Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

[EN] Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.

Ecology of marine bacteroidetes: a genomics approach

Institut de Ciències del Mar (ICM-CSIC). Doctorado en oceanografía. Con mención de Calidad de la ANECA

Direct estimation of the backward flow

[EN] The aim of this work is to propose a new method for estimating the backward flow directly from the optical flow. We assume that the optical flow has already been computed and we need to estimate the inverse mapping. This mapping is not bijective due to the presence of occlusions and disocclusions, therefore it is not possible to estimate the inverse function in the whole domain. Values in these regions has to be guessed from the available information. We propose an accurate algorithm to calculate the backward flow uniquely from the optical flow, using a simple relation. Occlusions are filled by selecting the maximum motion and disocclusions are filled with two different strategies: a min-fill strategy, which fills each disoccluded region with the minimum value around the region; and a restricted min-fill approach that selects the minimum value in a close neighborhood. In the experimental results, we show the accuracy of the method and compare the results using these two strategies.