nep-hea New Economics Papers
on Health Economics
Issue of 2008‒03‒08
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Decomposing Body Mass Index Gaps Between Mediterranean Countries: A Counterfactual Quantile Regression Analysis By Joan Costa-Font; Daniele Fabbri; Joan Gil
  2. Pollution, Health and Life Expectancy: How Environmental Policy Can Promote Growth By Xavier Pautrel
  3. On the Economics of Rational Self-Medication By Wisdom Akpalu
  4. "To array a man's will against his sickness is the supreme art of medicine". An analysis of multiple spells of sickness By Andrén, Daniela
  5. Motivations, Capability Handicaps and Firm Responses in the Early Phase of Internationalization from Emerging Economies: A study in the Indian Pharmaceutical Industry By Dixit M.R.;
  6. Pharmaceutical Pricing and Reimbursement Policies in Slovakia By Zoltán Kaló; Elizabeth Docteur; Pierre Moïse
  7. Modeling Expert Opinions on Food Healthiness: A Nutrition Metric By Jolie Mae Martin; John Leonard Beshears; Katherine Lyford Milkman; Max H. Bazerman; Lisa Sutherland
  8. Working Conditions and Health of European Older Workers By Thierry Debrand; Pascale Lengagne

  1. By: Joan Costa-Font; Daniele Fabbri; Joan Gil
    Abstract: Wide cross-country variation in obesity rates have been reported within European Union member states. However, health production determinants for these differences have been largely overlooked in the health economics literature. In this paper we propose a methodology for conducting standardized cross-country comparisons in BMI. The method we adopt is based on the estimation of the marginal density function of BMI in a given country implied by different counterfactual distributions of all the covariates included within a quantile regression framework. We apply our method to the analysis of the variation in BMI distribution in Spain with respect to Italy in the year 2003. Our findings suggest that Spain-to-Italy BMI gaps are largely explained by cross-country variation in the returns to each health input. Therefore, there appear to be differences in the country-specific behavioural responses to the caloric (im)balance.
    Date: 2008–02
  2. By: Xavier Pautrel (Université de Nantes)
    Abstract: This article investigates the influence of environmental policy on growth assuming that the channel of transmission relies on the link between pollution, health and the survival probability, in an overlapping generations model à la Blanchard (1985) where growth is driven by a mechanism à la Romer (1986). We demonstrate that environmental policy has an ambiguous effect on growth in the steady-state when the detrimental impact of pollution on health and lifetime is taken into account: for low levels of taxation, environmental policy promotes growth while it is harmful to growth for high levels. Furthermore, we show that the environmental policy is more likely to promote growth (i.e. it stimulates growth for a wider range of environmental taxes) when public expenditures in health and/or the impact of pollution on health are important. Finally, using numerical simulations, we find that for the value of parameters chosen the environmental policy will be more likely to harm growth when agents smooth consumption over time.
    Keywords: Growth, Environment, Overlapping generations
    Date: 2007–10
  3. By: Wisdom Akpalu (Agricultural Annex University of Pretoria)
    Abstract: It has been established in the medical literature that self-medicating with imperfect information about either the use of a genuine or counterfeit drug or based on wrong self-diagnosis of ailment, which is predominant especially in developing countries, is a risky investment in health capital. This paper models the decision to self-medicate and the demand for self-medicated drugs. We suppose that investment in self-medication depends on the perception of its effectiveness. The results obtained show that the decision to self-medicate depends on the relative price and perceived effectiveness of self-medication, the elasticity of the shadow value of health with respect to the quantity of health capital, and the relative effectiveness of self-medication in reducing the unpredictable changes in health capital. Furthermore, if an individual self-medicates, self-medication becomes a normal good: it increases if income increases; and it obeys the law of demand (i.e. it increases if its price, relative to that of the risk-free medication, decreases). Moreover, we have shown that some optimum subsidy can discourage self-medication.
    Keywords: Health Production, Self-Medication, Risky Investment, Government Policy, Dynamic Analysis
    JEL: I12 I18 D81 C61
    Date: 2008–01
  4. By: Andrén, Daniela (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: This paper analyzes the long-term sickness absences in Sweden using a longitudinal database that contains all compensated sickness spells for 2,789 persons during 1986-1991. Given the political focus on the improved collaboration between the individual, physician, employer, and social insurance officer, the strategy is to analyze the spells of long-term sickness grouping them by all available factors that concern these actors. The estimates of a mixed proportional hazards model suggest that there was more heterogeneity among spells grouped by the factors related to the health status of the individual and the physician's evaluation than among spells grouped by the factors expected to be related to the social insurance praxis or other sorting processes.<p>
    Keywords: sick leave; long-term sickness; multiple spells; mixed proportional hazards model
    JEL: I12 J21 J28
    Date: 2008–03–06
  5. By: Dixit M.R.;
    Abstract: This paper identifies and analyses the motivations, capability handicaps and responses of a sample of Indian pharmaceutical firms in the early phase of internationalization. It distinguishes between the experiences of two types of internationalisers –initial internationalisers and later internationalisers - in the industry. It argues that the initial internationalisers face several discontinuities vis-a-vis the experience of meeting the needs of domestic market. They need to cultivate new capabilities by leveraging on whatever is available within the firms and the external environment. Their capability to cultivate depends on their internal processes to absorb the new experiences. The later internationalisers do not experience these handicaps. They can benefit from the industry experience and congregate capabilities to move faster. Their capability to congregate depends on the initial endowments of the founders. Based on its findings, the paper outlines scope for further research in capability building for internationalization in the context of emerging economies.
