Day 2 :
Keynote Forum
Govinda R Timilsina
World Bank, USA
Keynote: The Nexus Of Energy Supply And Human Health
Time : 09:00-09:35
Biography:
Govinda R Timilsina is a Senior Research Economist at the Development Research Department of the World Bank. He works in the field of energy and economic development covering a wide range of topics including energy & environment, climate change, energy and poverty, clean and renewable energy. He has been widely published more than 50 journal articles, more two dozens of books, book chapters and technical reports.
Abstract:
The main sources of energy (coal, oil, and solid biomass) are directly linked to human health. Global health observatory data produced by the World Health Organization shows that ambient air pollution was responsible for 3.7 million deaths in 2012, of which 88% in low and middle-income countries. It was responsible for 16% of the lung cancer deaths, 11% of chronic obstructive pulmonary disease (COPD) deaths, more than 20% of ischaemic heart disease and stroke, and about 13% of respiratory infection deaths. Energy production activities, such as coal-fired power plants and fuel consumption activities, such as urban road transportation, are the primary sources of emissions responsible for ambient air pollution. Similarly, it is estimated that acute respiratory infections, mainly caused by indoor air pollution resulted from biomass and fossil fuel burning is the largest single category of deaths (64%) in children under 5 years of age in developing countries. Indoor air pollution ranks 4th on the global burden of disease risk factors at almost 5%, coming after high blood pressure (8%), tobacco smoking and second-hand smoke (7%), and alcohol use (6%). More than 40% of the global population today still rely on solid biomass fuels (e.g., fuel, wood, charcoal, coal, animal and crop wastes), the main precursors of the indoor air pollution, for cooking and home heating. These statistics indicate the deep nexus between energy supply and human health. Yet, the negative implications for human health are mostly ignored while developing energy supply plans and strategies in developing countries. If the costs to human health caused by an energy supply chain are reflected in the energy pricing system, it could significantly change the energy supply mix world-wide.
Keynote Forum
Johannes Bircher
University of Bern, Switzerland
Keynote: Impact On Health Economy Of A New Theoretical Framework Of Health: The Meikirch Model
Time : 09:35-10:10
Biography:
Johannes Bircher has completed his professional formation at the University of Zürich, and his postgraduate education at the Mayo Clinic and the University of Zürich. Then he worked at the Department of Clinical Pharmacology of the University of Bern, at the Black Lion Hos-pital in Addis Ababa and at the University of Gottingen before he became dean of the Faculty of Medicine at the University of Witten/Herdecke. Now he is retired. He published 253 papers partly in high ranking scientific journals, and seven books.
Abstract:
Costs of health care have become a growing and potentially dangerous burden to the society. Yet, so far health economy (HE) has not been able to relieve the situation. We invite health economists to give considerations to a new look at the nature of health described by the Mei-kirch model (MM) and to explore its possible benefits for HE. The Mm states: “Health is a dynamic state of wellbeing emergent from conductive interactions between individuals’ po-tentials, life’s demands, and social and environmental determinants. Throughout the life course health results when an individuals’ biologically given potential (BGP) and his or her personally acquired potential (PAP), interacting with social and environmental determinants, satisfactorily respond to the demands of life.” The PAP of each individual is the most modifi-able component of the model. It responds positively to constructive social interactions and to personal growth. It is the site of personal responsibility. The rising costs of health care pre-sumably are due in part to the tragedy of the commons, to Moral Hazard of patients and of physicians, to managers and to other factors. Only a new culture of health will bring costs down to a satisfactory level. This encompasses innovations in personal health leadership and renegotiations of relationships at all social levels. Thereby equal weight is to be given to the MM, to HE, and to normative considerations. Refocusing of the health care system on the Mm may relieve the society from damages related to a destructive financial burden.
- 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.
