nep-hea New Economics Papers
on Health Economics
Issue of 2007‒01‒23
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Effect of Growth and Inequality in Incomes on Health Inequality: Theory and Empirical Evidence from the European Panel By Tom Van Ourti; Eddy Van Doorslaer; Xander Koolman
  2. The effect of health care expenditure on sickness absence By Granlund, David
  3. Contracting-out of Reproductive and Child Health (RCH) Services through Mother NGO Scheme in India: Experiences and Implications By Bhat Ramesh; Maheshwari Sunil Kumar; Saha Somen
  4. Provision of Reproductive Health Services to Urban Poor through Public-Private Partnerships: The Case of Andhra Pradesh Urban Health Care Project By Bhat Ramesh; Mavalankar Dileep; Maheshwari Sunil; Saha Somen
  5. Mandated Health Insurance Benefits and the Utilization and Outcomes of Infertility Treatments By M. Kate Bundorf; Melinda Henne; Laurence Baker
  6. Estimating Interdependence Between Health and Education in a Dynamic Model By Li Gan; Guan Gong
  7. Pharmaceutical Pricing and Reimbursement Policies in Canada By Valérie Paris; Elizabeth Docteur
  8. Mortality and Immortality By Rablen, Matthew D.; Oswald, Andrew J.
  9. "Are Bruxellois and Walloons more optimistic about their health?" By Guido Citoni

  1. By: Tom Van Ourti (Erasmus Universiteit Rotterdam); Eddy Van Doorslaer (Erasmus Universiteit Rotterdam); Xander Koolman (Erasmus Universiteit Rotterdam)
    Date: 2006–12–12
  2. By: Granlund, David (Department of Economics, Umeå University)
    Abstract: This paper studies the effect of public health care expenditure on absence from work due to sickness or disability using an instrumental variable method. The study is based on data from a panel of the Swedish municipalities during the time period 1993-2004. Public health care expenditure is found to have no significant effect on absence due to sickness or disability and the standard errors are small enough to rule out all but a minimal effect. The same result is obtained when separate estimates are done for men and women and for sickness absence and absence due to disability pension, respectively.
    Keywords: health care expenditure; sickness absence; dynamic panel data models; endogeneity
    JEL: H51 I12 J22
    Date: 2007–01–16
  3. By: Bhat Ramesh; Maheshwari Sunil Kumar; Saha Somen
    Abstract: Partnership with NGOs in delivering and provision of Reproductive and Child Health (RCH) services through mother NGO (MNGO) in the un-served and under-served regions is one of the important initiatives in India. The scheme involves large number of contracts between government and the NGOs. As of April 2006, 215 MNGOs were working in 324 districts of the country. In addition to this there are about 3 to 4 Field NGOs attached with each MNGO in a district. This paper discusses this scheme with an objective to understand the make up of the partnership and the development of management capacity in the system. MNGO scheme is a central sponsored scheme. This scheme faces management challenge to implement it in all states in India. Further, the case study of three states presented in this paper suggests that this challenge emanates several factors. Inter alia, these include delay and uncertainty of funding and contract renewal, lack of partnership orientation in the scheme, lack of trust among the key stakeholders, capacity constrain in the district and state health system, weak monitoring system, procedural delays and multiple points of authority and reporting relationships. It is also observed that the capacity of field NGOs to deliver in the programme is constrained due to non-availability of financial and human resources. The scheme demands a strong leadership at local levels and ownership from the state health system. This can be achieved through effective decentralisation, flexibility in decision-making and creating adequate accountability systems. Regional Resource Centres has to play an important role in coordination between state/district RCH society and the NGOs and strengthening their capacities. The central government instead of focusing on micro-management of the scheme at state level should focus on developing and strengthening the enabling environment and capacity of various stakeholders to implement the scheme. Also, they need to address various systemic issues including development of accountable and performance oriented system, ensuring financial autonomy and decentralisation, delegation of authority, building trust and accountability in the system, effective integration, continuity of the scheme and fostering true sense of partnership between the state and non-state sector.
    Date: 2007–01–15
  4. By: Bhat Ramesh; Mavalankar Dileep; Maheshwari Sunil; Saha Somen
    Abstract: Andhra Pradesh had initiated the Urban Slum Health Care Project to provide basic primary healthcare and family welfare services to urban poor living in slums in 2002. As of now, the project has established 192 Urban Health Centres (UHCs) in 74 municipalities of the state through contracting-out process to the NGOs. These UHCs cover population of about 3 million. State government has played pivotal role in creating capacities to monitor and supervise the functioning of these UHCs. This project was started with the World Bank support and the state has effectively managed the transition from a donor-funded project to government programme and at the same achieving demonstrable impact on health status among its target population. The scheme ensures people’s participation in management of the UHCs and placing the power for identifying the health priority in the hand of the community. The case study identifies emerging challenges in the scheme implementation relating to (a) involvement of NGOs as partners in service delivery, (b) financing and financial management system, and (c) need to reposition the UHCs in view of changing epidemiological scenario. Some of the areas needing attention to address the challenge include: need to refine the service mix to better respond to the health needs of the population served; evolving a financial management practices to increase efficiency in disbursement; motivating NGOs to actively participate in the scheme; developing management capacity and competencies of both partners; and repositioning relationship between the state and non-state actors away from a contractual basis to an effective partnership.
