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Three essays on health economics.

机译：关于卫生经济学的三篇论文。

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摘要

This dissertation consists of three essays on health economics.;Lack of incentive to protect asset has been one of the theoretical explanations for the limited private long-term care insurance market. State long-term care insurance partnership program allows policy holders to protect a certain amount of their assets and become eligible for Medicaid after they exhaust their policy benefits. The first essay examines whether the asset protection from partnership program attracted people to buy long-term care insurance. The study found that implementation of long-term care partnership program did not increases long-term care insurance coverage among both general population and those who are more likely to be attracted to the asset protection feature. The results, to some extent, support existing theories that protecting asset and leaving bequests to children and spouse are not attracting people to purchase private long-term care insurance coverage.;The inverse correlation between the complexity of a drug regimen and medication adherence is well established. Fixed-dose combination (FDC) therapies are hypothesized to enhance compliance by decreasing the number of required pills. The second essay compares adherence of an FDC to a 2-pill regimen. Longitudinal data from a large claims database were used to assess adherence. Propensity score and fixed effect methods were used to mitigate concerns related to nonrandom assignment of patients to treatments. Adherence was measured by both medication possession ratio and refill persistency. Compared to 2-pill therapy, a FDC resulted in important increases in patient adherence. Economic analyses are warranted to determine whether the clinical benefits attributable to the adherence gains are worth the incremental cost of a FDC.;Focus On Diabetes is a drug benefit experiment conducted on the University of Michigan employees and their dependents. The FOD experiment reduced drug co-payments of four types of prescription medications for diabetic patients. The third paper evaluates how the co-payment reduction affected patient formulary tier utilization. The analyses show that the co-payment reduction did not change the tier utilization. The availability of new generic drugs after the patents of brand-name drugs expired and drug formulary change, instead, had significant impact on tier shifting.
机译：本文由三篇有关卫生经济学的论文组成。缺乏保护资产的动机一直是有限的私人长期护理保险市场的理论解释之一。州长期护理保险合作伙伴计划允许保单持有人保护一定数量的资产，并在用尽保单利益后有资格获得医疗补助。第一篇文章探讨了合伙制资产保护计划是否吸引人们购买长期护理保险。研究发现，实施长期护理合作伙伴计划并没有增加普通人群和更可能被资产保护功能吸引的人群的长期护理保险覆盖率。这一结果在一定程度上支持了现有的理论，即保护资产并将遗赠留给孩子和配偶的理论并未吸引人们购买私人长期护理保险。;药物治疗的复杂性与药物依从性之间的反相关性很好成立。假设固定剂量联合疗法（FDC）可通过减少所需药丸的数量来增强依从性。第二篇文章比较了FDC与2丸方案的依从性。来自大型索赔数据库的纵向数据用于评估依从性。倾向得分和固定效应方法用于缓解与患者非随机分配治疗相关的担忧。通过药物占有率和笔芯持久性来衡量粘附性。与2药疗法相比，FDC导致患者依从性的显着提高。必须进行经济分析，以确定归因于依从性收益的临床益处是否值得FDC的增量成本。；“关注糖尿病”是一项对密歇根大学员工及其家属进行的药物获益实验。 FOD实验减少了针对糖尿病患者的四种处方药的药物共付额。第三篇论文评估了减少共付额如何影响患者处方的利用率。分析表明，减少共付额不会改变等级利用率。在商标药品专利到期和药物配方变更之后，新仿制药的可用性对等级转换产生了重大影响。

著录项

  • 作者

    Pan, Feng.;

  • 作者单位

    University of Michigan.;

  • 授予单位 University of Michigan.;
  • 学科 Economics General.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 104 p.
  • 总页数 104
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 经济学;预防医学、卫生学;
  • 关键词

  • 入库时间 2022-08-17 11:38:28

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