nep-hea New Economics Papers
on Health Economics
Issue of 2007‒05‒04
four papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Comparing Subjective and Objective Measures of Health: Evidence from Hypertension for the Income/Health Gradient By Johnston, David W; Propper, Carol; Shields, Michael
  2. Bribery in Health Care in Peru and Uganda By Hunt, Jennifer
  3. How Does the Introduction of Health Insurance Change the Equity in the Health Care Provision in Bulgaria? By Nora Markova
  4. The Impact of New Drug Launches on the Loss of Labor from Disease and Injury: Evidence from German Panel Data By Van Bui; Michael Stolpe

  1. By: Johnston, David W; Propper, Carol; Shields, Michael
    Abstract: Economists rely heavily on self-reported measures of health status to examine the relationship between income and health. In this paper we directly compare survey responses to a self-reported measure of health that is commonly available in nationally-representative individual and household surveys, with objective measures of the same health condition. Our particular focus is on hypertension, which is the most prevalent health condition in Western countries. Using data from the Health Survey for England, we find that there is a substantial difference in the percentage of adult survey respondents reporting that they have hypertension as a chronic health condition compared to that from repeated measurements by a trained nurse. Around 85% of individuals measured as having hypertension do not report having it as a chronic illness. Importantly, we find no evidence of an income/health gradient using self-reported hypertension, but a large (about 14 times the size) gradient when using objectively measured hypertension. We also find that the probability of false negative reporting, that is an individual not reporting to have chronic hypertension when in fact they have it, is significantly higher for individuals living in low income households. Given the wide use of such self-reported chronic health conditions in applied research, and the asymptomatic nature of many major illnesses such as hypertension, diabetes, heart disease and cancer at moderate and sometimes very elevated levels, we show that using commonly available self-reported chronic health measures is likely to lead to an underestimate of true income-related inequalities in health. This has important implications for policy advice.
    Keywords: hypertension; income; objective health; reporting error; self-reported health
    JEL: C42 I10 I18
    Date: 2007–04
  2. By: Hunt, Jennifer
    Abstract: In this paper, I examine the role of household income in determining who bribes and how much they bribe in health care in Peru and Uganda. I find that rich patients are more likely than other patients to bribe in public health care: doubling household consumption increases the bribery probability by 0.2-0.4 percentage points in Peru, compared to a bribery rate of 0.8%; doubling household expenditure in Uganda increases the bribery probability by 1.2 percentage points compared to a bribery rate of 17%. The income elasticity of the bribe amount cannot be precisely estimated in Peru, but is about 0.37 in Uganda. Bribes in the Ugandan public sector appear to be fees-for-service extorted from the richer patients amongst those exempted by government policy from paying the official fees. Bribes in the private sector appear to be flat-rate fees paid by patients who do not pay official fees. I do not find evidence that the public health care sector in either Peru or Uganda is able to price-discriminate less effectively than public institutions with less competition from the private sector.
    Keywords: bribery; corruption; governance; health care
    JEL: H4 K4 O1
    Date: 2007–04
  3. By: Nora Markova
    Abstract: The study examines the effect of health care reform in Bulgaria in 1999 on the equity of health care financing. It explores the distribution of different types of health care financing by income. Furthermore, it separates the financial and social reasons for these differences, dividing them into economic and social inequalities. It suggests a method of distinguishing between financially based and "exclusion based" reasons for having progressive/regressive health care financing. Moreover, it looks at the social factors that shape health expenditure patterns and identifies those social characteristics that lead to exclusion from the health care system.
    Keywords: Health care financing , equity in health care financing , income inequality , redistribution , Health care , Bulgaria , Public finance , Income distribution , Social indicators , Poverty , Economic models ,
    Date: 2007–01–03
  4. By: Van Bui; Michael Stolpe
    Abstract: This paper studies the evolution of early retirement due to disease and injury in the German labor force between 1988 and 2004. Using data from the German Federation of Public Pension Providers, the IMS Health Drug Launches database and the WHO Mortality Database, we show that new drug launches have substantially helped to reduce the loss of labor at the disease-level over time. We employ a variety of econometric methods to exploit the pseudo-panel structure of our dataset and find that in Western Germany alone each new chemical entity has on average saved around 200 working years in every year of the observation period. Controlling for individual determinants of health-related retirement, such as worker’s age, sex and type of work, we also find evidence that the 2001 reform of pension laws has led to further reductions in the loss of labor from disease and injury.
    Keywords: Medical technology, Early retirement, Rehabilitation services, Pension reform, Pseudo-panel data
    JEL: I12 I18 J26
    Date: 2007–04

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