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Abstract Background Medical education is critical and the first step to foster the competence of a physician. Unlike developed countries, China has been adopting a system of multi-tiered medical education to training physicians, which is featured by the provision of an alternative lower level of medical practitioners, or known as a feldsher system since the 1950s. This study aimed to illustrate the impact of multi-tiered medical education on both the equity in the delivery of health care services and the efficiency of the health care market. Methods Based on both theoretical reasoning and empirical analysis, this paper documented evidence upon those impacts of the medical education system. Results First, the geographic distribution of physicians in China is not uniform across physicians with different educational training. Second, we also find the evidence that high-educated doctors are more likely to be hired by larger hospitals, which in turn add the fuel to foster the hospital-center health care system in China as patients choose large hospitals to chase good doctors. Third, through the channels of adverse selection and moral hazard, the heterogeneity in medical education also imposes costs to the health care market in China. Discussion Overall, the three-tiered medical education system in China is a standard policy trade-off between quantity and quality in training health care professionals. On the one hand, China gains the benefit of increasing the supply of health care professionals at lower costs. On the other hand, China pays the price for keeping a multi-tiered medical education in terms of increasing inequality and efficiency loss in the health care sector. Finally, we discuss the potential policy options for China to mitigate the negative impact of keeping a multi-tiered medical education on the performance of health care market.

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

The three types of policies which countries have developed against smoking include increasing the excise taxes on cigarettes, imposing smoking regulations in public places or private work areas and providing public information and education on the hazards of smoking. A measure of health knowledge of smoking hazards is used to analyze the determinants of health knowledge and how it affects smoking behavior. Anti-smoking campaigns were found to have a major positive effect on public health knowledge and a negative effect on smoking participation.

This article uses survey data obtained from Taiwan to investigate consumer perceptions of smoking risks and the linkage of these perceptions to smoking behavior. In our analysis. two equations are estimated: (1) risk perception, and (2) smoking probability. The simultaneity problem in estimating risk perception and smoking probability is also considered. Overall, the results indicate that the risk perceptions of cigarette smoking are substantially overestimated and that these risk perceptions in tum, have a significantly negative effect on smoking probability. Also, the results suggest that the determinants of risk perception are consistent with the predictions of a Bayesian learning framework. [ABSTRACT FROM AUTHOR]

Promoting competition between brand-name and generic drugs has long been recognized as an approach adopted to save on health care costs. However, there are substantial variations in the extent of the generic competition across countries. This study empirically estimates the determinants of the generic market share in Taiwan, wheremedical providers are in a position to profit directly fromthe sale of prescription drugs. Our empirical results point out that the profit-seeking behavior ofmedical providers plays an important and dominant role behind generic competition in the pharmaceutical market. As a result, there is a positive association between the generic-to-brand price ratio and the generic market share in Taiwan's pharmaceutical market, which contrasts with the conventional empirical finding that the relationship between the generic-to-brand price ratio and generic market share is negative. An important implication of our study is that the profitseeking behavior ofmedical providers undermines the policy effectiveness of using generic competition as the cost containment strategy in the health care market. [ABSTRACT FROM AUTHOR]

This paper uses a direct measure of information to empirically investigate the determinants of consumer health information and the linkage of the information to demand for preventive care. In our analysis, two equations are estimated: (1) health information and (2) demand for preventive care, which includes health information as an endogenous explanatory variable. Overall, the results show that more and better health information increases the probability that the elderly wilt use preventive care. This result, in combination with the finding that health information is not uniform among the elderly, suggests that poor information can become an access barrier to preventive care. [ABSTRACT FROM AUTHOR]

South Korea, Singapore and Taiwan are well known as export-oriented developmental states which for decades employed industrial policy to target particular industries for government support. In the past fifteen years, these three countries all identified the biopharmaceutical industry as a strategic sector. This article explores, through economic analysis, the rationale for this decision and the strategies chosen for linking into the global bio-economy with the objective of catching up in biopharmaceuticals. The paper identifies three comparative advantages enjoyed by these countries in the biopharma sector: (1) public investments in basic research; (2) private investments in phase 1 clinical trials; and (3) a potentially significant contract research industry managing latter-stage clinical trials. Governments employ a range of industrial policies, consistent with these comparative advantages, to promote the biopharmaceutical industry, including public investment in biomedical hubs, research funding and research and development (R&D) tax credits. We argue that the most important feature of the biopharmaceutical industry in these countries is the dominant role of the public sector. That these countries have made progress in innovative capabilities is illustrated by input measures such as R&D expenditure as share of gross domestic product, number of patents granted and clinical trials, and volume of foreign direct investment. In contrast, output indicators such as approval of new chemical entities suggest that the process of catching up has only just commenced. Pharmaceutical innovation is at the stage of mainly generating inputs to integrated processes controlled by the globally incumbent firms. [ABSTRACT FROM AUTHOR]

