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Health Economics
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Economics of healthcare and professional development are the keywords.
Can you please help to suggest other journals that would cover the scope, keywords, etc.
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The main ones (all of them indexed in Web of Science) could be
  • Health Economics
  • European Journal of Health Economics.
  • American Journal of Health Economics
  • Health Policy
  • Health Affairs
  • Health Economics Review
  • Health Economics Policy and Law
  • Applied Health Economics and Health Policy
You can even find articles on such a topic in journals of public health such as Gaceta Sanitaria, among many others.
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What attributes of a product make beneficial of health economic view in perioperative procedures?
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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.
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When assessing health state preferences for economic evaluation in children, has anyone had experience or success with soliciting children's personal or self-reported preferences (rather than adult surrogates or using adult values)? Whilst time trade off (TTO) may suit >17year olds and discrete choice experiments (DCE) may be suitable for >14year olds, what do researchers prefer for <10year olds? Does anyone have experience with best worst scaling (BWS) or other techniques in this cohort?
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Much helpfull. Thanks
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With the ever increasing potential of using Big Data in Healthcare in India, this discussion is aimed at sharing your experiences and challenges in publishing from large clinical datasets in Medicine.
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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
George Stoica
mentioned, we are getting better and better at mining information and this will become the NEW NORMAL for us healthcare practitioners.
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Hello,
I am new to fmm. If I run a two component mixture model I will have two sets of predicted values (one for each component). I can also generate the posterior prob and the most likely latent class membership. How do I combine these two sets of values to produce single predicted values which correspond  to my dependent variable?
Thanks
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Hi guys,
I'm a Master's student in Health Economics and I should start thinking about my Master thesis that should refer to the case of South Africa. Do you have any suggestions about which topic/topics might fit with my thesis?
Thanks
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If a topic has funding, do that, then it is easier. Even if it sounds boring, it will become interesting! :)
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The enforced public health measures and associated economic repercussions brought forth by the COVID-19 pandemic have found their staunch supporters and adversaries. It is not uncommon for two forces to be at odds, but in this case, both forces are necessary for what should be the ultimate goal: Human well-being.
One one side, the strictly imposed restrictions protect people from contracting and spreading the disease over a short period of time, while circumventing the otherwise inevitable overburdening of the healthcare system.
On the other, incurred financial losses, including unemployment and bankruptcy, conflict with the desires for well-being and the public's interest that has driven these same restrictions and public health measures.
This dilemma is not constrained to COVID-19, and can be applied more widely to discussions on the very foundations that healthcare systems and the public's access to them rest.
So where do we draw the line between the benefits of imposed public health measures and their economic repercussions? Who should be responsible for making such decisions? And what factors tip the balance on either end?
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We draw the line between them.
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Areas to consider are Public Economics and Health Economics
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The fiscal policy response to combat global pandemic
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The entire world is now affected and the resources are getting exhausted. Even the best healthcare systems are failing to tackle the explosion of COVID-19. Judicious use of resources is therefore very essential. Many of the COVID-19 patients will be frail, terminally ill, etc. in whom intubation/mechanical ventilation or resuscitation may be futile. So, is it high time to adopt DNR/DNI for such patients? If yes, for which patients? Should the administrations/governments/ethical aspects be less rigid so that such rules can be adopted? What is the local rule/policy in your place?
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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)
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Dear all,
I used those two types of regression to estimate effects of environment factors on hospital efficiency.
However, they gave me opposite results. For instance, in FR percentage of people above 65 was negatively associated with DEA score, whereas in DBTR it was positively associated. The same results was for turnover rate.
I appreciate if you could explain me such contradictory.
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Hi everyone,
I'm trying to do a partitioned survival analysis (PartSA) to model a cohort of patients directly from survival data in the trial and evaluate cost-effectiveness of two different treatments. There are Kaplan-Meier OS and PFS curves published for one of these trials, so I have fitted both curves separately with Weibull distribution and extrapolated them to the time horizon of interest (15 years). However, the extrapolated PFS curve turned out to be higher than extrapolated OS curve, which obviously does not make sense for the analysis.
