nep-hea New Economics Papers
on Health Economics
Issue of 2008‒02‒09
fourteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Missing Women: Some Recent Controversies on Levels and Trends in Gender Bias in Mortality By Stephan Klasen
  2. HIV/AIDS, Adult Mortality and Fertility: Evidence from Malawi By Durevall, Dick; Lindskog, Annika
  3. Welfare analysis of HIV/AIDS: Formulating and computing a continuous time overlapping generations policy model By Jamsheed Shorish
  4. HIV/AIDS and Agrarian Livelihoods in Zambia: a Test of the New Variant Famine Hypothesis. By Nicole M Mason; Antony Chapoto; T.S Jayne; Robert J. Myers
  5. The Effect of Tax Preferences on Health Spending By John F. Cogan; R. Glenn Hubbard; Daniel P. Kessler
  6. The Changing Effect of HMO Market Structure: An Analysis of Penetration, Concentration, and Ownership Between 1994-2005 By Yu-Chu Shen; Vivian Wu; Glenn Melnick
  7. Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance By Emma Hall; Carol Propper; John Van Reenen
  8. Health and civil war in rural Burundi By Akresh, Richard; Verwimp, Philip; Bundervoet, Tom
  9. The quality of medical advice in low-income countries By Leonard, Kenneth; Hammer, Jeffrey; Das, Jishnu
  10. Does Hepatitis B infection or son preference explain the bulk of gender imbalance in China ? : a review of the evidence By Das Gupta, Monica
  11. Linking Tribal Medicinal Plant Co-operatives and Ayurvedic Manufacturing Firms for Better Rural Livelihood and Sustainable Use of Resources By Madhavan, Harilal
  12. Motorways, tolls and road safety.Evidence from European Panel Data. By Daniel Albalate; Germa Bel
  13. The value of a Statistical Life under Ambiguity Aversion By TREICH Nicolas;
  14. The Impact of the Indonesian Health Card Program: A Matching Estimator Approach By Meliyanni Johar

  1. By: Stephan Klasen (Georg-August-Universität Göttingen / Germany)
    Abstract: This paper discusses two recent controversies surrounding levels and trends in the number of ‘missing women’ in the world. First, the impact of fertility decline on gender bias in mortality is examined. Contrary to the expectations of some authors, fertility decline has not generally led to an intensification of gender bias in mortality. Second, the paper finds that the claim that a substantial portion of ‘missing women’ is due to higher sex ratios at birth linked to hepatitis B prevalence in the affected regions is on rather weak foundations, while there is substantial evidence countering this claim.
    Keywords: Missing women, fertility decline, Hepatitis B, sex-selective abortions, gender bias in mortality
    JEL: J16 O15
    Date: 2008–01–15
  2. By: Durevall, Dick (Department of Economics, School of Business, Economics and Law, Göteborg University); Lindskog, Annika (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: The purpose of this paper is to analyse the impact of HIV/AIDS on fertility in Malawi. The future course of fertility will have an impact on both macroeconomic variables, such as GDP per capita, and various socioeconomic factors like mother-to-child-transmission of HIV, child mortality, the number of orphans, and public expenditures on schooling. Data on both prime-age adult mortality and HIV prevalence rates at districts level are used to measure the impact of HIV/AIDS, exploiting the large geographical variation in the distribution of HIV/AIDS in Malawi. Fertility is estimated for individual women, and measured as the number of births given during the last five years. Estimations are also carried out for the desired number of children. The major finding is that HIV/AIDS reduces fertility. Uninfected women both give birth to and desire to have fewer children in districts where prime-age adult mortality and HIV-prevalence are high, and vice versa. However, for young women, aged 15-19, there is a positive relationship between fertility and prime-age adult mortality and HIV prevalence, possibly because they wish to have children while being uninfected. This is likely to have negative effects on both educational attainment and child mortality. As also shown by previous studies, HIV-infected women give birth to fewer children than uninfected women. This is probably due to changed fertility preferences, as well as to physiological factors.<p>
    Keywords: Adult mortality; Desired fertility; Fertility; HIV/AIDS; Malawi; Sub-Saharan Africa
    JEL: I12 J13 O12
    Date: 2007–09–30
  3. By: Jamsheed Shorish
    Date: 2007
  4. By: Nicole M Mason (Department of Agricultural Economics, Michigan State University); Antony Chapoto (Department of Agricultural Economics, Michigan State University); T.S Jayne (Department of Agricultural Economics, Michigan State University); Robert J. Myers (Department of Agricultural Economics, Michigan State University)
    Abstract: 1. Consistent with the New Variant Famine (NVF) hypothesis, the negative impact of drought on crop output and output per hectare is further exacerbated where HIV prevalence rates are relatively high, particularly in the low- and medium rainfall zones of the country (agro-ecological regions I and II). 2. HIV prevalence rates and AIDS-related mortality rates in Zambia are highest in the lowest rainfall and most drought-prone zone of the country (agro-ecological region I). 3. Only for districts in agro-ecological region I do we find evidence of a robust negative effect of HIV/AIDS on agrarian livelihood indicators. Relatively stable food production zones and/or areas with relatively low HIV prevalence rates appear to be less vulnerable to the adverse effects predicted by the NVF hypothesis, which suggests that HIV/AIDS exacerbates the effects of drought and other shocks on agrarian communities. 4. HIV/AIDS reduces the crop production gains associated with fertilizer subsidy increases in the highest rainfall areas. 5. Increases in the percentage of female-headed households in a district are related to declines in agricultural production indicators, but these effects do not appear to worsen when the HIV/AIDS epidemic is severe. 6. Only in districts whose borders encompass both agro-ecological regions II and III do we consistently find weak evidence that HIV/AIDS reduces the contribution of productive assets to crop output and output per unit of land as would be expected under the NVF hypothesis.