- Health Economics
Health Policy
Healthcare Markets
Health Economics Modelling
Health Statistics
Private Healthcare Insurance
Chair
Jan Baekelandt
Imelda Hospital, Belgium
Session Introduction
Govinda R Timilsina
World Bank, USA
Title: The nexus of energy supply and human health
Biography:
Govinda R Timilsina is a Senior Research Economist at the Development Research Department of the World Bank. He works in the field of energy and economic development covering a wide range of topics including energy & environment, climate change, energy and poverty, clean and renewable energy. He has been widely published more than 50 journal articles, more two dozens of books, book chapters and technical reports.
Abstract:
The main sources of energy (coal, oil, and solid biomass) are directly linked to human health. Global health observatory data produced by the World Health Organization shows that ambient air pollution was responsible for 3.7 million deaths in 2012, of which 88% in low and middle-income countries. It was responsible for 16% of the lung cancer deaths, 11% of chronic obstructive pulmonary disease (COPD) deaths, more than 20% of ischaemic heart disease and stroke, and about 13% of respiratory infection deaths. Energy production activities, such as coal-fired power plants and fuel consumption activities, such as urban road transportation, are the primary sources of emissions responsible for ambient air pollution. Similarly, it is estimated that acute respiratory infections, mainly caused by indoor air pollution resulted from biomass and fossil fuel burning is the largest single category of deaths (64%) in children under 5 years of age in developing countries. Indoor air pollution ranks 4th on the global burden of disease risk factors at almost 5%, coming after high blood pressure (8%), tobacco smoking and second-hand smoke (7%), and alcohol use (6%). More than 40% of the global population today still rely on solid biomass fuels (e.g., fuel, wood, charcoal, coal, animal and crop wastes), the main precursors of the indoor air pollution, for cooking and home heating. These statistics indicate the deep nexus between energy supply and human health. Yet, the negative implications for human health are mostly ignored while developing energy supply plans and strategies in developing countries. If the costs to human health caused by an energy supply chain are reflected in the energy pricing system, it could significantly change the energy supply mix world-wide.
Johannes Bircher
University of Bern, Switzerland
Title: Impact on health economy of a new theoretical framework of health: The meikirch model
Biography:
Johannes Bircher has completed his professional formation at the University of Zürich, and his postgraduate education at the Mayo Clinic and the University of Zürich. Then he worked at the Department of Clinical Pharmacology of the University of Bern, at the Black Lion Hos-pital in Addis Ababa and at the University of Gottingen before he became dean of the Faculty of Medicine at the University of Witten/Herdecke. Now he is retired. He published 253 papers partly in high ranking scientific journals, and seven books.
Abstract:
Costs of health care have become a growing and potentially dangerous burden to the society. Yet, so far health economy (HE) has not been able to relieve the situation. We invite health economists to give considerations to a new look at the nature of health described by the Mei-kirch model (MM) and to explore its possible benefits for HE. The Mm states: “Health is a dynamic state of wellbeing emergent from conductive interactions between individuals’ po-tentials, life’s demands, and social and environmental determinants. Throughout the life course health results when an individuals’ biologically given potential (BGP) and his or her personally acquired potential (PAP), interacting with social and environmental determinants, satisfactorily respond to the demands of life.†The PAP of each individual is the most modifi-able component of the model. It responds positively to constructive social interactions and to personal growth. It is the site of personal responsibility. The rising costs of health care pre-sumably are due in part to the tragedy of the commons, to Moral Hazard of patients and of physicians, to managers and to other factors. Only a new culture of health will bring costs down to a satisfactory level. This encompasses innovations in personal health leadership and renegotiations of relationships at all social levels. Thereby equal weight is to be given to the MM, to HE, and to normative considerations. Refocusing of the health care system on the Mm may relieve the society from damages related to a destructive financial burden.
