Gordon G. Liu

Inappropriate Medication Use and Health Outcomes in the Elderly

Inappropriate medication use is a major problem for the elderly. Although increasing attention has been paid to inappropriate prescription medication use, most previous research has been limited to the investigation of prevalence and trends. Few studies provide the empirical evidence for the adverse effect of inappropriate medication use on health outcomes at the national level. This study is the first attempt to assess the relationship between inappropriate prescription use and health status for the elderly in the United States.

Equity in health care access to: assessing the urban health insurance reform in China ☆

This study evaluates changes in access to health care in response to the pilot experiment of urban health insurance reform in China. The pilot reform began in Zhenjiang and Jiujiang cities in 1994, followed by an expansion to 57 other cities in 1996, and finally to a nationwide campaign in the end of 1998. Specifically, this study examines the pre- and post-reform changes in the likelihood of obtaining various health care services across sub-population groups with different socioeconomic status and health conditions, in an attempt to shed light on the impact of reform on both vertical and horizontal equity measures in health care utilization. Empirical estimates were obtained in an econometric model using data from the annual surveys conducted in Zhenjiang City from 1994 through 1996. The main findings are as follows. Before the insurance reform, the likelihood of obtaining basic care at outpatient setting was much higher for those with higher income, education, and job status at work, indicating a significant measure of horizontal inequity against the lower socioeconomic groups. On the other hand, there was no evidence suggesting vertical inequity against people of chronic disease conditions in access to care at various settings. After the reform, the new insurance plan led to a significant increase in outpatient care utilization by the lower socioeconomic groups, making a great contribution to achieving horizontal equity in access to basic care. The new plan also has maintained the measure of vertical equity in the use of all types of care. Despite reform, people with poor socioeconomic status continue to be disadvantaged in accessing expensive and advanced diagnostic technologies. In conclusion, the reform model has demonstrated promising advantages over pre-reform insurance programs in many aspects, especially in the improvement of equity in access to basic care provided at outpatient settings. It also appears to be more efficient overall in allocating health care resources by substituting outpatient care for more expensive care at emergency or inpatient settings.

Urban Air Quality and Health in China

Urban air pollution is one of the most visible environmental problems in China. In this paper, we use emission inventory data to assess the air quality and health effects in the Chinese city of Shijiazhuang. A spatial model is developed to identify the sources of emissions and to estimate population exposure to high ambient concentrations. Dose-response functions are used to quantify the impact on human health. Our results show significant health costs associated with Shijiazhuangs high concentration of sulphate, a fine particulate matter originating mainly from coal consumption. Policy implications are explored by evaluating alternative pollution control options. The use of cleaner coal is found to be the most cost effective in improving urban air quality and reducing human exposure.

Economic costs to business of the HIV/AIDS epidemic

HIV infection is a devastating disease for individuals and society. The economic burden of employees with HIV infection is a matter of increasing concern for employers. The purpose of this paper was to conduct a comprehensive review of published studies which measured/estimated economic costs incurred by HIV-infected employees, and evaluate the potential economic impact of the HIV/AIDS epidemic on business in different countries. This review finds a conceptual consensus in the literature that suggests that the HIV/AIDS epidemic has a potentially sizable economic cost to business, primarily due to increased costs for employment-based insurance premiums, welfare benefits, lost productivity, new hiring and training, and a downsized economy and labour market.Based on published data in the US, accounting for the first three major cost items, in 2002 an HIV-infected worker would cost an employer in the US an estimated

Cost Comparisons of Olanzapine and Risperidone in Treating Schizophrenia

US37 320 for asymptomatic individuals and

Equity in health care financing: evaluation of the current urban employee health insurance reform in China.

US50 374 for symptomatic individuals per person-year. However, this review found little consistent empirical data in the literature regarding the scale of disease costs specific to businesses in different settings. In addition, the current literature offers little guidance in terms of well designed, validated, and easily replicated analytical frameworks for conducting a comprehensive cost analysis from a business perspective.Future research is needed to improve both the theoretical modelling and empirical work in assessing the full economic impact of the HIV/ADIS epidemic on patients, businesses and society at large.