    Keywords: food security, food policy, Zambia, HIV/AIDS
    JEL: Q20
    Date: 2007
  5. By: John F. Cogan; R. Glenn Hubbard; Daniel P. Kessler
    Abstract: In this paper, we estimate the effect of the tax preference for insurance on health spending based on the Medical Expenditure Panel Surveys from 1996-2005. We use the fact that Social Security taxes are only levied on earnings below a statutory threshold to identify the tax preference's impact. Because employer-sponsored health insurance premiums are excluded from Social Security payroll taxes, workers who earn just below the Social Security tax threshold receive a larger tax preference for health insurance than workers who earn just above it. We find a significant effect of the tax preference, consistent with previous research.
    JEL: H2 I1
    Date: 2008–01
  6. By: Yu-Chu Shen; Vivian Wu; Glenn Melnick
    Abstract: We analyze the role of three aspects of HMO market structure -- HMO penetration, HMO plan concentration, and HMO for-profit share on explaining hospital cost and revenue growth during the HMO expansion period (1994-1999) and backlash period (2000-2005). We find that HMO penetration effects differ over time: a 10 percentage point increase in HMO enrollment leads to 2.5 percent reduction in cost and revenues in the expansion period but only 0.4-1 percent reduction in the backlash period. Furthermore, this HMO backlash effect can be attributed to HMO dis-enrollment as well as the changing nature of HMO product. We find that revenue increases at a slower rate (by about 5 percent) in markets with relatively concentrated HMO markets power and more competitive hospital markets. Finally, increased for-profit HMO presence is associated with smaller cost and revenue growth, and the effect differs between low and high penetration markets.
    JEL: I11
    Date: 2008–02
  7. By: Emma Hall; Carol Propper; John Van Reenen
    Abstract: Labor market regulation can have harmful unintended consequences. In many markets, especially for public sector workers, pay is regulated to be the same for individuals across heterogeneous geographical labor markets. We would predict that this will mean labor supply problems and potential falls in the quality of service provision in areas with stronger labor markets. In this paper we exploit panel data from the population of English acute hospitals where pay for medical staff is almost flat across the country. We predict that areas with higher outside wages should suffer from problems of recruiting, retaining and motivating high quality workers and this should harm hospital performance. We construct hospital-level panel data on both quality - as measured by death rates (within hospital deaths within thirty days of emergency admission for acute myocardial infarction, AMI) - and productivity. We present evidence that stronger local labor markets significantly worsen hospital outcomes in terms of quality and productivity. A 10% increase in the outside wage is associated with a 4% to 8% increase in AMI death rates. We find that an important part of this effect operates through hospitals in high outside wage areas having to rely more on temporary "agency staff" as they are unable to increase (regulated) wages in order to attract permanent employees. By contrast, we find no systematic role for an effect of outside wages of performance when we run placebo experiments in 42 other service sectors (including nursing homes) where pay is unregulated.
    JEL: I18 J31 J45
    Date: 2008–02
  8. By: Akresh, Richard; Verwimp, Philip; Bundervoet, Tom
    Abstract: This paper combines household survey data with event data on the timing and location of armed conflicts to examine the impact of Burundi ' s civil war on children ' s health status. The identification strategy exploits exogenous variation in the war ' s timing across provinces and the exposure of children ' s birth cohorts to the fighting. After controlling for province of residence, birth cohort, individual and household characteristics, and province-specific time trends, the authors find that children exposed to the war have on average 0.515 standard deviations lower height-for-age z-scores than non-exposed children. This negative effect is robust to specifications exploiting alternative sources of exogenous variation.
