nep-hea New Economics Papers
on Health Economics
Issue of 2008‒02‒16
thirty papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Religion and Childhood Death in India By Sonia Bhalotra; Christine Valente; Arthur van Soest
  2. Childhood Mortality and Economic Growth By Sonia Bhalotra
  3. Stress and Birth Outcomes Evidence from Terrorist Attacks in Colombia By Adriana Camacho Gonzalez
  4. Institutions, health shocks and labour outcomes across Europe By Pilar García Gómez
  5. Assessing Hospital Efficiency: Non-parametric Evidence for Portugal By António Afonso; Sónia Fernandes
  6. Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment By Etienne Dumont; Bernard Fortin; Nicolas Jacquemet; Bruce Shearer
  7. Child Survival, Poverty and Policy Options from DHS Surveys in Kenya: 1993-2003 By Jane Kabubo-Mariara; Margaret M. Karienyeh; Francis K. Mwangi
  8. Evidence From Maternity Leave Expansions of the Impact of Maternal Care on Early Child Development By Michael Baker; Kevin Milligan
  9. Effects of the New Cooperative Medical Scheme on village doctor’s prescribing behaviour in Shandong Province By Xiaoyun Sun; Sukhan Jackson; Gordon Carmichael; Adrian C. Sleigh
  10. Longevity and Education: A Macroeconomic Perspective By Francesco Ricci; Marios Zachariadis
  11. Measurement of Non-Market Output in Education and Health By Peter C Smith; Andrew Street
  12. The Link Between Health Care Spending and Health Outcomes: Evidence from English Programme Budgeting Data By Stephen Martin; Nigel Rice; Peter C Smith
  13. Reference Pricing Versus Co-Payment in the Pharmaceutical Industry: Price, Quality and Market Coverage By Marisa Miraldo
  14. Hospital Financing and the Development and Adoption of New Technologies By Marisa Miraldo
  15. Reference Pricing Versus Co-Payment in the Pharmaceutical Industry: Firm's Pricing Strategies By Marisa Miraldo
  16. Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework By Hugh Gravelle; Matt Sutton; Ada Ma
  17. Modelling the Dynamics of a Public Health Care System: Evidence from Time-Series Data By Fabrizio Iacone; Steve Martin; Luigi Siciliani; Peter C Smith
  18. Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden By Andrew Street; Kirsi Vitikainen; Afsaneh Bjorvatn; Anne Hvenegaard
  19. Mark versus Luke? Appropriate Methods for the Evaluation of Public Health Interventions By Karl Claxton; Mark Sculpher; Tony Culyer
  20. Further evidence on the link between health care spending and health outcomes in England By Stephen Martin; Nigel Rice; Peter C Smith
  21. Economic Analysis of Cost-Effectiveness of Community Engagement to Improve Health By Andrew Street; Roy Carr-Hill
  22. A focus group study of health care priority setting at the individual patient, program and health system levels By Bradley Shrimpton; John McKie; Rosalind Hurworth; Catherine Bell; Jeff Richardson
  23. Severity as an independent determinant of the social Value of a health service By Jeff Richardson; John McKie; Stuart Peacock; Angelo Iezzi
  24. Reducing the incidence of adverse events in Australian hospitals: An expert panel evaluation of some proposals By Jeff Richardson; John McKie
  25. Does exercise reduce obesity? Evidence from Australia By Pushkar Maitra; Anurag Sharma
  26. Inter-DRG resource allocation in a prospective payment system: A Stochastic Kernel Approach By Anurag Sharma
  27. The Effect of Maternal Employment on the Likelihood of a Child Being Overweight By Anna Zhu
  28. Sickness and injury leave in France: moral hazard or strain? By Michel Grignon; Thomas Renaud
  29. Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey By Florence Jusot; Michel Grignon; Paul Dourgnon
  30. Promoting Social Participation for Healthy Ageing - A Counterfactual Analysis from the Survey of Health, Ageing, and Retirement in Europe (SHARE) By Thierry Debrand; Nicolas Sirven

  1. By: Sonia Bhalotra; Christine Valente; Arthur van Soest
    Abstract: Muslim children in India face substantially lower mortality risks than Hindu children. This is surprising because one would have expected just the opposite: Muslims have, on average, lower socio-economic status, higher fertility, shorter birth-spacing, and are a minority group in India that may be expected to live in areas that have relatively poor public provision. Although higher fertility amongst Muslims as compared with Hindus has excited considerable political and academic attention in India, higher mortality amongst Hindus has gone largely unnoticed. This paper considers this seeming puzzle in depth.
