Day 1 :
Keynote Forum
Richard M Scheffler
University of California, USA
Keynote: Estimating And Projecting Global Workforce Shortages To 2030
Time : 09:00-09:35
Biography:
Richard M. Scheffler is Distinguished Professor of Health Economics and Public Policy at the School of Public Health and the Goldman School of Public Policy at the University of California, Berkeley. He also holds the Chair in Healthcare Markets and Consumer Welfare endowed by the Office of the Attorney General for the State of California. Scheffler is director of the Global Center for Health Economics and Policy Research. He has been a visiting professor at the London School of Economics, Charles University in Prague, at the Department of Economics at the University of Pompeu Fabra in Barcelona and at Carlos III University of Madrid, Spain. Scheffler has been a visiting scholar at the World Bank, the Rockefeller Foundation in Bellagio, and the Institute of Medicine at the National Academy of Sciences. He has been a consultant for the World Bank, the WHO, and the OECD. Scheffler has been a Fulbright Scholar at Pontifica Universidad Catolica de Chile in Santiago, Chile, and at Charles University, Prague, Czech Republic. He was also awarded the Chair of Excellence Award at the Carlos III University of Madrid in 2013. In 2015 Scheffler was awarded the Gold Medal for Charles University in Prague for his longstanding and continued support of international scientific and educational collaboration.
Abstract:
A health workforce of adequate size and skills is critical to the attainment of any population health goal. However, countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education and training, deployment, retention, and performance of their health workforce. The growing demand for health workers is forecasted to add an estimated 40 million health sector jobs to the global economy by 2030 in 165 countries with sufficient data to develop projections. The employment and economic growth potential of the health economy is even greater than this projection, presenting opportunities which benefit youth and women in particular. Most of these jobs, however, will be in upper-middle and high-income countries, with demand fuelled by rising incomes and ageing populations.
Keynote Forum
Sudip Chattopadhyay
San Francisco State University, USA
Keynote: The Affordable Care Act Of 2010 And The Emerging Models Of Healthcare Delivery: The Critical Role Of Health Economist In Assessing The Economic Benefits And Costs Of Implementing The Delivery Models In The United States
Time : 09:35-10:10
Biography:
Sudip Chattopadhyay is the professor and past chairman of the Economics Department at San Francisco State University (SFSU). He obtained his Ph. D. in Economics in 1997 from University of Illinois at Urbana-Champaign. He has been on the SFSU Economics faculty since 1999.His works have been extensively cited and some of them have been reprinted in special volumes for their enduring quality. Currently, He is serving as an ORISE Fellow at the federal office of Health Resources and Services Administration (HRSA) to establish a research agenda focusing on healthcare workforce.
Abstract:
The landscape of healthcare delivery in the United States is changing at a rapid pace with the introduction of The Affordable Care Act of 2010 (ACA). The new insurance exchange marketplace is expected to provide over 25 million uninsured with a low-cost coverage. ACA’s extension of eligibility for Medicaid to adults with incomes less than 138% of the federal poverty level has enabled states to cover an additional 13 million people through Medicaid expansion. The sizable expansion of the potential patient base has called for new and innovative approaches to healthcare delivery – approaches that are focused on cost reduction coupled with increased access to high-quality care. A cost-efficient care delivery approach requires building a solid provider workforce to specifically meet the ambulatory and primary care needs of the population and to avoid preventable hospitalizations and expensive emergency visits. Improved communications - through health information technology - across a wider spectrum of provider types and between patients and providers, effective implementation of a multitude of delivery models, such as the patient-centred medical home model, nurse-managed health centre model, and team-based approach to care coordination are some of the key initiatives under consideration as possible candidates for future mode of cost-efficient delivery. The new models, however, are sustainable if and only if they pass the economic cost-benefit tests as per the guidelines prescribed by the Office of Management and Budget (OMB). Health economists, with training and experience in evaluating the economic impacts of these initiatives, can play a critically important role in helping policymakers with appropriate policy prescriptions that have economy-wide implications.