I'm sure this is happening quite a lot because the fact that correlation between time-to-event outcomes is not considered is one of the major limitations of this model. I was wondering if there any practical solutions on how to troubleshoot this. Is it possible to transform the data in any way to overcome this problem?
Many thanks,
Eugenia
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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.
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What are the applications of eigen decomposition in Health economic modelling such as Markov model?
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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
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Hello all,
I am doing a health economics survey on family economy on a specific disease which affects children.
Does anyone know how I can accommodate the fact that a family may have more than one child who suffers from the condition in my survey and do the analysis accordingly?
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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.
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I want to submit a paper exploring a cost-effectiveness analysis for a novel technology. The model we developed is currently being published as a subsection in a paper (with all details in the supplementary) with the manuscript's primary aim focused on the clinical aspects of the technology and there are many aspects of the cost-effectiveness analysis which are not included in that paper.
I am looking for advise on the best way I can reference the model structure to the initial paper and develop a manuscript which can aptly explain the scope and type of findings such an evaluation can report, specially when the initial paper in itself is under review and not published. Also, I feel that a health economics related journal would be better able to review and validate the model structure and methods as the model methods is an addition on the existing methodology being used and would be of interest for the readers of health economics and HTA focussed journals.
I look forward to some guidance on this matter, thank you so much in advance!
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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.
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Dear everyone,
I would like to evaluate the public health care cost of treatment including medication and services for adult patients. In Canada, medications will be covered for adult 65+, so if I evaluate medicine costs, can I include only these participants or can I include both adult 65+ and patients who pay out of pocket? Can I also exclude patients having private insurance, because the government or provincial don't expense for them?
I am confused about this.
Can you give me some options?
Thank you so much
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Depends on your question. What are you looking for?
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Health Economics, Cost-effectiveness analysis, Uncertainty analysis and Oncology modelling
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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
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Autism is a disorder which effects the behavioral skills of a child for the rest of his/ her life. Trying to estimate the cost of different variables to asses the cost benefit effectiveness of a Communication centered Parent mediated intervention for Autism in South Asia. Maximum literature is from the developed parts of the world which makes it in appropriate to adopt similar tools in Low and Middle Income Countries in South Asia.
For further details kindly refer to this link for the project description.
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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.
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What new and practical issues are important in the management and economics of the healthcare system in the world?
  • Please provide your suggested titles on these topics.
Thank you for answering...
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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
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I am pursuing an Mphil program in health economics. i would want to research into something relatively new. i would be glad if you can help me with suggestions.
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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
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Hello all, I am looking for publications that have costed the use of a laminar air flow hood (in an aseptic unit). Such a cost may appear in micro-costing health economic studies? I have been unsuccessful so far in my search but would be grateful for any help. Thank you in advance
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Hi Giulia, thanks for the help. In fact, the following link
K. proved useful for this question.
Thanks,
Regards,
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I am working in health economics and I wants to evaluate the efficacy and efficiency of many of hospitals
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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.
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Hello everyone,
I am looking for publications that I can quote in an article and that analyze the relative cost of imaging when imaging is used (Aquisition of images, radiological reading, etc.). Probably publications in the field of health economics.
thank you in advance for your help
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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.
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I need to start thinking about and preparing my thesis topic, but I have no idea where to even begin looking for possible topics. My master's is in health economics and management with a specialization in decision making in healthcare.
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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.
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Can anyone please explain me how to determine effectiveness of any treatment over the other in cost effective analysis.
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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!
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Hello everyone,
I'm looking for publications that I can quote in an article and that analyze the proportion of clinical studies that use imaging. Probably publications in the field of health economics.
Thank you in advance for your help
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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
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Is there any manual solution for the exercises in the book "Health Economics"
The book is in the link below:
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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.
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There has been a sharp increase in the number of corporate dental clinics and Elite dental clinics in India. Is it justified to try to wipe out the private practitioner? Do we have more freedom in private practice or in a corporate practice?
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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.
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Cost effectiveness, Health economics
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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.
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I am working on an economic evaluation of a drug to promote wound healing on diabetic foot ulcers based on retrospective data (cost-consequences). I need to make a sensitivity analysis of efficacy and cost of the intervention. To an univariate analysis how to select the range of these variables? Which other alternatives can I use for the analysis?
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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.
