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Purpose – The purpose of this study is to estimate the own- and cross-price elasticity of brand-name outpatient prescription drug cost-sharing for maintenance medications and to estimate the effects of changes in the price differential between generic and brand-name prescription drugs.

Methodology/approach – We first review the literature on the effects of an increase in brand-name drug patient cost-sharing. In addition, we analyze two examples of utilization patterns in filling behavior associated with an increase in brand-name cost-sharing for patients in employer-sponsored health plans with chronic illness.

Findings – We found that the own-price elasticity of demand for brand-name prescription drugs was inelastic. However, the cross-price elasticity was not consistent in sign, and utilization patterns for generic prescription fills did not always increase after a rise in brand-name cost-sharing.

Research limitations – The empirical examples are limited to the experience of patients with employer-sponsored health insurance.

Practical implications – The common practice of increasing brand-name prescription drug patient cost-sharing to increase consumption of generic drugs may not always result in higher generic medication use. Higher brand-name drug cost-sharing levels may result in discontinuation of chronic therapies, instead of therapeutic switching.

Originality/value of chapter – The value of this chapter is its singular focus on the effects of higher brand-name drug cost-sharing through a synthesis of the literature examining the own- and cross-price elasticity of demand for brand-name medications and two empirical examples of the effects of changes in brand-name cost-sharing.

The purpose of this study is to examine households’ behavior towards dirty cooking energy utilisation in an environment where relatively higher accessibility to clean energy is noted. Although the low utilisation rate of clean energy can partly be attributed to utility gains anticipated in dirty energy mixes (DEMs) arising out of accessibility constraints, affordances and enablers, it is still unclear on the extend at which each of these contributes towards DEMs manifestation among the seemingly well-to-do households with higher levels of clean energy mixes (CEM) access. This study, therefore, hinges on scrutinising on this lower utilisation patterns despite a seemingly higher accessibility of CEMs, specifically liquified petroleum gases (LPG).

The study is based on a household’s survey that was carried out in 2018, reaching a sample of 393 households using questionnaires in four wards of the Kigamboni district in Tanzania. Subsequent analyses were descriptive as well as inferential based on binary logistic regression analysis where utilisation of DEMs was predicted for both the high and low social economic status (SES) households by incorporating accessibility constraints, affordances and enablers.

The results show, first, if one assumes energy stacking is not an issue, as households become more constrained towards CEMs utilisation, they shift towards DEMs suggesting that the overall effect is a substitution, and second, the complementarity effect ultimately outweighs the substitution effect as households do not shift from DEMs to CEMs rather stack multiple energy. DEMs flourish in this case study area because those with high income are among those in the lowest SES, and some of those with the highest SES are from among the lowest income category, and all of them end up with more DEMs because shifting towards CEMs require income to complement SES.

Policy-wise, removing hurdles in accessing CEMs such as LPG subsidy programme, gas stove provision to the poor, and enhanced LPG awareness will most likely benefits only those who do not stack energy in cooking while strategies targeting those at the lowest SES such as higher education attainment, empower women as a family decision maker, encourage co-occupancy to enlarge the household size and contain urban growth within certain perimeter will have a significant impact only if they raise both incomes and SES.

Despite of the dominance of DEMs for cooking such as charcoal and firewood in Tanzania, CEMs such as LPG, have emerged as complements or alternatives in the household energy basket. The utilisation of such CEMs is, however, still very low despite the accessibility, cost, environmental and health advantages they offer. Accessibility is not the only factor fuelling CEMs; a complementarity must exist between SES and income for the positive transition towards CEMs to be realised.

