nep-hea New Economics Papers
on Health Economics
Issue of 2005‒06‒05
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Child Nutrition in India in the Nineties: A Story of Increased Gender Inequality? By Tarozzi, Alessandro; Mahajan, Aprajit
  2. Risk Adjustment and Primary Health Care in Chile By Veronica Vargas; Juergen Wasem
  3. Nonparametric Bounds on the Effect of Deductibles in Health Care Insurance on Doctor Visits - Swiss Evidence By Michael Gerfin; Martin Schellhorn
  4. How Does Marriage Affect Physical and Psychological Health? A Survey of the Longitudinal Evidence By Chris M. Wilson; Andrew J. Oswald
  5. Does Corporate Ownership Matter? Service Provision in the Hospital Industry By Jill R. Horwitz
  6. An Investigation of the Effects of Alcohol Consumption and Alcohol Policies on Youth Risky Sexual Behaviors By Sara Markowitz; Robert Kaestner; Michael Grossman
  7. Hospital Integration and Vertical Consolidation: An Analysis of Acquisitions in New York State By Robert S. Huckman
  8. Price and the Health Plan Choices of Retirees By Thomas C. Buchmueller
  9. Decentralisation of health care and its impact on health outcomes By Dolores Jimenez; Peter C Smith

  1. By: Tarozzi, Alessandro; Mahajan, Aprajit
    Abstract: We establish some new interesting stylized facts on the changes in boy versus girl nutritional status in India during the nineties, a period of rapid economic growth. Our analysis is based on the comparison, over time and across genders, of the distribution of z-scores calculated for height and weight measures. Overall, we find that child nutrition improved substantially, but we also find that gender differences in nutritional status increased as well, with nutritional status improving substantially more for boys than for girls. Consistent with a large literature that shows the existence of a steep North-South gradient in gender inequality in India, we find that changes in nutritional status appear to be much more similar between genders in the South. We also estimate predicted changes in nutritional status based on changes in the distribution of household wealth (proxied by asset ownership) and a few other observed household characteristics. Actual changes appear to be relatively close to predicted ones in urban areas. For children living in the rural sector the results are more mixed, and we observe that actual changes in weight are quite larger than predicted ones for boys, while they are much worse than the predicted ones for girl height. We also estimate that the predicted changes are generally larger for boys than for girls.
    Keywords: Child Nutrition, India, Child Anthropometry
    JEL: I12 J13 O53
    Date: 2005
  2. By: Veronica Vargas (Professor of Health Economics, ILADES-Georgetown University-Universidad Alberto Hurtado, Chile.); Juergen Wasem (Department of Economics, University of Essen, Germany)
    Abstract: Chile´s primary health care (PHC) payment system uses income of the municipalities and the geographic location of health centres (HCs) to adjust current capitation payments. Concerns over the ability of the formula to direct health resources where greater health needs are discussed. We uses a sample of 10,000 individuals was drawn and two years data was collected from a region in Chile. Three models were tested: i) age and gender, ii) age, gender and the presence of two key diagnoses and iii) age, gender and the presence of seven key diagnoses, to estimate how significant their effects were on utilization and per-capita expenditures. Regression analysis was performed to calculate the predictive values of the independent variables and two tests applied to select the best and next best model. The main results are the following. First, the use of services by age and gender confirmed international trends, where children under five, women and elderly were the main users of PHC services. Second, women consulted twice as much as men. Thrid, clear difference by SES were observed, indigents aged 65+ under-utilised PHC services. From the three models simulated, the major improvement in the predictive power took place from the demographic to the demographic plus two diagnoses model. Improvements were limited when five other diagnoses were added (R-square=28%). The conclusion is that the current normative formula used by the MOH provides little incentives to care appropriately for indigents and people with chronic conditions such as diabetes and hypertension. A capitation payment that adjusts for age, gender, and presence of hypertension and diabetes will better guide resources to those with poorer health and lower SES.
    Keywords: Primary health care, Payment system, Risk adjustment
    JEL: H51 I11 I18
    Date: 2005–05
  3. By: Michael Gerfin (University of Bern and IZA Bonn); Martin Schellhorn (GSF, Institute of Health Economics and Health Care Management, Munich, University of Bern and IZA Bonn)
    Abstract: We evaluate the effect of the size of deductibles in the basic health insurance in Switzerland on the probability of a doctor visit. We employ nonparametric bounding techniques to minimise statistical assumptions. In order to tighten the bounds we consider three further assumptions: mean independence of an instrument, monotone treatment response, and monotone treatment selection. Under the first two assumptions we are able to bound the treatment effect of high deductibles compared to low deductibles below zero. Adding the third assumption allows to tighten the bounds further. We conclude that there is a negative treatment effect.