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Dear Experts,
I am new to the field of Health Economics, and I am currently writing my master thesis which is also my first-hand experience in the area of health economic modelling. 
I want to create a two health state Markov model for three different scenarios where (i) a patient is diagnosed early and treated early (ii) a patient is diagnosed late and treated late (for six months) (iii) a patient is not diagnosed and therefore not treated. For the first two scenarios, I have the yearly survival probabilities which were calculated based on the odds ratios of the medications. I also have the yearly survival probabilities of the third scenario in which no medications are given. The survival probabilities are obtained from the literature.
Can these survival probabilities be taken as transition probabilities in my model or do I need to transform them to transition probabilities using some mathematical function?
I look forward to your expertise.
Regards,
Karan
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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. 
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I am looking for opportunities as a research fellow in institutions doing research in
1.clinical areas eg  evidence based medicine,  reproductive health,  population control,  infectious disease (HIV/AIDS, malaria,  tuberculosis etc) , noncommunicable diseases
2.public health ( health economics, health equity)  especially in developing countries 
3.Medical education ( quality and satisfaction measurements and improvements) 
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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
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In my opinion the main types of costs that should be determined include: productivity costs, medical costs, quality of life losses and administration and insurance costs.
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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.
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 I need some help. I am trying to make some assumptions about the Primary care cost for older women with primary breast cancer, since I did not get the data. I am wondering if you have any idea about the frequency of GP visit of breast cancer who are followed in the primary care?and if there is a cost for prescribing the drug in the primary care. What about other resources incurred in the primary care, i.e nurse visit? Does GP cost include the cost of prescribing the drug? Many thanks
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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.
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Studies done on the allocation of 4-hexaonylpyrazolone-5
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Let me check on that.
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I would like to estimate the total costs of getting a community to do something. Which is the best method to use in this estimation? Especially non monetary costs e.g time, in a community or group I am likely to spend more time than in individual decision making situation.
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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
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regardless if unblinding of practitioners was unavoidable or not, is blinding of patients only without the practitioners considered high or low risk of performance bias?
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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?
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I have a data set of 4100 households of Teknaf Peninsula, the southern part of Bangladesh. My variables are  as follows
Focus Variable: Living inside/outside the forest (data collected by GPS loggers)
Others
> Age
> Education Level
> Gender (considering the family head only)
> Dependency ratio
> Occupation Category (i.e. fisherman, farmer, business, labor, and others)
> Annual Income (sum of income from different sources)
> Length of residence
> Fuelwood collection (yes/no)
> Fuelwood consumption (amount in kg)
I want to develop a statistical model showing the effect of the determinants on the forest encroachment. 
I will be highly pleased to get advice on which type of statistical test should I go for.
Thank you in advance.
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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. 
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I am trying to assess effectiveness of neoadjuvant treatment for pancreatic cancer using Markov model. However RCTs do not yet exist for neoadjuvant therapy. The best available is prospective phase II trials which lack a control group. Can I perform a meta analysis of this existing data from which to calculate my transition probabilities or would multivariate analysis be better?
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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.
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The question relates to the topic of equity and actuarial adjustment for the purposes of developing flexible and later retirement options.
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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.) 
2. The first of the 3 accompanying editorials gives cites to similar UK and EU research.
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As part of promoting carbon neutrality from a baseline level, we would like to know if at all a standard questionnaire is available for estimating carbon emission from households through surveys. Target groups are local household to be surveyed by college/school students.
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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.
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Can anyone help with indications about references for an undergraduate Behavioral Investment/Behavioral Finance course?
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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.
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I am trying to locate surveys/data sets that provide information about ageing and health in a number of countries in the Asian region - including, for example, the 2014 Myanmar Ageing Study, 2011 Viet Nam National Aging Study and SAGE India Waves 0-2; however, I cannot locate studies in Lao PDR, Malaysia, Nepal, and the Philippines. Any connections to colleagues/surveys and advice would be welcome.
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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
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Am working on a project where am suppose to use theories to explain challenges of procurement plan implementation in an institution.
Thank You.
