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CINCH - Health Economics Research Center

Monday Health Economics Seminar

26.06.2018

On Monday, July 2 2018, 14:00 - 15:30, Eliana Barrenho (Imperial College London) will present:

The role of physician and environment-specific factors in the adoption behaviour of new technologies

Despite substantial research documenting extensive variations in healthcare delivery and rates of innovation, relatively little is known about what drives physicians’ decisions.

The proposed research builds on the literature on adoption of innovation and practice variation aiming to understand the role of physician and environment-specific factors in the adoption behaviour.  Particularly, we propose to assess how factors such as “school of thought” affect adoption of innovations.  Moreover, we will assess how these decisions are shaped by environment-specific factors, in particular, competition and collaboration.  Through collaborative practice we might expect practice spillovers across organizations to contribute to decreased variability in the technology adoption across practice settings. Under competition hospitals might engage in a “medical arms race” to attract more patients, leading to technology usage differences across providers.

Qualitative research carried out through interviews to experts informs us which factors affect the uptake of laparoscopic surgery in colorectal cancer treatment.  We test the hypotheses generated by this process by assembling a rich dataset based on hospital administrative records and information on clinicians’ career path. We use patient level data for all colorectal cancer surgeries performed between 2000 and 2014 by 3,522 consultants and across 200 publicly funded hospitals in England. We match information on clinicians’ training and job experience back to 1992. The choice of colorectal cancer relates to its rapid innovation and high incidence, the associated costs for taxpayers, and the fact that there are guidelines intended to reduce variation but in which the UK lags behind European counterparts in survival rates.

Our descriptive analysis shows a typical S-shaped diffusion curve. In 2000 less than 1 percent of the elective colorectal cancer surgeries were undertaken laproscopically. By 2006, the year in which the guidelines were introduced, this proportion had risen to 15 percent. And by 2014 this proportion had risen to 65 percent.  Analysis of the sample variance shows that consultant level characteristics persistently explain more than 40% of uptake variation, even if we consider different exposures to guidelines and technological environment.

Our results suggest that physician-specific factors, namely the “innate talent” are key drivers of the early adoption of laparoscopic techniques. Moreover, both encouragement and pressure from peers play a significant role on innovation adoption. We further show that clinical guidelines are generally regarded as a “tool” to persuade trusts to diffuse an innovation, rather than a determinant of innovation adoption.

Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen

To find more on upcoming seminars, click here.


Monday Health Economics Seminar

05.06.2018

On Monday, June 11 2018, 14:00 - 15:30, Katharina Blankart (CINCH, University Duisburg-Essen) will present:

The downside of the policy coin: explaining changes in off- vs. on-patent drug utilization - a decomposition approach

Generic utilization has increased at a faster rate than that of pharmaceuticals under patent protection within the last decade. In this study, we analyze to what extent the differences in changes in utilization between generic and brand name versions of pharmaceuticals over time can be explained by variation in promotional activity, competition, regulation for efficient prescribing and characteristics relevant to the prescribing physicians. We compile data from a list of generic entries, European Medicines agency brand name market authorizations, a panel of 3,025 prescribing physicians, promotional data at molecule level and information on policies for efficient drug use in Germany between 2011 and 2014. We employ an Oaxaca-Blinder decomposition approach to identify the share of unexplained variation between 1) on-patent (70 substances) and off-patent markets (51 substances) and 2) generic and brand name markets in the off-patent market (49 substances each). We account for common support of the explanatory variables and drug class fixed effects. Outcome variables reflect growth rates and first differences by the number of prescriptions, sales, number of patients prescribed and prescriptions per patient between the first quarters of 2011 and 2014. The partial regression results suggest heterogeneous effects of promotion and regulation specific characteristics (share of aut-idem prescriptions, reference pricing) by outcomes analyzed while changes in competition had similar effects. Across outcome specifications, we find that the component attributable to differences in the observed characteristics of off-patent and on patent markets (5.66% at maximum) and generic and branded substances (8.85% maximum) is small. Our results may suggest specification of a generic market structure function. Increases in generic utilization seem largely beyond regulators’ control of economically efficient prescribing

Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen

To find more on upcoming seminars, click here.


Monday Health Economics Seminar

29.05.2018

On Monday, June 4 2018, 14:00 - 15:30, Markus Fels (TU Dortmund) will present:

Incentivizing Efficient Utilization Without Reducing Access: The Case Against Cost-Sharing in Insurance

Cost-sharing is regarded as an important tool to reduce moral hazard in health insurance. Contrary to standard prediction, however, such requirements are found to decrease utilization both of efficient and of inefficient care. I employ a simple model that incorporates two possible explanations - consumer mistakes and limited access - to assess the welfare implications of different insurance designs. I find cost-sharing never to be an optimal solution as it produces two novel inefficiencies by limiting access. An alternative design, relying on bonuses, has no such side effects and achieves the same incentivization.

Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen

To find more on upcoming seminars, click here.