EuHEA 2020 Seminar Series

The EuHEA seminar series brings together health economists all across its member associations, and beyond, to discuss cutting-edge research

EuHEA 2020 Seminar Series

In fall 2020, EuHEA will launch a new web-based seminar series. Due to the cancellation of the in-person conference in Oslo earlier this year, the chairmen of Oslo’s scientific committee, Oddvar Kaarboe and Pedro Pita Barros, kindly agreed to organize a weekly online seminar, with the support of the countries’ representatives, inviting selected presenters who submitted their papers to the original conference. We are happy to announce that the program of the seminar has now been finalized, see details below.

The Seminar Series won't be recorded.

In order to participate in the seminar, we kindly ask you to register here.

 

Upcoming event

29 October 2020, 14.00-15.00 (CET)

License to kill? The impact of hospital strikes

Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent. This paper analyses the effect of different health professionals' strikes (physicians, nurses and diagnostic and therapeutic technicians - DTT) on patients' outcomes and hospital activity. Patient-level data, comprising all NHS hospital admissions in mainland Portugal from 2012 to 2018, is used together with a comprehensive strike dataset with almost 130 protests. Pooled OLS is employed to study the impact of strikes on health outcomes. A Hazard model is also used to analyze changes in patients' length of stay. Data suggests that hospital operations are partially disrupted during strikes, with sharp reductions in surgical admissions (up to 54%) and a decline on both inpatient and outpatient care admissions. Controlling for hospital characteristics, time and regional patterns, and differences in patients' composition, results suggest a 6% increase in hospital mortality for patients exposed to physicians' strikes. Urgent readmissions increase for patients exposed to nurses or DTTs' strikes. Results suggest that legal minimum staffing levels defined during strikes, particularly during physicians' strikes, fail to prevent declines in the quality of care provided.

Eduardo Costa, Nova School of Business and Economics

Chair: Sverre Kittelsen
Discussant: Adam Martin

Program

17 September 2020, 14.00-15.00 (CET)

Competition, reputation and feedback in health care markets: Experimental evidence

Thomas Rittmannsberger, University of Innsbruck

24 September 2020, 14.00-15.00 (CET)

Reductions in out-of-pocket costs and moral hazard delays in health care

Naimi Johansson, University of Gothenburg

1 October 2020, 14.00-15.00 (CET)

Maternal Depression and Child Human Capital: A Genetic Instrumental Variables Approach

We here address the causal relationship between maternal depression and child human capital using UK cohort data. To do so, we exploit the conditionally-exogenous variation in mothers’ genomes in an instrumental-variable approach, and describe the conditions under which mother’s genetic variants can be used as valid instruments. We show that an additional episode of maternal depression between the child’s birth up to age nine reduces both their cognitive and non-cognitive skills by 20 to 25% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and genetic inheritance.

Giorgia Menta, University of Luxembourg

Chair: Assoc. Prof. Knut Reidar Wangen
Discussant: Dr. Christoph Kurz

8 October 2020, 14.00-15.00 (CET)

Labour Productivity and Skill Mix in Maternity Services: Evidence from the English NHS

This paper analyses the role of medical and non-medical staff in the production of maternity services in the English NHS. Using hospital panel data (2004-2012) and estimating flexible production functions using system GMM estimators, we explore the output contribution of maternity services labour inputs. The results suggest that consultants and doctors have the highest marginal productivities while the productivity of support workers is insignificantly different from zero. Moreover, there is evidence for some degree of complementarity between midwives, support workers and consultants. Moreover, midwives could replace doctors and doctors could replace consultants in the production of maternity services.

Graham Cookson, University of Surrey

Chair: Jonas Minet Kinge
Discussant: Mika Kortelainen

15 October 2020, 14.00-15.00 (CET)

Incentivising Hospital Quality through Evidence-based Care Bundle Payment

Policymakers aim at improving quality of care and the efficiency of health systems.  One increasingly popular policy lever is the use of Pay for Performance (P4P) schemes that incentivise the adoption of best practice by financially rewarding process and outcome measures of quality in primary and secondary care. Despite their popularity, the evidence about their effectiveness remains inconclusive with several studies on hospitals suggesting small or mixed improvements in quality, possibly due to the small size of the bonuses or the design of the schemes. This study analyses the effects of a national P4P scheme in the English NHS that incentivises hospitals to achieve best practice in the delivery of hip fracture care. 

The Best Practice Tariff (BPT) for hip fracture, introduced in England in 2010, rewards providers based on a care bundle that consists of nine process measures that need to be jointly achieved. The payment for the care bundle therefore implies that the provider receives the financial bonus only if each of the nine measures are met. The development of these measures was clinically driven, formed by consensus with clinicians, informed by evidence and based on the comprehensive National Hip Fracture Database (NHFD). The nine measures include time to surgery within 36 hours, four measures of involvement of orthogeriatricians, the use of a multidisciplinary rehabilitation team, and provision of preventive activities (bone health assessment, falls prevention). In addition to the scheme being evidence-based, the size of the bonus was significant, up to 20% of the baseline tariff. Using patient level data between 2008-2014 on a sample of 275,898 patients with a rich set of covariates, we employ a difference-in-difference (DiD) strategy, with Wales as a control group, to identify the causal effect of this policy.

