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BACKGROUND: Increased costs in the health sector have put considerable strain on the public budgets allocated to pharmaceutical purchases. Faced with such pressures amplified by financial crises and pandemics, national purchasing authorities are presented with a puzzle: how to procure pharmaceuticals of the highest quality for the lowest price. The literature explored a range of impactful factors using data on producer and reference prices, but largely foregone the use of data on individual purchases by diverse public buyers. METHODS: Leveraging the availability of open data in public procurement from official government portals, the article examines the relationship between unit prices and a host of predictors that account for policies that can be amended nationally or locally. The study uses traditional linear regression (OLS) and a machine learning model, random forest, to identify the best models for predicting pharmaceutical unit prices. To explore the association between a wide variety of predictors and unit prices, the study relies on more than 200,000 purchases in more than 800 standardized pharmaceutical product categories from 10 countries and territories. RESULTS: The results show significant price variation of standardized products between and within countries. Although both models present substantial potential for predicting unit prices, the random forest model, which can incorporate non-linear relationships, leads to higher explained variance (R2 = 0.85) and lower prediction error (RMSE = 0.81). CONCLUSIONS: The results demonstrate the potential of i) tapping into large quantities of purchase-level data in the health care sector and ii) using machine learning models for explaining and predicting pharmaceutical prices. The explanatory models identify data-driven policy interventions for decision-makers seeking to improve value for money.
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Aprendizado de Máquina , Humanos , Comércio , Custos de Medicamentos/estatística & dados numéricos , Preparações Farmacêuticas/economia , PrevisõesRESUMO
BACKGROUND: Previous research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries. METHODS: The PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals' health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary. DISCUSSION: In addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies.
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Comunismo , Mortalidade/tendências , Privatização , Desemprego/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Europa Oriental , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Collusion among economic operators increases prices, reduces product quality, and hinders innovation. Structural links can affect the incentive and ability of firms to behave competitively by facilitating collusion. We use a network-based approach to study the relationship between ownership links and bidding behavior in procurement markets. We build temporal multiplex networks based on firms' ownership and co-bidding ties to find network measures that may signal collusion risk. We test four network measures, two at market-level (density and average harmonic closeness centrality) and two at firm-level (degree centrality and harmonic closeness centrality). Using data on public procurement contracts awarded in Sweden from 2010 to 2015, we found higher incidence of single bidding in markets that are more closely related through ownership links. Missing bidders are also more likely in these markets. Single bidding and missing bidders may indicate the presence of collusive arrangements such as of bid suppression or rotation. For the firm-level analyses, our results showed a positive relationship between winning probability and centrality in the ownership network. A similar result was obtained for cut-point position, indicating that firms that are more closely connected to other firms through ownership links have a more important position in the co-bidding network and are also more likely to win contracts.
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One-third of total government spending across the globe goes to public procurement, amounting to about 10 trillion dollars a year. Despite its vast size and crucial importance for economic and political developments, there is a lack of globally comparable data on contract awards and tenders run. To fill this gap, this article introduces the Global Public Procurement Dataset (GPPD). Using web scraping methods, we collected official public procurement data on over 72 million contracts from 42 countries between 2006 and 2021 (time period covered varies by country due to data availability constraints). To overcome the inconsistency of data publishing formats in each country, we standardized the published information to fit a common data standard. For each country, key information is collected on the buyer(s) and supplier(s), geolocation information, product classification, price information, and details of the contracting process such as contract award date or the procedure type followed. GPPD is a contract-level dataset where specific filters are calculated allowing to reduce the dataset to the successfully awarded contracts if needed. We also add several corruption risk indicators and a composite corruption risk index for each contract which allows for an objective assessment of risks and comparison across time, organizations, or countries. The data can be reused to answer research questions dealing with public procurement spending efficiency among others. Using unique organizational identification numbers or organization names allows connecting the data to company registries to study broader topics such as ownership networks.
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This article presents a global database of government contracts funded by the World Bank, Inter-American Development Bank and EuropeAid, principally from the years 2000-2017. The contract-level data were directly collected from the official contract publication sites of these organisations using webscraping methods. While the source publication formats are diverse both over time and across publishers, we standardized and harmonized the datasets so that they can be analysed jointly. The datasets contain key information on the contracting parties (e.g. buyer and supplier names) the contract's content (e.g. contract value and product description) and details of the contracting process (e.g. contract award date or the procedure followed). In addition, it also contains information on the development aid projects of the contracts (e.g. project title and value). The data has wide reuse potential for researchers looking for detailed micro-level information on how major development aid spending takes place and what impacts it has. This database underlies the research article "Anti-corruption in aid-funded procurement: Is corruption reduced or merely displaced?" [1] which develops corruption risk indicators using the dataset presented.
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BACKGROUND: Research on the health outcomes of globalisation and economic transition has yielded conflicting results, partly due to methodological and data limitations. Specifically, the outcomes of changes in foreign investment and state ownership need to be examined using multilevel data, linking macro-effects and micro-effects. We exploited the natural experiment offered by the Hungarian economic transition by means of a multilevel study designed to address these gaps in the scientific literature. METHODS: For this indirect demographic, retrospective cohort study, we collected multilevel data related to Hungary between 1995 and 2004 from the PrivMort database and other sources at the town, company, and individual level to assess the relation between the dominant company ownership of a town and mortality. We grouped towns into three ownership categories: dominant state, domestic private, and foreign ownership. We did population surveys in these towns to collect data on vital status and other characteristics of survey respondents' relatives. We assessed the relation between dominant ownership and mortality at the individual level. We used discrete-time survival modelling, adjusting for town-level and individual-level confounders, with clustered SEs. FINDINGS: Of 83 eligible towns identified, we randomly selected 52 for inclusion in the analysis and analysed ownership data from 262 companies within these towns. Additionally, between June 16, 2014, and Dec 22, 2014, we collected data on 78â622 individuals from the 52 towns, of whom 27â694 were considered eligible. After multivariable adjustment, we found that women living in towns with prolonged state ownership had significantly lower odds of dying than women living in towns dominated by domestic private ownership (odds ratio [OR] 0·74, 95% CI 0·61-0·90) or by foreign investment (OR 0·80, 0·69-0·92). INTERPRETATION: Prolonged state ownership was associated with protection of life chances during the post-socialist transformation for women. The indirect economic benefits of foreign investment do not translate automatically into better health without appropriate industrial and social policies. FUNDING: The European Research Council.
