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Big data refers to the vast volumes of structured, semi-structured, and unstructured data generated at an unprecedented rate. With the advent of technology and the digital age, data is being created and accumulated from numerous sources, such as social media, sensors, financial transactions, and scientific experiments. The ability to collect, store, and analyze this massive amount of data has revolutionized many sectors, including research. In the academic and research world, big data is transforming the way researchers approach questions, analyze patterns and generate insights. With big data, researchers can now analyze trends, predict outcomes and create models with greater accuracy. But with these advancements come new challenges, including the need for appropriate tools, ethical concerns and the ability to interpret vast amounts of information. This article explores the impact of big data on research, the opportunities it presents, the challenges it brings and how researchers can leverage big data to enhance their studies. The Role of Big Data in Research 1. Enhancing research with large-scale data sets Traditionally, research was conducted using small sample sizes, often leading to limited findings and conclusions. With big data, researchers now have access to vast datasets that allow them to analyze trends and patterns on a much larger scale. This is especially useful in fields such as healthcare, economics, and social sciences, where large-scale data can provide more accurate insights. For example, in medical research, large datasets from hospitals and clinical trials help identify trends in disease outbreaks, treatment efficacy and patient outcomes. This is made possible through the integration of electronic health records, wearable devices and other digital data sources. 2. Improved decision-making and predictive analytics Big data empowers researchers to make data-driven decisions with a high degree of accuracy. The ability to analyze large amounts of data allows researchers to identify correlations, trends and even predict future events. Predictive analytics powered by big data is widely used in various fields such as economics, public health and environmental studies. For example, researchers studying climate change can use big data to predict future climate patterns, whereas data scientists in marketing can use consumer data to predict buying behaviour. In the field of economics, big data helps predict market trends by analyzing consumer spending patterns, global trade and financial transactions.
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Dear Hamza Kweyu Omullah,
I have been conducting research in this area for years. Among other things, the following conclusions have emerged from my research:
I have been conducting research in this issue. Based on my research findings, I conclude that Big Data Analytics is undoubtedly a powerful tool that is revolutionising scientific research. The ability to analyse huge data sets opens up new possibilities for scientists to discover, predict and make decisions. As technology and data analysis methods continue to develop, Big Data can be expected to play an even greater role in scientific research, contributing to advances in various scientific fields and improving people's lives.
Big Data is not only a tool for analysing historical data, but also a powerful tool for predicting future events and making data-driven decisions. The ability to analyse large amounts of data allows researchers to identify correlations, trends and even predict future events with high accuracy. Predictive analytics, based on large datasets, is widely used in various fields such as economics, public health and environmental research.
Scientists studying climate change use Big Data to predict future climate patterns by analysing satellite data, climate models and historical meteorological data. In marketing, Big Data helps predict consumer purchasing behaviour by analysing consumer spending patterns, demographics and social media activity. In economics, Big Data helps predict market trends by analysing consumer spending patterns, global trade and financial transactions.
I have described the issue much more extensively in the following articles:
APPLICATION OF DATA BASE SYSTEMS BIG DATA AND BUSINESS INTELLIGENCE SOFTWARE IN INTEGRATED RISK MANAGEMENT IN ORGANISATION
Business Intelligence analytics based on the processing of large sets of information with the use of sentiment analysis and Big Data
The Big Data technologies as an important factor of electronic data processing and the development of computerized analytical platforms, Business Intelligence
And what is your opinion on this topic?
What is your opinion on this subject?
Please answer,
I invite you all to discuss,
Thank you very much,
Best wishes,
I would like to invite you to scientific cooperation,
Dariusz Prokopowicz
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What are the reasons that per capita health care expenditure and publically financing health expenditure negavitly affectin total health expenditure?
My estimated results from DOLS method for the SAARC countries showed that per capita health care expenditure and health expenditure publically finance impacted total health expenditure.
Can any body elaborates the economic reasons
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Per capita healthcare spending and public financing of healthcare can decrease total healthcare expenditure due to factors such as heightened utilization, fiscal constraints, inefficiencies in cost, and reliance on public funding.
