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Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients' (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Decision making in public health often happens against the background of scarce resources. The systematic use of economic evaluations can be a main enabler in the alignment of public health goals with budgetary constraints. However, the lack of standardized methodology in terms of costing method and perspective are a critical barrier to the implementation of economic evaluations and the international comparability of results. We present a novel set of 22 reference unit costs (RUCs) optimized for cross-sectoral economic evaluations in Austria suitable for international comparability calculated using the standardized PECUNIA RUC Template. The common framework for costing and reporting, as well as the easy availability of the RUCs will reduce the burden on researchers and policy makers in future economic evaluations. The higher quality, accuracy, transparency and availability of economic evidence for policy design will help to improve the efficiency of public health-relevant healthcare decisions and make it easier for policy makers to bring funding arrangements and decision making across multiple sectors in line with Health-in-All-Policies goals., (© 2022. The Author(s).)

Magnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder-Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question., (© 2021. The Author(s).)

Puehringer, Reinhard, Martin Berger, Michael Said, and Martin Burtscher. Age-dependent health status and cardiorespiratory fitness in Austrian military mountain guides. High Alt Med Biol . 21:346-351, 2020. Background: Mountaineering activities (at moderate and high altitudes) require a relatively high level of physical fitness, which may be closely associated with healthy aging. This cross-sectional study was aimed at evaluating the age-dependent health status and fitness level in Austrian military mountain guides. Methods: A total of 166 professional mountain guides were recruited for a comprehensive health check and exercise testing. Comparisons were made between 3 different age groups, that is, ≤40 years ( n  = 74), 41-50 years ( n  = 70), and >50 years ( n  = 22). Besides exercise capacity, anthropometric, biomedical, and cardiorespiratory parameters have been assessed. Results: None of the assessed parameters differed between age group 1 and 2. A slight increase was observed in the age group 3 concerning body weight, body mass index, blood lipids, blood glucose, and urea levels, and resting systemic blood pressure values. Peak aerobic capacity and maximal heart rates were slightly lower in this age group than the younger groups. When compared with the general population, mountain guides of similar age showed lower prevalence of being overweight, and suffering from systemic hypertension and diabetes. Conclusions: Our findings indicate favorable aging of mountain guides occupationally performing mountaineering activities (at moderate and high altitudes), characterized by maintaining a high fitness level and developing reduced cardiovascular risk factors until older than 50 years.

