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Hwang J, Hwang SS, Kim HB, Lee J, Lee J. Risk compensation after COVID-19 vaccination: Evidence from vaccine rollout by exact birth date in South Korea. HEALTH ECONOMICS 2024; 33:1811-1830. [PMID: 38728372 DOI: 10.1002/hec.4837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
We utilize the phased rollout of COVID-19 vaccines by exact birth date in South Korea as a natural experiment for testing risk compensation. People may resume face-to-face social activities following vaccination because they perceive lower risk of infection. Applying a regression discontinuity design based on birth date cutoffs for vaccine eligibility, we find no evidence of risk-compensating behaviors, as measured by large, high-frequency data from credit card and airline companies as well as survey data. We find some evidence of self-selection into vaccine take-up based on perception toward vaccine effectiveness and side effects, but the treatment effects do not differ between compliers and never-takers.
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Affiliation(s)
- Jisoo Hwang
- College of Liberal Studies, Seoul National University, Gwanak-gu, Korea
| | - Seung-Sik Hwang
- Graduate School of Public Health, Seoul National University, Gwanak-gu, Korea
| | - Hyuncheol Bryant Kim
- Department of Economics and Division of Public Policy, Hong Kong University of Science and Technology, Hong Kong, Hong Kong
| | - Jungmin Lee
- Department of Economics, Seoul National University, Gwanak-gu, Korea
| | - Junseok Lee
- Department of Economics, UC Berkeley, Berkeley, California, USA
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Ehsan AN, Wu CA, Minasian A, Bass M, Sana H, Patel A, Pace L, Mekary RA, Ranganathan K. Evaluation of Financial Interventions in Breast Cancer Care Worldwide: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5683. [PMID: 38784829 PMCID: PMC11115981 DOI: 10.1097/gox.0000000000005683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 05/25/2024]
Abstract
Background Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients. Methods A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes. Results Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies. Conclusions Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.
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Affiliation(s)
- Anam N. Ehsan
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
- Brigham and Women’s Hospital, Boston, Mass
| | | | | | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Mass
| | - Hamaiyal Sana
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
| | | | - Lydia Pace
- Brigham and Women’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
| | - Rania A. Mekary
- Brigham and Women’s Hospital, Boston, Mass
- School of Pharmacy, MCPHS University, Boston, Mass
| | - Kavitha Ranganathan
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
- Brigham and Women’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
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Asuming PO, Kim HB, Sim A. Selection and behavioral responses of health insurance subsidies in the long run: Evidence from a field experiment in Ghana. HEALTH ECONOMICS 2024; 33:992-1032. [PMID: 38291321 DOI: 10.1002/hec.4797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
We study the effects of a health insurance subsidy in Ghana, where mandates are not enforceable. We randomly provide different levels of subsidy (1/3, 2/3, and full) and evaluate the impact at 7 months and 3 years after the intervention. We find that a one-time subsidy increased insurance enrollment for all groups in both the short and long runs, but health care utilization in the long run increased only for the partial subsidy group. We find supportive evidence that ex-post behavioral responses rather than ex-ante selective enrollment explain the long-run health care utilization results.
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Affiliation(s)
| | - Hyuncheol Bryant Kim
- Department of Economics, Hong Kong University of Science and Technology, Hong Kong, Hong Kong
| | - Armand Sim
- Centre for Development Economics and Sustainability, Monash University, Caulfield East, Victoria, Australia
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Guthmuller S, Carrieri V, Wübker A. Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe. JOURNAL OF HEALTH ECONOMICS 2023; 92:102803. [PMID: 37688931 DOI: 10.1016/j.jhealeco.2023.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
We link data on regional Organized Screening Programs (OSPs) throughout Europe with survey data and population-based cancer registries to estimate effects of OSPs on breast cancer screening (mammography), incidence, and mortality. Identification is from regional variation in the existence and timing of OSPs, and in their age-eligibility criteria. We estimate that OSPs, on average, increase mammography by 25 percentage points, increase breast cancer incidence by 16% five years after the OSPs implementation, and reduce breast cancer mortality by about 10% ten years after.
