, but we must be wary of finding common ground in economic-investment and benefit-cost approaches. Striving for equity offers the best strategy to attain efficiency.

Health expenditures spent for prevention, economic performance, and social welfare.

PubMed

Wang, Fuhmei; Wang, Jung-Der; Huang, Yu-Xiu

2016-12-01

Countries with limited resources in economic downturns often reduce government expenditures, of which spending on preventive healthcare with no apparent immediate health impact might be cut down first. This research aims to find the optimum share of preventive health expenditure to gross domestic product (GDP) and investigate the implications of preventive health services on economic performance and the population's wellbeing. We develop the economic growth model to undertake health-economic analyses and parameterize for Taiwan setting. Based on the US experiences over the period from 1975 to 2013, this research further examines the model's predictions on the relationship between preventive health expenditure and economic performance. Theoretical analysis and numerical simulations show that an inverse U-shaped relationship exists between the proportion of GDP spent on prevention and social welfare, as well as between the proportion spent on prevention and economic growth. Empirical analysis shows an under-investment in prevention in Taiwan. The spending of preventive healthcare in Taiwan government was 0.0027 GDP in 2014, while the optimization levels for economic development and social welfare would be 0 · 0119 and 0 · 0203, respectively. There is a statistically significant nonlinear relationship between health expenditure on prevention and the estimated real impact of economic performance from US experiences. The welfare-maximizing proportion of preventive expenditure is usually greater than the proportion maximizing economic growth, indicating a conflict between economic growth and welfare after a marginal share. Our findings indicate that it is worthwhile increasing investment on prevention up until an optimization level for economic development and social welfare. Such levels could also be estimated in other economies.

Health economic analyses in medical nutrition: a systematic literature review.

PubMed

Walzer, Stefan; Droeschel, Daniel; Nuijten, Mark; Chevrou-Séverac, Hélène

2014-01-01

Medical nutrition is a specific nutrition category either covering specific dietary needs and/or nutrient deficiency in patients or feeding patients unable to eat normally. Medical nutrition is regulated by a specific bill in Europe and in the US, with specific legislation and guidelines, and is provided to patients with special nutritional needs and indications for nutrition support. Therefore, medical nutrition products are delivered by medical prescription and supervised by health care professionals. Although these products have existed for more than 2 decades, health economic evidence of medical nutrition interventions is scarce. This research assesses the current published health economic evidence for medical nutrition by performing a systematic literature review related to health economic analysis of medical nutrition. A systematic literature search was done using standard literature databases, including PubMed, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Additionally, a free web-based search was conducted using the same search terms utilized in the systematic database search. The clinical background and basis of the analysis, health economic design, and results were extracted from the papers finally selected. The Drummond checklist was used to validate the quality of health economic modeling studies and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist was used for published systematic reviews. Fifty-three papers were identified and obtained via PubMed, or directly via journal webpages for further assessment. Thirty-two papers were finally included in a thorough data extraction procedure, including those identified by a "gray literature search" utilizing the Google search engine and cross-reference searches. Results regarding content of the studies showed that malnutrition was the underlying clinical condition in most cases (32%). In addition, gastrointestinal disorders (eg

Responsible leader behavior in health sectors.

PubMed

Longest, Beaufort

2017-02-06

Purpose The purpose of this paper is to expand attention to responsible leader behavior in the world's health sectors by explaining how this concept applies to health sectors, considering why health sector leaders should behave responsibly, reviewing how they can do so, and asserting potential impact through an applied example. Design/methodology/approach This paper is a viewpoint, reflecting conceptualizations rooted in leadership literature which are then specifically applied to health sectors. A definition of responsible leader behavior is affirmed and applied specifically in health sectors. Conceptualizations and viewpoints about practice of responsible leader behavior in health sectors and potential consequences are then discussed and asserted. Findings Leadership failures and debacles found in health, but more so in other sectors, have led leadership researchers to offer insights, many of them empirical, into the challenges of leadership especially by more clearly delineating responsible leader behavior. Practical implications Much of what has been learned in the research about responsible leader behavior offers pathways for health sector leaders to more fully practice responsible leadership. Social implications This paper asserts and provides a supporting example that greater levels of responsible leader behavior in health sectors hold potentially important societal benefits. Originality/value This paper is the first to apply emerging conceptualizations and early empirical findings about responsible leader behavior specifically to leaders in health sectors.