- Health Economics
Health Policy
Healthcare Services
Public Health Economics
Behavioral Economics
Health Outcome Research
Nurses and Hospitals
Chair
Sylvia Y K Fung
Tung Wah College, Hong Kong
Co-Chair
Sudip Chattopadhyay
San Francisco State University, USA
Session Introduction
Marissa J Carter
Strategic Solutions, USA
Title: Cost effectiveness of adding clostridial collagenase ointment to standard of care in individuals with stage IV pressure ulcers
Time : 11:10-11:35
Biography:
Marissa J Carter holds BA and MA in Biochemistry from Oxford University and a Ph.D. in Chemistry from Brandeis University. She is the author/coauthor of over 100 peer-reviewed papers and book chapters in Medicine and Chemistry. She is the President of Strategic Solutions, Inc., and trained in epidemiology, biostatistics, and evidence-based medicine. Her research interests include wound care, evidence-based medicine, health economics, ophthalmic epidemiology, clinical practice guidelines, oncology, orthopedics, and pain. She designs and analyzes clinical trials, develops new modeling techniques in health economics, conducts -systematic reviews, and assists clients in approval of new products.
Abstract:
Analysis of an outpatient population with stage IV pressure ulcer indicated that addition of CCO (clostridial collagenase ointment; Santyl) to the standard of care (SOC) significantly increased the rate of healing over a 2-year period. The goal was to model the cost-effectiveness of adding CCO to SOC using data derived from the prior analysis. A Markov model using a cycle time of 4 weeks was chosen to model the intervention over a horizon time of 2 years. Healing rates were modeled using linear regression equations and on extrapolated percentage of subjects healed in each cycle accounting for subjects lost to follow-up to obtain the best fit. Mortality rates were modeled using the age structure in increment of 5 years of each group and adjusted for mortality rates using national census data. Markov health states included unhealed, healed, and dead. Unit costs included outpatient visits at hospital-based wound care clinics, dressing change the, debridement, and offloading. Costs were calculated for the first half of 2015 and were based on Medicare reimbursement charges with the exception of commercial costs for supplementary offloading devices. Costs and effectiveness were discounted at 3% for the second year. The model was calibrated in stages using a dependent validity method to ensure that final results were within prescribed limits when compared against dataset parameters. The cost-effectiveness of the base model resulted in an incremental cost-effectiveness (ICER) of –$375 per ulcer-free week with 17.2 additional ulcer-free weeks obtained attendant to a cost savings of $6,445 per patient over a 2-year period.
Sylvia Y.K. Fung
Tung Wah College, Hong Kong
Title: Health Policy - Sustainability In Practice For An Ageing Population
Time : 11:35-12:00
Biography:
Sylvia Fung graduated as a registered nurse. She obtained her Master in Business Administration from the University of Leicester and Master in Hospital & Health Management from the University of Birmngham and was conferred the hononary doctorate from the Girne American University. She is a fellow of the Australian College of Health Services Executive and American Academy of Nursing. She has served on the Elderly Commission and as Chief Nurse of the Hospital Authority in Hong Kong. She has received the Florence Nightingale Award from the International Red Cross and the Bronze Bauhinia Star from the Hong Kong Government.
Abstract:
Hong Kong has topped the world in 2015 in the longevity of her population. This brings along the heavy burden of chronic diseases and care of the lone elders. The Government of Hong Kong has a healthcare policy that “No one in Hong Kong is deprived of medical care because of lack of means”. With low taxation rate and escalating elderly population, public healthcare services are facing immense pressure of accessibility. Hong Kong is spending about 6% of her Gross Domestic Product (GDP) on healthcare where the public sector contributes half of the amount, i.e. less than 3% of GDP. Sustainability of the aforementioned public healthcare policy and thus its services has a gloomy outlook. Cost effectiveness is the major element within health economics that the government and services providers are levering on. Moreover, with the change in social structure in Hong Kong from extended to nuclear familiar, Hong Kong is having a very high institutionalized rate of more than 6% among the elders. Facilitaing elders to continue residing at their domestic place could ease the financial burden of the society as well as enhancing the quality of life of the elders. The complexity and technicality of integrating social and healthcare services poses great challenge when transforming the policy of “ageing in place” into practice.
