nep-hea New Economics Papers
on Health Economics
Issue of 2007‒02‒17
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. A Multilevel Approach to Explain Child Mortality and Undernutrition in South Asia and Sub-Saharan Africa By Kenneth Harttgen; Mark Misselhorn
  2. Poverty, Undernutrition, and Child Mortality: Some Inter-Regional Puzzles and their Implications for Research and Policy By Stephan Klasen
  3. Intra-household Gender Disparities in Children’s Medical Care before Death in India By Abay Asfaw; Stephan Klasen; Francesca Lamanna
  4. Peer Effects, Unobserved Factors and Risk Behaviours: An Analysis of Alcohol Abuse and Truancy among Adolescents By Rosa Duarte; José-Julián Escario; José-Alberto Molina
  5. Capabilities and Equality of Health II: Capabilities as Options By Hans Keiding
  6. Intergenerational Transfers of Time and Public Long-term Care with an Aging Population By Atsue Mizushima
  7. Exposure to pesticides, ill-health and averting behaviour: Costs and determining the relationships By Clevo Wilson
  8. Advance Market Commitments for Vaccines Working Paper and Spread Sheet By Ruth Levine; Ernst R. Berndt; Rachel Glennerster; Michael R. Kremer; Jean Lee; Georg Weizsacker; Heidi Williams
  9. Maternal Mortality rate in Bolivia: Projection Scenarios and Financial Requirements (in Spanish) By Vargas Barrenechea, Martin
  10. Unemployment and self-assessed health: Evidence from panel data By Böckerman, Petri; Ilmakunnas, Pekka
  11. The Macroeconomic Debate On Scaling up HIV/AIDS Financing By Terry McKinley; Degol Hailu

  1. By: Kenneth Harttgen (Universität Göttingen, Germany); Mark Misselhorn (Universität Göttingen, Germany)
    Abstract: While undernutrition among children is very pervasive both in Sub- Saharan Africa and South Asia, child mortality is rather low in South Asia. In contrast to that Sub-Saharan African countries suer by far the worst from high rates of child mortality. This dierent pattern of child mortality and undernutrition in both regions is well known, but approaches using aggregated macro data have not been able to explain it appropriately. In this paper we analyze the determinants of child mortality as well as child undernutrition based on DHS data sets for a sample of ve developing countries in South Asia and Sub-Saharan Africa. We investigate the eects of individual, household and cluster socioeconomic characteristics using a multilevel model approach and examine their respective inuences on both phenomena. We nd that the determinants of child mortality and undernutrition dier signi cantly from each other. Access to health infrastructure is more important for child mortality, whereas the individual characteristics like wealth and educational and nutritional characteristics of mothers play a larger role for anthropometric shortfalls. Although very similar patterns in the determinants of each phenomenon are discernable between countries, there are large dierences in the magnitude of the coecients. Besides regressions using a combined data set of all six countries show, that there are still signicant dierences between the two regions although taking account of a large set of covariates.
    Keywords: Child mortality, child undernutrition, multilevel modelling
    JEL: C40 I12 I31 I32 O57
    Date: 2006–10–19
  2. By: Stephan Klasen (Universität Göttingen)
    Abstract: This paper examines the relationship between measures of income poverty, undernourishment, childhood undernutrition, and child mortality in developing countries. While there is, as expected, a close aggregate correlation between these measures of deprivation, the measures generate some inter-regional paradoxes. Income poverty and child mortality is highest in Africa, but childhood undernutrition is by far the highest in South Asia, while the share of people with insufficient calories (undernourishment) is highest in the Caribbean. The paper finds that standard explanations cannot account for these inter-regional paradoxes, particularly the ones related to undernourishment and childhood undernutrition. The paper suggests that measurement issues related to the way undernourishment and childhood undernutrition is measured might play a significant role in affecting these inter-regional puzzles and points to implications for research and policy.