Background: To address concerns over the financial stability of South Korea's National Health Insurance (NHI) programme, the government transitioned from an outpatient copayment system to a coinsurance system in 2007. This policy aimed to reduce healthcare overutilization by increasing patients' financial responsibility for outpatient services. Methods: Using comprehensive data on NHI beneficiaries, this study employs a regression discontinuity in time (RDiT) design to assess the policy's impact on outpatient healthcare utilization and expenditures. We focus on changes in overall outpatient visits, average healthcare cost per visit and total outpatient healthcare expenditures. Results: Our findings indicate that the transition from outpatient copayment to coinsurance led to a substantial increase in outpatient healthcare utilization (up to 90%) while decreasing medical expenditures per visit by 23%. The policy shift incentivized beneficiaries to seek more medical treatments during the grace period and enroll in supplemental private health insurance, which provided access to additional medical services at lower marginal costs. Conclusions: The policy change and the emergence of supplemental private insurance contributed to moral hazard and adverse selection issues, culminating in South Korea becoming the country with the highest per capita utilization of outpatient health services worldwide since 2012. This study underscores the importance of carefully considering the unintended consequences of policy interventions in the healthcare sector. [ABSTRACT FROM AUTHOR]

The relationship between alcohol use, crime and public policy interventions is a pressing area of study in the policy sciences. This article compares the effects of alcohol price control policies and crime deterrence policies by type of crime through a case study of South Korea. Specifically, an instrumental variable was introduced to address the problem of endogeneity between alcohol consumption and crime. Instead of using the alcohol tax rate, this study's instrumental variable was derived from the vertical restraint structure of the Korean distilled liquor industry. The results of the study's empirical analysis show a significant and negative relationship between the arrest rate and violent, property, and economic crimes. Alcohol consumption is observed to have a positive relationship with violent crime only. Additionally, prevention activities deployed by the police were found to have a negative relationship with property crime, while the prosecution rate was determined to have a negative relationship with economic crime. Furthermore, as opposed to deterrence policies, an alcohol control policy through higher alcohol tax rates emerged as more effective for reducing alcohol-related crime, and a specific rate tax was found to be more effective than an ad valorem tax for deterring alcohol-related crime. [ABSTRACT FROM AUTHOR]

We study the effect of the spread of democracy on population health in 15 European countries since the middle of the 19th century, and more specifically the average height of adult males by five‐year birth cohort, and we estimate the effect of transitions to democracy using within‐country variation. We find that the advent of democracy increased average height by about 0.7 cm. When we also account for the extension of the franchise to women, this increases to 1 cm or about 9% of the total increase in height of birth cohorts from the 1870s to the 1970s. Intervening mechanisms include reduced inequality and increased expenditure on social and health services. Our results are robust to a wide range of econometric tests. [ABSTRACT FROM AUTHOR]

The article presents the abstract of "Injury, Liability and the Decision to File a Medical Malpractice Claim," by Frank A. Sloan and Chee Ruey Hsieh. In assessing the medical malpractice claim files, researchers used two data sets based on interviews with families in Florida who suffered an adverse birth outcome. Based on the study, researchers found that in cases in which doctors evaluators thought the physician had been negligent were more likely to have become claims and serious injuries

Growing concerns over the related problems of speedily bringing innovative pharmaceuticals (especially so-called precision medicines) to market, and addressing areas of unmet medical need, have engendered critical scrutiny of the existing process for the licensing of pharmaceutical products. The objective is to enable these products to receive approval sooner, but on the basis of the provision of less complete evidence, than was previously the case. This article examines the attempts made to tackle this issue at European Union level, through a pilot programme exploring 'adaptive' approaches to licensing operated by the European Medicines Agency. Responses to this initiative indicate significant difficulty in securing regulatory legitimacy in this context. This suggests that innovative pharmaceutical technologies are disruptive of existing regulatory frameworks, such that future attempts to accommodate them within these may be susceptible to failure. [ABSTRACT FROM AUTHOR]

