nep-hea New Economics Papers
on Health Economics
Issue of 2006‒07‒09
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Effect of Female Education on Fertility and Infant Health: Evidence from School Entry Policies Using Exact Date of Birth By Justin McCrary; Heather Royer
  2. Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence From Three States By José J. Escarce; Arvind K. Jain; Jeannette Rogowski
  3. Education and Health: Evaluating Theories and Evidence By David M. Cutler; Adriana Lleras-Muney
  4. Market Structure and Communicable Diseases By Stéphane Mechoulan
  5. Discordant couples : HIV infection among couples in Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania By de Walque, Damien
  6. The Relationship between Body Mass Index and Health-Related Quality of Life By Susan Macran
  7. Multiple Interfaces of Big Pharma and the Change of Global Health Governance in the Face of HIV/AIDS By Jan Peter Wogart
  8. Productivity and its Drivers in Finnish Primary Care 1988-2003 By Maija-Liisa Järviö; Juho Aaltonen; Tarmo Räty; Kalevi Luoma

  1. By: Justin McCrary; Heather Royer
    Abstract: This paper uses age-at-school-entry policies to identify the effect of female education on fertility and infant health. We focus on sharp contrasts in schooling, fertility, and infant health between women born just before and after the school entry date. School entry policies affect female education and the quality of a woman’s mate and have generally small, but possibly heterogeneous, effects on fertility and infant health. We argue that school entry policies manipulate primarily the education of young women at risk of dropping out of school.
    JEL: C3 D1 I1 J2
    Date: 2006–06
  2. By: José J. Escarce; Arvind K. Jain; Jeannette Rogowski
    Abstract: This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital discharge and vital statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York, but not Wisconsin. In addition, higher HMO penetration was associated with lower mortality in California, but higher mortality in New York. In the context of the study states’ history with managed care, these findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality.
    JEL: I1
    Date: 2006–06
  3. By: David M. Cutler; Adriana Lleras-Muney
    Abstract: There is a large and persistent association between education and health. In this paper, we review what is known about this link. We first document the facts about the relationship between education and health. The education ‘gradient’ is found for both health behaviors and health status, though the former does not fully explain the latter. The effect of education increases with increasing years of education, with no evidence of a sheepskin effect. Nor are there differences between blacks and whites, or men and women. Gradients in behavior are biggest at young ages, and decline after age 50 or 60. We then consider differing reasons why education might be related to health. The obvious economic explanations – education is related to income or occupational choice – explain only a part of the education effect. We suggest that increasing levels of education lead to different thinking and decision-making patterns. The monetary value of the return to education in terms of health is perhaps half of the return to education on earnings, so policies that impact educational attainment could have a large effect on population health.
    JEL: I1 I2
    Date: 2006–07
  4. By: Stéphane Mechoulan
    Abstract: Communicable diseases pose a formidable challenge for public policy. Using numerical simulations, we show under which scenarios a monopolist’s price and prevalence paths converge to a nonzero steady-state. In contrast, a planner typically eradicates the disease. If eradication is impossible, the planner subsidizes treatments as long as the prevalence can be controlled. Drug resistance exacerbates the welfare difference between monopoly and first best outcomes. Nevertheless, because the negative externalities from resistance compete with the positive externalities of treatment, a mixed competition/monopoly regime may perform better than competition alone. This result has important implications for the design of many drug patents.
    Keywords: communicable disease, resistance, epidemiology, patent
    JEL: I18 L12
    Date: 2005–06–27
  5. By: de Walque, Damien
    Abstract: Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys which include results from HIV tests allow studying HIV infection at the level of the cohabiting couple. The paper exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two surprising findings about the dynamics of the HIV/AIDS epidemic which have important implications for policy. First, at least two-thirds of the infected couples are discordant couples, that is, couples where only one of the two partners is infected. This implies that there is scope for prevention efforts among couples. Second, between 30 and 40 percent of the infected couples are couples where the female partner only is infected. This is at odds with levels of self-reported marital infidelity by females and with the common perception that unfaithful males are the main link between high risk groups and the general population. This study investigates and confirms the robustness of these findings. For example, even among couples where the woman has been in only one union for 10 years or more, the fraction of couples where only the female partner is infected remains high. These results suggest that extramarital sexual activity among cohabiting women, whatever its causes, is a substantial source of vulnerability to HIV that should be, as much as male infidelity, targeted by prevention efforts. Moreover, this paper uncovers several inconsistencies between the sexual behaviors reported by male and female partners, suggesting that as much as possible, prevention policies should rely on evidence including objectively measured HIV status.