Georgi Boichev
University of Regina, Canada
Title: Lump-Sum Finanancial Incentives Work In Attracting Primary Care Physicians To Rural Areas: Evidence From Bulgaria
Time : 10:10-10:35
Biography:
Jan Baekelandt qualified as a Medical Doctor (1999) and specialist in Gynaecology and Obstetrics (2004) at the Catholic University of Leuven, Belgium. He subspecialized as gynaecological oncologist (2004-2006) in Pretoria (South Africa) and Köln (Germany). He currently consults at Imelda Hospital (Bonheiden, Belgium), specializing in gynaecological oncology, and robotic and endoscopic surgery. He is a pioneer in the emerging field of Natural Orifice Surgery and has published multiple papers on transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) and on frugal innovations in endoscopic surgery. He was first to introduce transvaginal robotic surgery.
Abstract:
Minimally invasive surgery not only improves cosmetic outcome, it has the potential to restrict the magnitude of the surgical injury, which in turn can attenuate the inflammatory and neuroendocrine response resulting in less postoperative pain and quicker recovery. In recent years, innovations in minimally invasive surgery go hand in hand with technological innovations. As these technological innovations are often industry driven, they are geared for a first world market. Frugal innovation involves designing solutions specifically for low-income settings. We will present frugally innovative measures that can make new surgical techniques also available in a low resource setting, so that more patients can benefit from the advantages of these new techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) enables surgeons to operate in the abdominal cavity by scar free means. The Poor Man’s NOTES technique for the treatment of ectopic pregnancy, ovarian pathology, adhaesiolysis and hysterectomy, will be presented. We will present the Poor Man’s SILS technique that enables a surgeon to perform a hysterectomy through one small umbilical incision. We will demonstrate how innovations in smartphone development can replace expensive laparascopic cameras, light sources, screens and recording devices, and can reduce the investment needed to start performing minimally invasive surgery by more than 90%. We will also present a frugal morcellation technique to reduce the risk of tumor spread when retrieving a specimen from the abdominal cavity during laparoscopic surgery.
Wael Eweida
Children’s Cancer Hospital - 57357 Group, Egypt
Title: New Theory Linking Disease Prognosis With Healthcare Operations And Economics; “Scenario- Based Prediction-Of-Eventsâ€: The Future Magic Stick
Time : 11:50-12:15
Biography:
Wael Eweida is a pioneer in strategic sciences, healthcare operations and supply of healthcare. He is the Chief Operating Officer (COO) for the Children’s Cancer Hospital Egypt (57357 hospital) and he is the strategic consultant for Board of Trustees for 57357 Group. He has over 30 years of experience in strategic management, and healthcare business development. His research is now focused on health economics and healthcare operations management.
Abstract:
The “Scenario-based Prediction-of-Events” theory and conceptual model predicts the occurrence of future events according to different potential scenarios based on fixed certainities that include business, humanistic, and system-related factors, as well as other unexpected uncertainties. The new theory and model can be applied in any sector at the different industries. Upon applying the theory in the healthcare industry, it was found that the new model has the ability to link different scenarios of disease prognosis to healthcare operations management and economics, and strategic planning of rescource utilization in the future. The theory does not consider the incidence of an event as the deviation from the usual scenario, but rather deals with the occurrence of the different events in disease prognosis as predicted scenarios with varying likelihoods of occurrence, that all deviate from the best-case scenario called the “Zero-base scenario”. Prediction of how a certain disease will behave and creating scenarios based on the certainties (historical data) and the uncertainties (future expectations) using scenario-based analysis and planning is an innovative economic model to predict all the possible consequences of disease prognosis on the consumption of the resources of a healthcare organization. Developing SOPs for each written scenario with expected cost and capacity requirements will help the organization better strategically predict future needs for capacity-building and lead to better management of healthcare economics and resources based on strategic planning and readiness. By building alternative scenarios, you can foresee more unknowns that may happen and strategically plan measures to control the health economics.
