Health Economics - Science topic

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European Journal of Medical Research _ 2023

Gestational Diabetes Mellitus and associated factors in Ethiopia

In Ethiopia, gestational diabetes mellitus (GDM) is a significant public health issue and a risk to maternal and child health. Understanding the prevalence and factors of GDM in Ethiopia may also help determine the best interventions. Therefore, we tried to review gestational diabetes and its factors in Ethiopia.AQ: Please check and confirm the edit made to the article title.yes i have checked and confirm METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instrument was used to conduct the review. In order to report on the prevalence and contributing factors of gestational diabetes mellitus, the following databases were used: Google Scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature. Pilo-tests were conducted using a standardized data gathering form in research using a random sample. All statistical analyses were performed using STATA version 16 software for Windows and the random-effects meta-analysis method. The results are presented using texts, tables, and forest plots, along with measure of effect and a 95% confidence interval.Affiliations: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author Given name: [Fentahun Yenealem], Last name [Beyene], Given name: [Bekalu Getnet], Last name [Kassa], Given name: [Gedefaye Nibret], Last name [Mihretie], Given name: [Alemu Degu], Last name [Ayele].yes checked and corrected AQ: Is this word Pilo-tests spelled correctly throughout the article?Thank you the correction Affiliations: Please check and confirm whether the city name is correctly identified for the affiliation 2.yes checked and corrected RESULTS: Out of 1755 records, 10 studies with 6525 participants that fully satisfy the inclusion criteria were included for the meta-analysis. The pooled prevalence of gestational diabetes mellitus in Ethiopia was 12.04% [95% CI (8.17%, 15.90%)]. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity, and previous history of GDM were statistically significant.AQ: Please note that the sentence Inadequate dietary diversity, high body mass index… is repeated under the below heading Conclusion.yes checked and corrected CONCLUSION: The pooled prevalence of gestational diabetes mellitus is high in Ethiopia. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity and previous history of GDM were statically significant variables. Emphasize on early screening, prenatal care and all women having risk factors and trying to get pregnant should get screens for diabetes to improve the maternal and child health at large

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Health care interventions usually have as primary purpose to improve the health of patients, and not primarily to prevent health care costs. Therefore it is not good to only consider health care costs when estimating the value of an intervention.

See for example:

* Cost-Effectiveness in Health and Medicine (2nd edn)

Peter J. Neumann (ed.), Theodore G. Ganiats (ed.), Louise B. Russell (ed.), Gillian D. Sanders (ed.), Joanna E. Siegel (ed.)

* Methods for the Economic Evaluation of Health Care Programmes

Fourth Edition

Michael F. Drummond, Mark J. Sculpher, Karl Claxton, Greg L. Stoddart, and George W. Torrance

* The ISPOR web site on Economic Evaluation: https://www.ispor.org/heor-resources/heor-by-topic-new/economic-evaluation

* CEVR's Cost-Effectiveness Analysis (CEA) Registry: https://cevr.tuftsmedicalcenter.org/databases/cea-registry

In the US, there have been many quality measures developed but with varying levels of confidence and reliability. Once a quality measure is developed and accepted, it continues to exist even when there are better measures that should replace it. The result is a growing list of measures that seem to be given equal weight in many applications. We need to develop a system that weights these measures according to their reliability. For example, the statistical significance of findings and sample size should be weighting factors. Reproducibility of results should be a big factor. You get the idea and that's all I have to offer.

To find fully funded PhD scholarships in spatial and/or regional economics, you can:

1. Research universities and institutions known for their expertise in spatial and regional economics.

2. Check their websites or contact their admissions offices for information on available scholarships, grants, or funding opportunities.

3. Explore databases and platforms like Scholarships.com, Scholarshipportal.com, or GradSchools.com, filtering by your specific field of interest.

4. Consider reaching out to professors or researchers in the field for advice or potential funding opportunities.

5. Monitor professional associations, governmental organizations, and research institutes that offer scholarships or grants in spatial and regional economics.

Use the "find a match" function.

Measuring nurse productivity requires assessing both quantitative aspects, like patient outcomes and workload, and qualitative factors, such as patient satisfaction and teamwork. Combining both measures offers a more accurate evaluation of a nurse's productivity.

The attachment will assist you to think about research issue and topic.