Barbara Wieckowska
Ministry of Health, Poland
Title: Age-Period-Cohort Model For Regional Health Inequalities In Poland – Results For Cancer Care
Time : 12:00-12:25
Biography:
Barbara WiÄ™ckowska, Assistant Professor in Social Insurance Department (Warsaw School of Economics), has been graduated from Warsaw School of Eocnomics (Poland) as an expert in Quantity Methods and Information System, phd in Economics. She is specialist in health insurance (public and private), long-term care systems, and actuarial methods in social insurance. Author of nearly 70 articles about social insurance, healthcare insurance and risk management, 10 chapters in books and a monography (“Long-term care insurance”) and “Public long-term care systems in chosen countries” (report prepared for SENATE OF the republic of Poland). In years 2006-2007 she was a member of the group called by Ministry of Health for preparing the proposal of public long-term care insurance bill. In years 2009-2010 she was an expert for the World Bank - preparing report on long-term care benefits financed from different parts of social security system (benefits, beneficiaries, spending). In years 2011-2013 she is the head of Quantitative Methods Department in Strategic Analyses Department of Prime Minister Office of Poland. Since March 2013 she is the head of Strategic Analyses Department of Ministry of Health of Poland.
Abstract:
The EU ex ante conditions (maps of healthcare needs) were the trigger for development creation of a prognostic tool to estimate future demand for healthcare in Poland. Th is tool was aimed on (1) recognition the discrepancies in medical treatment between Polish voivodships, (2) to discern dynamics of medical standards between particular cohorts of patients and (3) provide scenario analysis based on assumed changes in medial decision trees. Defined in the Department, the universal instrument is based on the analysis of individual medical data in years 2009-2014 gathered by the public payer (National Healthcare Fund). Th e model allows for evaluation of differences in both accessibility of healthcare services and treatment choice concerning regions as well as cancer types and stages. Observed disparities amount even to 200% for example access to radiotherapy for breast cancer patients. Those inequalities may affect medical decisions – radical mastectomy vs. sublime surgery followed with radiotherapy. The analysis of the distinctions is highly crucial in the context of healthcare policy planning, i.e. (1) designating priority regions for infrastructural investments (e.g. radiotherapy); (2) disseminating new trends in treatment; (3) projecting scenarios that would minimize evident gaps in accessibility of healthcare benefits on the national level. Th is model was applied in 2015 into first healthcare needs maps prepared in Poland concerning oncology and cardiology, and will be further used in maps considering other diseases and health related problems.
Bridie Angela Evans
Swansea University Medical School, UK
Title: Involving Older People In A Multi-Centre Randomised Trial Of A Complex Intervention In Pre- Hospital Emergency Care: Implementation Of A Collaborative Model
Time : 12:25-12:50
Biography:
Bridie Angela Evans is lead for Public and Patient Involvement in PRIME Centre Wales, the research centre for primary and emergency care research in Wales, and at the Swansea Trials Unit in Wales. She is a health services researcher based at Swansea University and collaborates, alongside academics, lay members and health practitioners, in studies concerning service delivery in primary and prehospital settings. For her PhD, she developed and implemented a model for involving patients and public members in health services research.
Abstract:
Background: Health services research is expected to involve service users as active partners in the research process, but few examples report how this has been achieved in practice in trials. We implemented a model to involve service users in a multi-centred randomised controlled trial in pre-hospital emergency care. Methods: In our model, we planned to involve service users at all stages in the trial through decision-making forums at three levels: 1) strategic; 2) site (e.g. Wales; London; East Midlands); 3) local. We linked with charities and community groups to recruit people with experience of our study population. We collected notes of meetings alongside other documentary evidence such as attendance records and study documentation to track how we implemented our model. Results: We involved service users at strategic, site and local level. We also added additional strategic level forums (Task and Finish Groups and Writing Days) where we included service users. Service user involvement varied in frequency and type across meetings, research stages and locations but stabilized and increased as the trial progressed. Conclusion: Involving service users in the SAFER 2 trial showed how it is feasible and achievable for patients, careers and potential patients sharing the demographic characteristics of our study population to collaborate in a multi-centre trial at the level which suited their health, location, skills and expertise. A standard model of involvement can be tailored by adopting a flexible approach to take account of the context and complexities of a multi-site trial.