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Have you considered examining the perceptions of leadership held by stakeholders within the environment first? You might find hot spots :)
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My former topic is "Job Satisfaction of Health Assistants in Myanmar: Country wide study"; in which I will study a 4-year course bachelor degree holder who are assigned as Health Assistants and blocked their career development in terms of education and promotion. However it will be very difficult to manage within a short time to get a permission of Ministry of Health as far as I try my best. So I want to change my topic to highlight professional dissatisfaction of those para-medical degree holders in quantitative way of research. Please suggest me what kind of topic I should use for my problem.
Current number working as Gov staff  (Health Assistant)- 756
Job attrition number - 142
Alumni waiting for Gov job- 450 students
Health Assistants in Myanmar is different with other countries, they learned Medicine, Surgery, Epidemiology, Bio statistics, behavioral sciences and researches. But all of them dissatisfied of being their status, trying to quit job day by day. The worst thing is that they're never proud of their status under discrimination and stigmatization even Non-government jobs.
Please share your idea what kinds of research title I should do. For me, qualitative survey is not possible. Appreciate for each and every suggestions to my question. Thanks
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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!
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I have query regarding pharmaceutical data.
As part of my PhD in Health Economics I am interested in research questions such as impact of mergers, competition etc. on pharmaceutical industry or firm innovation lets say.
Could you please suggest me where I can access firm specific pharmaceutical data to address the above type of research questions? Thank you Manhal
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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
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Could someone please point me to a comparative analysis of social capital vs cohesion vs networks & impacts on health care utilization? Measures of social capital, social cohesion and social networks are many and varied: is the differentiation mainly in the perspective of the analyst (i.e. coming from health economics vs public health vs sociology vs anthropology vs...?). Is there a unifying model - or a Venn diagram out there?
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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...
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Is it possible to apply relational marketing in health care industry in order to maximize patients fidelity?
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Getting to personal level of patient, it is still possible to get rational with appeals of Quality, Expertise, Convenience, Costs, Value, etc.
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I have 4 variables for unit root test in time series data. I applied Zivot-andrew unit root test. I found mix order of intergration such as one variable I (0), two variable is I(1), one variable is I (2). So, i want to apply cointegration test. Please suggest me the cointegration test which capture all type of order of intergation.
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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. 
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Dear all,
I wish to get some preliminary idea on modelling household level / individual level health status of agricultural households / farmers with level of farm-level productivity.  Could someone help me with some literature on theory / models ?  It will be of great use.
Thanks. 
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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
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Under this assumption that the Zika epidemic is related to the increased number of microcephaly cases, where would it impact Latin American economies?  Tourism industry?  Birth gaps control policies?  Re-allocation of health care resources towards Zika prevention and control?
We published a blog post (link below) that explores the potential social and economic impact of the epidemic, but I would like to dig deeper and see how we can build evidence (and manage the knowledge gaps) on the economics of public health emergencies.
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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. 
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Turnover among novice nurses has been documented as a serious economic issue in healthcare services in North America and Europe. In the United States, the estimated cost to replace one nurse turnover ranges from 10,098 to 88,000 US Dollar (Li & Jones, 2013). However, there is a lack of empirical evidence of this issue in the GCC where indigenization programs are implemented whereby local new graduate nurses gradually replace expatriate nurses. Is there any empirical evidence of the estimated cost of a new graduate nurse turnover in the GCC countries?
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I read it was near 40K, but I don't have the source.
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How can we match ICPC and ICD codes? How can we measure co-morbidity from secondary level data for India?
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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! 
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Does any one have studies or articles about developing health financing strategies to assist the implementation of universal health coverage
Thanks
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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
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I am looking for the most recent comparisons for Duodopa with DBS and apomorphine SC in regards to the cost and QALY 
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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.
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This question has been around for decades and it requires truly interdisciplinary efforts to answer.
The major ecosystems of the planet are critically important for humans and for all creatures, and they are currently subject to very strong pressure from climate change and from human-induced ecological disturbances, such as agriculture and invasive species. Ecosystems change both slowly and abruptly in apparent response to extreme events that may be embedded in long-term change. Ecosystems have strong feedback effects on the atmospheric budgets of heat, moisture, greenhouse gases and aerosols, and, therefore, on climate.
