nep-hea New Economics Papers
on Health Economics
Issue of 2007‒03‒24
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Lowering blood alcohol content levels to save lives: A European case study By Daniel Albalate
  2. A reasonable benchmarking frontier using DEA : an incentive scheme to improve efficiency in public hospitals By Diego Prior; Jordi Surroca
  3. Maternal Employment and Childhood Obesity in Spain By Emma García; José M. Labeaga; Ana Carolina Ortega Masagué
  4. How Does Demography affect Long-Term Care Expenditures Projections? By Adelina Comas-Herrera; Alessandra di Maio; Alessandro Pozzi; Concepció Patxot; Cristiano Gori; Heinz Rothgang; Joan Costa i Font; Linda Pickard; Raphael Wittenberg
  5. Inequality in individual mortality and economic conditions earlier in life By van den Berg, Gerard; Lindeboom, Maarten; López, Marta
  6. Moral hazard among the sick and unemployed: evidence from a Swedish social insurance reform By Larsson, Laura; Runeson, Caroline
  7. Management Capacity Assessment for National Health Programs: A study of RCH Program in Gujarat State By Ramani K.V.; Mavalankar Dileep V.
  8. The German Social Long-Term Care Insurance: Structure and Reform Options By Melanie Arntz; Ralf Sacchetto; Alexander Spermann; Susanne Steffes; Sarah Widmaier
  9. Child Mortality, Income and Adult Height By Carlos Bozzoli; Angus S. Deaton; Climent Quintana-Domeque
  10. Obesity, Unhappiness, and The Challenge of Affluence : Theory and Evidence By Oswald, Andrew J; Powdthavee, Nattavudh
  12. Valuing the health impacts from particulate air pollution in Tianjin By Zhou Yuan; Richard S.J. Tol

  1. By: Daniel Albalate (Universitat de Barcelona)
    Abstract: Road safety has become an increasing concern in developed countries due to the significant amount of fatalities and the associated economic losses. Only in 2005 these losses rose to 200,000 million euros, a considerable sum approximately 2% of GDP that easily justifies any public intervention. One measure taken by governments to address this issue is to enact stricter policies and regulations. Since drunk driving is one of the greatest concerns among public authorities in this field, several European countries have lowered their illegal Blood Alcohol Content (BAC) levels to 0.5 mg/ml during the last decade. This study is the first evaluation of the effectiveness of this transition using European panel-based data (CARE) for the period 1991-2003 with the differences-in-differences method in a fixed effects estimation that allows for any pattern of correlation (Cluster-Robust). The results reveal a positive impact on certain groups of road users and on the whole population when the policy is accompanied by enforcement interventions. Moreover, positive results appeared after a time lag of over two years. Finally, I state the importance of controlling for serial correlation in the evaluation of this type of policy.
    Keywords: drunk driving;, road safety;, differences-in-differences;, policy evaluation;, illegal blood alcohol content levels (bac)
    JEL: K32 R41 H73 I18
    Date: 2007
  2. By: Diego Prior; Jordi Surroca
    Abstract: There exists research relating management concepts with productivity measurement methods that offers useful solutions for improving management control in the public sector. Within this sphere, we connect agency theory with efficiency analysis and describe how to define an incentives scheme that can be applied in the public sector to monitor the efficiency and productivity of managers. To fulfill the main objective of this research, we propose an iterative process for determining what we define as a ‘reasonable frontier’, a concept that provides the foundation required to establish the incentive scheme for the managers. Our ‘reasonable frontier’ has the following properties: i) it detects the presence of outliers, ii) it proposes a procedure to establish the influence introduced by extreme observations, and iii) it sorts out the problem of data masking. The proposed method is applied to a sample of hospitals taken from the public network of the Spanish health service. The results obtained confirm the applicability of the proposal made. Summing up, we define and apply a useful method, combining aspects of agency theory and efficiency analysis, which is of interest to those public authorities trying to design effective incentive schemes which influence the decision making of the public managers.
    Date: 2007–03
  3. By: Emma García; José M. Labeaga; Ana Carolina Ortega Masagué
    Abstract: In this paper we explore to which extent the increase in childhood overweight and obesity are consequences of the participation of mothers in the labour market. We think that the increase in female labor force participation can explain, at least in part, the observed increase in the prevalence of overweight and obesity among children. Since it is very difficult to establish causal effects between both variables, we intend to measure it indirectly by using discrete choice models. Our results confirm that maternal employment could be at the root of this personal and social problem, which in absence of specific measures from several fields could become epidemic in the next decades. Otherwise, individuals' quality of life could be threatened, and expenditure devoted to control or alleviate this health problem could put pressure on the sustainability of the National Health System in the future.