Michael Happich
Lilly Deutschland GmbH, Germany
Title: Reweighting Rct Evidence To Better Reflect Real Life – A Case Study Of The Innovation In Medicine Initiative
Time : 13:30-13:55
Biography:
Michael Happich has been graduated from Humboldt-University in Berlin as Economist. Later on he obtained his Health Economics post-graduation as part of a Post-doctoral research program with a Grant of the German Research Foundation (DFG). He started working in the Institute for Health Economics at the Helmholtz Research Centre in Munich before moving on to Eli Lilly & Co where he currently works as HTA director for Europe.
Abstract:
OBJECTIVES: Although the demonstration of improved patient and clinical outcomes within randomized controlled trials (RCTs) is widely accepted as foundational evidence of the efficacy of new treatments, concerns are frequently expressed that RCTs lack external validity. Get Real, a project under the umbrella of the Innovation in Medicine Initiative, is exploring how “real-life” clinical data can be brought in earlier in drug development. METHODS: We describe a case study that considers lung cancer the most common cancer worldwide. It investigates the generalizability of efficacy (overall survival [OS]) from the pivotal trial of pemetrexed vs gemcitabine use for the treatment of non-squamous NSCLC (Scagliotti et al 2008), using real-world data from the prospective observational FRAME study (Moro-Sibilot 2015) in a reweighting approach. Both inverse propensity scoring and entropy balancing were used to reweight RCT data based on real-world data to attempt to mirror routine clinical practice in the trial setting. RESULTS: Although OS differences between pemetrexed and gemcitabine appear more pronounced after reweighting, the reweighted analysis of the clinical trial yielded a hazard ratio (HR) closer to 1, with greater uncertainty: HR of 0.92 (95% CI: 0.60 to 1.33) compared with 0.81 (95% CI: 0.70 to 0.94) in a similar population in the clinical trial. Sensitivity analyses to both the methods of reweighting and the inclusion of baseline covariates gave broadly similar results. CONCLUSIONS: The key objective of this case study was to assess the generalizability of RCT results for the treatment of non-squamous NSCLC when projected to a real-world population. Tested reweighting efforts did not seem to invalidate findings from the original RCT.
Martin Kowarsch
Mercator Research Institute, Germany
Title: The Cartography Of Alternative Policy Pathways: A Legitimate Science-Policy Model?
Time : 13:55-14:20
Biography:
Martin Kowarsch heads the working group ‘Scientific Assessments, Ethics, and Public Policy’ (SEP) at the Mercator Research Institute on Global Commons and Climate Change (MCC) Berlin. SEP does research on integrated scientific assessment-making in the context of (environmental) public policy processes, and focuses in particular on the appropriate treatment of, and ethical reflection on, normative issues and multiple stakes therein. He is coordinator of a research initiative by MCC jointly with the United Nations Environment Programme (UNEP) on ‘the Future of Global Environmental Assessment Making’.
Abstract:
How can scientific assessments of complex, disputed policy issues be policy-relevant without being policy-prescriptive? The predominant technocratic and decisionist responses to this question misleadingly assume that value-neutral scientific recommendations for public policy means, or even objectives, are possible. On the other end of the spectrum, the literature on democratic and pragmatic models of expertise in policy often does not satisfactorily explain what researchers can contribute to public discourses surrounding disputed, value-laden policy objectives and means. Building on John Dewey’s philosophy, I develop the ‘pragmatic-enlightened model’ (PEM) of scientific assessment making, which refines the existing pragmatic models. According to the PEM’s policy assessment methodology, policy objectives and their means can only be evaluated in light of the practical implications of the means. Learning about the secondary effects, side effects and synergies of the best means may require a revaluation of the policy objectives, for instance, regarding the use of bioenergy for climate mitigation. Following the PEM, assessments would—based on a thorough problem analysis—explore alternative policy pathways, including their diverse practical implications, overlaps and trade-offs, in cooperation with various stakeholders. Such an interdisciplinary cartography of multiple objectives, multi-functional policy means and the broad range of their quantitative and qualitative practical consequences is laborious and faces considerable challenges as well as uncertainty. However, it could make assessments more policy-relevant and less prescriptive, and could effectively support a learning process about the political solution space.
