Open Access
Socio-demographic indicators of self-reported health based on EQ-5D-3L: a cross-country analysis of population surveys from 18 countries
(Frontiers Media, 2023) Szende, Agota; Janssen, Mathieu F.; Cabasés Hita, Juan Manuel; Ramos Goñi, Juan Manuel; Burström, Kristina; Economía; Ekonomia
Background: Generic health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic dierences in self-reported health using the EuroQol Group’s archive of EQ-5D-3L population surveys that accumulated over the past two decades. Methods: Analyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data. Results: Statistically significant socio-demographic dierences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries. Conclusion: The EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic dierences in self-reported health using various analytic methods. It oered a unique insight of inequalities by health dimensions
Open Access
Valuing health using EQ-5D: the impact of chronic diseases on the stock of health
(Wiley, 2019) Sánchez Iriso, Eduardo; Errea Rodríguez, María; Cabasés Hita, Juan Manuel; Ekonomia; Institute for Advanced Research in Business and Economics - INARBE; Economía
Chronic diseases strongly affect individuals' health status. In aggregate terms, this impact is reflected by the stock of health, which measures the amount of health of a population in a given period of time. The objectives of this study were to measure the relative burden of chronic illnesses by assessing health-related quality of life using the EQ-5D-5L instrument, to rank diseases according to their associations with the stock of health, and to calculate the stock of health of the Spanish population and the amount of health loss attributable to each chronic disease from a social perspective. Data were gathered from the Spanish Health Survey (ENSE 2011–2012, N = 20,587). A population weighted least squares model was used. Chronic diseases represent 19.19% of the stock of health losses in Spain compared with a country free from those diseases. In Spain, the stock of health in 2011 was 31.86 million units on the visual analog scale. The diseases with the strongest impact in terms of loss of stock of health at the individual level were mental illness and embolism, stroke, or cerebral hemorrhage. Collectively, the diseases with the largest impact included osteoarthritis, arthritis, or rheumatism; chronic back pain; and high blood pressure.
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
Incentives beyond the money: identity and motivational capital in public organizations
(2012) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimality of contracts and incentives when the principal (public organisation) can undertake investments to change agents’ (public workers) identity. In the model, workers within the organisation can have different identities. We develop a principal-agent dynamical model with moral hazard, which captures the possibility of affecting this workers’ identity through contracts offered by the firm. In the model, identity is a motivation source which reduces agents’ disutility from effort. We use the term identity to refer to a situation in which the worker shares the organisational objectives and views herself as a part of the organisation. Contrary, we use the term conflict to refer to a situation in which workers behave self-interested and frequently in the opposite way of the organisation. We assume that identity can be achieved when principal include mission-sense developing investments in contracts. By mission we mean a single culture that is shared by all the members of an organization. We discuss the conditions under which spending resources in changing workers’ identity and invest in this kind of motivational capital is optimal for organisations. Our results may help to inform public firms’ managers about the optimal design of incentive schemes and policies. For instance, we conclude that investing in motivational capital is the best option in the long run whereas pure monetary incentives works better in the short run.
Open Access
Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations
(2013) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Hernández Arenaz, Íñigo; Economía; Ekonomia
The validity and reliability of the EQ-5D-5L in comparison with the standard 3L has been tested through the analysis of psychometric properties making use of different samples of patients. However, it is likely that the condition of the illness may affect the power of the 5L version with respect to the 3L one. Here we report on parallel testing of EQ-5D-5L and 3L administered to a sample of chronic patients of both somatic and mental illness. The aim of this study is to check some psychometric properties in both subsamples. Methods: We check for the usual psychometric properties: feasibility, (in)consistency, ordinality (and transitivity), informativity, face validity and convergent validity. Also, we perform new analysis for checking transitivity and the Cronbach-? for convergent validity. Finally, we proposed a complementary way for looking at the property of informativity through three different indexes (effective, absolute and overall) based on the statistical discriminatory power. Data: We have a total of 1002 questionnaires finally collected. 444 (46.25%) chronic mental patients, 516 (53.75%) have somatic chronic illnesses; 42 observations of unknown origin of the illness have been dropped to perform this analysis. Results: The mean value reported in the VAS for the full sample is 60.93. Somatic patients report a mean of 64.42 points in this scale and mental patients report 56.83 points in the VAS. Analyzing the distribution of the responses to problems on each dimension we found, for all cases, a highly skewed distribution. Moreover, the distribution of responses changes significantly between subsamples, as expected. In all dimensions, it seems that somatic patients take more advantage of the extra levels introduced by the EQ-5D-5L. This group reduces to a greater extent the missing response rate, commit less (and of lower importance) inconsistencies, get a higher correlation of the 5L scale and the VAS within the 3L levels, complements better the dimensions to get an overall score (measured through the Cronbach’s alpha), reduces in a more significant way the “no problem” response and the Informativity gain is also superior (for both the Shannon Evenness Index and our Absolute Index). This higher performance of the EQ-5D-5L on somatic patients is endorsed by a higher preference of somatic patients toward the 5L version of the questionnaire than to the 3L one. Conclusion: Results show the suitability of the 5L version in both subsamples, but it is much more effective for somatic patients. These subsamples’ differences may be of concern when aggregating and comparing different data.