Background: Increased physical activity level is related to lower risk of depressive symptoms, and there is an inverse association between muscle strength and risk of depressive symptoms among the elderly. Although there is evidence of an inverse association between muscle strength and depressive symptoms, the relationship between these variables in a younger population is still unknown. This study aimed to examine the association between handgrip strength, a representative indicator of skeletal muscle strength, and the risk of depressive symptoms among Chinese female college freshmen.Methods: A cross-sectional study was conducted among 867 participants aged between 16 and 23 years. Handgrip strength was measured with a handheld digital Smedley dynamometer, and handgrip strength relative to body weight (kg/kg) was calculated and was classified into tertiles as follows: low (0.32-0.50), medium (0.51-0.58), and high (0.59-0.94). Depressive symptoms were evaluated using the 20-item Zung self-rating depression scale (SDS), and three cutoff points were used to indicate different depression levels.Results: We found that 10.7% of participants were classified as having severe depressive symptoms using an SDS score of 50 as the cutoff point. After adjusting for potential confounders, the adjusted odds ratios and 95% confidence intervals (CIs) for moderate-to-severe depressive symptoms across tertiles of the relative handgrip strength were 1.00 (reference) for tertile 1, 0.614 (0.353, 1.069) for tertile 2, and 0.537 (0.292, 0.988) for tertile 3 (P for trend = 0.041). The significant associations remained when other cutoff points (SDS scores: 48 or 45) were used. Interactions between handgrip strength and potential confounders for depressive symptoms in the final models were not significant.Conclusions: Our findings indicate that handgrip strength is inversely and independently related to the risk of depressive symptoms among Chinese female college freshmen. The present findings can help develop an effective intervention strategy against depression. Further intervention studies are needed to explore the mechanisms underlying the effects of handgrip strength on depressive symptoms. [ABSTRACT FROM AUTHOR]

How do courts award noneconomic damages? Does it matter if the state is the defendant? This article addresses these questions in the context of medical malpractice appeals to the Spanish Supreme Court. Moreover, this study provides the first empirical analysis of the quantification of noneconomic damages in medical malpractice cases in administrative courts, where the state is the defendant, and in civil courts. This separation of jurisdictions is a common feature in civil law tradition countries. Yet, critics of this separation in general, and specialized courts in particular, argue that parties might be subject to different treatments and that similar cases might reach different outcomes, namely in terms of the quantification of damages. A consistent result of this paper is that no significant differences between noneconomic damages in civil and administrative appeals were found. The separation of jurisdictions does not necessarily imply that courts reach different outcomes, even when the state is the defendant. Citizens should not refrain from bringing their claims forward against the state, a more powerful party. In the current era of increasing juridification and judicialization of modern life (Ginsburg 2009; Hirschl 2006; Hirschl 2011), it is crucial for society that citizens and other parties litigating with the state are not disadvantageously treated. [ABSTRACT FROM AUTHOR]

Mental health conditions such as depression is a rapidly rising epidemic and a major contributor to the overall global burden of disease. In addition to the direct medical costs and indirect economic costs that falls into the traditional boundary of disease burden estimation, many social costs associated with depression are hidden yet important. This paper provides empirical evidence on the existence of two hidden costs associated with depression: negative impact on social trust and life satisfaction. Based on the data obtained from 2012 China Family Panel Studies, our estimated results indicate that individuals who have a high tendency for depression or depressive symptoms are less likely to trust other people, and they also have significantly lower life satisfaction than their counterparts who are relatively mentally healthy. Given that trust is an important component of social capital, which in turn is an important input to foster economic growth in general and innovation in particular, the reduction in trust induced by the increasing prevalence of depression imposes a significant cost to the society in terms of poor economic performance. Similarly, as life satisfaction has been widely recognized as an important measure of well‐being, our study also highlights that the increase in the prevalence of depression leads to a reduction in the well‐being that individual can enjoy. All these costs are real, but did not receive sufficient attention in the previous research. The contribution of our research is to shed light on the existence of these hidden costs and to quantify the magnitude of such costs in the context of China. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined whether changes in alcohol tax rates in U.S. states predict changes in child maltreatment rates in the state level. Topics covered include whether the association differs based on the type of alcohol being taxed or the type of child maltreatment, the determination of the effectiveness of an alcohol tax as a policy lever in reducing child abuse and/or neglect, and the value of the study for child advocacy organizations.

