This document summarizes a presentation on provider competition in the NHS. It discusses the theory and evidence on competition, outlines NHS policy history on competition, and assesses the feasibility of competition across different health services and markets. Key points include that competition can reduce costs and waiting times but also quality if not monitored, and the appropriateness of competition depends on market characteristics like demand stability and ability to assess quality.
Tender scout imsta briefing series - collaboration between medical device s...Tony Corrigan
The document discusses medical device procurement in Ireland and the UK. It finds that collaboration between medical device suppliers and buyers can improve procurement outcomes. Currently in Ireland, price is often the dominant evaluation criteria for tenders rather than quality. Suppliers are recommended to improve the quality of their submissions and develop cost-benefit models to better demonstrate value. Industry groups should work with health services to increase capabilities in evaluating devices and support adoption of evaluation frameworks.
Public sector hospital competition improved quality and productivity in the English NHS according to a study of reforms introduced in 2006. The key findings were:
1. Hospitals located in more competitive areas pre-reform saw a relative 6.7% reduction in AMI mortality post-reform, saving approximately 300 lives per year.
2. Competition between public hospitals improved productivity, with each additional hospital associated with a 4-9% increase in lean production.
3. Entrance of private providers did not help or harm public hospital productivity but led to risk selection, leaving public hospitals with older, less wealthy patients and excess costs of £700,000 per hospital.
UK COMMUNICATIONS PROVIDER CONSUMER SWITCHING EXPERIENCE REPORT 2015Homestars
The research examined these experiences at various key stages in the switching journey, covering initial engagement with the market, assessment of switching options, decision-making on whether to switch or not, and completion among those who decided to switch. The research investigated consumer experiences at these stages in the pay TV, fixed landline, fixed broadband and mobile markets, with a particular focus on . . .
Notes: The research investigated consumer experiences at these stages in the pay TV, fixed landline, fixed broadband and mobile markets, with a particular focus on . . .
NHS finances: the challenge all policital parties need to face - charts and t...The Health Foundation
The document discusses NHS finances and the challenge of funding the NHS that all political parties must address. It provides historical data on UK public spending on health from 1949 to 2014, which shows spending increasing from 3.6% to 7.5% of GDP. The document also examines projections for NHS funding pressures, estimating a funding gap of £108 billion by 2030 if productivity does not increase. Maintaining productivity growth could reduce the gap but would require unprecedented long-term improvement. All parties will need to decide how best to fund growing demands on the healthcare system.
The document summarizes public opinion research on views of the UK's National Health Service (NHS) as it turns 65 years old. It finds that pride in the NHS remains high, though there are some concerns about quality and funding challenges. While most see lack of resources as the top problem, there is no appetite to cut NHS funding. Opinions are divided on whether the NHS is changing to meet future needs and on optimism about the NHS's future.
Primary Care Trust perspective: Make or Buy - Paul Zollinger-ReadThe King's Fund
Paul Zollinger-Read, NHS Cambridgeshire Chief Executive, looks at whether GPs will be able to 'make' as well as 'buy' services from a Primary Care Trust perspective.
Carol Propper: Is choice and competition happening?Nuffield Trust
This document discusses choice and competition in the UK healthcare system. It provides evidence that:
1) Healthcare markets in England are highly concentrated according to the HHI index, with an average provider HHI over 6000.
2) Concentration levels vary by clinical area, with hips/knees and general admissions being the least concentrated and maternity and CABG the most.
3) Market concentration is influenced by existing supply patterns, relationships between providers/commissioners, and patient willingness to travel - not just the number of providers.
4) Increased consolidation through mergers could enhance market power issues in more concentrated areas like maternity over less concentrated areas like CABG.
This document discusses the potential for using competition and choice to improve health care outcomes while preserving public policy objectives. It argues that competition is feasible for many common medical procedures, especially in urban areas, but may not be possible for specialized or rare services. The document proposes several pro-competitive reforms, including carefully defining fees to avoid "cream skimming," using diagnostic-related groups to set prices, and having an independent pricing authority. However, it notes customers must be able to make informed choices and competition must be sustainable. Overall, the document concludes there is some scope for pro-competitive health care reforms if appropriate safeguards are in place.
