ISSN:1057-9230    

DOI:10.1002/hec.4730020302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThe assessment of economic and quality‐of‐life outcomes of health care interventions is moving into a new era, with such assessments increasingly being made within the context of controlled clinical trials. Traditionally the measurement of many variables in economic evaluations, particularly costs, has been deterministic. In the context of clinical trials the measurement of variables is stochastic, with the standard principles of statistical inference being applied to analyse differences between treatments in terms of effectiveness. Economists participating in clinical research are therefore being called upon to specify the sample size for the economic component of the evaluation and to undertake statistical tests for differences in cost or cost‐effectiveness. This paper discusses the current methodological issues surrounding stochastic measurement in clinical trials, discusses the additional issues raised by the assessment of economic and quality‐of‐life outcomes and specifies the challenges facing economists if they are to answer the questions now being posed about economic analysis by statisticians and clinical researchers. It is concluded that application of the standard principles of statistical inference to economic data is not straightforward and will require value judgements to be made about statistical significance and economic importance, which may differ from those already made in purely clinica

ISSN:1057-9230    

DOI:10.1002/hec.4730020303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730020304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractRecently, Ware and Sherbourne1published a new short‐form health survey, the MOS 36‐Item Short‐Form Health Survey (SF‐36), consisting of 36 items included in long‐form measures developed for the Medical Outcomes Study. The SF‐36 taps eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, general mental health, social functioning, energy/fatigue, and general health perceptions. It also includes a single item that provides an indication of perceived change in health. The SF‐36 items and scoring rules are distributed by MOS Trust, Inc. Strict adherence to item wording and scoring recommendations is required in order to use the SF‐36 trademark. The RAND 36‐Item Health Survey 1.0 (distributed by RAND) includes the same items as those in the SF‐36, but the recommended scoring algorithm is somewhat different from that of the SF‐36. Scoring differences are discussed here and new T‐scores are presented for the 8 multi‐item scales and two factor analytically‐derived physical and men

ISSN:1057-9230    

DOI:10.1002/hec.4730020305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractIn the paper, a test of convergent validity is undertaken for two methods of quality of life assessment, one based on a shortened version of the Health Measurement Questionnaire and the other based on professional clinical judgement. The Nottingham Health Profile is used as the comparator, and the data derive from a sample of colorectal cancer patients. Criteria for convergent validity are established and both methods yield outcomes broadly consistent with such criteria.

ISSN:1057-9230    

DOI:10.1002/hec.4730020306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractProblem: Non‐response and non‐usable response were found in population surveys on valuation of health states. If non‐response is selective regarding valuations, then generalization of the resulting values to the whole survey population is not permitted. This could limit the use of empirical utility values in resource allocation in health care.Methods: Response behaviour of a sample of 1400 from the Dutch general population to the mailed EuroQolc‐questionnaire was analyzed by four methods. I. Phoning resolute non‐respondents; II. comparison of zip code characteristics of respondents and non‐respondents (because individual data on background characteristics were not available for the non‐respondents); III. analysis of response over time (wave‐analysis); IV: comparison of background variables of successful (less than two valuations missing) and unsuccessful respondents, combined with analysis of the effect of these background variables on valuations.Results: No indications for selective non‐response were found, although the phenomenon appeared hard to investigate. The successful response came from a slightly younger and better educated subsample. However, a general influence of age and educational level on valuations could not be shown. This finding is consistent with the literature.Conclusion: Although the existence of selective non‐response cannot be excluded, its relevance can be considered to be small. This finding is encouraging for the use of empirical utility values in a

ISSN:1057-9230    

DOI:10.1002/hec.4730020307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractSuccessive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost. The paper presents the results of a cost function analysis of a random stratified sample of staffed community facilities in England excluding London.Both costs and quality of care were found to vary greatly amongst community residential facilities. The most important factors explaining differences in cost were case‐mix factors relating to client age, dependency and length of stay. Facility characteristics such as the type of building, the internal layout and the structural quality were not significant. Quality of service measures such as the extent to which care‐regimes were client orientated and made use of local community services were positively and significantly associated with costs. Type of provider had no impact on costs independent of differences in case‐mix and quality of care with the exception of the private for profit sector which appeared less expensive than other agencies.The shortcomings of the methods and implications of these findings for policy makers are disc

ISSN:1057-9230    

DOI:10.1002/hec.4730020308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to elicit the implied discount rates to be used in economic evaluations of health care programmes. The paper presents results from two Norwegian surveys in which a random sample of the population and a sample of health planners were asked to prioritise between alternative health care programmes, and make trade‐offs between future health gains and more immediate gains. The questionnaire had four hypothetical choice situations; two for life saving and two for health improvemen

ISSN:1057-9230    

DOI:10.1002/hec.4730020309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractInterventive action aimed at reducing the incidence of an irreversible chronic noncommunicable disease in a population has various effects. Hopefully, it increases total longevity in the population and it causes the disease to develop later in time in a smaller portion of the population. In this paper a statistical model is built by which these effects can be estimated. A three dimensional probability density function that underlies this model is changed by the interventive action. It is shown how a three dimensional utility function can be defined to appropriately judge this change.

ISSN:1057-9230    

DOI:10.1002/hec.4730020310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractIn the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax‐exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with aquid pro quohypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON license

ISSN:1057-9230    

DOI:10.1002/hec.4730020311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY