Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.
Volume 15, Issue 3
The articles that I’ll highlight from the latest issue of HEPL have come in pairs, on the topics of competition, public involvement in health policy, and international differences in HTA.
Relating to competition in health care, we have one study from the UK and one from the Netherlands.
A study of the NHS in the UK is mostly concerned with the ‘L‘ of HEPL. It explores the trajectory of regulatory decision-making between 2015 and 2018, since the publication of the Five Year Forward View. In general, policy has downplayed the role of competition. This is in contrast to legislative changes over the past 30 years, such as the controversial Health and Social Care Act. The study is somewhat hampered by a lack of transparency. Nevertheless, by assessing decisions about mergers and acquisitions and about commissioning disputes, the authors identify that decision-making has become more sector-specific. Health care can’t be treated like any other market. The paper discusses appropriate lawmaking and the remit of the courts in this context.
The study of the Dutch health care system takes us back to more comfortable empirical ground (more comfortable for me, at least). The researchers observed a high level of variability in the prices that hospitals pay for products, both between different hospitals and between different insurers within hospitals. This is in the context of managed competition, where prices are usually private, but the authors were able to use data made public by one large insurer and one medium-sized hospital. The authors offer a variety of possible explanations for the variation in prices and suggest policies that might reduce it.
Two studies look at the role of public involvement in the formulation of health policy.
First up is a study based on a telephone survey relating to the Swedish health system, which revealed a low level of public involvement. What’s more, the most common methods of involvement were quite passive involvement by patients, based on individual actions, such as responding to a patient survey (36%) or signing petitions (28%). Participants estimated the impact of their involvement as being quite low. The authors suggest that there might be a need for greater support for collective involvement initiatives, which are perceived to have a more substantial impact on policy.
A study on service reconfiguration in the UK reports on findings from a series of interviews with various stakeholders alongside analysis of documents, focussing on two case studies from each devolved country in the UK. Several differences are identified between the countries, relating mostly to their overall appetite for change and reorganisation. For instance, participants from Northern Ireland expressed frustration with consultations and little change, while England sees repeated redisorganisations with little involvement from central government. You can read more about this paper in a blog post by the authors.
Finally, there are two articles on comparing HTA in different countries. Both attempt to identify some theoretical basis for observed differences.
One study compares HTA decisions in England and Germany, focusing on the idea of policy paradigms and the need for paradigm shifts where core values are challenged, such as in the case of highly ‘cost-effective’ but unaffordable new medicines. The other study sets out to develop a more comprehensive conceptual framework to explain differences. The authors present an empirical framework based on the characteristics of a particular assessment and the wider organisational context. Both qualitative and quantitative evidence is used to reveal the influence of different factors in England, Scotland, France, and Sweden, with differences in deliberative processes seemingly being an important determinant of discrepancies.
Volume 10, June 2020
Five articles were published in June, and I’m happy to report that the quality of the writing is not nearly as bad as those that I reviewed in May.
Two economic evaluations were published. Most interesting to me is one of a digital CBT intervention for depression. The study reports on a randomised trial, for which the primary outcome was health insurance costs. 3,805 people were randomised and the researchers had access to the necessary administrative data for one year either side of the 12-week programme. Costs decreased by 32% in the intervention group, compared with 13% in the control group. The other economic evaluation is a model-based study of a screening tool for atrial fibrillation, which found that the intervention dominates the alternative of not screening in Germany.
Last month also saw the publication of a study on the drivers of expenditure in the English NHS. The authors used routinely collected expenditure data for hospital-based care, diagnostics and therapeutics, and community care, for 2008-2017. Expenditure has increased pretty much across the board, as you might expect. Most of the increase in expenditure is driven by an increase in activity, but the researchers are able to identify some other drivers, such as high-cost drugs. Trends in the various categories of care are summarised, which allows for the identification of some potential substitutions over time. For example, reduced expenditure on inpatient elective care and increased expenditure on day cases may reflect incentives for same-day discharge.
Health Economics Review published some quality studies last month, which were very readable. Let’s hope that the poor editing seen in recent years is becoming a thing of the past.