To find out how climate change will affect forests and dry-land vegetation, and how those changes will affect atmospheric composition, we need more observations. Observations need to be on timescales of decades or longer to reflect processes in the atmosphere and of the major ecosystems. They also need to span local, regional and global spatial scales. Finally, we need ecosystem models integrated with atmospheric models that work like real systems.
In the United States, there are efforts to study parts of this problem and to make the requisite observations, supported by the National Science Foundation, the Department of Energy, NASA, the U.S. Forest Service and NOAA. What remains to be done is to coordinate and invigorate these efforts, and to commit to solving the problem on the relevant time and space scales. We have certainly seen a lot of progress in the last few years, but it has mostly served to point to the serious the gaps in our knowledge.
Ecosystem health goes hand-in-hand with human health and economic vitality. Atmosphere-biosphere interactions are powerful and have vast implications.   
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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).
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By the health economics I mean the intrusion of economic reasoning into health, through which health becomes a commodity that is measured, bought, sold and accounted for by cost-benefit analyses. That is so say, I am looking for critiques of the sort of accounts that constantly measure the costs of e.g. smoking, obesity, diabetes etc. in terms of productivity or the loss thereof.
Thanks 
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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:
  • Health Care Anal. 2005 Dec;13(4):289-301
  • Journal of Pain and Symptom Management 38 (2009), 27–31
  • Journal of Pain and Symptom Management 42 (2011), 460–463
  • Journal of Health Economics 31 (2012) 521– 527
(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.
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I am looking at SES among young people and adults with Type 1 Diabetes 
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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.
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Cost shifting is a phenomena observed in medicare insurance where cost incurred on medicare patients were allocated to non-medicare patients by hospitals to gain higher reimbursement.
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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.
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Which test is better to evaluate equity-lorenz or concentration curve?
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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...
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I need bibliografic about this 
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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.
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1 How can I properly structure metrics for assessing health benefits of urban mobility projects, as well as healthier food supply?
2 In other words, how can HIA procedures (through detailed metrics) help urban planners to make tangible health plus economic advantages of their projects ( whether possible)?
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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
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Dear All,
I am working on measuring the perceptions of policyholders towards health insurance schemes. Kindly suggest me some references where I can get reviews related to health insurance.
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Hi Shabi,
The link below may be of help to you. You can get related articles from health insurance experts.
I can also be of help if you want to speak to professionals or experts in the health insurance business.
Regards,
Eric
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A publication in Value of Health in 2012 by Robert J. Nordyke, et al., concluded that relative to the value placed on therapeutics, the reimbursed value of CDs is a small fraction of what would be expected under value-based pricing.
Has there been an update to this study? Do the results still hold given the reimbursement environment has changed significantly since then?
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NEEDED SOMETHING MUCH BETTER
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Conceptualizing the spatial organization of defense production shares common element with "health production" (such as growing cost of infrastructures, optimal coverage of space, etc.). Any suggestions are welcome. Thanks.
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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
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I am using the patients' survival times in an open cohort study of cancer patients as a measure of the life expectancy .I would like to predict the patients' life expectancy considering other patients' covariates i.e. age and sex. I could not use COX-regression because it predicts the death rate rather than life expectancy .Moreover, I could not use linear regression because the survival time data is positively skewed. Does anyone know what the best fit model in this case considering survival time as the dependent variable 
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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.
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I am looking at the impact of activity-based funding on the length of stay (LOS) in the hospital. I will run three models: 1) 2009 vs 2010; 2) 2009 vs 2011; 3) 2009 vs 2012. For the treatment groups I have same percentile distribution till 90 percentile. Is it a problem? Conceptually, this is expected because the reduction in LOS will occur from the patients who stays longer. I am taking log of the dependent variable. I get reasonable results. I found a small statistically significant coefficient for the interaction term in the third period. The question is: is it worth doing because of the distribution issue. I personally see no problem, but one of my colleagues thinks I shouldn't proceed with this project.
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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
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Hi everyone,
Conventional cost function assumes that the hospitals is minimizing cost, or maximizing profit or patients.
However, this is likely not the case for public hospitals in developing countries, in absence of incentive to compete and to self-sustain.
1. So, what are public hospitals in developing countries maximizing / minimizing?
2. How should a cost function for these public hospitals look like? 
3. Is there any literature discussing how should a cost function for public hospitals in developing countries be specified? How similar or different should it be from conventional cost function?