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"Should governments and international organizations shift their focus and allocate more resources towards the development of antiviral treatments for dengue and chikungunya, in place of or alongside current mosquito control and prevention strategies, given the significant healthcare, economic, and societal burdens these diseases impose on affected regions, or should the primary emphasis remain on prevention and mosquito control efforts?" why?
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A post-pandemic increase in international travel has contributed to a surge in dengue in parts of southern Europe, where it had not been recorded previously. The long and warm summer is also to blame: it allowed tiger mosquitoes (Aedes albopictus), which inhabit southern Europe and can carry the disease, to thrive. Most people who catch dengue have no symptoms, but it can cause fever, headaches and fatigue, and kills as many as 40,000 people each year. Because the European outbreaks are small, scientists don’t expect dengue to become endemic there — at least, not anytime soon...
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This was first published almost 10 years ago.
Now almost a decade later, has there been any progress? Chronic workplace inactivity has been a pandemic in developed societies for much longer than a decade. The healthcare and productivity costs of workplace inactivity are all increasingly well documented. Unfortunately, this sentence from 2012 probably still applies: "Employers often provide break time and specific areas for smoking, yet to do this for exercise may be considered distracting, counterproductive, and/or too expensive." .
Thank you for considering this discussion.
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Donald E. Watenpaugh Such a nice concern about working communities or individuals. Everybody have information about obesity but sitting for long can lead to muscle atrophy that observed in long bed rest patients or the astronauts. While sitting, anti-gravity bones and muscles relaxed and gravity influences decreases, similar phenomenon observed in space. As per the literature, bad lifestyle decreases bone density by 10% per 3-6 months. 6-9 hour sitting is playing havoc with workers life. Govt or company should provide compulsory walk or stretching sessions.
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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,
I need to suggestions on non-monetary incentives ( eg- Agri) that can be used to improve both nutrition related behaviours among tribal parents as well as serve to increase duration (days) in hospital for treating SAM. If there is any work on this, please suggest reports.
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Hi Marian,
I presume you are talking about Severe Acute Malnutrition, but I think you need to be more specific about the behavioural problems you are encountering and why financial incentives are unavailable/inappropiate. As for reports that might be useful, you might start with
Collins, S., Sadler, K., Dent, N., Khara, T., Guerrero, S., Myatt, M., Saboya, M. and Walsh, A., 2006. Key issues in the success of community-based management of severe malnutrition. Food and nutrition bulletin, 27(3_suppl3), pp.S49-S82. and the papers that cite it.
In terms of behavioural economics (my area) then you can think in terms of creating clear reference points for treatment and discharge. E.g. A Seven days rule or a weight /height / arm circumference rule . It helps also if you can establish social norms by getting respected figures in the community to back rules and take responsibility for enforcing messages. Small tokens of reward (bags with a message on them, badges, bags of food etc. may also motivate. Ultimately, though I feel you need to understand why people are departing from the treatment protocol.
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In the era of Industrial Revolution 4.0 (IR4.0), people are talking about Smart hospital. What are the characteristics of smart hospital?
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Yes, agree Nesreen Hassaan. Gradually, shall move towards that direction (at least partially).
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I'm about to start writing my Master's thesis and I'm majoring in Finance but I would be interested in studying this topic of real economic cost of delayed medical treatment in the Nordic countries. I ran into this topic in one of the forums here.
How could I relate this to finance and what would be the best way of establishing such a study (methods, data etc.)?
Thank you for Your help!
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You can compare, for example, preventive costs with the costs of treating selected diseases. These can be the most common diseases in the Nordic countries. In addition, you can also pay attention to the economic aspects of the implementation of systemic solutions aimed at increasing public awareness of health. You can compare, for example, the effectiveness of marketing campaigns, direct payments for medical bills - there are many possibilities.
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Starting from personal & patient safety issues within hospital in terms of widespread emergence sntimicrobial infections, infections affecting the hospital staff to now acquiring a community wide expansion, all led to mismanaged hospital waste practices. The issue has gone serious both the patients now not responding conventional antibiotics to both morecaffected by serious infections. This has not only added to payltient misery but also affected the healthcare economics.
yes there are guidelines, workshops & seminars but would require your comments & some nivel strategies to address this menace
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Medical waste management has not received much attention in developing countries. Segregation into risk and non risk waste is usually not performed. Workers have little awareness of hazards associated, and disposal techniques are poor. There is also lack of awareness at health policy and law levels.