Information and communications technology (ICT) offers enormous opportunities for individuals, businesses and society. The application of ICT is equally important to economic and non-economic activities. Researchers have increasingly focused on the adoption and use of ICT by small and medium enterprises (SMEs) as the economic development of a country is largely dependent on them. Following the success of ICT utilisation in SMEs in developed countries, many developing countries are looking to utilise the potential of the technology to develop SMEs. Past studies have shown that the contribution of ICT to the performance of SMEs is not clear and certain. Thus, it is crucial to determine the effectiveness of ICT in generating firm performance since this has implications for SMEs’ expenditure on the technology. This research examines the diffusion of ICT among SMEs with respect to the typical stages from innovation adoption to post-adoption, by analysing the actual usage of ICT and value creation. The mediating effects of integration and utilisation on SME performance are also studied. Grounded in the innovation diffusion literature, institutional theory and resource-based theory, this study has developed a comprehensive integrated research model focused on the research objectives. Following a positivist research paradigm, this study employs a mixed-method research approach. A preliminary conceptual framework is developed through an extensive literature review and is refined by results from an in-depth field study. During the field study, a total of 11 SME owners or decision-makers were interviewed. The recorded interviews were transcribed and analysed using NVivo 10 to refine the model to develop the research hypotheses. The final research model is composed of 30 first-order and five higher-order constructs which involve both reflective and formative measures. Partial least squares-based structural equation modelling (PLS-SEM) is employed to test the theoretical model with a cross-sectional data set of 282 SMEs in Bangladesh. Survey data were collected using a structured questionnaire issued to SMEs selected by applying a stratified random sampling technique. The structural equation modelling utilises a two-step procedure of data analysis. Prior to estimating the structural model, the measurement model is examined for construct validity of the study variables (i.e. convergent and discriminant validity).

The estimates show cognitive evaluation as an important antecedent for expectation which is shaped primarily by the entrepreneurs’ beliefs (perception) and also influenced by the owners’ innovativeness and culture. Culture further influences expectation. The study finds that facilitating condition, environmental pressure and country readiness are important antecedents of expectation and ICT use. The results also reveal that integration and the degree of ICT utilisation significantly affect SMEs’ performance. Surprisingly, the findings do not reveal any significant impact of ICT usage on performance which apparently suggests the possibility of the ICT productivity paradox. However, the analysis finally proves the non-existence of the paradox by demonstrating the mediating role of ICT integration and degree of utilisation explain the influence of information technology (IT) usage on firm performance which is consistent with the resource-based theory. The results suggest that the use of ICT can enhance SMEs’ performance if the technology is integrated and properly utilised. SME owners or managers, interested stakeholders and policy makers may follow the study’s outcomes and focus on ICT integration and degree of utilisation with a view to attaining superior organisational performance.

This study urges concerned business enterprises and government to look at the environmental and cultural factors with a view to achieving ICT usage success in terms of enhanced firm performance. In particular, improving organisational practices and procedures by eliminating the traditional power distance inside organisations and implementing necessary rules and regulations are important actions for managing environmental and cultural uncertainties. The application of a Bengali user interface may help to ensure the productivity of ICT use by SMEs in Bangladesh. Establishing a favourable national technology infrastructure and legal environment may contribute positively to improving the overall situation. This study also suggests some changes and modifications in the country’s existing policies and strategies. The government and policy makers should undertake mass promotional programs to disseminate information about the various uses of computers and their contribution in developing better organisational performance. Organising specialised training programs for SME capacity building may succeed in attaining the motivation for SMEs to use ICT. Ensuring easy access to the technology by providing loans, grants and subsidies is important. Various stakeholders, partners and related organisations should come forward to support government policies and priorities in order to ensure the productive use of ICT among SMEs which finally will help to foster Bangladesh’s economic development.

This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.

The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.

Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.

To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

This paper reports an analysis of the evolution of equity in the utilisation of health care in Spain over the period 1987–2001, a time span covering the development of the modern Spanish National Health System. Our measures of utilisation are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures, we obtain indices of horizontal inequity from microeconometric models of utilisation that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001, the system had improved insofar as differences in income no longer lead to differences in utilisation given the same level of need. However, tenure of private health insurance leads to differences in utilisation given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilisation for the three services has also increased.

Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4.

Methodology/approach – A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression.

Findings – This study found that dual eligible RHC patients utilized ER services at higher rates than nondual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively.

Research limitations/implications – Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in CMS Region 4.

Originality/value – In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 years and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.

Since health behaviors of elderly Asian Americans are often underreported, the study, based on the health behavioral model (Andersen’s model), was to examine if there is a reciprocal relationship between healthcare utilization and health outcomes, and how social characteristics play their role in this relationship between US-born and foreign-born elderly Asian Americans.