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Disparidades nos Níveis de Saúde , Internacionalidade , Investimentos em Saúde , Mortalidade/tendências , Propriedade/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multinível , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
BACKGROUND: Population-level data suggest that economic disruptions in the early 1990s increased working-age male mortality in post-Soviet countries. This study uses individual-level data, using an indirect estimation method, to test the hypothesis that fast privatisation increased mortality in Russia. METHODS: In this retrospective cohort study, we surveyed surviving relatives of individuals who lived through the post-communist transition to retrieve demographic and socioeconomic characteristics of their parents, siblings, and male partners. The survey was done within the framework of the European Research Council (ERC) project PrivMort (The Impact of Privatization on the Mortality Crisis in Eastern Europe). We surveyed relatives in 20 mono-industrial towns in the European part of Russia (ie, the landmass to the west of the Urals). We compared ten fast-privatised and ten slow-privatised towns selected using propensity score matching. In the selected towns, population surveys were done in which respondents provided information about vital status, sociodemographic and socioeconomic characteristics and health-related behaviours of their parents, two eldest siblings (if eligible), and first husbands or long-term partners. We calculated indirect age-standardised mortality rates in fast and slow privatised towns and then, in multivariate analyses, calculated Poisson proportional incidence rate ratios to estimate the effect of rapid privatisation on all-cause mortality risk. FINDINGS: Between November, 2014, and March, 2015, 21â494 households were identified in 20 towns. Overall, 13â932 valid interviews were done (with information collected for 38â339 relatives [21â634 men and 16â705 women]). Fast privatisation was strongly associated with higher working-age male mortality rates both between 1992 and 1998 (age-standardised mortality ratio in men aged 20-69 years in fast vs slow privatised towns: 1·13, SMR 0·83, 95% CI 0·77-0·88 vs 0·73, 0·69-0·77, respectively) and from 1999 to 2006 (1·15, 0·91, 0·86-0·97 vs 0·79, 0·75-0·84). After adjusting for age, marital status, material deprivation history, smoking, drinking and socioeconomic status, working-age men in fast-privatised towns experienced 13% higher mortality than in slow-privatised towns (95% CI 1-26). INTERPRETATION: The rapid pace of privatisation was a significant factor in the marked increase in working-age male mortality in post-Soviet Russia. By providing compelling evidence in support of the health benefits of a slower pace of privatisation, this study can assist policy makers in making informed decisions about the speed and scope of government interventions. FUNDING: The European Research Council.
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OBJECTIVES: With markets and competition dominating much of the debate on health care reform, health care planning has received little scholarly attention in recent years. Yet in many high-income countries, governments have continued to plan some elements of their health care systems. We use a new framework for analysing health care planning organised around the dimensions of 'vision', 'governance' and 'intelligence' to assess the approach in two deliberately contrasting countries, Germany and New Zealand. METHODS: A review of the literature on health care planning in general and specifically in Germany and New Zealand, supported by key participant interviews. RESULTS: Planning in both countries largely reflects the different institutional arrangements of their wider health systems. Planning in Germany is fragmented, in part due to federalism and corporatism, with separate approaches in different health care sectors and regions. In contrast, New Zealand's NHS-style health system favours a more hierarchical, integrated approach, with clear lines of accountability, and central government capacity to define objectives and monitor developments. Both countries find it difficult to use planning to align demand for and supply of health care though New Zealand makes some use of population needs assessments to support this process while these are currently absent in Germany. CONCLUSIONS: While it remains challenging to compare health care systems that are institutionally very different, this new framework for analysing their approaches to planning draws attention to their advantages and disadvantages. It also generates an agenda for future research to improve our understanding of the role and effectiveness of different forms of planning versus, and in combination with, other policy tools to relating health care supply and demand.
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Planejamento de Instituições de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Alemanha , Nova ZelândiaRESUMO
Tobacco use is one of the largest avoidable causes of morbidity and premature death in the EU. Whilst smoking prevalence in the EU has been declining over the past 30 years, smoking has remained more prevalent among men than women in the EU-27, with some of the new Member States reporting the widest gaps between male and female smokers. For young smokers (13 to 15 years old) this situation is somewhat reversed, with slightly more girls than boys smoking. Against this background, the European Commission Directorate-General for Health and Consumer Protection (DG SANCO) considered a revision of the Tobacco Products Directive 2001/37/EC across five general areas: scope of the directive, labelling requirements, registration and market control fees, ingredients, and sales arrangements. More specifically, the types of policy options under consideration included (but were not limited to): an increase of warning label sizes on the back of packaging to 100%, a restriction for the display of products at retail outlets and an introduction of additional measurement method for TNCO (the modified ISO method) with maximum limits set accordingly. DG SANCO commissioned RAND Europe to provide support in assessing the potential health, macroeconomic, and compliance cost and administrative burden impacts of revising the Tobacco Products Directive. In addition to assessing impacts, the study provides an up-to-date overview of the evidence and basis for current tobacco product regulation that may be of interest to a wider audience interested in tobacco control policies.