Sustainable agriculture is farming in sustainable ways meeting society's present food and textile needs, without compromising the ability for current or future generations to meet their needs.“A sustainable agriculture is one that over the long-term, enhances environmental quality and the resource base on which agriculture depends; provides for basic human food and fiber needs, is economically viable; and enhances the quality of life for farmers and society as a whole”.Government has been promoting organic farming in the country since 2015-16 through the schemes of Paramparagat Krishi Vikas Yojana (PKVY) and Mission Organic Value Chain Development for North Eastern Region (MOVCDNER). Hindrise Social welfare foundation is one of the most prestigious Agriculture NGO in India.Sustainable development in the agriculture sector aims to increase the productivity, efficiency and level of employment and further aims to protect and preserve the natural resources by the over utilization.Eco friendly or sustainable agriculture is essential for human health, food safety, environmental protection, long term food security, protecting soil health, empowering farmers through economic stability, conserving water resources, biodiversity protection and climate change.

Dear Sninate,

I wish I can say surely. But, i can give an idea. Surch Google on "authentic Journal publisher in Europe with different language". Here YOU must get journal list. Choice 5 and check journal Impact Factor.

Select your desire one and submit YOUR manuscript.

YOUR effort will work.

Yes sure, send me your email, and I will send some.

The main ones (all of them indexed in Web of Science) could be

You can even find articles on such a topic in journals of public health such as Gaceta Sanitaria, among many others.

Dear Mr. Boer,

Thank you for your answer and nice to have another view for this. The methodology is near my heart and critique is welcome when planning a new study. It is true that by Researchgate Q&A I won't get absolute methods for the study. Therefore, it is important to clear the theory, and thanks for your resources.

Before starting this study, I wanted to clear existing studies, methods, frames of reference, and even the answer to my research question. During the last weeks, I have done this investigation of frames of reference and answers for a research question. My research problem seems complex and the answer won't be simple even.

As earlier is mentioned, there are already different health economic evaluations existing. Thus, I have not found the right method to study this from reliable and valid view. I think I need to get back at the research table and take a couple of steps backward.

Much helpfull. Thanks

Lisbeth Bang Thank you for your comment. We have progressed far beyond in domains like finance and social media when it comes to handling voluminous loads of data. In healthcare however we are now realizing the potential of mining large datasets generated over the years. We will learn a lot for sure as we explore this path for generating insights to help increase the efficiency of health care delivery in different geographies. As mentioned, we are getting better and better at mining information and this will become the NEW NORMAL for us healthcare practitioners.

If a topic has funding, do that, then it is easier. Even if it sounds boring, it will become interesting! :)

We draw the line between them.

The fiscal policy response to combat global pandemic

My opinion: As a physician, when you accept responsibility for the care of a patient, you must provide the best care possible for that patient, at the time, based upon your skills, resources and circumstances at the time. You are not the government and you are not God, don't try to be, focus on the best you can do to support the wishes and the outcome of that patient. If the patient requests DNR, then fine, but if the patient wants help, then you must do the best you can. I found a good test was, "Are you able to sleep that night?" If not, you are going to have problems (Unless the physician is a sociopath; but they should have been weeded out in premed)

Aleksandar P. Medarevic Double-Bootstrapped Truncated Regression please see

Hi Eugenia,

From visual inspection, it seems that the extrapolated survival curve has not fitted very well. It would be worth checking other parametric survival functions and evaluate their goodness of fit by AIC-BIC relative to each other and then select the best fit. Have you read NICE DSU guidance ( http://nicedsu.org.uk/wp-content/uploads/2016/03/NICE-DSU-TSD-Survival-analysis.updated-March-2013.v2.pdf )? Maybe you might not have this problem (PFS > OS) later on.

All the best,

Masnoon.

Hi Masnoon,

It is hard to know what is not included in a methods section of a paper. My guess would be that modelers who do something like this would proudly mention it in their methods.

The paper to which you refer states that most models do not use anything like eigen decomposition when changing cycle length. That is, of course, until they published their paper. I assume that knowledge and application of the paper is still disseminating and that there are at most very few recent papers that apply their methods.

More generally, I would say that the paper is yet another illustration of how important it is to check whether your model represents observations correctly wherever reasonably possible.

I would also like to add that lack of clarity in the methods does not imply that the authors used a correct solution for a problem such as changing model cycle length to something else than the observation cycle length.

