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AimTo assess, from a United States (US) payer's perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery.Materials and methodsA decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.ResultsIn this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.LimitationsThere are no available data on the effects of intrauterine spacers or IUAs on patients' quality of life. Resultingly, the model could not evaluate patients' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided.ConclusionThis analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients' pregnancy-related outcomes.

Purpose: This work aims to analyse the relationship between public health efficiency and well-being considering a panel of 102 Italian provinces from 2000 to 2016 and evaluates if there are omitted variable biases and endogeneity biases and also evaluates if there are heterogeneous effects among provinces with different income levels. Design/methodology/approach: We use a multi-input and output bootstrap data envelopment analysis to assess public health efficiency. Then, we measure well-being indices using the min-max linear scaling transformation technique. A two-stage least squares model is used to identify the causal effect of improving public health efficiency on well-being to account for time-invariant heterogeneity, omitted variable bias and endogeneity bias. Findings: After controlling for important economic factors, the results show a significant effect of an accountable and efficient public health system on well-being. Those effects are concentrated in the North, the most economically, geographically and environmentally advantageous areas. Research limitations/implications: The use of the sample mean, probably the oldest and most used method for aggregating the indicators, could be affected by variable compensation, with consequent misleading results in the process of constructing the well-being index. Another limitation is the use of lagged values of the main predictor as an instrument in the instrumental variables setting because it could lead to information loss. Finally, the availability of data over a long period of time. Practical implications: The findings could help policymakers adopt measures to strengthen the public health system, encourage private providers and inspire countries worldwide. Social implications: These results draw the attention of local authorities, who play an important role in designing and implementing policies to stimulate local public health efficiency, which puts individuals in the conditions of achieving overall well-being in their communities. Originality/value: For the first time in Italy, a panel of well-being indices was constructed by developing new methodologies based on microeconomic theory. Furthermore, for the first time, the assessment of the relationship between public health efficiency and well-being is carried out using a panel of 102 Italian provinces. [ABSTRACT FROM AUTHOR]

The following article presents an analysis of the impact of the Environmental, Social and Governance-ESG determinants on Hospital Emigration to Another Region-HEAR in the Italian regions in the period 2004-2021. The data are analysed using Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS, Weighted Least Squares-WLS, and Dynamic Panel at 1 Stage. Furthermore, to control endogeneity we also created instrumental variable models for each component of the ESG model. Results show that HEAR is negatively associated to the E, S and G component within the ESG model. The data were subjected to clustering with a k-Means algorithm optimized with the Silhouette coefficient. The optimal clustering with k=2 is compared to the sub-optimal cluster with k=3. The results suggest a negative relationship between the resident population and hospital emigration at regional level. Finally, a prediction is proposed with machine learning algorithms classified based on statistical performance. The results show that the Artificial Neural Network-ANN algorithm is the best predictor. The ANN predictions are critically analyzed in light of health economic policy directions. [ABSTRACT FROM AUTHOR]

Background: The Affordable Care Act (ACA), enacted in 2010, aimed to improve healthcare coverage for American citizens. This study investigates the impact of Medicaid expansion (ME) under the ACA on the racial and ethnic composition of nursing home admissions in the U.S., focusing on whether ME has led to increased representation of racial/ethnic minorities in nursing homes. Methods: A difference-in-differences estimation methodology was employed, using U.S. county-level aggregate data from 2000 to 2019. This approach accounted for multiple time periods and variations in treatment timing to analyze changes in the racial and ethnic composition of nursing home admissions post-ME. Additionally, two-way fixed effects (TWFE) regression was utilized to enhance robustness and validate the findings. Results: The analysis revealed that the racial and ethnic composition of nursing home admissions has become more homogeneous following Medicaid expansion. Specifically, there was a decline in Black residents and an increase in White residents in nursing homes. Additionally, significant differences were found when categorizing states by income inequality, and poverty rate levels. These findings remain statistically significant even after controlling for additional variables, indicating that ME influences the racial makeup of nursing home admissions. Conclusions: Medicaid expansion has not diversified nursing home demographics as hypothesized; instead, it has led to a more uniform racial composition, favoring White residents. This trend may be driven by nursing home preferences and financial incentives, which could favor residents with private insurance or higher personal funds. Mechanisms such as payment preferences and local cost variations likely contribute to these shifts, potentially disadvantaging Medicaid-reliant minority residents. These findings highlight the complex interplay between healthcare policy implementation and racial disparities in access to long-term care, suggesting a need for further research on the underlying mechanisms and implications for policy refinement. [ABSTRACT FROM AUTHOR]

