Measuring the benefits of health and life‐saving programmes is a difficult and problematic task. Nevertheless, if one wants to compare the costs and benefits of a programme using…
Abstract
Measuring the benefits of health and life‐saving programmes is a difficult and problematic task. Nevertheless, if one wants to compare the costs and benefits of a programme using cost‐benefit analysis methodology the value of life extension and improved quality of life ought to be expressed in monetary terms. The willingness‐to‐pay approach can serve as a tool to deal practically with this task. Over the years considerable criticism of the reliability and validity of this method has appeared in the literature (for example, ). In spite of the vast criticism it seems that “methods for measuring willingness to pay are being strengthened and may soon play an important role in health services research”.
Afschin Gandjour, Nadja Chernyak, Andrea Icks and Amiram Gafni
In Germany, the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)) makes recommendations for…
Abstract
Purpose
In Germany, the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)) makes recommendations for reimbursement prices of drugs based on an evaluation of the relationship between incremental costs and effects. In 2009, the German government (“Koalitionsvertrag”) announced its intention to evaluate the transparency and acceptability of IQWiG's work. The purpose of this paper is to conduct a survey of a sample of the German population: to check the acceptance of the IQWiG's decision rule compared to a decision rule used in countries such as England and Wales; and to test if the way the IQWiG's decision rule is presented affects its acceptance.
Design/methodology/approach
A questionnaire was developed eliciting acceptability of IQWiG's decision rule and a single cost-effectiveness threshold applying to all diseases (i.e. absolute rule (AR)). To check for a framing effect IQWiG's decision rule was presented in two ways. One version presented it, based on IQWiG's official publication, as a constant ratio between incremental costs and effects within a therapeutic area (proportional rule (PR), Version 1). The other version presented it in terms of a proportional relationship between costs and effects within a therapeutic area (PR, Version 2). χ 2 goodness of fit test and two-proportion z-test tested for differences between acceptance rates of decision rules.
Findings
A sample of 108 persons from the general public (average age: 41 years, 48 per cent male) filled out the questionnaire. Acceptance rates for AR, PR Version 1, and PR Version 2 were 33, 48, and 39 per cent, respectively. Direct comparisons show that acceptance of PR Version 1 was significantly higher than acceptance of AR (p=0.026) and that there was a clear trend towards higher acceptance of PR Version 1 compared to Version 2 (p=0.22). The difference between PR Version 2 and AR was not significant (p=0.32).
Research limitations/implications
In our study, different presentations of the IQWiG decision rule did not significantly alter its acceptance, although there was a clear trend towards accepting IQWiG's official version. Furthermore, the acceptance of the IQWiG's official version was significantly higher than AR. Because of the relevance of the research question we recommend additional research for confirmation and explanation of the choices made.
Originality/value
This is one of the few studies on the impact of framing on allocation preferences in health care.
Details
Keywords
Hsiang Ru Chen and Bor‐Wen Cheng
The purpose of this paper is to integrate the ISO 9001:2008 and blueprints by using a process approach, to have systematic regulation in hospital quality management.
Abstract
Purpose
The purpose of this paper is to integrate the ISO 9001:2008 and blueprints by using a process approach, to have systematic regulation in hospital quality management.
Design/methodology/approach
This study promotes a process approach when developing, implementing, and improving the effectiveness of hospital service quality to enhance patients’ satisfaction by meeting their requirements. This study completes the hospital’s blueprints with the process approach by using case study research methods such as in‐depth interviews with relevant personnel, on‐site observations, and experts’ advice.
Findings
The results of hospital blueprints described in this study comprise five‐plane lines to have systematic regulations. The ISO 9001:2008 process approach and service blueprint are not merely a technological application for medical healthcare services, but rather a fully patient‐driven, technologically integrated, and diligently implemented programme.
Practical limitations
Because of organisational financial confidentiality, this study does not consider the financial performance of the case hospital, and the results of blueprints may be revised afterward.
Originality/value
This paper promotes the adoption of a process approach when developing, implementing, and improving the effectiveness of a hospital outpatient service management system, to enhance outpatients’ satisfaction by meeting their requirements.