Rob

I am in Maria Bautista's camp, not Efayena Obukohwo's. You did not indicate what the condition is, but conceptually, think of the problem as fixed and variable costs, where variable costs may have economies to scale or inefficiencies to scale. For example, suppose the 2 children are wheelchair-bound. You only need to install one set of wheelchair ramps. You might get a discount if you buy two wheelchairs. But the motor vehicle that would transport one wheelchair and one healthy child may be far less costly than one that can accommodate 2 wheelchairs. Or it might be possible for Mom to work part-time with one child with the condition but impossible with two. You need to carefully think thru the chart of accounts you will collect, and do collect the detailed HH structure.

I may have misunderstood your questions, but about: "the best way I can reference the model structure". I see only one way, therefore that is automatically the best way: refer to the submitted manuscript as 'submitted'.

However, as reviewer I would find it unacceptable if you only refer to a manuscript that I cannot read (yet) for your model structure.

BTW: You can't give a specific reference to a submitted paper, therefore I don't see how it matters how well-respected journal is. As it happens, just recently I saw a paper in an OK journal refer to a preceding paper with their model that was published in a journal on Beall's List of predatory open-access publishers. They practically repeated their model description, though.

You could include a copy of the submitted manuscript with your submission of your CEA paper. However, I would not like getting referred to another paper, find a sub-section on CEA, and get referred from there to a technical appendix.

I would suggest to include a description of your model in your CEA paper, and include a new technical appendix with full detail concerning the model version of this CEA paper. You can keep the description of your model in the main text relatively brief because you can refer to a submitted manuscript and to the appendix. I also advise to write an original description in the main text because papers do not like copying other papers, i.e. they generally require original material. I don't expect that the appendix needs to be so original but make sure that it does describe the model version of your new paper and not of the clinical paper.

Thanks Rob. Your response was very helpful. Considering alternate survival distribution seems very logical here. Thank you again for sharing your knowledge with us and I hope more people will get benefit by reading this. Best Regards, Masnoon

Thank you for the text. It was very helpful in understanding the broader context of costs involved and research practices.

I am presently developing a cost of Illness Inventory which will collect information on the monetary and time costs related with the child from the parents. I am having difficulties in capturing opportunity cost of the parent who are willing to do a job but cannot do so.

Given scarcity of data and literature on autism in India it difficult to assume such costs. It seems very speculative.

How about the nearness to death effect. Widely recognised by economists but has never been applied to health care capacity planning and demand forecasting. See papers at http://www.hcaf.biz/2010/Publications_Full.pdf

Establishing patients registries, RWD, as base for HE models and analyses;

new models for market access of medicines, is HTA set for emerging markets, what do we need next? etc.

Kind regards and a lot of success, HE seems to be hot topic in many countries

Hi Giulia, thanks for the help. In fact, the following link

K. proved useful for this question.

Thanks,

Regards,

To measure the efficacy of any production unit we must have a given, well defined objective function which is absent in most of the cases. Hence to measure the efficacy is almost impossible. But we can measure the relative efficiency of hospitals (any economic production unit) by using DEA, SFA etc. Because in absence of well defined objective function , we can measure relative efficiency easily and effectively.

Call various insurance companies i.e. see what is covered, what is real cost, and what is patient copayment. Various insurance companies may vary on cost. Check cost for people without insurance paying cash as well. What insurance is prevalent in your target population? I work with people who have medicaid so most things are covered. Those with medicare and other insurances have to pay more out of pocket.

Interesting question. It is always difficult to find new subjects for research.

I would try to read some of the latest literature on the subject and to think which of the topics in the literature would interest me enough to devote my time to research it.

Dear Ankit,

If you are conducting CEA using intermediate or short-term outcome(s), the ICER that you obtain may only be reflective for the short-duration of period. Although it may not be cost-effective for short term duration, if you project the outcomes for longer duration, it may be cost-effective, provided that you have set the CE threshold or WTP threshold. It would be great if you can compare it to your country's threshold or suggested threshold by WHO.

Good luck!

