Publications
103 results found
Camejo RR, Miraldo M, Rutten F, 2017, Cost-effectiveness and dynamic efficiency: does the solution lie within?, Value in Health, Vol: 20, Pages: 240-243, ISSN: 1524-4733
The majority of the current systems spread across the world require the demonstration of the value of pharmaceuticals to be done with an acceptable degree of certainty before a technology is funded. Often involving the notion of cost-effectiveness, one of the key characteristic of such assessments tends to be the consideration of efficiency as a static outcome; with a strong emphasis on current health gains but a disregard of the impact of decision making on the potential health value over time. In this manuscript we argue that current systems using cost-effectiveness thresholds may provide an incomplete indicator of value and defend that funding decisions should be informed by dynamic efficiency considerations by considering both the current and the future value of achieving a certain level of effectiveness in a disease area. We further lay down the foundations for the implementation such framework.
Galizzi M, Miraldo M, Stravopoulou C, et al., 2016, Doctor-patient differences in risk and time preferences: a field experiment, Journal of Health Economics, Vol: 50, Pages: 171-182, ISSN: 0167-6296
We conduct a framed field experiment among patients and doctors to test whether the two groups have similar risk and time preferences. We elicit risk and time preferences using multiple price list tests and their adaptations to the healthcare context. Risk and time preferences are compared in terms of switching points in the tests and the structurally estimated behavioural parameters. We find that doctors and patients significantly differ in their time preferences: doctors discount future outcomes less heavily than patients. We find no evidence that doctors and patients systematically differ in their risk preferences in the healthcare domain.
Ekman I, Busse R, van Ginneken E, et al., 2016, Health-care improvements in a financially constrained environment, Lancet, Vol: 387, Pages: 646-647, ISSN: 1474-547X
Greenhalgh T, Annandale E, Ashcroft R, et al., 2016, An open letter to The BMJ editors on qualitative research, BMJ, Vol: 352, ISSN: 1756-1833
Miraldo M, Galizzi MM, Stravopoulou C, 2016, In Sickness but Not in Wealth. Field Evidence on Patients’ Risk Preferences in Financial and Health Domains, Medical Decision Making, Vol: 36, Pages: 503-517, ISSN: 1552-681X
We present results from a hypothetical framed field experiment assessing whether risk preferences significantly differ across the health and financial domains when they are elicited through the same multiple price list paired-lottery method. We consider a sample of 300 patients attending outpatient clinics in a university hospital in Athens during the Greek financial crisis. Risk preferences in finance were elicited using paired-lottery questions with hypothetical payments. The questions were adapted to the health domain by framing the lotteries as risky treatments in hypothetical health care scenarios. Using maximum likelihood methods, we estimated the degree of risk aversion, allowing for the estimates to be dependent on domain and individual characteristics. The subjects in our sample, who were exposed to both health and financial distress, tended to be less risk averse in the financial domain than in the health domain.