Tender scout imsta briefing series - collaboration between medical device s...Tony Corrigan
The document discusses medical device procurement in Ireland and the UK. It finds that collaboration between medical device suppliers and buyers can improve procurement outcomes. Currently in Ireland, price is often the dominant evaluation criteria for tenders rather than quality. Suppliers are recommended to improve the quality of their submissions and develop cost-benefit models to better demonstrate value. Industry groups should work with health services to increase capabilities in evaluating devices and support adoption of evaluation frameworks.
Public sector hospital competition improved quality and productivity in the English NHS according to a study of reforms introduced in 2006. The key findings were:
1. Hospitals located in more competitive areas pre-reform saw a relative 6.7% reduction in AMI mortality post-reform, saving approximately 300 lives per year.
2. Competition between public hospitals improved productivity, with each additional hospital associated with a 4-9% increase in lean production.
3. Entrance of private providers did not help or harm public hospital productivity but led to risk selection, leaving public hospitals with older, less wealthy patients and excess costs of £700,000 per hospital.
UK COMMUNICATIONS PROVIDER CONSUMER SWITCHING EXPERIENCE REPORT 2015Homestars
The research examined these experiences at various key stages in the switching journey, covering initial engagement with the market, assessment of switching options, decision-making on whether to switch or not, and completion among those who decided to switch. The research investigated consumer experiences at these stages in the pay TV, fixed landline, fixed broadband and mobile markets, with a particular focus on . . .
Notes: The research investigated consumer experiences at these stages in the pay TV, fixed landline, fixed broadband and mobile markets, with a particular focus on . . .
NHS finances: the challenge all policital parties need to face - charts and t...The Health Foundation
The document discusses NHS finances and the challenge of funding the NHS that all political parties must address. It provides historical data on UK public spending on health from 1949 to 2014, which shows spending increasing from 3.6% to 7.5% of GDP. The document also examines projections for NHS funding pressures, estimating a funding gap of £108 billion by 2030 if productivity does not increase. Maintaining productivity growth could reduce the gap but would require unprecedented long-term improvement. All parties will need to decide how best to fund growing demands on the healthcare system.
The document summarizes public opinion research on views of the UK's National Health Service (NHS) as it turns 65 years old. It finds that pride in the NHS remains high, though there are some concerns about quality and funding challenges. While most see lack of resources as the top problem, there is no appetite to cut NHS funding. Opinions are divided on whether the NHS is changing to meet future needs and on optimism about the NHS's future.
Primary Care Trust perspective: Make or Buy - Paul Zollinger-ReadThe King's Fund
Paul Zollinger-Read, NHS Cambridgeshire Chief Executive, looks at whether GPs will be able to 'make' as well as 'buy' services from a Primary Care Trust perspective.
Carol Propper: Is choice and competition happening?Nuffield Trust
This document discusses choice and competition in the UK healthcare system. It provides evidence that:
1) Healthcare markets in England are highly concentrated according to the HHI index, with an average provider HHI over 6000.
2) Concentration levels vary by clinical area, with hips/knees and general admissions being the least concentrated and maternity and CABG the most.
3) Market concentration is influenced by existing supply patterns, relationships between providers/commissioners, and patient willingness to travel - not just the number of providers.
4) Increased consolidation through mergers could enhance market power issues in more concentrated areas like maternity over less concentrated areas like CABG.
This document discusses the potential for using competition and choice to improve health care outcomes while preserving public policy objectives. It argues that competition is feasible for many common medical procedures, especially in urban areas, but may not be possible for specialized or rare services. The document proposes several pro-competitive reforms, including carefully defining fees to avoid "cream skimming," using diagnostic-related groups to set prices, and having an independent pricing authority. However, it notes customers must be able to make informed choices and competition must be sustainable. Overall, the document concludes there is some scope for pro-competitive health care reforms if appropriate safeguards are in place.
This document summarizes evidence on incentivizing competition in public services like healthcare. It finds that separating healthcare provision from funding through insurance schemes can introduce competition but consolidation limits its effects. Prices set prospectively for hospitals may increase quality and activity. Limited evidence shows negotiated prices between insurers and providers can decrease quality. More autonomy and control over surpluses for providers is associated with better outcomes but regulations often erode such autonomy. Competition among family doctors with limited cost sharing can increase satisfaction and quality to a small degree. However, strong consolidation trends and heavy regulation limit meaningful competition in many European healthcare systems.
Walzer Case Study Launching And Selling A Pharmaceutical Compound With The Pa...walzer_18
The importance of the health care payer view in the development of a new compund is exemplarily shown and was presented at a conference in London in March 2012
Prof. Carol Propperin esitys VATT-päivässä 1.11.2016.