    Keywords: Millennium Development Goals, Undernutrition, Child Mortality, Poverty
    JEL: I1 I3 O1
    Date: 2007–01–09
  3. By: Abay Asfaw (International Food Policy Research Institute); Stephan Klasen (Göttingen University and IZA); Francesca Lamanna (Göttingen University)
    Abstract: The excess female mortality in India and other South Asian countries is no longer contentious. Less known are the reasons for such excess female mortality in the country. In this study, we argue that intra-household gender-discrimination in receipt of medical attention can be one of the most important factors for the unbalanced sex ratio in the country. The 52nd Indian National Sample Survey, which collected for the first time detailed verbal autopsies of deceased persons, is used in the analysis. Place of death, which indicates whether a person get medical help immediately before her/his death, is used as a health indicator variable. The multinomial logit results show that keeping all other factors constant, girls are 1.7 percent less likely to die in hospital than their brothers. The coefficients of different interaction variables also reveal that the probability of infant and very young girls with live female siblings to die in hospital is extremely low. The robustness of the results is also checked using different indicators. The results confirm that girls are highly discriminated in access to hospital treatment and in the number of times being hospitalized before their death compared to boys. Therefore, in addition to the current effort of the government to control sex-selective abortions, efforts should be made to reduce the current intra-household gender-disparities in getting medical care at least for life threatening illnesses.
    Keywords: gender discrimination, access to health care, place of death, India
    JEL: D63 I12 J16
    Date: 2007–01
  4. By: Rosa Duarte (University of Zaragoza); José-Julián Escario (University of Zaragoza); José-Alberto Molina (University of Zaragoza and IZA)
    Abstract: The objective of this paper is to examine the factors which affect alcohol abuse and truancy among adolescents. We propose a new theoretical specification in which alcohol abuse and truancy appear as derived demands, given that they condition peer group and family acceptance, and we introduce unobserved individual effects that can influence both behaviours. Empirically, our paper develops an analysis where, after controlling for the existence of unobserved individual factors affecting both decisions, we test for peer influences. Our results first show evidence that alcohol abuse and truancy share unobserved factors affecting both decisions, and then confirm the existence of significant peer group influences on these two deviant behaviours.
    Keywords: peer, unobserved factors, risk behaviours, alcohol, truancy, bivariate probit
    JEL: I10 I12 I20 I21
    Date: 2007–01
  5. By: Hans Keiding (Department of Economics, University of Copenhagen)
    Abstract: The concept of capabilities, introduced originally by Sen, has inspired many researchers but has not found any simple formal representation which might be instrumental in the construction of a comprehensive theory of equality. In a previous paper (Keiding, 2005), we investigated whether preferences over capabilities as sets of functionings can be rationalized by maximization of a suitable utility function over the set of functionings. Such a rationalization turned out to be possible only in cases which must be considered exceptional and which do not allowfor interesting applications of the capability approach to questions of health or equality. In the present paper we extend the notion of rationalizing orderings of capabilities to a dynamical context, in the sense that the utility function is not yet revealed to the individual at the time when the capabilities are ordered. It turns out that orderings which are in accordance with such probabilistic utility assignments can be characterized by a smaller set of the axioms previously considered.
    Keywords: Capabilities; characteristics; equality of health
    JEL: D63 I10
    Date: 2007–02
  6. By: Atsue Mizushima (Graduate School of Economics, Osaka University)
    Abstract: In this paper, we use a two-period overlapping generations model to examine the behavior of an economy that incorporates intergenerational transfers of time. In the first part, we describe the dynamics and steady state of the economy in which there is no government. We show that the rate of life expectancy has negative impact on the steady-state level of the capital stock. In the second part, we study the role and the effect of public long-term care policy. We also show that public long-term care lowers the steady-state level of the capital stock but enhances the welfare when the rate of tax is small.
    Keywords: time transfers, household production, overlapping generations
    JEL: E60 I12 J14 J22
    Date: 2007–02
  7. By: Clevo Wilson (School of Economics and Finance, Queensland University of Technology)
    Abstract: Farmers' exposure to pesticides is high in developing countries. As a result they suffer from ill-health, both short and long term. Deaths are not uncommon. The paper examines the cause of this high exposure by estimating farmers’ expenditure on precautions taken using the avertive behaviour approach. The data show that the expenditures on defensive behaviour are low. The paper then uses tobit regression analysis to determine factors that influence defensive behaviour. The results are useful, not only for Sri Lanka, but for many countries in South Asia, Africa and Latin America in reducing the current high levels of direct exposure to pesticides among farmers and farm workers using hand sprayers. Farmers' exposure to pesticides is a major occupational health hazard in these countries.