  4. By: Adelina Comas-Herrera; Alessandra di Maio; Alessandro Pozzi; Concepció Patxot; Cristiano Gori; Heinz Rothgang; Joan Costa i Font; Linda Pickard; Raphael Wittenberg
    Abstract: This study examines the sensitivity of future long-term-care demand and expenditure estimates to "official" demographic projections in four selected European countries: Germany, Spain, Italy and the United Kingdom. It uses standardised methodology in the form of a macro-simulation exercise and finds evidence for significant differences in assumptions about demographic change and its effect on the demand for long-term care, and on relative and absolute long-term care expenditure. It concludes that mortality-rate assumptions can have a considerable influence on welfare policy planning. Relative dispersion between country-specific and Eurostat official estimates was found to be higher for the United Kingdom and Germany than for Italy and Spain, suggesting that demographic projections had a greater influence in those countries.
  5. By: van den Berg, Gerard (IFAU - Institute for Labour Market Policy Evaluation); Lindeboom, Maarten (Free University Amsterdam); López, Marta (Free University Amsterdam)
    Abstract: We analyze the effect of being born in a recession on the mortality rate later in life in conjunction with social class. We use individual data records from Dutch registers of birth, marriage, and death certificates, covering the period 1815-2000, and we merge these with historical data on macro-economic outcomes and health indicators. We estimate duration models and inequality measures. The results indicate that being born in a recession increases the mortality rate later in life for most of the population. Lower social classes suffer disproportionally from being born in recessions. This exacerbates mortality inequality. This is not affected by social mobility: upward mobility does not vary much with the business cycle at birth, for each social class.
    Keywords: Death; longevity; recession; life expectancy; lifetimes; social inequality; social class; health
    JEL: C41 E32 I12 J14 N13 N33
    Date: 2007–02–18
  6. By: Larsson, Laura (IFAU - Institute for Labour Market Policy Evaluation); Runeson, Caroline (Institute for Labour Market Policy Evaluation)
    Abstract: This paper looks at a specific type of moral hazard that arises in the interplay between two large public insurance systems in Sweden, namely the sickness insurance (SI) and the unemployment insurance (UI). Moral hazard can arise from the benefit size structure as for some unemployed persons, benefits from the SI are higher than benefits from the UI. We use a reform of the SI system that came in force 1 July, 2003, to identify the effect of economic incentives arising from the different benefit sizes. Our results from a duration analysis show clearly that the higher the benefits, the larger the probability of reporting sick.
    Keywords: Unemployment insurance; sickness insurance; health; duration analysis; discrete hazard models
    JEL: C41 H55 I18 J64 J65
    Date: 2007–03–14
  7. By: Ramani K.V.; Mavalankar Dileep V.
    Abstract: The Ministry of Health and Family Welfare, Government of India administers a large number of national health programs such as Malaria control program, Blindness control program, National AIDS control program, Reproductive and Child Health (RCH) Program and so on. However, effective management of these programs has always come under scrutiny, as these programs consume a large amount of resources. As health is a state government subject in India, it is necessary to assess the management capacity of the department of Health and Family Welfare (H & FW) in each state. In this paper, we focus on the management capacity assessment for RCH program. Based on extensive literature survey, and discussions with senior officers in charge of RCH program at the centre and several states, we have developed a conceptual framework for management capacity assessment. Central to our conceptual framework are the following determinants of management capacity at the state dept of H & FW: (1) Capacity to formulate a clear statement of the state’s RCH Policy, Goals, and a Strategic Plan to achieve the Objectives, consistent with the resources available, (2) A well designed organizational structure for the H&FW department to provide the necessary support for achieving the policy goals, (3) Capacity of the H & FW department for effective management of RCH program, (4) Clear documentation of HR policies (qualifications, transfer, promotions, training etc) for RCH managers, (5) Role of External Stakeholders (6) Management Systems for Planning, Implementation and Monitoring RCH program, and (7) Institutional Processes and procedures For each of the above determinants, we have identified a set of indicators to assess the management capacity and designed a management capacity assessment tool to estimate these indicators. A pilot survey of our management capacity assessment tool in a few states helped us to refine certain instruments in our tool and finalize the same. Our management tool has been accepted by the Ministry of H & FW, Government of India and it has asked all the states and union territories to carry out a self assessment of their management capacity for RCH program. We have also recommended a suitable structure for effective management of RCH program for each state based on its population, the number of people in the reproductive age group, expected number of childbirths, and the current status of its H&FW department in delivering RCH services. This recommended structure can be used as a guideline by each state to identify its capacity gaps and take the necessary steps to augment its management capacity.