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With my students, we are trying to use the ECI framework to shed light on economic integration of neighbouring countries, i.e., Tunisia, Algeria and Morocco. When using the RCA we found difficulties in interpreting the results. To wit, computing the three countries RCAs separately and collectively generates, of course, different results which are not easy to interpret and thus makes it difficult to proceed! What say you? Thanks in advance for your cooperation. (jelel.ezzine@gmail.com)
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Namibia is one of the countries in sub-Sahara Africa with high HIV/AIDS prevalance, HIV/AIDS consumes most of the health expenditure which is currently mainly funded by donors, and the donors are withdrawing for the government to take full financing. I am thinking of an intervention on the youths in schools, if effective to be extended to communities. The intervention is continuous screening and testing of HIV in youths, by knowing their status can empower them to take full responsibility on protection against HIV and also those diagnosed can be supported and properly managed early. A main limitation to this can be fear of stigmatization but yet creating awareness with this intervention can also help fight stigma in HIV.
i would like your ideas in how i can do a cost analysis for this intervention and its feasibility as a cost-effective study/intervention.
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The first thing you must do (if you haven't done so already) is find a recent systematic review of of the efficacy of HIV testing and counseling (HTC)  in preventing HIV and STIs in youth in sub-Saharan Africa. Ideally, the review should also assess evidence quality. If there is no quite recent review, you may need to conduct your own. After you know the relative risk of incident infection in youth receiving HTC, compared to those who don't, you will have a basis for your cost-effectiveness analysis. Without knowing this, you cannot do a cost-effectiveness analysis.
Our review (conducted in 2011 to inform WHO's 2013 adolescent HTC guidelines) found mostly very low quality, very indirect evidence that such interventions are efficacious. However, several years have passed and new, more directly-applicable research may have been done since that time.
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I am planning to do an analysis on the healthcare inequality persisting between rural and urban areas in  India.  My research topic is "Economic Burden of Healthcare cost on Rural Women - A study on Healthcare Inequality in a Human right perspective with special reference to Karnataka". It is not finalized yet.
The research is about quantifying the health needs that are unmet due to economic reasons and gender discrimination.
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Hi, I'm not pretty sure about what you really need. If you want to measure the cost of health care (or the economic/financial burden), health indicators are not exactly what you should look for.
In Poland we have a number of studies measuring the share of health spendings in home budgets. Or quantifying the health needs that are unmet due to economic reasons (i.e. the frequency of resignations of different health services due to its price). Is this the kind of study you are about to do?
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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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I am trying to fit a gamma distribution for costing data, the only information that I have are mean plus interquartile range from NHS reference costs. However, in order to fit a gamma distribution, the standard error and mean are required. Does anyone know how to use the interquartile range to estimate the gamma distribution parameters that later will be used to conduct a probabilistic sensitivity analysis for economic evaluation study
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Dear Rimal,
We also work with NHS data and therefore we have faced the same problem.When you know the mean and any two quantiles (like in NHs reference costs where 0.25 and 0.75 quartiles are reported), it is possible to estimate the parameters of the distribution (in this case, for costs, Gamma) by solving two equations. This can be done in multiple ways, for example like this:
In that pdf there is a link to a software application that can be used to estimate the parameters of different distributions given two quantiles. I think this is the kind of tools that you are looking for.
In the meantime, I have also found out how to do this directly in R. There is an example here:
I hope this helps!
Isaac
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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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Market interested in is Singapore. 
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Hi Oindrila!
Basically there could be several factors determine the choice of provider. From the socio-economic perspective, income (or monthly per capita expenditure may be used as a proxy), gender, education, social/ethnic background, age, religion, occupation, access to insurance facilities, living condition, geographic location etc. are mostly responsible for choice of provider. However, these are only demand side factors. On the supply side, there may be many factors too; like availability of (different type of) facility, cost structure across different facilities, availability of medicine etc. determine choice of provider. There are plenty of good literature in this area. I would suggest you to consult few literature for better understanding of the issue.
Thanks!    
