Applied health economics and health policy
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Appl Health Econ Health Policy · Jan 2006
Comparative StudyComparing patient access to pharmaceuticals in the UK and US.
The debate on access to new drugs has focused on the time lag between applications for approval and granting of marketing authorisation. This delay was identified as the first barrier with respect to patient access to new drugs, encompassing the hurdles of safety, efficacy and quality. Additional barriers have since been identified. These pertain to reimbursement and pricing of approved drugs, the so-called fourth and fifth hurdles. ⋯ The US provides faster, more flexible access to most, but not all, of the UK-approved pharmaceuticals in our sample. However, US patients have higher cost sharing than the UK and coverage is less evenly spread across the population. From a policy perspective, our study findings confirm the need to bolster the NICE fast-track initiative to decrease the amount of time it takes to appraise certain new pharmaceuticals. Also, the study findings point to the need in the US for careful monitoring of plan compliance with regulations pertaining to the Medicare drug benefit, particularly with respect to formulary restrictions and limits on cost sharing.
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Appl Health Econ Health Policy · Jan 2004
Senior citizens and the burden of prescription drug outlays: what lessons for the Medicare prescription drug benefit?
This article uses data from a cohort of elderly and retired persons over the 1996-2001 period in the US to (i) determine the extent to which changes in socioeconomic or demographic characteristics, particularly age, income and education, impact the total amount that is spent on prescription drugs and (ii) to analyse the predictors of individual out-of-pocket (OOP) prescription drug outlays among the same cohort and determine whether age, race, sex, income, education, marital status and health status have an influence on these. The analysis considers the implications for elderly individuals who choose to participate in the new Medicare Part D drug benefit, labelled the Medicare Prescription Drug, Improvement, and Modernisation Act of 2003. The results highlight the necessity for the Medicare prescription drug benefit to carefully target the eldest among the elderly, who are most in need and are in danger of becoming trapped in the so-called Medicare 'doughnut hole', i.e. incur high prescription drug outlays, without adequate coverage. The study also finds evidence that women, those who are not married, middle income elderly and those in poor health, who purchase drugs more intensively, are at risk of incurring significant prescription OOP drug outlays.
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Alcohol-impaired driving is one of the major contributing factors to fatal and serious crashes in New Zealand. To curb the high level of road trauma resulting from drink-driving, a compulsory breath test (CBT) programme was introduced in 1993 and a supplementary road safety package (SRSP) in 1995/1996. The SRSP aimed to enhance road safety enforcement and advertising activities, and focused primarily on drink-driving and speeding. ⋯ This paper examines the impacts of these drink-driving interventions. The analysis shows that the CBT programme and the SRSP have contributed to the reduction in alcohol-related crashes in recent years. There is also some evidence that, following the lowering of the drinking age, there has been an increase in drink-driving and subsequent alcohol-related crash involvement for drivers under 18 years.
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Appl Health Econ Health Policy · Jan 2002
ReviewWhat do we know about hospital at home? Lessons from international experience.
Hospital in the home' or 'hospital at home' services have become popular solutions to the apparent problems of conventional hospital care in many countries. Until recently their evaluation has been limited, and little has been known about their costs and benefits. ⋯ Overall it does not appear that such services produce cost savings, although this may depend greatly on local circumstances. This discussion paper uses the findings of a systematic review of the literature evaluating hospital at home and hospital in the home services to answer questions surrounding the supplementary or substitution status of these services.
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Appl Health Econ Health Policy · Jan 2002
Cost-benefit analysis of ambulance and rescue helicopters in Norway: reflections on assigning a monetary value to saving a human life.
This paper reports the results of a cost-benefit analysis undertaken in 1996 for a public commission set up to plan the future operation of state-owned ambulance and rescue helicopters in Norway. The analysis indicates that the benefits of ambulance missions flown by helicopters exceeds the costs by a factor of almost six. To do this analysis it was necessary to assign a monetary value to human life. ⋯ It is concluded that human preferences for the provision of health care or other life-saving interventions are probably too complex to be adequately represented by means of a single monetary value expressing the benefits of life-saving. The task of developing an inclusive framework for a normative approach to priority setting in injury prevention is daunting, and may be insoluble. It is important to assess the extent to which current value-of-life estimates depend on study methods and social context.