Jan Baekelandt
Imelda Hospital, Belgium
Title: Frugal Innovations In Minimally Invasive Surgery
Time : 10:35-11:00
Biography:
Jan Baekelandt qualified as a Medical Doctor (1999) and specialist in Gynaecology and Obstetrics (2004) at the Catholic University of Leuven, Belgium. He subspecialized as gynaecological oncologist (2004-2006) in Pretoria (South Africa) and Köln (Germany). He currently consults at Imelda Hospital (Bonheiden, Belgium), specializing in gynaecological oncology, and robotic and endoscopic surgery. He is a pioneer in the emerging field of Natural Orifice Surgery and has published multiple papers on transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) and on frugal innovations in endoscopic surgery. He was first to introduce transvaginal robotic surgery.
Abstract:
Minimally invasive surgery not only improves cosmetic outcome, it has the potential to restrict the magnitude of the surgical injury, which in turn can attenuate the inflammatory and neuroendocrine response resulting in less postoperative pain and quicker recovery. In recent years, innovations in minimally invasive surgery go hand in hand with technological innovations. As these technological innovations are often industry driven, they are geared for a first world market. Frugal innovation involves designing solutions specifically for low-income settings. We will present frugally innovative measures that can make new surgical techniques also available in a low resource setting, so that more patients can benefit from the advantages of these new techniques. Natural Orifice Transluminal Endoscopic Surgery (NOTES) enables surgeons to operate in the abdominal cavity by scar free means. The Poor Man’s NOTES technique for the treatment of ectopic pregnancy, ovarian pathology, adhaesiolysis and hysterectomy, will be presented. We will present the Poor Man’s SILS technique that enables a surgeon to perform a hysterectomy through one small umbilical incision. We will demonstrate how innovations in smartphone development can replace expensive laparascopic cameras, light sources, screens and recording devices, and can reduce the investment needed to start performing minimally invasive surgery by more than 90%. We will also present a frugal morcellation technique to reduce the risk of tumor spread when retrieving a specimen from the abdominal cavity during laparoscopic surgery.
Sherif Aboulnaga
Children’s Cancer Hospital - 57357 Group, Egypt
Title: Delivering Healthcare And Education As Righteous Services Not Commodities: A Noble Concept With Great Practical Implications
Time : 12:15-12:40
Biography:
Sherif Aboulnaga is a pioneer in healthcare reform and health economics. He is the Chief Executive Officer (CEO) of 57357 Group, and the Managing Director of the Children’s Cancer Hospital Egypt (57357 hospital). He has extensive experience and research activities in the areas of health economics and health policy, healthcare management, healthcare strategic sciences and peditaric oncology. He is a leader in transforming the healthcare system in Egypt for children with cancer, and transforming the educational system in Egypt.
Abstract:
Health care and education should be delivered to everyone as righteous services with a moral motive evolving form the fact that they are basic human rights and not commodities. Services are attainable rights, while commodities are only delivered or become of better quality when someone pays for them. Being labelled as righteous services, healthcare and education cannot be owned. And that is the right policy for health and education reform, because if they were owned as commodities, it would be easy to control them and limit their delivery based on affordability to pay. The delivery of healthcare and educational services as righteous services has humanistic, economic, and developmental implications. From a humanistic standpoint, healthcare and education should be delivered as basic human rights, and not as gifts or privileges that are granted to people with terms and conditions. Also, the concept of delivering healthcare and education from an economical –versus commercial- point of view will lead to the delivery of more services with lower costs, thus increasing access to these services, and leading to more productivity and overall economic positive output. Consequently, this would have a developmental implication, where the performance of individuals who receive their basic human rights would tremendously improve as a result of being healthy and well-educated. These concepts have actually been practically applied at the Children’s Cancer Hospital Egypt (57357 hospital) which treats children with cancer free of charge and implements continous learning and education for its patients and employees as righeous services.