Professori Carol Propper on taloustieteen professori Imperial College London -yliopistossa Lontoossa, Iso-Britanniassa. Professori Propperin tutkimus keskittyy kannustin- ja kilpailukysymyksiin terveydenhuoltomarkkinoilla sekä yleisemmin kannustimien suunnitteluun ja vaikutuksiin julkisella sektorilla sekä julkisen ja yksityisen markkinoiden rajapinnalla. Hän on kuuluisa erityisesti tutkimuksistaan, joissa on tarkasteltu kilpailun ja valinnanvapautta lisäävien uudistusten vaikutuksia terveydenhuollon toimintaan Iso-Britanniassa.
Martin Gaynor: "Inside the ‘Black Box’ of Health Care Spending Data?" 2.18.16reportingonhealth
Martin Gaynor's slides from the Center for Health Journalism webinar "Inside the ‘Black Box’ of Health Care Spending Data," 2.18.16
http://www.centerforhealthjournalism.org/content/inside-black-box-health-care-spending-data
This document provides an overview of commissioning for value in healthcare. It discusses highlighting unwarranted variation in quality, outcomes, activity and spend using tools like the NHS Atlas of Variation. It emphasizes empowering patients through shared decision making using decision aids. It also covers engaging clinicians and commissioners to shift from "rationing" to "rational commissioning" and using information and insights to drive action and sharing of best practices. The goal is to increase value by focusing on health outcomes relative to total costs.
This document discusses whether market forces can make the NHS more efficient. It notes that while some market elements exist in secondary/tertiary and primary care like pharmacy and optometry, general practice faces limitations due to GP shortages. Market forces may positively sharpen organizations and encourage innovation, but can also result in market domination, cost-cutting affecting quality/safety, and competition focusing only on profitable services. The document advocates for choice of any willing provider operating under NHS standards/prices and competition on a level playing field, but acknowledges uncertainties around who directs decisions, practical shifting of care between providers, and sufficient development of competitive elements.
Public procurers in the EU are under pressure to focus on price in public tenders. However, using a value-based procurement framework that considers outcomes and quality can help capture the value of innovative products. As tenders typically have strict criteria defined in invitations, companies need to develop value-based pre-tender strategies up to 18 months in advance. These strategies should identify the key outcomes of importance to stakeholders and how the company's product or solution best meets customer needs and differentiates based on quality criteria.
Presentation by Laura Boland, Programme Manager - Product Management, Innovation Agency at Excel in Health: developing your innovation for business on Tuesday 12 March 2019 at the Innovation Centre, Daresbury.
This presentation by Helen JENKINS, Managing Partner of OXERA was made during the discussion on “Market study methodologies for competition authorities” held at the 125th meeting of the OECD Working Party No. 3 on Co-operation and Enforcement on 20 June 2017. More papers and presentations on the topic can be found out at oe.cd/1ZX.
Anita Charlesworth: The economics of integrationNuffield Trust
The document discusses regulatory issues related to integration in healthcare systems. It summarizes Monitor's new role as an economic regulator under the Health and Social Care Bill, including licensing providers, regulating prices, and promoting competition. It also discusses the empirical evidence around whether healthcare exhibits natural monopoly characteristics. While some studies find volume-outcome relationships and potential economies of scale, other research shows costs leveling off or increasing with scale beyond a relatively small threshold. The impact of mergers on costs and prices is mixed in the evidence.
Transitioning to Value Based Care: Tennessee Oncology, A Case StudyWes Chapman
Transitioning to value based care in medical oncology is a major strategic change in any medical practice. In this presentation to Grand Rounds at the Norris Cotton Cancer Center at Dartmouth, we look at the strategic and operational considerations of making such a transition effective.
Commercial Reasonableness: What You Must Know Before Contracting with Physic...MD Ranger, Inc.
Before compensating a physician to take emergency call or provide an administrative service, it's crucial to consider whether paying is commercially reasonable or not. Not all physician services warrant payment. Most hospital leaders deal with the challenges of determining commercial reasonableness.