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Affiliation(s)
- Sophie Guthmuller
- Health Economics and Policy group, Department of Socioeconomics, Vienna University of Economics and Business, Welthandelsplatz 1, Building D4 1020 Vienna, Austria; RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; European Commission, Joint Research Centre, Ispra, VA, Italy.
| | - Vincenzo Carrieri
- RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; Department of Political and Social Sciences, University of Calabria 87036, Rende, Italy; Forschungsinstitut zur Zukunft der Arbeit (IZA), Schaumburg-Lippe-Straße 5-9 53113 Bonn, Germany
| | - Ansgar Wübker
- RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; Hochschule Harz, Friedrichstraße 57-59 38855 Wernigerode, Germany
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Hwang Y, Bae H. Patient Outcomes Associated with the First Remote Monitoring Experience of Cardiac Implantable Electronic Devices in South Korea. Clin Interv Aging 2023; 18:1587-1595. [PMID: 37772031 PMCID: PMC10522456 DOI: 10.2147/cia.s422626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023] Open
Abstract
Purpose Remote monitoring of cardiac devices reduces unnecessary outpatient visits and increases patient satisfaction. We aimed to evaluate remote monitoring in terms of patient satisfaction, economic efficiency, and safety. Patients and Methods This was a single university hospital survey. The time/medical cost efficacy and satisfaction index were evaluated using a questionnaire to investigate patient satisfaction before and after remote monitoring in patients using Biotronik implantable cardiac devices. The questionnaire was adopted and modified from Hwang's 2020 Survey on Telehealth Patient Experience. Results Remote monitoring was associated with a decrease in total outpatient visits. Of 1270 remote monitoring-related alerts clinicians received during the study period, more than 95% were from patients with pacemakers. Still, the severity of alerts was higher for implantable cardioverter defibrillators and cardiac resynchronization therapy with defibrillators. The post-RM survey results demonstrated that patients were generally satisfied with RM, perceived it as cost-effective, and found that RM facilitated health management without disrupting their daily routines. Conclusion The study participants were satisfied with their first remote monitoring experience and reported having time- and cost-savings by using remote monitoring. Remote monitoring-related alerts from high-voltage devices were more severe and required medical intervention.
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Affiliation(s)
- YouMi Hwang
- Department of Cardiology, St. Vincent’s Hospital, the Catholic University of Korea, Suwon, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Hannah Bae
- Department of Economics, University of California - San Diego, La Jolla, CA, USA
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Abbasi A, DiTraglia FJ, Gazze L, Pals B. Hidden hazards and screening policy: Predicting undetected lead exposure in Illinois. JOURNAL OF HEALTH ECONOMICS 2023; 90:102783. [PMID: 37413713 DOI: 10.1016/j.jhealeco.2023.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Lead exposure still threatens children's health despite policies aiming to identify lead exposure sources. Some US states require de jure universal screening while others target screening, but little research examines the relative benefits of these approaches. We link lead tests for children born in Illinois between 2010 and 2014 to geocoded birth records and potential exposure sources. We train a random forest regression model that predicts children's blood lead levels (BLLs) to estimate the geographic distribution of undetected lead poisoning. We use these estimates to compare de jure universal screening against targeted screening. Because no policy achieves perfect compliance, we analyze different incremental screening expansions. We estimate that 5,819 untested children had a BLL ≥5μg/dL, in addition to the 18,101 detected cases. 80% of these undetected cases should have been screened under the current policy. Model-based targeted screening can improve upon both the status quo and expanded universal screening.
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Affiliation(s)
- Ali Abbasi
- University of California San Francisco, San Francisco, USA.
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Kowalski AE. Behaviour within a Clinical Trial and Implications for Mammography Guidelines. THE REVIEW OF ECONOMIC STUDIES 2023; 90:432-462. [PMID: 36798741 PMCID: PMC9928190 DOI: 10.1093/restud/rdac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Mammography guidelines have weakened in response to evidence that mammograms diagnose breast cancers that would never eventually cause symptoms, a phenomenon called "overdiagnosis." Given concerns about overdiagnosis, instead of recommending mammograms, US guidelines encourage women aged 40-49 to get them as they see fit. To assess whether these guidelines target women effectively, I propose an approach that examines mammography behavior within an influential clinical trial that followed participants long enough to find overdiagnosis. I find that women who are more likely to receive mammograms are healthier and have higher socioeconomic status. More importantly, I find that the 20-year level of overdiagnosis is at least 3.5 times higher among women who are most likely to receive mammograms. At least 36% of their cancers are overdiagnosed. These findings imply that US guidelines encourage mammograms among healthier women who are more likely to be overdiagnosed by them. Guidelines in other countries do not.
