http://www.mdpi.com/journal/ijerph/special_issues/health-economics/ Dear Colleagues, Health Economics can be defined as the application of the theories, concepts and techniques of economics to any issue related to health. During the last decades there has been a growing interest in this field which partly can be explained by the reduced economic growth, deficits in public budgets and increased unemployment rates and partly by the rapid introduction of new and more expensive health care technologies. The increasing number of treatments that potentially can be used to improve health has led to a widening gap between what the health sector technically can achieve and what society is able and willing to pay. This has led to an increased attention to economic research questions in the health sector. Health economics research focus particularly on issues within a number of different areas related to the health sector such as economics of public health, organization, financing and incentives of different actors related to the health sector, and methods for the economic evaluation of medical technologies and prevention. This special issue is devoted to health economics as then represents a discipline on its own in economics research with strong relevance to significant issues covered by this journal and which also complement other disciplines research by other related aspects. Prof. Dr. Ulf-G. Gerdtham Guest Editor Submission All manuscripts should be submitted to ijerph@mdpi.com with a copy to the Guest Editor. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website. Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. The Int. J. Environ. Res. Public Health (IJERPH, ISSN 1660-4601) was launched in 2004 and is an international peer-reviewed Open Access monthly journal published by MDPI. This journal is covered by the Science Citation Index Expanded (Web of Science), Current Contents/Agriculture, Biology, and Environmental Sciences, Chemical Abstracts, Medline (PubMed) and EMBASE. The IJERPH maintains a rapid editorial procedure and a rigorous peer-review system. Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this Open Access journal is 1000 CHF per accepted paper. http://www.mdpi.com/1660-4601/7/8/3150/ Lifestyle interventions (i.e., diet and/or physical activity) are effective in delaying or preventing the onset of diabetes and cardiovascular disease. However, policymakers must know the cost-effectiveness of such interventions before implementing them at the large-scale population level. This review discusses various issues (e.g., characteristics, modeling, and long-term effectiveness) in the economic evaluation of lifestyle interventions for the primary and secondary prevention of diabetes and cardiovascular disease. The diverse nature of lifestyle interventions, i.e., type of intervention, means of provision, target groups, setting, and methodology, are the main obstacles to comparing evaluation results. However, most lifestyle interventions are among the intervention options usually regarded as cost-effective. Diabetes prevention programs, such as interventions starting with targeted or universal screening, childhood obesity prevention, and community-based interventions, have reported favorable cost-effectiveness ratios. http://www.mdpi.com/1660-4601/7/8/3150/ Mon, 09 Aug 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-08-09 7 8 Review 3150 3195 1660-4601 Economic Evaluation of Lifestyle Interventions for Preventing Diabetes and Cardiovascular Diseases 2010-08-09 doi: 10.3390/ijerph7083150 Sanjib Saha Ulf-G Gerdtham Pia Johansson http://www.mdpi.com/1660-4601/7/7/2881/ This study estimates the avoidable and unavoidable costs of alcohol-related, liver cirrhosis inpatient care, controlling for the lag structure and period of decline in disease risk. Lag structures with different lengths are applied to the exposure to risk from alcohol consumption, which allows for differentiation between avoidable and unavoidable cases due to prior consumption. A lag length of 20 (men) and 23 (women) years (expected remaining life years) gives a total cost of 592 million SEK. Given alcohol consumption is reduced to zero, 72% of cost could potentially be avoided. It is important to account for the length and structure of the risk decline following a consumption change as this substantially affects the estimates. http://www.mdpi.com/1660-4601/7/7/2881/ Fri, 16 Jul 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-07-16 7 7 Article 2881 2895 1660-4601 On Measurement of Avoidable and Unavoidable Cost of Alcohol: An Application of Method for Estimating Costs Due To Prior Consumption 2010-07-16 doi: 10.3390/ijerph7072881 Jarl Gerdtham Ludbrook Petrie http://www.mdpi.com/1660-4601/7/6/2708/ This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes. http://www.mdpi.com/1660-4601/7/6/2708/ Wed, 23 Jun 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-06-23 7 6 Review 2708 2725 1660-4601 Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature 2010-06-23 doi: 10.3390/ijerph7062708 Skriabikova Pavlova Groot http://www.mdpi.com/1660-4601/7/6/2473/ Using aggregated panel data taken