THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE? Manuel García-Goñi ...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE? <ul><li>Outline </l...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  INTRODUCTION <ul>...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  INTRODUCTION <ul>...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  Educational progr...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  Educational progr...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL <ul><li...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL <ul><li...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL <ul><li...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL <ul><li...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL <ul><li...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL Scenari...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL I I* TM...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE MODEL Result ...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THE CASE STUDY <u...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  ESTIMATION METHOD...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  RESULTS <ul><li>D...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  RESULTS Dependent...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  RESULTS Dependent...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  RESULTS Dependent...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  RESULTS Dependent...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  CONCLUSIONS <ul><...
THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?:  THANK YOU! THANK ...
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Manuel García Goñi

  1. 1. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE? Manuel García-Goñi (Universidad Complutense de Madrid, e-mail: mggoni@ccee.ucm.es) Paul Windrum (MMUBS, e-mail: p.windrum@mmu.ac.uk)
  2. 2. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE? <ul><li>Outline </li></ul><ul><li>Introduction </li></ul><ul><li>Educational programs and information used by patients </li></ul><ul><li>The model. </li></ul><ul><li>The case study </li></ul><ul><li>Estimation Methods </li></ul><ul><li>Results </li></ul><ul><li>Conclusions </li></ul>
  3. 3. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: INTRODUCTION <ul><li>Grossman (1972) offers a model on the demand of health services: </li></ul><ul><ul><li>Health is included into the stock of human capital </li></ul></ul><ul><ul><li>Individuals are able to invest in health and become potentially investors in health status. </li></ul></ul><ul><li>Inputs for the individual investment in health </li></ul><ul><ul><li>Diet, exercise, lifestyle,… </li></ul></ul><ul><ul><li>Information </li></ul></ul><ul><ul><ul><li>Patients with more and better information prevent better their health status (Viscusi, Magat and Huber, 1986) </li></ul></ul></ul><ul><ul><ul><li>Strong correlation between health and education (Kenkel, 1991; deWalque, 2007) or between health and income (Sen, 1999; Bloom and Canning, 2000; Currie and Gruber, 1996). </li></ul></ul></ul><ul><ul><ul><li>Better educated or with greater income people, or with more information, usually take better health-related choices, and therefore, they use and demand MORE health services (Kenkel, 1990), as they know better the marginal utility of their choices </li></ul></ul></ul>
  4. 4. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: INTRODUCTION <ul><li>It is not only important the information available for the patient, but also the way in which the information is obtained , using more and more lately new ways of reach doctors, as the Internet (Wagner, Hu, and Hibbard, 2001). </li></ul><ul><li>Hence, it is important how individuals receive information relative to their health status. </li></ul><ul><ul><li>And health policy makers can influence that information through the educational programs to patients and population. </li></ul></ul><ul><li>In this article, we develop a model in which there are two different styles of health information provision to patients. </li></ul><ul><ul><li>We study and compare both models to test whether there are differences in the way each model provide the information, in order to see whether one of them is more beneficial than the other for different types of patients. We differentiate between: </li></ul></ul><ul><ul><ul><li>Chronic </li></ul></ul></ul><ul><ul><ul><li>Acute </li></ul></ul></ul><ul><ul><li>The difference with other articles in the health economics literature is that usually information is presented as a homogeneous good for everyone. Here, information is going to be good for all patients, chronic and patients, but we examine the differences in the need of information of both types of patients, and thus, in the effect information might have in them. </li></ul></ul>