    Keywords: AIDS HIV,HIV AIDS and Business,Health Monitoring & Evaluation,Health Service Management and Delivery,Poverty and Health
    Date: 2006–06–01
  6. By: Susan Macran (Centre for Health Economics, The University of York)
    Abstract: Study Objectives: This paper explores the relationship between body mass index (BMI) and health-related quality of life (HRQoL), measured using EQ-5D, for men and women within a national population sample.Methods: Data were taken from the 1996 Health Survey for England, an annual survey commissioned by the UK Department of Health. HRQoL was measured using EQ-5D. Informants’ BMI was calculated from height and weight measurements collected by trained nurses. Details of any long-standing illness were also collected. Complete data was available for 11,783 cases aged 18 years or more. Main Results: There were significant differences in EQ-5D by BMI category, although the nature of the relationship between EQ-5D and BMI differed by gender. For women, significant differences in EQ-5Dindex could be observed for each BMI category, which was independent of age and the presence of long-standing illness. For men, being classified within the obese BMI range was associated with poor EQ- 5Dindex score, although this relationship disappeared after accounting for age and long-standing illness. The EQ-5D pain and mobility dimensions showed the greatest change in reported problems with increasing BMI. Analysis showed little relationship between BMI and the EQ-5D anxiety/depression dimension.Discussion: Most of the apparent relationship between BMI and HRQoL could be accounted for by age and the presence of long-standing illness. However women’s HRQoL did appear to be sensitive to their weight. Further investigation of the nature of the gender differences in the relationship between BMI and HRQoL would be useful.
    Keywords: EQ-5D, UK, gender differences
    Date: 2004–08
  7. By: Jan Peter Wogart (University of Applied Sciences, Bremen)
    Abstract: By using a game theoretical approach and the notion of “forum” or “regime shifting” this paper examines the multiple interfaces of the multinational pharmaceutical corporations (MNPCs) with their major counterparts at home and abroad, including the governments of the North and South, the international organizations and increasingly with national and international NGOs in the context of the spreading HIV/AIDS crisis. It shows how the execution of the MNPCs’ strategies led to significant reactions from other actors, which led to further moves and countermoves in a strategic battle between representatives of the North and the South in the global health arena.
    Keywords: Multinational Pharmaceutical Corporations (MNPCs), HIV/AIDS, global health governance, pricing of ARVs;
    JEL: I K
    Date: 2006–06
  8. By: Maija-Liisa Järviö; Juho Aaltonen; Tarmo Räty; Kalevi Luoma
    Abstract: We measure productivity changes of primary care in Finland between 1988 and 2003 as a ratio of key services produced and real operating costs. In the second stage we estimate a truncated regression model that quantifies the contribution of certain internal and exogenous factors to productivity. We use newly developed techniques to correct asymptotic bias in non-parametric efficiency scores and bootstrap the confidence intervals for the explanatory model parameter estimates. The bias accounts on average 2.8 percent decrease in efficiency level. From 1997 to 2003 the average productivity declined 13.7 percent; the result is insensitive to estimated bias. Even if standard parametric confidence intervals do not generally apply when efficiency scores are regressed, our bootstrapped intervals are almost equal to parametric ones. Of the correlates used the increased income subject to municipal taxation accounted for three percentage points of the productivity decrease. The correlates, that are expected to decrease the need of primary care services, had a negative impact on productivity, implying that health centres have not been able to adjust their resource usage correspondingly. Organisational changes that have taken place within primary care have not resulted in desired productivity improvements.
    Keywords: primary care, health centres, productivity, bootstrap
    JEL: I11 D61 C15
    Date: 2005–12–29

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