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Mossialos E.,LSE Health | Lear J.,LSE Health
Health Policy | Year: 2012

EU Health policy exemplifies the philosophical tension between EC economic freedoms and social policy. EC competition law, like other internal market rules, could restrict national health policy options despite the subsidiarity principle. In particular, European health system reforms that incorporate elements of market competition may trigger the application of competition rules if non-economic gains in consumer welfare are not adequately accounted for. This article defines the policy and legal parameters of the debate between competition law and health policy. Using a sample of cases it analyses how the ECJ, national courts, and National Competition Authorities have applied competition laws to the health services sector in different circumstances and in different ways. It concludes by considering the implications of the convergence of recent trends in competition law enforcement and health system market reforms. © 2012 Elsevier Ireland Ltd.


Traditional medicine is known to be popular in sub-Saharan Africa, where over 80% have reported its utilization. It is claimed to be easily accessible, affordable, available and acceptable, but little is known about at which stage of treatment-seeking individuals turn to traditional medicines and the resulting satisfaction once used. This is due to a paucity of quantitative demand data on how many recourses of care people take for one episode of illness, whether individuals use traditional medicines as a secondary option to orthodox medicines, and if used, how satisfied they are with results. This study presents descriptive data from fieldwork carried out on 772 households in two regions of Ghana to ascertain actions taken for self-reported episodes of acute and previously diagnosed chronic diseases. Quantitative results that show by looking merely at first recourse, use of traditional medicines is fairly low, but once second recourses are accounted for there is a doubling and tripling of incidence of traditional medicine use for acute and chronic diseases, respectively. A commonly used patient-reported outcome measurement, the EuroQol 5 Dimension (EQ5D), is used to measure satisfaction before and after traditional medicine use, to reveal significantly positive changes. The study shows that whilst individuals are highly satisfied with traditional medicine, it is more often the second recourse of treatment with a revealed preference for orthodox medicines as a first recourse. This suggests that research is needed to investigate why individuals turn to traditional medicine only as a second recourse and to clarify the insufficiencies of orthodox treatment. Policies which guide individuals to take the most efficient recourses for given symptoms, and further exploration of key reasons behind high levels of satisfaction following utilization, are encouraged. © 2012 The Author.


Schurer W.,LSE Health
European Journal of Health Economics | Year: 2010

This paper discusses the current care management arrangements for colorectal cancer (CRC) in 16 OECD countries plus the Russian Federation by analysing data sources, the uptake of screening and surveillance, the available capacity in endoscopy services, the treatment pathways in medical treatment, as well as the type and availability of pharmaceutical care. The paper highlights significant variations in practice across the 17 countries. Common themes emerge from each of these practices and standards in terms of political interest in policies and awareness of CRC (both of which need to be enhanced), affordability (in terms of scarcity of resources in some countries and out-of-pocket payments for parts of the overall treatment process), access (in terms of the significant variation that has been observed within and across countries with regard to diagnostics, treatment and certain pharmaceuticals) and quality of CRC services (which may arise due to variations in treatment and pharmaceutical guidelines as well as minimal monitoring). When considering policy options for the future, it is important to, first, improve data collection both within as well as across countries through international co-operation; second, it is critical to have greater national and international support for cancer screening activities proven to be effective and cost-effective; third, endoscopy capacity in individual countries needs to be improved, also allowing more choice to ensure timely diagnosis, regardless of screening activities; fourth, public and political awareness needs to be enhanced as it is the key to improving CRC outcomes; fifth, where appropriate, to give consideration to the principles of equity, human dignity and disease severity, among others, when deciding on the uptake of new (targeted) treatments, rather than base decisions solely on cost-effectiveness criteria; and sixth, to firm up national guidelines including screening, diagnosis, treatment, pharmaceutical treatments and surveillance, with a view to enhancing their timeliness, evidence-base and free access to all. © 2009 Springer-Verlag.