  5. 5. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: Educational programs and information used by patients <ul><li>The idea of the model on the importance of information under different types of patients and educational programs can be presented as: </li></ul><ul><ul><li>In the literature, health information is a homogeneous good for every patient, increasing the knowledge of the utility promoted by health service provision, and thus, increasing the demand of health services (Kenkel, 1990). </li></ul></ul><ul><ul><ul><li>INFORMATION EFFECT = INCOME EFFECT in a normal good </li></ul></ul></ul><ul><ul><li>In our model, information is not homogeneous in the sense that different types of patients obtain different utility, as their need of health services is different (chronic and acute). </li></ul></ul><ul><ul><ul><li>Acute patients do not need as much health information as chronic patients. Chronic patients benefit more from information because their need to learn with their health conditions is greater, as they will have the condition for a long time and changes in lifestyle or habits will reduce more their need of health services than for acute patients. </li></ul></ul></ul><ul><ul><ul><li>MORE INFORMATION ALSO SUPPOSES A SUBSTITUTION EFFECT </li></ul></ul></ul>
  6. 6. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: Educational programs and information used by patients <ul><li>Traditional Model: </li></ul><ul><ul><li>Patients are a passive agent in the health production function. Only the health producer acts, and patients follow the provision of health services (?) if they do. </li></ul></ul><ul><ul><li>Health services are the control variable for health policy makers </li></ul></ul><ul><ul><li>When we talk about information, the Traditional Model consists of information given to patients without interaction. The consequence is that information is valuable… but barely affect the lifestyle or habits. </li></ul></ul><ul><li>… The preferences of patients evolve in time with respect to the relationship they have with doctors. Patients prefer more information to less information (Vick and Scott, 1998)… </li></ul><ul><li>“ Patient-Centred health” Model: </li></ul><ul><ul><li>The patient plays an active role in the provision of health services or information. </li></ul></ul><ul><ul><li>Through better information on their health status, patients can improve their lifestyle, or habits in order to prevent their illness compared to the TM model. </li></ul></ul><ul><ul><li>In terms of health policy, it is needed to promote a different relationship between doctors and patients as it is possible to influence the health production function with information. </li></ul></ul>
  7. 7. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL <ul><li>Utility for patients depends on </li></ul><ul><ul><li>Need of health services: we do not model ex post moral hazard and demand of health services is fully determined by need. Need depends on lifestyles, which is the variable controlled by patients, depending on </li></ul></ul><ul><ul><ul><li>Information available for patients </li></ul></ul></ul><ul><ul><ul><li>Educational level or income level </li></ul></ul></ul><ul><ul><li>Information available I : variable controlled by health providers or policy makers, but not by patients. It can stem from PC or TM models. </li></ul></ul><ul><ul><li>Education or income variables Z : not controlled by neither patients or health providers, as income, education, genetics, and so on. Might be observed or not. </li></ul></ul><ul><ul><li>Cost: separable function for health service provision AND health information provision </li></ul></ul>
  8. 8. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL <ul><li>There are two agents: </li></ul><ul><ul><li>Patients: choosing their healthy lifestyle </li></ul></ul><ul><ul><li>Health providers or policy makers: choosing the level of education for patients </li></ul></ul><ul><li>Model is solved by backwards induction: First, the patients problem and then, the health providers problem. </li></ul>
  9. 9. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL <ul><li>the consumers’ problem </li></ul>The first order condition is provided by: And here we can solve for: .
  10. 10. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL <ul><li>the provider or policy maker’s problem </li></ul>The first order condition is provided by: . From the first order condition we obtain: From the first order condition we obtain: Now, it is interesting to solve this foc taking into account the assumptions given in each of the educational programs
  11. 11. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL <ul><li>Scenario 1: Traditional Model </li></ul><ul><li>Under TM, </li></ul><ul><li>and then, from the foc we obtain: </li></ul>I i I* TM Figure 1: optimal Choice of information level under the TM model
  12. 12. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL Scenario 2: Patient-Centred Model Let us divide equation 7, from the first order condition into two parts: and Under the PC model, and from the first order condition in equation 7 we cannot ignore the first part of the equation as we did under the TM model because now . Lets manipulate the terms to show that: And from here we solve for I* PC . Result 1: The optimal level of information provided to individuals is greater under the PC model than under the TM model.
  13. 13. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL I I* TM Figure 2: optimal Choice of information level under the PC compared to the TM model I* PC i
  14. 14. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE MODEL Result 2: Optimal level of information is greater for chronic patients than for acute patients when the PC model is used. I Figure 3: Optimal choice of information level under PC for chronic and acute patients i