from three waves of the Indonesian Family Life Survey (1993–2000), this article tests the myopic addiction behaviour of cigarette demand. Sensitivity analysis is done by examining a rational addiction behavior of cigarette demand. The results provide support for myopic addiction. The short- and long-run price elasticities of cigarette demand are estimated at −0.28 and −0.73 respectively. Excise taxes are more likely to act as an effective tobacco control in the long-run rather than a major source of government revenue. http://www.mdpi.com/1660-4601/7/6/2473/ Fri, 04 Jun 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-06-04 7 6 Article 2473 2485 1660-4601 Cigarette Smoking in Indonesia: Examination of a Myopic Model of Addictive Behaviour 2010-06-04 doi: 10.3390/ijerph7062473 Hidayat Thabrany http://www.mdpi.com/1660-4601/7/5/2274/ Public health interventions have received increased attention from policy makers, and there has been a corresponding increase in the number of economic evaluations within the domain of public health. However, methods to evaluate public health interventions are less well established than those for medical interventions. Focusing on health as an outcome measure is likely to underestimate the impact of many public health interventions. This paper provides a review of outcome measures in public health; and describes the benefits of using the capability approach as a means to developing an all encompassing outcome measure. http://www.mdpi.com/1660-4601/7/5/2274/ Thu, 06 May 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-05-06 7 5 Review 2274 2289 1660-4601 Outcome Measurement in Economic Evaluations of Public Health Interventions: a Role for the Capability Approach? 2010-05-06 doi: 10.3390/ijerph7052274 Lorgelly Lawson Fenwick Briggs http://www.mdpi.com/1660-4601/7/5/1901/ This study examines the relationships between alcohol taxation, drinking during pregnancy, and infant health. Merged data from the US Natality Detailed Files, as well as the Behavioral Risk Factor Surveillance System (1985–2002), data regarding state taxes on beer, wine, and liquor, a state- and year-fixed-effect reduced-form regression were used. Results indicate that a one-cent ($0.01) increase in beer taxes decreased the incidence of low-birth-weight by about 1–2 percentage points. The binge drinking participation tax elasticity is −2.5 for beer and wine taxes and −9 for liquor taxes. These results demonstrate the potential intergenerational impact of increasing alcohol taxes. http://www.mdpi.com/1660-4601/7/5/1901/ Tue, 27 Apr 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-04-27 7 5 Article 1901 1912 1660-4601 Alcohol Taxes and Birth Outcomes 2010-04-27 doi: 10.3390/ijerph7051901 Zhang http://www.mdpi.com/1660-4601/7/4/1835/ An article published in this Journal argued that New Zealand does not apply a cost-effectiveness threshold because medicines are funded within a fixed budget and because cost-effectiveness is only one of nine criteria that inform decisions. This Comment has explained that, from a theoretical perspective, the cost-effectiveness threshold model is not inconsistent with these two arguments. The observed annual variation in incremental cost-effectiveness ratios in New Zealand may originate from yearly differences in new medicines that request reimbursement and in the budget size, and from the fact that decision makers take into account other decision criteria in addition to cost-effectiveness. http://www.mdpi.com/1660-4601/7/4/1835/ Tue, 20 Apr 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-04-20 7 4 Reply 1835 1840 1660-4601 Health Economic Assessment: Cost-Effectiveness Thresholds and Other Decision Criteria 2010-04-20 doi: 10.3390/ijerph7041835 Simoens http://www.mdpi.com/1660-4601/7/4/1831/ The Journal recently incorrectly ascribed cost-effectiveness thresholds to New Zealand, alongside other countries. New Zealand has no such thresholds when deciding the funding of pharmaceuticals. As we fund pharmaceuticals within a fixed budget, and cost-effectiveness is only one of nine decision criteria used to inform decisions, thresholds cannot be inferred or calculated. Thresholds inadequately account for opportunity cost and affordability, and are incompatible with budgets and maximising health gains. In New Zealand, pharmaceutical investments can only be considered ‘cost-effective’ when prioritised against other proposals at the time, and threshold levels must inevitably vary with available funds and the other criteria. http://www.mdpi.com/1660-4601/7/4/1831/ Tue, 20 Apr 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-04-20 7 4 Commentary 1831 1834 1660-4601 Comments on “Simoens, S. Health Economic Assessment: A Methodological Primer. Int. J. Environ. Res. Public Health 2009, 6, 2950-2966”—New Zealand in Fact Has No Cost-Effectiveness Threshold 2010-04-20 doi: 10.3390/ijerph7041831 Metcalfe Grocott http://www.mdpi.com/1660-4601/7/4/1622/ This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results. http://www.mdpi.com/1660-4601/7/4/1622/ Fri, 09 Apr 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-04-09 7 4 Review 1622 