4. Studies from developing countries have used the conventional cost function such as Weaver & Deolalikar (2004) below. Is this correct?
I have tried to look for literature but to no avail.
Would be glad to have some discussion here.
Thank you very much in advanced.
Regards,
Ka Keat
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Thank you everyone for the interesting discussion!
Learned a lot from all your inputs.
I agree that the underlying cost function would be dependent on the setting in which the hospitals are operating.
I would actually like to study the hospitals run by the Ministry of Health, which are tax funded, budget based, and could always use public budget to compensate eventual deficit, to cite a few of you.
I think the MOH hospitals can be described as having a "satisficing" model of behaviour, in which "managers and staff only hope to achieve some level of output and quality within a fixed budget that will satisfy their own expectations and those of higher level managers." (World Bank 1993)
Found a World Bank document discussing this issue:
"Our expectation is, therefore, that even in the absence of an underlying maximisation objective that is universally applicable, a functional relation exists between observed hospital costs and output." (Howard Barnum & Joseph Kutzin 1993. Public Hospitals in Developing Countries: Resource Use, Cost, Financing - Link below.)
Another relevant document which I found useful is this: Adam Wagstaff & Howard Barnum 1992. Hospital Cost Functions for Developing Countries - link below.)
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Relatively little is known about the association between ageing and health care costs in middle- and low-income countries - whereas, in high income countries, available data does not yet point to a clear answer - with income elasticity and patient expectations, time to death, the type of service (inpatient or outpatient), and expensive technology, all possibly contributing more to increased spending than ageing populations.
See for example, Asia in the ageing century: Part III - Health care. www.cepar.edu.au/media/113850/asia_in_the_ageing_century_-_part_iii_-_healthcare.pdf
Any relevant and recent (last 5 years) analyses, published or in the grey literature, would be appreciated.
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Dear Jose-Ignacio and Sandra,
Do appreciate your responses. What I am looking for is recent published or unpublished literature/data on health systems responses to population ageing, the determinants and drivers in LMICs. The NCD burden will certainly be one component of health system expenditures unless we can change the trajectory of ageing at an earlier stage in life.
Sincerely, Paul
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What is the latest research on health outcomes and cost savings attributable to behavioral health interventions in clinical settings? 
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I'll add to Brian's comment in that you need to additionally define what do you mean by behavioral intervention. There are psychological, social, and psychosocial behaviors that could be targeted for change and a multitude of approaches that target these. See the links below, for example
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We search for controls within a social experiment.
Our social experiment is made up of 9 areas and we are searching for similar areas. We use cluster analysis to find groups of areas and then look which group is the closest to our area. We cannot use propensity scores as logistic regression with a group containing one individual (or even 9) is not very adequate.
Do you know whether there are examples of the use of clustering for a similar work?
We also use synthetic control, but this technique implies that we would know the outcome of our research well before the end of the experiment.
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You could use the Mahalanobis distances between groups. A non-significant distance could be treated as zero. Sample size will influence this approach, so you could decide that a Mahalanobis distance less than "some value" will be sufficient to treat the two sets of data as coming from the same group. This would be from discriminant analysis.
Cluster analysis should also work. Look in the taxonomy literature where people are trying to work out the phylogenetic relationship between different species. The group (species) is made up of individuals, and you group them by both their similarities and differences. Entomologists do this sort of thing. Botanists used to do this, and may still. Usually the data in such studies is a combination of continuous and categorical variables. Continuous variables might be something like width of pronotum. Categorical variables might be something like number of spots on the elytra. Some key words would be cladistics, and numerical taxonomy.
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I found that most checklists are used for  either model or trial-based economic evaluations. However, some checklists, like the one by Evers, 2005 seems to be model-based, yet classified as to be used for trial- based. Can someone please explain? Also, is it alright to use a model-based checklist for studies not model-based? 
Thanks!
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The first criteria list was published in 1974 by Alan Wiliam’s [1] and since that time there has been so much activity, you will find systematic reviews on the subject [2] and seems endless attempts to reach a consensus on the subject [3-4]. For general introduction, CRD have provided an good overview of assessing quality of economic evaluations [5]. The Drummond (BMJ) Checklist remains the most highly cited [6]
Choice of checklist depends on your specific question, the perspective you are coming from and types of economic evaluation.