    Keywords: religion, child mortality, Muslim, Hindu, India
    JEL: I12 O12 J13
    Date: 2008–01
  2. By: Sonia Bhalotra
    Abstract: This paper investigates the extent to which the decline in childhood mortality over the last three decades can be attributed to economic growth. In doing this, it exploits the considerable variation in growth over this period, across states and over time. The analysis is able to condition upon a number of economic and demographic variables. The estimates are used to produce a crude estimate of the rate of economic growth that would be necessary to achieve the Millennium Development Goal of reducing the under-5 mortality by two thirds, from its level in 1990, by the year 2015. The main conclusion is that, while growth does have a significant impact on mortality risk, growth alone cannot be relied upon to achieve the goal.
    Keywords: childhood mortality, economic growth, MDGs, India
    JEL: O12 I12 I18 J13
    Date: 2008–01
  3. By: Adriana Camacho Gonzalez
    Abstract: This paper estimates the impact of random terrorist attacks (landmines) in Colombia on the health of babies born between 1998 and 2003. The results suggest that these types of terrorist activities that occur during a woman’s first trimester of pregnancy have a negative and significant impact on child health outcomes such as birth weight and preterm deliveries, and behaviors such as use of prenatal care. These findings persist when mother fixed effects are included, suggesting that neither observable nor unobservable characteristics of the mothers are driving the main results. The paper contributes to the existing literature by identifying yet another important indirect channel through which violence affects economic well being. Given that studies have found a strong link between Low Birth Weight (LBW) and short and long-term socioeconomic outcomes; the negative consequences of violence identified in this paper may have long-term effects on economic activity as they affect the net returns to human capital accumulation of the new generations.
    Date: 2007–05–01
  4. By: Pilar García Gómez
    Abstract: This paper investigates the relationship between health shocks and labour outcomes in 9 European countries using the European Community Household Panel. In order to control for the non-experimental nature of the data I use matching and matching combined with difference-in-differences techniques. My results suggest that there is a significant effect running from health to the probability of employment and to income: individuals who suffer a health shock are significantly more likely to leave employment, and in several countries this is associated to a significant reduction in some types of income. There are differences in the estimates across countries, with the largest employment effects being found in the Netherlands, Denmark and Ireland, and the smallest in France, Italy and Greece. The differences in Social Security arrangements help to explain the differences in the estimates for the effects of the health shocks.
    Date: 2008–01
  5. By: António Afonso; Sónia Fernandes
    Abstract: We compute DEA efficiency scores and Malmquist indexes for a panel data set comprising 68 Portuguese public hospitals belonging to the National Health System (NHS) in the period 2000-2005, when several units started being run in an entrepreneurial framework. With data on hospital services’ and resource quantities we construct an output distance function, we assess by how much can output quantities be proportionally expanded without changing input quantities Our results show that, on average, the NHS hospital sector revealed positive but small productivity growth between 2000 and 2004. The mean TFP indices vary between 0.917 and 1.109, implying some differences in the Malmquist indices across specifications. Furthermore, there are significant fluctuations among NHS hospitals in terms of individual efficiency scores from one year to the other.
    Keywords: Public hospitals; Data Envelopment Analysis; Malmquist indices; Portugal.
    JEL: C14 C61 D24 H51 I12
    Date: 2008–02
  6. By: Etienne Dumont; Bernard Fortin; Nicolas Jacquemet; Bruce Shearer
    Abstract: We analyse how physicians respond to contractual changes and incentives within a multitasking environment. In 1999 the Quebec government (Canada) introduced an optional mixed compensation system, combining a fixed per diem with a discounted (relative to the traditional fee-for-service system) fee for services provided. We combine panel survey and administrative data on Quebec physicians to evaluate the impact of this change in incentives on their practice choices. We highlight the differentiated impact of incentives on various dimensions of physician behaviour by considering a wide range of labour supply variables: time spent on seeing patients, time devoted to teaching, administrative tasks or research, as well as the volume of clinical services and average time per clinical service. Our results show that, on average, the reform induced physicians who changed from FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours of work spent on seeing patients by 2.57%. Their average time spent per service increased by 3.58%, suggesting a potential quality-quantity substitution. Also the reform induced these physicians to increase their time spent on teaching and administrative duties (tasks not remunerated under the fee-for-service system) by 7.9%.
