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on Health Economics |
| By: | Sonia Bhalotra; Arthur van Soest |
| Abstract: | A dynamic panel data model of neonatal mortality and birth spacing is analyzed, accounting for causal effects of birth spacing on subsequent mortality and of mortality on the length of the next birth interval, while controlling for unobserved heterogeneity in mortality (frailty) and birth spacing (fecundity). The model is estimated using micro data on almost 30,000 children of 7,300 Indian mothers, for whom a complete retrospective record of fertility and child mortality is available. Information on sterilization is used to identify an equation for completion of family formation that is needed to account for right-censoring in the data. We find clear evidence of frailty, fecundity, and causal effects of birth spacing on mortality and vice versa, but find that birth interval effects can explain only a limited share of the correlation between neonatal mortality of successive children in a family. We also predict the impact of mortality on total fertility. Model simulations suggest that, for every neonatal death, an additional 0.37 children are born, of whom 0.3 survive. |
| Keywords: | fertility, birth spacing, neonatal mortality, health, dynamic panel data models, siblings |
| JEL: | I12 J13 C33 |
| Date: | 2007–04 |
| URL: | http://d.repec.org/n?u=RePEc:bri:cmpowp:07/168&r=hea |
| By: | Sonia Bhalotra |
| Abstract: | There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about -0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth-order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes). |
| Keywords: | public spending, health, poverty, infant mortality, India |
| JEL: | I12 J13 C33 |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:bri:cmpowp:07/169&r=hea |
| By: | David W.Johnston; Carol Propper; Michael A.Shields |
| Abstract: | Economists rely heavily on self-reported measures of health status to examine the relationship between income and health. In this paper we directly compare survey responses to a self-reported measure of health that is commonly available in nationally-representative individual and household surveys, with objective measures of the same health condition. Our particular focus is on hypertension, which is the most prevalent health condition in Western countries. Using data from the Health Survey for England, we find that there is a substantial difference in the percentage of adult survey respondents reporting that they have hypertension as a chronic health condition compared to that from repeated measurements by a trained nurse. Around 85% of individuals measured as having hypertension do not report having it as a chronic illness. Importantly, we find no evidence of an income/health gradient using self-reported hypertension, but a large (about 14 times the size) gradient when using objectively measured hypertension. We also find that the probability of false negative reporting, that is an individual not reporting to have chronic hypertension when in fact they have it, is significantly higher for individuals living in low income households. Given the wide use of such self-reported chronic health conditions in applied research, and the asymptomatic nature of many major illnesses such as hypertension, diabetes, heart disease and cancer at moderate and sometimes very elevated levels, we show that using commonly available self-reported chronic health measures is likely to lead to an underestimate of true income-related inequalities in health. This has important implications for policy advice. |
| Keywords: | Hypertension, Objective Health, Self-Reported Health, Reporting Error, Income |
| JEL: | I10 I18 C42 |
| Date: | 2007–03 |
| URL: | http://d.repec.org/n?u=RePEc:bri:cmpowp:07/171&r=hea |
| By: | Stephanie von Hinke Kessler Scholder |
| Abstract: | Recent literature has shown consistent evidence of a positive relationship between maternal employment and children’s excess body weight. These studies have largely focused on the effect of average weekly work hours over the child’s life on its overweight status. The aim of this paper is to explore the importance of the timing of employment. Timing of maternal absences has been shown to matter for child cognitive and behavioral outcomes. This paper explores whether this timing effect also exists with respect to children’s excess body weight. Data on a nationally representative British birth cohort are used to examine this, permitting a detailed exploration of the potential endogeneity of mother’s employment. The results show a significant positive correlation between full-time maternal employment during mid-childhood and the probability of being overweight at age 16. There is no evidence that part-time or full-time employment at earlier or later ages leads to a higher probability of being overweight at age 16. Subgroup analysis suggests this effect is driven by lower socio-economic groups. Various econometric techniques are used to explore whether employed mothers are systematically different from non-employed mothers, but there is no evidence that this unobserved heterogeneity biases the estimates. |