The policy was successful in increasing the proportion of patients for whom all of the criteria are met by 52 percentage points. However, we find large heterogeneity across different performance measures. The largest improvement is in the measures requiring involvement of geriatricians in the care of patients (between 20 and 65 percentage points). The effect is much smaller in areas in which the achievement was already high in both countries before the introduction of the policy, such as falls prevention and cognitive assessment. Our results further suggest that providers in England focus on achieving all of the criteria, while the number of achieved conditions shows a more uniform distribution in Wales. Overall, we find that a scheme based on care bundle, which is evidence based, and used a sizable bonus can be effective in improving hospital performance. 

Katja Grasic, University of York

Chair: Tor Iversen
Discussant: Anne Sophie Oxholm

22 October 2020, 14.00-15.00 (CET)

The Interaction between Industry Payments to Physicians, Insurance and Drug Costs: Evidence from Medicare Part D

High and growing prescription drug costs in the United States are a major concern for policy makers. This paper focuses on the extent to which promotional gifts and other transfers made to physicians by pharmaceutical companies causes physicians to prescribe more expensive medicines. In our analysis, we link data from a federal database on the universe of industry payments between 2014 and 2017 to prescribing behavior in Medicare Part D. We develop a novel empirical strategy that uses data on the prescription behavior of physicians in Vermont, where a strict ban on industry payments to physicians is in place, combined with machine learning techniques to construct the counterfactual outcome for physicians who receive payments in the nearby states of New Hampshire and Maine. We find that a gift ban, such as the one implemented in Vermont in 2009, has the potential to result in a 3% decline in the total cost to treat diabetes. We investigate heterogeneity in the treatment effect and find that physicians who have a high share of patients with a low-income subsidy, and thus lower out-of-pocket expenditures, prescribe relatively more brand drugs and expensive drugs in response to industry payments. Our findings illustrate how industry payments interact with insurance to drive up health care costs.

Melissa Newham, KU Leuven University

Chair: Assoc. Prof. Emliy Burger
Discussant: Prof. Paolo Pertile

29 October 2020, 14.00-15.00 (CET)

License to kill? The impact of hospital strikes

Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent. This paper analyses the effect of different health professionals' strikes (physicians, nurses and diagnostic and therapeutic technicians - DTT) on patients' outcomes and hospital activity. Patient-level data, comprising all NHS hospital admissions in mainland Portugal from 2012 to 2018, is used together with a comprehensive strike dataset with almost 130 protests. Pooled OLS is employed to study the impact of strikes on health outcomes. A Hazard model is also used to analyze changes in patients' length of stay. Data suggests that hospital operations are partially disrupted during strikes, with sharp reductions in surgical admissions (up to 54%) and a decline on both inpatient and outpatient care admissions. Controlling for hospital characteristics, time and regional patterns, and differences in patients' composition, results suggest a 6% increase in hospital mortality for patients exposed to physicians' strikes. Urgent readmissions increase for patients exposed to nurses or DTTs' strikes. Results suggest that legal minimum staffing levels defined during strikes, particularly during physicians' strikes, fail to prevent declines in the quality of care provided.

Eduardo Costa, Nova School of Business and Economics

Chair: Sverre Kittelsen
Discussant: Adam Martin

5 November 2020, 14.00-15.00 (CET)

Exploring the causal relationship between obesity and healthcare costs

Gudrun Bjørnelv, Norwegian University of Science and Technology

12 November 2020, 14.00-15.00 (CET)

Defining worse-than-death health states: an unavoidable necessity for the QALY approach?

Afschin Gandjour, Frankfurt School of Finance & Management

19 November 2020, 14.00-15.00 (CET)

Public Health Insurance and Financial Security: Evidence from the ACA Expansion

Cortnie Shupe, University of Copenhagen

26 November 2020, 14.00-15.00 (CET)

Public preferences for allocation of health care: Disentangling inequity aversion and risk aversion

Lise Desireé Hansen, The Danish Centre for Health Economics

3 December 2020, 14.00-15.00 (CET)

Provider responses to discontinuous tariff schedules: evidence from Dutch rehabilitation care

Katalin Gaspar, Talma Institute - VU University

10 December 2020, time tba

Predicting high-cost users among people with cardiovascular disease using machine learning

Nhung Nghiem, University of Otago

17 December 2020, 14.00-15.00 (CET)

Same patients, same care? Insights into the health care provision of high-need, high-cost patients from OECD countries

Kosta Shatrov, University of Bern