A systematic review of economic evaluations of health and health-related interventions in Bangladesh

PubMed Central

2011-01-01

Background Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh. Methods Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER). Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context. Conclusion Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis of knowledge in the area. The

Economic hardships in adulthood and mental health in Sweden. The Swedish National Public Health Survey 2009.

PubMed

Ahnquist, Johanna; Wamala, Sarah P

2011-10-11

Possible accumulative effects of a combined economic hardship's measure, including both income and non-income related economic hardships measures, on mental health has not been well investigated. The aim of this paper was to investigate; (i) independent associations between multiple measures of economic hardships and mental health problems, and (ii) associations between a combined economic hardships measure and mental health problems. We analysed data from the 2009 Swedish National Survey of Public Health comprising a randomly selected representative national sample combined with a randomly selected supplementary sample from four county councils and three municipalities consisting of 23,153 men and 28,261 women aged 16-84 years. Mental health problems included; psychological distress (GHQ-12), severe anxiety and use of antidepressant medication. Economic hardship was measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. The results from multivariate adjusted (age, country of birth, educational level, occupational status, employment status, family status and long term illness) logistic regression analysis indicate that self-reported current economic difficulties (inability to pay for ordinary bills and lack of cash reserves), were significantly associated with both women's and men's mental health problems (all indicators), while low income was not. In addition, we found a statistically significant graded association between mental health problems and levels of economic hardships. The findings indicate that indicators of self-reported current economic difficulties seem to be more strongly associated with poor mental health outcomes than the more conventional measure low income. Furthermore, the likelihood of mental health problems differed significantly in a graded fashion in relation to levels of economic hardships.

Economic modeling of surgical disease: a measure of public health interventions.

PubMed

Corlew, D Scott

2013-07-01

The measurement of the burden of disease and the interventions that address that burden can be done in various units. Reducing these measures to the common denominator of economic units (i.e., currency) enables comparison with other health entities, interventions, and even other fields. Economic assessment is complex, however, because of the multifactorial components of what constitutes health and what constitutes health interventions, as well as the coupling of those data to economic means. To perform economic modeling in a meaningful manner, it is necessary to: (1) define the health problem to be addressed; (2) define the intervention to be assessed; (3) define a measure of the effect of the health entity with and without the intervention (which includes defining the counterfactual); and (4) determine the appropriate method of converting the health effect to economics. This paper discusses technical aspects of how economic modeling can be done both of disease entities and of interventions. Two examples of economic modeling applied to surgical problems are then given.

Intensive Care Nurses’ Belief Systems Regarding the Health Economics: A Focused Ethnography

PubMed Central

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-01-01

Background: Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses’ beliefs and their effect on nurse’s: practices and behavior patterns regarding the health economics. Methods: In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Findings: Eight beliefs were found that gave meaning to ICU nurse’s practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2. Monitoring and auditing improve consumption; 3. There is a fear of possible shortage in the future; 4. Supply and replacement of equipment is difficult; 5. Higher prices lead to more accurate consumption; 6. The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8. Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. Conclusions: ICU nurses’ belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the

Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography.

PubMed

Heydari, Abbas; Vafaee-Najar, Ali; Bakhshi, Mahmoud

2016-09-01

Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital

Declining fertility and economic well-being: do education and health ride to the rescue?

PubMed Central

Prettner, Klaus; Bloom, David E.; Strulik, Holger

2015-01-01

It is widely argued that declining fertility slows the pace of economic growth in industrialized countries through its negative effect on labor supply. There are, however, theoretical arguments suggesting that the effect of falling fertility on effective labor supply can be offset by associated behavioral changes. We formalize these arguments by setting forth a dynamic consumer optimization model that incorporates endogenous fertility as well as endogenous education and health investments. The model shows that a fertility decline induces higher education and health investments that are able to compensate for declining fertility under certain circumstances. We assess the theoretical implications by investigating panel data for 118 countries over the period 1980 to 2005 and show that behavioral changes partly mitigate the negative impact of declining fertility on effective labor supply. PMID:26388677

Division of Behavioral Health: FAQ

Science.gov Websites

State Employees Behavioral Health DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice Public

Economic recession and mental health: an overview.