| Keywords: | Childhood obesity; Maternal Employment; Timing of Employment; Overweight |
| JEL: | I12 J22 |
| Date: | 2007–09 |
| URL: | http://d.repec.org/n?u=RePEc:bri:cmpowp:07/180&r=hea |
| By: | Sonia Bhalotra |
| Abstract: | This paper investigates the impact of macroeconomic shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature shows that mortality at most ages is pro-cyclical but similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses individual data on infant mortality for about 150000 children born in 1970- 1997, merged by birth-cohort with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks. I cannot reject the null that income shocks have no effect on mortality in urban households, but I find that rural infant mortality is counter-cyclical, the elasticity being about -0.46. This is despite the possibility that relatively high risk women avert birth or suffer fetal loss in recessions. It seems related to the fact that women’s participation in the (informal) labour market increases in recessions, presumably, to compensate a decline in their husband’s wages. Consistent with this but, in contrast to results for richer countries, antenatal and postnatal health-care decline in recessions. These effects are reinforced by pro-cyclicality in state health and development expenditure. Another interesting finding that is informative about the underlying mechanisms is that the effect of aggregate income on rural mortality is driven by non-agricultural income. |
| Keywords: | infant mortality, income volatility, business cycles, India , health care, maternal labour supply, public expenditure. |
| JEL: | I12 J10 O49 |
| Date: | 2007–09 |
| URL: | http://d.repec.org/n?u=RePEc:bri:cmpowp:07/181&r=hea |
| By: | Venkataraman, S.; Stremersch, S. (Erasmus Research Institute of Management (ERIM), RSM Erasmus University) |
| Abstract: | Decision-making by physicians on patients? treatment has come under increased public scrutiny. In fact, there is a fair amount of debate on the effects of marketing actions of pharmaceutical firms toward physicians and their impact on physician prescription behavior. While some scholars find a strong and positive influence of marketing actions, some find only moderate effects, and others even find negative effects. Debate is also mounting on the role of other influencers (such as patient requests) in physician decision-making, both on prescriptions and sample-dispensing. The authors argue that one factor that may tip the balance in this debate is the role of drug characteristics, such as a drug?s effectiveness and a drug?s side effects. Using a unique data set, they show that marketing efforts ? operationalized as detailing and symposium meetings of firms to physicians ? and patient requests do affect physician decision-making differentially across brands. Moreover they find that the responsiveness of physicians? decision-making to marketing efforts and patient requests depends upon the drug?s effectiveness and side effects. The paper presents clear guidelines for public policy and managerial practice and envisions that the study of the role of drug characteristics ? such as effectiveness and side effects ? may lead to valuable insights in this surging public debate. |
| Keywords: | Physician decision-making;marketing efforts;patient requests;drug effectiveness;side effects;drug prescription;sampling;sample-dispensing;pharmaceuticals;public policy; |
| Date: | 2007–09–06 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:eureri:300011782&r=hea |
| By: | Betliy Oleksandra; Kuziakiv Oksana; Onishchenko Katerina |
| Abstract: | Sound panel data analysis both on the macro and micro levels intends to define key macro and micro determinants of health of the population and quality of health services. The research will contribute to development of quality-enhancing policies in health sector on regional level and on the level of medical establishments. |
| Date: | 2007–07–26 |
| URL: | http://d.repec.org/n?u=RePEc:eer:wpalle:04-909e&r=hea |
| By: | Raouf Boucekkine; Bity Diene; Theophile Azomahou |
| Abstract: | We first provide a nonparametric inference of the relationship between life expectancy and economic growth on an historical data for 18 countries over the period 1820-2005. The obtained shape shows up convexity for low enough values of life expectancy and concavity for large enough values. We then study this relationship on a benchmark model combining "per- petual youth" and learning-by-investing. In such a benchmark, the generated relationship between life expectancy and economic growth is shown to be strictly increasing and concave. We finally examine a model departing from "perpetual youth" by assuming age-dependent survival probabilities. We show that life-cycle behavior combined with age-dependent sur- vival laws can reproduce our empirical finding. |
| Keywords: | Life expectancy, economic growth, perpetual youth, age-dependent mortality, nonparametric estimation |
| JEL: | O41 I20 J10 |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:gla:glaewp:2007_24&r=hea |