Behkami NA, Daim TU, 2016, Background Literature on the Adoption of Health Information Technologies, Healthcare Technology Innovation Adoption, Publisher: Springer International Publishing, Pages: 9-35, ISBN: 9783319179742
Wheelock A, Parand A, Rigole B, et al., 2015, Socio-Psychological Factors Driving Adult Vaccination: A Qualitative Study (vol 9, e113503, 2014), PLOS ONE, Vol: 10, ISSN: 1932-6203
Miraldo M, Wheelock A, Parand A, et al., 2014, Socio-psychological factors driving adult vaccination: a qualitative study, PLoS ONE, Vol: 9, ISSN: 1932-6203
Background: While immunization is one of the most effective and successfulpublic health interventions, there are still up to 30,000 deaths in major developedeconomies each year due to vaccine-preventable diseases, almost all in adults. Inthe UK, despite comparatively high vaccination rates among§65 s (73%) and, to alesser extent, at-risk #65 s (52%) in 2013/2014, over 10,000 excess deaths werereported the previous influenza season. Adult tetanus vaccines are not routinelyrecommended in the UK, but may be overly administered. Social influences andrisk-perceptions of diseases and vaccines are known to affect vaccine uptake. Weaimed to explore the socio-psychological factors that drive adult vaccination in theUK, specifically influenza and tetanus, and to evaluate whether these factors arecomparable between vaccines.Methods: 20 in-depth, face-to-face interviews were conducted with members of theUK public who represented a range of socio-demographic characteristicsassociated with vaccination uptake. We employed qualitative interviewingapproaches to reach a comprehensive understanding of the factors influencingadult vaccination decisions. Thematic analysis was used to analyze the data.Results: Participants were classified according to their vaccination status asregular, intermittent and non-vaccinators for influenza, and preventative, injury-led,mixed (both preventative and injury-led) and as non-vaccinators for tetanus. Wepresent our finding around five overarching themes: 1) perceived health and healthbehaviors; 2) knowledge; 3) vaccination influences; 4) disease appraisal; and 5)vaccination appraisal.Conclusion: The uptake of influenza and tetanus vaccines was largely driven byparticipants’ risk perception of these diseases. The tetanus vaccine is perceived assafe and sufficiently tested, whereas the changing composition of the influenzavaccine is a cause of uncertainty and distrust. To maximize the public health impact of adult vaccines, policy should be b
Wheelock Zalaquett A, Parand A, Rigole B, et al., 2014, Personal context and childhood experiences affect adult vaccination behaviour, EUPHA, Publisher: Oxford University Press (OUP), ISSN: 1101-1262
Miraldo M, Galizzi MM, Merla A, et al., 2014, Should I pay for your risky behaviours? Evidence from London, PREVENTIVE MEDICINE, Vol: 66, Pages: 145-158, ISSN: 0091-7435
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Miraldo M, Crea G, Longo R, et al., 2014, Collusion in regulated pluralistic markets, Collusion in regulated pluralistic markets, Publisher: Imperial College Business School, 2014/6
Wheelock A, Parand A, Miraldo M, et al., 2014, PERSONAL CONTEXT AND CHILDHOOD EXPERIENCES INFLUENCE ADULT VACCINATION BEHAVIOUR, INTERNATIONAL CONGRESS OF BEHAVIORAL MEDICINE (ICBM 2014), Publisher: SPRINGER, Pages: S67-S67, ISSN: 1070-5503
Wheelock A, Parand A, Miraldo M, et al., 2014, SOCIAL AND PSYCHOLOGICAL FACTORS UNDERLYING INFLUENZA VACCINATION BEHAVIOUR IN THE US AND THE UK, INTERNATIONAL CONGRESS OF BEHAVIORAL MEDICINE (ICBM 2014), Publisher: SPRINGER, Pages: S36-S36, ISSN: 1070-5503
Refoios Camejo R, McGrath C, Miraldo M, et al., 2014, Distribution of health-related social surplus in pharmaceuticals: an estimation of consumer and producer surplus in the management of high blood lipids and COPD (vol 15, pg 439, 2014), EUROPEAN JOURNAL OF HEALTH ECONOMICS, Vol: 15, Pages: 447-447, ISSN: 1618-7598
Wheelock A, Miraldo M, Parand A, et al., 2014, Journey to vaccination: a protocol for a multinational qualitative study, BMJ Open, Vol: 4, ISSN: 2044-6055