The document discusses key challenges and opportunities for market access in the NHS, including its complex structure with multiple decision makers, the role of appraisal bodies like NICE, reforms through the Health and Social Care Bill, and initiatives to promote innovation. It outlines the NHS's multi-layered structure with hospitals, GP surgeries, commissioning bodies and more. Technology must demonstrate benefits to patients, providers and the overall healthcare system to gain adoption in this environment.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
Isolde Goggin, Chairperson, The Competition AuthorityInvestnet
This document discusses universal healthcare in Ireland and how competition could operate within such a system. It outlines the vision of universal primary care and universal health insurance that is compulsory and provides a guaranteed package for all. It discusses creating a risk equalization system and white papers on financing. It explores how competition could work in primary care, hospitals, and among health insurers, noting the importance of information, incentives, and supply and demand conditions for effective competition.
Delivering the Healthcare Pricing Transparency That Consumers Are DemandingHealth Catalyst
Can you imagine having your detailed healthcare pricing published in the Wall Street Journal? The thought makes most health systems cringe with concern that they’d lose money on the unknown. And yet every other major consumer category includes pricing up front. Amazingly, one health system has developed just such a care model for most major specialties that is predictable and completely transparent. Join us in this webinar to learn how they did it. You’ll get amazing insight into the importance of their quality measures and actual, daily costing for each procedure, not just allocated costs.
Drug pricing strategies to balance patient access and the funding of innovati...Noura Aljohani
The document discusses strategies for balancing patient access to drugs with funding pharmaceutical innovation. It notes that developing a new drug takes over 10 years and $2.6 billion on average. Spending on prescription drugs makes up only 10% of total healthcare spending in the US. Cross-country drug price comparisons are misleading because pricing systems differ between countries. Alternative pricing schemes like outcomes-based agreements can help address uncertainties around drug effectiveness and outcomes. Key actions to facilitate value-based pricing in Saudi Arabia include updating regulations, improving data collection, building trust between stakeholders, and establishing standardized outcome measures.
Should Drug Prices Differ by Indication? Outlining the debate on indication-b...Office of Health Economics
The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
Author(s) and affiliations(s): Amanda Cole, OHE Bernarda Zamora, OHE Adrian Towse, OHE
Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
Date: 13/11/2018
Professor Nancy Devlin argues that the use of utility theory to value health-related quality of life (HRQoL) in cost-effectiveness analysis (CEA) warrants reexamination. While utility theory has been convention for over 30 years, its application in health economics departs from the normative foundations of CEA. Extra-welfarism permits weighting outcomes based on principles other than preferences and allows multiple stakeholders to provide values. The orthodox utility-based approach is inconsistent with extra-welfarism and utility theory choices influence results. Further, stated preference methods construct rather than reveal preferences, limiting their validity. Devlin concludes the field should refocus on simple, fit-for-purpose HRQoL measures
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This document summarizes evidence on incentivizing competition in public services like healthcare. It finds that separating healthcare provision from funding through insurance schemes can introduce competition but consolidation limits its effects. Prices set prospectively for hospitals may increase quality and activity. Limited evidence shows negotiated prices between insurers and providers can decrease quality. More autonomy and control over surpluses for providers is associated with better outcomes but regulations often erode such autonomy. Competition among family doctors with limited cost sharing can increase satisfaction and quality to a small degree. However, strong consolidation trends and heavy regulation limit meaningful competition in many European healthcare systems.
Walzer Case Study Launching And Selling A Pharmaceutical Compound With The Pa...walzer_18
The importance of the health care payer view in the development of a new compund is exemplarily shown and was presented at a conference in London in March 2012
Prof. Carol Propperin esitys VATT-päivässä 1.11.2016.
Professori Carol Propper on taloustieteen professori Imperial College London -yliopistossa Lontoossa, Iso-Britanniassa. Professori Propperin tutkimus keskittyy kannustin- ja kilpailukysymyksiin terveydenhuoltomarkkinoilla sekä yleisemmin kannustimien suunnitteluun ja vaikutuksiin julkisella sektorilla sekä julkisen ja yksityisen markkinoiden rajapinnalla. Hän on kuuluisa erityisesti tutkimuksistaan, joissa on tarkasteltu kilpailun ja valinnanvapautta lisäävien uudistusten vaikutuksia terveydenhuollon toimintaan Iso-Britanniassa.
Martin Gaynor: "Inside the ‘Black Box’ of Health Care Spending Data?" 2.18.16reportingonhealth
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http://www.centerforhealthjournalism.org/content/inside-black-box-health-care-spending-data
This document provides an overview of commissioning for value in healthcare. It discusses highlighting unwarranted variation in quality, outcomes, activity and spend using tools like the NHS Atlas of Variation. It emphasizes empowering patients through shared decision making using decision aids. It also covers engaging clinicians and commissioners to shift from "rationing" to "rational commissioning" and using information and insights to drive action and sharing of best practices. The goal is to increase value by focusing on health outcomes relative to total costs.