Tuvia Horev
Ben-Gurion University of the Negev, Israel
Title: How To Strengthen The Capacities Of A National Health Authority In The Effort To Mitigate Health Inequity: A Generic Framework Based On An Israeli Model
Time : 12:40-13:05
Biography:
Tuvia Horev is an associate professor in the Department of Health Systems Management, Ben-Gurion University of the Negev (BGU). He holds a PhD in Health Policy and Management (BGU), a Master of Public Health degree from the Hebrew University Jerusalem (HUJI), and he is Dental Surgeon (HUHI). Horev served in various senior executive positions in the Israeli Healthcare system. His latest position, until December 2014, was Senior Deputy Director General for Strategic and Economic Planning, in the Ministry of Health (MoH), Israel.
Abstract:
The need for a national policy to mitigate health inequity has been recognized in scientific research and policy papers around the world. Despite the moral duty and the social, medical, and economic logic behind this goal, much difficulty surfaces in implementing national policies that propose to attain it. This is mainly due to an implementation gap that originates in the complex interventions that are needed and the lack of practical ability to translate knowledge into practices and policy tools. The article describes the Israeli attempt to design and implement a national strategic plan to mitigate health inequity. It describes the basic assumptions and objectives of the plan, its main components, and various examples of interventions implemented. Limitations of the Israeli policy and future challenges are discussed as well. Based on the Israeli experience, the article then sketches a generic framework for national-level action to mitigate inequalities in health and in the healthcare system. The framework suggests four main focal points as well as an outline of the main stakeholders that a national policy should take into consideration as agents of change. The Israeli policy and the generic framework presented in the article may serve researchers, decision-makers, and health officials as a case study on ways in which prevalent approaches toward the issue of health inequality may be translated into policy practice.
Sophie Ces,
Catholic University of Louvain, Belgium
Title: Estimation Of The Cost Of The Home-Based Support Of The Frail Older People Living At Home In Belgium
Time : 14:10-14:25
Biography:
Sophie Ces has a Master’s degree in health economics (2005, Conservatoire des Arts et Métiers Paris,). Since 2012, she is a Phd candidate in public health at Universite Catholique de Louvain.
Abstract:
The article focuses on the estimation of the costs of long term care, both formal and informal care, provided to the frail older people living at home in Belgium. A typology of situations is built by combining the level of impairment and the presence of informal caregivers is used to describe the costs of long term care. The cost estimation is performed for the patients, the informal caregivers, the National Institute for Health and Disability Insurance.Individual data are collected through patient questionnaires: the inter RAI Home Care instrument and an ad-hoc questionnaire for assessing the utilisation of non-health care services at home and the time spent on informal caregiving. In complement, the data of the reimbursed health care consumption (routinely recorded by the health care insurance) is also available for the sample. The “normal” consumption part for the household aid, pedicure or meals-on-wheels has to be retrieved since they are not specific to frailty. Therefore, to obtain a sample of individuals with similar characteristics (e.g. the age, the socio-economic status, gender,) but without any disability, a propensity score is used. The time spent on informal caregiving is valued by using the proxy-good method. The costs of the health care reimbursed services are directly available in the official database. The estimation of the different cost components of long care for the frail older people living at home will allow an accurate description of the contributions of the main stakeholders in Belgium according to the different types of situations (impairment level/informal caregiver presence).
Jessica Ho
Central Queensland University, Australia
Title: The Consumerisation Of Healthcare Data In Australiaa
Time : 14:25-14:40
Biography:
Jessica Ho is currently finishing her PhD thesis - 'Building an Australian Health Interoperability Framework' with Central Queensland University. She is currently working in the Australian Government, as the CIO for Australian Financial Security Authority. She is an experienced IT executive with extensive background delivering large and complex programs in change and digital transformation agenda. She has published a number of papers and co-authored books in the field of health informatics.