  15. 15. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THE CASE STUDY <ul><li>In this paper, we utilize in the empirical part the change in the educational program for chronic patients with diabetes type 2 in Salford PCT programme in Manchester, UK. </li></ul><ul><li>The change consists of going from a TM model to a PC model from one year to another. As a consequence, there is no risk of selection bias. </li></ul>5% 4% 4% 13% 26% 20% Drop out rate 61/64 = 95% 50/52 = 96% 111/116 = 96% 47/54 = 87% 48/65 = 74% 95/119 = 80% Proportion 61 50 111 47 48 95 # patients who complete the course 64/96 = 67% 52/88 = 59% 116/184 = 63% 54/103 = 52% 65/141 = 46% 119/244 = 49% Proportion 64 52 116 54 65 119 # patients who attend 1 st session 96 88 184 103 141 244 # patients contacted with appointment Women Men Total Women Men Total   Traditional Program Patient Centred Program
  16. 16. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: ESTIMATION METHODS <ul><li>Diff in diff estimation </li></ul><ul><li>Dependent variables: </li></ul><ul><li>Comprehension: What are the symptoms of diabetes? </li></ul><ul><li>Need: HbA1c blood test </li></ul><ul><li>Preferences: : “ How often have you looked at the learning materials provided on your education program ?” </li></ul><ul><li>Preferences: How useful has the Salford Community Diabetes Team been? </li></ul><ul><li>Self confidence to see long run effect: </li></ul>β 3 Β 2 β 2 + β 3 Difference β 1 + β 3 β 0 + β 2 β 0 + β 1 + β 2 + β 3 After the education program β 1 β 0 β 0 + β 1 Before the education program Difference Control group &quot;Traditional program&quot; Treatment group &quot;Patient Centred program&quot;
  17. 17. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: RESULTS <ul><li>Dependent variables: </li></ul><ul><li>Comprehension: What are the symptoms of diabetes? PC IS UNDERSTOOD BETTER THAN TM </li></ul>  0,3922 R-squared       362 N 0,203 -1,28 0,0282 -0,0361 Constant 0,874 0,16 0,0313 0,0050 Older than 65 0,042 2,04 0,0302 0,0618 Sex 0,003 2,97 0,0857 0,2545 PC Model * After Change 0,000 5,29 0,0592 0,3131 After Change 0,926 -0,09 0,0042 -0,0004 PC Model           P>|t| T Std.Err. Coefficient Dependent Variable: Knowledge of Symptoms
  18. 18. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: RESULTS Dependent variables: 2) Need: HbA1c blood test : PC MODEL DECREASES THE NEED OF HEALTH SERVICES   0,0778 R-squared       410 N 0,000 84,32 0,0242 2,0395 Constant 0,468 -0,73 0,0206 -0,0150 Older than 65 0,737 -0,34 0,0200 -0,0067 Sex 0,030 -2,19 0,0218 -0,0477 PC Model * After Change 0,000 -4,04 0,0162 -0,0653 After Change 0,926 0,09 0,0267 0,0025 PC Model           P>|t| t Std.Err. Coefficient Dependent Variable: log of HbA1c blood test
  19. 19. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: RESULTS Dependent variables: 3) Preferences: : “ How often have you looked at the learning materials provided on your education program ?” PATIENTS PREFER THE PC MODEL TO THE TM MODEL   0,4116 R-squared       368 N 0,387 -0,87 0,1775 -0,1537 Constant 0,141 1,48 0,2152 0,3179 Older than 65 0,626 -0,49 0,2520 -0,1231 Sex 0,002 3,14 0,6743 2,1139 PC Model * After Change 0,000 12,44 0,2184 2,7172 After Change 0,686 0,40 0,0217 0,0088 PC Model           P>|t| T Std.Err. Coefficient Dependent Variable: How often look at materials
  20. 20. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: RESULTS Dependent variables: 4) Preferences: How useful has the Salford Community Diabetes Team been? PATIENTS PREFER THE PC MODEL TO THE TM MODEL   0,8353 R-squared       361 N 0,500 0,68 0,0652 0,0441 Constant 0,964 -0,05 0,0881 -0,0040 Older than 65 0,344 -0,95 0,0826 -0,0782 Sex 0,075 1,79 0,2358 0,4224 PC Model * After Change 0,000 20,41 0,1684 3,4366 After Change 0,919 0,10 0,0055 0,0006 PC Model           P>|t| t Std.Err. Coefficient Dependent Variable: useful of educational team
  21. 21. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: RESULTS Dependent variables: 5) Self confidence to see long run effect: PATIENTS UNDER THE PC MODEL PRESENT A GREATER LEVEL OF SELF CONFIDENCE AND THEREFORE IN THE LONG RUN IT IS EXPECTED A GREATER EFFECT IN LIFESTYLES AND THUS IN NEED OF HEALTH SERVICES   0,1857 R-squared       363 N 0,493 -0,69 0,0183 -0,0126 Constant 0,061 1,88 0,0211 0,0397 Older than 65 0,238 -1,18 0,0236 -0,0279 Sex 0,008 2,67 0,0676 0,1805 PC Model * After Change 0,013 2,51 0,0370 0,0927 After Change 0,694 0,39 0,0030 0,0012 PC Model           P>|t| t Std.Err. Coefficient Dependent Variable: self-confidence
  22. 22. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: CONCLUSIONS <ul><li>Information is good for everyone </li></ul><ul><li>However, educational programs on health are more useful for chronic patients, as they present a greater need of changing their lifestyles. </li></ul><ul><li>We present a model under which we allow for differences in educational programs, affecting (PC) their lifestyle or not (TM) following what we learned from the experience at a case study </li></ul><ul><li>With the PC model, the optimal provision of information is greater than for the TM </li></ul><ul><li>This optimal provision is even greater for chronic patients </li></ul><ul><li>At the time of determining educational programs, it is important to evaluate the need of information </li></ul><ul><li>Information, when it is provided in the right way, it is effective in improving the lifestyles, and thus, it decreases the need of health services (and healthcare cost!!!) </li></ul>
  23. 23. THE EFFECT OF INFORMATION IN THE PROVISION OF HEALTH CARE. IS INFORMATION EQUALLY USEFUL FOR EVERYONE?: THANK YOU! THANK YOU VERY MUCH!!!! Any comment: [email_address]

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