Aida Isabel Tavares

Substitutes or Complements? Diagnosis and Treatment with Non-Conventional and Conventional Medicine

BACKGROUND Portugal has a strong tradition of conventional western healthcare. So it provides a natural case study for the relationship between Complementary/Alternative Medicine (CAM) and Western Medicine (WM). This work aims to test the relationship between CAM and WM users in the diagnosis and treatment stages and to estimate the determinants of CAM choice. METHODS The forth Portuguese National Health Survey is employed to estimate two single probit models and obtain the correlation between the consumption of CAM and WM medicines in the diagnosis and treatment stages. RESULTS Firstly, both in the diagnosis and the treatment stage, CAM and WM are seen to be complementary choices for individuals. Secondly, self-medication also shows complementarity with the choice of CAM treatment. Thirdly, education has a non-linear relationship with the choice of CAM. Finally, working status, age, smoking and chronic disease are determinant factors in the decision to use CAM. CONCLUSION The results of this work are relevant to health policy-makers and for insurance companies. Patients need freedom of choice and, for the sake of safety and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint and integrated health system.

Physical activity and healthy diet: determinants and implicit relationship

OBJECTIVE People who decide to lose weight by dieting often do so without participating in any associated physical activity. Although some people who participate in sports are unconcerned about their diet, it is generally believed that people who exercise tend to eat a healthy diet and those who do not exercise eat a less healthy diet. There is no clear relationship between the decisions regarding participation in physical activity and eating a healthy diet when choices are taken freely and not influenced by policy factors promoting healthy behaviour. However, these decisions may reveal some common explanatory factors and an implicit link. As such the aim of this study was to identify the common explanatory factors and investigate the existence of an implicit relationship. STUDY DESIGN Econometric estimate - bivariate probit estimation. METHOD Using data from the Portuguese National Health Survey, a bivariate probit was undertaken for decisions regarding participation in physical activity and eating a healthy diet. The correlation between the residuals gives information on the implicit relationship between the healthy choices. RESULTS Common explanatory factors were found between the decisions to eat healthy snacks and participate in physical activity, such as being married. However, holding voluntary private health insurance, smoking, getting older, living alone and unemployment were found to dissuade people from making healthy choices. Positive correlation was found between the residuals of the probit estimations, indicating that other unmeasurable variables have a similar influence on both decisions, such as peer pressure, cultural values, fashion, advertising and risk aversion. CONCLUSIONS Further research is needed to improve understanding of decision making related to participation in physical activity and eating a healthy diet. This will facilitate the design of policies that will make a greater contribution to healthy lifestyles.

Health insurance and lifestyles

This article contributes to the discussion surrounding the existence of ex ante moral hazard and propitious selection in a voluntary private health insurance scenario. Moreover, it provides an estimation of the determinants of lifestyle choices and of private health insurance demand. A multivariate probit is estimated for health insurance demand and lifestyle decisions to take into account the potential endogeneity of these decisions. The results indicate that there is evidence of ex ante moral hazard in deciding to do sports and eating healthy snacks. Hence, no propitious selection has been found for these decisions. Another relevant result shows that there is no individual heterogeneity for the lifestyle choices, except for smoking, and private health insurance choice. Evidence from the results also supports the idea that there are nonobservable variables playing a role in the lifestyle decisions. These results provide some directions for policymakers, such as the promotion of precautionary behaviours and the use of implicit lifestyle drivers to promote healthy choices by people.

eHealth, ICT and its relationship with self-reported health outcomes in the EU countries

This work contributes to the discussion on the relationship between ICT and ehealth solutions in primary care, and self-reported health and health status in the European Union. The method used is an ordinary least squares linear model. The results show that there is no significant relation between self-reported health outcomes and ICT and ehealth indexes, except for self-reported chronic health problems. The more advanced that countries are in ICT, the larger is the share of people reporting a chronic health problem. This provides evidence on the existence of a link between chronic patients and ICT development.

EU health systems classification: a new proposal from EURO-HEALTHY

BackgroundIn accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems.MethodsThree methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data were mainly collected from the WHO and Eurostat databases.ResultsThe most relevant result is the proposed classification of health systems into the following clusters: Austria-Germany, Central and Northern Countries, Southern Countries, Eastern Countries ‘A’ and Eastern Countries ‘B’.ConclusionsThe proposed typology contributes to the discussion about how to classify health systems; the typology of EU health systems allows comparisons of characteristics and health system performance across clusters and policy assessment and policy recommendation within each cluster.

Generic substitution policy, an incentive approach

Generic substitution policy has been adopted in several countries in order to control health expenditures. Using a model based on incentives, this work aims to analyze the response of doctors and pharmaceutical companies to the implementation of this policy. It is shown that after the implementation of GSP, the effort of doctor’s convincing the patient to take generics increase or decrease depending on his level of concern for patient well-being; pharmaceutical companies decrease the amount of detailing and the market share of generics tends to increase.

Infant mortality in Europe, socio-economic determinants based on aggregate data

ABSTRACT A great deal of research has been conducted on the determinant factors of infant mortality. In this work, the focus is placed on the aggregate determinants of infant mortality in the EU. Data is collected from Eurostat and World Health Organization – Health for All databases for the period 2005-12. Robust regressions and panel data regressions are estimated in order to test the main determinants of infant mortality in the EU. Both the GDP and birth before the age of 20 influence infant mortality rate. It is likely that as mothers mean age at the first child increases, the rate of infant mortality decreases. The results found here contribute to the discussion on the factors explaining infant mortality in Europe and to future health policy. In particular, controlling teen motherhood may help to reduce infant mortality rate in the EU.

The Challenge of Complementary and Alternative Medicine After Austerity: A Response to Recent Commentaries

Complementary and Alternative Medicine (CAM) is frequently used in Portugal and it contributes to the improvement of peoples health. CAM and Western Medicine (WM) are taken as complements both in the diagnosis and the treatment stage. The Portuguese health system is able to generate certified CAM professionals but the provision of CAM care and services is not included in the national health system. In times of austerity, this is not expected to change and access to CAM care continues to be out-of-pocket health expenditure. But the future for health in Portugal may well involve including CAM therapies in an integrated health system.

Doctor-Nurse Teams, Incentives and Behavior

Nurses have been gaining expertise over time and it is common that they work together in a team with doctors to treat patients. Using a model based on contract theory, the aim of this article is to analyze the effects of an improvement in nurses’ productivity on the incentives paid and on the behavior of doctors and nurses, in particular when the budgets are limited. The results show that following an improvement in nurse productivity, nurses’ incentives are lower but the overall budget of incentives is higher. Under a restricted health care budget, results show that the treatment of patients is mainly carried out by nurses, and not doctors, reflecting free-riding by doctors. The contribution of this work is particularly relevant for human resources policy makers in primary health-care units.