Journal of Preventive Medicine and Public Health

Special Article

The Primary Process and Key Concepts of Economic Evaluation in Healthcare: Younhee Kim, Yunjung Kim, Hyeon-Jeong Lee, Seulki Lee, Sun-Young Park, Sung-Hee Oh, Suhyun Jang, Taejin Lee, Jeonghoon Ahn, Sangjin Shin; J Prev Med Public Health. 2022;55(5):415-423. Published online August 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.195

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Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

Summary

Korean summary
보건의료분야에서 경제성 평가는 의약품과 진단검사 및 치료법 등 의료기술에 대한 평가에서 널리 활용되고 있다. 본 연구에서는 경제성 평가절차를 경제성 평가 설계, 결과 산출, 비용산출, 모형 구축 및 분석, 비용-효과성 결과 제시 및 불확실성 평가와 의사 결정 단계로 나누어 주요 개념과 쟁점들을 소개하였다.

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Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies
Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang
Epidemiology and Health.2023; 45: e2023057. CrossRef

Original Articles

An Analysis of Determinants of Elderly Medical Costs Inflation Using Deterministic Model.: Seung Hum Yu, Myong Sei Sohn, Eun Cheol Park; Korean J Prev Med. 1994;27(1):135-144.

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Abstract PDF: The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data (1985-1991) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. we concluded that the level of medical cost inflation and the determinants in elderly was the highest-especially in per capita medical utilization, therefore, the inflation of medical costs in elderly will be higher than other age groups for the further in Korea.; Summary

An Analysis of Determinants of Medical Cost Inflation using both Deterministic and Stochastic Models.: Han Joong Kim, Ki Hong Chun; Korean J Prev Med. 1989;22(4):542-554.

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Abstract PDF: The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation. The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory. The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.; Summary

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