Teresa M. Waters

Why do people drink? Tests of the rational addiction model

The rational addiction (RA) model applied to alcoho consumption is tested using 1983 US Health Interview Survey data. The RA model yields refutable hypotheses concerning effects of current, past, and future prices, past and future consumption, time preference and marginal utility of wealth on addictive good consumption. The estimations provide relatively strong support for the RA model. Past and present consumption had strong positive relationship with current consumption. Coefficients on past, present, and future money prices and fines for first oflence drunk driving (as a form of price for alcohol consumption) were significant and of the predical sign.

The economic impact of intermittent high-dose intravenous versus oral corticosteroid treatment of juvenile dermatomyositis

OBJECTIVE To perform a cost-identification and cost-effectiveness analysis comparing oral corticosteroids (OCS) with high-dose intermittent intravenous corticosteroid (IVCS) regimens in the treatment of juvenile dermatomyositis (JDM). METHODS Children previously diagnosed and treated for JDM (without myositis-specific or myositis-associated autoantibodies) at a single medical center by a single provider were identified. Two treatment protocols were compared: OCS and IVCS. Data on initial disease severity, time to remission, resource use, and costs generated were collected from patient records. Incremental cost-effectiveness ratios (ICE) were constructed. RESULTS Patients treated with IVCS achieved median remission 2 years earlier at median increased cost of

Economic Analyses in Clinical Trials for Cooperative Groups: Operational Considerations

13,736. The ICE ratio comparing IVCS to OCS is

COMPETITIVE BIDDING FOR MEDICARE SERVICES

6,868 per year of disease avoided. CONCLUSION This study suggests that, although IVCS treatments are costly, they are cost-effective.

Costs and cost-effectiveness of new technologies in cancer.

Clinical trials have served as valuable tools for evaluating new therapeutic strategies in the treatment of cancer. Traditionally, new pharmaceuticals and procedures have been appraised on the basis of effectiveness, efficacy, and safety. Recently, economic concerns have become increasingly important when considering treatment strategies for cancer patients. The national emphasis on assessing the costs of health care has focused primarily on the cost-effectiveness of resource allocation. Policy makers are exhibiting greater interest in economic data to supplement clinical data of new procedures and pharmaceutical agents before the approval and widespread application of such methodologies. Clinical trials have increasingly become viewed as a proper setting for such economic analyses. In this paper, we review operational details for carrying out economic analyses of clinical trials being conducted in the cancer cooperative group setting.

The national practitioner data bank: promoting safety and quality.

One of the key issues in implementing prospective Medicare fee schedules is how to set prices that accurately reflect competitive market forces. Competitive bidding has long been used in government procurement efforts for nonhealth services. In this paper, we evaluate how provider behavior will be affected if Medicare uses competitive bidding to set Medicare fee schedules. Our model provides several important insights about competitive bidding for health care services. First, the model shows that competitive bidding will lead to 2-stage competition between providers. In the bidding stage, providers will compete to submit winning bids. In the following stage, winning providers will compete for business through marketing efforts that may enhance quality. Second, the model shows how the design of the bidding mechanism affects bidding strategies and the importance of individual provisions within the design, such as penalties for losing bidders. Third, the model demonstrates how competitive bidding will affect quality. It shows how quality may deteriorate if the bidding mechanism chooses an exclusive winner and why naming multiple winners can keep quality at acceptable levels. Finally, we identify criteria for determining whether a particular type of Medicare service is well-suited for competitive bidding.

Health care economics and bone marrow transplantation.

The delivery of healthcare has changed significantly, from the perspective of both physicians and patients, in recent years. Previously, the physician was the advocate of the patient, and the insurer was only a distant, third-party observer who picked up the bill at the end. There were many advantages to this system of care: the patient received high quality care and could be relatively sure that his physician was doing everything possible for him, physicians were free to operate in a relatively independent manner which was professionally satisfying, and America was home to some of the most cutting-edge technologies in the world.

Physicians as double agents: maintaining trust in an era of multiple accountabilities.

The National Practitioner Data Bank attempts to help maintain a level of quality and safety assurance by providing data on the clinical competence of physicians. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Economic analyses of new technologies: the case of stem-cell transplantation.

Cancer care is expensive, and Americans paid over

Ethnicity and access to care in systemic lupus erythematosus : Gender, glass, and ethnicity/race

35 billion for cancer related treatment in 1990. One of the most costly cancer treatments is bone marrow transplantation (BMT) for malignant diseases which, in 1989, cost approximately