Medical malpractice litigation lends itself to empirical research. This article draws on a unique dataset consisting of all the filed cases closed by a major medical malpractice insurer over a two-year period. Using this data, this article addresses two questions. First, what factors drive indemnity payments made in settlement of claims? Second, what factors drive the amount of those indemnity payments? We were able to assess a number of potential factors affecting case resolution that are rarely available to researchers. We find that the insurer's internal assessment of potential liability, along with the number of experts designated by the parties, is a strong predictor of payment. We also find that once the decision to seek a settlement is made by the insurer, non-medical factors become significant. Specifically, the plaintiff's age and marital status, as well as the number of experts designated by the plaintiff, are the most important predictors of the amount of payment. The severity of the plaintiff's injury is not a reliable predictor of the amount of payment. [ABSTRACT FROM AUTHOR]

Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression-induced medical costs may be primarily driven by the cost-shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy-induced obstacles for the access to mental health care resources. [ABSTRACT FROM AUTHOR]

U.S. policymakers, scholars, and advocates have long displayed an ideological commitment to exposing insured patients to substantial out-of-pocket expenses. These commitments derive from both overt political ideologies, which favor individual responsibility and oppose redistribution of wealth and risks, as well as more-subtle ideological commitments of academic economists, which link observed patterns of consumption to value-claims about welfare. In this symposium contribution, we document those ideological commitments and juxtapose them with a review of the scientific evidence about the actual effects of patient cost-sharing. We find, as economic theory predicts, that patients exposed to healthcare costs consume less healthcare. However, a fair review of the evidence--including the effects on health outcomes, access to care, and financial insecurity--makes it very hard to conclude that substantial and untailored cost-sharing exposure--as we have seen in actual application--is good social policy. We suggest directions for future study and reform. [ABSTRACT FROM AUTHOR]

Consumer litigation funding, a growing industry in the United States, is an alternative credit source for cash-strapped tort plaintiffs. Financiers give plaintiffs nonrecourse loans that are premised on lawsuit outcomes. This article is the first to empirically examine the effect of consumer litigation funding. Specifically, I explore the impact of nonrecourse loans on medical malpractice litigation outcomes by exploiting the variation in timing and geography from two Ohio policy changes: the Ohio Supreme Court's 2003 ban of funding in Rancman v. Interim Settlement Funding Corporation and the state's subsequent legislative legalization of funding in 2008. Using closed-claim data from the National Practitioner Data Bank, I find evidence that the availability of funding increases claim payment and claim duration. [ABSTRACT FROM AUTHOR]

Reinforcing global competitiveness of the pharmaceutical industry through development of new drugs is a key task and target for pharmaceutical industry and government. As part of this goal, Korea government has been dedicating to an implementation of various systems since 2000s in order to correct the wrong practices of the industries and to reduce national medical expenses. The sliding scale rebate-medical reimbursement system in 2009, Dual punishment of a rebate in 2010 and the Sunshine Act in 2018 would have contributed to a competitive environment that the pharmaceutical companies can strive for a development of new products and its quality improvement rather than focus on appealing to financial benefits to the hospitals, clinics and pharmacies. In particular, the government has cut down the price of original drugs and generic drugs sharply, of which patents have expired through the reorganized reimbursement policy and the advancement policy of the pharmaceutical industry since 2012, thereby reinforcing ability to block the source of provision of a rebate and to further promote research and development. However, there are still many unexpected side effects in the process of establishing the system because of not having sufficient competitiveness in new drug development. For example, the domestic companies have been forced into a co-marketing of the original products for short-term sales outcome and obtaining prescription records by granting the modified profit. Wholesale profit has been reduced due to squeezed distribution margins. In this study, we will explore alternatives to these major adverse events and suggest ways to improve them through collaboration between industries or industry and government. [ABSTRACT FROM AUTHOR]

