nep-hea New Economics Papers
on Health Economics
Issue of 2007‒06‒02
seven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health Economics for Low-Income Countries By Germano Mwabu
  2. Risk and Mortality of Recurrent Breast Cancer in Stockholm 1985-2005 By Jönsson, Bengt; Lundkvist, Jonas; Kasteng, Frida; Lidgren, Mathias; Adolfsson, Jan; Bergh, Jonas; Fornander, Tommy; Wilking, Nils
  3. What Should Macroeconomists Know about Health Care Policy? By Peter S. Heller
  4. Mortality and Lifetime Income: Evidence from U.S. Social Security Records By James E. Duggan; John S. Greenlees; Robert Gillingham
  5. End-stage Renal Disease and Economic Incentives: The International Study of Health Care Organization and Financing By Avi Dor; Mark V. Pauly; Margaret A. Eichleay; Philip J. Held
  6. How Do Workplace Smoking Laws Work? Quasi-Experimental Evidence from Local Laws in Ontario, Canada By Christopher Carpenter
  7. I'm not fat, just too short for my weight - Family Child Care and Obesity in Germany By Philippe Mahler

  1. By: Germano Mwabu (University of Nairobi and Yale University)
    Abstract: Good health is a determinant of economic growth and a component of well-being. This paper discusses and synthesizes economic models of individual and household behavior, showing how they may be used to illuminate health policy making in low-income countries. The models could help address questions such as: How can the health of the poor be improved, and what are the economic consequences of better health? What policies would improve intra-household distribution of health outcomes? An extensive literature on health human capital and household models, and on related field experiments is reviewed in an attempt to answer these questions. It is found that there are large returns to health improvements in low-income countries. Moreover, health improvements in poor nations can be achieved through implementation of simple interventions such as dietary supplements, control of parasitic diseases, and pro-poor social expenditures. The paper concludes with a discussion of these policy options.
    Keywords: Health Production, Health Care Markets, Household Production and Intrahousehold Allocation, Health Economics, Low-income countries
    JEL: I12 I11 D13 O12
    Date: 2007–05
  2. By: Jönsson, Bengt (Dept. of Economics, Stockholm School of Economics); Lundkvist, Jonas (Karolinska Institutet); Kasteng, Frida (European Health Economics); Lidgren, Mathias (Karolinska Institutet); Adolfsson, Jan (Onkologiskt Centraum, Karolinska University Hospital); Bergh, Jonas (Radiumhemmet, Karolinska Institutet och University Hospital); Fornander, Tommy (Dept of Oncology, Karolinska University Hospital at Södersjukhuset); Wilking, Nils (Karolinska Institutet)
    Abstract: The purpose of this study was to estimate the risk and mortality of breast cancer recurrences in Swedish women, and to analyse changes over time and variations between patients in different risk groups. Such estimates are of key importance for modelling the cost-effectiveness of different strategies for adjuvant treatment of breast cancer. <p> The study was based on all women diagnosed with breast cancer in Stockholm County between 1985 and 2005. Information about dates for locoregional recurrences, metastatic relapses, new contralateral tumours and death was collected. Cox proportional hazard and Weibull regression models were used to estimate survival functions, where year of diagnosis (dived into 5-year intervals), were included as explanatory variables in the models. <p> The risk of recurrences has decreased during the last 20 years for all three types of recurrence; for metastatic relapse the 5-year risk was reduced from 12.9% to 6.0% from 1985-90 to 2000-2005 . Mortality has also been reduced, resulting in an increased 5-year survival from 52.6% to 64.1% after locoregional recurrence and from 10.4% to 15.5% for metastatic relapse. For contralateral tumours, with a 5-year survival rate of 74.6% in 1985-1990 and 78% 2000-2005, no significant increase was observed. Analysis of risk groups according to TNM classification showed large difference in the risk of metastatic breast cancer between the three defined groups, but small differences for the risk of locoregional recurrences and new contralateral tumours. <p> The findings indicate that the early detection and new treatments have been successful in improving outcome for breast cancer patients and that it is important to use up-to-date information, when assessing the value of new treatment options.