Myong-Il Kang
Korea University, Japan
Title: Time Discounting, Present Biases, And Health-Related Behaviors: Evidence From Japan
Time : 14:20-14:45
Biography:
Myong-Il Kang has completed his Ph.D. in economics at Osaka University in 2009, and is presently an assistant professor at Department of Business Administration in Korea University which was established in 1956 as a highest educational institute for the Korean residents in Japan. He and Shinsuke Ikeda, the professor of the Institute of Social and Economic Research (ISER), Osaka University, have found associations between time-preferences and human behaviors by using Japanese survey data. Their joint papers are published in several academic journals such as Journal of Health Economics, Health Economics, Economics and Human Biology, and Japanese Economic Review.
Abstract:
Human health is considered the outcome of intertemporal choices under trade offs between a small immediate reward and a larger delayed reward. Health-related behaviors are thus affected by personal time preferences. Based on an internet-based survey conducted on Japanese adults, we contribute to the literature by incorporating the multifaceted nature of time discounting in an analysis of the associations between time preference and health-related behaviors. We find that, first, less patient respondents tend to exhibit worse health-related attributes. Second, present bias, which is measured by the degree of declining impatience, is positively associated with unhealthy behaviors for naïve respondents, who are unaware of their self-control problem. Third, such associations cannot be found in sophisticates, who are aware of that. As a policy implication, direct intervention policies, including “nudging,” are more effective than a commitment device provision in correcting the unhealthy behaviors due to present bias. Fourth, the sign effect, wherein future losses are discounted at a lower rate than future gains, is negatively associated with unhealthy outcomes, although at weak statistical significance levels.
Shu fang Tseng
Taipei Veterans General Hospital, Taiwan
Title: Competitive Strategy And Games Of The New Entry Hospital In The Taiwan Hospital Market
Time : 14:45-15:10
Biography:
Shu-Fang Tseng received her PhD from Fu-Jen Catholic University in 2016. She is employed in the Nursing Department of Taipei Veterans General Hospital (TVGH). She has published a paper in reputed journals and has been serving at TVGH for many years.
Abstract:
Taiwan’s healthcare industry is facing a period of competition among healthcare institutions and physician manpower shortages. In addition, DRGs and GBs have been implemented and new hospitals have entered the market. Consequently, the equilibrium of the “game” in the medical service market has been disrupted, and a prisoner’s dilemma has been created among hospitals. However, the medical centers in Taiwan are operating in a highly competitive market with a low concentration. Through an empirical analysis, this study determined the dominant strategy of best response profile as well as the optimal organizational structure and competitive strategy for new hospitals entering the medical center market game. Alternative variables for consumer medical demand and time cost were selected using data from annual statistical reports (2007–2011) and the website to analyze the game. Moreover, the following factors were analyzed through descriptive statistics, cluster analysis and the negative binomial distribution of regression models: resource input and output, market competition (regarding CR4, market share, and the HHI), sequential games, the Hotelling model, and the tragedy of the commons property resources. Furthermore, for a regression model in a sequential game, eight cumulative density functions and four action profiles were adopted, which involved players adopting cooperative or noncooperative strategies for increasing or not increasing the number of discharged patients. The Nash equilibrium of the total medical service quantity is higher than the total social medical service quantity. It means the point value of medical service in the medical centers will be reduced, and the tragedy of commons property resources will occur. Therefore, the prisoner’s dilemma between the quality and quantity of medical services causes strong or weak peer review.
Leegail Adonis
University of Witwatersrand, South Africa
Title: Health-Care Cost Outcomes And Adherence To Screening Guidelines In A Health-Insured Population
Time : 15:10-15:35
Biography:
Leegail Adonis is a Public Health Physician with a PhD in Public Health from the University of Witwatersrand. She has a particular interest in preventative medicine and has worked for one of the largest health insurers in South Africa as well as on various projects in collaboration with the World Health Organization. She currently works as a Medical Specialist for the National Department of Health, Non-communicable diseases Directorate in South Africa.
