The validity and reliability of EQ-5D health state valuations in a survey of Maori.

This note reports on a 2000 study of the content validity of the EQ-5D's representation of health for 66 Maori (New Zealand's indigenous people, comprising 14.5% of the population) accessed through cultural networks. Also examined was the construct validity of the health state valuation instrument and its test-retest reliability based on repeated valuations for the two extreme health states. The possibility that the EQ-SD fails to capture what Maori regard as 'health' derives from the so-called 'Maori health model' that augments biological health with mental, spiritual and family well-being. Seventy six percent of respondents considered the EQ-5D's representation of health to be adequate. This proportion is not statistically significantly different from the rates for non-Maori and Maori respectively in an earlier study and might suggest the EQ-5D has content validity for Maori. However, the high prevalence of missing valuations, particularly for dead, and logical inconsistencies suggests that the health state valuation instrument lacks construct validity, although there is evidence of test retest reliability.

The social costs of alcohol abuse in New Zealand.

AIMS: This study updates and extends previous New Zealand research on the social costs of alcohol abuse. DESIGN: This economic cost study used the human capital approach. SETTING: New Zealand, 1991. PARTICIPANTS: The total New Zealand population. MEASUREMENTS: The estimated cost of alcohol abuse for 1 year included direct and indirect costs. Costs such as lost production resulting from premature death and sickness, reduced working efficiency and excess unemployment comprised indirect costs. Direct costs included hospital costs, accident compensation payments, police and justice system costs. A range of social cost estimates was constructed based on various prevalence rates of alcohol abuse, discount rates for lost production and the excess unemployment rate. FINDINGS: Using a range of assumptions regarding the proportion of each event attributable to alcohol, the sum of social costs ranged from $1045 million to $4005 million in 1991. The direct costs ranged from $341 million to $589 million, respectively. CONCLUSIONS: While providing an indication of the societal impact of alcohol abuse, these costs pertain to a relatively narrow range of alcohol-related effects. The paper identifies a number of areas where further research is required.

The cost-effectiveness of mammography screening: evidence from a microsimulation model for New Zealand.

Mammography screening currently represents the only means by which the mortality rate from breast cancer can be modified substantially. A national mammography screening programme is being considered for New Zealand, and pilot programmes were established in two regions (Otago/Southland and Waikato) in 1991 to determine the potential costs and benefits of mammography for New Zealand women. The aim of this paper is to explore the cost-effectiveness of mammography screening in New Zealand relative to no screening, and to examine the marginal change in costs and benefits of altering programme characteristics such as the age of women invited and screening frequency. Cost-effectiveness is measured by the net cost (the costs of screening minus the treatment savings averted by the early detection of cancers) per year of life gained, from the perspective of the public health care sector. A microsimulation computer model, MICROLIFE, was developed to facilitate the estimation of mortality reduction and cost-effectiveness. The results show that, while mammography screening does not 'save money' overall, the cost per year of life saved for a range of policies compares favourably with other New Zealand health services, and is comparable to the results from economic evaluations of mammography screening overseas. Of those regimes considered, screening women 50-64 years of age at 3-yearly intervals appears to be most cost-effective.

The costs of mammography screening in New Zealand: evidence from the pilot programmes.

AIMS: To measure the public health service costs associated with New Zealand's pilot mammography screening programmes. To compare the early evidence on cost per woman screened and per cancer detected in those programmes to that of overseas screening programmes. To estimate the cost of introducing a national screening programme in New Zealand. METHODS: Costs in each screening centre were obtained by a careful examination of screening budgets and public health service accounts; these were inflation adjusted using a consumers price index, and analysed in terms of equivalent annual operating costs. RESULTS: In the first year of screening the cost per woman screened (in $1991) was $182 in Waikato and $178 in Otago/Southland. The cost per woman screened in the third year of screening (with an assumed full screening throughput of 8,000 women per annum) is estimated to fall to $106 and $113 for the Waikato and Otago/Southland programmes respectively. The cost per cancer detected in the first screening round differs between the two programmes. In the first year of screening the cost per cancer detected was $35,975 in Waikato and $21,908 in Otago/Southland. The difference was primarily attributable to a lower cancer detection rate in Waikato in that period (0.51% of women screened compared with 0.81% in Otago/Southland). CONCLUSIONS: The initial performance of the New Zealand pilot programmes, both in terms of cost per woman screened and cost per cancer detected, falls within the range indicated from overseas experience. An established national screening programme is estimated to add between $9.3 and $9.9 million dollars (in 1991 dollar terms) to health service costs each year. These costs will be partly offset by savings resulting from the earlier detection of cancers.

The effects of denturism: New Zealand dentists' response to competition.

The New Zealand Dental Act of 1988 allowed clinical dental technicians to deal directly with the public in fitting and supplying dentures. This study tested the hypothesis that dentists responded to competition from dental technicians by lowering their fees. The results indicate that there was no significant change in the fees charged by dentists for dentures. The apparent failure of deregulation to produce the expected outcome could be due to the competitive pressure imposed by dental technicians practicing illegally prior to 1988, to consumers' lack of information, or to barriers to "consumer search" imposed by the act itself.

The economics of dental practice in New Zealand, 1974-1993.

New Zealand Dental Association survey data were used to explore trends in the principal indicators of dental practice economics over the last two decades. Gross income in the most recent financial year, 1992, was the highest during this period. However, the costs of dental practice have also risen, and now absorb close to 60 percent of revenue compared with around 50 percent in the early 1970s. As a result, real net income has yet to return to the "peak" levels achieved in the mid-1970s. Nevertheless, average real net incomes earned in 1992 (in 1988 dollar terms) of $85,701 is around 8 percent higher than the average real net income between 1974 and 1992 of $79,243. Furthermore, the lower income tax rates applying in the post-1990 period have produced post-1990 after-tax incomes which are higher in real terms than those in the pre-1990 period. The trends in real net dental income earned by dentists between 1982 and 1992 are shown to correspond closely to the trends in the average incomes of higher-income consumers. The rate of increase in the fees charged by dentists between 1978 and 1993 has, for most services, exceeded the rate of increase in consumer prices generally. A notable exception is the fee charged for complete dentures, which displayed much more modest increases. It is possible that this is attributable to the presence of competing suppliers (dental technicians) for this service.(ABSTRACT TRUNCATED AT 250 WORDS)

The distribution of household expenditures on health care.

AIMS: To find out whether New Zealand household expenditures on health care services vary according to the income of the household. To compare expenditures on health care in 1987 with 1991. METHODS: Information about household income and expenditure on health services was obtained from the Department of Statistics annual household expenditure and income surveys for the 1987 and 1991 financial years. Four categories of health expenditure were examined: general practitioner fees, dental fees, optician and optometrist fees, and spending on all health services combined. RESULTS: Spending on health care is unequally distributed across income groups. In particular, the highest income households spend six times as much on dental care as the lowest income households. The difference between high and low income households in the amount spent on all health services was greater in 1991 than in 1987. In 1991 high income households spent 3.6 times as much on health services as low income households, compared with three times as much in 1987. CONCLUSIONS: High income households spend substantially more on health care than do low income households. Households appear to assign a higher priority to medical care than dental care, although this may reflect the lack of any state subsidy on adult dental care.