This document discusses whether market forces can make the NHS more efficient. It notes that while some market elements exist in secondary/tertiary and primary care like pharmacy and optometry, general practice faces limitations due to GP shortages. Market forces may positively sharpen organizations and encourage innovation, but can also result in market domination, cost-cutting affecting quality/safety, and competition focusing only on profitable services. The document advocates for choice of any willing provider operating under NHS standards/prices and competition on a level playing field, but acknowledges uncertainties around who directs decisions, practical shifting of care between providers, and sufficient development of competitive elements.
Public procurers in the EU are under pressure to focus on price in public tenders. However, using a value-based procurement framework that considers outcomes and quality can help capture the value of innovative products. As tenders typically have strict criteria defined in invitations, companies need to develop value-based pre-tender strategies up to 18 months in advance. These strategies should identify the key outcomes of importance to stakeholders and how the company's product or solution best meets customer needs and differentiates based on quality criteria.
Presentation by Laura Boland, Programme Manager - Product Management, Innovation Agency at Excel in Health: developing your innovation for business on Tuesday 12 March 2019 at the Innovation Centre, Daresbury.
This presentation by Helen JENKINS, Managing Partner of OXERA was made during the discussion on “Market study methodologies for competition authorities” held at the 125th meeting of the OECD Working Party No. 3 on Co-operation and Enforcement on 20 June 2017. More papers and presentations on the topic can be found out at oe.cd/1ZX.
Anita Charlesworth: The economics of integrationNuffield Trust
The document discusses regulatory issues related to integration in healthcare systems. It summarizes Monitor's new role as an economic regulator under the Health and Social Care Bill, including licensing providers, regulating prices, and promoting competition. It also discusses the empirical evidence around whether healthcare exhibits natural monopoly characteristics. While some studies find volume-outcome relationships and potential economies of scale, other research shows costs leveling off or increasing with scale beyond a relatively small threshold. The impact of mergers on costs and prices is mixed in the evidence.
Transitioning to Value Based Care: Tennessee Oncology, A Case StudyWes Chapman
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Commercial Reasonableness: What You Must Know Before Contracting with Physic...MD Ranger, Inc.
Before compensating a physician to take emergency call or provide an administrative service, it's crucial to consider whether paying is commercially reasonable or not. Not all physician services warrant payment. Most hospital leaders deal with the challenges of determining commercial reasonableness.
The document discusses key challenges and opportunities for market access in the NHS, including its complex structure with multiple decision makers, the role of appraisal bodies like NICE, reforms through the Health and Social Care Bill, and initiatives to promote innovation. It outlines the NHS's multi-layered structure with hospitals, GP surgeries, commissioning bodies and more. Technology must demonstrate benefits to patients, providers and the overall healthcare system to gain adoption in this environment.
The document discusses health care reform under the Affordable Care Act and new models of care, specifically Accountable Care Organizations (ACOs). It provides an overview of the key elements of ACOs, noting they accept responsibility for quality and cost of care for a defined patient population. The document contrasts old models like PHOs with the new ACO model, which emphasizes coordinated, patient-centric care paid for based on quality rather than volume of services.
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This document discusses universal healthcare in Ireland and how competition could operate within such a system. It outlines the vision of universal primary care and universal health insurance that is compulsory and provides a guaranteed package for all. It discusses creating a risk equalization system and white papers on financing. It explores how competition could work in primary care, hospitals, and among health insurers, noting the importance of information, incentives, and supply and demand conditions for effective competition.
Delivering the Healthcare Pricing Transparency That Consumers Are DemandingHealth Catalyst
Can you imagine having your detailed healthcare pricing published in the Wall Street Journal? The thought makes most health systems cringe with concern that they’d lose money on the unknown. And yet every other major consumer category includes pricing up front. Amazingly, one health system has developed just such a care model for most major specialties that is predictable and completely transparent. Join us in this webinar to learn how they did it. You’ll get amazing insight into the importance of their quality measures and actual, daily costing for each procedure, not just allocated costs.
