nep-hea New Economics Papers
on Health Economics
Issue of 2005‒03‒13
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The value of improved road safety By Hultkrantz, Lars; Lindberg, Gunnar; Andersson, Camilla
  2. Immigrant health: selectivity and acculturation By ; Guillermina Jasso; ; Douglas S. Massey; ; Mark R. Rosenzweig; ; James P. Smith
  3. Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level By Frank Windmeijer; ; Hugh Gravell; ; Pierre Hoonhout
  4. Building the Infrastructure to Reach and Care for the Poor: Trends, Obstacles and Strategies to overcome them By Mavalankar Dileep; Ramani K V; Patel Amit; Shankar Parvathy
  5. Technology, Monopoly, and the Decline of the Viatical Settlements Industry By Neeraj Sood; Abby Alpert; Jay Bhattacharya
  6. Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help? 16th Annual Herbert Lourie Memorial Lecture on Health Policy By Milton C. Weinstein
  7. Social Interaction and the Health Insurance Choices of the Elderly By Eldar Beiseitov; Jeffrey D. Kubik; John R. Moran
  8. Maternal Employment and Adolescent Self-Care By Leonard M. Lopoo
  9. Duration Data from the National Long-Term Care Survey: Foundation for a Dynamic Multiple-Indicator Model of ADL Dependency By James N. Laditka; Douglas A. Wolf
  10. Funeral Costs, Saving Behaviour and HIV/AIDS By Sandra Freire

  1. By: Hultkrantz, Lars (Department of Business, Economics, Statistics and Informatics); Lindberg, Gunnar (VTI); Andersson, Camilla (Umeå University)
    Abstract: We report the results of a contingent valuation study of the value of a serious statistical accident (VSSA) in an urban road safety context in Sweden. To account for scale bias of responses (i.e., the insensitivity of the willingness-to-pay value to the size of the risk reduction being valued) we derive a lower-bound estimate. This is computed from the willingness to pay for a private-good device or a public safety program that completely eliminates the risk of fatal and serious injury road accidents. <p> We search for values from respondents with self- reported high confidence in their answers. Our conservative estimates result in average benefits of public road-safety measures targeting serious accidents that are greater than previous studies have indicated.
    Keywords: Value of statistical life; vision zero; contingent valuation; scale bias; scope bias
    JEL: H43 I18 Q51
    Date: 2005–03–10
  2. By: ; Guillermina Jasso; ; Douglas S. Massey; ; Mark R. Rosenzweig; ; James P. Smith
    Date: 2004–01
  3. By: Frank Windmeijer (Institute for Fiscal Studies); ; Hugh Gravell; ; Pierre Hoonhout
    Abstract: We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis is novel in that it focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between outpatient visits, inpatient admissions, daycase treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply.
    Keywords: waiting time; waiting list; hospital admissions
    JEL: I11 H42
    Date: 2004–12
  4. By: Mavalankar Dileep; Ramani K V; Patel Amit; Shankar Parvathy
    Abstract: Infrastructure forms a critical part of health service delivery in any country. Availability, Accessibility, Affordability, Equity, Efficiency and Quality of MNH services highly depend on the distribution, functionality and quality of infrastructure. Most developing countries have invested substantially in developing health infrastructure in rural areas which provides a base for extending MNH services to the poor. Still, there is clear evidence that in many countries there are gaps and inadequacies in health infrastructure. The functionality and utilization of health infrastructure has been sub-optimal or poor due to a variety of reasons. This paper reviews available literature and assesses the coverage and gaps in infrastructure for MNH. It also identifies critical issues in management of infrastructure and analysis their causes and impact on services delivery to the poor. The paper also reviews impacts of reforms on infrastructure and provides some recommendations for improvement of infrastructure management so as to ensure better services to the poor.
    Date: 2005–03–04
  5. By: Neeraj Sood; Abby Alpert; Jay Bhattacharya
    Abstract: The viatical settlement industry provides an opportunity for terminally-ill consumers, typically HIV patients, to exploit a previously untapped source of equity in existing life insurance contracts to finance consumption and medical expenses. The 1996 introduction and dissemination of effecive anti-HIV medication reduced AIDS mortality, but also reduced viatical settlement prices, even holding fixed changes in life expectancy. Using Freedom of Information Act requests to state insurance regulatory agencies, we have assembled a unique dataset of over twelve thousand viatical transactions from firms licensed in states that regulate viatical settlement markets. We distinguish two explanations for falling prices---an increase in market power, and a change in market expectations about the likelihood of further improvements in HIV care. We find that both explanations have contributed to diminishing settlement prices over the last decade, but increased market power has been the more important driver in the most recent years. Our estimates imply that the increase in market power of firms reduced the value of life insurance holdings of HIV persons by about $1.0 billion.
