摘要：《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风
声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。
期刊介绍：
《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风险健康行为）、疾病不良后果、需求者、供应者和其他卫生保健机构的行为模型、政策干预的评估以及卫生政策的效率和分配等方面。该刊每年发行6期，平均每期发表文章10篇左右，2024年影响因子为3.4。
本期看点：
●根据意大利一家医院数据，医院供应减少（医院关闭）会导致心脏病患者住院死亡率增加了10%，主要因就医路程延长，住院时间增加了0.3天，但再入院率无显著变化。
●加入340B计划（340B计划是美国联邦政府于 1992年设立的一个药品折扣项目，旨在帮助符合条件的医疗机构以大幅折扣价格购买处方药，从而更有效地为弱势人群提供医疗服务）的医生显著提高了患者接受药物治疗的比例，并增强了每位患者的处方强度，但研究未发现患者生存率出现统计学意义上的显著变化。
●联合疗法既可能提升治疗价值，也可能推高药品价格并削减医疗盈余；基于适应症的定价提高了效率，但以更高支出为代价。
●挪威初级卫生保健团队显著增加了针对目标人群（主要由护士提供的）质量相关服务，新增的护士资源被用于加强对目标患者的护理，而非扩大初级卫生服务的可及性。
●基于美国样本数据，疫情现金补贴对婴儿健康指标（出生体重、孕周及胎儿生长状况）几乎未产生具有统计学显著性、临床意义或经济意义的积极影响。
●Gompertz定律指预测死亡率随年龄呈近乎完美的指数增长。考虑到实际年龄不是死亡原，将该定律分解为以虚弱指数衡量的健康赤字指数增长和其与死亡率的幂律关系，用于推断群体生物年龄和健康状况。
●基于奥地利数据发现，实施更严格的残疾保险申请筛查，可以带来巨大的边际财政效益。
※ 本期目录
●The impact of budget cuts on individual patient health: Causal evidence from hospital closures
●The incentive to treat: Physician agency and the expansion of the 340B drug pricing program
●The long term benefits of the measles vaccine in Mexico
●Taking the competitor’s pill: When combination therapies enter pharmaceutical markets
●The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program
●Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks
●How do we age? A decomposition of Gompertz law
●Disability insurance screening and worker health
The impact of budget cuts on individual patient health: Causal evidence from hospital closures
预算削减对个体患者健康的影响：来自医院关闭的因果证据
作者
Simone Ghislandi（博科尼大学DONDENA研究中心；博科尼大学管理学院），Anna-Theresa Renner（维也纳工业大学金融与基础设施政策系），Nirosha Elsem Varghese（博科尼大学管理学院）
摘要：Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.
2008年欧洲金融危机后的公共财政紧缩往往影响到医院部门。本文调查了i）医院供应减少对健康的因果影响，以及ii）解释这些影响的可能机制。我们使用交错差异框架，研究了2008年至2015年间意大利一家医院关闭对所有心脏病发作患者预后的影响。结果显示，关闭使住院死亡率增加了10%，住院时间增加了0.3天，但对再入院没有影响。我们使用不同的估计方法探索了潜在的机制，并表明关闭后就医路程时间的增加解释了大部分的死亡率效应。
The incentive to treat: Physician agency and the expansion of the 340B drug pricing program
治疗激励：医生自主权与340B药品定价计划的扩张
作者
Danea Horn （美国加州大学旧金山分校）
摘要：The 340B Drug Pricing Program incentivizes healthcare providers to increase medication use. It does this by allowing certain safety-net hospitals and clinics to purchase outpatient drugs at considerable discounts from manufacturers but be reimbursed at full price by payers. Yet, previous literature has left largely unstudied how the 340B program influences physician prescribing behavior. In this paper, I provide evidence of physician agency among 340B providers in the treatment of breast cancer. I leverage the staggered diffusion of the program to identify the impact of 340B participation on prescribing behavior and patient outcomes. Physicians who join the 340B program increase the share of patients who receive pharmaceutical treatments and increase the intensity of per-patient prescribing. I also find significant increases in prescribing medications that are not included in clinical treatment recommendations and medications to treat side effects. Despite more intensive treatment use, I find no statistically significant change in survival.