Drug pricing strategies to balance patient access and the funding of innovati...Noura Aljohani
The document discusses strategies for balancing patient access to drugs with funding pharmaceutical innovation. It notes that developing a new drug takes over 10 years and $2.6 billion on average. Spending on prescription drugs makes up only 10% of total healthcare spending in the US. Cross-country drug price comparisons are misleading because pricing systems differ between countries. Alternative pricing schemes like outcomes-based agreements can help address uncertainties around drug effectiveness and outcomes. Key actions to facilitate value-based pricing in Saudi Arabia include updating regulations, improving data collection, building trust between stakeholders, and establishing standardized outcome measures.
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The notion that the price of a medicine should be linked in some way to the value it generates for patients and the health system is generally accepted. Yet, how can this be achieved when, increasingly, medicines are being developed that derive patient across many different indications? We summarise the current state-of-play for indication-based pricing (IBP), both in theory as described in the key literature, and in practice by investigating its use in the US and five major European countries.
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Conference/meeting: ISPOR Europe
Event location: ISPOR Europe
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Professor Nancy Devlin argues that the use of utility theory to value health-related quality of life (HRQoL) in cost-effectiveness analysis (CEA) warrants reexamination. While utility theory has been convention for over 30 years, its application in health economics departs from the normative foundations of CEA. Extra-welfarism permits weighting outcomes based on principles other than preferences and allows multiple stakeholders to provide values. The orthodox utility-based approach is inconsistent with extra-welfarism and utility theory choices influence results. Further, stated preference methods construct rather than reveal preferences, limiting their validity. Devlin concludes the field should refocus on simple, fit-for-purpose HRQoL measures
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Graham participated in an organised session on Monday July 15th 2019. In the session he presented his paper with his co-author Ioannis Laliotis from the London School of Economics. The paper revisits the relationship between workforce and maternity outcomes in the English NHS in an attempt to contribute knowledge to an important policy question for which there has been a paucity of research.
This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and
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Poster presentation from the EuroQol Plenary Meeting 2019, Brussels, Belgium. By Koonal Shah, Brendan Mulhern, Patricia Cubi-Molla, Bas Janssen, and David Mott.
Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University.
Author(s) and affiliation(s): Koonal Shah, Office of Health Economics
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Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London)
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Location: Cologne, Germany
The document discusses challenges with developing new antibiotics and incentivizing research and development. It notes that existing health technology assessment models do not fully capture the public health value of new antibiotics. It recommends that countries modify their HTA and contracting approaches to better recognize individual and societal benefits, such as preventing transmission and avoiding outbreaks. The document also recommends exploring pilots of delinked payment models from England and Sweden and applying modeling techniques used for vaccines to the assessment of antibiotics.
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This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch.
Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics
Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD
Date: 12/06/2019
Location: Albacete, Spain
This document summarizes a presentation on pay-for-performance (P4P) programs in the English National Health Service (NHS), specifically the PSS-CQUIN schemes for specialised services. PSS-CQUIN uses incentive payments to encourage quality improvement and value for money in specialised care areas like cancer treatment and mental health. The schemes link a portion of provider funding to performance indicators. While PSS-CQUIN aims to improve care quality, its complexity and lack of evidence linking indicators to outcomes are areas for improvement. An ongoing evaluation will assess PSS-CQUIN's effectiveness and cost-effectiveness to inform future contract designs.
In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions.
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Date: 21/05/2019
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated.
Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Provider Competition in the NHS -- Economics and Policy
1. Provider Competition in the NHS –
Economics and Policy
Jon Sussex
Office of Health Economics
2012 Centre for Health Economics Seminars
University of York, York
4 October 2012
1
3. Policy on Provider Competition in the NHS
1991-> Purchaser/provider split
1991-1997 GP fundholders “shop around”
2002 First “patient choice” pilots
2003 Activity-based funding begins
2008-> “Any willing/qualified provider”
2009-2013 NHS Cooperation & Competition Panel
2013-> Monitor as competition regulator
3
4. Current Guidance to Commissioners
Competition IN the Competition FOR the
market market
July 2011 – Any July 2010 – Competitive
Qualified Provider Procurement
4
5. NHS Competition: Neither Disaster nor Panacea
• NHS provides a whole variety of services
• with many different characteristics
• no reason for competition to work the same for all
• When does competition serve public interest?
• economics has studied characteristics that are
problematic for competition
• some health services have such characteristics
• which ones?