Thank Theophilus for your prompt answer. Actually I can not find any publications or report in pubmed, SCIMAGO etc. I cannot believe that such analysis or survey have not been released somewhere. Therefore if somebody have something in mind, i will be more than interested. Thanks in advance

I had a conversation with Prof. Zweifel in 2015 and he personally said that the book has become too tough, it could be easier than its present form. Unfortunately, there is no solution for the exercise given in the book. However, if you have gone through the book carefully, it would be easier to solve the problems.

Private practice is more fulfilling and rational than corporate sector at any point of time for any registered practioner. Patients also get benefitted ultimate as it is more cost effective and builds a satisfying patient doctor bonding which is lacking in corporate sector.

Your question is quite general and explaining the methods of CEA here is beyond the scope of a brief answer in RG. Several (also open-access) sources are available in the web, for example "WHO Guide to cost-effectiveness analysis".

I do not know whether it was your intention but when it comes to difference between societal and health system perspective:

Societal perspective includes benefits gained and costs borne by the whole society, including non-health sector entities e.g. households, employers, government. Health system perspectives only accounts for benefits and costs in health system.

If the sensitivity analysis is intended to show robustness, then I think you should use plausible ranges and not and arbitrary percentage up and down.

I would also say that a plausible range is generally wider than a standard deviation up and down.

I would start with trying to find or estimate 95% confidence intervals.

Is that what you mean by "per cent intervals"?

If so, then I assume that the critique you got about that is because there may be more uncertainty than described by the confidence interval. That only describes uncertainty due to random error in a specific analysis. They should have given you some clue why they think that there is more uncertainty and preferably also suggest a way to determine actual uncertainty. It is hard for me to tell without detailed knowledge about your input parameters and their function in your evaluation.

(I don't know what you mean by "media analysis".)

I wish you the best of success with getting your degree and I hope that you will still want to continue with this type of work after you're done!

By the way: I would also love to know a bit more about how health economics is applied in Cuba.

Hi Karan,

If the cycle length in your model will be one year then annual survival probabilities you already have can be used to inform the transition from alive to death in your model. If for some reason you want to change cycle length then appropriate mathematical transformations will be needed. The only caution is needed here: "I have the yearly survival probabilities which were calculated based on the odds ratios of the medications" - is this transformation is correct. 

p.s.

And Ahmed is suggesting the good approach with partitioned survival models, which can be better solution then Markov in this case. 

Public health activities in developing countries are mostly government supported.I think you should think about join in Nigerian Govt. Public Health wing first.

You can also follow the below link:

 Wish your success!!

Regards,

Dr.Munzur-E-Murshid

First, it depends on whether you are taking the perspective of society, the employer, the worker, the government, or the health care system. From society's & worker perspectives, your list is reasonably good but should exclude insurance costs (those double-count the losses). For societal & employer perspectives, need to add emergency services (police, fire & ambulance), employer costs (workplace disruption, incident investigation, rehiring, etc. -- see Rikhardsson et al. Corporate cost of occupational accidents: an activity-based analysis, Accident Analysis & Prevention, 2004.) as well as the costs of property damage/loss (think of a jack-knifed tractor-trailer that was carrying tomatoes or eggs to market) and production delays (think of an explosion inside a manufacturing plant or a fire that destroyed the IT servers). I include prosthetics, wheelchairs, etc in medical costs but health insurance may not count such medical devices - or home modifications, specialized transportation. Costs to the employer focus on insurance expenditures (Worker's Comp (medical, disability, rehab and retraining), disability, life) and sick leave rather than the actual medical costs and productivity losses -- plus the employer & property damage costs, liability costs when employees injury others & the employee was on-the-clock or in a company vehicle or had been drinking at a company-sanctioned event , costs of lost reputation in major events (Union Carbide after Bhopal, the airline that folded after a crash in Florida), taxes paid to fund government payments related to the injury. Employer costs also include insurance, leave, and disruption costs for worker injuries when the worker is not on duty, especially if the employer providers health insurance for the employee & the employee's spouse & children. Plus there is the cost of reduced productivity when injured workers are temporarily reassigned to restricted duty tasks rather than out on leave.

First, it is very important to you do define which costs you will consider. Second, If you do not have direct access to these estimatives, I would recommend a literature review. Certainly other studies mention these costs.

Let me check on that.