340B药品定价计划通过激励医疗服务提供者增加药物使用，其运作机制是允许特定的安全网医院和诊所以大幅折扣价格从制药企业采购门诊药物，同时仍可获得医保机构的足额报销。然而，现有文献大多未涉及该计划如何影响医生处方行为这一重要议题。本文通过乳腺癌治疗案例，为340B计划参与机构中医生的自主处方行为提供了实证证据。研究采用双重差分法，利用该计划分阶段扩散的特征，识别340B计划参与对处方行为和患者预后的影响。研究发现：加入340B计划的医生显著提高了患者接受药物治疗的比例，并增强了每位患者的处方强度。值得注意的是，医生对未纳入临床治疗建议的药物及辅助治疗副作用药物的处方量均呈现显著增长。尽管治疗强度显著提升，但研究未发现患者生存率出现统计学意义上的显著变化。
The long term benefits of the measles vaccine in Mexico
墨西哥麻疹疫苗的长期效益
作者
Alicia Atwood（瓦萨学院），Sarah Pearlman（瓦萨学院）
摘要：We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes “immune amnesia”, leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.
本研究评估了墨西哥全国免疫计划通过降低麻疹发病率对教育程度与就业状况产生的影响。因为麻疹会引发"免疫遗忘"现象，导致个体易受其他疾病侵袭，该计划的实施能显著改善儿童健康状况。研究发现麻疹疫苗接种使男女受教育水平大幅提升，其中女性提升集中在初中教育阶段，男性则在初中和高中阶段均有显著改善。劳动力市场表现也同步改善：女性就业率大幅提高，男性收入显著增长。
Taking the competitor’s pill: When combination therapies enter pharmaceutical markets
同时服下竞争对手的药：当联合疗法进入药品市场
作者
Kurt R. Brekke（挪威经济学院），Dag Morten Dalen（BI挪威商学院），Odd Rune Straume（米尼奥大学）
摘要：We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan’s surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.
我们研究了药品市场中联合疗法（combination therapies）的竞争效应，这些效应关键取决于药物联合使用所带来的额外治疗价值，以及与最相关单药疗法之间的治疗可替代性。如果联合疗法的治疗价值足够大，其推出会导致药品价格上涨，并且有些矛盾地可能减少医疗计划的盈余（定义为总医疗收益减去药品支出）。如果允许企业协调定价策略，在统一定价下会导致价格更高，而在基于适应症的定价（indication-based pricing）下则会导致价格更低。引入后者可能提高资源配置效率，但代价是药品支出更高。
The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program
团队式基层医疗对医疗服务质量及初级卫生服务可及性的影响：挪威初级卫生保健团队试点项目
作者
Øyvind Snilsberg（挪威奥斯陆大学卫生管理与卫生经济学系），Tor Iversen（挪威奥斯陆大学卫生管理与卫生经济学系）
摘要：This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.
本研究评估了挪威初级卫生保健团队（PHT）试点项目。该项目通过在普通诊所引入团队协作式护理模式，旨在改善复杂病症患者的护理质量。参与诊所通过聘用护士，并选择基于活动量或整体拨款的资金模式。本分析聚焦于采用护士按服务付费（FFS）机制的活动量资金模式。通过双重差分法（DID），研究评估了该项目对以下方面的影响：质量相关初级卫生服务、非工作时间护理服务、住院率、全科医生（GP）工作时长及患者名单规模。研究发现表明，PHT显著增加了针对目标人群（主要由护士提供的）质量相关服务，且未影响全科医生工作时间或患者名单规模，表明新增的护士资源被用于加强对目标患者的护理，而非扩大初级卫生服务的可及性。除发现2型糖尿病患者的门诊敏感病症住院率可能存在下降外，初级卫生服务之外的医疗资源使用情况未见显著变化。
Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks
收入对婴儿健康的影响：基于扩展儿童税收抵免与疫情补助支票的实证研究
作者
Wei Lyu（阿拉巴马大学伯明翰分校健康服务管理系），George L. Wehby（爱荷华大学健康管理与政策系；爱荷华大学经济系、预防与社区牙科系，公共政策研究中心；美国国家经济研究局（NBER））， Robert Kaestner（芝加哥大学哈里斯公共政策学院；美国国家经济研究局（NBER））
摘要：During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.