Objective To assess the characteristics and incidence of medical litigation in China and the potential usefulness of the records of such litigation as an indicator of health-care quality. Methods We investigated 13 620 cases of medical malpractice litigation that ended between 2010 and 2015 and were reported to China's Supreme Court. We categorized each case according to location of the court, the year the litigation ended, the medical specialization involved, the severity of the reported injury, the type of allegation raised by the plaintiff -- including any alleged shortcomings in the health care received -- and the outcome of the litigation. Findings The annual incidence of medical malpractice litigation increased from 75 in 2010 to 6947 in 2014. Most cases related to general surgery (1350 litigations), internal medicine (3500 litigations), obstetrics and gynaecology (1251 litigations) and orthopaedics (1283 litigations). Most of the reported injuries were either minor (1358 injuries) or fatal (4111 deaths). The most frequent allegation was of lack of consent or notification (1356 litigations), followed by misdiagnosis (1172 litigations), delay in treatment (1145 litigations) and alteration or forgery of medical records (975 litigations). Of the 11 014 plaintiffs with known litigation outcomes, 7482 (67.9%) received monetary compensation. Conclusion Over our study period, the incidence of litigation over potential medical malpractice increased in China. As many of the cases related to alleged inadequacies in the quality of health care, records of medical malpractice litigation in China may be worth exploring as an indicator of health-care quality. [ABSTRACT FROM AUTHOR]

The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies. [ABSTRACT FROM AUTHOR]

Scholars sometimes refer to the civil jury decision-making process as a "black box," because researchers cannot view juries' interior workings. However, state institutions structure the environment in which disputes arise and determine the rules courts apply, while environmental factors condition courts' responses to claims. This article utilizes an original data set of civil jury verdicts in five states to examine the influence of cross-state institutional variation and trial location on courts' dispute resolution and resource allocation functions. The results indicate that institutions and trial location significantly influence patterns of winners and losers, while case-specific factors predict the amount awarded. [ABSTRACT FROM AUTHOR]

Damages in wrongful death lawsuits, like damages in all tort lawsuits, defy prediction. In order to understand the factors influencing the determination of wrongful death damages, this Article examined the outcomes and case characteristics of all the wrongful death lawsuits defended by a medical malpractice insurer in Virginia and North Carolina from 2009 through 2015. The data was derived from the insurer's closed claims files. The goal was to identify the factors that affected whether compensation was paid, as well as the factors that affected the amount of compensation, when that occurred. Using multivariate analysis, the data showed that three variables had predictive power: the claims adjuster's assessment of liability, the marital status of the deceased, and whether the primary physician-defendant was engaged either as a specialist, or in primary care. [ABSTRACT FROM AUTHOR]

Background: Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes. Methods: This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance: population coverage, the range of services covered, and the extent to which costs are covered. Each of the health insurance scheme's policies were categorized and analyzed. An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC), which included 1506 discharges, was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes. Results: Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI, who have less inpatient expenses than those covered by the UEBMI). We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups. In terms of financial inequity, TB patients who earned less paid more. The NCMS provides modest financial protection, based on income. Overall, TB patients from lower socioeconomic groups were the most vulnerable. Conclusion: There are large disparities in reimbursement for TB care among the three health insurance schemes and this, in turn, hampers TB control. Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control. Achieving equity through integrated policies that avoid discrimination is likely to be effective. [ABSTRACT FROM AUTHOR]

Currently, a mass media campaign is underway in Turkey using a new communication means called the “public spot” (kamu spotu). This article concentrates on the public spots produced by Turkey’s Ministry of Health, and more specifically on those that advocate quitting smoking and preventing obesity. Drawing on interviews with Ministry of Health personnel and analyzing the content of these spots, we suggest that they operate as risk caveats. They caution individuals against smoking and obesity’s potential harms and guide her/him towards self-health governance by encouraging the maintenance of a particular lifestyle that embraces a balanced diet, regular activity, and no smoking. As such, we read these spots as a technique of neoliberal governmentality. This technique works primarily by responsibilizing individuals as health entrepreneurs investing in risk free lifestyles; that is, by conceptualizing health as a matter of self-conduct where personal responsibilities are emphasized. [ABSTRACT FROM PUBLISHER]

Background: Tuberculosis (TB) patients in China still face a number of barriers in seeking diagnosis and treatment. There is evidence that the economic burden on TB patients and their households discourages treatment compliance. Methods: A cross-sectional study was conducted in three cities of China. Patients were selected using probability proportional to size (PPS) cluster sampling of rural townships or urban streets, followed by list sampling from a patient register. Data were collected using a questionnaire survey, key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance. Results: A total of 797 TB patients were surveyed, of which 60 were interviewed in-depth following the survey. More than half had catastrophic health expenditure. TB patients with higher household incomes were less likely to report non-compliance (OR 0.355, 95% CI 0.140-0.830) and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance (OR 3.650, 95% CI 1.278-12.346). Those who had high costs for transportation, lodging and food were also more likely to report non-compliance (OR 4.150, 95% CI 1.804-21.999). The findings from the qualitative studies supported those from the survey. Conclusion: The economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China. Reducing the cost of treatment and giving patients subsidies for transportation, lodging and food is likely to improve treatment compliance. Improving doctors' salary system to cut off the revenue-oriented incentive, and expanding current insurance's coverage can be helpful to reduce patients' actual burden or anticipated burden. Future research on this issue is needed. [ABSTRACT FROM AUTHOR]