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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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I need to explore the economics of various countries in context with health related issues. I mean the money being spent for treating/preventing any diseases/disorders. If any one came across such kind of database or websites or institutes, Please let me know.
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You could try with OECD Health at a glance. here the link.
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Can a healthcare system achieve both equity and efficiency objectives at the same time? Would you say equity and efficiency are complementary or contradictory concepts in healthcare?
Governments and policymakers often seek to provide healthcare to all citizens based on their health needs. Thus, all persons should have full and equal access to healthcare commensurate to their health needs no matter where they are or the cost. However, due to increasing cost of healthcare, there is also the need to ensure prudent and efficient use of resources. Can the equity drive co-exist with efficiency? Should one be achieved before the other. 
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This is a good question and replaying is not an easy task.
Public economics’ models teach that there is a trade-off between equity and efficiency, and for efficiency I mean allocative (Pareto) efficiency. An example could be the copayment for the health services. If there is universal coverage, Governments introduce it to avoid welfare loss  due to patients moral hazard (in the absence of a price). However, this instrument is against equity because it is viewed as a tax on the poorest or on the sickest. So its use should be avoided where the demand of services is rigid (for example chronic patients) whereas it is efficient on services for which the demand is elastic.
For what is concerning health systems as a whole, it is possible to find systems where both inequity and inefficiency are present (such as the USA model – very high per capita health expenses – and almost 48 million people without health insurance ) and models where there is a balance between efficiency and equity (such as the British NHS or the Italian SSN). In Italy for example we have low per capita expenses, universal coverage and good health outcomes, such as life expectancy.
But, of course,  if it is the Government who rules the service supply, as Buchanan suggests, the excess of demand due to moral hazard could be controlled for by controlling the supply….with possible consequences such as long waiting times.
As told before, it is difficult to answer within few lines. As someone already suggested within this blog, the aims of a good health care system should be conjugating both the objectives.
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I recently took over as divisional lead for clinical audit in my hospital. I noticed, that there seems to be - mildly spoken - a lack of enthusiasm for quality improvement and audit, with the latter really having become a tick box exercise to progress at the ARCP. I am not sure if this is generally the same throughout the NHS in England or specific to our hospital/postgraduate deanery.
I have done quite an extensive literature research on the subject and have come up with a survey regarding "Audit knowledge, attitudes and barriers".
I was wondering if anybody - particularly trainees would be interested to help me distribute this survey in different hospitals and if interested help in the analysis of the data afterwards. A similar, slightly adapted questionnaire could also be distributed amongst final year medical students.
Identifying issues is the first step to improve the situation.
Best wishes,
Immo
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I have seen the the HQIP guidance and do agree with Nancy's statement regarding attitudes towards audit being shaped by the organisation as a whole. As "organisation" I do regard the wider NHS, though. Trainees have been formed/influenced in various hospitals through their careers, the lack of enthusiasm here seems to be something that is not limited to trainees who have come from a certain hospital or postgraduate school of medicine.
I have sent a message to Lauren and Mohammed regarding the project.
Could anybody else who is interested please send me a contact email via Researchgate messenger, I shall send more information out about the project after the Easter break.
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I am currently engaged in a project to develop a Health Technopolis at the National University of Malaysia's campus in Cheras, Kuala Lumpur. I wish to learn from experiences of researchers who have developed business models for healthcare clusters or science and technology parks in the health and medical fields.
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We use health systems framework in evaluating such projects and business models. The building blocks of this framework are human resources, infrastructure, supplies and information technology. How these can be impacted or modulated by vision and concerns of key stakeholders, payment system, regulations and public policy, consumer concerns and technology. These can be linked to figure out whether we will be able to achieve the goals we have set for the system. In health sector we face many challenges - such as translating the need into demand. So for each park what kind of echo system one would like to create so that the needs are translated in demand. The IT and persuasion helps a lot in this process. Best
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We are doing a study to validate a questionnaire on dying and death in terminally ill burn patients (TBSA >80%). We have constructed a questionnaire based on previous questionnaires but on different diesases. We have taken those questions only that were statistically significant in previous studies. We have also asked a final question (global) about the quality of life to link/compare it with the questionnaire domains, that is answered on a Likert Scale. Now could someone help us out about validating this questionnaire in simple terms. Questions were just asked once after 2-3 days of admission and before death, sample size is 20.