PubMed

Cooper, Brian

2011-01-01

Effects of the current global economic downturn on population mental health will emerge in the years ahead. Judging from earlier experience of financial crises in various parts of the world, stresses associated with rising unemployment, poverty and social insecurity will lead to upward trends in many national suicide rates, as well as to less readily charted increase in the prevalence of psychiatric illness, alcohol-related disorders and illicit drug use. At the same time, mental health services are being cut back as part of government austerity programs. Budget cuts will thus affect psychiatric services adversely just when economic stressors are raising the levels of need and demand in affected populations. Proactive fiscal and social policies could, however, help to mitigate the health consequences of recession. Evidence- based preventive measures include active labor market and family support programs, regulation of alcohol prices and availability, community care for known high-risk groups, and debt relief projects. Economic mental health care could best be achieved, not by decimating services but by planning and deploying these to meet the needs of defined area populations.

The Influence of Health Behaviors During Childhood on Adolescent Health Behaviors, Health Indicators, and Academic Outcomes Among Participants from Hawaii.

PubMed

Nigg, Claudio R; Amato, Katie

2015-08-01

Health behaviors during childhood may influence adolescent health behaviors and be related to other important outcomes, but no longitudinal research has examined this in a multicultural population in Hawaii to date. This study investigated if childhood moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, and sedentary behavior influence adolescent (1) MVPA, fruit and vegetable consumption, and sedentary behavior; (2) body mass index (BMI) percentile, general health, and stress; and (3) school marks and school absenteeism. Three cohorts of public elementary school children (fourth to sixth graders) who participated in a state-mandated after-school program in 2004, 2005, and 2006 completed baseline (demographics, MVPA, fruit and vegetable consumption, and sedentary behavior) and 5-year follow-up surveys (demographics, MVPA, fruit and vegetable consumption, and sedentary behavior; BMI, general health, stress, school marks, and absenteeism; combined follow-up n = 334; 14.76 ± 0.87 years old; 55.1% female; 53% Asian, 19.8% Native Hawaiian/other Pacific Islander, 15.3% White, and 11.9% other). Regressions found that childhood MVPA (mean [m] = 45.42, standard deviation [SD] = 31.2 min/day) and fruit and vegetable consumption (m = 6.96, SD = 4.54 servings/day) predicted these behaviors in adolescence (m = 47.22, SD = 27.04 min/day and m = 4.63, SD = 3.03 servings/day, respectively, p < 0.05). Childhood sedentary behavior (m = 3.85, SD = 2.85 h/day)) predicted adolescent BMI percentile (m = 60.93, SD = 28.75, p < 0.05). Childhood fruit and vegetable consumption and sedentary behavior negatively predicted adolescent marks (B average, p < 0.05). Childhood health behaviors do influence adolescent health behaviors, some health outcomes, and some academic indicators in this population, especially childhood sedentary behavior, which underlines the importance of sedentary behavior

Integrating Behavioral Economics and Behavioral Genetics: Delayed Reward Discounting as an Endophenotype for Addictive Disorders

ERIC Educational Resources Information Center

MacKillop, James

2013-01-01

Delayed reward discounting is a behavioral economic index of impulsivity, referring to how much an individual devalues a reward based on its delay in time. As a behavioral process that varies considerably across individuals, delay discounting has been studied extensively as a model for self-control, both in the general population and in clinical…

Promoting Health and Behavioral Health Equity in California.

PubMed

Mishra, Meenoo; Lupi, Monica Valdes; Miller, Wm Jahmal; Nolfo, Tamu

2016-01-01

Behavioral health disparities are not usually considered part of the same system of health disparities. However, the California Department of Public Health focused its health equity strategies on reducing behavioral health disparities through its California Statewide Plan to Promote Health and Mental Health Equity. This statewide plan was developed through a community-wide stakeholder engagement and outreach process. In addition, the California Reducing Disparities Project is a prevention and early intervention effort to reduce mental health disparities in underserved populations. This strategic plan represents the voice of several racial/ethnic communities, such as African American, Asian and Pacific Islander, Latino, Native American, as well as lesbian, gay, bisexual, transgender, and queer and questioning communities in California, through 5 strategic planning workgroups. The workgroups were composed of a broad range of stakeholders, including community leaders, mental health care providers, consumer and family members, individuals with lived experience, and academia. This case example highlights the various efforts of California's Office of Health Equity in eliminating behavioral health disparities and promoting mental health equity, as well as discusses the unique statutory and regulatory role of the Office of Health Equity's deputy director.

Teaching Health Care in Introductory Economics

ERIC Educational Resources Information Center

Cutler, David M.

2017-01-01

Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…

Economic evaluation of occupational health and safety programmes in health care.

PubMed

Guzman, J; Tompa, E; Koehoorn, M; de Boer, H; Macdonald, S; Alamgir, H

2015-10-01

Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Decision modeling for economic evaluation of health technologies].

