nep-hea New Economics Papers
on Helth Economics
Issue of 2005‒01‒16
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Birth Spacing and Neonatal Mortality in India: Dynamics, Frailty and Fecundity By Sonia Bhalotra; Arthur van Soest
  2. Risk adjustment in the Netherlands: an analysis of insurers' health care expenditures By Rudy Douven
  3. Does job loss shorten life? By Eliason, Marcus; Storrie, Donald
  4. Costs of Climate Policy when Pollution Affects Health and Labour Productivity. A general Equilibrium Analysis Applied to Sweden By Östblom, Göran; Samakovlis, Eva
  5. Third Party Administrators and Health Insurance in India: Perception of Providers and Policyholders By Bhat Ramesh; Maheshwari Sunil Kumar; Saha Somen
  6. Directions for Reforms in the Health Sector: Reflections from a State in a Developing Country By Maheshwari Sunil Kumar; Bhat Ramesh; Saha Somen
  7. Drinking and Academic Performance in High School By Jeff DeSimone; Amy M. Wolaver
  8. Work and the Disability Transition in 20th Century America By Sven Wilson; Joseph Burton; Benjamin Howell
  9. Reporting Bias and Heterogeneity in Self-Assessed Health. Evidence from the British Household Panel Survey By Cristina Hernandez-Quevedo; Andrew M Jones; Nigel Rice

  1. By: Sonia Bhalotra; Arthur van Soest
    Abstract: A dynamic panel data model of neonatal mortality and birth spacing is analyzed, accounting for causal effects of birth spacing on subsequent mortality and of mortality on the next birth interval, while controlling for unobserved heterogeneity in mortality (frailty) and birth spacing (fecundity). The model is estimated using micro data on about 30000 children of 7000 Indian mothers, for whom a complete retrospective record of fertility and child mortality is available. Information on sterilization is used to identify an equation for completion of family formation that is needed to account for right-censoring in the data. We find clear evidence of frailty, fecundity, and causal effects of birth spacing on mortality and vice versa, but find that birth interval effects can explain only a limited share of the correlation between neonatal mortality of successive children in a family.
    Keywords: fertility, birth spacing, childhood mortality, health, dynamic panel data models, siblings.
    JEL: I12 J13 C33
    Date: 2004–12
  2. By: Rudy Douven
    Abstract: As of 2006, the Dutch healthcare system will be run by regulated competition. An important part of regulated competition is a system of risk adjustment. This paper presents an empirical analysis of the effects of risk adjustment in the Dutch social health insurance system covering the years 1991-2001. By comparing insurers' health care expenditures with their risk adjusted premiums, our analysis estimates the impact of risk adjustment over a number of years. <P> Results indicate that the risk-adjustment system has improved substantially. Whereas in the beginning of the nineties prospective risk adjustment could explain about 20% of the variation in health care expenditure differentials between insurers, this figure rose to 55% in 2001. The explanation of the same variation after retrospective payments did not show a clear upward or downward trend, and has varied since 1995 around 85%. The remaining variation in insurers' health care expenditure differentials are determined more by structural than random factors. One such factor may be related to the low ex-ante projections of the government's total health care expenditures, which favour insurers with a population of relatively good health risks. <P> Results show that new entrants in the Dutch health insurance market had significantly lower health care expenditures. Furthermore, economies of scale do not seem to have played a role during the sample period: the expenditures of large insurers were not significantly lower than those of the smaller insurers.