Air pollution is a threat to the general population, especially to pollen allergy sufferers in urban environments. Different air quality parameters have hitherto been examined which add to the burden of pollen allergy sufferers. Parameters such as NO 2 , SO 2 , PM 10 , PM 2.5 , and O 3 are supposed to have additional impact, not only on health in general (increase in asthma, allergy sensitization frequency), but also on pollen grains (increase of allergenicity). However, it remains unknown if those air quality parameters increase symptom severity during the pollen season. We selected the birch, grass, and ragweed pollen seasons as different time periods throughout the year and analyzed the relationship of symptom data to pollen, air quality, and meteorological data (temperature, relative humidity) for the metropolis of Vienna (Austria). A linear regression model was computed based on different symptom data, and both pollen and air quality data were tested simultaneously. Ozone was positively and significantly associated with symptom scores in all three seasons, whereas this was only rarely the case with other pollutants. Therefore, only ozone was selected for further analysis in a model including meteorological parameters. In this model, effect estimates of ozone were attenuated but remained significant for the grass pollen season. The lack of significance in the other seasons may be attributed to the less numerous symptom data entries and the shorter duration of the pollen seasons for birch and ragweed. All other air quality parameters usually showed lower concentrations during the pollen seasons and displayed little variation. This might explain the lack of a clear signal. Our results suggest that today's allergic population is already affected by air quality (rising O 3 levels). Air quality should be considered as well in pollen information and pollen allergy studies in general because of its increasing importance in the light of global warming., Competing Interests: Declaration of competing interest No conflicts of interest are reported., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Soft budget constraints (SBCs) undermine reforms to increase hospital service efficiency when hospital management can count on being bailed out by (subnational) governments in case of deficits. Using cost accounting data on publicly financed, non-profit hospitals in Austria from 2002 to 2015, we analyse the association between SBCs and hospital efficiency change in a setting with negligible risk of hospital closure in a two-stage study design based on bias-corrected non-radial input-oriented data envelopment analysis and ordinary least squares regression. We find that the European debt crisis altered the pattern of hospital efficiency development: after the economic crisis, hospitals in low-debt states had a 1.1 percentage point lower annual efficiency change compared to hospitals in high-debt states. No such systematic difference is found before the economic crisis. The results suggest that sudden exogenous shocks to public finances can increase the budgetary pressure on publicly financed institutions, thereby counteracting a pre-existing SBC., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Pollen allergies affect a significant proportion of the population globally. At present, Web-based tools such as pollen diaries and mobile apps allow for easy and fast documentation of allergic symptoms via the internet., Objective: This study aimed to characterize the users of the Patient's Hayfever Diary (PHD), a Web-based platform and mobile app, to apply different symptom score calculations for comparison, and to evaluate the contribution of organs and medications to the total score for the first time., Methods: The PHD users were filtered with regard to their location in Austria and Germany, significant positive correlation to the respective pollen type (birch/grass), and at least 15 entries in the respective season. Furthermore, 4 different symptom score calculation methods were applied to the datasets from 2009 until 2018, of which 2 were raw symptom scores and 2 were symptom load index (normalized) calculations. Pearson correlation coefficients were calculated pairwise for these 4 symptom score calculations., Results: Users were mostly male and belonged to the age groups of 21 to 40 years or >40 years. User numbers have increased in the last 5 years, especially when mobile apps were made available. The Pearson correlation coefficients showed a significant linear relationship above 0.9 among the 4 symptom score datasets and thus indicated no significant difference between the different methods of symptom score calculation. The nose contributed the most to the symptom score and determined about 40% of the score., Conclusions: The exact method of calculation of the symptom score is not critical. All computation methods show the same behavior (increase/decrease during the season). Therefore, the symptom load index is a useful computation method in all fields exploring pollen allergy, and Web-based diaries are a globally applicable tool to monitor the effect of pollen on human health via electronically generated symptom data., (©Katharina Bastl, Maximilian Bastl, Karl-Christian Bergmann, Markus Berger, Uwe Berger. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.02.2020.)

Background: Traumatic events are commonly experienced in the general population and can lead to both psychological and physical consequences. While some may process the experienced event without developing trauma related symptoms in the long term, others develop persistent symptomatology in the form of chronic pain depending on the type of trauma as well as various other risk factors., Objective: The aim of this study was to examine the relationship of the number of lifetime traumas and chronic pain in a sample of transcultural patients to further develop existing research highlighting an association between the number of traumas and chronic pain that may be independent of a categorical diagnosis of PTSD., Methods: Using a case-control design, this study compared 29 chronic pain patients (Gerbershagen II/III) born in former Yugoslavia (21 female; age: 52.5 years, SD 7.3) to 21 patients of a general psychiatric sample who were matched by age- (±5 years), migratory-background, and gender. The number of traumas and PTSD symptomatology were assessed using the Harvard Trauma Questionnaire (HTQ). Somatisation, social dysfunction and anxiety were assessed by the General Health Questionnaire 28 (GHQ-28). The Beck Depression Inventory (BDI) was used to determine the presence of depression., Results: 96.9 % of the chronic pain patients reported at least one traumatic event compared to 76.2 % within the control group (p = 0.029). Likewise, the mean number of reported traumas was significantly higher among the chronic pain group at 12 vs. 7 respectively (p = 0.024). Regarding anxiety, depression and social dysfunction, no significant difference between the two groups was found., Conclusions: Chronic pain patients with migratory background report an unusually high number of traumatic events. Clinicians should carefully screen for trauma history in this group of patients. The present study supports prior research suggesting a cumulative effect of trauma on chronic pain.