| By: | Thunström, Linda (The Swedish Retail Institute (HUI)) |
| Abstract: | With food, consumers often face a trade-off between taste and nutrition. A priori, it is not obvious which would be more important to the average consumer, so it is an empirical question how consumers value food characteristics that simultaneously affect taste and nutritional value. In this paper, Swedish consumer preferences regarding food characteristics in breakfast cereals, hard bread and potato products are analyzed. In particular, the value consumers attach to fat, fibre, salt and sugar is studied, as well as the value of easily accessible nutritional information provided by a nutrition symbol. The equations estimated are derived from a hedonic price model. The price data originates from a household panel and scanner data, whereas the corresponding data on food characteristics was collected manually in supermarkets or from producers. The value consumers attach to food characteristics are found to vary by product and the results also imply that these values could be sensitive to changes in the combination of characteristics in a product. |
| Keywords: | hedonic pricing; willingness to pay; food characteristics |
| JEL: | D12 I10 |
| Date: | 2007–11–06 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:huiwps:0012&r=hea |
| By: | Janlöv, Nils (Department of Economics, Lund University) |
| Abstract: | This paper investigates the relative efficiency of 21 Swedish county councils through two efficiency models; one focusing on a traditional productivity measure (activity model) in terms of the production of intermediate outputs, and the other on quality outputs in the form of health-related outcomes (outcome model). Efficiency is estimated using Data Envelopment Analysis (DEA) and the two models are used to test whether there are significantly different efficiency estimates among the councils. The efficiency concept used consists of technical efficiency, here measured as cost efficiency, where the relationship between inputs and outputs for each council is compared to a “best practice” consisting of a production frontier. A weak positive correlation is found between the two models, indicating that cost efficiency regarding activities and outcomes may foremost be seen as complements in the production process. In a second stage, the efficiency scores in both models are used as dependent variables in multiple regressions with several independent structural factors that may be used to explain differences in efficiency. The paper finds that councils which are net receivers in the equalization grant system have lower efficiency scores in both models. |
| Keywords: | Productive efficiency; quality indicators; data envelopment analysis; Tobit regression; Sweden |
| JEL: | C14 I11 |
| Date: | 2007–10–31 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2007_017&r=hea |
| By: | Doug Andrews |
| Abstract: | The cost of the Canadian health care system is approximately 10% of Gross Domestic Product (GDP). Survey-evidence suggests that Canadians do not wish to have additional funds spent on health care but believe that the system should be able to deliver better quality care. Due to low fertility rates and increasing life expectancy, the Canadian population is aging. Over the next 25 years, the dependency ratio will increase, primarily due to the aging of the “baby boom generation” 2. This will place twofold cost pressures on governments responsible for maintaining the health care system: 1) As a consequence of increased life expectancy, on average, Canadians will have a longer period of health care consumption. Although age-specific cost may not increase, with an aging population aggregate annual health care expenditures are expected to increase. 2) The dependency ratio is a proxy for the ability of the population to support itself. The increasing dependency rate may result in a slowdown in GDP growth, given constant technology. In Section I, this paper attempts to quantify these factors. A single measure combining cost and quality is developed to demonstrate the magnitude of the challenge. In Section II, this paper examines a number of different approaches to health care financing including user fees and alternative compensation methods for physicians. The paper highlights documented information from Canada and international experience on the implementation issues involved. The paper evaluates the desirability of implementing these approaches in Canada. |
| Keywords: | Alternative physician reimbursement models, Capitation, DALE, Disability Adjusted Life Expectancy, QAHE, Quality-Adjusted Health Expenditures, QAHE Index, SID, Supplier-Induced Demand |
| JEL: | I19 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:sedapp:224&r=hea |
| By: | Roy Wada; Erdal Tekin |