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We examine the effect of a nationwide healthcare reform implemented in Turkey on women's fertility decisions. Established in 2005, the Family Medicine Program (FMP) provides a wide range of free-of-charge healthcare services to all Turkish citizens through neighborhood clinics. Results indicate that the FMP significantly reduced childbearing among females at various age categories, especially teenagers and those aged 25–29. Among teenagers, the FMP had an immediate impact on childbearing that is increasing over time, suggesting that the reproductive-heath and family-planning services had a direct negative influence on unplanned pregnancies. Among nonteenage women, however, the program had a gradual and slowly increasing impact over time, consistent with the notion that the FMP might have led to greater female empowerment. The results from an auxiliary analysis suggest that the FMP might have played a significant role in promoting gender equality and female empowerment, a finding consistent with reduced fertility. [ABSTRACT FROM AUTHOR]

Background: Evidence of integrated healthcare networks' effect on population health is scarce. Moreover, current designs for evaluating such networks have shortcomings that can result in misleading conclusions. Our paper evaluates Gesundes Kinzigtal, a best-practice integrated healthcare network, using an innovative design that enlightens the discussion about health gains produced by integrated healthcare. Research question: What is the effect of Gesundes Kinzigtal on population health? Methods: We evaluated the effect of the integrated healthcare initiative by performing a quasi-experimental evaluation based on entropy balancing. Integrated network participants were compared to a control group and followed for five years. Claims data from 2004 to 2018 was used. Population health outcomes correspond to survival (Cox hazard ratio, Kaplan-Meier curve), mortality ratio, mean age at the time of death, and years of life lost or gained. Design validity was evaluated by assessing group balance at baseline. Finally, we compared our results to those obtained using a previously published design for evaluating integrated networks. Results: The treatment group was composed of 9083 network participants, compared to an equivalent control group, showing, respectively, a mortality ratio of 5.4% vs 7.5% (p 0.05) and a gain of 0.2 years of life per person for the treatment group (p > 0.05). The Cox hazard ratio (0.72; p

During the state of epidemic in Poland in 2020, all facilities providing medical services were subject to constant reorganization. Legal changes, which were introduced at a very rapid pace, did not allow the standardization of the work of the health service. Therefore, the assessment of the practical effects of the introduced legal measures is challenging due to the lack of fixed benchmarks. Accordingly, the research method used in the article is a survey conducted among employees of the Voivodeship Specialist Hospital in December 2020, in which 165 employees from different wards participated. For this purpose, the article presents the detailed description of policy regulations related to healthcare management introduced in Poland in 2020. Combining legal research and qualitative data allowed general conclusions to be drawn with regard to the quality assessment of the implemented policy measures from the perspective of healthcare professionals.

This study evaluates how healthcare employers' staffing decisions and labor demand respond to increased Medicaid eligibility using a database of more than 14 million job vacancies for healthcare workers. The results indicate that increased Medicaid eligibility leads to healthcare employers posting more job vacancies and hiring additional healthcare workers. Healthcare employers that typically hire lower-skilled workers appear to be the most responsive to Medicaid expansions. These results imply that there are providers that respond to Medicaid patients' needs but also highlight issues arising from Medicaid's low reimbursement rates. [ABSTRACT FROM AUTHOR]

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients. One consisted of patients who underwent an early thyroid ultrasound that according to medical guidelines—at this point—was probably not indicated. The other group consisted of patients, who underwent no ultrasound examination at all or later in the course of the disease, making probable a correct indication. Both groups were made comparable by the means of a matching procedure. Average thyroid-specific health costs were substantially higher for the first group in the quarter in which the ultrasound examination took place. Some deviation in these specific costs persisted over a substantial period of time, with drug expenditures exhibiting the biggest difference. If, however, total health costs were considered, difference in costs was only found in the initial quarter. We conclude that non-indicated ultrasound examination of the thyroid gland may have some moderate effects on thyroid-specific costs. Yet the data do not suggest that long-lasting overtreatment and excess health expenditures are initiated by non-indicated ultrasound in Germany. [ABSTRACT FROM AUTHOR]