Regular cost-benefit analisys can be used, but concerning family labor do not value it at market price unless the member of the family left a job to work at the farm or community. The cost of that labor is the diference betwen monetary income and monetary expenses

It is difficult to provide a categorical answer that is "high risk" or "low risk" without also considering the context of the study. For example, the answer is dependent on the type of intervention which the practitioner is unblinded to e.g. the extent to which the practitioners actions/practices may inadvertently alter the effect of the intervention, or not. Similarly, to what extent is the intervention being measured considered to be routine practice, or not?

First of all, I would like to recommend you to revisit previous literature and statistical methods that have been used preciously. Perhaps, that would be the best solution.

As per my understanding from your explanation, your data has been collected through observation and survey. Your dataset also contains both primary and secondary sources and have a dummy variable (though I don't know your standpoint).

If I fall into your situation, I would apply SEM once. However, I'm not confident that SEM would be able to answer the research question, yet I can see understand some pros and cons. 

The case you present is absolutely real and the discussion about this aspect is interesting as the type of information provided by longitudinal cohort interventional studies are not provided by RCTs. Provided the limitations are acknowledged the metanalytic approach is feasibile. Attached a document that I guess provides theoretical basis and numerous real examples.

1. For the US, see this 2016 study by Raj Chetty & colleagues, which builds from linked longitudinal income tax returns (NB: also pull up the correction; I cannot recall what was corrected.) 

http://jamanetwork.com/journals/jama/article-abstract/2513561  

2. The first of the 3 accompanying editorials gives cites to similar UK and EU research.

My guess is no. I would first ask how many households are ecologically educated enough to appreciate their carbon footprint. In many cases this can be as simple as asking "does your house have insulation in the walls?" For many American households the answer is probably "I don't know." This is because the people living in the house had little or nothing to do with its construction and they have not drilled holes in the wall to find out if insulation is present in part/all of the house. I have a Ph.D. in biology and a fair understanding of the problems. I know that there is ceiling insulation, but the walls are more mystery. One part that I tore out was not insulated, but a fair bit of the exterior walls are concrete block.

It might be more effective to do a survey, but also have the students trained to do an on-site inspection to try and answer some of the questions that the occupant may not be qualified to answer.

Hi Armira,

For textbooks, I suggest using:

1. Behavioral Finance, By William Forbes

2. Behavioral Finance: Psychology, Decision-Making, and Markets

By Lucy Ackert, Richard Deaves

For articles: please see the reference list of the attached article.

Hope this helps.

Hi, Paul.

Please check whether this can be helpful

National Health and Morbidity Survey

Global Ageing Study (GLAS), 2007

Malaysian Population and Family Survey

National Medical Care Survey (NMCS) 2010

East Asia Retirement Survey

The Mental Health and Quality of Life of Older Malaysians Survey

Philippine Elderly Survey (PES)

Philippine Longitudinal Survey on Aging (PLSOA)

Best,

Mamta

Have you considered examining the perceptions of leadership held by stakeholders within the environment first? You might find hot spots :)

I realise that you have said that a qualitative survey is not possible, but I am not sure what a purely quantitative approach could tell you. A measure of job satisfaction would show that average job satisfaction is at a particular level - but unless you have a validated scale with norms for Myanmar that's not really very informative.

However, I think you could learn a lot from some focused (in depth) qualitative research that explored and described the issues that they experience and what the consequences are (in terms of motivation, decisions to stay or leave the job etc.) . Access to a relatively small number of people might be sufficient (10-15 say). I realise that there is a very specific skill set required but it also feels like the most appropriate approach to exploring the issues from the perspective of the assistants themselves.

You say you want to highlight the job dissatisfaction -   I think whatever approach to research you take you should aim to explore the sources of satisfaction / dissatisfaction If you are right that satisfaction is low,  it will likely take you to the same place but it will make it sound less as if you have predetermined the answer. people can surprise you!

Hi Manhal,

You might wish to read: Product Innovation, Product-Market Competition and Persistent Profitability in the U.S. Pharmaceutical Industry by Peter Roberts. Although it will not be of much help in the area of  mergers and acquisitions (M&A) it is rather extensive in the areas of competition and innovation.  In addition, it frequently cited and the references are helpful.

I hope this helps,

Rob

What health care problem are you trying to solve/investigate?  BTW, some people view "cohesion" as a form of social capital, while other definitions/structures are also supported by various scholars.

Here is a paper on how within-hospital social networks help spread info about reducing the spread of bloodstream infections...