The advantages held by haves over have nots in litigation have long fascinated scholars, with a long line of research revealing that litigant status often affects litigant resources, experience, and chances of overall success from trial courts to appellate courts. What has received considerably less attention, however, is how this status affects the decision to appeal. Bringing a new perspective to this important area holding implications for the shape and content of the judicial hierarchy, this study analyzes the decision of the losing federal district court litigant to appeal to the US courts of appeals. Utilizing an original database containing a sample of federal district court civil cases decided between 2000 and 2004, the results indicate, as predicted, that litigant status differentials affect whether there will be an appeal. This influence is further magnified when conditioned upon the relative costs of the appeal. These findings provide one of the first detailed examinations of litigant status and appeals coming from US trial courts and, simultaneously, offer the first empirical evidence to date that business litigants, like previously known government parties, are advantaged over individuals when deciding whether to appeal. [ABSTRACT FROM AUTHOR]

In his influential piece, Galanter (1974) argues that repeat players in the judicial system can be expected to succeed at trial in part because of the advantages repeat players enjoy compared to the one-shotters. This article explores the effect of a number of the benefits Galanter identifies on litigation outcomes for civil jury trials in four states with particular attention to the size of the law firms representing the litigants. We find possessing an advantage in relative firm size, without considering other factors, appears to produce no significant advantage in terms of achieving plaintiff compensation. On the other hand, a local presence in the county where the trial occurs increases plaintiff attorney success rates when challenging out-of-town defense firms, especially when the plaintiff's law firm is the larger of the two. Additionally, devoting more resources in terms of human capital to a particular case increases the probability of favorable outcomes. [ABSTRACT FROM PUBLISHER]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jhealeco.2008.10.009 Byline: Ya-Ming Liu (a), Yea-Huei Kao Yang (b), Chee-Ruey Hsieh (c) Keywords: Incentives; Prescription decision; Price regulation; Generic drugs; Brand-name drugs Abstract: This paper tests the hypothesis of whether or not financial incentives affect a physician's prescription decision on the choice of generic versus brand-name drugs within a system in which physicians prescribe and dispense drugs. By using data obtained from Taiwan and focusing on diabetic patients, our empirical results provide several consistent findings in support of the hypothesis that profit incentives do affect the physician's prescribing decision, suggesting that physicians act as imperfect agents. An important implication of our findings is that rent seeking for profit margin between the reimbursement and the acquisition price instead of reducing costs is the major driving force behind generic substitution. As a result, the providers instead of the payers or consumers reap the financial benefits of generic substitution. Author Affiliation: (a) Department of Economics, College of Social Sciences, National Cheng-Kung University, 1 University Road, Tainan 70101, Taiwan (b) Institute of Clinical Pharmacy & Institute of Biopharmaceutical Sciences, College of Medicine, National Cheng-Kung University, 1 University Road, Tainan 70101, Taiwan (c) Institute of Economics, Academia Sinica, 128, Section 2, Academia Road, Taipei 11529, Taiwan Article History: Received 4 March 2008; Revised 20 October 2008; Accepted 24 October 2008