    Keywords: Physician payment mechanisms, multitasking, mixed-payment systems, incentive contracts, labour supply, self-selection, panel estimation
    JEL: I10 J22
    Date: 2007
  7. By: Jane Kabubo-Mariara; Margaret M. Karienyeh; Francis K. Mwangi
    Abstract: This paper analyses multidimensional aspects of child poverty in Kenya. We carry out poverty and inequality comparisons for child survival and also use the parametric survival model to explain childhood mortality using DHS data. The results of poverty comparisons show that: children with the lowest probability of survival are from households with the lowest level of assets; and poverty orderings for child survival by assets are robust to the choice of the poverty line and to the measure of wellbeing. Inequality analysis suggests that there is less mortality inequality among children facing mortality than children who are better off. The survival model results show that child and maternal characteristics, and household assets are important correlates of childhood mortality. The results further show that health care services are crucial for child survival. Policy simulations suggest that there is potential for making some progress in reducing mortality, but the ERS and MDG targets cannot be achieved.
    Keywords: Child survival, multidimensional poverty, inequality, stochastic dominance, childhood mortality, asset index, Kenya
    JEL: J13 I12 I32 I38 D63
    Date: 2008
  8. By: Michael Baker; Kevin Milligan
    Abstract: We study the impact of maternal care on early child development using an expansion in Canadian maternity leave entitlements. Following the leave expansion, mothers who took leave spent between 48 and 58 percent more time not working in the first year of their children's lives. We find that this extra maternal care primarily crowded out home-based care by unlicensed non-relatives, and replaced mostly full-time work. However, the estimates suggest a weak impact of the increase in maternal care on indicators of child development. Measures of family environment and motor-social development showed changes very close to zero. Some improvements in temperament were observed but occurred both for treated and untreated children.
    JEL: J13 J22
    Date: 2008–02
  9. By: Xiaoyun Sun; Sukhan Jackson; Gordon Carmichael; Adrian C. Sleigh (School of Economics, The University of Queensland)
    Abstract: Objective: To assess the effects of China’s new community health insurance, the New Cooperative Medical Scheme (NCMS), on village doctors’ prescribing behaviour. NCMS began in 2003. Method, In 2005 we conducted a quasi-experimental case-control study in Shandong Province, and collected information from 2,271 patient visits in 30 village health stations. Results, NCMS has adversely influenced prescribing behaviour of village doctors. Average number of drugs prescribed, percentage of prescriptions containing antibiotics, number of antibiotics per prescription, percentage of patients given injections, and average per prescription cost were consistently higher in NCMS village health stations than non-NCMS. Within NCMS villages, prescribing behaviour towards insured patients was significantly different to the uninsured. Conclusion, Over-prescribing is common in villages with and without health insurance, with grave concerns for service quality and drug-use safety. Policy implications are NCMS should be redesigned to exert more influence on health providers, with incentives for cost containment and service quality. Stricter regulatory environment for prescriptions is necessary to counter irrational drug-use and ensure people’s access to effective care at reasonable cost.
    Date: 2008
  10. By: Francesco Ricci; Marios Zachariadis
    Abstract: This paper investigates the determinants of longevity at a macroeconomic level, emphasizing the important role played by education. To analyze the determinants of longevity, we build a model where households intentionally invest in health and education, and where education exerts external effects on longevity. Performing an empirical analysis using data across 71 countries, we find that society’s tertiary education attainment rate is important for longevity, in addition to any role that basic education plays for life expectancy at the individual level. This finding uncovers a key externality of education, consistent with the theoretical hypothesis advanced in our macroeconomic model.
