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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (1 May 2023) | Viewed by 40239

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Prof.Dr. Manuel García-Goñi

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Guest Editor

Department of Applied & Structural Economics and History, Faculty of Economics and Business, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain
Interests: health economics; public economics

Special Issue Information

Dear Colleagues,

The increase in healthcare and pharmaceutical spending in recent decades is a common concern for policy makers in many countries. This growth trend runs concurrently with an aging population and the increasing relevance of chronic diseases and multimorbid patients in the concentration of healthcare spending. In addition, the almost permanent need to adjust budgets after the long economic crisis that hit many developed countries during the last decade, and the COVID pandemic that is still affecting our public accounts, has made it necessary to look with some urgency for new ways of organizing healthcare and managing public health services efficiently, to get the most value for money.

Different agents participate in the co-creation of value in the provision of services, from the patients themselves, who influence their adherence to treatments or their lifestyles; to society as a whole, which demands that the services it needs be provided; to the healthcare professionals who provide the services; or to the public managers who determine the resources to be used in this provision. The role of each of these agents influences the way in which innovations, whether technological or organizational, are adopted to bring about the desired value creation. Thus, in terms of technological innovations, it is useful to analyse how the use of innovative medical devices that improve the diagnosis or treatment of patients, or new innovative drugs that improve the quality of life of patients and/or their life expectancy, or even vaccines that resolve a pandemic can be adopted. In terms of organizational innovations, it is worth analysing the evolution of public health management, i.e., the way in which health organizations, especially those that provide public services, are managed in search of efficiency in provision with the available resources, to ensure that medical devices, drugs, or vaccines reach the population that needs them most.

This Special Issue calls for papers dealing from a broad point of view with the adoption of innovations in health systems, the creation of value in the provision of public health services, and public health management. We encourage the submission of manuscripts that focus on but are not limited to the following topics:

Efficiency in Healthcare Provision and Spending;
Public Health Management;
The Process of Innovation in Health;
Co-creation of Value in Healthcare Services;
Health and Pharmaceutical Policy;
Market Access and Public Financing for Innovative Products;
Health Technology Assessment;
Chronic Care Models and Integrated Care Provision.

Dr. Manuel García-Goñi
Guest Editor

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Keywords

health innovation
health management
value co-creation
health expenditures
pharmaceutical expenditures
efficiency
health technology assessment
integrated care
chronic care

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Published Papers (11 papers)

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Research

11 pages, 319 KiB

Open AccessArticle

The Contribution of Intersectoral Healthcare Centres with an Extended Outpatient Care Model to Improve Regional Care-Structures—A Qualitative Study

by Heidrun Sturm, Florian Kaiser, Philipp Leibinger, Edgar Drechsel-Grau, Stefanie Joos and Andreas Schmid

Int. J. Environ. Res. Public Health 2023, 20(7), 5365; https://doi.org/10.3390/ijerph20075365 - 3 Apr 2023

Cited by 1 | Viewed by 2322

Abstract

Many smaller hospitals in Germany are currently threatened with closure due to economic reasons and politically derived centralization. In some—especially rural areas—this may result in a lack of accessible local care structures. At the same time, patients are unnecessarily admitted to hospitals due to insufficient primary care structures and healthcare coordination. Intersectoral health centers (IHC), as new intermediary structures, may offer round-the-clock monitoring (Extended Outpatient Care, EOC), with fewer infrastructure needs than hospitals and, thus, could offer a sustainable solution. In an iterative process, 30 expert interviews (with physicians, nurses and other healthcare experts) formed the basis for the derivation of diagnostic groups, relevant related patient characteristics and scenarios, as well as structural preconditions necessary for safe care in the setting of the new model of IHC/EOC. Additionally, three workshops within the multidisciplinary research team (including healthcare services researchers, GPs, and health economists) were performed. Inductive categories on disease-, case-, sociodemographic- and infrastructure-related criteria were derived following thematic analysis. Due to the expert interviews, general practice equipment plus continuous monitoring beds should form the basic infrastructure for EOCs, which should be adjusted to local needs and infrastructure demands. GPs could be aided through (electronic) support by other specialists. IHC, as a physician-led facility, should rely on experienced nurses to allow for 24-h services and to support integrated team-based primary care with GPs. Alongside nurses, case managers, therapists and social workers can be included in the structure, allowing for improved integration of (primary) care services. In order to sustain low-threshold, local access to care, especially in rural areas, IHC with extended monitoring and integration of coordinative support, emerged as a promising solution that could solve many common patient needs without the need for hospital-based inpatient care. Full article