Using structural equation modeling, this research examined the proposed hypotheses which consisted of direct and indirect effects among health outcomes, healthcare utilization and social characteristics, as well as the disparities of the effects between US-born and foreign-born elderly Asian Americans (65 + ). A sample size of elderly Asian Americans was divided into a US-born group (N = 1,305) and a foreign-born group (N = 4,902) from the National Health Interview Survey (NHIS) 1998–2012. Health outcomes consisted of current health status and health change. Healthcare utilization included general doctor visit, ER, and mental health professional visit. Social characteristics of population included predisposing characteristics (such as age, sex, marital status, and region of residency) and enabling resources (such as education, family size, and family income).

Results from the study indicated that first, there was a reciprocal relationship between health outcomes and healthcare utilization for both groups. Second, predisposing characteristics had a direct effect on health outcomes, and enabling resources had an indirect effect on health outcomes via healthcare utilization. In addition, living in the West had both direct and indirect effects on health outcomes. Third, regarding disparities of the effects between both groups, the US-born elderly are more likely to attain health benefits from healthcare utilization and their social characteristics than the foreign-born. As a result, the interactive relationship between health outcomes, healthcare utilization, and social characteristics, as well as disparities of healthcare outcomes through health utilization and social characteristics for elderly Asian Americans is highlighted.

First, due to the design of NHIS, this research was limited to fully present the needs and more characteristics of elderly Asian Americans. This shows the great need for a large scale, representative study for health behaviors of elderly Asian Americans. Second, in the dataset, the study was limited to explore health behaviors of elderly Asian Americans into each Asian ethnic subgroup. Since the culture of Asian Americans is heterogeneous, it is recommended that future research can explore differences and commonalities of the health behaviors between Asian subgroups. Third, based on the health behavioral model and the design of the dataset, this study was limited to illustrate variations of life experiences between both groups. These differences regarding their needs and desires for healthcare services and health outcomes can become an important foundation for service providers and policy makers to provide appropriate services that improve the quality of the later lives of elderly Asian Americans.

First, the study applied the health behavioral model and proved that the effect of healthcare utilization and social characteristics on health outcomes is greater for the US-born elderly Asian Americans than for the foreign-born. Second, this study confirmed that the healthcare services in US society are still beneficial for the health outcomes of elderly Asian Americans. Third, the study found that when family is used to explain the social behaviors of elderly Asian Americans, researchers need to be more careful to identify various family factors in accordance to its dynamics, such as interpersonal relationship, material supply, and emotional support.

Migration appears to be a determinant in health-care utilisation, particularly among the elderly in India. Ageing and migration are essential socio-demographic phenomena in the 21st century for developing and developed countries to establish better public health-care policies. This study aims to focus on the status and determinants of health-care utilisation among elderly migrants who have migrated after attaining the age of 45 and above.

This study used the data from the first wave of the longitudinal ageing study in India (LASI) in 2017–2018. Two outcome variables were used to examine the health-care utilisation, including in-patient and out-patient care. Binary logistic regression was used to explore the predictors of healthcare utilisation in terms of in-patient and out-patient care among the elderly migrant population.

A total of 82.9% of elderly migrants had visited out-patient care when they were sick, whereas 15.3% have used in-patient care. Enabling factors, such as wealth quintile and health insurance, and need factor, such as chronic disease and self-rated health, were more significant factors influencing the health-care utilisation.

This study contributes to our understanding of older migrants’ health-care utilisation. Focussing on this study’s outcome, policymakers and decision makers may consider improving older migrants’ access to health-care by raising their income level, offering local health insurance and health awareness programs.

The rising volume of open government data (OGD) contrasts with the limited acceptance and utilization of OGD among citizens. This study investigates the reasons for citizens’ not using available OGD by comparing citizens’ attitudes towards OGD with the development of OGD portals. The comparison includes four OGD utilization processes derived from the literature, namely OGD awareness, needs, access and consumption.

A case study in China has been carried out. A sociological questionnaire was designed to collect data from Chinese citizens (demand), and personal visits were carried out to collect data from OGD portals (supply).

Results show that Chinese citizens have low awareness of OGD and OGD portals. Significant differences were recognized between citizens’ expectations and OGD portals development in OGD categories and features, data access services and support functions. Correlations were found between citizens’ OGD awareness, needs, access and consumption.

By linking the supply of OGD from the governments with each process of citizens’ OGD utilization, this paper proposes a framework for citizens’ OGD utilization lifecycle and provides a new tool to investigate reasons for citizens’ not making use of OGD.