    Date: 2007–03–12
  8. By: Melanie Arntz (ZEW Mannheim); Ralf Sacchetto (ZEW Mannheim); Alexander Spermann (ZEW Mannheim, University of Freiburg and IZA Bonn); Susanne Steffes (ZEW Mannheim); Sarah Widmaier (ZEW Mannheim)
    Abstract: Regarding social needs in Germany long-term care is an important issue due to an ageing population. Shrinking social networks are leading to a greater need for a public long-term care system. In 1995 the social long-term care insurance was introduced in Germany. In recent years some drawbacks of the social long-term care insurance structure turned out to be in need of reform: While health insurance is a fully comprehensive system, long-term care insurance only provides limited cover. Therefore, insurance funds have an incentive to shift some services from health care to long-term care insurance. Additionally, there is no free competition on the long-term care market because care packages included in the in-kind transfers are negotiated (with respect to services and prices) between insurance funds and professional care providers. Finally, the financial situation of the German social long-term care insurance is tight. While in the first years after introduction the net results of revenues and expenditures were positive they have been negative since 1999 which is due to an increasing number of benefit recipients. Therefore, we discuss several reform options which have been proposed in order to overcome the financial and structural problems. Suggestions for the income side include the introduction of fixed premiums, a fully funded system, a private insurance, or a citizens’ insurance. The introduction of individual budgets is the most popular option for the outcome side. A social experiment is under way in order to evaluate the impact of so-called matching transfers.
    Keywords: long-term care, cash transfers, in-kind transfers, social experiments
    JEL: I10 I12 I18
    Date: 2007–02
  9. By: Carlos Bozzoli; Angus S. Deaton; Climent Quintana-Domeque
    Abstract: We investigate the childhood determinants of adult height in populations, focusing on the respective roles of income and of disease. We develop a model of selection and scarring, in which the early life burden of nutrition and disease is not only responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height, as well as in late-life disease. Across a range of European countries and the United States, we find a strong inverse relationship between postneonatal (one month to one year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. In pooled birth-cohort data over 30 years for the United States and eleven European countries, postneonatal mortality in the year of birth accounts for more than 60 percent of the combined cross-country and cross-cohort variation in adult heights. The estimated effects are smaller but remain significant once we allow for country and birth-cohort effects. In the poorest and highest mortality countries of the world, there is evidence that child mortality is positively associated with adult height. That selection should dominate scarring at high mortality levels, and scarring dominate selection at low mortality levels, is consistent with the model for reasonable values of its parameters.
    JEL: I12 J13 O12
    Date: 2007–03
  10. By: Oswald, Andrew J (Department of Economics, University of Warwick); Powdthavee, Nattavudh (Institute of Education, University of London)
    Abstract: Is affluence a good thing? The book The Challenge of Affluence by Avner Offer (2006) argues that economic prosperity weakens self-control and undermines human well-being. Consistent with a pessimistic view, we show that psychological distress has been rising through time in modern Great Britain. Taking over-eating as an example, our data reveal that half the British population view themselves as overweight, and that happiness and mental health are worse among fatter people in both Britain and Germany. A 10-point move up in body mass index (BMI) is associated in the cross-section with a drop in psychological health of approximately 0.3 GHQ points. Comparisons also matter. For a given level of BMI, we find that people who are educated or who have high income are more likely to view themselves as overweight. We discuss problems of inference and argue that longitudinal data on BMI are needed. We suggest a theory of imitation -- where utility depends on relative weight -- in which there can be obesity spirals after only small drops in the price of food.
    Keywords: Body mass index ; happiness ; mental health ; General Health Questionnaire ; GHQ scores ; BMI ; well-being ; obesity ; BHPS ; GSOEP ; imitation ; weight ; relative income ;comparisons
    JEL: D1 I12 I31
    Date: 2007
  11. By: Caterina Conigliani; A Tancredi
    Abstract: We consider the problem of assessing new and existing technologies for their cost-effectiveness in the case where data on both costs and effects are available from a clinical trial, and we address it by means of the cost-effectiveness acceptability curve. The main difficulty in these analyses is that cost data usually exhibit highly skew and heavytailed distributions, so that it can be extremely difficult to produce realistic probabilistic models for the underlying population distribution, and in particular to model accurately the tail of the distribution, which is highly influential in estimating the population mean. Here, in order to integrate the uncertainty about the model into the analysis of cost data and into cost-effectiveness analyses, we consider an approach based on Bayesian model averaging: instead of choosing a single parametric model, we specify a set of plausible models for costs and estimate the mean cost with its posterior expectation, that can be obtained as a weighted mean of the posterior expectations under each model, with weights given by the posterior model probabilities. The results are compared with those obtained with a semi-parametric approach that does not require any assumption about the distribution of costs. 1 Introduction
  12. By: Zhou Yuan; Richard S.J. Tol (Economic and Social Research Institute, Dublin)
    Abstract: Although China has made dramatic economic progress in recent years, air pollution continues to be the most visible environmental problem and imposes significant health and economic costs on society. Using data on pollutant concentration and population for 2003, this paper estimates the economic costs of health related effects due to particulate air pollution in urban areas of Tianjin, China. Exposure-response functions are used to quantify the impact on human health. Value of a statistical life and benefit transfer are used to obtain the unit value of some health effects. Our results show significant health costs associated with air pollution in Tianjin. The total economic cost is estimated to be US$1.1 billion, about 3.7% of Tianjin’s GDP in 2003. The findings underscore the importance of urban air pollution control. Finally, the policy implications for alternative energy options and climate policies are given.
    Keywords: particulate air pollution, PM10, economic valuation, Tianjin
    JEL: Q51 Q53
    Date: 2005–09

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