(This article belongs to the Special Issue Health Management and Innovation)

16 pages, 1581 KiB

Open AccessArticle

Towards a Healthcare Innovation Scaling Framework—The Voice of the Innovator

by Chipo Nancy Ngongoni, William Wasswa, Lindiwe Makubalo, Matshidiso Moeti and Moredreck Chibi

Int. J. Environ. Res. Public Health 2022, 19(23), 15515; https://doi.org/10.3390/ijerph192315515 - 23 Nov 2022

Cited by 1 | Viewed by 3461

Abstract

This paper investigates the systemic challenges that African healthcare innovators experience in the quest to scale their innovations. The aim is to aggregate insights and to conceptualize a foundation towards building a framework that can be used as a guide by intermediary organizations and global partners to support collaborative innovation in African countries. These insights were gained from analyzing a dataset of survey responses obtained from a follow-up on 230 innovators who took part in the inaugural WHO Africa Innovation Challenge that was held in 2018. The insights led to the identification of 10 key foundational blocks that assist in ecosystem management in a bid to strengthen national health innovation ecosystems and to improve the sustainability and integration of innovations in the health system. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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13 pages, 2070 KiB

Open AccessArticle

Pharmaceutical Enterprises’ R&D Innovation Cooperation Moran Strategy When Considering Tax Incentives

by Yanping Xu and Lilong Zhu

Int. J. Environ. Res. Public Health 2022, 19(22), 15197; https://doi.org/10.3390/ijerph192215197 - 17 Nov 2022

Cited by 4 | Viewed by 2211

Abstract

Drug R&D innovation contributes to the high-quality development of the pharmaceutical industry, which is related to people’s life and health, economic development, and social stability. Tax incentives and industry cooperation are conducive to promoting pharmaceutical enterprises’ innovation. Therefore, this paper constructs a Moran process evolutionary game model and analyzes the evolutionary trajectory of N pharmaceutical enterprises’ drug R&D innovation strategic choice and considers the choice of R&D innovation strategy and non-R&D innovation strategy. We obtain the conditions for the two strategies to achieve evolutionary stability under the dominance of external factors, the dominance of expected revenue, and the dominance of super expected revenue. The evolutionary process is simulated by MATLAB 2021b. The results show that, firstly, when the number of pharmaceutical enterprises is higher than a threshold, the market is conducive to pharmaceutical enterprises choosing an R&D innovation strategy. Secondly, the higher the tax incentives, the higher the probability of pharmaceutical enterprises choosing an R&D innovation strategy. Thirdly, when the R&D success rate increases, pharmaceutical enterprises gradually change from choosing a non-R&D innovation strategy to choosing an R&D innovation strategy. Fourthly, the threshold of strategy change of pharmaceutical enterprises is the same under the dominance of expected revenue and super expected revenue. This paper puts forward some countermeasures and suggestions for promoting the R&D innovation of pharmaceutical enterprises in practice. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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13 pages, 1837 KiB

Open AccessArticle

Validation Study of a Value-Based Digital Health Questionnaire

by Roberto Nuño-Solinís, Elena Urizar, Marisa Merino, Jaime Del Barrio and María Errea Rodríguez

Int. J. Environ. Res. Public Health 2022, 19(12), 7034; https://doi.org/10.3390/ijerph19127034 - 8 Jun 2022

Cited by 3 | Viewed by 3109

Abstract

The paradigm of value-based health care is spreading worldwide; however, Value-Based Digital Health (VBDH) is still an emerging concept. VBDH is understood as the use of digital tools to facilitate the generation of value in health. It is accelerated by technological change, cultural, and organizational factors. An accurate diagnosis of the organizational VBDH maturity is crucial to define and implement strategic actions to progress with VBDH transformation. This study aimed to validate a VBDH questionnaire, which measures the degree of maturity of VBDH from the perspective of managers (N = 146) in Spanish healthcare organizations. Results show good internal consistency of the questionnaire. Factor analysis identified seven dimensions to measure VBHC maturity: (1) Resources, incentives, and financing; (2) Knowledge and participation of patients and workers in the strategy of progress towards VBDH; (3) Training of professionals and tool knowledge for advancement in VBDH; (4) Innovation initiatives; (5) Information and its quality; (6) Leadership, strategy and governance; and (7) Knowledge of the fundamentals and objectives, as well as access to relevant VBDH information. The questionnaire presents good validity and internal consistency and meets the requirements to be an instrument for routine use to assess VBDH organizational maturity. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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12 pages, 636 KiB