Introduction In the past two decades, childhood vaccination coverage has increased dramatically, averting an estimated 2–3 million deaths per year. Adult vaccination coverage, however, remains inconsistently recorded and substandard. Although structural barriers are known to limit coverage, social and psychological factors can also affect vaccine uptake. Previous qualitative studies have explored beliefs, attitudes and preferences associated with seasonal influenza (flu) vaccination uptake, yet little research has investigated how participants’ context and experiences influence their vaccination decision-making process over time. This paper aims to provide a detailed account of a mixed methods approach designed to understand the wider constellation of social and psychological factors likely to influence adult vaccination decisions, as well as the context in which these decisions take place, in the USA, the UK, France, India, China and Brazil.Methods and analysis We employ a combination of qualitative interviewing approaches to reach a comprehensive understanding of the factors influencing vaccination decisions, specifically seasonal flu and tetanus. To elicit these factors, we developed the journey to vaccination, a new qualitative approach anchored on the heuristics and biases tradition and the customer journey mapping approach. A purposive sampling strategy is used to select participants who represent a range of key sociodemographic characteristics. Thematic analysis will be used to analyse the data. Typical journeys to vaccination will be proposed.Ethics and dissemination Vaccination uptake is significantly influenced by social and psychological factors, some of which are under-reported and poorly understood. This research will provide a deeper understanding of the barriers and drivers to adult vaccination. Our findings will be published in relevant peer-reviewed journals and presented at academic conferences. They will also be presented as practical
Miraldo M, Galizzi M, Stavropoulou C, 2013, In sickness but not in wealth: Field evidence on patients’ risk preferences in the financial and health domain, In sickness but not in wealth: Field evidence on patients’ risk preferences in the financial and health domain, Publisher: Imperial College Business School, 2013/08
Miraldo M, Galizzi M, Stavropoulou C, 2013, Doctor-patient differences in risk preferences, and their links to decision-making: a field experiment, Doctor-patient differences in risk preferences, and their links to decision-making: a field experiment, Publisher: Imperial College Business School, 2013/07
Oliveira ALSD, Cerceau R, 2013, Saúde Suplementar Estado do Rio Grande do Norte Regional de Saúde I ETAM, Publisher: Cerceau, ISBN: 9788567211824
Barrenho E, Smith PC, Miraldo M, 2013, The determinants of attrition in drug development: a duration analysis, Publisher: Imperial College Business School
Camejo RR, McGrath C, Rutten F, et al., 2013, Distribution of health-related social surplus in pharmaceuticals: an estimation of consumer and producer surplus in the management of high blood lipids and COPD, Eur J Health Econ.
Refoios R, McGrath C, Miraldo M, et al., 2013, The determinants of cost effectiveness potential: a historical perspective on lipid lowering therapies, Pharmacoeconomics
Miraldo M, Galizzi MM, 2012, Are you what you eat? Experimental evidence on risk preferences and health habits, Are you what you eat? Experimental evidence on risk preferences and health habits, Publisher: Imperial College Business School
Adesanya T, Gbolahan O, Ghannam O, et al., 2012, Exploring the responsiveness of public and private hospitals in Lagos, Nigeria., Journal of Public Health Research, Vol: 1, Pages: 2-6, ISSN: 2279-9028
According to the World Health Report 2000, health system responsiveness is proposed as one of the three key objectives of any health system. This multi-domain concept describes how well a health system responds to the expectations of their users concerning the non-health enhancing aspects of care. In this study we aim to compare the levels of responsiveness experienced by users of private and publicly managed hospitals in Nigeria, and through these insights, to propose recommendations on how to improve performance on this measure. This quantitative, cross-sectional study uses a questionnaire that is adapted from two responsiveness surveys designed by the World Health Organization (WHO). Researchers collected responses from 520 respondents from four hospitals in Lagos, Nigeria. Analysis of the data using statistical techniques found that significant differences exist between the performance of public and private hospitals on certain domains of responsiveness, with privately operated hospitals performing better where differences exist. Users of private hospitals also reported a higher level of overall satisfaction. Private hospitals were found to perform particularly better on the domains of dignity, waiting times, and travel times. These findings have implications for the management of public hospitals in focusing their efforts on improving their performance in low scoring domains. Performance in these hospitals can be improved by emphasis on staff training and demand management.