5
6. • Arrow pointed out that many health services have characteristics
under which competition works imperfectly
• He suggested that aspects of the US health care system (private
insurance and licensing of doctors) may be a response to this
• He did not argue that a healthcare system without competition
would be better than one with competition
6
7. Competition when Prices Are Flexible
Evidence:
• Greater competition reduces costs and waiting
times:
• Pete Smith summarises: “There is quite strong evidence
that competition for business from collective health care
purchasers has led to cost reductions.” (OECD, 2009)
• But may also result in lower quality care for patients:
• Carol Propper et al: “*NHS+ hospitals in competitive
markets reduced unmeasured and unobserved quality in
order to improved measured and observed waiting times”
(The Economic Journal, 2008)
7
8. Competition with Flexible Prices (cont’d)
• Empirical findings unsurprising in light of economic
theory
• particular danger where quality of care not visible to
patients / GPs / NHS commissioners
• Not appropriate to recommend wholesale price
competition
• But where commissioning one or a few providers for
an area, with quality monitored directly, it makes
sense to take cost of provision into account
8
9. Competition with Regulated Prices –
Quality Competition
• Recent studies of heart attack NHS admissions
(Gaynor et al, 2010; Cooper et al, 2011):
• find increased competition from activity based
funding and patient choice reduced mortality
• have weaknesses
• but critics have not done better statistical analysis
reaching opposite conclusions
• so still best evidence available
• Evidence that can be beneficial without increased
inequity in access to care (Cookson et al, 2011)
9
10. Common Objections to Competition (in the NHS)
1. Privatization – Competition does not require
privatization
• NHS trusts can and do compete
• even in countries with much more competition in
health care than England – NL, US – most providers
are not-for-profit
2. Waste – Depends on minimum efficient scale
and scope relative to size of market
3. Higher transactions costs – Cooperation and
competition both have transactions costs.
Evidence needed
10
11. Common Objections to Competition (in the NHS)
4. Competition may crowd out intrinsic
motivation – An empirical question but
evidence so far suggests not a problem
5. Provider failure – A problem with or without
competition
6. Quality skimping and patient selection – A
problem with all prospective payment
arrangements, but likely to be worse with
competition
11
12. 7. Integrated Care
• Areas outside health care where services need
to be effectively co-ordinated – and
competition does not appear to hinder that
• No evidence. Anecdotally, NHS commissioners
gave examples where credible threat of
competition helped in getting integration,
specifically between hospital and community
• Degree of service integration can be a
procurement criterion
12
13. The OHE Commission Recommended
• Where current providers’ performance
suggests health care could be improved,
competition should be given serious
consideration
• Assess the likely effectiveness of competition
before trying it (see the framework “tool”)
• “Any qualified provider” arrangements are
suitable in some cases
• In other cases competitive procurement by
local NHS commissioners may be appropriate
• Routine collection and publication of patient
outcome measures should be expanded to
enable evaluation of the effects of competition
13
14. Assessing Feasibility – 8 Main Dimensions
(of 23)
1. Density and stability of demand High Medium Low
2. Willingness/ability to travel High Medium Low
3. Ease of acquiring information about output
Easy Medium Difficult
quality
4. Economies of scale Small Medium Large
5. Economies of scope None Medium Large
6. Scope for cherry picking and/or dumping None Minor Major
7. Asymmetric competitive constraints None Modest Substantial
8. Politics: too important too fail No Maybe Yes
14
15. 1. Density and Stability of Demand
Competition is more feasible….
• The greater is the demand for a service in a
given area relative to the minimum efficient
scale of production of that service
• The more stable and predictable is demand,
and hence the more attractive is the market
Elective hip Major trauma Tertiary
Density and stability of demand
replacement services hospital care
15
16. 2. Willingness/Ability to Travel
Competition is more feasible the greater the
extent of the potential market and hence….
• The more willing patients are to travel to
receive the (non-emergency) service
• The less damaging to their health is the travel
time to the (emergency) service
Cardiac Elective hip GP
Willingness/ability to travel
surgery replacement consultations
16
17. 3. Ease of Acquiring Information about
Output Quality
• Competition is more feasible the easier it is for the
“customer” to determine the quality of the service,
i.e. where….
- likely quality of output is visible in advance
- quality of output can be defined and monitored
- costs of switching between providers are low
• “Customer” can effectively be the patient, their GP
or the commissioning agency (PCT/CCG), depending
on the service
Community
Ease of acquiring information about output Cancer
IVF based mental
quality chemotherapy
health care
17
18. 4. Economies of Scale
Competition is more feasible where economies
of scale are small or non-existent, i.e. where….