    Keywords: Exposure to pesticides, ill-health, defensive behaviour, influencing factors, developing countries
  8. By: Ruth Levine; Ernst R. Berndt; Rachel Glennerster; Michael R. Kremer; Jean Lee; Georg Weizsacker; Heidi Williams
    Abstract: The G8 is considering committing to purchase vaccines against diseases concentrated in low-income countries (if and when desirable vaccines are developed) as a way to spur research and development on vaccines for these diseases. Under such an “advance market commitment,” one or more sponsors would commit to a minimum price to be paid per person immunized for an eligible product, up to a certain number of individuals immunized. For additional purchases, the price would eventually drop to close to marginal cost. If no suitable product were developed, no payments would be made. We estimate the offer size which would make revenues similar to the revenues realized from investments in typical existing commercial pharmaceutical products, as well as the degree to which various model contracts and assumptions would affect the cost-effectiveness of such a commitment. We make adjustments for lower marketing costs under an advance market commitment and the risk that a developer may have to share the market with subsequent developers. We also show how this second risk could be reduced, and money saved, by introducing a superiority clause to a commitment. Under conservative assumptions, we document that a commitment comparable in value to sales earned by the average of a sample of recently launched commercial products (adjusted for lower marketing costs) would be a highly cost-effective way to address HIV/AIDS, malaria, and tuberculosis. Sensitivity analyses suggest most characteristics of a hypothetical vaccine would have little effect on the cost-effectiveness, but that the duration of protection conferred by a vaccine strongly affects potential cost-effectiveness. Readers can conduct their own sensitivity analyses employing a web-based spreadsheet tool.
    Keywords: advance market commitment, vaccine, disease, HIV/AIDS, malaria, tuberculosis, cost-effective
    JEL: I11 I12 I10
    Date: 2006–08
  9. By: Vargas Barrenechea, Martin
    Abstract: The objectives of the study are to project the value of the maternal mortality rate till the year 2015 under a tendency scenario and to find the most cost-efficient option to reach the millenium development goal of to reduce this rate in 3/4, which implies, in the case of Bolivia, to reduce it until the value of 104. Using a model constructed with techniques of system dynamics, we conclude that Bolivia will not reach the goal, by the contrary, the value of the rate will be 208 at the year 2015. Also, we verified that the most cost-efficient intervention is the increase of the quality of the post labor attention, we also find it the most cost-efficient option to reach the millenium development goal at 2015. Los objetivos del estudio son proyectar el valor de la tasa de mortalidad materna por 100,000 nacidos vivos para el año 2015 bajo un escenario de tendencia y encontrar la opción más costo-eficiente para alcanzar la meta del milenio de reducir esta tasa en ¾, lo que implica, en el caso de Bolivia, reducirla hasta el valor de 104. Utilizando un modelo construido con técnicas de dinámica de sistemas, se concluye que Bolivia no alcanzará la meta; por el contrario, el valor de la tasa de mortalidad materna será de 208 para el año 2015. Asimismo, se comprueba que la intervención más costo-eficiente es el incremento de la calidad de la atención durante el puerperio, lo que posibilitaría alcanzar una tasa de 105. Esto significaría que si se mantiene las actuales políticas de salud publica pero se incrementa la calidad de puerperio y se cubre totalmente tanto atención de puerperio como atención prenatal en las áreas urbana y rural de Bolivia con un costo adicional de 105 millones de dólares del 2003 sobre el escenario base esto para el periodo 2007-2015.
    JEL: I12 I18 C02
    Date: 2006–12
  10. By: Böckerman, Petri; Ilmakunnas, Pekka
    Abstract: We analyse the relationship between unemployment and self-assessed health using the European Community Household Panel (ECHP) for Finland over the period 1996-2001. Our results reveal that the event of becoming unemployed does not matter as such for self-assessed health. The health status of those that end up being unemployed is lower than that of the continually employed. Hence, persons who have poor health are being selected for the pool of the unemployed. This explains why, in a cross-section, unemployment is associated with poor self-assessed health. However, we are somewhat more likely to obtain the negative effects of unemployment on health when long-term unemployment is used as the measure of unemployment experience.
    Keywords: health; subjective well-being; unemployment
    JEL: I10
    Date: 2007–02–12
  11. By: Terry McKinley (International Poverty Centre); Degol Hailu
    Keywords: Poverty, ECONOMIC, Macroeconomic, HIV, AIDS
    JEL: B41 D11 D12 E31 I32 O54
    Date: 2006–09

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