nep-hea New Economics Papers
on Health Economics
Issue of 2005‒10‒04
three papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Efficient Kidney Exchange: Coincidence of Wants in a Structured Market By Alvin E. Roth; Tayfun Sönmez; M. Utku Ünver
  2. Gatekeeping in Health Care By Kurt R. Brekke; Robert Nuscheler; Odd Rune Straume
  3. Understanding the Effects of Siblings on Child Mortality: Evidence from India By Gerald Makepeace; Sarmistha Pal

  1. By: Alvin E. Roth (Harvard University); Tayfun Sönmez (Boston College); M. Utku Ünver (Koç University)
    Abstract: Patients needing kidney transplants may have willing donors who cannot donate to them because of blood or tissue incompatibility. Incompatible patient-donor pairs can exchange donor kidneys with other such pairs. The situation facing such pairs resem- bles models of the ìdouble coincidence of wants,î and relatively few exchanges have been consummated by decentralized means. As the population of available patient-donor pairs grows, the frequency with which exchanges can be arranged will depend in part on how exchanges are organized. We study the potential frequency of exchanges as a function of the number of patient-donor pairs, and the size of the largest feasible exchange. Developing infrastructure to identify and perform 3-way as well as 2-way exchanges will have a substantial effect on the number of transplants, and will help the most vulnerable patients. Larger than 3-way exchanges have much smaller impact. Larger populations of patient-donor pairs increase the percentage of patients of all kinds who can find exchanges.
    Keywords: efficient exchange, transplants, double coincidence of wants
    JEL: C78 D63 I10
    Date: 2005–05–23
  2. By: Kurt R. Brekke; Robert Nuscheler; Odd Rune Straume
    Abstract: We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of general practitioners (GPs). In the secondary care market there are two hospitals choosing quality and specialisation. Patients, who are ex ante uninformed, can consult a GP to receive an (imperfect) diagnosis and obtain information about the secondary care market. We show that hospital competition is amplified by higher GP attendance but dampened by improved diagnosing accuracy. Therefore, compulsory gatekeeping may result in excessive quality competition and too much specialisation, unless the mismatch costs and the diagnosing accuracy are sufficiently high. Second-best price regulation makes direct regulation of GP consultation redundant, but will generally not implement first-best.
    Keywords: gatekeeping, imperfect information, quality competition, product differentiation, price regulation
    JEL: D82 I11 I18 L13
    Date: 2005
  3. By: Gerald Makepeace (Cardiff Business School); Sarmistha Pal (Department of Economics & Finance, Brunel University)
    Abstract: This paper examines the efffect of siblings on child mortality in the Indian state of West Bengal arguing that prior and posterior spacing between consecutive siblings are important measures of the intensity of competition among siblings for limited resources. Parental decisions regarding spacing is endogenous to allocation of resources though available estimates of child mortality largely ignore it. To correct for this possible endogeneity bias, we allow for family specific unobserved heterogeneity and model birth spacing and child mortality as correlated processes within a sequential framework. These corrected estimates suggest: (a) the hazard of prior spacing may increase while that of posterior spacing decrease with mother’s literacy and household assets. (b) the chances of child survival increase with an increase in both prior and posterior birth interval but decrease with the birth of a twin. (c) prior and posterior birth intervals have different effects on young boys and girls, which, in turn, reflect the nature of decisions made by resource constrained parents characterised by pro-male bias.
    Keywords: Sibling competition, Age and gender composition, Birth spacing, Child mortality, Pro-male bias, Unobserved heterogeneity.
    JEL: D13 I12 O15
    Date: 2005–09–27

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