nep-hea New Economics Papers
on Health Economics
Issue of 2006‒04‒01
six papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Does Reporting Heterogeneity bias The Measurement of Health Disparities? By Teresa Bago d'Uva; Eddy van Doorslaer; Maarten Lindeboom; Owen O'Donnell; Somnath Chatterji
  2. Cost-Effectiveness Analysis and its Application for Policy Evaluation for Medicine or Public Health By Yasushi Ohkusa; Tamie Sugawara
  3. The Impact of Antihypertensive Drugs on the Number and Risk of Death, Stroke and Myocardial Infarction in the United States By Genia Long; David Cutler; Ernst R. Berndt; Jimmy Royer; Andrée-Anne Fournier; Alicia Sasser; Pierre Cremieux
  4. A Healthy Economy Can Break Your Heart By Christopher J. Ruhm
  5. Public Health Insurance, Program Take-Up, and Child Health By Anna Aizer
  6. Health, Education and Life-Cycle Savings in Different Stages of Development By K.K.Tang; Jie Zhang

  1. By: Teresa Bago d'Uva (University of York); Eddy van Doorslaer (Erasmus Universiteit Rotterdam and Netspar); Maarten Lindeboom (Vrije Universiteit Amsterdam, HEB, IZA, and Netspar); Owen O'Donnell (University of Macedonia, and Netspar); Somnath Chatterji (World Health Organization)
    Abstract: Heterogeneity in reporting of health by socio-economic and demographic characteristics potentially biases the measurement of health disparities. We use anchoring vignettes to identify reporting heterogeneity in self reports on health for Indonesia, India and China. Correcting for reporting heterogeneity tends to reduce estimated disparities in health by age, sex (not Indonesia), urban/rural and education (not China) and to increase income disparities in health. Overall, while homogeneous reporting by socio-demographic group is significantly rejected, the results suggest that the size of the reporting bias in measures of health disparities is not large.
    Keywords: health measurement; vignettes; self-reported health; reporting heterogeneity
    JEL: D30 D31 I10 I12
    Date: 2006–03–28
  2. By: Yasushi Ohkusa (Japanese National Institution of Infectious Disease); Tamie Sugawara (University of Tsukuba)
    Abstract: In comparison to the policy for other field, the policy for medicine and public health is to consider the value of life or the value of the quality of life. Quality of life is very well known as a concept of QOL. Also, Quality Adjusted Life of Years (QALY) which integrates QOL over life of years is widely used as a measure of the value of life. Cost-effectiveness analysis for medicine and public health adopts two approaches to incorporate value of QOL or QALY. We summarize those advantage and disadvantage briefly at first. Unfortunately, cost-effectiveness analysis has not been committed and operated as an official rule for the method of policy evaluation for medicine or public health in Japan, yet. Thus we show some researches about it which examines ex post or ex ante policy evaluation using cost-effectiveness analysis. In other countries, some political decision making in medicine or public health is based on cost-effectiveness analysis. However, the pressure of the financial deficit will require more accountability about evidence. Therefore, cost-effectiveness analysis must be more important even in political decision making in medicine or public health in Japan.
    Keywords: cost-effectiveness, public health, quality of life
    JEL: H51
    Date: 2006–02
  3. By: Genia Long; David Cutler; Ernst R. Berndt; Jimmy Royer; Andrée-Anne Fournier; Alicia Sasser; Pierre Cremieux
    Abstract: Estimating the value of medical innovation is a continual challenge. In this research, we quantify the impact of antihypertensive therapy on U.S. blood pressures, risk and number of heart attacks, strokes, and deaths. We also consider the potential for further improvements. We estimate the value of innovation using equations relating blood pressure to adverse outcomes from the Framingham Heart Study. Our results show that without antihypertensive therapy, 1999-2000 average blood pressure for the U.S. population age 40 plus would have been 10-13 percent higher. 86,000 excess premature deaths from cardiovascular disease (2001), and 833,000 hospital discharges for stroke and heart attacks (2002) would have occurred. Life expectancy would be 0.5 (men) and 0.4 (women) years lower. At guideline care, there would have been 89,000 fewer premature deaths (2001) and 420,000 fewer hospital discharges for stroke and heart attack (2002) than observed. Our analysis suggests that antihypertensive therapy has had a significant impact on cardiovascular health outcomes but that mortality gains would have been approximately twice as high if guideline care had been achieved for all.
    JEL: I1 O3
    Date: 2006–03
  4. By: Christopher J. Ruhm
    Abstract: Panel data econometric methods are used to investigate how the risk of death from acute myocardial infarction (AMI) varies with macroeconomic conditions after controlling for demographic factors, fixed state characteristics, general time effects and state-specific time trends. The sample includes residents of the 20 largest states over the 1979 to 1998 period. A one percentage point reduction in unemployment is predicted to raise AMI mortality by 1.3 percent, with a larger increase in relative risk for 20-44 year olds than older adults, particularly if the economic upturn is sustained. Nevertheless, the much higher absolute AMI fatality rate of senior citizens implies that they account for most of the additional deaths. This suggests the importance of factors like air pollution and traffic congestion that increase with economic activity, are linked to coronary heart disease and may have particularly strong effects on vulnerable segments of the population, such as the frail elderly. AMI mortality risk quickly rises when the economy strengthens and increases further if the favorable economic conditions persist. This is consistent with strong effects of other short-term factors on heart attack risk and with health being a durable capital stock that is affected by flows of lifestyle behaviors and environmental conditions whose effects accumulate over time.
    JEL: E32 I12
    Date: 2006–03
  5. By: Anna Aizer
    Abstract: Of the ten million uninsured children in 1996, nearly half were eligible for Medicaid, the public health insurance program for poor families, but not enrolled. In response, policy efforts to improve coverage have shifted to increasing Medicaid take-up among those already eligible rather than expanding eligibility. However, little is known about the reasons poor families fail to use public programs or the consequences of failing to enroll. The latter is of particular relevance to Medicaid given that children are typically enrolled when they become sufficiently sick as to require hospitalization. Using new data on Medicaid outreach, enrollment and child hospitalizations in California, I find that information and administrative costs are important barriers to program enrollment, with the latter particularly true for Hispanic and Asian families. In addition, enrolling children in Medicaid before they get sick promotes the use of preventative care, reduces the need for hospitalization and improves health.
    JEL: I12 I18 I38 J13
    Date: 2006–03
  6. By: K.K.Tang (MRG - School of Economics, The University of Queensland); Jie Zhang (MRG - School of Economics, The University of Queensland)
    Abstract: This paper studies investment in health and education in a life-cycle model. Health investment enhances survival to old age by improving health from its endowed level. The model predicts two distinctive phases of development. When income is low enough, the economy has no health investment and little savings, leading to slow growth. When income grows, health investment will become positive and the saving rate will rise, leading to higher life expectancy and faster growth. A health subsidy can move the economy from the first phase to the next. Subsidies on health and education investments can improve welfare.

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