    Keywords: Education, life expectancy, health, externalities, absorptive capacity, welfare
    Date: 2008–02
  11. By: Peter C Smith (Centre for Health Economics, University of York); Andrew Street (Centre for Health Economics, University of York)
    Abstract: In recent years considerable progress has been made in developing improved methodologies to measure non-market output in the National Accounts. Most EU Member States have supported the introduction of a legal framework to implement these methodologies and have introduced current best practice methods to measure output of health and education services. This report summarises contributions at a Workshop held in October 2006 that focussed on building on this foundation and further improving the measurement of non-market output in the National Accounts. The Workshop supports a project intended to provide detailed international guidelines for the further development of volume measures of non-market outputs, in particular for education and health.
    Date: 2007–02
  12. By: Stephen Martin (Department of Economics, University of York); Nigel Rice (Centre for Health Economics, University of York); Peter C Smith (Centre for Health Economics, University of York)
    Abstract: This report describes preliminary results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative.
    Date: 2007–03
  13. By: Marisa Miraldo (Centre for Health Economics, University of York)
    Abstract: Within a horizontally differentiation model, we analyse the relative effects of reference pricing and copayment reimbursement on firms pricing and quality strategies as well as on market coverage under different market structures: competitive market, local monopolies and exogenous full market coverage. Results allow us to shed some light on the welfare and total drug expenditure implications of different drug reimbursement policies.
    Keywords: Reference Pricing; Co-payment; Product Differentiation
    JEL: D40 I11 O33
    Date: 2007–04
  14. By: Marisa Miraldo (Centre for Health Economics, University of York)
    Abstract: We study the influence of different reimbursement systems, namely Prospective Payment System, Cost Based Reimbursement System and Mixed Reimbursement System on the development and adoption of different technologies with an endogenous supply of these technologies. We focus our analysis on technology development and adoption under two models: private R&D and R&D within the hospital. One of the major findings is that the optimal reimbursement system is a pure Prospective Payment System or a Mixed Reimbursement System depending on the market structure.
    Keywords: Prospective Payment System; Cost Based Reimbursement; R&D
    JEL: I11 O33
    Date: 2007–04
  15. By: Marisa Miraldo (Centre for Health Economics, University of York)
    Abstract: Within a horizontally differentiation model and allowing for heterogeneous qualities, we analyze the effects of reference pricing reimbursement on firms’ pricing strategies. With this analysis we find inherent incentives for firms’ pricing behaviour, and consequently we shed some light on time consistency of such policy. The analysis encompasses different reference price rules. Results show that if drugs have equal quality, reference pricing may lead to higher prices. With quality differentiation both the minimum and linear policies unambiguously lead to higher prices.
    Date: 2007–04
  16. By: Hugh Gravelle (National Primary Care Research & Development Centre, Centre for Health Economics, University of York); Matt Sutton (Health Economics Research Unit, University of Aberdeen); Ada Ma (Health Economics Research Unit, University of Aberdeen)
    Abstract: Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declares are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.
    Keywords: Quality. Incentives. Gaming. Pay for performance.
    Date: 2007–05
  17. By: Fabrizio Iacone (Department of Economics and Related Studies, University of York); Steve Martin (Department of Economics and Related Studies, University of York); Luigi Siciliani (Centre for Health Economics, University of York); Peter C Smith (Centre for Health Economics, University of York)
    Abstract: The English National Health Service was established in 1948, and has therefore yielded some long time series data on health system performance. Waiting times for inpatient care have been a persistent cause of policy concern since the creation of the NHS. This paper develops a theoretical model of the dynamic interaction between key indicators of health system performance. It then investigates empirically the relationship between hospital activity, waiting times and population characteristics using aggregate time-series data for the NHS over the period 1952-2005. Structural Vector Auto-Regression suggests that in the long run: a) higher activity is associated with lower waiting times (elasticity = -0.9%); b) a higher proportion of old population is associated with higher waiting times (elasticity = 1.6%). In the short run, higher lagged waiting time leads to higher activity (elasticity = 0.2%). We also find that shocks in waiting times are countered by higher activity, so the effect is only temporary, while shocks in activity have a permanent effect. We conclude that policies to reduce waiting times should focus on initiatives that increase hospital activity.
    Keywords: Waiting times, Dynamics, Vector Auto-Regression.