    Keywords: treatment effects, bounds, health insurance
    JEL: C14 I19
    Date: 2005–05
  4. By: Chris M. Wilson (University of East Anglia); Andrew J. Oswald (University of Warwick, Harvard University and IZA Bonn)
    Abstract: This paper examines an accumulating modern literature on the health benefits of relationships like marriage. Although much remains to be understood about the physiological channels, we draw the judgment, after looking across many journals and disciplines, that there is persuasive longitudinal evidence for such effects. The size of the health gain from marriage is remarkable. It may be as large as the benefit from giving up smoking.
    Keywords: mortality, health, marriage, happiness, longitudinal
    JEL: I0 I12
    Date: 2005–05
  5. By: Jill R. Horwitz
    Abstract: Three types of firms %uF818 nonprofit, for-profit, and government %uF818 own U.S. hospitals, yet we do not know whether ownership results in the specialization of medical service provision. This study of over 30 medical services in urban, general hospitals (1988-2000) shows that ownership types specialize in medical services according to the profitability of those services. The paper examines three theories to explain the differences: 1) objectives, 2) capital prices, and 3) market characteristics. The findings are best explained by differences in the objectives adopted by hospital types rather than differences in capital constraints faced by them. Preliminary evidence suggests that hospital behavior depends on the ownership form of neighboring hospitals.
    JEL: I1 L3 L2
    Date: 2005–05
  6. By: Sara Markowitz; Robert Kaestner; Michael Grossman
    Abstract: The problems of teen pregnancy, HIV/AIDS and the high rates of other sexually transmitted diseases among youth have lead to widespread concern with the sexual behaviors of teenagers. Alcohol use is one of the most commonly cited correlates of risky sexual behavior. The purpose of this research is to investigate the causal role of alcohol in determining sexual activity and risky sexual behavior among teenagers and young adults. This research also addresses the question of whether there are public policies that can reduce the risky sexual behavior that results in harmful consequences. Individual and aggregate level data are used to investigate these questions. Results show that alcohol use appears to have no causal influence in determining whether or not a teenage has sex. However, alcohol use may lower contraception use among sexually active teens.
    JEL: I0
    Date: 2005–05
  7. By: Robert S. Huckman
    Abstract: While prior studies tend to view hospital integration through the lens of horizontal consolidation, I provide an analysis of its vertical aspects. I examine the effect of hospital acquisitions in New York State on the distribution of market share for major cardiac procedures across providers in target markets. I find evidence of benefits to acquirers via business stealing, with the resulting redistribution of volume across providers having small effects, if any, on total welfare with respect to cardiac care. The results of this analysis--along with similar assessments for other services--can be incorporated into future studies of hospital consolidation.
    JEL: I1 L2
    Date: 2005–05
  8. By: Thomas C. Buchmueller
    Abstract: This study analyzes health plan choices of retirees in an employer-sponsored health benefits program that resembles "premium support" models proposed for Medicare. In this program, out-of-pocket premiums depend on when an individual retired and his or her years of service as of that date. Since this price variation is exogenous to unobserved plan attributes and retiree characteristics, it possible to obtain unbiased premium elasticity estimates. The results indicate a significantly negative effect of premiums. The implied elasticities are at the low end of the range found in previous studies on active employees.
    JEL: I11 D12
    Date: 2005–06
  9. By: Dolores Jimenez; Peter C Smith
    Abstract: This paper explores the impact of health care decentralisation on a characteristic of human development: the overall level of population's health. While much of the literature on decentralisation in health care has stressed the advantages of sub national provision of health services, in the absence of a quantitative measure of the magnitude of the effect of decentralisation, there is little that can be said in terms of its benefits and costs for the health sector. The purpose of this study is therefore to contribute to the limited empirical literature on this issue by investigating the hypothesis that shifts towards more decentralisation would be accompanied by improvements in population health. The analysis draws on a theoretical model of theoretical model of local government's public finance applied to health. We use the ten provinces of Canada as a case study. Apart from being one of the most decentralised countries in the world, Canadian data required to estimate our model was found to be one of the best.
    Keywords: Fiscal decentralisation; health outcomes; Canada
    JEL: I12 H77

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