nep-hea New Economics Papers
on Health Economics
Issue of 2006‒10‒21
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Benefit efficient statistical distributions on patient lists By Ubøe, Jan; Lillestøl, Jostein
  2. The cost of multiple sclerosis in Norway – (and how certain can we be?) By Svendsen, Bjørn; Myhr, Kjell-Morten; Nyland, Harald; Aarseth, Jan H.
  3. Does Health Information Matter for Modifying Consumption? A Field Experiment Measuring the Impact of Risk Information on Fish Consumption By Roosen, Jutta; Marette, Stéphan; Blanchemanche, Sandrine; Verger, Philippe
  4. Physician Labour Supply in Canada: a Cohort Analysis By Thomas F. Crossley; Jeremiah Hurley; Sung-Hee Jeon
  5. On the determinants of mortality reductions in the developing world By Rodrigo Reis Soares
  6. Fat City: The Relationship Between Urban Sprawl and Obesity By Jean Eid; Henry G. Overman; Diego Puga; Matthew A. Turner
  7. Should New Anti-Malarial Drugs be Subsidized? By Laxminarayan, Ramanan; Parry, Ian W.H.; Smith, David L.; Klein, Eili
  8. Health, Welfare and Inequality By Gabriella Berloffa; Agar Brugiavini; Dino Rizzi
  9. Relative Risks and the Market for Sex: Teenagers, Sugar Daddies and HIV in Kenya By Dupas, Pascaline

  1. By: Ubøe, Jan (Dept. of Finance and Management Science, Norwegian School of Economics and Business Administration); Lillestøl, Jostein (Dept. of Finance and Management Science, Norwegian School of Economics and Business Administration)
    Abstract: In this paper we consider statistical distributions of different types of patients on the patient lists of doctors. In our framework different types of patients have different preferences regarding their preferred choice of doctor. Assuming that the system is benefit efficient in the sense that distributions with larger total utility have higher probability, we can construct unique probability measures describing the statistical distribution of the different types of patients.
    Keywords: Patient lists; efficient welfare; statistical distributions
    JEL: I18 I30
    Date: 2006–04–27
  2. By: Svendsen, Bjørn (Dept. of Finance and Management Science, Norwegian School of Economics and Business Administration); Myhr, Kjell-Morten (Multiple Sclerosis National Competence Center); Nyland, Harald (Haukeland University Hospital); Aarseth, Jan H. (Multiple Sclerosis National Register)
    Abstract: The research question initially formulated for this study was to attempt to set a numerical target for the total yearly cost of MS to the Norwegian society, and relate the cost and patients´ experienced quality of life to illness severity. As work progressed, the question of how much confidence may be put in this kind of information in Norway as for today turned into another main issue. It turned out that much of the information that could be used for our study was so imprecise or unreliable that giving an impression that the information could be used to give an acceptably precise single estimate of the cost of MS to the Norwegian society would be seriously misleading. Therefore both “conservative” and “best” estimates are given. A conservative estimate of the yearly cost of MS to the Norwegian society around year 2002 is NOK 1 836 million. A best estimate is NOK 4 033 million, more than twice the conservative estimate. Mainly three factors account for the difference between the estimates: Uncertainty on what elements should be included in cost-of-illness studies, uncertainty on how some cost elements should be valued, and a combination of differences in information on the same phenomena in different sources of information and the researchers´ choices on how to handle them. For decision making purposes the combined effect of differences in information from different sources and the researchers´ choices on how to handle them is most grave since it will usually go unrecognized. <p> When related to illness severity, the total cost per patient to society seem to increase, and the patients experienced quality of life to decrease, in a close to linear fashion with increasing EDSS-levels 1. However, a warning should be raised that because of the uncertainties as those mentioned, Norway probably has a long way to go before studies like ours in general might be regarded as providing acceptable information for decisions as important as those that have to be made in the health sector. <p> 1 The EDSS, Kurtzke`s “Expanded Disability Status Scale”, is the most common tool used to express illness severity in MS. The scale ranges from 0 (no disability) to 10 (dead due to MS) and is divided in 20 half-point steps.
    Keywords: Multiple sclerosis; cost-of-illness study; human-capital method
    JEL: I19 J24
    Date: 2006–10–11
  3. By: Roosen, Jutta; Marette, Stéphan; Blanchemanche, Sandrine; Verger, Philippe
    Abstract: A field experiment was conducted in France to evaluate the impact of health information on fish consumption. A warning given to the treatment group revealed the risks of methylmercury contamination in fish and also gave consumption recommendations. Using difference-in-differences estimation, we show that this warning led to a significant but relatively weak decrease in fish consumption. However, consumption of the most contaminated fish did not decrease despite advice to avoid consumption of these types of fish. Accompanying questionnaires show that consumers imperfectly memorize the fish species quoted in the warning. The results point to the relatively poor efficacy of a complex health message, despite its use by health agencies around the world.
    Keywords: econometrics, field experiment, fish consumption, health information, nutrition.
