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Chris Sampson’s journal round-up for 19th October 2020

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. If you’d like to write one of our weekly journal round-ups, get in touch.

Applied Health Economics and Health Policy

Volume 18, Issue 5

The latest issue of AHEHP leads with an editorial on the inclusion of environmental impacts in health technology assessments. Given the scale and impact of the health care industry, it should go without saying that HTA policy has relevance to the climate emergency. The author outlines the barriers to accounting for environmental consequences in economic evaluations in health care. Rather than identifying practical barriers, most of the challenges correspond to a general lack of alignment between health care and environmental priority-setting. And, as is the case for the consideration of any non-health consequences (and why I remain a societal perspective sceptic), selective inclusion of environmental consequences could lead to faulty decision-making. The solution is, inevitably, cross-disciplinary collaboration.

Another opinion piece in this issue is concerned with mental health investments in the US. The authors argue that technology assessments and appraisals need to consider the extent to which interventions for mental health and substance use impact on poverty and disability and, by extension, eligibility for publicly-funded health care.

Most of the research studies in this issue are either systematic reviews or applied cost-effectiveness analyses.

A systematic review of hospital prices and quality finds a mixed bag of results, as does a review of reviews on monetary incentives for physicians. A review of HPV prevention strategies in low- and middle-income countries provides insights into the characteristics of cost-effective programmes; for example, vaccination alone is likely to need a high rate of coverage. There is also a review study on health promoting schools.

As for applied cost-effectiveness analyses, there is research on lifestyle interventions to prevent diabetes, exercise interventions for prostate cancer, treatments for melanoma brain metastases, and payment models in gene therapies for congestive heart failure.

The issue also includes a study estimating unit costs in India, a DCE on weight loss treatment, and a comment on a recent article about Italy’s lessons from COVID-19.

Journal of Public Economics

Volume 190

A few papers of interest to health economists appeared in the latest JPE.

A difference-in-difference analysis uses regional and temporal variation in the US to model the effect of earned income tax credits on children’s health outcomes. Unsurprisingly, a financial boost for low-income families, especially single-parent households, gives kids a health boost. By the time they’re young adults, they are more likely to report being in very good health and 4% less likely to be obese between the ages of 22 and 27.

The organisation of health care creates a complex set of incentives for physicians, and some of those incentives relate to doctors’ pro-social tendencies. A study in this issue looks at non-linearity in needs assessments for long-term care. Spanish doctors play the system to help claimants access greater benefits, as demonstrated by a kinky non-linearity; fewer people are rated just below thresholds than just above. This serves to increase costs and so the authors outline the benefits of a linear scoring system or one with a greater number of thresholds, which would make the system fairer.

There are also some not-so-health-related articles about COVID-19, on topics such as the US’s Paycheck Protection Program, child maltreatment reporting, and the macroeconomic impacts of lockdown.

American Economic Journal: Applied Economics

Volume 12, Issue 4

The latest AEJ:AE also has a few articles for us.

As do so many other studies, one paper uses a difference-in-differences analysis to examine the impact of insurance expansions since the introduction of the Affordable Care Act. This study is different because it focuses on the impact on people who were already insured. The authors find no evidence that expansions had negative spillovers in terms of health care access or use by Medicare beneficiaries. Apparently, this has been a popular view among those opposed to the ACA.

Another study looks at demand responses to complex health care pricing in the US. The research adds evidence to inform the feasibility of supporting patients in shopping around. The findings show that people do respond to prices when they are predictable and clearly defined.

In the great AER tradition of publishing articles with uninformative titles, there is a study on ‘the elasticity of science‘. It certainly doesn’t deserve its discipline-defining title, but it’s easy to see why it has gained more attention than any of the other articles mentioned in this round-up. The elasticity in question is researchers’ willingness to change the direction of their work to secure grant funding. The analysis relies on an algorithm that identifies scientific similarity between abstracts. Using data on health research funding in the US, the author shows that scientists don’t easily switch their focus; science is inelastic (or scientists are inflexible). However, it seems that more productive scientists ensure that the extra costs needed to incentivise shifts are offset. This has implications for the allocation of funds to either investigator-initiated grants or requests for applications on specific topics.


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