nep-hea New Economics Papers
on Health Economics
Issue of 2007‒03‒03
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Market Structure and Hospital-Insurer bargaining in the Netherlands By Halbersma, R.S.; Mikkers, M.C.; Motchenkova, E.
  2. Cycling: An Increasingly Untouched Source of Physical and Mental Health By Inas Rashad
  3. Hypertension and Happiness across Nations By David G. Blanchflower; Andrew J. Oswald
  4. Is Well-being U-Shaped over the Life Cycle? By David G. Blanchflower; Andrew Oswald
  5. Migration and mental health : evidence from a natural experiment By Stillman, Steven; McKenzie, David; Gibson, John
  6. Adult mortality and children ' s transition into marriage By Beegle, Kathleen; Krutikova, Sofya
  7. The state of knowledge regarding tobacco harm, 1920-1964: industry and public health service perspectives By Martin Forster; M Walsh; M Rodgers; Sue Bowden; S Duffy
  8. Participatory approach to comunity health:Sustainable strategy from India By Venu Menon, Sudha
  9. Asthma Management Survey of Participants in an Inner City Asthma Intervention By Matthew Sadof; Sylvia Brandt
  10. Why Not 'Front-Load' ODA for HIV/AIDS? By John Serieux; Terry McKinley
  11. Inequality and Suicide Mortality: A Cross-Country Study By Antonio Rodriguez

  1. By: Halbersma, R.S. (Vrije Universiteit Amsterdam, Faculteit der Economische Wetenschappen en Econometrie (Free University Amsterdam, Faculty of Economics Sciences, Business Administration and Economitrics); Mikkers, M.C.; Motchenkova, E.
    Abstract: In 2005, competition was introduced in part of the hospital market in the Netherlands. Using a unique dataset of transaction and list prices between hospitals and insurers in the years 2005 and 2006, we estimate the influence of buyer and seller concentration on the negotiated prices in the first two years after the institutional change. First, we use a traditional Structure-Conduct-Performance model (SCP-model) along the lines of Melnick et al. (1992) to estimate the effects of buyer and seller concentration on price-cost margins. Second, we model the interaction between hospitals and insurers in the context of a generalized bargaining model (Brooks et al., 1997). In the SCP-model, we obtain that the concentration of hospitals (insurers) has a significantly positive (negative) impact on the hospital price-cost margin. In the bargaining model, we also find a significant negative effect of insurer concentration on the bargaining share of hospital, but no significant effect of hospital concentration on the division of the gains from bargaining. In both models we find a significant impact of idiosyncratic effects on the market outcomes, consistent with the fact that the Dutch hospital sector is not yet in a long-run equilibrium.
    Keywords: Competition; Market Structure; Hospitals; Insurers; Bargaining
    JEL: I11 L1 C7
    Date: 2007
  2. By: Inas Rashad
    Abstract: Cost savings associated with increased gasoline prices and lower levels of urban sprawl have been cited in terms of personal savings, environmental awareness, reduced costs through lower travel times and congestion, and reduced income inequality. Cost savings in terms of improved health, however, are often not cited yet represent another dimension of savings associated with reduced urban sprawl and gas prices. Cycling is a form of exercise that can also be used as a mode of transportation if the surrounding environment facilitates such use. According to the United States Department of Transportation, 73 percent of adults want new bicycle facilities such as bike lanes, trails, and traffic signals. Using data from the 1990, 1995, and 2001 waves of the Nationwide Personal Transportation Survey, in addition to data from the Behavioral Risk Factor Surveillance System (1996-2000), I propose to analyze the effects of variations in the built environment in the form of urban sprawl and in real gasoline prices on cycling as a form of physical activity. Using bivariate probit and propensity score methods, I show how cycling can lead to improved physical health outcomes. This is turn may carry policy implications in terms of improved public awareness and city planning.