Open Access
Motivational capital and incentives in health care organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimal incentive schemes in public health institutions when agents (doctors) are intrinsically motivated. We develop a principal-agent dynamic model with moral hazard in which agents’ intrinsic motivation could be promoted (crowding-in) by combining monetary and non-monetary rewards, but could also be discouraged (crowding-out) when the health manager uses only monetary incentives. We discuss the conditions under which investing in doctors’ motivational capital by the use of well designed nonmonetary rewards is optimal for the health organizations manager. Our results show that such investments will be more efficient than pure monetary incentives in the long run. We will also prove that when doctors are riskaverse, it is profitable for the health manager to invest in motivational capital.
Open Access
An economic model of behaviour: attitudes towards altruistic blood and organ donations
(2009) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
The aim of this research is to model altruistic blood and organ donors behaviour. First, we make an analysis of the decision of to be or not to be a donor for any individual. We propose a model where individuals compare the expected utility of deciding to become a donor, with the utility of the alternative decision (not to become a donor). Second, we continue with the identification of the variables having influence over this decision, the expected effects of such a donation (positive and negative) and the importance of the expectations over individuals well-being and the subsequent decision. We work with rational individuals that behave altruistically when making a decision. The model is specific because the goods we consider can only cover vital needs. We posed hypothesis about some variables for each kind of the donations considered (blood and organ donations). This hypothesis can be useful to identify which are the variables having influence actually over this decision. We propose a pilot survey to test our model. First results from a university students survey show the relevant variables influencing blood an organ donations, and seem to confirm the model.
Open Access
Osasunaren ekonomia: balioa neurtzeko modua osasungintzan
(2020) Cabasés Hita, Juan Manuel; Economía; Ekonomia
Osasunari eta ekonomiari buruz hitz egin behar dut gaur. Edo bestela, hobeki esateko, osasunaren ekonomiari buruz, herritarren osasuna eta ongizatea hobetzeko eskasak diren baliabideak esleitzea helburutzat duen diziplinari buruz. Hausnarketa batzuk eginen ditut, zehazki osasun teknologien ebaluazio ekonomikoari buruz, eta ebaluazio horren alderdi espezifikoenean eta konplexuenean jarriko dut arreta: osasuna neurtzeko moduan, osasungintzako esku-hartzeen eraginkortasunaren aldagaia den aldetik. Eta espero dut erakutsiko dizuedala nolako garrantzia duen neurtzeko modu horretan pazienteak esaten duenak, guk gerok esaten dugunak, galdera erabakigarri honi erantzuteko: Zenbat geundeke prest ordaintzeko osasun beteko urte bat izateagatik?
Open Access
Incentives when altruism is impure: the case of blood and living organ donations
(2013) Errea Rodríguez, María; Cabasés Hita, Juan Manuel; Economía; Ekonomia
The decision to donate blood and living organs is considered voluntary and altruistic. However, the shortage of donors has opened an interesting debate in recent years, considering offering economic incentives to donors. This paper analyzes theoretically and empirically, the effects of incentives over individuals when facing the decision of becoming donors. Results show that crowding-in of blood donors would be more likely by offering 'Information concerning blood donations' or 'Blood Tests'. In both, blood and living organ donations, 'Money' would be very likely to crowd-out individuals from donating. Concerning living organs, we do not find good evidence for crowding-in. We conclude donation policies, properly designed, could help to increase the number of donors, and more specifically suggest implementing non-monetary incentives.
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.