1648 1660-4601 Economic Evaluation and Transferability of Physical Activity Programmes in Primary Prevention: A Systematic Review 2010-04-09 doi: 10.3390/ijerph7041622 Wolfenstetter Wenig http://www.mdpi.com/1660-4601/7/4/1577/ Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of concomitant illnesses; and a binary variable indicating the treatment received. However, most studies estimate only one model, which usually includes all the covariates. This procedure ignores the question of uncertainty in model selection. In this paper, we examine four alternative Bayesian variable selection methods that have been proposed. In this analysis, we estimate the inclusion probability of each covariate in the real model conditional on the data. Variable selection can be useful for estimating incremental effectiveness and incremental cost, through Bayesian model averaging, as well as for subgroup analysis. http://www.mdpi.com/1660-4601/7/4/1577/ Tue, 06 Apr 2010 00:00:00 CEST International Journal of Environmental Research and Public Health 2010-04-06 7 4 Article 1577 1596 1660-4601 Bayesian Variable Selection in Cost-Effectiveness Analysis 2010-04-06 doi: 10.3390/ijerph7041577 Negrín Vázquez-Polo Martel Moreno Girón http://www.mdpi.com/1660-4601/7/3/870/ This paper assesses the methodology employed in longitudinal studies of advertising and youth drinking and smoking behaviors. These studies often are given a causal interpretation in the psychology and public health literatures. Four issues are examined from the perspective of econometrics. First, specification and validation of empirical models. Second, empirical issues associated with measures of advertising receptivity and exposure. Third, potential endogeneity of receptivity and exposure variables. Fourth, sample selection bias in baseline and follow-up surveys. Longitudinal studies reviewed include 20 studies of youth drinking and 26 studies of youth smoking. Substantial shortcomings are found in the studies, which preclude a causal interpretation. http://www.mdpi.com/1660-4601/7/3/870/ Mon, 08 Mar 2010 00:00:00 CET International Journal of Environmental Research and Public Health 2010-03-08 7 3 Review 870 926 1660-4601 What is Learned from Longitudinal Studies of Advertising and Youth Drinking and Smoking? A Critical Assessment 2010-03-08 doi: 10.3390/ijerph7030870 Jon P. Nelson http://www.mdpi.com/1660-4601/7/1/9/ We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals\' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits. http://www.mdpi.com/1660-4601/7/1/9/ Tue, 29 Dec 2009 00:00:00 CET International Journal of Environmental Research and Public Health 2009-12-29 7 1 Article 9 27 1660-4601 The Selection of an Appropriate Count Data Model for Modelling Health Insurance and Health Care Demand: Case of Indonesia 2009-12-29 doi: 10.3390/ijerph7010009 Budi Hidayat Subhash Pokhrel http://www.mdpi.com/1660-4601/6/12/2950/ This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments. http://www.mdpi.com/1660-4601/6/12/2950/ Fri, 27 Nov 2009 00:00:00 CET International Journal of Environmental Research and Public Health 2009-11-27 6 12 Review 2950 2966 1660-4601 Health Economic Assessment: A Methodological Primer 2009-11-27 doi: 10.3390/ijerph6122950 Steven Simoens http://www.mdpi.com/1660-4601/6/10/2676/ We use discrete-time hazard models with internationally comparable data from the full eight waves of the European Community Household Panel (ECHP) to study the relationship between retirement and health in nine European countries. Our results provide new evidence of the relationship of health shocks to early retirement. The pattern of results across countries reflects international differences in the incentives created by social security systems. http://www.mdpi.com/1660-4601/6/10/2676/ Tue, 20 Oct 2009 00:00:00 CEST International Journal of Environmental Research and Public Health 2009-10-20 6 10 Article 2676 2695 1660-4601 Health and Retirement in Europe 2009-10-20 doi: 10.3390/ijerph6102676 Ronald Hagan Andrew M. Jones Nigel Rice http://www.mdpi.com/1660-4601/6/8/2271/ A recursive system of ordered self assessed health together with BRFSS data were used to investigate health and obesity in the Appalachian state of West Virginia. Implications of unobserved heterogeneity and endogeneity of lifestyle outcomes on health were investigated. Obesity was found to be an endogenous lifestyle outcome associated with impaired health status. Risk of obesity is found to increase at a decreasing rate with per capita income and age. Intervention measures which stimulate human capital development, diet-disease knowledge and careful land use planning may improve health and obesity outcomes in Appalachia in particular and rural America in general. http://www.mdpi.com/1660-4601/6/8/2271/ Wed, 19 Aug 2009 00:00:00 CEST International Journal of Environmental Research and Public Health 2009-08-19 6 8 Article 2271 2287 1660-4601 The Influence of Socioeconomic and Environmental Determinants on Health and Obesity: A West Virginia Case Study 2009-08-19 doi: 10.3390/ijerph6082271 Anura Amarasinghe Gerard D’Souza Cheryl Brown Hyungna Oh Tatiana Borisova