新冠疫情期间，联邦政府发放了补助支票，并扩展了儿童税收抵免。这些政策支付的金额因婚姻状况和家庭子女人数而异。我们利用母亲孕期收入的这种准外生变化，评估收入对婴儿健康的影响。数据来源于出生证明，研究样本聚焦于高中及以下学历的母亲群体。主要研究结果表明，疫情现金补贴对婴儿健康指标（出生体重、孕周及胎儿生长状况）几乎未产生具有统计学显著性、临床意义或经济意义的积极影响——至少对大多数母亲获得的补贴金额范围而言如此。
How do we age? A decomposition of Gompertz law
我们如何变老？Gompertz定律的分解
作者
Casper Worm Hansen（哥本哈根大学经济系和经济政策研究中心），Holger Strulik（哥廷根大学经济系）
摘要：A strong regularity of human life is Gompertz’s law, which predicts a near-perfect exponential increase in mortality with age. In this paper, we take into account that chronological age is not a cause of death and decompose Gompertz’s law into two equally strong laws: (i) an exponential increase in health deficits as measured by the frailty index, and (ii) a power law association between the frailty index and the mortality rate. We show how the increase in the frailty index can be derived from the feature of self-productivity of health deficits. We explore the robustness of the Gompertz decomposition across countries, sex, and over time and show how information about mortality rates can be used to infer the state of health of an age-structured population. Finally, we use this method to infer the biological ages of past populations, such as Australians in 1940 and Swedes in 1770.
人类生活的一个很强的规律性是Gompertz定律，该定律预测死亡率随年龄呈近乎完美的指数增长。在这篇论文中，我们考虑到实际年龄不是死亡原因，并将Gompertz定律分解为两个同样强的定律：（i）以虚弱指数衡量的健康赤字呈指数增长，以及（ii）虚弱指数与死亡率之间的幂律关联。我们展示了虚弱指数的增加是如何从健康缺陷的自我生产力特征中得出的。我们探索了Gompertz分解在国家、性别和时间上的稳健性，并展示了如何使用死亡率信息来推断年龄结构人群的健康状况。最后，我们使用这种方法来推断过去人群的生物年龄，例如1940年的澳大利亚人和1770年的瑞典人。
Disability insurance screening and worker health
残疾保险筛查与工人健康
作者
Alexander Ahammer（林茨大学），Analisa Packham（范德比尔特大学，美国国家经济研究局）
摘要：We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening, they are more likely to remain in the labor force. However, we estimate no statistical differences in any physical or mental health outcomes, and can rule out large effects on overall healthcare utilization. Our findings imply that imposing stricter DI screening can yield large fiscal benefits, on the margin.
我们从劳动力参与率、项目溢出效应和工人健康方面，为更具针对性的残疾保险（DI）项目的回报提供了新的证据。为此，我们分析了奥地利工人在工作场所受伤后经历不同程度的申请筛查。我们发现，当工人面临更严格的筛查时，他们更有可能留在劳动力市场。然而，我们估计在身体或心理健康结果方面不存在统计学差异，并且可以排除其对整体医疗保健利用率的巨大影响。我们的研究结果表明，实施更严格的DI筛查可以带来巨大的边际财政效益。
来源：13个精算师