Questionnaire consists of four domains with following number of questions:
Domain 1: 2 questions, both likert
Domain 2: 5 questions, (2 likert, 3 are Yes/No)
Domain 3: 5 questions, all Yes/No
Domain 4: 3 questions, 2 likert, 1 Yes/No
Plus one final global rating of their quality of life on likert scale in the end time.
Kindly provide inputs about what can be achieved through this data
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the sample size is too small! and the answer for each item was different, the construct validity might not be assessed.  
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I'm interested in measuring livelihood index in a community. I need a valid livelihood measurement index/methodology. Can anybody help me, please?
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Hi Makuachukwa,
FAO developed some indexes to measuring rural livelihoods. The methodologies are;
·         Household and Livelihoods Security (HLS) Approach,
·         Household Economy Approach (HEA) approach
·         Economic/financial Security Analysis Approach,
·         Social Security Analysis Approach,
·         Vulnerable Group Profiling approach
·         Integrated Food Security and living standards Analysis System.
These approaches have been extensively used to measure impacts of projects on the livelihoods of the rural poor. Please read them and see. I hope this helps
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I am interested in pursuing  research related to Behavioural Finance .  I am looking for articles related to it. Can any one suggest emerging areas related to it. 
Kindly Help.
Thank You.
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 Thank You Sir for your valuable insights.
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. Kindly suggest me good reads and free software for it ?
A free distance learning, online course will also help
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From a public health perspective, I have found this briefing paper "Economic appraisal of public health interventions" by UK NHS Health Development Agency quite interesting (Kelly et al., 2005)
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1. i want to forecast health care expenditure(HCE) for 2020 and 2030 for Asian developing countries. I am using annual data ranging form 1995-2014 n the following variables per capita HCE, GDP per capita, education, life expectancy at birth, population under 15 and above 65 years and some other variables.
2. How can i get the future values for GDP and HCE like2015,2016, 2017.....?
Appreciated if some one tell me the codes in E-Views or Grtle or SPSS
3. How can i forecast HCE and GDP ?
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Projecting the future using data from the past is a dangerous game with a question like this, because the effect of "era" has an enormous impact on something like HCE, and it is unlikely that data from 1995, 1996, 1997 have almost any relevance to the amount of HCE that will occur in 2020 and beyond (things have just changed so much).  It is certainly something that we often resort to but I have some serious concerns about the simplistic approach you seem to be taking.
One very important thing to keep in mind: many of the variables you have collected DO have an effect on HCE but it will not be immediately apparent.  The classic example of this is smoking and cancer incidence: a decrease in smoking TODAY does not mean lower cancer incidence TODAY, but most likely lower cancer incidence in 10, 15, 20 years from now.
An aging population  may have immediate effects on HCE.  But changes in education and life expectancy at birth are not likely to manifest themselves immediately.  The statistical model you create to project future HCE in 2020-2030 should account for this.
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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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I am working on my master's thesis and will be testing models that have facets of health as the outcome. Specifically, I am looking at:
  • physical health (i.e., health problems, such as hypertension, pain, vision problems),
  • functional health (i.e., how health problems impair or limit daily functioning, such as working, sleeping, seeing),
I'm thinking that these facets of health are formed by their indicators, rather than the indicators being reflective of the facet of health. But can an argument be made in favor of reflective?
Related, if I do treat these are formative, what are the implications for treating these latent variables as endogenous outcomes? I've read Diamantopoulos et al (2008) and I am not sure how, or if any recommendations for formative latent variables change if the latent variable is the outcome.
If it helps in any way, most of my indicators are categorical, but I also have a few continuous. I was planning on using robust weighted least squares as my estimator and conducting my analyses in Mplus.
Thank you in advance, and let me know if you need more details.
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Gretchen, I think we get into trouble when we try to turn "physical [or mental] health" into an outcome measure. There's no agreed-on measure for that, if we even agreed on what "that" is.
I'd try for more precise constructs like physical function, perceived health status, medical history and distinct biometric values like BP and BMI.
