nep-hea New Economics Papers
on Health Economics
Issue of 2007‒09‒24
seventeen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Determinants of demand for antenatal care in Colombia By Andrés Vecino Ortiz
  2. Ethnicity and obesity: evidence of implicit work performance stereotypes in Sweden By Jens, Agerström; Carlsson, Rickard; Rooth, Dan-Olof
  3. Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad By Patel Amit; Ramani K.V.; Mavalankar Dileep; Agarwal Anurag; Maiya Shilpa, Nayak Beena
  4. Is Child Labor Harmful? The Impact of Working Earlier in Life on Adult Earnings By Patrick M. Emerson; André Portela Souza
  5. Youth Risk-Taking Behavior in Brazil: Drug Use and Teenage Pregnancies By Ana Rute Cardoso; Dorte Verner
  6. Health and Labor Market Consequences of Eliminating Federal Disability Benefits for Substance Abusers By Pinka Chatterji; Ellen Meara
  7. The Effects of Mandatory Seatbelt Laws on Seatbelt Use, Motor Vehicle Fatalities, and Crash-Related Injuries among Youths By Christopher S. Carpenter; Mark Stehr
  8. Risks and Prices: The Role of User Sanctions in Marijuana Markets By Rosalie Liccardo Pacula; Beau Kilmer; Michael Grossman; Frank J. Chaloupka
  9. The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness By HUD - PD&R
  10. Infant mortality over the business cycle in the developing world By Schady, Norbert; Friedman, Jed; Baird, Sarah
  11. Leakage of public resources in the health sector : an empirical investigation of Chad By Wane, Waly; Gauthier, Bernard
  12. Investment in hospital care technology under different purchasing rules: a real option approach By Rossella Levaggi; Michele Moretto
  13. Investment decisions in hospital technology when physicians are devoted workers By Rossella Levaggi; Michele Moretto; Vincenzo Rebba
  14. Modelling Stochastic Mortality for Dependent Lives By Elisa Luciano; Jaap Spreeuw; Elena Vigna
  15. Choosing Longevity with Overlapping Generations By Weichun Chen; Merwan Engineer; Ian King
  16. The Effects of Detailing on Prescribing Decisions under Two-Sided Learning By Ching, Andrew; Ishihara, Masakazu
  17. The Demand for Private Health Insurance in Malawi By Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick

  1. By: Andrés Vecino Ortiz
    Abstract: Even though antenatal care is universally regarded as important, determinants of demand for antenatal care have not been widely studied. Evidence concerning which and how socioeconomic conditions influence whether a pregnant woman attends or not at least one antenatal consultation or how these factors affect the absences to antenatal consultations is very limited. In order to generate this evidence, a two-stage analysis was performed with data from the Demographic and Health Survey carried out by Profamilia in Colombia during 2005. The first stage was run as a logit model showing the marginal effects on the probability of attending the first visit and an ordinary least squares model was performed for the second stage. It was found that mothers living in the pacific region as well as young mothers seem to have a lower probability of attending the first visit but these factors are not related to the number of absences to antenatal consultation once the first visit has been achieved. The effect of health insurance was surprising because of the differing effects that the health insurers showed. Some familiar and personal conditions such as willingness to have the last children and number of previous children, demonstrated to be important in the determination of demand. The effect of mother’s educational attainment was proved as important whereas the father’s educational achievement was not. This paper provides some elements for policy making in order to increase the demand inducement of antenatal care, as well as stimulating research on demand for specific issues on health.
    Date: 2007–09–03
  2. By: Jens, Agerström (Department of psychology, Lund University); Carlsson, Rickard (Department of economics, Kalmar University); Rooth, Dan-Olof (Department of economics, Kalmar University)
    Abstract: Using the Implicit Association Test, we investigate whether employers and students possess implicit and explicit negative attitudes and implicit performance stereotypes toward Arab-Muslim men relative to native Swedish men. We also examine if employers and students have implicit and explicit performance stereotypes toward obese individuals relative to people of normal weight. The results demonstrate that employers and students both implicitly and explicitly associate Arab-Muslim men with less work performance. Also, they have more implicit negative attitudes toward this ethnic group. Obese individuals are both implicitly and explicitly associated with less work performance compared with normal-weight individuals.