    JEL: I11 I18 H42 H52
    Date: 2007–09
  18. By: Andrew Street (Centre for Health Economics, University of York); Kirsi Vitikainen; Afsaneh Bjorvatn; Anne Hvenegaard
    Abstract: We review and evaluate the international literature on activity-based funding of health services, focussing especially on experience in Australia (Victoria), Denmark, Norway and Sweden. In evaluating this literature we summarise the differences and pros and cons of three different funding arrangements, namely cost-based reimbursement, global budgeting and activity-based financing. The institutional structures of the four jurisdictions that are the main focus of the review are described, and an outline is provided about how activity-based funding has been introduced in each. We then turn to the mechanics of activity-based funding and discuss in detail how patients are classified, how prices are set and how other services are funded. Although concentrating on the four jurisdictions, we draw on wider international experience to inform this discussion. We review evidence of the impact of activity-based funding in the four jurisdictions on efficiency, activity rates, waiting times, quality and overall expenditure. Finally we conclude with a brief commentary of some of the challenges that would have to be faced if implementing activity-based funding.
    Date: 2007–10
  19. By: Karl Claxton (Centre for Health Economics, University of York); Mark Sculpher (Centre for Health Economics, University of York); Tony Culyer (Institute for Work and Health, Toronto, Ontario, Canada)
    Abstract: The purpose of this paper is to demonstrate that a social decision making approach to evaluation can be generalised to interventions such as public health and national policies which have multiple objectives and impact on multiple constraints within and beyond the health sector. We demonstrate that a mathematical programming solution to this problem is possible, but the information requirements make it impractical. Instead we propose a simple compensation test for interventions with multiple and cross-sectoral effects. However, rather than compensation based on individual preferences, it can be based on the net benefits falling on different sectors. The valuation of outcomes is based on the shadow prices of the existing budget constraints, which are implicit in existing public expenditure and its allocation across different sectors. A ‘welfarist’ societal perspective is not sufficient; rather, a multiple perspective evaluation which accounts for costs and effects falling on each sector is required.
    Keywords: cost-effectiveness analysis, decision rules, public health
    Date: 2007–11
  20. By: Stephen Martin (Department of Economics and Related Studies, University of York); Nigel Rice (Centre for Health Economics, University of York); Peter C Smith (Centre for Health Economics, University of York)
    Abstract: This report describes results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative. It builds on our earlier report for the Health Foundation – The link between health care spending and health outcomes: evidence from English programme budgeting data – that took advantage of the availability of a major new dataset to examine the relationship between health care expenditure and mortality rates for two disease categories (cancer and circulation problems) across 300 English Primary Care Trusts. Our results are useful from a number of perspectives. Scientifically, they confirm our previous findings that health care has an important impact on health across a range of conditions, suggesting that those results were robust across programmes of care and across years. From a policy perspective, these results can help set priorities by informing resource allocation across a larger number of programmes of care. They also add further evidence to help NICE decide whether its current QALY threshold is at the right level.
    Date: 2007–12
  21. By: Andrew Street (Centre for Health Economics, University of York); Roy Carr-Hill (Centre for Health Economics, University of York)
    Abstract: Liberty of association is one of the building blocks of a democratic society, and presumes that community engagement in a democratic society is universally a good thing. This presumption is not subject to economic analysis, but the issue considered here is whether community engagement is a better vehicle for improving the community’s health than another approach. The problems of applying the standard framework of economic evaluation to consider this issue include: multiple perspectives and time frames; identifying and costing activities and specifically the costs of volunteer time; identifying and measuring benefits; identifying comparator communities; how the intervention interacts with the community and therefore identifying end gainers and losers and eventually how the former might compensate the latter; attribution of any changes in community (health) to the approaches and methods of community engagement (CE); quantification across the whole range of community engagement. We consider three possible ways to apply the tools of economic appraisal to assess community engagement, these being: developing a typology; relying just on effectiveness data from the literature and guesstimating costs; and developing a scenario based on partial information about both costs and benefits. We assess the impact of community engagement on health and health behaviour; the contribution of community engagement to supporting social networks and social capital formation; and other impacts specific to a particular situation, including collective and ideological outcomes (whether of citizenship, obedience or political literacy). We conclude with a set of questions to ask of any CE intervention.