    Keywords: risk adjustment; health care; health care expenditure; health care insurers; health care insurance
    JEL: I11 I18
    Date: 2004–10
  3. By: Eliason, Marcus (Department of Economics, School of Economics and Commercial Law, Göteborg University); Storrie, Donald (Department of Economics, School of Economics and Commercial Law, Göteborg University)
    Abstract: We examine whether there is a causal relationship from job displacement to mortality. The study is based on employees who lost their job from all establishment closures in 1987 and 1988 in Sweden and, as a control group, a large random sample of employees not experiencing displacement at that time. The registers follow all these individuals, between 1983 and 2000 with minimal attrition. They also provide much relevant information on individual, family and establishment characteristics, and predisplacement health and labor market history. Using propensity score matching, we find higher mortality among the displaced up to the eighth follow-up year, mainly due to suicide and heart diseases. Estimates of all-cause mortality risk show significant effects for displaced men, but not for women, up to nine years after displacement. An important methodological conclusion is that research that focuses only on those who leave late in the closure process may over-state the impact of displacement on mortality. <p>
    Keywords: Plant closure; displaced workers; mortality; propensity score matching
    JEL: I12 J63 J65
    Date: 2004–12–01
  4. By: Östblom, Göran (National Institute of Economic Research); Samakovlis, Eva (National Institute of Economic Research)
    Abstract: Much of the debate over global climate change involves estimates of the direct costs of global climate change mitigation. Recently this debate has included the issue of <p> ancillary benefits. These benefits consist mainly of health improvements. Although it is <p> generally acknowledged that air pollution affects respiratory health, and that valuations <p> of these impacts make up a significant proportion of the damage costs of air pollution, <p> these impacts are often neglected when evaluating the costs of climate policy. Since <p> reducing greenhouse gases has the effect of also reducing other pollutants affecting <p> human health and labour productivity these effects should be taken into consideration. <p> The analysis incorporates a linkage between air pollution and health effects into a <p> general equilibrium model for Sweden through a theoretical consistent framework. <p> Results from recent Swedish concentration-response and contingent valuation studies <p> are used to model direct disutility and indirect health effects that negatively affects the <p> productivity of labour. The costs of feedback effects on health and productivity are <p> compared in three different scenarios for attaining the Swedish carbon dioxide target <p> with alternative projected emission levels in the baseline scenario as well as alternative <p> harmful emission levels. Results show that not including feedback effects could mean <p> overstating the costs of climate policy. The magnitude of these effects are, however, <p> very sensitive to projected emission levels and to the judgement of harmful emission <p> levels.
    Keywords: air pollution; ancillary benefits; climate policy; general equilibrium; health
    JEL: D58 I10 Q52 Q53
    Date: 2004–12–28
  5. By: Bhat Ramesh; Maheshwari Sunil Kumar; Saha Somen
    Abstract: The advent of Third Party Administrators (TPAs) is expected to play an important role in health insurance market in ensuring better services to policyholders. In addition, their presence is expected to address the cost and quality issues of the vast private healthcare providers in India. However, the insurance sector still faces challenge of effectively institutionalising the services of the TPA. A lot needs to be done in this direction. Towards this the present paper describes the findings of a survey study, which was carried out with the objective to ascertain the experiences and challenges perceived by hospitals and policyholders in availing services of TPA in Ahmedabad, Gujarat. The major findings from the study are: (i) low awareness among policyholders about the existence of TPA; policyholders mostly rely on their insurance agents; (ii) policyholders have very little knowledge about the empanelled hospitals for cashless hospitalisation services; (iii) TPAs insist on standardisation of fee structure of medical services/procedures across providers; (iv) healthcare providers do experience substantial delays in settling of their claims by the TPAs; (v) hospital administrators perceive significant burden in terms of effort and expenditure after introduction of TPA and (vi) no substantial increase in patient turnover after empanelling with TPAs. However, there is an indication that hospital administrators foresee business potential in their association with TPA in the long-run. There is a clear indication from the study that the regulatory body need to focus on developing mechanisms, which would help TPAs to strengthen their human capital and ensure smooth delivery of TPA services in emerging health insurance market.
