Mental health care system optimization from a health-economics perspective: where to sow and where to reap?

Health care expenditure (as % of GDP) has been rising in all OECD countries over the last decades. Now, in the context of the economic downturn, there is an even more pressing need to better guarantee the sustainability of health care systems. This requires that policy makers are informed about optimal allocation of budgets. We take the Dutch mental health system in the primary care setting as an example of new ways to approach optimal allocation.

Can the direct medical cost of chronic disease be transferred across different countries? Using cost-of-illness studies on type 2 diabetes, epilepsy and schizophrenia as examples

OBJECTIVES: To systematically review cost of illness studies for schizophrenia (SC), epilepsy (EP) and type 2 diabetes mellitus (T2DM) and explore the transferability of direct medical cost across countries.

METHODS: A comprehensive literature search was performed to yield studies that estimated direct medical costs. A generalized linear model (GLM) with gamma distribution and log link was utilized to explore the variation in costs that accounted by the included factors. Both parametric (Random-effects model) and non-parametric (Boot-strapping) meta-analyses were performed to pool the converted raw cost data (expressed as percentage of GDP/capita of the country where the study was conducted).

RESULTS: In total, 93 articles were included (40 studies were for T2DM, 34 studies for EP and 19 studies for SC). Significant variances were detected inter- and intra-disease classes for the direct medical costs. Multivariate analysis identified that GDP/capita (p<0.05) was a significant factor contributing to the large variance in the cost results. Bootstrapping meta-analysis generated more conservative estimations with slightly wider 95% confidence intervals (CI) than the parametric meta-analysis, yielding a mean (95%CI) of 16.43% (11.32, 21.54) for T2DM, 36.17% (22.34, 50.00) for SC and 10.49% (7.86, 13.41) for EP.

CONCLUSIONS: Converting the raw cost data into percentage of GDP/capita of individual country was demonstrated to be a feasible approach to transfer the direct medical cost across countries. The approach from our study to obtain an estimated direct cost value along with the size of specific disease population from each jurisdiction could be used for a quick check on the economic burden of particular disease for countries without such data.

Estimating the economic value of Mount Buffalo National Park with the travel cost and contingent valuation models

The Mount Buffalo National Park is the oldest national park in Victoria, Australia. There has been a rapid increase in the number of visitors to the park during the last decade and park management has been a concern, especially in the light of declining budgetary allocations and potential damage due to the increased visitor numbers. Policy options to increase park revenue remain unclear because of a lack of information on demand parameters and user costs. This study estimates the economic value of the park using the travel cost method (TCM) and the contingent valuation method (CVM). The TCM gives higher consumer surplus (CS) than the CVM. The CS shows that the economic value of the park is high and that there are opportunities to introduce innovative fee schemes to enhance its revenue. Present entry fee systems do not capture the economic value of the park.

Multi-market industrial organizational economic models for the internationalization process by small and medium enterprise construction design service firms

Small and medium enterprises (SMEs) are critical to strategic initiatives in an economy; however, their contribution to foreign trade is not as significant. SMEs are one of the principal driving forces in economic development. One of the greatest challenges is the internationalization process for longevity rather than seeing the process as initial market entry. The internationalization process research has typically involved four key constructs: market selection, decision to enter, entry modes and factors affecting entry modes. Past research has focused on large manufacturing firms. The export of architectural, engineering and construction (AEC) firms has undergone growth, yet there is still significant opportunity for further growth. The majority of AEC firms are SMEs. Notwithstanding assistance provided through international trade missions, organized export firm support networks and information packages by a burgeoning number of government agencies, there are still perceived barriers to market entry and long-term economic sustainability for SMEs. There are a number of problems faced by SMEs acting in foreign trade. This investigation explores the successful initial internationalization process constructs and identifies unique project-oriented sector characteristics. The study identified similarities and differences between two firms that have been exporting to various localities, including Eastern Europe, Africa, Middle East, UK, Asia and South America, for more than two decades. The similarities and differences were identified within eight major constructs: purpose, firm type, market image and design philosophy, entry mode strategy, institutional arrangement, factors affecting mode of entry, market selection and firm strategy in relation to project selection. The primary reasons for internationalization were associated with the firms' motivations related to growth and financial viability. This article discusses the various internationalization processes and strategies intrinsic to each case study and establishes a detailed set of empirical observations from which to develop further a grounded theoretical model of reflexive capability for the internationalization process. This study contributes to the body of knowledge around the SME AEC design service firm's internationalization process, as a dynamic, evolving and continuously adaptable construct for project-based sectors.

Rational economic models (cognitive models)

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Economic models of preventive dentistry for Australian children and adolescents

Purpose:
To identify economic evaluation models and parameters that could be replicated or adapted to construct a generic model to assess cost-effectiveness of and prioritise a wide range of community-based oral disease prevention programmes in an Australian context.
Methods:
The literature search was conducted using MEDLINE, ERIC, PsycINFO, CINHAL (EBSCOhost), EMBASE (Ovid), CRD, DARE, NHSEED, HTA, all databases in the Cochrane library, Scopus and ScienceDirect databases from their inception to November 2012.
Results:
Thirty-three articles met the criteria for inclusion in this review (7 were Australian studies, 26 articles were international). Existing models focused primarily on dental caries. Periodontal disease, another common oral health problem, was lacking. Among caries prevention studies, there was an absence of clear evidence showing continuous benefits from primary through to permanent dentition and the long-term effects of oral health promotion.
Conclusion:
No generic model was identified from previous studies that could be immediately adopted or adapted for our purposes of simulating and prioritising a diverse range of oral health interventions for Australian children and adolescents. Nevertheless, data sources specified in the existing Australian-based models will be useful for developing a generic model for such purposes.