If you wish to check ‘does this constitute an economic evaluation?’, the checklists mentioned already will confirm whether basic items required have been considered. For example, Drummond/BMJ or CHEC might initially screen the economic evaluation in a funding applications. Alternatively, CHEERS might be used to assess quality of reporting of pharmaco-economic evaluations.
However, if you wish to check ‘is this a reliable economic evaluation’ (so the objective is critical appraisal models), you should also note Cochrane Handbook, Chapter 15: Incorporating economics evidence, section 15.5.2 Critical appraisal of methodological quality [7]. Specifically for critical appraisals of decision-analytic models, the handbook has cited Philips checklist [8]. For modelling, of equal (or maybe greater) importance might be assessment of the quality of data inputs used for decision models; Cooper et al (2005) provide a useful framework using a hierarchical assessment to assess the quality of the data sources [9] .
References
  1. THE COST-BENEFIT APPROACH http://www.med.mcgill.ca/epidemiology/courses/EPIB654/Summer2010/CBA/CB%20approach%20Williams.pdf
  2. Walker, Damian G., et al. "Best practices for conducting economic evaluations in health care: A systematic review of quality assessment tools." (2012). http://effectivehealthcare.ahrq.gov/ehc/products/485/1302/MethodsBestPractices_FinalReport_20121023.pdf
  3. Evers, Silvia, et al. "Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria." International journal of technology assessment in health care 21.02 (2005): 240-245. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=292673&fileId=S0266462305050324
  4. Husereau, Don, et al. "Consolidated health economic evaluation reporting standards (CHEERS) statement." BMC medicine 11.1 (2013): 80. http://www.biomedcentral.com/1741-7015/11/80 
  5. CRD's guidance for undertaking reviews in health care. Centre for Reviews and Dissemination, 2009. http://www.york.ac.uk/inst/crd/SysRev/!SSL!/WebHelp/5_5_QUALITY_ASSESSMENT.htm
  6. Drummond, M. F., and T. O. Jefferson. "Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party." BMJ: British Medical Journal 313.7052 (1996): 275. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2351717/ 
  7. Shemilt I, Mugford M, Byford S, Drummond M, Eisenstein E, Knapp M, Mallender J, McDaid D, Vale L, Walker D. Chapter 15: Incorporating economics evidence. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available at: http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch15_Economics.pdf
  8. Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al.Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36). http://www.journalslibrary.nihr.ac.uk/hta/volume-8/issue-36 , p.89-93
  9. Cooper, Nicola, et al. "Use of evidence in decision models: an appraisal of health technology assessments in the UK since 1997." Journal of health services research & policy 10.4 (2005): 245-250. http://hsr.sagepub.com/content/10/4/245.long
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I wanted to ask of some of the best conducted health economic evaluation studies for a research project. Thank you for your help!
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Any number of validated general health quality-of-life measures can be used to calculate the utility values that you will need for CEA. In addition to EQ-5D, SF-36 can be used, so can SF-12 (though this is not as robust for small sample sizes). Other newer instruments such as PROMIS-10 are also being used. All of these are "patient-reported outcomes measures", (PROMs). To my knowledge, disease-specific instruments cannot be used to calculate QALYs, though obviously they are useful for tracking clinical progress.
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Hi all,
I have a categorical independent variable (1-20) and based on theory it should have a positive sign in regression, i.e. larger category ID, larger dependent variable. although it could be nonlinear.
Except for treating it as continuous variable valued from 1-20 or use 19 dummies, is there any other method to test this variable has a significantly positive effect?
it's kind of like I use 19 dummies, then find a way to test the coefficients for these 19 dummies are significantly getting larger. In other words, I am testing the differences between each indicator and the referent group are increasing.
Thanks very much!
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Since you have a lot of statistical power, you could also try a semi-parametric approach: 
Include all 20 categories as fixed effects, capture the coefficients and confidence intervals, put the ordered fixed effects on the x-axis, and then put the coefficients and confidence interval whiskers  on the y-axis. 
