nep-hea New Economics Papers
on Health Economics
Issue of 2007‒10‒20
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Beyond the Health Concentration Index: An Atkinson Alternative for the Measurement of the Socioeconomic Inequality of Health By Erreygers G.
  2. Comparing the cost-effectiveness of Haloperidol, Risperidone and Olanzapine in the treatment of schizophrenia using the net-benefit regression approach By De Ridder A.; De Graeve D.
  3. Revelation of Preferences in Patient List Data By Ubøe, Jan; Lillestøl, Jostein
  4. Overweight in Adolescents: Implications for Health Expenditures By Alan C. Monheit; Jessica P. Vistnes; Jeannette A. Rogowski
  5. Structural Uncertainty and the Value of Statistical Life in the Economics of Catastrophic Climate Change By Martin Weitzman
  6. Information Technology and Medical Missteps: Evidence from a Randomized Trial By Jonathan C. Javitt; James B. Rebitzer; Lonny Reisman
  7. Wages, Violence and Health in the Household By Anna Aizer
  8. The Income Gradient in Children's Health: A Comment on Currie, Shields and Wheatley Price By Anne Case; Diana Lee; Christina Paxson
  9. The Welfare Effects of Public Drug Insurance By Darius Lakdawalla; Neeraj Sood
  10. Early identification of at-risk youth in Latin America : an applic ation of cluster analysis By Cunningham, Wendy; Bagby, Emilie
  11. Informal payments in developing countries' public health sector By Liu, Ting; Sun, Jiayin
  12. Health Econometric: Uncovering the Anthropometric Behavior on Women's Labor Market By Lopez-Pablos, Rodrigo A.

  1. By: Erreygers G.
    Abstract: The Health Concentration Index is a frequently used indicator for the measurement of the socioeconomic inequality of health. This note starts from a discussion of some of the weaknesses of this index. It then presents two possible alternative measures. The .first is an adaptation of the Concentration Index. The second and more important of the two is constructed by following an Atkinson approach.
    Date: 2006–11
  2. By: De Ridder A.; De Graeve D.
    Abstract: Schizophrenia is a serious mental disease with an early onset mostly between the ages 15-25. It is characterised by distortions of thinking and perception with inappropriate or blunted personal and social behaviour as a result. Schizophrenia is usually a chronic disease with acute relapses. It is therefore expensive in terms of direct treatment costs due to re-hospitalisations and lifelong maintenance treatment. The disease is burdensome for the family who spends much time care-giving. It is hard for the individual who experiences a low quality of life and who has disadvantaged employment experiences resulting in low income and marginalisation. Various anti-psychotics, differing in costs and effects, can be used for treatment. An optimal treatment choice is important for the patient’s health and for the costs generated by the disease. Such an optimal choice should achieve a better balance between the resources expended and the resulting outcomes. Economic evaluation studies typically compare costs and effects between different treatment alternatives, and can assist in choosing. Many evaluation studies have already been performed, but most of them suffer from methodological problems. Part of the studies are attached to RCTs. These studies have the advantage that they are comparing the effects and costs of treatments for similar groups of patients (because of randomization). At the same time trials do not reflect everyday clinical practice and often suffer from other shortcomings, such as a relatively limited follow-up time (up to maximum 1 year), a small number of patients (mostly less than 100 patients), inadequate consideration of uncertainty, etc.. In everyday practice treatments are not random but chosen by the practitioner on the basis of patient characteristics and / or experience of the practitioner. A simple comparison of treatment costs and effects can then be misleading, since the results are distorted by patient and physician characteristics. Retrospective cohort-based evaluation studies often fail to account for baseline differences. Despite the relatively large number of evaluation studies already performed, Basu therefore concludes further studies of cost-effectiveness need to be carried out with careful consideration of the limitations of published analyses.
    Date: 2007–06
  3. By: Ubøe, Jan (Dept. of Finance and Management Science, Norwegian School of Economics and Business Administration); Lillestøl, Jostein (Dept. of Finance and Management Science, Norwegian School of Economics and Business Administration)
    Abstract: In this paper we will show how the patient list model in Ubøe & Lillestøl (2007) can be used to infer strength of preferences from patient list data. We prove that we can construct unique sets of preferences that replicates patient list data, and we also show how to approach cases where we only have partial information of the system. As an illustration we apply the new theory to some patient list data from the Norwegian patient list system in general practice.