Open AccessArticle

The Relation of Surgical Procedures and Diagnosis Groups to Unplanned Readmission in Spinal Neurosurgery: A Retrospective Single Center Study

by Caroline Sander, Henry Oppermann, Ulf Nestler, Katharina Sander, Michael Karl Fehrenbach, Tim Wende, Nikolaus von Dercks and Jürgen Meixensberger

Int. J. Environ. Res. Public Health 2022, 19(8), 4795; https://doi.org/10.3390/ijerph19084795 - 15 Apr 2022

Cited by 2 | Viewed by 1693

Abstract

Background: Unplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. Methods: In this study, from 2015 to 2017, spinal neurosurgical procedures were recorded for surgical and non-surgical treated patients. The main reasons for an unplanned readmission within 30 days following discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results: A total of 1172 patient records were examined, of which 4.27% disclosed unplanned readmissions. Among the surgical patients, the readmission rate was 4.06%, mainly attributable to surgical site infections, while it was 5.06% for the non-surgical patients, attributable to uncontrolled pain. A night-time surgery presented as the independent predictive factor. Conclusion: In the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is the timing of surgery. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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15 pages, 727 KiB

Open AccessArticle

Influencing Mechanism and Difference of Poultry Farmers’ Willingness and Behavior in Breeding Scale—Evidence from Jianghan Plain, China

by Yanqi Han, Hui Lyu, Shixiong Cheng and Yuhang He

Int. J. Environ. Res. Public Health 2022, 19(3), 1631; https://doi.org/10.3390/ijerph19031631 - 31 Jan 2022

Cited by 5 | Viewed by 3489

Abstract

This paper uses the Heckprobit two-stage econometric model to explore the influence mechanism of poultry farmers’ willingness and behavior regarding scale based on 269 household survey data in the hinterland of Jianghan Plain, China. The results show that (1) family endowments, social capital, economic capital, product market prediction, and major public emergencies are the main influencing factors for farmers to engage in poultry farming; (2) economic capital, policy guarantees, product market prediction, and major public emergencies are the main factors that influence the changes in farmers’ poultry breeding scale; and (3) sampled poultry farmers are inconsistent between their breeding willingness and breeding behavior in poultry decision-making and the factors that affect the willingness and behavior are varied. Based on these findings, this paper suggests that the government should pay attention to inducing corresponding assistance and subsidy policies, formulating financial support countermeasures, organizing training and exchange meetings of the breeding industry, and promoting poultry market informatization to help the poultry industry prosper. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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19 pages, 1685 KiB

Open AccessArticle

Innovations in Health Care—A Conceptual Framework

by Steffen Flessa and Claudia Huebner

Int. J. Environ. Res. Public Health 2021, 18(19), 10026; https://doi.org/10.3390/ijerph181910026 - 24 Sep 2021

Cited by 52 | Viewed by 11959

Abstract

Innovations are the source of all human development and improvement of quality of life. At the same time, they challenge existing standards, solutions and societal patterns. In health care in particular, innovations enable us to treat previously incurable diseases or to make better use of scarce resources. However, they also make existing health care technologies obsolete, force specialists to learn completely new methods and require high investments. Consequently, in this paper we develop a conceptual framework model for the development, adoption and diffusion of innovations in health care. We analyse barriers and promoters of innovations, in particular meta-stability, costs, innovative ability and leadership and apply the framework to three innovations: personalized medicine, digital health, and implants. We conclude that strategic innovation management in healthcare is a prerequisite of the rapid development and adoption of innovations and the improvement of quality of life of the (aging) population. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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11 pages, 336 KiB

Open AccessArticle

Economic Burden of Depressive Symptoms Conditions among Middle-Aged and Elderly People with Hypertension in China

by Yun Wu, Dongbao Zhao, Jianwei Guo, Yingsi Lai, Lijin Chen, Sihui Jin and Yixiang Huang

Int. J. Environ. Res. Public Health 2021, 18(19), 10009; https://doi.org/10.3390/ijerph181910009 - 23 Sep 2021

