Open Access
A pilot inquiry on incentives and intrinsic motivation in health care: the motivational capital explained by doctors
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
Where the contracts are incomplete, the resulting co-ordination problems may be attenuated if workers are intrinsically motivated to do the work. It is established by theoretical and empirical literature that workers within public organizations are intrinsically motivated to exert effort doing the job and have a strong sense of social agents with the mission of providing collective goods to citizens and tax payers. This paper is an empirical pilot study in the health care sector using methods of Qualitative Analysis research. We run semistructured interviews á-la-Bewley to sixteen physicians of Navarre’s health Care Servicio Navarro de Salud-Osasunbidea (SNS-O). The objective of the work is twofold: first, to find empirical evidence about doctors’ non-monetary motives and second, to find evidence about how these non-monetary motives shape doctors’ behavior. We formulate several testable hypotheses: (1) Doctors are intrinsically motivated agents, (2) Economic incentives and control policies may crowd-out intrinsic motivation and (3) Well designed incentives may crowd-in agents intrinsic motivation. Results confirm the hypotheses formulated above and coming from our theoretical findings [11], [12]. Finally, we also found empirical evidence of conflict between political advisors or health managers (principals) and physicians (agents). Results are a step forward in the optimal design of incentive schemes and policies which crowd in doctors’ intrinsic motivation.
Open Access
Health related quality of life of patients with generalized anxiety disorder
(2008) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Rovira i Forns, Joan; Economía; Ekonomia
Aims: To analyze the health-related quality of life of patients with Generalized Anxiety Disorder (GAD), with respect to the population at large and to a control group. The following goals are addressed: 1.- To determine what, if any, differences exist between the health status of patients diagnosed with GAD, the population in general and a group of control patients; 2.- To analyze the relation between the variables age, sex, and health status (as assessed by the patient’s GP) measured on the Hamilton anxiety scale, with the quality of life of the GAD patients and of the control group; 3.- To determine whether the variables age, sex, Hamilton scale values and index of quality of life influence the annual cost caused by the illness; 4.- To determine whether there are any differences in the evaluation of the same health status made by GAD patients and by the general population. This study forms part of a broader-ranging one (the ANCORA Study) set up to analyze Generalized Anxiety Disorder (GAD) and the costs and other burdens provoked by this illness in Spain. Material and Methods: Regression models were used to obtain the EQ-5D index of health state (EQindex) and to analyze the above-mentioned variables. The data on patients and on the costs of the illness are those registered in the ANCORA study. Results: The patients with GAD present a self-perceived level of health (EQ-5D) that is conspicuously below that corresponding to the general population, especially in three of the dimensions, namely usual activities, pain/discomfort and anxiety/depression. The mean value of the health index (EQindex) is ten points below that of the general population and that of the control group. Age was found to be negatively related to the health variables, as was a higher score on the Hamilton scale. For the group of patients with GAD, a worse perceived health state and a higher score on the Hamilton scale were associated with higher costs, although in the latter case the explicative power of the model is weak. Finally, the GAD patients assessed their health status more negatively than did the general population, with a visual analogue scale (VAS) result that was four points lower than that made by the general population.
Open Access
Valuation and modeling of EQ-5D-5L health states using a hybrid approach
(Wolters Kluwer Health, 2017) Ramos Goñi, Juan Manuel; Pinto Prades, José Luis; Oppe, Mark; Cabasés Hita, Juan Manuel; Serrano Aguilar, Pedro; Economía; Ekonomia
Background: The EQ-5D instrument is the most widely used preference-based health-related quality of life questionnaire in cost-effectiveness analysis of health care technologies. Recently, a version called EQ-5D-5L with 5 levels on each dimension was developed. This manuscript explores the performance of a hybrid approach for the modeling of EQ-5D-5L valuation data. Methods: Two elicitation techniques, the composite time trade-off, and discrete choice experiments, were applied to a sample of the Spanish population (n=1000) using a computer-based questionnaire. The sampling process consisted of 2 stages: stratified sampling of geographic area, followed by systematic sampling in each area. A hybrid regression model combining composite time trade-off and discrete choice data was used to estimate the potential value sets using main effects as starting point. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony. Results: Twenty-seven participants from the 1000 were removed following the exclusion criteria. The best-fitted model included 2 significant interaction terms but resulted in marginal improvements in model fit compared to the main effects model. We therefore selected the model results with main effects as a potential value set for this methodological study, based on the parsimony criteria. The results showed that the main effects hybrid model was consistent, with a range of utility values between 1 and −0.224. Conclusion: This paper shows the feasibility of using a hybrid approach to estimate a value set for EQ-5D-5L valuation data.
Open Access
How the relationship between physical activity and health changes with age
(Springer, 2018-03-28) Lera López, Fernando; Ollo López, Andrea; Garrués Irisarri, Mirian; Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
In the context of age-related declines in physical activity (PA) and the dramatic increase in ageing populations in many countries, this paper sheds further light on the link between PA and self-perceived health (SPH) by examining whether the magnitude of this relationship is age specific. With a sample of 14,456 Spanish individuals aged 18–69, we estimated three levels of intensity in PA using the International Physical Activity Questionnaire. Individuals who did more PA per week showed higher levels of SPH (β = 0.28; 95% CI 0.24–0.32), and age moderated this relationship, with a positive effect over age 49. People aged 50–59 and 60–69 who practiced PA had higher probabilities of better SPH compared with those aged 40–49 (β = 0.14; 95% CI 0.04–0.24) and (β = 0.32; 95% CI 0.21–0.43), respectively. This association between PA and SPH also depended on the intensity of PA, especially for walking (β = 0.14; 95% CI 0.04–0.24). In particular, in comparison with people age 40–49, a statistically significant relationship with SPH was found among people age 50–59 who walked (β = 0.22; 95% CI 0.07–0.36) and people age 60–69 who did moderate PA (β = 0.38; 95% CI 0.23–0.54). This paper provides a major rationale for the design, organisation and implementation of public policies promoting PA and healthy ageing for different age groups.
