Cubí-Mollá Patricia, Jofre-Bonet Mireia, Serra-Sastre Victoria
Office of Health Economics, London, UK.
Department of Economics, City, University of London, London, UK.
Health Econ. 2017 Dec;26(12):1826-1843. doi: 10.1002/hec.3509. Epub 2017 Apr 20.
Healthcare funding decisions in the UK rely on health state valuations of the general public. However, it has been shown that there is disparity between the valuation of the impact of hypothetical conditions on health and the reported health by those experiencing them. Patients' adaptation to health states is among the most common explanations for this discrepancy. Being diagnosed with a disease appears to affect individual perception of health over time so that better subjective health may be reported over a disease trajectory. This paper examines adaptation to health states using a longitudinal dataset. We use four waves of the British Cohort Study (BCS70), which tracks a sample of British individuals since birth in 1970 and contains information on self-assessed health (SAH), morbidity, and socioeconomic characteristics. We implement a dynamic ordered probit model controlling for health state dependence. Results are supportive of the existence of adaptation: Time since diagnosis has a positive impact on SAH. Moreover, adaptation happens over relatively long durations. We do not find significant results proving different adaptation paths for patients reporting prior better SAH. The analysis by specific conditions generally supports the existence of adaptation, but results are statistically significant only for a subset of conditions.
英国的医疗保健资金决策依赖于普通公众对健康状态的估值。然而，研究表明，对于假设状况对健康的影响的估值与经历这些状况的人所报告的健康状况之间存在差异。患者对健康状态的适应是造成这种差异的最常见解释之一。随着时间的推移，被诊断出患有疾病似乎会影响个人对健康的认知，以至于在疾病发展过程中可能会报告更好的主观健康状况。本文使用纵向数据集研究对健康状态的适应情况。我们使用了英国队列研究（BCS70）的四个波次，该研究自1970年起追踪一组英国个体，包含自我评估健康（SAH）、发病率和社会经济特征等信息。我们实施了一个控制健康状态依赖性的动态有序概率模型。结果支持适应的存在：确诊后的时间对自我评估健康有积极影响。此外，适应过程持续时间相对较长。我们没有发现显著结果证明报告之前自我评估健康状况较好的患者有不同的适应路径。按特定状况进行的分析总体上支持适应的存在，但结果仅对部分状况具有统计学意义。