Rural women and local economic development in south-west Victoria

In the 1990s, the appearance of women in leadership roles in local economic development organisations in small south-west Victorian towns heralded a change in gender relations in rural Australia. This paper contributes to an understanding of this process by investigating the actions and motives of women in leadership roles in small rural towns in south-west Victoria. The paper begins by establishing a framework of analysis based upon a notion of ‘paradigms in progress’. The argument is that in an increasingly interconnected world broader economic, social and political concerns encroach upon local cultures. In this process, older social paradigms or popularly accepted models for how the world works are either transformed, discarded or replaced on different levels. The different levels to which this paper refers are the macromodels of patriarchy, the mesomodels of economic development and the micromodels of leadership. It is the way that these levels intersect and how they are being changed that informs the explanation of women and leadership in south-west Victoria. The paper applies this framework to an analysis of interviews with 15 women in small towns in south-west Victoria. The paper concludes that women in the south-west have been able both to feminise the politics of local economic development as well as reposition the feminine in local social discourses.

Living precariously: the struggle for social and economic citizenship

The central relationship between the labour market and citizenship in Australia is highlighted thus engaging with the broader issued of risk and security, inclusion and exclusion rights and freedoms. There has been a recent shift from social liberal models of industrial and economic citizenship to individualised market models.

Economic evaluation of Australian stroke services: a prospective, multicenter study comparing dedicated stroke units with other care modalities

Background and Purpose: Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs). Methods: A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications. Results: The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (P=0.024), but borderline for SCU (n=102, P=0.08; $AUD12 251; $AUD15 903; $AUD15 383 respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was $AUD9867 per patient achieving thorough adherence to clinical processes and $AUD16 372 per patient with severe complications avoided, based on costs to 28 weeks. Conclusions: Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.

Should we save or should we consume? Linking growth theories and the Keynesian models

In major economic growth theories, high saving rate gives rise to high level of output per capita. But in Keynesian economics, high saving rate causes low consumption and will lead the economy into recession. Students may ask, "For the well-being of an economy, should we save or should we consume?" In most of the intermediate macroeconomics textbooks, economic growth and Keynesian economics are taught in separate chapters; and in many cases, these chapters are not even successive to each other. There lacks a continuity between the long run and short run models. This paper builds a bridge between growth theories and Keynesian models. It links the Solow diagram and the IS-LM curves and depicts the short run and long run implications of a change in the saving rate.

Monetary models of exchange rates and the random walk

Three alternative monetary models of exchange rate are tested using data on the Italian lira - US doIIar exchange rate. II is shown that up to the early 1990s these economic models perform better than the random walk model in out-of-sample forecasts.

Democracy and economic growth : a meta-analysis

Despite a sizeable theoretical and empirical literature, no firm conclusions have been drawn regarding the impact of political democracy on economic growth. This article challenges the consensus of an inconclusive relationship through a quantitative assessment of the democracy-growth literature. It applies meta-regression analysis to the population of 483 estimates derived from 84 studies on democracy and growth. Using traditional meta-analysis estimators, the bootstrap, and Fixed and Random Effects meta-regression models, it derives several robust conclusions. Taking all the available published evidence together, it concludes that democracy does not have a direct impact on economic growth. However, democracy has robust, significant, and positive indirect effects through higher human capital, lower inflation, lower political instability, and higher levels of economic freedom. Democracies may also be associated with larger governments and less free international trade. There also appear to be country- and region-specific democracy-growth effects. Overall, democracy's net effect on the economy does not seem to be detrimental.

How socio-economic status contributes to participation in leisure-time physical activity

The aim of this cross-sectional study was to identify individual, social, and environmental contributors (mediators) to individual- and area-level differences in leisure-time physical activity across socio-economic groups. A two-stage stratified sampling design was used to recruit 20–65 year old adults (N = 2194) living in 154 census collection districts of Adelaide, Australia (overall response rate: 12%). Participants completed two surveys six months apart (response rate on the second survey: 83%). Individual-level socio-economic status (SES) was assessed using self-report measures on educational attainment, household income, and household size. Area-level SES was assessed using census data on median household income and household size for each selected census district. Bootstrap generalized linear models were used to examine associations between SES, potential mediators, and leisure-time physical activity. The product-of-coefficient test was used to estimate mediating effects. All SES measures were independently associated with potential individual and social mediators of the SES-activity relationships. Individual- and area-level income was also associated with perceived neighborhood attributes. Self-efficacy and social support for physical activity explained virtually all of the differences in physical activity across educational attainment groups. Physical barriers to walking and access to public open space contributed in part to the explanation of differences in recreational walking across income groups. Yet, self-efficacy and social support were the key mediators of the observed relationships between individual- and area-level income and physical activity. This study suggests that in order to increase physical activity participation in the more disadvantaged segments of the population, comprehensive, multilevel interventions targeting activity-related attitudes and skills as well as social and physical environments are needed.