| Abstract: | This paper examines the effect of body composition on wages. We develop measures of body composition – body fat (BF) and fat-free mass (FFM) – using data on bioelectrical impedance analysis (BIA) that are available in the National Health and Nutrition Examination Survey III and estimate wage models for respondents in the National Longitudinal Survey of Youth 1979. Our results indicate that increased body fat is unambiguously associated with decreased wages for both males and females. This result is in contrast to the mixed and sometimes inconsistent results from the previous research using body mass index (BMI). We also find new evidence indicating that a higher level of fat-free body mass is consistently associated with increased hourly wages. We present further evidence that these results are not the artifacts of unobserved heterogeneity. Our findings are robust to numerous specification checks and to a large number of alternative BIA prediction equations from which the body composition measures are derived. Our work addresses an important limitation of the current literature on the economics of obesity. Previous research relied on body weight or BMI for measuring obesity despite the growing agreement in the medical literature that they represent misleading measures of obesity because of their inability to distinguish between body fat and fat-free body mass. Body composition measures used in this paper represent significant improvements over the previously used measures because they allow for the effects of fat and fat free components of body composition to be separately identified. Our work also contributes to the growing literature on the role of non-cognitive characteristics on wage determination. |
| JEL: | I1 J3 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:13595&r=hea |
| By: | W. Kip Viscusi; Joni Hersch |
| Abstract: | This article estimates the mortality cost of smoking based on the first labor market estimates of the value of statistical life by smoking status. Using these values in conjunction with the increase in the mortality risk over the life cycle due to smoking, the value of statistical life by age and gender, and information on the number of packs smoked over the life cycle, produces an estimate of the private mortality cost of smoking of $222 per pack for men and $94 per pack for women in 2006 dollars, based on a 3 percent discount rate. At discount rates of 15 percent or more, the cost decreases to under $25 per pack. |
| JEL: | I12 I18 J17 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:13599&r=hea |
| By: | John Cawley; Feng Liu |
| Abstract: | Recent research has found that maternal employment is associated with an increased risk of childhood obesity. This paper explores mechanisms for that correlation. We estimate models of instrumental variables using a unique dataset, the American Time Use Survey, that measure the effect of maternal employment on the mother’s allocation of time to activities related to child diet and physical activity. We find that employed women spend significantly less time cooking, eating with their children, and playing with their children, and are more likely to purchase prepared foods. We find suggestive evidence that these decreases in time are only partly offset by husbands and partners. These findings offer plausible mechanisms for the association of maternal employment with childhood obesity. |
| JEL: | I12 J13 J22 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:13600&r=hea |
| By: | Bipasa Datta; Qianhui Yan |
| Abstract: | Health care providers are almost always universally reimbursed by third party purchasers. As a result, health care purchasers are faced with risk selection challenges. In response, risk adjustment methods are introduced in the reimbursement for services. However, health care providers under this arrangement have incentives to manipulate the risk elements in an attempt to obtain larger payments from the purchasers i.e. the realisation of risk adjuster then becomes sensitive to the providers?upcoding behaviour. Whilst there is usually an outside auditor (e.g from the o¢ ce of inspector general of the department of health and human services in the United States) who randomly monitors providers?beahviour and imposes penalty in the event that dishonesty is detected, monitoring such behaviour is highly costly. In this paper, we propose a reward scheme to combat such moral hazard problems. We analyse two types of incentive schemes where treatment intensity is contractible in one and not in the other. We show that under both incentive schemes, the honest provider receives the same reward and obtains higher expected utility in comparison to the full information case. Further, with contractible treatment intensity, the contract resembles the full information one. |
| Keywords: | Upcoding, Asymmetric information, Health contracts, Risk adjuster, Treatment intensity. |
| JEL: | I11 D82 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:yor:yorken:07/30&r=hea |
| By: | Casey Quinn |