Background: Irrational use of medicines has been an issue concerned all over the world and the outlooks in developing countries are more severe. This study aimed to assess the different patterns of irrational use of medicines and its influential factors in China and Vietnam. Methods: A systematic review was performed on both published and grey literatures in English, Chinese and Vietnamese languages between 1993 and 2013 based on the WHO framework. Quality assessment was conducted on the basis of the Critical Appraisal Skills Programme. Key indicators were analyzed to compare the irrational use of medicines in two countries. Results: A total of 67 published works about China and 29 about Vietnam were included, the majority of which were cross-sectional prescription studies in both China and Vietnam. Irrational use of medicines was found in both the countries but issues with polypharmacy as well as overuse of antibiotics were more severe in Vietnam while overuse of injections was unique to China. Various patterns of irrational use were also indicated between urban and rural areas, and among different levels of hospitals. Rarely does literature focus on the analysis of influential factors of irrational use of medicines. While lack of proper knowledge from both providers and patients were the most recognized influential factors in both countries, economic incentives from pharmaceutical companies in China, and weak control and regulation over prescriptions in Vietnam were the main factors attributed to this issue. Conclusion: Severe irrational use of medicines has been abundantly evidenced in both China and Vietnam, highlighting the importance of policy interventions on the issue. However, limited evidence on the appropriateness or its compliance (conformity) to guidelines of prescription has been found. In addition, convincing evidence on the underlying explanation of this issue is lacking, although economic incentives, health insurance coverage, and knowledge of service providers and users have been implied to be factors influencing irrational drug use. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper empirically investigates the relationship between the health care expenditure of end-of-life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee-for-services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005-2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end-of-life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public-private differences vary across accreditation levels. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article discusses several aspects of the U.S. Drug Price Competition and Patent Term Restoration (Hatch-Waxman) Act of 1984, and it mentions consumer legislation in America, a legal and economic framework for the nation's generic drug industry, and pathways for drug approval in the U.S. Drug patent protection and America's legislative history are examined, along with the U.S. Biologics Price Competition and Innovation Act of 2009 (Biosimilars Act) and the marketing of medicines.

Although the technological change in medicine has been recognized widely as the major driver of rising healthcare costs, there is very little research that estimates this effect directly. This paper uses both a single-equation and a simultaneous equations approach to investigate empirically the interactive relationship between technological innovation and the growth of health expenditure in the context of the pharmaceutical market in Taiwan. Based on observing 182 therapeutic groups between 1997 and 2006, we find evidence to support the argument that technological innovation and health expenditure are determined simultaneously as technological innovation, and that the growth of health expenditure are endogenous rather than exogenous. Specifically, we find that therapeutic groups associated with higher pharmaceutical expenditure are likely to attract more new products to the market. Meanwhile, therapeutic groups with more new products are associated with higher pharmaceutical expenditures. An important implication of the paper is that cost containment policies will affect not only the growth of health expenditure, but also the progress of technological innovation in the health sector. [ABSTRACT FROM AUTHOR]

Background: Although substantial efforts have been made to curtail smoking in Vietnam, the 2010 Global Adult Tobacco Survey (GATS) revealed that the proportion of male adults currently smoking remains high at 47.4%. Objectives: To determine the level of, and characteristics associated with, knowledge of the health consequences of smoking among Vietnamese adults. Design: GATS 2010 was designed to survey a nationally representative sample of Vietnamese men and women aged 15 and older drawn from 11,142 households using a two-stage sampling design. Descriptive statistics were calculated and multivariate logistic regression was used to examine associations between postulated exposure factors (age, education, access to information, ethnic group etc.) and knowledge on health risks. Results: General knowledge on the health risks of active smoking (AS) and exposure to second hand smoke (SHS) was good (90% and 83%, respectively). However, knowledge on specific diseases related to tobacco smoking (stroke, heart attack, and lung cancer) appeared to be lower (51.5%). Non-smokers had a significantly higher likelihood of demonstrating better knowledge on health risks related to AS (OR 1.6) and SHS (OR 1.7) than smokers. Adults with secondary education, college education or above also had significantly higher levels knowledge of AS/SHS health risks than those with primary education (AS: ORs 1.6, 1.7, and 1.9, respectively, and SHS: ORs 2.4, 3.9, and 5.7 respectively). Increasing age was positively associated with knowledge of the health consequences of SHS, and access to information was significantly associated with knowledge of AS/ SHS health risks (ORs 2.3 and 1.9 respectively). Otherwise, non-Kinh ethnic groups had significantly less knowledge on health risks of AS/SHS than Kinh ethnic groups. Conclusions: It may be necessary to target tobacco prevention programs to specific subgroups including current smokers, adults with low education, non-Kinh ethnics in order to increase their knowledge on health risks of smoking. Comprehensive messages and/or images about specific diseases related to AS/SHS should be conveyed using of different channels and modes specific to local cultures to increase knowledge on smoking health consequences for general population. [ABSTRACT FROM AUTHOR]

The article discusses the scarcity of injury cases claims at the threshold of tort law by highlighting both, economic and cultural forms of explanation reflecting humans' response to physical harm. Economic explanation unveils that injury victims measure the benefits of filing a complaint against the costs. The cultural explanation depicts that social norms permeate complaining and litigating with specific meanings that lead people to value or disvalue themselves.