Open Access
Contracting arrangements in the health strategy contex. A regional approach for Spain
(2000) Cabasés Hita, Juan Manuel; Gaminde, Idoia; Gabilondo, Luis; Economía; Ekonomia
Background. Several different proposals have been made recently to reform the organisation, financing and management of the health care system in Spain. The aim is to obtain improved efficiency, without prejudicing the equity level already achieved, by creating a more competitive framework. However, current health strategies seem not to be in accord with these proposals. This paper approaches the issue of matching these two main components of the health systems, health strategy and contracts, and emphasises the need to develop contracting arrangements within the general health policy framework. Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants. Results and discussion. A review of regional health strategies and regional contracts developed in the 1990s is presented, followed by an analysis of the degree of incoherence between them. Then we discuss whether the programme contract can be an instrument guided by the health plan, commenting on its potential and limitations. Conclusion. The relationship between health strategy and health care management is practically non-existent in Spain. The need to insert the contract cycle within the broader framework of the planning cycle has led to proposals to adapt contracts and health plans to guarantee their coherence. This will require changes in the structure of both of these instruments and, probably, deeper structural modifications of the context within which both have been developed. To this aim, we make some recommendations for policy making.
Open Access
Actividad física y salud autopercibida en personas mayores de 50 años
(Universidad Autonoma de Madrid, 2017) Lera López, Fernando; Garrués Irisarri, Mirian; Ollo López, Andrea; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Sánchez-Santos, José Manuel; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
El propósito del estudio es analizar los posibles efectos de la actividad física sobre la salud autopercibida. Para ello, se encuestó a 765 personas entre 50-70 años durante 2012 en España. Se utilizó el cuestionario internacional de actividad física (IPAQ) para estimar el equivalente metabólico de la tarea (MET) total y en cuatro ámbitos: trabajo, ocio, hogar y desplazamientos. La salud auto-percibida se obtuvo de la escala visual analógica del EQ-5D-5L. Los resultados muestran que únicamente el gasto energético de actividad física en el tiempo de ocio incide positivamente en el nivel de salud percibido, el resto de ámbitos no tienen influencia significativa. Asimismo, la autopercepción de la salud es más negativa con mayor edad, menor nivel educativo y mayor frecuencia de uso de servicios sanitarios. En conclusión, la actividad física desarrollada en el tiempo libre podría plantearse como alternativa para mejorar la calidad de vida de los mayores.
Open Access
Attitudes towards blood and living organ donations
(2010) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.
Open Access
Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis
(BioMed Central, 2020) Bretos Azcona, Pablo Evaristo; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Economía; Ekonomia; Gobierno de Navarra / Nafarroako Gobernua
Background: The purpose of this study was to produce a risk stratification within a population of high-risk patients with multiple chronic conditions who are currently treated under a case management program and to explore the existence of different risk subgroups. Different care strategies were then suggested for healthcare reform according to the characteristics of each subgroup. Methods: All high-risk multimorbid patients from a case management program in the Navarra region of Spain were included in the study (n = 885). A 1-year mortality risk score was estimated for each patient by logistic regression. The population was then divided into subgroups according to the patients' estimated risk scores. We used cluster analysis to produce the stratification with Ward's linkage hierarchical algorithm. The characteristics of the resulting subgroups were analyzed, and post hoc pairwise tests were performed. Results: Three distinct risk strata were found, containing 45, 38 and 17% of patients. Age increased from cluster to cluster, and functional status, clinical severity, nursing needs and nutritional values deteriorated. Patients in cluster 1 had lower renal deterioration values, and patients in cluster 3 had higher rates of pressure skin ulcers, higher rates of cerebrovascular disease and dementia, and lower prevalence rates of chronic obstructive pulmonary disease. Conclusions: This study demonstrates the existence of distinct subgroups within a population of high-risk patients with multiple chronic conditions. Current case management integrated care programs use a uniform treatment strategy for patients who have diverse needs. Alternative treatment strategies should be considered to fit the needs of each patient subgroup.
Open Access
Impact of successful treatment with directacting antiviral agents on health-related quality of life in chronic hepatitis C patients
(Public Library of Science, 2018) Juanbeltz Zurbano, Regina; Martínez Baz, Iván; San Miguel Elcano, Ramón; Goñi Esarte, Silvia; Cabasés Hita, Juan Manuel; Castilla Catalán, Jesús; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Economía; Ekonomia
Background. Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in healthrelated quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. Methods. In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. Results. Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45±64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. Conclusions The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.
Open Access
Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys
(BioMed Central, 2018) Martí Pastor, Marc; Pont, Angels; Ávila, Mónica; Garin, Olatz; Cabasés Hita, Juan Manuel; Economía; Ekonomia
Background: The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population. Methods: A representative sample (N = 7554) from the Catalan Health Interview Survey 2011–2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean. Results: A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤ 30% in half of the 28 chronic conditions). Conclusion: Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.