| Abstract: | This paper considers the simultaneous explanation of mortality risk, health and lifestyles, using a reduced-form system of equations in which the multivariate distribution is defined by the copula. A copula approximation of the joint distribution allows one to avoid usually implicit distributional assumptions, allowing potentially more robust and efficient estimates to be retrieved. By applying the theory of inference functions the parameters of each lifestyle, health and mortality equation can be estimated separately to the parameters of association found in their joint distribution, simplifying analysis considerably. The use of copulas also enables estimation of skewed multivariate distributions for the latent variables in a multivariate model of discrete response variables. This flexibility provides more precise estimates with more appropriate distributional assumptions, but presents explicit trade-offs during analysis. Information that can be retrieved concerning distributional assumptions, skewness and tail dependence require prioritisation such that different needs could generate a different ’best’ model even for the same data. |
| Keywords: | health, lifestyle, mortality multivariate models, copulas, inference functions. |
| JEL: | C1 C3 I1 |
| Date: | 2006–07 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:06/05&r=hea |
| By: | Edward C Norton; Euna Han |
| Abstract: | Economists have argued that obesity may lead to worse labor market outcomes, especially for women. Empirical methods to test this hypothesis have not thus far adequately controlled for the endogeneity of obesity. We use variation in genotype to predict variation in phenotype (obesity). Genetic information from specific genes linked to obesity in the biomedical literature provide strong exogenous variation in the body mass index, and thus can be used as instrumental variables. These genes predict swings in weight of between 5 and 20 pounds for persons between five and six feet tall. We use additional genetic information to control for omitted variables correlated with both obesity and labor market outcomes. We analyzed data from the third wave of the Add Health data set, when respondents are in their mid-twenties. Results from our preferred models show no effect of obesity on the probability of employment or on wages, for either men or women. This paper shows the potential of using genetic information in social sciences. |
| Keywords: | Obesity, genetics, labor market outcomes, employment, wages, Add Health |
| Date: | 2007–07 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/15&r=hea |
| By: | Murat K. Munkin; Pravin K. Trivedi |
| Abstract: | This paper analyzes the effect of dental insurance on utilization of general dentist services by adult US population aged from 25 to 64 years. Our econometric framework accommdates endogeneity of insurance and the ordered nature of the measure of dental utilization. The study finds strong evidence of endogeneity of dental insurance to utilization and identifies interesting patterns of nonlinear dependencies between the dental insurance status and individual’s age and income. The calculated average treatment effect supports the claim of adverse selection into the treated (insured) state and indicates a strong positive incentives effect of dental insurance. |
| Date: | 2007–07 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/16&r=hea |
| By: | Teresa Bago d’Uva; Andrew M. Jones; Eddy van Doorslaer |
| Abstract: | This paper analyzes the effect of dental insurance on utilization of general dentist services by adult US population aged from 25 to 64 years. Our econometric framework accommdates endogeneity of insurance and the ordered nature of the measure of dental utilization. The study finds strong evidence of endogeneity of dental insurance to utilization and identifies interesting patterns of nonlinear dependencies between the dental insurance status and individual’s age and income. The calculated average treatment effect supports the claim of adverse selection into the treated (insured) state and indicates a strong positive incentives effect of dental insurance. |
| Keywords: | Inequality, inequity, health care utilisation, panel data, ECHP |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/17&r=hea |
| By: | Andrew M. Jones |
| Abstract: | Much of the empirical analysis done by health economists seeks to estimate the impact of specific health policies and the greatest challenge for successful applied work is to find appropriate sources of variation to identify the treatment effects of interest. Estimation can be prone to selection bias, when the assignment to treatments is associated with the potential outcomes of the treatment. Overcoming this bias requires variation in the assignment of treatments that is independent of the outcomes. One source of independent variation comes from randomised controlled experiments. But, in practice, most economic studies have to draw on non-experimental data. Many studies seek to use variation across time and events that takes the form of a quasi-experimental design, or “natural experiment”, that mimics the features of a genuine experiment. This chapter reviews the data and methods that are used in applied health economics with a particular emphasis on the use of panel data. The focus is on nonlinear models and methods that can accommodate unobserved heterogeneity. These include conditional estimators, maximum simulated likelihood, Bayesian MCMC, finite mixtures and copulas. |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/18&r=hea |