Here is how social network analysis was used by the CDC to map the spread of TB in a community...

Finally, a study of women's social networks who were trying to quit smoking...

Getting to personal level of patient, it is still possible to get rational with appeals of Quality, Expertise, Convenience, Costs, Value, etc.

I(2) variables such as price level can be made I(1) by differencing so we have "delta P" , that is, inflation. see Johansen Soren (1992) in Journal of Policy Modelling 313-341. OR Arize, Malindrestos and Nam (2005) in Atlantic Economic Journal, pp461-471 Vol. 33. Also, see, Arize and Malindretos (2012) Nonstationarity and Nonlinearity in Inflation Rate: Some further evidence in International Review of Economic & Finance. 

Hi Balaji, I don't know if my answer makes any sense but I think ROI (Return on Investment) model would work. such that, the investment is what the farmer invests in the farm/ farm productivity and return could be the nutritional portfolio from consuming the harvest. And then measure it against WHO's DALY. For theory, I am well conversant with theoretical literature but for empirical, search on marginal SROI (Social return on Investment) and Impact measurement tools. Most of these theory you can get it from M&E journals for agricultural organisations. Good luck

I think this is a question of pertinent interest given the ongoing Zika outbreak. Yes, the economic impact is expected to be both Macro and Micro. Macroeconomic impact would directly relate to decline in tourism, low productivity because of work absenteeism, budgetary constraints in other sectors due to prioritization of health departments etc. However, the microeconomic impact especially to households with children born with Zika side effects can be huge in terms of short and long-term costs of care for the ill. I don't think we know much yet but it surely warrants detailed investigation. 

I read it was near 40K, but I don't have the source.

Hello Andre,

Thank you so much for your response. Your suggestions are really helpful. I would read the updates from WHO  sites and the manual.

Thanks again! 

The International Union Against TB and Lung Disease produced the following discussion paper on sustainable funding mechanisms for tobacco control - the funding model also extends to / has potential for wider issues and such a model is being established with governments in several countries. http://www.tobaccofreeunion.org/images/stories/research/Sustainable%20Funding%20Models%20for%20Tobacco%20Control,%20a%20Discussion%20Paper.pdf

Yesterday, a review was published by Sarah Greig in Drugs Ther Perspect

(DOI 10.1007/s40267-016-0297-2) with a brief section on cost at the end of the article. Information is scarce in published literature so far, but Joke Dijk and co-workers in the Netherlands currently run the INVEST study with this particular focus.

I can anticipate the results of a personal research on forests.

The main forest associations were well characterized by Sandro Pignatti in his book on “Boschi d’Italia” (1998), giving the possibility to calculate the biotic indices of Ellenberg at the moment of their first relevés. These data can be compared with the Ellenberg indices of recent forest surveys (2005-2015). In this period of about 50-60 years, the raise of climatic temperature was strong: after 1985 the mean T°C increased in Italy of about 1-2 °C and the perennial snow limit of altitude on the Alps passed from 2980 to 3080 m.

            The analysis of 72 forest samples indicate two different behaviours, (1) the boreal-Alpine conifer formations present a little decrease in thermophile species, while (2) the temperate and Mediterranean formations increased their thermophile species. So, even altitudinal belts follow a similar behaviour. Anyway, at this time the increase of thermophile species (case 2) results 7.47% in an altitude belt of 180 m (mean), while the decrease (case 1) results 3.0 % in an altitude belt of 1520 m (mean).

For a general (if deliberately polemical) critique in an elite journal, see:

This also provoked some keen responses!

For a more detailed discussion of the (in)appropriateness of health economic evaluation in a specific context (end-of-life care), see:

(As a health economist) a personal view is that while there are numerous legitimate points from which to attack health economics, you will need to be rigorous in your appraisal of the many published critiques, which vary wildly in quality.

A typical starting point is essentially to conflate economists with Oscar Wilde’s definition of a cynic (“a man who knows the price of everything and the value of nothing”).  The misrepresentation of (health) economics as the quest to put a $ price on everything and make all decisions on this basis alone then allows the setting up and knocking down of as many straw men as the critic requires.

However, the purpose of health economics is not to establish a universal systematic pricing structure of tangible commodities and abstract concepts alike, and no health economist I have ever met believes that this would be either possible or desirable.  Rather, the purpose of health economics can be summarised in two words: managing scarcity.