    Keywords: Youth and Governance,Rural Poverty Reduction,Population Policies,Post Conflict Reconstruction,Health Monitoring & Evaluation
    Date: 2008–01–01
  9. By: Leonard, Kenneth; Hammer, Jeffrey; Das, Jishnu
    Abstract: This paper provides an overview of recent work on quality measurement of medical care and its correlates in four low and middle-income countries-India, Indonesia, Tanzania, and Paraguay. The authors describe two methods-testing doctors and watching doctors-that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures, their correlates, and how they may be used to evaluate policy changes. Finally, the authors outline an agenda for further research and measurement.
    Keywords: Health Monitoring & Evaluation,Health Systems Development & Reform,Gender and Health,Health Economics & Finance,Disease Control & Prevention
    Date: 2008–01–01
  10. By: Das Gupta, Monica
    Abstract: China has a large deficit of females, and public policies have sought to reduce the son preference that is widely believed to cause this. Recently a study has suggested that up to 75 percent of this deficit is attributable to hepatitis B infection, indicating that immunization programs should form the first plank of policy interventions. However, a large medical dataset from Taiwan (China) shows that hepatitis B infection raises women ' s probability of having a son by only 0.25 percent. And demographic data from China show that the only group of women who have elevated probabilities of bearing a son are those who have already borne daughters. This pattern makes it difficult to see how any biological factor can explain a large part of the imbalance in China ' s sex ratios at birth -- unless it can be shown that it somehow selectively affects those who have borne girls, or causes them to first bear girls and then boys. The Taiwanese data suggest that this is not the case with hepatitis B, since its impact is unaffected by the sex composition of previous births. The data support the cultural, rather than the biological, explanation for the " missing women. "
    Keywords: Population Policies,Gender and Health,Disease Control & Prevention,Gender and Law,Reproductive Health
    Date: 2008–01–01
  11. By: Madhavan, Harilal
    Abstract: The analysis brings forth the major issues in medicinal plant sector, taking Kerala as a case. The analysis, basically use the supply chain framework, focuses on the Southern Western Ghats part of Kerala, gives the picture of the lopsided sharing of income and hence the side-streamed tribal collectors in the medicinal plant chain. In the existing two types of chains, first one dominated by largely unequal distribution of income because of the existence of a large number of mediators while the second supply chain network, where the major player is tribal co-operatives and include less number of players, seems relatively efficient. The latter is less visible in Kerala because of some specific internal and external factors. The study proposes the need for a move towards the second type of chain and initiation of more and more tribal medicinal plant co-operatives. This will lead to better linkage with co-operatives and Ayurvedic manufacturing firms, and a well defined contract to be enforced for both environmentally sustainable collection through avoiding the information asymmetry, high bargaining power. This can work as a better economic incentive structure and hence can bring more efficiency from the view of both firms and rural collectors.
    Keywords: Rural Livelihood; Tribal Co-operatives; Supply Chain; Medicinal Plants; Sustainable Development.
    JEL: Q13 Q01 P48
    Date: 2008–02–01
  12. By: Daniel Albalate (Faculty of Economics, University of Barcelona); Germa Bel (Faculty of Economics, University of Barcelona)
    Abstract: The use of tolls is being widespread around the world. Its ability to fund infrastructure projects and to solve budget constraints have been the main rationale behind its renewed interest. However, less attention has been payed to the safety effects derived from this policy in a moment of increasing concern on road fatalities. Pricing best infrastructures shifts some drivers onto worse alternative roads usually not prepared to receive high traffic in comparable safety standards. In this paper we provide evidence of the existence of this perverse consequence by using an international European panel in a two way fixed effects estimation.
    Keywords: Road Safety, Tolls, Motorways and Transportation.
    JEL: H23 I18 R48
    Date: 2008–02
  13. By: TREICH Nicolas;
    Date: 2008–01
  14. By: Meliyanni Johar (School of Economics, The University of New South Wales)
    Abstract: This study evaluates the effectiveness of a pro-poor nation-wide health card program in Indonesia which provides free basic health care at public health facilities. To quantify the effect of the program, it departs from the traditional regression-based approach in the literature to employ propensity score matching to reduce the selection bias due to non-random health card distribution. The setting of the program and the richness of the data set support this strategy in providing accurate estimates of the program’s effect on its recipients. The result finds that in general the health card program only has limited impact on the consumption of primary health care by its recipients. This finding suggests the presence of other factors that are counteracting the generous demand incentive.
    Keywords: Impact evaluation; health sector reform; Indonesia
    JEL: I1
    Date: 2007–10

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