| By: | Eugenio Zucchelli; Anthony Harris; Nigel Rice; Andrew M. Jones |
| Abstract: | This paper investigates the causal relationship between ill-health and retirement among older working individuals. We represent the transition to retirement as a discrete-time hazard model using a stock-sample from the first five waves (2001- 2005) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Our results show that health plays an important role in individual retirement decisions and that negative shocks to health greatly increase the hazard of retirement, especially for men. This is true for both a measure of health limitations and a measure of latent health obtained using pooled ordered probit models, as well as for three alternative health shock measures. We also consider the effects of partners’ health and labour market status on an individual’s retirement decision. Our estimates suggest that partners’ characteristics do not significantly influence individual retirement choices. |
| Keywords: | health, health shocks, discrete-time hazard model, retirement. |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/19&r=hea |
| By: | Matt Sutton; Divine Ikenwilo; Diane Skatun |
| Abstract: | In 2004 the UK government introduced a new ‘pay for performance’ element into the contract for family doctors (FDs). Its universal introduction with no pre-intervention data is not atypical of system-wide health reform but poses a considerable evaluation challenge. We derive estimates of its impact based on qualitative perceptions of the treatment effect reported by a sample of participants. We exploit variation in the firstyear achievements of those participants who thought quality had remained the same to generate pre-intervention estimates for those that perceived a change in quality. The average partnership of 4 FDs was paid £74,000 for achieving 982 of the 1,050 quality points available in the first year. Of these, we estimate the mean net gains attributable to the new contract to be less than 4 quality points. These gains were predominantly made on the clinical criteria and were larger for partnerships facing more competition for patients and with markers of higher quality prior to the introduction of the new contract. |
| Keywords: | Family doctors, pay for performance, perceptional evaluation |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/20&r=hea |
| By: | Anurag Sharma |
| Abstract: | This paper empirically investigates the distribution dynamics of resource allocation decisions across Diagnosis Related Groups (DRGs), in a continuing Prospective Payment System (PPS) . The theoretical literature suggests a PPS could lead to moral hazard effects, where hospitals have an incentive to change the intensity of services provided to a given set of patients, a selection effect whereby hospitals have an incentive to change the severity of patients they see, and thirdly hospitals could change their market share by specialization (practice style effect). The related econometric literature has mainly focussed on the impact of PPS on average Length of Stay (LOS) concluding that the average LOS has declined post PPS. There is little literature on distribution of this decline across DRGs, in a PPS. The present paper helps fill this gap. The paper models the evolution over time of the empirical distribution of LOS across DRGs. The empirical distributions are estimated using a non parametric “stochastic kernel approach” based on Markov Chain theory. The results suggest that relative prices of DRGs are one of the determinants in resource allocation across DRGs. In addition, a reduction in the high outlier episodes indicates existence of potential selection effect even in a continuing PPS. |
| Keywords: | Keywords: Resource Allocation, Stochastic Kernel, Case-mix funding, Prospective Payment System, Length of Stay |
| Date: | 2007–10 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/21&r=hea |
| By: | Casey Quinn |
| Abstract: | A copula is best described, as in Joe (1997), as a multivariate distribution function that is used to bind each marginal distribution function to form the joint. The copula parameterises the dependence between the margins, while the parameters of each marginal distribution function can be estimated separately. This is a brief introduction to copulas and multivariate dependence issues within a health economics context. The research presented here will make its own contributions to the development of copulas as a methodology, but more importantly will make deliberate inroads into health economic applications of copulas. To do this, common analytic problems faced by health economists are considered. Some of the differences between the copula methodology and existing alternatives are discussed, and a generalisable, systematic approach to estimation is provided. |
| Keywords: | Keywords: |
| JEL: | C1 C3 C5 I3 I10 |
| Date: | 2007–10 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/22&r=hea |