    Keywords: Third Part Administrators, Health Insurance, Behaviour
    Date: 2005–01–11
  6. By: Maheshwari Sunil Kumar; Bhat Ramesh; Saha Somen
    Abstract: Meeting the health care needs of population goes beyond mere budget allocations. The organisation of programmes and commitment of people working in the health sector has significant bearing on sector performance and its reform process. The reform process, among other things, intrinsically makes some fundamental assumptions: high organisational commitment of health care providers, high professional commitment of health care providers and adequate skills of health care providers. The current paper attempts to analyse the HR practices in Madhya Pradesh and its implications on commitment of the health officials. The findings of the study indicate that district health officials do not share strong emotional bond with the department which is likely to affect their willingness to take initiative. The findings suggest the need to consult senior doctors in staffing decisions in order to develop a sense of belongingness in the mind of the health officials. The study suggests investing in development of multiple strategies for the growth and career development of health professionals. The study also advocates the need for intense socialisation among health professionals to facilitate the effective implementation of reforms. Finally the study advocates the need to develop informal channels of communications and networking among various health providers.
    Keywords: Commitment, Health Reform, HR Practices
    Date: 2005–01–11
  7. By: Jeff DeSimone; Amy M. Wolaver
    Abstract: This paper examines the relationship between drinking and academic performance for high school students in 2001 and 2003 Youth Risk Behavior Survey (YRBS) data. In particular, we attempt to determine the extent to which the observed negative association between alcohol use and grades reflects correlated unobserved factors rather than a true causal impact of drinking. Taking advantage of the abundant information the YRBS collects on behaviors that are potentially related with both drinking and academic performance, we estimate regressions that successively add proxies for risk and time preference, mental health and self-esteem, along with measures of other substances used. Results indicate that although estimated effects of drinking on grades are substantially reduced in magnitude when these additional covariates are included, they typically remain significantly negative. The impact on the extensive margin is over twice as large for binge drinking than for non-binge drinking, and binge drinking also has intensive margin effects that non-binge drinking does not. Drinking-related grade reductions are larger among those who are more risk averse and future-oriented. An absence of effects on outcomes with which drinking is likely associated in a non-causal way provides further support for our interpretation of the coefficient estimates as causal effects.
    JEL: I1 I2
    Date: 2005–01
  8. By: Sven Wilson; Joseph Burton; Benjamin Howell
    Abstract: Using data from Union Army pensioners and from the National Health Interview Surveys, we estimate that work-disability among white males aged 45-64 was 3.5 times as high in the late 19th century than at the end of the 20th century, including a decline and flattening of the age-profile since 1970. We present a descriptive model of disability that can account for a) the secular decline in prevalence; b) changes in slope of the age-profile; and c) periods of increasing prevalence. The high level and relatively flat slope of the historical disability age-profile is consistent with the early onset of chronic conditions and with high mortality associated with a subset of those conditions. We show that many common conditions in the 19th century have been either eliminated, delayed to later ages, or rendered less disabling by treatment innovations and the transformation of the workplace. These improvements have swamped the effect of declining mortality, which put upward pressure on disability prevalence. Given the low rate of mortality prior to age 65, technological changes will likely induce further reductions in work-disability, though recent increases in the prevalence of asthma and obesity may eventually work against this trend.
    JEL: I12
    Date: 2005–01
  9. By: Cristina Hernandez-Quevedo; Andrew M Jones; Nigel Rice
    Abstract: This paper explores reporting bias and heterogeneity in the measure of self-assessed health (SAH) used in the British Household Panel Survey (BHPS). The ninth wave of the BHPS includes the SF-36 general health questionnaire, which incorporates a different wording to the self-assessed health variable used at other waves. Considerable attention has been devoted to the reliability of SAH and the scope for contamination by measurement error; the change in wording at wave 9 provides a form of natural experiment that allows us to assess the sensitivity of panel data analyses to a change in the measurement instrument. In particular, we investigate reporting bias due explicitly to the change in the question. We show how progressively more general specifications of reporting bias can be implemented using panel data ordered probit and generalised ordered probit models. Our results suggest that the distribution of SAH does shift at the ninth wave but there is little evidence that this varies with socio-economic characteristics at an individual level.
    Keywords: self-assessed health; reporting bias; ordered probit; generalised ordered probit; panel data
    JEL: I12 C23

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