    Keywords: Implicit; attitudes; stereotypes; discrimination; ethnicity; obesity
    JEL: J53 J64 J71
    Date: 2007–08–31
  3. By: Patel Amit; Ramani K.V.; Mavalankar Dileep; Agarwal Anurag; Maiya Shilpa, Nayak Beena
    Abstract: Governments in many developing countries acknowledge they are facing difficulties in their attempt to meet the basic health needs of their populations. They rely on contracting out to private (for-profit and not-for-profit) organizations as a strategy to meet the needs of underserved populations. For the most part, the public sector chooses to contract out primary healthcare services to the private sector to expand access, increase the availability of medicines and medical supplies, and improve the quality of care. In both urban and rural settings, private for-profit and non-profit health service providers serve both the rich and the poor. Communities often recognize private sector healthcare providers to be more responsive to their healthcare needs and preferences in terms of services available, suitable timings and geographical access etc. Private sector has always played a significant role in the delivery of health services in developing countries. Public-private-partnership (PPP) is an approach under which services are delivered by the private sector, while the responsibility for providing the resources rests with the government. Establishing a PPP requires a legal framework acceptable to all the partners, clarity on the commitment of resources, roles and responsibilities of each partner, as well as accountability to provide a given set of services at a desired level of quality and affordable user charges. Formalizing such an arrangement between partners requires conceptualising a framework for Public Private Partnership (PPP) to manage the delivery of health services. In this paper, we describe the design, development and implementation of a PPP for managing urban health services in Ahmedabad city, Gujarat. Our model has succeeded in bringing together compatible public and private partners to plan and deliver quality healthcare services to meet the community needs of Vasna ward, in Ahmedabad. The new Vasna Urban Health centre was inaugurated on July 23, by the Chief Minister of Guajarat. This new centre now serves about 120 outpatients everyday as against an average of 10 outpatients daily earlier.
    Date: 2007–09–08
  4. By: Patrick M. Emerson (Oregon State University and IZA); André Portela Souza (São Paulo School of Economics, Fundação Getulio Vargas)
    Abstract: This paper explores the question: is working as a child harmful to an individual in terms of adult outcomes in earnings? Though an extremely important question, little is known about the effect of child labor on adult outcomes. Estimations of an instrumental variables earnings model on data from Brazil show that child labor has a large negative impact on adult earnings for male children even when controlling for schooling and that the negative impact of starting to work as a child reverses at around ages 12-14.
    Keywords: child labor, Brazil, adult outcomes
    JEL: J31 O12 O54
    Date: 2007–08
  5. By: Ana Rute Cardoso (IZA); Dorte Verner (World Bank)
    Abstract: Using an extensive survey addressing risk factors faced by the population in the shantytowns of Fortaleza, Brazil, the aim of this paper is to study interactions among different types of risktaking behavior by youth, namely drug use and teenage pregnancy. We check the impact of factors such as exposure to mass media, the existence of support networks, self-esteem, or the occurrence of violence at home and in the neighborhood, on the probability of risk-taking behavior. A bivariate probit model is estimated. Findings indicate that reliance on support networks and exposure to mass media are associated with a lower probability of either type of risk behavior. Living in a violent home increased drug consumption. Race does not have a significant impact on either type of behavior.