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Resources in the American healthcare industry are increasingly scarce. As the patient care environment demands the increasingly complex division of resources, what is the impact of implicit rationing on patient outcomes?
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John -- it's taken me a little more than a year to feel intelligent enough to engage in this discussion with you. Let's just say, lots of reading. :-)
I am currently working with an instructor who has done some research on implicit rationing by nurses in the U.S. Here, the term "implicit rationing" is almost taboo but my instructor uses the term to refer to the prioritization process that nurses undergo in the hospital setting when they are unable provide all of the care needed for the patients they are assigned. The care that is not provided is called unfinished nursing care. Another nurse scientist in the U.S. refers to the same phenomenon as missed care. In Europe, Australia, and New Zealand, the nursing researchers call it implicitly rationed nursing care.
Regardless of what it is called, and the nuance around the specific terms and conceptual models, all of the studies point to this implicit rationing of care being a symptom of time scarcity. The cause of the time scarcity may be staffing, resources, team work, work flow, or many other things. But, in the end, the nurses do not have the time to provide the care the patient needs.
This has been measured by surveying the nurses providing the care. At first, this seems to insert some source bias. But, nurses have been shown to be pretty good at judging the quality of the care in a hospital. And, the connection to outcomes (for patients, nurses, and organizations) has been established. For some, the increased risk is minuscule (increased odds ratios of 2-5%) but if you consider that this represents a 2-5% increased risk of an adverse event for every nurse that omits some form of care, for every patient, this small risk becomes clinically significant pretty quickly.
If you are interested, I've provided the reference for a recent state of the science paper on the subject. My apologies for taking so long to get back to you with something somewhat intelligible.
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Jones, Terry L., Hamilton, Patti, & Murry, Nicole. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud, 52(6), 1121-1137. doi: 10.1016/j.ijnurstu.2015.02.012
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The incidence of gall bladder cancers in females of our population is amongst the highest in the world and in male population it is highest in India. The fatality due to gall bladder cancer is very high in our population, given the fact that almost all the cases  are diagnosed in advanced stages.The high morbidity and mortality due to gall bladder cancer is having a significant impact in the efforts for cancer control in this part of the world. The hypothesis is that, if the cases of gall bladder cancers (incidental gall bladder cancers) can be detected at an early stage by a screening hepato-biliary system ultra-sonogram as part of organized population based screening program, the mortality due to gall bladder cancer can be reduced substantially to say the least. 
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When we speak about  cancer screening, it must detect the disease at very early stage in which the patient is asymptomatic. But gall bladder cancer usually present in late stage. Yes, in this part of the country,  gall bladder cancer incidence is quite high. Cancer Awareness and development of  healthy food habit may  help in reducing cancer incidence.
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We conducted a study to estimate the economic burden of ADHD in United States using the Medical Expenditure Panel Survey (national survey by Agency of Healthcare Research and Quality). Our primary objective was to estimate the incremental cost for ADHD compared to the non-ADHD population. We used a two-part model to estimate the incremental cost for ADHD. The variable total cost is the sum of direct and indirect cost categories mentioned in the table attached here. We ran separate models to estimate incremental costs for each category. However, when we add the incremental estimates of each cost category, it does not equal to the incremental estimate of the variable "total cost". We looked for literature that might explain this anomaly but could not find any explanation. Can total cost ever be lower than the sum of individual incremental cost estimates? Did anyone come across a similar situation before. Please share your thoughts on it. I have attached the results table (Title: Cost) for your reference.
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Hi Rakesh,
I have a couple  comments based on your post:
I don't think you used the appropriate model for your estimations. A two-part model starts with estimating the probability of having any costs (>0), and the second part is modeling the costs that are >0. In your data, you are comparing those with and without ADHD, and I am assuming that those in the first part are non-ADHD, and then those in the second part are ADHD? If so, this is not the intent of the two-part model. Moreover, I would argue that there is inherent bias in who has zero costs vs those with >0 costs (regardless of their disease status). In this case, the more appropriate model is a Heckman selection model, which estimates the two parts separately. Moreover, there are model checks to see if indeed the two parts follow different underlying processes.
