Role of budget impact in drug reimbursement decisions

There are three known criteria that underlie drug reimbursement decisions: therapeutic value, cost-effectiveness, and burden of disease. However, evidence from recent reimbursement decisions in several jurisdictions points to residual, unexplained variables, among which is budget impact. Budget impact refers to the total costs that drug reimbursement and use entail with respect to one part of the health care system, pharmaceutical care, or to the entire health care system, taking into account the possible reallocation of resources across budgets or sectors of the health care system. The economic and equity rationale for carrying out budget impact analyses is opportunity cost, or benefits forgone, measured in terms of utility or equitable distribution, by using resources in one way rather than another. In other words, by choosing to draw down the budget in one way, decision makers forgo other opportunities to use the same resources. Under a set of unrealistic assumptions, cost-effectiveness analysis accounts for opportunity cost while conveying to the decision maker the price of maximizing health gains, subject to a budget or resource constraint. However, the underlying assumptions are implausible, particularly in the context of pharmaceutical care. Moreover, budget impact analysis is more useful to the decision maker than cost-effectiveness analysis if the objective is not to maximize health gains subject to a budget or resource constraint, but to reduce variance in health gains. With respect to equitable distribution, budget impact analyses lay bare the individuals or groups who lose out - those who bear the opportunity cost of spending resources in accordance with one decision rule rather than another.     

Does supported employment work?

Providing employment‐related services, including supported employment through job coaches, has been a priority in federal policy since the enactment of the Developmental Disabilities Assistance and Bill of Rights Act in 1984. We take advantage of a unique panel data set of all clients served by the South Carolina Department of Disabilities and Special Needs between 1999 and 2005 to investigate whether job coaching leads to stable employment in community settings. The data contain information on individual characteristics, such as IQ and the presence of emotional and behavioral problems, that are likely to affect both employment propensity and likelihood of receiving job coaching. Our results show that unobserved individual characteristics and endogeneity strongly bias naive estimates of the effects of job coaching. However, even after correcting for these biases, an economically and statistically significant treatment effect remains. © 2010 by the Association for Public Policy Analysis and Management.     

Assessing nation-state-sponsored cyberattacks using aspects of Situational Crime Prevention

Research Summary

This study utilized a quantitative analysis of 246 cyberattack incidents reported in the Extremist CyberCrime Database to identify significant predictors of nation-state-sponsored cyberattacks relative to those performed by non-nation-state-sponsored ideological actors. Clarke and Newman's Situational Crime Prevention framework for terrorism was used to identify differential opportunities to successfully affect targets on the basis of tools, weapons, and the ability to access targets in online settings. The analysis noted nation-state-sponsored attacks were less likely to use high-visibility attack methods and more likely to utilize attack methods leading to data breaches. In addition, they were more likely to target state governments and military entities relative to ideological actors.

Policy Implications

Nation-state attacks are more difficult to identify or mitigate while in process, requiring a more robust national cybersecurity policy framework to be implemented that moves beyond current practices. There is a need to better utilize all aspects of government, from legislation to grant funding, in order to deter cyberattacks from continuing into the future.