Abstract:
Being up to date with screening guidelines should infer a cost benefit for medical insurance organizations. This study assessed whether there were any difference in health care expenses between those up to date with screening guidelines and those not. A retrospective longitudinal cohort study for the period 2006-2011 was conducted consisting of 170,471 health-insured members form a single insurer. Adherence to screening guidelines was found to range from 0.33% for females 41-50 years to 2.21% for females 16-35 years. Only 0.97% of males aged 41-50 years were up to date with screening tests while 2.95% of males 18-40 years were up to date. Both men and women who adhered to screening guidelines had significantly higher health care expenses compared to those not up to date with screening tests. Females 41-50 years who were up to date with screening tests used 362% more out patient expenses than females who were not up to date (median yearly cost of ZAR10 130.09 vs. ZAR2801.52; p<0.001). However, men 18-40 years who were up to date with screening had a median of zero ZAR out patient expenses compared to ZAR3572.60 for men not up to date with screening tests (p=0.002). In conclusion, health care expenditure were significantly higher in both males and females up to date with screening guidelines except for men aged 18-40 years who had significantly lower out patient expenses. Greater emphasis should be placed on males to screen regularly as they tend to consume less out of hospital health care resources.
Shyama Janaka Mahakalanda
Fiji National University, Fiji
Title: Using Google Maps To Monitor The Demand For Preventive Health Care By Geographical Location: Experience From Fiji, Micronesia, Palau And Marshall Islands Pilot Projects
Time : 15:55-16:20
Biography:
Shyama Janaka Mahakalanda graduated from the Faculty of Medicine, University of Colombo as a medical doctor. However his interest was more in health policy hence he took to development economics for post graduate diploma, and then completed his masters in Economics from University of Colombo. He also completed an Executive Masters in Science (Health Administration) from Malaysia. He is a full time researcher in health systems at the Fiji National University. He has performed many consultancies and provided policy reports in his career for many pacific island countries and Sri Lanka.
Abstract:
The shortages in healthcare are many in the remote islands in Pacific. This project was to identify the demand for services by the geographical location in order to plan services to deliver. The other intention was to relocate redundant services to more useful locations. In all the countries mentioned above, patient records were categorised by diagnosis and demographics and were plotted on google maps. This was done because we could not afford GIS and google maps could be updated online and real time using smart phones. The maps were then used to identify diseases by location and plan services to be delivered. The other advantage was the outcomes could be recorded on the maps itself and the records get updated real time. We could even monitor spread of some diseases. By using free software we managed to establish the different diseases present in localities and then decide the secondary prevention package to be delivered. Due to the maps we are now able to monitor service delivery by the very household of the patient. It was also possible to plan stronger primary prevention packages because we were aware of the disease in different locations.
Ikuo Tanabe
Nagaoka University of Technology, Japan
Title: Development Of Innovative Tool Using Taguchi-Methods For The Near Future
Time : 16:45-17:10
Biography:
Ikuo Tanabe has completed his Ph.D. from the Nagaoka University of Technology. He is the Professor of Mechanical Engineering at the Nagaoka University of Technology. He has published more than 116 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Recently, Taguchi method is used to decide optimum processing conditions with narrow dispersion for robust design. On the other hand, innovative development with short-term, low cost, labor saving and energy-saving is also required in the world. In this research, the software for innovative tool using Taguchi methods is developed and evaluated. There are two parts in the innovative tool; Part 1 is the management of production and Part 2 is the analysis for investigation regarding the influence of the control. In Part 1, the Taguchi methods first calculated the average and the standard deviation regarding all combinations using all parameters. The management of production was finally used to select the optimum combination of all parameters for success percentage, accuracy, manufacturing time and total cost. The spring back to warm press forming on the magnesium alloy plate was investigated for evaluating the Part 1 in the experiment. It is concluded from the result that this system effectively predicted optimum process conditions in each priority and the predicted results confirmed the results of the spring back test. In Part 2, this part is firstly accomplished for selecting important control factors, and the next trial decides the optimum combination of the control factors by more detail trial. The optimum condition for cooling system at cutting was investigated for evaluating the Part 2 in the experiment. It is concluded from the result that this system was useful for development with short-term and lower cost and this tool could quickly and exactly decide the optimum cooling condition.