    Keywords: drug use, teenage pregnancy, sexual behavior, reproductive health, teenage behavior
    JEL: I12 J13
    Date: 2007–08
  6. By: Pinka Chatterji; Ellen Meara
    Abstract: Using annual, repeated cross-sections from national household survey data, we estimate how the January 1997 termination of federal disability benefits for those with Drug Addiction and Alcoholism affected labor market outcomes, health insurance, health care utilization, and arrests among individuals targeted by the legislation. We employ propensity score methods and a difference-in-difference-in-difference approach to mitigate potential omitted variables bias. Declines in SSI receipt accompanied increases in labor force participation and current employment, but had little measurable effect on insurance and utilization. In the long-run, (1999-2002), rates of SSI receipt rebounded somewhat, and short-run gains in labor market outcomes waned.
    JEL: I1 I28
    Date: 2007–09
  7. By: Christopher S. Carpenter; Mark Stehr
    Abstract: We provide the first comprehensive assessment of the effects of mandatory seatbelt laws on self-reported seatbelt use, highway fatalities, and crash-related injuries among high school age youths using data from the Centers for Disease Control's (CDC) national, state, and local Youth Risk Behavior Surveys (YRBS) and the Fatality Analysis Reporting System (FARS) from 1991 to 2005, a period spanning over 20 changes in state seatbelt laws. Our quasi-experimental approaches isolate the independent effects of seatbelt laws net of demographic characteristics, area and year fixed effects, and smooth area-specific trends. Across all data sources, we find consistent evidence that state mandatory seatbelt laws -- particularly those permitting primary enforcement -- significantly increased seatbelt use among high school age youths by 45-80 percent, primarily at the extensive margin. Unlike previous research for adults, however, we find evidence against the selective recruitment hypothesis: seatbelt laws had consistently larger effects on those most likely to be involved in traffic accidents (drinkers, alcohol-involved drivers). We also find that mandatory seatbelt laws significantly reduced traffic fatalities and serious injuries resulting from fatal crashes by 8 and 9 percent, respectively. Our results suggest that if all states had primary enforcement seatbelt laws then regular youth seatbelt use would be nearly universal and youth fatalities would fall by about 120 per year.
    JEL: I1
    Date: 2007–09
  8. By: Rosalie Liccardo Pacula; Beau Kilmer; Michael Grossman; Frank J. Chaloupka
    Abstract: User sanctions influence the legal risk for participants in illegal drug markets. A change in user sanctions may change retail drug prices, depending on how it changes the legal risk to users, how it changes the legal risk to dealers, and the slope of the supply curve. Using a novel dataset with rich transaction-level information, this paper evaluates the impact of recent changes in user sanctions for marijuana on marijuana prices. The results suggest that lower legal risks for users are associated with higher marijuana prices in the short-run, which ceteris paribus, implies higher profits for drug dealers. Additionally, the findings have important implications for thinking about the slope of the supply curve and interpreting previous research on the effect of drug laws on demand for marijuana.
    JEL: I18 K42
    Date: 2007–09
  9. By: HUD - PD&R
    Abstract: This report presents the findings from an exploratory study of the Housing First approach of providing permanent supportive housing to single, homeless adults with mental illness and co-occurring substance-related disorders. In recent years, Congress and the leadership of the U.S. Department of Housing and Urban Development (HUD) have encouraged the development of permanent housing for homeless people. Concurrently, there has been a shift toward committing a greater proportion of HUD McKinney-Vento Act funds toward housing as opposed to supportive services and an increase in attention toward the hardest-to-serve, chronically homeless population, a substantial number of whom are mentally ill. Because it addresses this population and its needs, the Housing First approach is currently experiencing increased attention as a method of serving this population consistent with the above-stated goals.