Kanavos P.,The London School of Economics and Political Science | Ferrario A.,LSE Health | Vandoros S.,LSE Health | Anderson G.F.,University of Baltimore
Health Affairs | Year: 2013

The United States spends considerably more per capita on prescription drugs than other countries in the Organization for Economic Cooperation and Development (OECD). Drawing on the Intercontinental Medical Statistics Midas database, we examined the variation in drug prices among selected OECD countries in 2005, 2007, and 2010 to determine which country paid the highest prices for brandname drugs, what factors led to variation in per capita drug spending, and what factors contributed to the rate of increase in drug spending. We found that depending on how prices were weighted for volume across the countries, brand-name prescription drug prices were 5-198 percent higher in the United States than in the other countries in all three study years. (A limitation is that many negotiated price discounts obtained in the United States may not be fully reflected in the results of this study.) A contributor to higher US per capita drug spending is faster uptake of new and more expensive prescription drugs in the United States relative to other countries. In contrast, the other OECD countries employed mechanisms such as health technology assessment and restrictions on patients' eligibility for new prescription drugs, and they required strict evidence of the value of new drugs. Similarly, US health care decision makers could consider requiring pharmaceutical manufacturers to provide more evidence about the value of new drugs in relation to the cost and negotiating prices accordingly. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.


Schurer W.,LSE Health
European Journal of Health Economics | Year: 2010

Cancer is now the primary cause of death in the Netherlands, with colorectal cancer (CRC) being responsible for a significant portion of cancer incidence (14%) and mortality (11.8%) in men and women. An aging population and the possibility of national CRC screening, currently under discussion, will likely increase this burden. Despite switching in 2006 to obligatory subsidized private health insurance, health expenditure continues to rise, along with increased cancer and drug expenditures. Despite rising drug expenditures, new targeted biological treatments are available under centrally subsidized provisions. CRC treatment guidelines are available, published online, regularly updated, and monitored for quality purposes. There are concerns regarding waiting times for diagnosis and treatment, as well as projected staff shortages; however, various plans are in place to combat these issues. Overall, it appears that the Netherlands is aware of the oncology issues affecting CRC management, and is contemplating the optimal course of action for the future. © 2009 Springer-Verlag.


Masseria C.,LSE Health
European Journal of Health Economics | Year: 2010

Colorectal cancer (CRC) is one of the most prevalent and deadly cancers in Italy. Its burden is expected to remain significant in the coming years, although it is mostly a preventable disease. Prevention and screening programmes will play an important role in the fight against CRC. A national formal screening programme was introduced in the 2003-2005 and 2005-2007 national health programmes, leaving the planning and implementation, respectively, to each region and local health unit. In 2007, screening programmes covered 46.6% of the eligible population, with a higher coverage in the North (71.6%) and in the Centre (52.1%) than in the South (7%). The majority of programmes used the guaiac faecal occult blood test (FOBT) as first-line test. Only few programmes used the flexible sigmoidoscopy, or a combination of both tests. The quality and efficacy of the screening programmes are evaluated using ad hoc indicators with acceptable and desirable targets. In Italy, there are formal guidelines for population-based and opportunistic screening, diagnosis, surgery, adjuvant and neoadjuvant treatments and surveillance, differentiating colon cancer from rectal cancer and advanced CRC. Guidelines are updated yearly. Overall, Italy is well positioned in the fight against CRC. Although many regions lag behind in the uptake of screening programmes, they are in the process of introducing them. © 2009 Springer-Verlag.