    Keywords: Patient lists; efficient welfare; statistical distributions
    JEL: I18 I30
    Date: 2007–09–21
  4. By: Alan C. Monheit; Jessica P. Vistnes; Jeannette A. Rogowski
    Abstract: We consider two compelling research questions raised by the increased prevalence of overweight among adolescents. First, what factors explain variation in adolescent bodyweight and the likelihood of being overweight? Next, do overweight adolescents incur greater health care expenditures compared to those of normal weight? We address the former question by examining the contribution of individual characteristics, economic factors, parental and family attributes, and neighborhood characteristics to variation in these bodyweight outcomes. For the second question, we estimate a two-part, generalized linear model of health spending. Using data from the Medical Expenditure Panel Survey, our econometric analyses indicate that adolescent bodyweight and the likelihood of being overweight are strongly associated with parental bodyweight, parental education, parental smoking behavior, and neighborhood attributes such as the availability of fresh food markets and convenience/snack food outlets, and neighborhood safety and material deprivation. Our expenditure model indicates that overweight females have annual expenditures that exceed those of normal weight by nearly $800 with part of the disparity explained by differences in mental health expenditures. We use both sets of empirical results to draw implications for policies to address adolescent overweight.
    JEL: I1
    Date: 2007–10
  5. By: Martin Weitzman
    Abstract: Using climate change as a prototype motivating example, this paper analyzes the implications of structural uncertainty for the economics of low-probability high-impact catastrophes. The paper shows that having an uncertain multiplicative parameter, which scales or amplifies exogenous shocks and is updated by Bayesian learning, induces a critical "tail fattening" of posterior-predictive distributions. These fattened tails can have strong implications for situations (like climate change) where a catastrophe is theoretically possible because prior knowledge cannot place sufficiently narrow bounds on overall damages. The essence of the problem is the difficulty of learning extreme-impact tail behavior from finite data alone. At least potentially, the influence on cost-benefit analysis of fat-tailed uncertainty about the scale of damages -- coupled with a high value of statistical life -- can outweigh the influence of discounting or anything else.
    JEL: Q54
    Date: 2007–10
  6. By: Jonathan C. Javitt; James B. Rebitzer; Lonny Reisman
    Abstract: We analyze the effect of a decision support tool designed to help physicians detect and correct medical "missteps". The data comes from a randomized trial of the technology on a population of commercial HMO patients. The key findings are that the new information technology lowers average charges by 6% relative to the control group. This reduction in resource utilization was the result of reduced in-patient charges (and associated professional charges) for the most costly patients. The rate at which identified issues were resolved was generally higher in the study group than in the control group, suggesting the possibility of improvements in care quality along measured dimensions and enhanced diffusion of new protocols based on new clinical evidence.
    JEL: I12
    Date: 2007–10
  7. By: Anna Aizer
    Abstract: Three quarters of all violence against women is perpetrated by domestic partners. I study both the economic causes and consequences of domestic violence. I find that decreases in the male-female wage gap reduce violence against women, consistent with a household bargaining model. The relationship between the wage gap and violence suggests that reductions in violence may provide an alternative explanation for the well-established finding that child health improves when mothers control a greater share of the household resources. Using instrumental variable and propsensity score techniques to control for selection into violent relationships, I find that violence against pregnant women negatively affects the health of their children at birth. This work sheds new light on the health production process as well as observed income gradients in health and suggests that in addition to addressing concerns of equity, pay parity can also improve the health of American women and children via reductions in violence.
    JEL: I12 J12 J13 J16
    Date: 2007–10
  8. By: Anne Case; Diana Lee; Christina Paxson
    Abstract: This paper reexamines differences found between income gradients in American and English children's health, in results originally published by Case, Lubotsky and Paxson (2002) for the US, and by Currie, Shields and Wheatley Price (2007) for England. We find that, when the English sample is expanded by adding three years of data, and is compared to American data from the same time period, the income gradient in children's health increases with age by the same amount in the two countries. In addition, we find that Currie, Shields and Wheatley Price's measures of chronic conditions from the Health Survey of England were incorrectly coded. Using correctly coded data, we find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering children's health from the effects of chronic conditions in England. We find no evidence that the British National Health Service, with its focus on free services and equal access, prevents the association between health and income from becoming more pronounced as children grow older.