    Date: 2007–01–17
  5. By: M. Kate Bundorf; Melinda Henne; Laurence Baker
    Abstract: During the last two decades, the treatment of infertility has improved dramatically. These treatments, however, are expensive and rarely covered by insurance, leading many states to adopt regulations mandating that health insurers cover them. In this paper, we explore the effects of benefit mandates on the utilization and outcomes of infertility treatments. We find that use of infertility treatments is significantly greater in states adopting comprehensive versions of these mandates. While greater utilization had little impact on the number of deliveries, mandated coverage was associated with a relatively large increase in the probability of a multiple birth. For relatively low fertility patients who responded to the expanded insurance coverage, treatment was often unsuccessful and did not result in a live birth. For relatively high fertility patients, in contrast, treatment often led to a multiple, rather than a singleton, birth. We also find evidence that the beneficial effects on the intensive treatment margin that have been proposed in other studies are relatively small. We conclude that, while benefit mandates potentially solve a problem of adverse selection in this market, these benefits must be weighed against the costs of the significant moral hazard in utilization they induce.
    JEL: I1
    Date: 2007–01
  6. By: Li Gan; Guan Gong
    Abstract: This paper investigates to what extent and through which channels that health and educational attainment are interdependent. A dynamic model of schooling, work, health expenditure, and savings is developed. The structural framework explicitly models two existing hypotheses on the correlation between health and education. The estimation results strongly support the interdependence between health and education. In particular, the estimated model indicates that an individual's education, health expenditure, and previous health status all affect his health status. Moreover, the individual's health status affects his mortality rate, wage, home production, and academic success. On average, having been sick before age 21 decreases the individual's education by 1.4 years. Policy experiments indicate that a health expenditure subsidy would have a larger impact on educational attainment than a tuition subsidy.
    JEL: C61 I12
    Date: 2007–01
  7. By: Valérie Paris; Elizabeth Docteur
    Abstract: This paper describes and assesses pharmaceutical pricing and reimbursement policies in Canada, considering them in the context of the broader policy and market environment in which they operate, and investigating their role in contributing to Canada’s achievements in meeting a range of objectives relating to the pharmaceutical policy. The federal government regulates prices of patented pharmaceutical products with the objective of protecting consumers against excessive prices. Regulation has very likely been responsible for bringing Canada’s prices for patented medicines roughly in line with European comparators. Prices of generic products, which are not regulated, are relatively high although high... <BR>Ce document décrit et évalue les politiques de prix et de remboursement des médicaments au Canada, en les situant dans le contexte politique et l’environnement de marché dans lesquels elles s’inscrivent ; et en observant leur rôle dans l’atteinte des objectifs relatifs à la politique pharmaceutique canadienne. Le gouvernement fédéral régule les prix des médicaments brevetés dans le but de protéger les consommateurs de prix excessifs. Cette régulation a très probablement eu pour effet d’amener les prix des médicaments brevetés canadiens au niveau des prix des pays européens auxquels le Canada se compare. Les prix des médicaments génériques, qui ne sont pas régulés, sont relativement élevés malgré une forte pénétration des...
    Keywords: Canada, Canada, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, prix et remboursement, pharmaceutical market, marché pharmaceutique
    JEL: I11 I18
    Date: 2006–12–22
  8. By: Rablen, Matthew D.; Oswald, Andrew J. (University of Warwick)
    Abstract: It has been known for centuries that the rich and famous have longer lives than the poor and ordinary. Causality, however, remains trenchantly debated. The ideal experiment would be one in which status and money could somehow be dropped upon a sub-sample of individuals while those in a control group received neither. This paper attempts to formulate a test in that spirit. It collects 19th-century birth data on science Nobel Prize winners and nominees. Using a variety of corrections for potential biases, the paper concludes that winning the Nobel Prize, rather than merely being nominated, is associated with between 1 and 2 years of extra longevity. Greater wealth, as measured by the real value of the Prize, does not seem to affect lifespan.
    Keywords: Longevity ; status ; health ; wealth ; mortality
    JEL: I12
    Date: 2007
  9. By: Guido Citoni (University "La Sapienza" Rome and DULBEA, Free University of Brussels.)
    Abstract: Using the data collected for the year 2004 in the Belgian Health Survey, we aim to show that, controlling for all the determinants of self-reported health state, there is a residual effect of geographic location on the self-assessed health, namely a more favourable scoring for individuals that are resident both in the region of Brussels and in the region of Walloonia, with respect to individuals that are resident in the Flanders. Regional effects do not change either if we take account of supply of health services or if we control for their utilization. Moreover the effect of past level of health is encompassed to test for habituation, and the results still hold. The above findings can be used both to construct “equivalent expected QALY’s or EEQ” , i.e. the average quality adjusted life years that a newborn, taking account of the different average level of health at the regional level, can expect to experience in the different geographical areas of Belgium (the three regions have approximately the same EEQ), and to predict a “need factor” to be used either for equity analysis or to ascertain its evolution in time.
    Keywords: Self-assessed health; Quality of life; QALY’s; Regions of Belgium; Health Survey; Ordered Probit.
    JEL: I10 I12 I19
    Date: 2007–01

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