• Fixed costs are small
• Sunk costs / highly specific assets are few or
none
• Learning-by-doing conveys little advantage
GP Cardiac
Economies of scale Radiotherapy
consultations surgery
18
19. 5. Economies of Scope
Competition is more feasible where there are
few or no economies of scope, i.e. it is not
significantly lower cost (for a given quality) to
produce services separately rather than
together
Flu Elective hip Major trauma
Economies of scope
vaccination replacement services
19
20. 6. Scope for Cherry Picking and/or Dumping
• Competition is more feasible if service
providers would find it difficult to select low
cost patients and exclude high cost patients
• Which arises when the provider can predict
patient cost before treatment and the payer
cannot detect that selection is occurring
End of life Cardiac GP
Scope for cherry picking and/or dumping
palliative care surgery consultations?
20
21. 7. Asymmetric Competitive Constraints
Existing providers may have different capacities to
compete with one another -- e.g. a hospital-based
provider might be able readily to expand into
community provision, but a community-based provider
would not be able to match the hospital-based
providers’ back-up facilities. This imbalance could
render the weaker party unwilling to try to compete
Community
Elective hip Cancer
Asymmetric competitive constraints based mental
replacement chemotherapy?
health care
21
22. 8. Politics: Too Important to Fail
• Say no more....
Flu Elective hip Major trauma
Politics: too important too fail
vaccination replacement services
22
23. Assessing Feasibility
Elective hip Major trauma Flu
replacement services vaccination
1. Density and stability of demand High Medium High
2. Willingness/ability to travel Medium Medium Low
3. Ease of acquiring information about output
Easy Difficult Easy
quality
4. Economies of scale Medium Large Small
5. Economies of scope Medium Large None
6. Scope for cherry picking and/or dumping Minor Minor None
7. Asymmetric competitive constraints None None None
8. Politics: too important too fail No Yes No
23
24. NHS Supply2Health Adverts 22/9/08 to 3/8/12
Not AWP AWP Total
Not awarded 1,534 78 1,612
Awarded 647 25 672
Total 2,181 103 2,284
Spread across the majority of PCTs
24
25. Any Qualified Provider (“AQP”)
• Aka “Any Willing Provider (AWP)”
• Covers all non-emergency tariffed services (i.e.
price fixed)
• Being extended to other services – mainly
community based
25
26. 647 Competitive Procurements (non-AWP)
Reached Contract Award in <4 Years
Wide range of “service sectors”
Service sector Frequency (first Frequency (listed
named services only) anywhere)
Mental Health 76 137
Dental Services & General Dental Services 74
General Medical Practice 52
Public Health 27
Screening 24
:
Dermatology 13
Physiotherapy 13
:
Total 647 647
26
27. Many Contracts Awarded to Non-NHS Providers
Provider type Number of Procurements % of Procurements
NHS only 170 26%
NHS + non-NHS 63 10%
Non-NHS only 382 59%
n/a 32 5%
Total 647 100%
27
28. (Maximum) Values for Awarded Contracts
434/647 records with plausible maximum values (>£10k)
[15 state implausibly small values; 198 state no value]
Sum of 434 max values = £2.24bn, mean = £5.2m, median = £925k
Max value in range: Number of Awards % of Awards (n=434)
> £100m & ≤ £300m 5 1%
> £20m & ≤ £100m 7 2%
> £10m & ≤ £20m 22 5%
> £5m & ≤ £10m 39 9%
> £1m & ≤ £5m 130 30%
> £0.1m & ≤ £1m 167 38%
> £0.01m & ≤ £0.1m 64 15%
28
29. 52% of Contracts are for 3 Years,
76% are for ≤ 3 Years
Percentage of contracts by contract duration
60.00%
50.00%
40.00%
Percentage
30.00%
20.00%
10.00%
0.00%
0 1 2 3 4 5 7 10 12 20 30
Contract duration (years)
29
Recent studies of heart attacks: Critics have argued that studies have not:shown why heart attacks (for which patients do not normally choose where to be treated) affected by competitioncountered by argument that competition affects the whole hospital and heart attacks are a particularly good condition to measure its effects because there are good measures of outcomes (survival) that are really important in that caseadequately controlled for the introduction of new proceduresadequately controlled for such things as urban/rural differencesAuthors of studies have responded to each of these and there is an on-going debate about complicated statistical issuesFundamental point is that critics have not done statistical analyses controlling appropriately for factors they think neglected that actually come up with opposite conclusions.