An Economic Cost Analysis of Oral Ganciclovir Prophylaxis for the Prevention of CMV Disease

OBJECTIVE: To review the literature on the healthcare costs associated with olanzapine and risperidone in treating schizophrenia. DATA SOURCES AND STUDY SELECTION: Published English-language pharmacoeconomic studies on olanzapine and risperidone obtained through a MEDLINE search (1990–May 2003) were selected. Additional studies were identified from a manual search of the references of retrieved articles. DATA EXTRACTION: Based on the identified studies, data were extracted on various treatment costs associated with the use of antipsychotic drugs, concomitant drugs from other classes, inpatient care, outpatient care, and emergency care. Emphasis was placed on studies directly comparing olanzapine and risperidone. DATA SYNTHESIS: Both olanzapine and risperidone were generally associated with a trend of decrease in total medical costs compared with typical antipsychotics. When directly comparing the drugs, some studies found significant cost savings in favor of olanzapine and some suggested risperidone to save total costs. Still others showed no significant difference in total costs between the 2 drug regimens. CONCLUSIONS: While both olanzapine and risperidone appear to be more cost saving than typical antipsychotics, the literature offers no conclusive evidence to determine the comparative advantage of one versus another in terms of total cost outcomes. Major factors that contribute to the inconclusive findings may include across-study variations in populations, design, outcome measures, dosage, severity of illness, inclusion criteria, and statistical methodologies.

Potential Expanded Use of Pharmacoeconomics and Outcomes Research in China

ABSTRACT This paper uses multi-year, individual-level data to evaluate the effects of the current Chinese urban employee health insurance reform on equity in health care financing. It found that the new Urban Employee Basic Health Insurance Scheme financed by personal medical savings accounts (MSAs) plus a social-risk pooling account (SPA) is regressive. The contributions to the SPA, although slightly regressive, played an important role in equalizing health care financial burden; the payments from the SPA favored low-income insured employees. The introduction of MSAs has resulted in more resources being available for high-income insured employees and an increased burden on low-income ones. The amount of resources currently collected by the new program would achieve equity in health care financing if they were pooled in a social insurance fund without MSAs. These results have important policy implications for both China and other countries contemplating implementing MSAs.

Children’s Health Insurance Status and Emergency Department Utilization in the United States

AbstractPurpose. The study conducted an economic cost analysis oforal ganciclovir prophylaxis in preventing cytomegalovirus (CMV) disease forAIDS patients in a randomized clinical trial setting. Methods. Data were generated from patient interviews,medical records, and case reports from a multi-center, randomized,double-blind, and placebo-controlled pharmacoeconomic study appended to aclinical trial. The outcomes were measured in monthly cost per patient.Various cost functions were tested in the context of sample-selection model(SSM) and two-part model (TPM), and were estimated using both the ordinaryleast squares (OLS) and the bounded influence estimation (BIE) methods. Results. The use of informal caregiver services did notdiffer significantly between patients in the treatment group and those inthe placebo group. The OLS estimates for the ganciclovir prophylaxis armshowed a reduced, but statistically insignificant use of formal care in bothoutpatient and inpatient settings. The BIE results for the ganciclovirprophylaxis arm, in contrast, showed a significant reduction of 27%in hospital cost among hospital users, and 44% among the total sampleof AIDS patients. The monthly total cost function also identified adecreasing but insignificant trend due to the treatment effect. Conclusions. At the methodological level, this studydemonstrated the value of employing more rigorous econometric techniques inidentifying subtle treatment effects on cost outcomes from clinical trialdata in the economic assessment of medical technologies. At the empiricallevel, the study concluded that beyond its demonstrated efficacy ofpreventing CVM disease among AIDS patients, ganciclovir prophylaxis did notlead to additional health care costs, other than the cost of the drugtherapy.

Direct Cost Analyses of Palivizumab Treatment in a Cohort of At-Risk Children: Evidence From the North Carolina Medicaid Program

In an era of cost containment and managed care, pharmacoeconomics and outcomes research are increasingly used in both public and private sectors to improve the allocation of healthcare and pharmaceutical resources. While this trend has been well observed in developed nations, little is known about its status in developing countries. This article presents an overview of pharmacoeconomics and outcomes research in China.This article highlights the increasing demand and great market potential for pharmacoeconomics and outcomes research in China. This is largely based on a number of observations: the impact of China’s growing economy, dominant pharmaceutical expenditures, and World Trade Organization (WTO) entry.China is among the fastest growing economies. It is currently the seventh largest economy in the world, and is creating a strong income effect on the demand for pharmaceutical use and application of pharmacoeconomics in allocating limited resources. Pharmaceutical expenditure accounts for over 50% of total healthcare costs in China, making the pharmaceutical market a central focus of recent healthcare reforms. Thus, demand for cost-effectiveness data is expected to play an increasingly critical role in shaping both public and private policy making in the pharmaceutical market.China’s recent entry into the WTO is resulting in unprecedented changes in the pharmaceutical industry. Among other benefits, trade barriers will be reduced substantially, leading to an even more competitive pharmaceutical market than before. Furthermore, mechanisms for market competition are anticipated to change from traditional cost-based pricing to a basis of cost-effectiveness and outcomes assessment as the health insurance, drug distribution, and pharmacy markets become open to foreign vendors.