    JEL: I38
    Date: 2007–07
  10. By: Schady, Norbert; Friedman, Jed; Baird, Sarah
    Abstract: The diffusion of cost-effective life saving technologies has reduced infant mortality in much of the developing world. Income gains may also play a direct, protective role in ensuring child survival, although the empirical findings to date on this issue have been mixed. This paper assembles data from Demographic and Health Surveys (DHS) in 59 countries to analyze the relationship between changes in per capita GDP and infant mortality. The authors show that there is a strong, negative association between changes in per capita GDP and infant mortality- in a first-differenced specification the implied elasticity of infant mortality with respect to per capita GDP is approximately -0.56. In addition to this central result, two findings are noteworthy. First, although there is some evidence of changes in the composition of women giving birth during economic upturns and downturns, the observed changes in infant mortality are not a result of mothers with protective characteristics timing fertility to correspond with the business cycle. Second, the association between infant mortality and per capita GDP is particularly pronounced for periods of large contractions in GDP, suggesting the inability of developing country households or health systems (or both) to smooth resources. Simple back-of-the-envelope calculations using the estimates suggest that there may have been more than 1 million " excess " deaths in the developing world since 1980 as a result of large, negative contractions in per capita GDP.
    Keywords: Population Policies,Health Monitoring & Evaluation,Early Child and Children ' s Health,Health Systems Development & Reform,Early Childhood Development
    Date: 2007–09–01
  11. By: Wane, Waly; Gauthier, Bernard
    Abstract: In the public sector in developing countries, leakage of public resources could prove detrimental to users and affect the well-being of the population. This paper empirically examines the importance of leakage of government resources in the health sector in Chad, and its effects on the prices of drugs. The analysis uses data collected in Chad as part of a Health Facilities Survey organized by the World Bank in 2004. The survey covered 281 primary health care centers and contained information on the provision of medical material, financial resources, and medicines allocated by the Ministry of Health to the regional administration and primary health centers. Although the regional administration is officially allocated 60 percent of the ministry ' s non-wage recurrent expenditures, the share of the resources that actually reach the regions is estimated to be only 18 percent. The health centers, which are the frontline providers and the entry point for the population, receive less than 1 percent of the ministry ' s non-wage recurrent expenditures. Accounting for the endogeneity of the level of competition among health centers, the leakage of government resources has a significant and negative impact on the price mark-up that health centers charge patients for drugs.
    Keywords: Health Monitoring & Evaluation,Health Systems Development & Reform,Public Sector Expenditure Analysis & Management,Health Economics & Finance,Population Policies
    Date: 2007–09–01
  12. By: Rossella Levaggi (Università di Brescia); Michele Moretto (Università di Padova)
    Abstract: Quality of health care is the product of several factors as the literature has long recognized. In this article we focus on the relationship between quality and investment in health technology by analysing the optimal investment decision in a new health care technology of a repre sentative hospital that maximises its surplus in an uncertain environment. The new technology allows the hospital to increase the quality level of the care provided, but the investment is irreversible. The article uses the framework of the real option literature to show how the purchaser might inuence the quality level by setting a quality-contingent long-term contract with the hospital.The investment in new technology is in fact best incentivated within a long-term contract where the number of treatments reimbursed depends on the level of investment made when the technology is new. In this way, asymmetry of information does not affect the outcome of the contract. In our model in fact the purchaser can verify the level of the investment only at the end of each period but the purchasing rule has an anticipating e¤ect on the decision to invest.
    Keywords: Health care technologies, Medical quality, Irreversible investments, Real options.
    JEL: I11 D81
    Date: 2007–09
  13. By: Rossella Levaggi (Università di Brescia); Michele Moretto (Università di Padova); Vincenzo Rebba (Università di Padova)
    Keywords: Hospital Technology, Devoted worker, Quality, Irreversible investment, Real options.