    Date: 2008–01
  22. By: Bradley Shrimpton (Centre for Program Evaluation, University of Melbourne); John McKie (Centre for Health Economics, Monash University); Rosalind Hurworth (Centre for Program Evaluation, University of Melbourne); Catherine Bell (Centre for Program Evaluation, University of Melbourne); Jeff Richardson (Centre for Health Economics, Monash University)
    Abstract: Faced with an ageing population and newspaper warnings that escalating costs are leading to a health crisis, debate has intensified in Australia and elsewhere on the allocation of limited health resources. But whose values should inform decision-making in the health area, and should the influence of different groups vary with the level of decision-making? These questions were put to 54 members of the public and health professionals in eight focus groups. Unlike previous studies, participants were not asked if particular groups should be involved in decisions but rather through deliberation and discussion nominated their own potential decision makers. This delivered a clear message that participants saw a legitimate role for a broad range of stakeholders in priority setting decisions. The results suggest that qualitative methods of investigation have the potential to improve the legitimacy and accountability of policy decisions by contributing to a better understanding of the values of the public and health professionals.
    Date: 2007–02
  23. By: Jeff Richardson (Centre for Health Economics, Monash University); John McKie (Centre for Health Economics, Monash University); Stuart Peacock (British Columbia Cancer Agency, Vancouver, British Columbia, Canada); Angelo Iezzi (Centre for Health Economics, Monash University)
    Abstract: The measure of benefit in cost utility analysis (CUA) is the increase in utility which is attributable to a health service. This paper reviews the evidence that the severity of an illness – the health state before receipt of the health service – may be independently important for social (as distinct from individual) preferences for different services. An earlier 1997 Australian study is summarised. Data from a 2004 survey are used to quantify the apparent importance of severity. Person trade off (PTO) scores are used to measure social preferences and time trade off (TTO) scores to measure individual preferences. Econometric results suggest the severity may more than double the index of social value of a health service.
    Date: 2007–07
  24. By: Jeff Richardson (Centre for Health Economics, Monash University); John McKie (Centre for Health Economics, Monash University)
    Abstract: The aim of this paper is to demonstrate a method for identifying policy options for reducing adverse events in Australia’s hospitals, which could have been adopted, but was not adopted, in the wake of the landmark 1995 ‘Quality in Australian Health Care’ study, and to indicate the lapse time before these measures could be expected to have a major effect. The study used a quasi Delphi technique that first elicited options for reducing adverse events from an expert panel and then collated and returned them for re-consideration and comment. Completed responses from both stages were obtained from 20 experts selected on the basis of their expertise, position and publications in the area of adverse events and quality assurance. Forty-one options were identified with an average lapse time of 3.5 years. Hospital regulation had the least delay (2.4) years, and out of hospital information the greatest (6.4 years). Following identification of the magnitude of the problem of adverse events in the ‘Quality in Australian Health Care’ study a more rapid response was possible than occurred. Viable options for reducing adverse events remain.
    Date: 2007–08
  25. By: Pushkar Maitra (Department of Economics, Monash University); Anurag Sharma (Centre for Health Economics, Monash University)
    Abstract: The International Obesity Taskforce calls obesity one of the most important medical and public health problems of our time. An estimated 1 billion people around the world are over weight, of whom around 300 million are clinically obese. Estimates suggest that obesity levels will continue to rise in the early 21st century - with severe health consequences in the absence of quick and directed intervention. Leaving genetics aside, obesity is essentially due to an imbalance between caloric intake and expenditures i.e, too high caloric intake and too low caloric expenditure. A large part of the economic research on obesity has focused on factors that lead to this imbalance. In this paper we examine the relationship between obesity (as measured by BMI) and the duration of exercise. Single equation estimates show that exercise duration has a negative and statistically significant effect on the probability of being overweight or obese. However when we take into account the potential endogeneity of exercise duration in the BMI regressions (arising from a standard problem of reverse causation), we no longer nd a negative relationship between exercise duration and BMI. There is either no eect or the eect is actually positive indicating that the results are essentially driven by individuals who are and who perceive themselves to be overweight and obese conducting more exercise.