The advantage to this: it would impose minimal assumptions on the shape of the relationship (e.g. it could be linear, quadratic, exponential, etc), but that shape would be revealed by the shape of the line connecting the coefficients. It would also provide a lot of information in a very simple and intuitive way. 
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We are considering clinical audit in diabetes and we have collected monthly result tests of Hemogloboulin for a period of 3 years, to assess whether an intervention occured last year demonstrated any benefit on hemogloboulin levels. Given that the samples are not the same (both in size and composition i.e. in one month we have 1700 results, next month 1600) what's the best way to perform a statistical analysis to assess whether the levels of hemogloboulin were affected or not in this specific time period?
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Sorry, I really feel funny when I read that many people invest a lot of time, work, money and resources in getting/collecting data and that this investment is done obviousely with no idea in mind about how the data is to be analyzed. Especially in clinical settings there are so many covariables to consider and there are so many pitfalls that collecting data without exactly knowing what information will be important and how the reserch question can be addressed will likely produce data that is just missing a relevant variable, and the results are likely to be either non-conclusive or misleading.
My advice is to consult a local statistician.
Actually you should have contacted one 4 years back, when you were planning the study. Now all one can do will be a kind of a post-mortem analysis...
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Cost per QALY is a standard health economic endpoint however given the various clinical endpoints and decision-maker's perspective (national, regional, local) which other endpoints (e.g. Cost per time to institutionalization) might be relevant and important?
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If it is important to the decision-makers that generic health be expressed in QALYs, you may wish to refer to the HERC database of mapping studies1; this might indicate methods to map health state utilities from condition specific measures. At the time of writing, the database has identified only one mapping algorithm from ‘Alzheimer's Disease Cooperative Study Activities of Daily Living scale (ADCS–ADL)’ to EQ-5D2. Alternatively, you may also refer to work on developing the DEMQOL3.
As Jerome mentioned, many of the benefits of intervention for dementia may more readily expressed directly in monetary terms and, as an example, you might refer to my paper applying proxy-good value to informal care4.
References
1. Dakin, H, 2013. Review of studies mapping from quality of life or clinical measures to EQ-5D: an online database. Health and Quality of Life Outcomes. 11:151. HERC database of mapping studies, Version 3.0 (Last updated: 26th June 2014). Available at: http://www.herc.ox.ac.uk/downloads/mappingdatabase.
2. Rive, B., Grishchenko, M., Guilhaume-Goulant, C., Katona, C., Livingston, G., Lamure, M., Toumi, M., & Francois, C. (2010). Cost effectiveness of memantine in Alzheimer's disease in the UK. J Med Econ, 13(2), 371-380.
3. Mulhern B, Rowen D, Brazier J, Smith S, Romeo R, Tait R, Watchurst C, Chua KC, Loftus V, Young T, Lamping D, Knapp M, Howard R, Banerjee S. Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation. Health Technology Assessment Volume: 17 Issue: 5.
4. Trépel, D. Informal Cost of Dementia Care – A Proxy-Good Valuation in Ireland. The Economic and Social Review, Vol. 42, No. 4, Winter, 2011, pp. 479–503
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I'm trying to model events happening at certain time intervals in function of the total time. For instance if a doctor visited patients every 12 hours, it would be intuitive to assume that a group of patients with a mean length of stay (LoS) of 12 hours have an average of 1.0 follow-up visit (and so forth, 1.5 visits for 18 hours etc.). In reality, the actual mean number of visits is consistently smaller because all patients below 10 hours (which would be approx. half of them for a normal distribution) receive 0 visits. Is there a "formal" method to estimate the number of visits from the LoS?
I have been suggested to round down the number of visits as an approximation but I'm not sure that would be academically acceptable... I hope this makes sense as I'm not a statistician. Thanks in advance!
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Queueing theory is a good place to start. You can also try using a Poisson Regression. You can create a response variable, say patients per hour/12hrs. On top of that, you can use Doctor and Day of the week as predictor variables, among others. 
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I'm now working in some studies related to health economics.
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A quintile is a specific type of quantile - divided into 5ths. A quartile is is a quantile divided into 4ths.
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In many public health field analysis, quantile of income is mostly used but in health economics analysis, quintile of income is used instead of quantile . Is there any difference meaning between these two usages?
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