    Keywords: Breast cancer; Mortality; Survival; Recurrence; Sweden
    JEL: I10
    Date: 2007–05–07
  3. By: Peter S. Heller
    Abstract: This primer aims to provide IMF macroeconomists with the essential information they need to address issues concerning health sector policy, particularly when they have significant macroeconomic implications. Such issues can also affect equity and growth and are fundamental to any strategy of poverty reduction. The primer highlights the appropriate roles for the state and market in health care financing and provision. It also suggests situations in which macroeconomists should engage health sector specialists in policy formulation exercises. Finally, it reviews the different health policy issues that confront countries at alternative stages of economic development and the range of appropriate policy options.
    Keywords: Health care , Government expenditures , Economic policy , Social policy , Poverty reduction ,
    Date: 2007–01–25
  4. By: James E. Duggan; John S. Greenlees; Robert Gillingham
    Abstract: Studies of the empirical relationship between income and mortality often rely on data aggregated by geographic areas and broad population groups and do not distinguish disabled and nondisabled persons. We investigate the relationship between individual mortality and lifetime income with a large micro data base of current and former retired participants in the U. S. Social Security system. Logit models by gender and race confirm a negative relationship. Differences in age of death between low and high lifetime income are on the order of two to three years. Income-related mortality differences between blacks and whites are largest at low-income levels while gender differences appear to be large and persistent across income levels.
    Keywords: Income , United States , Social indicators , Economic models ,
    Date: 2007–01–25
  5. By: Avi Dor; Mark V. Pauly; Margaret A. Eichleay; Philip J. Held
    Abstract: End-stage renal disease (ESRD), or kidney failure, is a debilitating, costly, and increasingly common medical condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small and is correlated with overall per capita health care spending. Between-country variations in spending are reduced using an input price parity index constructed for this study. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives embedded in national programs.
    JEL: I10 I11 I12 I18
    Date: 2007–05
  6. By: Christopher Carpenter
    Abstract: There are very large literatures in public health and economics on the effects of workplace smoking bans, with most studies relying on cross-sectional variation. We provide new quasi-experimental evidence on the effects of workplace bans by using the differential timing of adoption of over 100 very strong local smoking by-laws in Ontario, Canada over the period 1997-2004. We employ restricted-use repeated cross section geocoded outcome data to estimate reduced form models that control for demographic characteristics, year fixed effects, and county fixed effects. We first show that the effects of the local laws on actual worksite smoking policy (i.e. the "first stage") were not uniform; specifically, local laws were only effective at increasing ban presence among blue collar workers. Among blue collar workers, adoption of a local by-law significantly reduced the fraction of worksites without any smoking restrictions (i.e. where smoking is allowed anywhere at work) by over half. The differential effect of local policies also improved health outcomes: we find that adoption of a local by-law significantly reduced SHS exposure among blue collar workers by 25-30 percent, and we confirm that workplace smoking laws reduce smoking. We find plausibly smaller and insignificant estimates for white collar and sales/service workers -- the vast majority of whom worked in workplaces with privately initiated smoking bans well before local by-laws were adopted. Overall our findings advance the literature by confirming that workplace smoking bans reduce smoking, documenting the underlying mechanisms through which local smoking by-laws improve health outcomes, and showing that the effects of these laws are strongly heterogeneous with respect to occupation.
    JEL: I1 J08
    Date: 2007–05
  7. By: Philippe Mahler (Socioeconomic Institute, University of Zurich)
    Abstract: Obesity is increasing worldwide for both adults and children. Genetic disposition is responsible for some variation in body weight but cannot explain the dramatic increase in the last two decades. The increase must be due to structural and behavioral changes. One such behavioral change is the increase in working females in the last decades. The absence from the mother reduces potential child care time in the family. Reduced child care time may have adverse effects on the prevalence of obesity in children and adults. This paper analyzes the effect of mother’s labor supply in childhood on young adults probability of being obese in Germany. Using a sample drawn from the German Socio-Economic Panel the results show that a higher labor supply of the mother increases the probability for her child to be obese as young adult. This result underlines the importance of childhood environment on children’s later life outcome and the importance of behavioral changes in explaining the increase in obesity.
    Keywords: GSOEP, obesity, female labor supply, child care, sibling estimation
    JEL: I12 J22 D10
    Date: 2007–05

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