    Keywords: Obesity, exercise, Australia
    Date: 2007–10
  26. By: Anurag Sharma (Centre for Health Economics, Monash University)
    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: Resource allocation, stochastic kernel, case-mix funding, prospective payment system, length of stay
    Date: 2007–10
  27. By: Anna Zhu (School of Economics, The University of New South Wales)
    Abstract: Childhood obesity has increased dramatically in the developed world. One cause of this trend, suggested by studies in the United States, is the increase in maternal employment. This paper explores if the causal relationship exists in Australia. Using recent data from the Longitudinal Survey of Australian Children (LSAC), a 2SLS procedure and a Full Information Maximum Likelihood (FIML) model that jointly estimates a multinomial treatment and binary outcome is used to control for endogeneity and self-selection bias, respectively. The results consistently show that maternal employment does have an impact on the likelihood of a child being overweight and that this impact is positive and statistically significant.
    Keywords: Child obesity; Maternal employment; Regression analysis; 2SLS; FIML; Endogeneity; Self-selection bias
    JEL: I10 J22 C30 C31 C35
    Date: 2007–06
  28. By: Michel Grignon (Departments of Economics and Health, Aging and Society, McMaster University, Hamilton, Ontario); Thomas Renaud (IRDES institut for research and information in health economics)
    Abstract: From 1997 to 2001, the total payment to compensate for sickness and injury leaves increased dramatically in France. Since this change coincided with a decrease in unemployment rate,three hypothesizes should be proposed as possible explanations consistently with the literature: moral hazard (workers fear less to loose their job, therefore use sickness leave more confidently); strain (workers work longer hours or under more stringent rules); labor-force composition effect (less healthy individuals are incorporated into the labor force). We investigate the first two strands of explanation using a household survey (ESPS) enriched with claims data from compulsory health insurance funds on sickness leaves (EPAS). We model separately number of leaves per individual (cumulative logit) and duration of leaves (random-effect model). According to our findings, in France, the individual propensity to take sickness leave is mainly influenced by strain in the workplace and by a labor-force composition effect. Conditional duration of spells is not well explained at the individual level: the only significant factor is usual weekly work duration. Influence of moral hazard is not clearly ascertained: it has few impact on occurrences of leave and no impact on duration.
    Keywords: Sickness, Labour Force
    JEL: I1 D81 J21
    Date: 2007–02
  29. By: Florence Jusot (IRDES institut for research and information in health economics); Michel Grignon (Departments of Economics and Health, Aging and Society, McMaster University, Hamilton, Ontario); Paul Dourgnon (IRDES institut for research and information in health economics)
    Abstract: We study the psychosocial determinants of health, and their impact on social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital controlling for standard sociodemographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and self-esteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.
    Keywords: social capital, social support, relative deprivation, sense of control, social health inequalities, France
    JEL: J12 I10
    Date: 2007–11
  30. By: Thierry Debrand (IRDES institut for research and information in health economics); Nicolas Sirven (IRDES institut for research and information in health economics)
    Abstract: Promoting social participation of the older population (e.g. membership in voluntary associations) is often seen as a promising strategy for 'healthy ageing' in Europe. Although a growing body of academic literature challenges the idea that the link between social participation and health is well established, some statistical evidence suggest a robust positive relationship may exist for older people. One reason could be that aged people have more time to take part in social activities (due to retirement, fewer familial constraints, etc.); so that such involvement in voluntary associations contributes to maintain network size for social and emotional support; and preserves individuals' cognitive capacities. Using SHARE data for respondents aged fifty and over in 2004, this study proposes to test these hypotheses by evaluating the contribution of social participation to self-reported health (SRH) in eleven European countries. The probability to report good or very good health is calculated for the whole sample (after controlling for age, education, income and household composition) using regression coefficients estimated for individuals who do and for those who do not take part in social activities (with correction for selection bias in these two cases). Counterfactual national levels of SRH are derived from integral computation of cumulative distribution functions of the predicted probability thus obtained. The analysis reveals that social participation contributes by three percentage points to the increase in the share of individuals reporting good or very good health on average. Higher rates of social participation could improve health status and reduce health inequalities within the whole sample and within every country. Our results thus suggest that 'healthy ageing' policies based on social participation promotion may be beneficial for the aged population in Europe.
    Keywords: Healthy ageing, Self-reported health, Social participation, Social capital, SHARE data, Counterfactual analysis, Stochastic dominance
    JEL: I12 Z13
    Date: 2008–01

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