nep-hea New Economics Papers
on Health Economics
Issue of 2007‒06‒11
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. How to correctly assess mortality benefits in public policies By Olivier Chanel; Pascale Scapecchi; Jean-Christophe Vergnaud
  2. Provision of Primary Healthcare Services in Urban areas of Bangladesh – the Case of Urban Primary Health Care Project By Ahmad, Alia
  3. Individuals' Use of Care While Uninsured: Effects of Time Since Episode Inception and Episode Length By Carole Roan Gresenz; Jeannette Rogowski; José J. Escarce
  4. Cross-country Analysis of Efficiency in OECD Health Care Sectors: Options for Research By Unto Häkkinen; Isabelle Joumard
  5. Distribution matters: Expressed Value Judgements among Health Planners in Tanzania By Trygve Ottersen; Deogratius Mbilinyi; Ottar Mæstad; Ole Frithjof Norheim
  6. Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework By Hugh Gravelle; Matt Sutton; Ada Ma
  7. The advantages and disadvantages of needs-based resource allocation in integrated health systems and market systems of health care provider reimbursement By Gugushvili, Alexi
  8. Multivariate Cointegration Technique Estimation of Health Demand Function: The Case of Croatia By Josip Tica; Šime Smolić

  1. By: Olivier Chanel (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - [Université de la Méditerranée - Aix-Marseille II][Université de droit, d'économie et des sciences - Aix-Marseille III] - [Ecole des Hautes Etudes en Sciences Sociales]); Pascale Scapecchi (OECD - [Organisation for Economic Cooperation and Development]); Jean-Christophe Vergnaud (CES - Centre d'économie de la Sorbonne - [CNRS : UMR8174] - [Université Panthéon-Sorbonne - Paris I])
    Abstract: Abstract<br />This paper concerns the difficulty of taking long-term effects on health into account in an economic valuation. Indeed, public decision makers should incorporate the cessation lag between implementation of an abatement policy and achievement of all of the expected mortality-related benefits for any projects involving health impacts. This paper shows how this time lag problem can be handled by proposing two approaches - either in terms of deaths avoided or of life years saved - within a dynamic perspective. The main findings are that long-term health benefits calculated by standard methods and widely applied to adverse health effects should be corrected downwards when incorporated into an economic analysis. The magnitude of correction depends on the discount rate, on technical choices dealing with epidemiology and on the method chosen to assess mortality benefits.
    Keywords: air pollution; health effect; lattency effect
    Date: 2007–05–30
  2. By: Ahmad, Alia (Department of Economics, Lund University)
    Abstract: Primary healthcare in Bangladesh is supposed to be a public responsibility, and until recently the government has tried to provide basic services directly through its own bureaucracy. However, the public sector faces acute problems in meeting the growing needs of urban population, especially the poor. In recent years, new institutions such as partnerships with not-for-profit private organizations are sought to improve the access and quality of primary care. This paper focuses on one urban partnership project, UPHCP in Bangladesh. It analyzes the accountability relationships among different stakeholders involved in the project and cost effectiveness of contracting out. The paper finds that the accountability relationships in UPHCP are not transparent, and the programme is costly in terms of human resources because of multiple principals and agents involved compared to direct government provision. The beneficial impact of UPHCP on urban primary care is well-documented, but such institutional arrangement will have difficulties in expansion on a large scale without external assistance. Another weakness of the programme is the lack of a sense of ownership and trust in its continuity among the population that works against social accountability and client power.
    Keywords: Contracting out; NGO's; Primary healthcare
    JEL: I12 I18
    Date: 2007–05–29
  3. By: Carole Roan Gresenz; Jeannette Rogowski; José J. Escarce
    Abstract: Few studies have addressed how use of care may vary over the course of an episode of being uninsured or across uninsured episodes of varying duration. This research models the probability that an uninsured individual has (a) any medical expenditures or charges, and (b) any office-based visit during each month of an uninsured episode. We find that the ultimate length of an individual's episode of being uninsured bears relatively little on individuals' use of healthcare in any particular month and that the probability of health care utilization rises during the first year of the episode, with more use in the second six months of the year compared to the first six months.