    JEL: I1 L1 O3
    Date: 2005–03
  6. By: Milton C. Weinstein (Department of Health Policy and Management, Harvard School of Public Health)
    Abstract: Are we getting the most health improvement possible for our money. In other words, are all the things that we do in medicine really worth it? That is where cost-effectiveness comes in. As a nation, we have been unwilling, at least publicly, to look explicitly at the value, in terms of improved health outcome, that we get for our health care dollars. With advances in medical technology putting unsustainable pressure on health care costs, our historical reluctance to measure value for health care may have to change. I start this brief by describing cost-effectiveness analysis as a method of determining the value, measured in Quality-Adjusted Life Years, of medical technologies as they are applied to treat, diagnose, or prevent various conditions. Based on this information, I then argue that some highly beneficial, low-cost procedures are significantly underutilized, and that other medical technologies may be overutilized based on the amount of health benefit they yield in relation to their cost. Next, I give examples from current research, my own and that of colleagues, illustrating how cost-effectiveness analysis can be used to guide the use of new diagnostic testing technologies (such as DNA or RNA typing of infectious agents or identification of genomic or proteinomic markers in cancer patients).
    JEL: I12 I18
    Date: 2005–01
  7. By: Eldar Beiseitov (Department of Economics, Maxwell School, Syracuse University); Jeffrey D. Kubik (Center for Policy Research, Maxwell School, Syracuse University); John R. Moran (Center for Policy Research, Maxwell School, Syracuse University)
    Abstract: Using data from the 1998 wave of the Health and Retirement Study, we examine the effect of social interactions on the health insurance choices of the elderly. We find that having more social interactions, as measured by contacts with friends and neighbors, reduces the likelihood of enrolling in a Medicare managed care plan relative to purchasing a medigap policy or having coverage through Medicare alone. Our estimates indicate that social networks are an important determinant of the health insurance choices of the elderly and provide suggestive evidence that "word-of-mouth" information sharing may have played a role in the preference of some seniors for traditional indemnity insurance over managed care.
    JEL: I11 J14
    Date: 2004–05
  8. By: Leonard M. Lopoo (Center for Policy Research, Maxwell School, Syracuse University)
    Abstract: Mounting evidence shows that self-care produces deleterious consequences for adolescents in the U.S. Since desscriptive evidence suggests that maternal employment is the primary explanation for adolescent self-care, maternal employment, it is frequently argued, is harming children. Heretofore, very little empirical research has actually investigated the impact of maternal employment on adolescent self-care, however, calling into question this assertion. This paper aims to fill this gap. The author uses the National Education Longitudinal Survey of 1988 supplemented by the National Longitudinal Survey of Youth-1979 to estimate the relationship between maternal employment and adolescent self-care. Unlike prior research, the author employs a variety of fixed effects models to account for omitted variables that may be related to maternal employment and adolescent self-care. Findings suggest that the adolescents of mothers who work full-time spend an additional 43 minutes per week in self-care compared to the adolescents of mothers who work part-time. Further, a standard deviation increase in the number of weeks a mother works during the year increases the probability that her child will be unsupervised by 27 percent. These effects are not constant across socio-economic groups: affluent families have strong effects, while the relationship is more tenuous among low-income families. This finding has important implications for pro-work social welfare policies in the United States.
    JEL: J12 J13 J22
    Date: 2004–03
  9. By: James N. Laditka; Douglas A. Wolf (Center for Policy Research, Maxwell School, Syracuse University)
    Abstract: This report describes preparation of data from the National Long-Term Care Survey (NLTCS) fur use in a dynamic multiple-indicator model of dependency in Activities of Daily Living (ADLs). The data set descrdibed makes use of all functional status information available across four NLTCS waves for six ADLs, including information from screening interviews, detailed interviews in the community, and institutional interviews. Importantly, it also captures all available information elicited from respondents about the *duration* of any impairment in these ADLs. The data was prepared as described in this report to enable the calculation of improved estimates of the probabilities that an older individual will transition from one functional status state to another in any of six ADLs. These probabilities can then be used to improve estimates of active life expectancy.
    JEL: I12 J14
    Date: 2004–12
  10. By: Sandra Freire (TEAM)
    Abstract: The purpose of the paper is to highlight that funeral costs matter in households' decisions. In particular they do matter in the understanding of the impact of HIV/AIDS on households' wealth in developing countries. Nevertheless the magnitude of the implications on households through the channel of funerals depends deeply on funeral social norms and on individual characteristics. Four funeral motives household models are drawn in order to understand the complex relationship between households' wellbeing, funreals and HIV/AIDS. They differ in the existence of funeral social norms and in two specific funeral motives, joy of proper funeral or altruistic funeral motive. A preliminary analysis of the Centre for Health Systems Research & Development survey on socioeconomic impact of HIV/AIDS in South Africa illustrates first that funeral costs alter the long term behaviour of households. Then it suggests that HIV/AIDS changes the funeral behaviour in particular by lowering life expectancies. A relative funeral social norm rather than an absolute on influences the magnitude of funeral expenses. Finally, households appear to behave according to the joy of proper funeral motive rather than the altruistic funeral motive.
    Keywords: HIV/AIDS, saving behaviour; household, decision theory; optimal control; funerals
    JEL: D11 D91 I12 J26
    Date: 2004–10

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