| By: | Casey Quinn |
| Abstract: | A copula is best described, as in Joe (1997), as a multivariate distribution function that is used to bind each marginal distribution function to form the joint. The copula parameterises the dependence between the margins, while the parameters of each marginal distribution function can be estimated separately. This is a brief introduction to copulas and multivariate dependence issues within a health economics context. The research presented here will make its own contributions to the development of copulas as a methodology, but more importantly will make deliberate inroads into health economic applications of copulas. To do this, common analytic problems faced by health economists are considered. Some of the differences between the copula methodology and existing alternatives are discussed, and a generalisable, systematic approach to estimation is provided. |
| Keywords: | Keywords: |
| JEL: | C1 C3 C5 I3 I10 |
| Date: | 2007–10 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/23&r=hea |
| By: | Casey Quinn |
| Abstract: | This paper introduces a new approach to measuring the association between health and socioeconomic status. Measuring inequalities in health is difficult when health is measured qualitatively, specifically on an ordinal scale. This paper demonstrates a rank-based dependence measure - the copula - that is invariant to both the scale and any monotonic transformations of its dimensions. Accordingly, the copula measure of association between health and income is robust under different cardinal scales for health as well as different income distributions, and can be used for ordering countries. The copula is also used to generate contingency tables of joint probability, which illustrate how this ordering can be due to polarity in the distributions of health and income, as well as stronger association between the distributions of health and income. |
| Keywords: | Keywords: |
| Date: | 2007–10 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:07/24&r=hea |
| By: | Jochen Hartwig (KOF Swiss Economic Institute, ETH Zurich) |
| Abstract: | In a recent paper I argued that Baumol’s (1967) model of ‘unbalanced growth’ offers a ready explanation for the observed secular rise in health care expenditure (HCE) in rich countries (HARTWIG 2006). Baumol’s model implies that HCE is driven by wage increases in excess of productivity growth. I tested this hypothesis empirically using data from a panel of 19 OECD countries and found robust evidence in favor of Baumol’s theory. An alternative way to test Baumol’s theory is to check whether its implication that variations in the relative price of medical care contribute significantly to explaining variations in health expenditure in the same direction has an empirical grounding. Earlier studies, although mostly not in an explicit attempt to test Baumol’s theory, have occasionally rejected this hypothesis. Despite poor data quality of the available medical price indices, I perform the alternative test using data for nine OECD countries. My findings suggest that the relative price of medical care is in fact a statistically significant explanatory variable for health expenditure, thus lending support to Baumol’s theory. |
| Keywords: | Rising health expenditure, ‘unbalanced growth’, medical care prices, OECD panel |
| JEL: | C12 C23 E31 I10 O41 |
| Date: | 2007–11 |
| URL: | http://d.repec.org/n?u=RePEc:kof:wpskof:07-178&r=hea |
| By: | Böckerman, Petri; Johansson, Edvard; Helakorpi, Satu; Uutela, Antti |
| Abstract: | This paper examines the relationship between relative income inequality and health in Finland, using individual microdata over the period 1993-2005. Our data allows us to analyse a large spectrum of health indicators. Overall, our results suggest that income inequality is not associated with increased morbidity in the population. The results for women differ to quite a large extent from those of men and the pooled sample. There is evidence that an increase in the Gini coefficient is negatively related to the probability of good physical health and no disability retirement. For men, relative income inequality is clearly not important for health. |
| Keywords: | Health; health behaviour; economic inequality; relative income inequality; relative deprivation; Gini coefficient |
| JEL: | I00 I32 |
| Date: | 2007–11–07 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:5640&r=hea |
| By: | Marc Ground (Department of Economics, University of Pretoria); Steven F. Koch (Department of Economics, University of Pretoria) |
| Abstract: | Estimates of participation or expenditure elasticities depend upon the assumptions made regarding the observation of zero expenditure at the household level. This research examines two single-hurdle models across two commodities for which nearly two-thirds of the observations are zero. The research shows that one hurdle model consistently outperforms the other, and does so for intuitively appealing reasons. |
| JEL: | C31 D12 |
| Date: | 2007–02 |
| URL: | http://d.repec.org/n?u=RePEc:pre:wpaper:200703&r=hea |