    Date: 2006–10–11
  4. By: Thomas F. Crossley; Jeremiah Hurley; Sung-Hee Jeon
    Abstract: This paper employs cohort analysis to examine the relative importance of different factors in explaining changes in the number of hours spent in direct patient care by Canadian general/ family practitioners (GP/FPs) over the period 1982 to 2002. Cohorts are defined by year of graduation from medical school. The results for male GP/FPs indicate that: there is little age effect on hours of direct patient care, especially among physicians aged 35 to 55; there is no strong cohort effect on hours of direct patient care; but there is a secular decline in hours of direct patient care over the period. The results for female GP/FPs indicate that: female physicians on average work fewer hours than male physicians; there is a clear age effect on hours of direct patient care; there is no strong cohort effect; there has been little secular change in average hours of direct patient care. The changing behaviour of male GP/FPs accounted for a greater proportion of the overall decline in hours of direct patient care from the 80’s through the mid 90’s than did the growing proportion of female GP/FPs in the physician stock.
    Keywords: physician, labour supply, hours, cohorts
    JEL: I11 J24
    Date: 2006–09
  5. By: Rodrigo Reis Soares (Department of Economics PUC-Rio)
    Abstract: This paper presents and critically discusses a vast array of evidence on the determinants of mortality reductions in developing countries. We argue that increases in life expectancy between 1960 and 2000 were largely independent from improvements in income and nutrition. We then characterize the age and cause of death profile of changes in mortality and ask what can be learned about the determinants of these changes from the international evidence and from country-specific studies. Public health infrastructure, immunization, targeted programs, and the spread of less palpable forms of knowledge all seem to have been important factors. Much of the recent debate has revolved around antagonistic approaches, which are not supported by the evidence discussed here. Finally, the paper suggests that the evolution of health inequality across and within countries is intrinsically related to the process of diffusion of new technologies and to the nature of these new technologies (public or private).
    Date: 2006–10
  6. By: Jean Eid; Henry G. Overman; Diego Puga; Matthew A. Turner
    Abstract: We study the relationship between urban sprawl and obesity. Using data that tracks individuals over time, we find no evidence that urban sprawl causes obesity. We show that previous findings of a positive relationship most likely reflect a failure to properly control for the fact the individuals who are more likely to be obese choose to live in more sprawling neighborhoods. Our results indicate that current interest in changing the built environment to counter the rise in obesity is misguided.
    Keywords: urban sprawl; obesity; selection effects
    JEL: I12 R14
    Date: 2006–10–06
  7. By: Laxminarayan, Ramanan (Resources for the Future); Parry, Ian W.H. (Resources for the Future); Smith, David L.; Klein, Eili (Resources for the Future)
    Abstract: We use analytical and numerical models to explain and quantify the welfare effects of subsidies for artemisinin combination treatments (ACTs), a valuable new class of antimalarial drugs. There are two (second-best) efficiency rationales for such subsidies: by expanding drug use, they reduce infection transmission from one individual to another, and they slow the evolution of drug resistance by deterring use of substitute monotherapy drugs for which resistance emerges more rapidly than for ACTs. Our analysis merges epidemiological models of malaria transmission among individuals and mosquitoes, evolution of drug resistance, and economic models of the demand for alternative drugs; parameter values for the simulations are representative of malaria prevalence in sub-Saharan Africa. We find that large subsidies for ACT are welfare improving across many plausible scenarios for malaria transmission, drug-demand elasticities, and evolution of drug resistance; the benefits of the policy are often several times larger than the costs.
    Keywords: antimalarial drugs, resistance externality, transmission externality, subsidies, welfare effects
    JEL: I18 H23 O15
    Date: 2006–09–25
  8. By: Gabriella Berloffa (University of Trento); Agar Brugiavini (Department of Economics, University Of Venice Cà Foscari); Dino Rizzi (Department of Economics, University of Venice Cà Foscari)
    Abstract: This paper uses data from the Health and Retirement Study (HRS) to study the relationship between health status and economic welfare at household level. We develop a model to estimate the welfare cost of ill health by exploiting the methodology of the equivalence scales. The crucial variables in this approach are, besides the health status (measured in several dimensions), the economic decisions of the household which can be directly related to health conditions, such as health-related expenses. By estimating a demand system we derive health-equivalence scales to learn about the cost of health conditions on economic welfare, controlling for other covariates. Our estimates suggest that – when taking account of health – the welfare of households in poor health drops substantially and inequality increases. There are important social welfare costs associated with differences in the health status of the elderly in the USA.
    Keywords: welfare cost, health, inequality
    JEL: I12 I31 J14
    Date: 2006
  9. By: Dupas, Pascaline
    Abstract: An information campaign that provided Kenyan teenagers in randomly selected schools with the information that HIV prevalence was much higher among adult men and their partners than among teenage boys led to a 65% decrease in the incidence of pregnancies by adult partners among teenage girls in the treatment group relative to the comparison. This suggests a large reduction in the incidence of unprotected cross-generational sex. The information campaign did not increase pregnancies among teenage couples. These results suggest that the behavioral choices of teenagers are responsive to information on the relative risks of different varieties of a risky activity. Policies that focus only on the elimination of a risky activity and do not address risk reduction strategies may be ignoring a margin on which they can have substantial impact.
    JEL: O12
    Date: 2005–10

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