PubMed

de Soárez, Patrícia Coelho; Soares, Marta Oliveira; Novaes, Hillegonda Maria Dutilh

2014-10-01

Most economic evaluations that participate in decision-making processes for incorporation and financing of technologies of health systems use decision models to assess the costs and benefits of the compared strategies. Despite the large number of economic evaluations conducted in Brazil, there is a pressing need to conduct an in-depth methodological study of the types of decision models and their applicability in our setting. The objective of this literature review is to contribute to the knowledge and use of decision models in the national context of economic evaluations of health technologies. This article presents general definitions about models and concerns with their use; it describes the main models: decision trees, Markov chains, micro-simulation, simulation of discrete and dynamic events; it discusses the elements involved in the choice of model; and exemplifies the models addressed in national economic evaluation studies of diagnostic and therapeutic preventive technologies and health programs.

Behavioral economics: the key to closing the gap on maternal, newborn and child survival for Millennium Development Goals 4 and 5?

PubMed

Buttenheim, Alison M; Asch, David A

2013-05-01

Millennium Development Goals (MDGs) 4 and 5 set ambitious targets to reduce maternal, newborn and child mortality by 2015. With 2015 fast approaching, there has been a concerted effort in the global health community to "close the gap" on the MDG targets. Recent consensus initiatives and frameworks have refocused attention on evidence-based, low-cost interventions that can reduce mortality and morbidity, and have argued for additional funding to increase access to and coverage of these life-saving interventions. However, funding alone will not close the gap on MDGs 4 and 5. Even when high-quality, affordable products and services are readily available, uptake is often low. Progress will therefore require not just money, but also advances in health-related behavior change and decision-making. Behavioral economics offers one way to achieve real progress by improving our understanding of how individuals make choices under information and time constraints, and by offering new approaches to make it easier for individuals to do what is in their best interest and harder to do what is not. We introduce five behavioral economic principles and demonstrate how they could boost efforts to improve maternal, newborn, and child health in pursuit of MDGs 4 and 5.

Behavioral health leadership: new directions in occupational mental health.

PubMed

Adler, Amy B; Saboe, Kristin N; Anderson, James; Sipos, Maurice L; Thomas, Jeffrey L

2014-10-01

The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.

The Effect of Health Beliefs, Media Perceptions, and Communicative Behaviors on Health Behavioral Intention: An Integrated Health Campaign Model on Social Media.

PubMed

Yoo, Sun-Wook; Kim, Jarim; Lee, Yeunjae

2018-01-01

Social media have recently gained attention as a potential health campaign tool. This study examines this line of expectation concerning the role social media may play in health campaigns by testing an integrated health campaign model that combines insights from research on social media-specific perceptions and communicative behaviors in order to predict health behaviors. Specifically, this study aims to (a) develop a more holistic social media campaign model for predicting health behaviors in the social media context, (b) investigate how social media channel-related perceptions affect preventive health behaviors, and (c) investigate how communicative behaviors mediate perceptions and behavioral intention. The study conducted an online survey of 498 females who followed the Purple Ribbon Twitter campaign (@pprb), a cervical cancer prevention campaign. The results indicated that information acquisition mediated perceived risk's effect on intention. Information acquisition also mediated the relationships between intention and information selection and information transmission. On the other hand, social media-related perceptions indirectly impacted behavioral intention through communicative behaviors. The findings' theoretical and practical implications are discussed.

Parent Conversations about Healthful Eating and Weight: Associations with Adolescent Disordered Eating Behaviors

PubMed Central

Berge, Jerica M.; MacLehose, Rich; Loth, Katie A.; Eisenberg, Marla; Bucchianeri, Michaela M.; Neumark-Sztainer, Dianne