    JEL: I10 I12
    Date: 2007–02
  3. By: David G. Blanchflower; Andrew J. Oswald
    Abstract: A modern statistical literature argues that countries such as Denmark are particularly happy while nations like East Germany are not. Are such claims credible? The paper explores this by building on two ideas. The first is that psychological well-being and high blood-pressure are thought by clinicians to be inversely correlated. The second is that blood-pressure problems can be reported more objectively than mental well-being. Using data on 16 countries, the paper finds that happier nations report lower levels of hypertension. The paper's results are consistent with, and seem to offer a step towards the validation of, cross-national estimates of well-being.
    JEL: I10
    Date: 2007–02
  4. By: David G. Blanchflower; Andrew Oswald
    Abstract: Recent research has argued that psychological well-being is U-shaped through the life cycle. The difficulty with such a claim is that there are likely to be omitted cohort effects (earlier generations may have been born in, say, particularly good or bad times). Hence the apparent U may be an artifact. Using data on approximately 500,000 Americans and Europeans, this paper designs a test that makes it possible to allow for different birth-cohorts. A robust U-shape of happiness in age is found. Ceteris paribus, well-being reaches a minimum, on both sides of the Atlantic, in people's mid to late 40s. The paper also shows that in the United States the well-being of successive birth-cohorts has gradually fallen through time. In Europe, newer birth-cohorts are happier.
    JEL: I1 J0
    Date: 2007–02
  5. By: Stillman, Steven; McKenzie, David; Gibson, John
    Abstract: People migrate to improve their well-being, whether through an expansion of economic and social opportunities or a reduction in persecution. Yet a large literature suggests that migration can be a stressful process, with potentially negative impacts on mental health, reducing the net benefits of migration. However, to truly understand the effect of migration on mental health one must compare the mental health of migrants to what their mental health would have been had they stayed in their home country. The existing literature is not able to do this and typically settles for comparing the mental health of migrants to that of natives in the destination country, which takes no account of any pre-existing differences between these groups. This paper overcomes the selection problems affecting previous studies of the effect of migration on mental health by examining a migrant lottery program. New Zealand allows a quota of Tongans to immigrate each year with a lottery used to choose among the excess number of applicants. A unique survey conducted by the authors in these two countries allows experimental estimates of the mental health effects of migration to be obtained by comparing the mental health of migrants who were successful applicants in the lottery to the mental health of those who applied to migrate under the quota, but whose names were not drawn in the lottery. Migration is found to lead to improvements in mental health, particularly for women and those with poor mental health in their home country.
    Keywords: Health Monitoring & Evaluation,Population Policies,Disease Control & Prevention,Mental Health,Gender and Health
    Date: 2007–02–01
  6. By: Beegle, Kathleen; Krutikova, Sofya
    Abstract: Adult mortality due to HIV/AIDS and other diseases is posited to affect children through a number of pathways. On top of health and education outcomes, adult mortality can have significant effects on children by influencing demographic outcomes including the timing of marriage. The authors examine marriage outcomes for a sample of children interviewed in Tanzania in the early 1990s and re-interviewed in 2004. They find that while girls who became paternal orphans married at significantly younger ages, orphanhood had little effect on boys. On the other hand, non-parental deaths in the household affect the timing of marriage for boys
    Keywords: Population Policies,Youth and Governance,Population & Development,Adolescent Health,Street Children
    Date: 2007–02–01
  7. By: Martin Forster; M Walsh; M Rodgers; Sue Bowden; S Duffy
    Abstract: Referencing once-confidential tobacco industry documents, we compare reviews of the epidemiological literature concerning tobacco harm that were carried out by the U.S. Tobacco Industry Research Committee (T.I.R.C.) and the U.S. Public Health Service and related groups during the 1950s and early 1960s. Results show that the T.I.R.C. operated an unbiased and reasonably comprehensive literature review operation which, from 1956 onwards, was providing summaries of published epidemiological studies to its members within an average of 2.3 months of date of publication. Although the epidemiological evidence reviewed by the T.I.R.C. was similar to that reviewed by the U.S. Public Health Service and related groups, public statements assessing the evidence made by the organisations differ significantly. We discuss our results in the light of present-day academic and legal debates concerning the ‘controversy’ surrounding tobacco harm in the mid-twentieth century.