Masseria C.,LSE Health | Giannoni M.,University of Perugia
European Journal of Public Health | Year: 2010

Background: Equitable access to health care is a core objective of the Italian health care system. Despite having achieved universal coverage for a fairly comprehensive set of health services for decades, there is still evidence of inequities systematically associated with income. Method: Income-related inequity indices were estimated for the probability of general practitioner (GP), specialist, inpatient care and also emergency care using a variety of need indicators. The data used were the Multiscopo survey, 2000 matched with the European Community Household Panel survey for Italy. The contribution of regional inequality was also estimated. Horizontal inequity indices for health care utilization measures were computed separately for people reporting hypertension, arthritis, tumour and heart disease. Results: Significant pro-rich income related inequity was found for GP, specialist and emergency care, no inequity was found for inpatient care. The disease approach showed statistically significant inequity in the probability of specialist care in three of the four chronic conditions analysed, and pro-poor inequity in GP care for all conditions. Inequity was mainly caused by income and regional variations. Conclusions: By reducing regional variation it would be possible to significantly reduce the pro-rich inequity in GP, specialist and emergency care. For specialist care inequity was found for the overall adult population and also among people with serious chronic conditions, and was caused not only by income and regional variation, but also by educational attainment and insurance. © The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


Percutaneous pulmonary valve implantation (PPVI) using the Melody * transcatheter pulmonary valve is a new procedure introduced in 2000 as a less invasive treatment for right ventricular outflow tract (RVOT) dysfunction. The aim of this new procedure is to restore pulmonary valve competence without the need of open-chest operation. By prolonging the conduit lifespan, it delays surgical pulmonary valve replacement (PVR) and it can therefore potentially reduce the number of open-chest interventions over a patient's lifetime. PPVI has been shown to be feasible and safe and can be performed with a low complication rate. The aim of this study is to assess the cost of PPVI and the cost of surgical pulmonary valve replacement (PVR) in patients with right ventricular outflow tract dysfunction using a cohort simulation model applied to the UK population. The model resulted in an estimate of mean cost per patient of £5,791 when PPVI is unavailable as a treatment option and in an estimate of mean cost per patient of £8,734 when PPVI is available over the 25-year period of analysis. After sensitivity analysis was undertaken the results showed that the mean per patient cost difference in implementing PPVI over 25 years as compared to surgical PVR lies somewhere between £2,041 and £3,913. Given the lack of long-term data on treatment progression, the cost estimates derived here are subject to considerable uncertainty, and extensive sensitivity analysis has been used to counter this. Consequently this study is merely indicative of the levels of cost which can be expected in a cohort of 1,000 patients faced with a choice of treatment with PPVI or surgery. It is not a cost-effectiveness study but it helps place current knowledge on short-term benefits into context. As this analysis shows PPVI is associated with a relatively small increase in treatment management costs over a long time period. It is left entirely to the reader to value whether this inferred increase in long-term cost is worthwhile given the known short-term benefits and any personal judgement formed over long-term benefit.


Costa-Font J.,The London School of Economics and Political Science | Jofre-Bonet M.,City University London | Jofre-Bonet M.,LSE Health
Economica | Year: 2013

Excessive preoccupation with self-image (or identity) is regarded as a factor contributing to the proliferation of food disorders, especially among young women. This paper models how self-image and peer effects influence health-related behaviours, specifically food disorders. We empirically test our claims using data from the Eurobarometer Survey. Our findings suggest that the larger peers' body mass, the lower the likelihood of being anorexic. Self-image is correlated with body weight. We use several definitions of peers' body mass, and find that all are negatively associated with the likelihood of women being thin or extremely thin. © 2013 The London School of Economics and Political Science.


Sorenson C.,LSE Health | Chalkidou K.,Johns Hopkins University
Health Economics, Policy and Law | Year: 2012

Health technology assessment (HTA) has assumed an increasing role in health systems in recent years, with many countries establishing agencies or programmes to evaluate health technology and other interventions to inform policy decisions and clinical practice. This paper reflects upon its development and evolution in Europe over the last decade, with a focus on England, France, Germany and Sweden. In particular, we explore how HTA has evolved over time as well as its impact on policy and practice. While countries share many of the same objectives, there are differences in the way HTA agencies and programmes are organised, operate, and influence decision making. Despite these differences, all systems are faced with opportunities and challenges related to stakeholder involvement and acceptance, the suitability and transparency of assessment requirements and methods, balancing evidence and values in decision making, and demonstrating impact. Copyright © 2012 Cambridge University Press.

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