Cited by 8 | Viewed by 2683

Abstract

People with hypertension are more prone to incur depressive symptoms, while depressive symptoms have an obvious influence on the healthy functioning, treatment, and management of hypertensive patients. However, there have been limited studies on the association between depression and the economic burden of hypertension. We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) to estimate the additional annual direct and indirect economic burden of depressive symptoms among middle-aged and elderly hypertensive patients with a multivariable regression model. The depressive symptoms were associated with substantial additional direct and indirect economic burden. Compared with non-co-MHDS (non-co-morbid hypertension and depressive symptoms) patients, the direct economic burden of lower co-MHDS (co-morbid hypertension and depressive symptoms) patients and higher co-MHDS patients increased 1887.4 CNY and 5508.4 CNY, respectively. For indirect economic burden, the lower co-MHDS patients increased 331.2 CNY and the higher co-MHDS patients increased 636.8 CNY. Both direct and indirect economic burden were incremental with the aggravation of depressive symptoms. The results showed depressive symptoms increased total healthcare costs by increasing the utilization and expenditure of primary healthcare services. Depressive symptoms also led to economic loss of productivity, especially for agricultural workers. This study highlights the importance of mental healthcare for hypertensive patients. Full article

(This article belongs to the Special Issue Health Management and Innovation)

16 pages, 1026 KiB

Open AccessArticle

Are Diverse Media Better than a Single Medium? The Relationship between Mixed Media and Perceived Effect from the Perspective of Online Psychological Counseling

by Jingfang Liu and Lu Gao

Int. J. Environ. Res. Public Health 2021, 18(16), 8603; https://doi.org/10.3390/ijerph18168603 - 14 Aug 2021

Cited by 1 | Viewed by 2450

Abstract

The progress of new media has promoted the development of online health consultations. Previous research has investigated the impact of media richness on user satisfaction; however, little attention has been given to the mixed effects of the nesting of multiple media. The purpose of this study is to analyze the impact and differences of the use of single or mixed media on users’ perceived effect from the perspectives of social support and satisfaction by mining user reviews on online health platforms. The data were collected from a professional online psychological counseling platform. We collected data on 48,807 reviews from 11,694 users. Text annotation and sentiment analysis were then used to extract variable eigenvalues from the reviews. One-way analysis of variance (ANOVA) and hierarchical regression analysis were used for statistical analysis. The results show that mixed media with different richness has a significant impact on the users’ perceived effects. Among them, compared to “text + audio,” using “text + audio + video/face to face” can significantly improve the users’ perceived social support and satisfaction. However, compared to single medium, mixed media with higher richness may not necessarily achieve a better effect. We found that the inclusion of “video/face to face” mixed media significantly reduced the users’ perceived social support and satisfaction compared to text or audio use alone. These research results complement the blank media richness theory in the field of online health care and provide guidance for improving the personalized customization of online psychological counseling platforms. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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14 pages, 772 KiB

Open AccessArticle

Cost-Effectiveness Analysis of Perioperative Oral Management after Cancer Surgery and an Examination of the Reduction in Medical Costs Thereafter: A Multicenter Study

by Hideki Sekiya, Yasuhiro Kurasawa, Yutaka Maruoka, Hitoshi Mukohyama, Akihide Negishi, Shiro Shigematsu, Junpei Sugizaki, Masaru Ohashi, Shiro Hasegawa, Yutaka Kobayashi, Masayuki Ueno and Yukihiro Michiwaki

Int. J. Environ. Res. Public Health 2021, 18(14), 7453; https://doi.org/10.3390/ijerph18147453 - 13 Jul 2021

Cited by 8 | Viewed by 2385

Abstract

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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23 pages, 1171 KiB

Open AccessArticle

A Metagovernance Model of Innovation Networks in the Health and Social Services Using a Neo-Schumpeterian Framework

by Alberto Peralta and Luis Rubalcaba

Int. J. Environ. Res. Public Health 2021, 18(11), 6133; https://doi.org/10.3390/ijerph18116133 - 6 Jun 2021

Cited by 4 | Viewed by 2720

Abstract

Health and social services (HSS) are now, more than ever, at the center of the debate of public policy. We are interested in studying the HSS services innovations from the networked-governance strategy standpoint. With this research, we contribute by analyzing the criteria leading to the formation of HSS public service innovation networks (HSS PSINs). These criteria are important because they may result in the much-needed empirical foundation of the metagovernance of public networks for sustainable innovation. Our analysis rests on neo-Schumpeterian interpretations of product, process, organizational, market, and input innovations, and their characteristics. By an empirical partial least squares structural equations model, we present here the relationships between those characteristics and HSS PSINs. Our intent is that these relationships become clearer, and help enhance HSS PSINs metagovernance—i.e., their control, democratic legitimacy, and accountability by public decision-makers. Hence, our research supports the voices for an extended use of networks for policy and service collaborative innovation for sustainability. Full article

(This article belongs to the Special Issue Health Management and Innovation)

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