As for the issue of total costs being lower than the sum of the variable and fixed costs: If those are adjusted costs (ie., you estimated some model and these costs are the predicted values as opposed to the actual values), then yes, I can see how those separately estimated costs may be higher than the actual total costs.
Without any adjustment, does the sum of the various costs add up to the total cost? If not, then there is a problem with the data. Also, the MEPS data is weighted. Did you use that weight in your models?
Ariel   
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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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I have recently came across a case of a patient in coma who was also pregnant. Although she was initially in a coma state, eventually she came out of it and started to move with visible volition at several levels. At this point the insurance coverage will end for her rehabilitation. I wonder in general how patients in the US cope with coma states (i.e. how the relatives do this?) and how is it in relation to other nations of the European Union or Canada where insurance coverage is different?
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Thanks!
The person that I am in contact with is really improving by the day but her insurance coverage will be cut off soon and the family will have to cover everything from that point on. Some anonymous donors have raised funds for this coverage because the case gained some interest in the Fresno area but those funds will run out very soon as the therapies are very expensive.
Thanks for your information. It is very useful. I came across insurance coverage issues before in the field of autism where parents beg for sensory-motor integration OT and PT therapies but none of it is covered. Public schools have some of it but they is very useless to the kids. Anyhow, this case is a completely different scenario (life or dead issues involved) but just as bad. I wonder how other nations cope with these problems.
thanks again for your input
very few people know about these issues as it is hard to navigate the maze of complex forms, red tape and people making decisions for your loved ones (very frustrating system in the US)
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I am working on the hospital economic burden of infectious diseases in the US. I would like to understand why the CCR is used as a proxy for estimating the hospitalization costs when the American hospital funding is based on the DRG.
Would it be wrong to use the amount fixed by the DRG ? 
Thank you for your help 
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Hi Sarah,
In the US, not all hospitals are reimbursed using DRGs. In most cases, hospitals have a variety of different contract terms, depending on the payer. For instance, private insurers may pay per-diem rates, or if the hospital is part of an accountable care organization (ACO), they may be paid as part of a larger per-patient-per-month contract. Thus, at any one time, hospitals may be paid differently for every hospitalized patient.
Yes, this is very confusing, but welcome to the US healthcare system!
I hope this helps
Ariel
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I'm seeking a research partner who has experience in mining HCRIS data to perform and analysis of certain financial aspects of Michigan hospitals.  I am familiar with MS-Access as a database tool.
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You would likely find several people interested in this at the University of Michigan (in Health Management and Policy, as well as possibly the School of Information, and the Medical school). Perhaps email me with more information and I can try to link you up.
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While there is much current interest in learning in the health care cost control literature, I have not found any references of it leading to contracts involving learning curve pricing similar to products with high front-end costs and technological uncertainty in defense contracting and electronics manufacture.
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This is mostly economy of scale stuff but same principle:
However have never come across any learning curve studies, maybe someone has dones some studies on time taken to conduct procedures for doctors in training?
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That is, how well does this new organisation presents the preferences of the people of the ground, not those of the office?
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Hi Mohammed,
Many thanks to your constructive feedback.
It is much appreciated.
Have a good day.
Panos
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Health is the fundamental right of every citizen and it's very important that the government and international organisations provide basic healthcare whenever its needed.
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Brilliant, Paul. Well said! We are in complete agreement regarding the integration of all the required elements community by community for their individual attributes and uniqueness.
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I am working on a costing paper in primary health care and would like to obtain your opinions on how sensitivity analysis is important in improving my work or other wise. and which kind of variables should be varied if any   
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I assume you know the reason for sensitivity analyses, namely to be able to specify the robustness of your results.  For a concise discussion of the basics, see:  http://en.wikipedia.org/wiki/Sensitivity_analysis    
The fact is that any of the variables in your model can be assessed in a sensitivity analysis.  Assuming that you are trying to reach a conclusion from the results of your model, the kind of question you should be asking yourself and addressing for those whom you want to benefit from what you have done is something like this: "What if our estimate of x (or y, or z) was wrong by a factor of 1.5 (or 2 or 3), how much would that have altered our conclusions?"  The more robust your results the less they will be affected if your estimates are incorrect by such factors.