    JEL: I11 D81
    Date: 2007–09
  14. By: Elisa Luciano (University of Turin, Icer and Collegio Carlo Alberto); Jaap Spreeuw (Cass Business School, London); Elena Vigna (University of Turin)
    Abstract: Stochastic mortality, i.e. modelling death arrival via a jump process with stochastic intensity, is gaining increasing reputation as a way to represent mortality risk. This paper represents a first attempt to model the mortality risk of couples of individuals, according to the stochastic intensity approach. We extend to couples the Cox processes set up, namely the idea that mortality is driven by a jump process whose intensity is itself a stochastic process, proper of a particular generation within each gender. Dependence between the survival times of the members of a couple is captured by an Archimedean copula. We also provide a methodology for fitting the joint survival function by working separately on the (analytical) copula and the (analytical) margins. First, we calibrate and select the best fit copula according to the methodology of Wang and Wells (2000b) for censored data. Then, we provide a sample-based calibration for the intensity, using a time-homogeneous, non mean-reverting, affine process: this gives the marginal survival functions. By coupling the best fit copula with the calibrated margins we obtain a joint survival function which incorporates the stochastic nature of mortality improvements. Several measures of time dependent association can be computed out of it. We apply the methodology to a well known insurance dataset, using a sample generation. The best fit copula turns out to be a Nelsen one, which implies not only positive dependency, but dependency increasing with age.
    Date: 2007–04
  15. By: Weichun Chen; Merwan Engineer; Ian King
    Abstract: We extend Diamond’s (1965) OLG model to allow agents to choose whether to participate in the second period of life. The valuation of early exit (x) is a key parameter. We characterize competitive equilibria, efficient allocations, and predictions for income and life expectancy over time. We find that, with logarithmic utility, for any value of x, there is a range of initial values of the capital stock for which some agents would prefer to exit in equilibrium. The shape of the transition function and the number of steady state equilibria depend crucially on the value of capital’s share of income.
    Keywords: ndogenous longevity, overlapping generations, growth
    JEL: D91 O1
    Date: 2007
  16. By: Ching, Andrew; Ishihara, Masakazu
    Abstract: A fundamental question in pharmaceutical marketing management is: How does the effectiveness of detailing change when additional information on drugs is revealed via patients' experiences during the product lifecycle? To address this question, we develop a model of detailing and prescribing decisions which incorporates uncertainty about the quality of drugs. Our model assumes that not only physicians/patients, but also drug manufacturers are uncertain about the qualities of drugs, and a representative opinion leader is responsible for updating the prior belief about these qualities. Physicians are heterogeneous in their information sets, and drug manufacturers use detailing as a means to increase/maintain the measure of well-informed physicians. We explicitly model physicians' forgetting by allowing the measure of well-informed physicians to depreciate over time. We estimate our model using product level data of ACE-inhibitor with diuretic in Canada. Our estimation approach allows us to control for the potential endogeneity of detailing. The results show that our model is able to fit the diffusion pattern very well, the effectiveness of detailing depends on the current information set and the measure of well-informed physicians, and the role of detailing-in-utility is minimal. Using our parameter estimates, we examine how a public awareness campaign, which encourages physicians/patients to report their drug experiences, would affect managerial incentives to detail.
    Keywords: Detailing; Prescription Drugs; Decisions Under Uncertainty; Two-sided Learning; Representative Opinion Leader; Diffusion
    JEL: I18 C15 M31 D83 M37 C35 I11
    Date: 2007–09–10
  17. By: Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick
    Abstract: This study investigates the determinants of demand for private health insurance among formal sector employees in Malawi, a poor country with heavy pressure on under-funded free government health services. The study is based on membership in the Medical Aid Society of Malawi’s (MASM), three schemes, namely: the VIP, the best; the Executive, the intermediate; and the Econoplan, the minimum. The results indicate that formal sector employees prefer to receive medical treatment from private fee-charging health facilities, where health insurance would be relevant. The study finds that the probability of enrolling in any of MASM’s schemes increases with income and with age for the top and minimum schemes. More children and good health status reduce the probability of enrolling into the two lower schemes. The results suggest the potentially important roles that can be played by information and interventions that address the affordability factor such as through employer contributions that take into consideration income and family size.
    Keywords: Health insurance; MASM; Multinomial logit
    JEL: D1 I1
    Date: 2007

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