Galizzi MM, Miraldo M, Stavropoulou C, et al., 2012, Who is more likely to use doctor-rating websites, and why? A cross-sectional study in London, BMJ Open, Vol: 2, ISSN: 2044-6055
Objectives To explore the extent to which doctor-rating websites are known and used among a sample of respondents from London. To understand the main predictors of what makes people willing to use doctor-rating websites.Design A cross-sectional study.Setting The Borough of Hammersmith and Fulham, London, England.Participants 200 individuals from the borough.Main outcome measures The likelihood of being aware of doctor-rating websites and the intention to use doctor-rating websites.Results The use and awareness of doctor-rating websites are still quite limited. White British subjects, as well as respondents with higher income are less likely to use doctor-rating websites. Aspects of the doctor–patient relationship also play a key role in explaining intention to use the websites. The doctor has both a ‘complementary’ and ‘substitute’ role with respect to Internet information.Conclusions Online rating websites can play a major role in supporting patients’ informed decisions on which healthcare providers to seek advice from, thus potentially fostering patients’ choice in healthcare. Subjects who seek and provide feedback on doctor-ranking websites, though, are unlikely to be representative of the overall patients’ pool. In particular, they tend to over-represent opinions from non-White British, medium–low-income patients who are not satisfied with their choice of the healthcare treatments and the level of information provided by their GP. Accounting for differences in the users’ characteristics is important when interpreting results from doctor-rating sites.
Miraldo M, Siciliani L, Street A, 2012, Price adjustment in the hospital sector. Reply, Journal of Health Economics, Vol: 31
Galizzi M, Ghislandi M, Miraldo M, 2011, Effects of reference pricing in pharmaceutical markets, PharmacoEconomics, Vol: 29
This work aims to provide a systematic and updated survey of original scientific studies on the effect of the introduction of reference pricing (RP) policies in Organisation for Economic Co-operation and Development (OECD) countries.We searched PubMed, EconLit and Web of Knowledge for articles on RP.We reviewed studies that met the inclusion criteria established in the search strategy. From a total of 468 references, we selected the 35 that met all of the inclusion criteria.Some common themes emerged in the literature. The first was that RP was generally associated with a decrease in the prices of the drugs subject to the policy. In particular, price drops seem to have been experienced in virtually every country that implemented a generic RP (GRP) policy. A GRP policy applies only to products with expired patents and generic competition, and clusters drugs according to chemical equivalence (same form and active compound). More significant price decreases were observed in the sub-markets in which drugs were already facing generic competition prior to RP. Price drops varied widely according to the amount of generic competition and industrial strategies: brand-named drugs originally priced above RP values decreased their prices to a greater extent. A second common theme was that both therapeutic RP (TRP) and GRP has been associated with significant and consistent savings in the first years of application. A third general result is that generic market shares significantly increased whenever the firms producing brand-named drugs did not adopt one of the following strategies: lowering prices to RP values; launching new dosages and/or formulations; or marketing substitute drugs still under patent protection. Finally, concerning TRP, although more evidence is needed, studies based on a large number of patient-level observations showed no association between the RP policy and health outcomes.
Miraldo M, Galizzi M, 2010, The effect of hospitals' governance on optimal contracts: bargaining versus contracting, Journal of Health Economics, Dec 2010
Miraldo M, Sicialiani L, Street A, 2010, Price adjustment in the hospital sector, Journal of Health Economics, Vol: 30, Pages: 112-125
We analyse the properties of optimal price adjustment to hospitals when no lump-sum transfers are allowed and when prices differ to reflect observable exogenous differences in costs. We find that: a) when the marginal benefit from treatment is decreasing and the cost function is the power function, price adjustment for hospitals with higher costs is positive but partial; if the marginal benefit is constant, the price is identical across providers; b) if the cost function is exponential or it is separable in monetary and non-monetary costs (and linear in monetary costs), price adjustment is positive even when the marginal benefit is constant; c) higher inequality aversion of the purchaser increases concentration in prices and lowers concentration in quantities; d) if some dimensions of costs are private information, a higher correlation between the observable and unobservable costcomponent increases the optimal price for providers whose observable costs are above the average.
Miraldo M, Galizzi M, 2010, Are you what you eat?, Publisher: VoxEU.org
Street A, Sivey P, Manson A, et al., 2009, Are Treatment Centres treating less complex patients?, Health Policy, Vol: 94
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