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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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Hi Rahul,
a publication refering to theoretical basis and the methodology in several European countries can be found in the following address:
Yours,
Matti Pursula
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There are several sources for this data, but I am not sure if there are validations of these ratios. They also are for specific years. Do people use them across years or do they adjust for inflation, changes over time, etc?
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Mike, call me. We can discuss. The answer in short is: It depends on whether you want them for your institution or another and for what types of charges. And yes, use the medical consumer price index to adjust for inflation.
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Weald (1998 BMJ) commented on the application of the inconsistent triad economic theory to healthcare provision and stated that whilst any 2 criteria could be achieved the third was not possible. Comprehensive, high quality and free at the point of delivery... What are the prime objectives? As a clinician are your aims the same as your patients? If as a practitioner you agree that the 3 objectives are not possible, then what should be "rationed" and what are the ethical considerations in rationing?
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State funded health care has always been and will always be rationed in one way or another. Explicitly or implicitly.
Rationing is also an area where there exist no perfect solutions or formula for how to make decisions. Careful balancing of different values and a continuos openness for reconsideration in the light of new evidence and arguments. Reasonable disagreements for when to ration care will always exist. Therefore it is self-defeating and unrealistic to strive toward consensus agreements on all issues at hand when dealing with health care rationing. Instead, the most promising way forward is to be explicit about reasonable disagreements that exist.
Some of my work might be useful.
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I am developing a questionnaire to assess the QALY gain/loss attached to a (temporary, short term) procedure. We are considering TTO (both standard and waiting time trade off) but I cannot find much in the literature about how to ensure the questions posed are valid and will return useful values. It was suggested that I look in the field of experimental economics, but I have so far failed to find much of use. Please can anyone offer any advise/evidence/publications?
Thanks
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Thanks so much, I really appreciate your help. Caz
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I am planning a telephone survey similar to a PTO study. It seems that PTOs and similar trade-off questions are mostly asked using the ping-pong method, but I haven´t been able to find out why, even though I have browsed through quite a lot scientific articles. What would be the downside of not using the ping-pong method and instead asking questions directly like: “How many patients with headache need to be cured to make it equally good as curing 10 people with paraplegia?”?
By the way, does anyone know of a textbook/article or similar with practical tips on how to perform trade off interviews?
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Hej Joakim,
There is a thirty-year literature on this question, but not in health economics. Health researchers borrowed this method, called contingent valuation, from environmental economics where it was developed in the 1970s and 1980s. The so-called "ping-pong" method is called a "bidding game" in this literature. It was abandoned by environmental economists in the early 1980s when it was found to be vulnerable to strong starting-point bias. I've always been puzzled that health researchers have enshrined this approach as the standard for health-state utility studies.
The single matching question you suggest as an alternative also has poor validity. It is extremely difficult, since no real-life decision requires figuring out the point of indifference. Nearly all real choices involve just determining which of a small number of alternatives is better than the others. A simple single-bounded dichotomous-choice question with a randomized "bid" or possibly a double-bounded dichotomous choice which doubles or halves the initial bid, depending on whether the response is yes or no became standard in environmental economics. A major disadvantage is that you need a large sample size to estimate trade-off values, since you get very little statistical information from each respondent. For a recent debate on the status of CV methods in environmental economics, see Journal of Economic Perspectives, 2012; 26(4).
In your case, a methodologically superior study design would be a discrete-choice experiment, also known as conjoint analysis, in which you ask respondents to choose the preferred alternative in a series of pairs or triplets of outcome profiles. It is much easier for people to compare the relative importance or severity of a list of symptom endpoints than to compare numbers of patients. For a recent assessment of best practices in health applications of conjoint analysis, see Value in Health 2011; 14(4):403-13.
mvh,
Reed Johnson
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I need a theoretical framework for my master thesis, I will later concentrate on access and equity problems, but firstly I need to explain the causes of informal payments during the communist regime.
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I would look at economic models starting with the law of supply and demand. Look in a basic economics textbook with attention to price controls and how they affect supply and demand. It is commonly stated that the law of supply and demand does not apply to healthcare. I do not agree. I believe that you will find that "informal payments" are very simply a way for patients to bring the government fixed price closer to the natural market price for the services they desire.