2013-01-01

Objective The prevalence of weight-related problems in adolescents is high. Parents of adolescents may wonder whether talking about eating habits and weight is useful or detrimental. This study aimed to examine the associations between parent conversations about healthful eating and weight and adolescent disordered eating behaviors. Design Cross-sectional analysis using data from two linked multi-level population-based studies. Setting Anthropometric assessments and surveys completed at school by adolescents and surveys completed at home by parents in 2009–2010. Participants Socio-economically and racially/ethnically diverse sample (81% ethnic minority; 60% low income) of adolescents from EAT (Eating and Activity in Teens) 2010 (n = 2,793, mean age=14.4) and parents from F-EAT (Families and Eating and Activity in Teens) (n = 3,709, mean age = 42.3). Main Exposure Parent conversations about healthful eating and weight/size. Outcome Measures Adolescent dieting, unhealthy weight control behaviors, and binge eating. Results Mothers and fathers who engaged in weight-related conversations had adolescents who were more likely to diet, use unhealthy weight control behaviors, and engage in binge eating. Overweight/obese adolescents whose mothers engaged in conversations that were focused only on healthful eating behaviors were less likely to diet and use unhealthy weight control behaviors. Additionally, sub-analyses with adolescents with data from two parents showed that when both parents engaged in healthful eating conversations, their overweight/obese adolescent children were less likely to diet and use unhealthy weight control behaviors. Conclusion Parent conversations focused on weight/size are associated with increased risk for adolescent disordered eating behaviors, whereas conversations focused on healthful eating are protective against disordered eating behaviors. PMID:23797808

Comprehensive Health Care Economics Curriculum and Training in Radiology Residency.

PubMed

Keiper, Mark; Donovan, Timothy; DeVries, Matthew

2018-06-01

To investigate the ability to successfully develop and institute a comprehensive health care economics skills curriculum in radiology residency training utilizing didactic lectures, case scenario exercises, and residency miniretreats. A comprehensive health care economics skills curriculum was developed to significantly expand upon the basic ACGME radiology residency milestone System-Based Practice, SBP2: Health Care Economics requirements and include additional education in business and contract negotiation, radiology sales and marketing, and governmental and private payers' influence in the practice of radiology. A health care economics curriculum for radiology residents incorporating three phases of education was developed and implemented. Phase 1 of the curriculum constituted basic education through didactic lectures covering System-Based Practice, SBP2: Health Care Economics requirements. Phase 2 constituted further, more advanced didactic lectures on radiology sales and marketing techniques as well as government and private insurers' role in the business of radiology. Phase 3 applied knowledge attained from the initial two phases to real-life case scenario exercises and radiology department business miniretreats with the remainder of the radiology department. A health care economics skills curriculum in radiology residency is attainable and essential in the education of future radiology residents in the ever-changing climate of health care economics. Institution of more comprehensive programs will likely maximize the long-term success of radiology as a specialty by identifying and educating future leaders in the field of radiology. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Benefits Innovations in Employee Behavioral Health.

PubMed

Sherman, Bruce; Block, Lori

2017-01-01

More and more employers recognize the business impact of behavioral health concerns in the workplace. This article provides insights into some of the current innovations in behavioral health benefits, along with their rationale for development. Areas of innovation include conceptual and delivery models, technological advance- ments, tools for engaging employees and ways of quantifying the business value of behavioral health benefits. The rapid growth of innovative behavioral health services should provide employers with confidence that they can tailor a program best suited to their priorities, organizational culture and cost limitations.

Health Risk Behavior in Foster Youth

PubMed Central

Gramkowski, Bridget; Kools, Susan; Paul, Steven; Boyer, Cherrie; Monasterio, Erica; Robbins, Nancy

2010-01-01

Problem Adolescent health problems are predominantly caused by risk behavior. Foster adolescents have disproportionately poor health; therefore identification of risk behavior is critical. Method A secondary analysis of data from a larger study investigated the health risk behavior of 56 foster youth using the CHIP-AE. Findings Foster youth had some increased risk behavior. Younger adolescents and those in kinship care had less risky behavior. Youth had more risk behavior when: in group homes, parental death, histories of physical or emotional abuse, or history of attempted suicide. Conclusions These results point to areas of strength and vulnerability in foster youth. PMID:19490278

Relationships Between eHealth Literacy and Health Behaviors in Korean Adults.

PubMed

Kim, Sun-Hee; Son, Youn-Jung

2017-02-01

The Internet is a useful and accessible source for health-related information for modern healthcare consumers. Individuals with adequate eHealth literacy have an incentive to use the Internet to access health-related information, and they consider themselves capable of using Web-based knowledge for health. This cross-sectional study aimed to describe the relationship between eHealth literacy and health behaviors. A total of 230 adults aged 18 to 39 years and residing in South Korea participated in the study. The mean (SD) score for eHealth literacy was 25.52 (4.35) of a total possible score of 40. The main source of health information was the Internet. Using hierarchical linear regression, the results showed that eHealth literacy was the strongest predictor of health behaviors after adjusting for general characteristics. These findings indicate that eHealth literacy can be an important factor in promoting individual health behaviors. Further research on eHealth literacy and actual health behaviors including intention and self-reported health behaviors are required to explain the impact of eHealth literacy on overall health status.