    JEL: D1 I1
    Date: 2007–10
  9. By: Darius Lakdawalla; Neeraj Sood
    Abstract: Rewarding inventors with inefficient monopoly power has long been regarded as the price of encouraging innovation. Public prescription drug insurance escapes that trade-off and achieves an elusive goal: lowering static deadweight loss, while simultaneously encouraging dynamic investments in innovation. As a result of this feature, the public provision of drug insurance can be welfare-improving, even for risk-neutral and purely self-interested consumers. In spite of its relatively low benefit levels, the Medicare Part D benefit generate $3.5 billion of annual static deadweight loss reduction, and at least $2.8 billion of annual value from extra innovation. These two components alone cover 87% of the social cost of publicly financing the benefit. The analysis of static and dynamic efficiency also has implications for policies complementary to a drug benefit: in the context of public monopsony power, some degree of price-negotiation by the government is always strictly welfare-improving, but this should often be coupled with extensions in patent length.
    JEL: H2 H51 I11
    Date: 2007–10
  10. By: Cunningham, Wendy; Bagby, Emilie
    Abstract: A new literature on the nature of and policies for youth in Latin America is emerging, but there is still very little known about who are the most vulnerable young people. This paper aims to characterize the heterogeneity in the youth population and identify ex ante the youth that are at-risk and should be targeted with prevention programs. Using non-parametric methodologies and specialized youth surveys from Mexico and Chile, the authors quantify and characterize the different sub-groups of youth, according to the amount of risk in their lives, and find that approximately 20 percent of 18 to 24 year old Chileans and 40 percent of the same age cohort in Mexico are suffering the consequences of a range of negative behaviors. Another 8 to 20 percent demonstrate factors in their lives that pre-dispose them to becoming at-risk youth - they are the candidates for prevention programs. The analysis finds two observable variables that can be used to identify which children have a higher probability of becoming troubled youth: poverty and residing in rural areas. The analysis also finds that risky behaviors increase with age and differ by gender, thereby highlighting the need for program and policy differentiation along these two demographic dimensions.
    Keywords: Adolescent Health,Youth and Governance,Health Monitoring & Evaluation,Population Policies,Gender and Health
    Date: 2007–10–01
  11. By: Liu, Ting; Sun, Jiayin
    Abstract: In China and some other developing countries' public health sectors, many patients give their doctors a payment outside the official channel before a major treatment. This secret payment has been documented as informal payment in the literature. We argue that the fundamental cause for informal payments is that patients have more information about doctors' skill than the government does. The price, set by the government, for services offered by doctors cannot fully differentiate patients' various needs. As a consequence, informal payment rises as a tool for patients to compete for the skillful doctor. We study the welfare implications of different policies that can potentially be used to regulate such payments. Patient heterogeneity plays a central role in welfare implications of different policies: when patients' willingness-to-pay differs a lot, informal payments should be allowed and when it differs little, informal payments should be banned. Also we show that selling the right to choose physicians publicly always improves social welfare.
    Keywords: informal payments; public health sector; welfare; efficiency
    JEL: I18 O17 H44
    Date: 2007–10–11
  12. By: Lopez-Pablos, Rodrigo A.
    Abstract: Exploring current literature that assess relations between cognitive ability and height, obesity, and its productivity-employability effect on women's labor market; we appraised the Argentine case to and these social-physical relations which involve anthropometric and traditional economic variables. Adapting an anthropometric Mincer approach by using probabilistic and censured econometric models which were developed for it. Subtle evidence of discriminative behavior on obese women, and a good performance of height variable as unobserved cognitive ability approximate measure to explain feminine productivity has been found.
    Keywords: Height; Obesity; Anthropometric Mincer; Discrimination.
    JEL: J24 I12 C34
    Date: 2007–08–30

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