Abstract:
Consumerisation of healthcare data is an inescapable growing trend worldwide. With the evolution of technology, the availability and increased affordability of new health gadgets, health care consumers are consuming these devices and applications in drove. Data, in particular health data are swapped, exchanged, saved in memory, saved in cloud, within a number of different platforms, standards, ready to be manipulated, shared, uploaded in other social media spaces. Health care consumers are increasingly taking an active role in their care experience and are evermore empowered to choose their own care alternatives, consulting with "Dr. Google", easily available health information and their social circles. Today's patients are used to having mobile tools at their fingertips to access and manage information anywhere, anytime. There is a greater expectation for personalised experience in healthcare. The implementation of Australia current e-Health agenda may not be sufficient in keeping up with the demand from health care consumer. This paper aims to examine the economic impact of the consumer health care technology evolution and the opportunities it will bring in lowering the cost of care and improving current state of health funding, most importantly, the improvements to the overall health outcomes and wellbeing of health consumers.
Selden Coskun
Isık University, Istanbul
Title: A Theoretical Assessment On The Relationship Of Hospital’s Quality And Accreditation Applications With Asymmetric Informationa
Time : 14:40-14:55
Biography:
Selden COSKUN has been Graduated from Chemical Engineering and made a master degree on chemical engineering and on business administration. Later on she worked as professional on medical device sector as a quality profession. Now she is giving lectures at Isık University on quality at health sector and on occupational health & Safety. Meanwhile she is also on her last quarter to finish her PhD on health management at Okan University , Istanbul.
Abstract:
Many country governments try to control the hospital costs and make re-arrangements in health systems. In other respect, the quality phenomenon which is been adding to all products, is also effective in hospital sector. The basic reasons of increased health expenditures are an increase in the life time, development of health acknowledgement among people, use of advanced technology and except these factors problems due to asymmetric information also exist. At the same time in Turkey and in all over the world, both in public hospitals and private hospitals quality management systems are spreading wide. By the quality management systems the loaded cost also increases more. Information asymmetry and the demand that has been made by supply problem is getting layered by the rapidly developing quality phenomenon. In this work the effect of hospital quality costs to asymmetric information has been evaluated by analyzing publishes from foreign and internal releases. Under a theoretical perspective in a short period analyses, limiting the supply by quality management systems and because of the cost increase, the equilibrium service production level would decrease; in long term according to the increase of the information asymmetry the decrease will show up in a equilibrium according to the demand that has been occurred by supply and only the price increase will be a result.
Manhal Mohammad Ali
University of Manchester, UK
Title: Hospital Heterogeneity: What Determines The Quality Of Care?
Time : 15:10-15:25
Biography:
Manhal Mohammad Ali is a 3rd year Ph.D. student at Alliance Manchester Business School and researching in the area of health economics. His research specifically focuses on healthcare performances measured by quality, productivity, organizational and managerial performances and, trying to understand what causes their variations. He completed his MSc and BSc in Economics from the University of Bristol and the University of Greenwich respectively and worked as senior Lecturer at East West University, Bangladesh. His other research interests include econometrics, causal inference, digital economy and big data.
Abstract:
A feature of health care systems, for instance, the NHS is the presence of heterogeneity in health care quality across hospitals. This study seeks to understand what internal and external hospital based factors are responsible for explaining variations in quality of care measured using the processes of care in the case of stroke. We used NHS trust data from National Sentinel Stroke Audit from 2004 to 2010. The data were merged with other administrative data sets to capture hospital’s characteristics. We employed a new class of panel regression tree estimators from the machine learning literature to study the data. A reason behind the choice of the method is the intuitive interpretability of the results. The non-parametric method has the capability to reveal potential interactions among the variables, which could offer valuable information about the processes driving variations in quality across NHS hospitals. The study found complex interactions or complementarities amongst the hospitals organizational, structural and regional level factors in determining quality with organizational factors for stroke care to be the most important predictors. The main results from the tree method are robust to alternative specifications and methods for instance, linear and fixed effect models which control for fixed effects. Cross validations and in sample statistics were carried out to assess the sample predictive performances and fit the data. The findings shed new light on previous research determinants of healthcare quality by identifying critical interactions. The findings helped us to improve and inform policy decisions for quality improvement by identifying the factors that drive quality.