nep-hea New Economics Papers
on Health Economics
Issue of 2007‒06‒30
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Child Health and Family Income: Physical and Psychosocial Health By Nahum, Ruth-Aïda
  2. Decentralized Provision of Primary Healthcare in Rural Bangladesh – a Study of Government Facilities By Ahmad, Alia; Bose, Manik; Persson, Therése Hindman
  3. HIV/AIDS and social capital in a cross-section of countries By David, Antonio C.
  4. Ramsey Waits: Allocating Public Health Service Resources when there is Rationing by Waiting By Hugh Gravelle; Luigi Siciliani
  5. Longevity and environmental quality in an OLG model By Pierre-André Jouvet; Pierre Pestieau; Grégory Ponthière
  6. Developing Countries, Donor Leverage, and Access to Bird Flu Vaccines By CHAN Chee Khoon; Gilles de Wildt
  7. Market Effects of Generic Entry: The Role of Physicians and of Non-Bioequivalent Competitors By Gonzalez, Jorge; Sismeiro, Catarina; Dutta, Shantanu; Stern, Philip
  8. Have Pro-Poor Health Policies Improved the Targeting of Spending and the Effective Delivery of Health Care in South Africa? By Ronelle Burger; Christelle Grobler

  1. By: Nahum, Ruth-Aïda (Institute for Futures Studies)
    Abstract: This paper contributes to the important policy related literature on income and health by providing a detailed investigation of the family income/child health relationship using matched parent–child survey data from the Swedish Survey of Living Conditions (ULF). This study differs from previous work in the field in a number of respects. First, we focus on both physical as well as on the psychosocial health of the child. Second, we focus on the parent’s socioeconomic background as well as on the liquidity constraint problems the household faces. We find little evidence of an income gradient or effect on children’s physical and psychosocial health. However, our study suggests that the occurrence of liquidity constraints in the household increases the likelihood of the child having a lower psychosocial health status.
    Keywords: child health; income gradient; liquidity constraint; psychosocial health
    JEL: I12 I30
    Date: 2007–01
  2. By: Ahmad, Alia (Department of Economics, Lund University); Bose, Manik (World Fish Center); Persson, Therése Hindman (Econ Analys)
    Abstract: Bangladesh has made significant progress in health indicators in recent years in spite of her low level of income. This is mainly due to the commitment of the state supported by donors in providing preventive care with respect to child health and family planning. However, there are serious problems related to both access and quality of curative care that hurt the poor most. Infrastructures for service delivery exist at local level in rural areas but they function inefficiently. This paper deals with the systemic weaknesses of decentralized service provision of primary healthcare in Bangladesh and focuses on accountability links between different actors and functions of delegation, finance, performance, information and enforcement. The study is based on facility- and household-based data collected during 2005 in Khulna Division. The main findings of the study are: the health system in rural areas represents deconcentration rather than decentralization of central government functions where inter-sectoral discipline works poorly; local health providers are not accountable to local government, and poor citizens/clients are neither aware of their rights nor are capable of expressing their needs as effective channels do not exist.
    Keywords: decentralization; accountability; governance; primary healthcare
    JEL: I12 I18
    Date: 2007–06–18
  3. By: David, Antonio C.
    Abstract: This paper attempts to quantify the impact of the HIV/AIDS epidemic on social capital with cross-country data. It estimates reduced-form regressions of the main determinants of social capital controlling for HIV prevalence, institutional quality, social distance, and economic indicators using data from the World Values Survey. The results obtained indicate that HIV prevalence affects social capital negatively. The empirical estimates suggest that a one standard deviation increase in HIV prevalence will lead to a 1 percent decline in trust, controlling for other determinants of social capital. If one moves from a country with a relatively low level of HIV prevalence such as Estonia, to a country with a high level such as Zimbabwe, one would observe an approximate 8 percent decline in social capital. These results are robust in a number of dimensions and highlight the empirical importance of an additional mechanism through which HIV/AIDS hinders the development process.
    Keywords: Social Capital,Population Policies,Inequality,Economic Theory & Research,HIV AIDS
    Date: 2007–06–01
  4. By: Hugh Gravelle; Luigi Siciliani
    Abstract: The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.
    Keywords: Waiting times, prioritisation, rationing, cost effectiveness ratios
    JEL: H21 H42 I11 I18
    Date: 2007–06
  5. By: Pierre-André Jouvet; Pierre Pestieau; Grégory Ponthière
    Abstract: Whereas existing OLG models with endogenous longevity neglect the impact of environmental quality on mortality, this paper studies the design of the optimal public intervention in a two-period OLG model where longevity is influenced positively by health expenditures, but negatively by pollution due to production. It is shown that if individuals, when choosing how much to spend on health, do not internalize the impact of their decision on environmental quality (i.e. the space available for each person), the decentralization of the social optimum requires a tax not only on capital income, but also, on health expenditures. The sensitivity of the optimal second-best public intervention is also explored numerically..
    Date: 2007
  6. By: CHAN Chee Khoon; Gilles de Wildt
    Abstract: In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centres pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity?
    Keywords: avian flu vaccines, global health equity, international health security, essential medicines, public patents
    JEL: I18
    Date: 2007–06
  7. By: Gonzalez, Jorge; Sismeiro, Catarina; Dutta, Shantanu; Stern, Philip
    Abstract: Patent expiration represents a turning point for the brand losing patent protection as bioequivalent generic versions of the drug quickly enter the market at reduced prices. In this paper, we study how physician characteristics and their prescribing decisions impact the competition among molecules of a therapeutic class, once generic versions of one of these molecules enter the market. Specifically, we study the evolution of the Selective Serotonine Reuptake Inhibitors (SSRIs) after the introduction of generic versions of fluoxetine (brand name Prozac) in the United Kingdom (UK). Our results suggest that, to fully understand the market evolution after generic entry, public health officials need to consider the marketing activities of pharmaceutical companies and determine how (1) individual physicians prescribe all competing drugs, and (2) respond to drug prices and marketing actions. For example, we find that a group of physicians sensitive to detailing switch from fluoxetine to non-bioequivalent branded alternatives after patent expiration, as Prozac significantly reduces its marketing support. Consequently, the market share of fluoxetine decreases despite being available at significant price discount under generic form, and despite the increase of prescriptions by price-sensitive physicians. Hence, governments interested in assessing generics diffusion should consider the prescribing across all competitors, whether or not bioequivalent, and determine the size of physician segments sensitive to pharmaceutical marketing activity and prices.
    JEL: I1 H51 C50 M31 C11
    Date: 2006–10
  8. By: Ronelle Burger; Christelle Grobler (Stellenbosch University)
    Abstract: Abstract: Since 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished. The paper examines how these recent changes have affected the incidence of spending and the accessibility and quality of health care. The paper finds that between 1995 and 2003 there have been advances in the pro-poor spending incidence of both clinics and hospitals. The increased share of the health budget allocated to the more pro-poor clinic services has contributed further to the improvement in the targeting of overall health spending. Also, it appears that the elimination of user fees for clinics and the expansion of the clinic network have helped to make health services more affordable and geographically accessible to the poor and were associated with a notable rise in health service utilisation for individuals in the bottom two expenditure quintiles.
    Keywords: fiscal incidence, South Africa, health
    JEL: H51 I18
    Date: 2007–06

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