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Moran P, Cullinan J. Is mammography screening an effective public health intervention? Evidence from a natural experiment. Soc Sci Med 2022; 305:115073. [PMID: 35660698 DOI: 10.1016/j.socscimed.2022.115073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Population-based breast screening programmes aim to improve clinical outcomes, alleviate health inequalities, and reduce healthcare costs. However, while screening can bring about immediate changes in mode of presentation and stage at diagnosis of breast cancer cases, the benefits and harms of these programmes can only be observed at a population level, and only over a long enough timeframe for the cascade of events triggered by screening to culminate in disease-specific mortality reductions. In this paper we exploit a natural experiment resulting from the phased geographic rollout of a national mammography screening programme to examine the impact of screening on breast cancer outcomes from both a patient cohort and a population perspective. Using data on 33,722 breast cancer cases over the period 1994-2011, we employ a difference-in-differences research design using ten-year follow-up data for cases diagnosed before and after the introduction of the programme in screened and unscreened regions. We conclude that although the programme produced the intended intermediate effects on breast cancer presentation and incidence, these failed to translate into significant decreases in overall population-level mortality, though screening may have helped to reduce socioeconomic disparities in late stage breast cancer incidence.
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Affiliation(s)
- Patrick Moran
- School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - John Cullinan
- School of Business & Economics, National University of Ireland Galway, University Road, Galway, Ireland.
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Abstract
Prostate cancer is a global health problem, but incidence varies considerably across different continents. Asia is traditionally considered a low-incidence area, but the incidence and mortality of prostate cancer have rapidly increased across the continent. Substantial differences in epidemiological features have been observed among different Asian regions, and incidence, as well as mortality-to-incidence ratio, is associated with the human development index. Prostate cancer mortality decreased in Japan and Israel from 2007 to 2016, but mortality has increased in Thailand, Kyrgyzstan and Uzbekistan over the same period. Genomic analyses have shown a low prevalence of ERG oncoprotein in the East Asian population, alongside a low rate of PTEN loss, high CHD1 enrichments and high FOXA1 alterations. Contributions from single-nucleotide polymorphisms to prostate cancer risk vary with ethnicity, but germline mutation rates of DNA damage repair genes in metastatic prostate cancer are comparable in Chinese and white patients from the USA and UK. Pharmacogenomic features of testosterone metabolism might contribute to disparities seen in the response to androgen deprivation between East Asian men and white American and European men. Overall, considerable diversity in epidemiology and genomics of prostate cancer across Asia defines disease characteristics in these populations, but studies in this area are under-represented in the literature. Taking into account this intracontinental and intercontinental heterogeneity, translational studies are required in order to develop ethnicity-specific treatment strategies.
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Einav L, Finkelstein A, Oostrom T, Ostriker A, Williams H. Screening and Selection: The Case of Mammograms. THE AMERICAN ECONOMIC REVIEW 2020; 110:3836-3870. [PMID: 34305149 PMCID: PMC8300583 DOI: 10.1257/aer.20191191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting the recommendation from age 40 to 45 results in three times as many deaths if compliers were randomly selected than under the estimated patterns of selection. The results highlight the importance of considering characteristics of compliers when making and designing recommendations.
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Affiliation(s)
- Liran Einav
- Department of Economics, Stanford University, and the National Bureau of Economic Research
| | - Amy Finkelstein
- Department of Economics, Massachusetts Institute of Technology, and the National Bureau of Economic Research
| | | | | | - Heidi Williams
- Department of Economics, Stanford University, and the National Bureau of Economic Research
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Kim HB, Lee SA, Lim W. Knowing is not half the battle: Impacts of information from the National Health Screening Program in Korea. JOURNAL OF HEALTH ECONOMICS 2019; 65:1-14. [PMID: 30877903 DOI: 10.1016/j.jhealeco.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/21/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Health screening provides information on disease risk and diagnosis, but whether this promotes health is unclear. We estimate the impacts of information provided by Korea's National Health Screening Program by applying a regression discontinuity design around different biomarker thresholds of diabetes, obesity, and hyperlipidemia risk using administrative data that includes medical claims, biomarkers, and behavioral surveys over four years after screening. Generally, we find limited responses to disease risk information alone. However, we find evidence for weight loss around the high risk threshold for diabetes, where information is combined with active prompting for a secondary examination for diagnosis and treatment.
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Affiliation(s)
- Hyuncheol Bryant Kim
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY 14853, United States.
| | - Suejin A Lee
- Department of Economics, Cornell University, Ithaca, NY 14853, United States
| | - Wilfredo Lim
- Mathematica Policy Research, Oakland, CA 94612, United States
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