    Date: 2006–12
  8. By: Venu Menon, Sudha
    Abstract: In social development and health sector, India’s performance is still lagging behind many Sub-Saharan African countries. There are also disparities between the urban and rural sectors and between privileged upper class and the socially disadvantaged groups. Widespread illiteracy, avoidable morbidity, premature mortality and deep-seated inequality of opportunity are still prevailing in India. India’s achievements in dealing with life expectancy, elementary education, nutritional well being, protection from illness, social security and consumption levels has been substantially and systematically out passed by many other developing countries. Compared to other countries, social sector expenditure is negligible in India, especially when compared it with UNDP recommended ratio. In the case of Indian state we can see that accelerated growth rate does not to have led to a corresponding change in living condition of rural poor. Here lies the importance of participatory mode of approach. The provision of social security cannot rely exclusively either on market forces or on the state initiative. There is an urgent need for participation in the distribution of social security measure. The move towards participatory growth calls for an integrated view of the process of economic expansion. The UN has defined community participation as ‘the creation of opportunity to enable all members of a community and the larger society to actively contribute to and influence the development process to share equitable the fruits of development’. This participatory mode of development views village community as the site for intervention. In this process it has to mediate through agencies working at that level. This is most commonly done through NGOs. In this broader context of Indian state’s commitment to liberalization, present paper attempts to study the participatory intervention of NGO in community health. For a detailed study, success story of AWARE - NGO working among the marginalized people in rural Andhra Pradesh is selected. The paper does not project NGO as viable alternative to fill the space vacated by state. But it only tries to establish that the objective of “Health for All” can be achieved only through community participation. The present paper is divided into 4 parts. The first part briefly outlines health sector performance and trends during the post reform era and its outcomes. The second part analyses the status of health sector in Andhra Pradesh, major indicators and initiatives. The third part in detail discusses the sustainable strategy of AWARE and its impact on health sector in rural Andhra. The final part contains major findings and concluding remarks.
    Keywords: India; Community health; participatory development; Andhra Pradesh.
    JEL: I18
    Date: 2007–02–27
  9. By: Matthew Sadof (Tufts University School of Medicine, Baystate Children’s Hospital); Sylvia Brandt (Department of Resource Economics, University of Massachusetts Amherst)
    Abstract: Background: The Inner City Asthma Intervention (ICAI) was a national multi-center implementation of an evidence-based intervention to reduce asthma morbidity. Objective: This study describes mitigating behaviors and reported outcomes in families with asthma who completed the intervention and a post-intervention survey at one of the ICAI sites. Results: Eighty percent (0.72- 0.88, 95% confidence interval) of these families made five or more changes to mitigate exposure to environmental asthma triggers. The majority of families (0.84-0.96, 95% confidence interval) reported an improved awareness of asthma symptoms and less school absences, limitations of activity, unplanned doctor visits, and asthma related sleep disruption.
    Keywords: Asthma, health intervention, health behavior
    JEL: I12 I18 Z13
    Date: 2007–02
  10. By: John Serieux (Dept. of Economics, University of Manitoba); Terry McKinley (International Poverty Centre)
    Keywords: HIV/AIDS, Official Development Assistance, Poverty, Sub-Saharan Africa
    Date: 2007–02
  11. By: Antonio Rodriguez (Institute for Advanced Development Studies)
    Abstract: This paper tests whether economic inequality is related to suicide mortality. Using an unbalanced panel of 40 countries for the period 1947-2001 allows us to control for the effect of unobserved factors that may have an impact on suicide rates. Our results indicate that there is a statistically insignificant positive effect of inequality on the incidence of suicide. The latter result seems to be robust to a number of specification issues explored in a sensitivity analysis. Our results also suggest that female labour participation has a significant positive effect on the total (males and female) suicide rates, supporting the sociological argument that the role conflict dominates more than the role expansion. Contrary to the total and male suicide rates findings, the fertility rate matters in explaining female suicide rates. Finally, in contrast to previous studies, suicide rates were not sensitive to income levels, divorce rates and alcohol consumption.
    Keywords: Inequality, suicide, panel data, autocorrelation
    JEL: I12 N30
    Date: 2006–10

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