Thus, when an economic evaluation measures the costs of, say, smoking and expresses this is $ amounts, it does so not because this is the best or only way to measure the detrimental effect of smoking on an individual or on society, but because it is informative for the specific purpose of considering *resource-based* responses (increasing tobacco taxes, introducing anti-smoking programmes, subsidising nicotine gum, etc.).

Since health demands will always exceed available resources in formulating responses to health problems, such responses are usefully informed by the relative costs of available choices.  *This is not the same thing as saying that costs should be the only consideration*, or even the only economic consideration (see Sen’s capability approach, cited by Bircher).

A strong critique of health economics is therefore not one that makes an unanswerable argument in response to a straw man (e.g. the inadequacy of putting a price on an extra year of life; the superiority of alternative approaches in a world without scarcity).  A strong critique of health economics is one that addresses its true purpose, informing resource-based decisions in the context of scarcity; identifies ways in which it fails in this purpose; and proposes superior alternatives.

Hello Jacqueline!

I agree with Mary-Helen regarding defining Young adults as people between 18-25 years old as many researchers are defining this age group nowadays in USA and in some European countries. Be aware that in some countries, young adults are like teenagers - developing their identity and testing many fields, so many do not have stable works as adults over 30 years old. Even in the injury field you can find that Young adults have higher injury rates in comparisson to teenagers and adults over 30 years old because they are like teenagers with legal rights to drive and drink.

About SES: search for level of education, type of employment, level of income and type of housing. As well as parents' level of income and occupation. If it is possible: disponible income and/or capacity to save 100 euros every month.

There are several points that have to be clarified/taken into account. Are we talking about private patients or charity cases? If it is the former, what conditions/services are we talking about? If it is the latter, what type of facility are we talking about and what is the reimbursement system applicable. Usually, medicare/public insurance pay less compared to privately insurance so there is an incentive to bill patients as private patients. If we know the streams of payments, we can compare the rates applied to each stream.

You can use Gini to look at the distribution of health but you would be measuring pure health inequality and not socioeconomic health inequality. The difference between the Lorenz curve and the concentration curve resides in what you are using as a ranking variable. In the Lorenz Curve you will rank people according to their health whereas when you use the Concentration Curve you will rank people according to their socioeconomic status...

In a previous article, I have presented the decision-making rule for medical tourists. Destination (i.e. country and health facility) is an important consideration for the patient.

Runnels V, Carrera PM. Why do patients engage in medical tourism? Maturitas. 2012 Dec;73(4):300-4.

Obesity and BMI change relatively slowly therefore they may be not very practical variables for measuring the effects of a project. 

Depending on the project that you evaluate, it may be good to measure all relevant physical activity (not just exercise). You can provide people who are in the project area with measuring devices or interview them, but you can also measure activity in the area by observation. That may be useful if they are only occasionally in the area.

I am not sure if you are also interested in predicting/optimizing health effects before implementing the project.

You may want to speak with some other people, e.g.

Reid Ewing:

Deborah Cohen:

Rob

Hi Shabi,

The link below may be of help to you. You can get related articles from health insurance experts.

https://www.choice.com.au/money/insurance/health 

I can also be of help if you want to speak to professionals or experts in the health insurance business.

Regards,

Eric

NEEDED SOMETHING MUCH BETTER

Dear Bernard,

Thank you for this interesting answer and for suggesting to broaden the scope of the literature I should examine  (and sorry for this late reply). More particularly, thanks for highligthing the notion of "R&D driven" and the connections with IT literature. It might be useful in my case.

Best regards

Josselin

Hi Rimal,

The right approach is to use parametric survival models. As dr. Linden says, the Weibull function is one option for that analysis.

You should looking for these books:

Applied Survival Analysis: Regression Modeling of Time to Event Data. David W. Hosmer, Jr., Stanley Lemeshow, Susanne May, John Wiley & Sons, 2011.

Modeling Survival Data: Extending the Cox Model. Terry M. Therneau, Patricia M. Grambsch. Springer Science & Business Media, 2000.

Best regards. Andrés.

I'm adding consideration from Ariel answer. Are you sure that from 2009 till 2012 no changing in technology (drugs, pathways) occoured in the hospital? And the same no changing from personnel capacity?

Ciao

Davide