    JEL: D1 D19 I19
    Date: 2007–05
  4. By: Unto Häkkinen; Isabelle Joumard
    Abstract: A key policy challenge in most OECD countries is to improve outcomes of the health care system while containing its costs. Benchmarking countries and identifying best practices to enhance public spending cost-effectiveness would, in this regard, be a useful exercise. This paper presents three main options for measuring effectiveness in the health care sector, discusses their pros and cons, including data availability and the possibility of whether these options would allow an analysis of how the institutional setting shapes spending effectiveness. <P>Comparer l'efficacité du secteur de la santé entre pays de l'OCDE : Options pour des travaux d'analyse <BR>Améliorer les résultats du système de santé tout en contenant ses coûts constitue un défi majeur de la politique économique dans la plupart des pays de l'OCDE. A cet égard, il serait particulièrement utile de pouvoir établir des comparaisons internationales et d'identifier les bonnes pratiques permettant d'améliorer le rapport résultats-coûts des dépenses publiques dans le secteur de la santé. Cet article présente trois grandes options pour mesurer l?efficacité dans le domaine de la santé, discute leurs avantages et inconvénients, notamment l'existence de données et la possibilité d'analyser à terme comment l'organisation institutionnelle affecte l'efficacité des dépenses.
    Keywords: health care, soins de santé, dépenses publiques, public spending, efficiency, efficacité, international benchmarking, comparaisons internationales
    JEL: H4 H51 I12
    Date: 2007–05–28
  5. By: Trygve Ottersen; Deogratius Mbilinyi; Ottar Mæstad; Ole Frithjof Norheim
    Abstract: Maximising health as the guiding principle for resource allocation in health has been challenged by concerns about the distribution of health outcomes. There are few empirical studies which consider these potentially divergent objectives in settings of extreme resource scarcity. The aim of this study is to fill some of this knowledge gap by exploring distributional preferences among health planners in Tanzania. Methodology: A deliberative group method was employed. Participants were health planners at district and regional level, selected by strategic sampling. The health planners alternated between group discussion and individual tasks. Respondents ranked health programmes with different target groups, and selected and ranked the reasons they thought should be given most importance in priority setting. Findings: A majority consistently assigned higher rankings to programmes where the initial life expectancy of the target group was lower. A high proportion of respondents considered "affect those with least life expectancy" to be the most important reason in priority setting. Conclusion: Distribution of health outcomes, in terms of life-years, matters. Specifically, the lower the initial life expectancy of the target group, the more important the programme is considered. Such preferences are compatible, within the sphere of health, with what ethicists call "prioritarianism".
    Keywords: Tanzania Priority setting Equity Stated preferences Group deliberation
    Date: 2006
  6. By: Hugh Gravelle (National Primary Care Research & Development Centre, Centre for Health Economics, University of York); Matt Sutton (Health Economics Research Unit, University of Aberdeen); Ada Ma (Health Economics Research Unit, University of Aberdeen)
    Abstract: Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declares are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.
    Keywords: Quality. Incentives. Gaming. Pay for performance.
    Date: 2007–05
  7. By: Gugushvili, Alexi
    Abstract: This paper reviews the vital health care resource allocation in integrated systems and contrasts it with the market-based health care resource provisions. It is believed that among several alternatives a method of centrally managed needs-based resource distribution is best suited for universally appraised code of “equal treatment of equals”. However, the main problem hides in identification and measurement of “need” and in economic effectiveness of the methodology. Supposedly, from the 1980s, as an innovative approach, the market system of health care provider reimbursement had to resolve the problems associated with centralised needs-based resource allocation, maintaining the main achievements and improving the effectiveness of the systematic distribution. Nonetheless, as this paper shows, so far there is little evidence that the market-based health care provider reimbursement advances the allocative performance of various health care systems.
    Keywords: Health systems; Resource allocation; Health care needs; Marketisation of health
    JEL: I11 D63 H51 I18
    Date: 2007–05
  8. By: Josip Tica (Faculty of Economics and Business, University of Zagreb); Šime Smolić (Faculty of Economics and Business, University of Zagreb)
    Abstract: In this paper multivariate Johansen cointegration technique is used in order to estimate health demand function in Croatia. Empirical estimate is based on the theoretical foundation of Grossman's model. According to the estimate, the number of physician visits in Croatia is a function of percentage of urban population, GDP, number of beds per 100 000 people, number of physicians per 100 000 people and total fertility rate. All estimated systems demonstrated strong feedbacks indicating number of endogenous variables greater than one.
    Keywords: health demand function, health capital, Grossman's model, Croatian health care system, Johansen cointegration technique
    JEL: I11 I18 H51
    Date: 2007–05–29

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