    Date: 2008–02–28
  6. By: Zoltán Kaló; Elizabeth Docteur; Pierre Moïse
    Abstract: This paper examines aspects of the policy environment and market characteristics of Slovakia's pharmaceutical sector, and assesses the degree to which Slovakia has achieved certain policy goals. Pharmaceutical expenditure in Slovakia accounts for a higher share of total health expenditure than it does in any other OECD country, and the share of national income going to pharmaceuticals is exceeded only in Hungary. Although its relatively low national income is a partial explanation for Slovakia's status in this respect, this review finds that Slovakia has scope to reduce its expenditures and the rapid rate of growth in its pharmaceutical spending. Financing of pharmaceutical expenditure in Slovakia rests more heavily on the public sector than is typical in the OECD, with out-of-pocket spending accounting for just a quarter of total expenditure. The effectiveness of international price referencing in limiting Slovak prices for on-patent pharmaceutical products is questionable. For products that have gone off-patent and for those with similar chemical structure, a reference-pricing scheme and competition among generic alternatives results in effective price control, although incentives for generic substitution are weak (for patients) and misaligned (for pharmacists). When deciding whether a drug will be reimbursed through the social insurance scheme, the cost-effectiveness of new pharmaceuticals is not assessed. On the other hand, certain policy goals have been achieved. The accessibility and availability of medicines--including the most innovative products--is good; affordability is supported by relatively low average co-payment levels. While more expensive drugs usually have higher cost-sharing, drugs are not excluded from coverage on affordability grounds. <BR>Le présent document examine les différents aspects des politiques et des caractéristiques du marché du secteur pharmaceutique slovaque, et évalue les objectifs atteints. La part des dépenses pharmaceutiques dans l'ensemble des dépenses de santé est plus élevée en République slovaque que dans tout autre pays de l'OCDE, et la proportion du revenu national consacrée aux produits pharmaceutiques n'est plus forte qu'en Hongrie. Si la modestie relative du revenu national explique en partie cette situation, le présent examen indique que la République slovaque dispose d'une certaine marge de manœuvre pour réduire ses dépenses pharmaceutiques et ralentir la croissance rapide de ceux-ci. En République slovaque, le financement des dépenses pharmaceutiques dépend davantage du secteur public que dans les autres pays membres de l'OCDE : la participation aux coûts des ménages n'en supporte que le quart. Le recours aux prix de référence externes n'a pas fait la preuve de modérer les prix slovaques des produits pharmaceutiques qui sont encore protégés par un brevet. S'agissant des produits tombés dans le domaine public et des produits ayant une structure chimique comparable, un dispositif de prix de référence et la concurrence avec les génériques permettent une maîtrise effective des prix, même si les incitations à la substitution par des produits génériques sont faibles pour les patients et ne sont pas aligné pour les pharmaciens. Par ailleurs, le processus de décision de remboursement d'un médicament par l'assurance sociale ne donne pas lieu à une évaluation du coût-efficacité des nouveaux produits pharmaceutiques. D'un autre côté, certains objectifs des politiques pharmaceutiques ont été atteints. La facilité d'accès et la disponibilité des médicaments - y compris les plus innovants - sont satisfaisantes ; l'accessibilité financière aux médicaments est soutenue par la relative modération de la participation aux coûts de l'assuré. Si les médicaments chers sont en général synonymes pour l'assuré d'une participation financière supérieure, le critère de l'accessibilité financière n'est pas un motif d'exclusion de la liste des médicaments remboursés.
    Keywords: République slovaque, Slovakia, pharmaceutical policy, politique pharmaceutique, pharmaceutical market, marché pharmaceutique, pricing, reimbursement, tarification et remboursement
    JEL: I11 I18
    Date: 2008–02–25
  7. By: Jolie Mae Martin (Harvard Business School); John Leonard Beshears (Harvard Business School); Katherine Lyford Milkman (Harvard Business School); Max H. Bazerman (Harvard Business School, Negotiation, Organizations & Markets Unit); Lisa Sutherland (Dartmouth Medical School, Department of Pediatrics)
    Abstract: Background Research over the last several decades indicates the failure of existing nutritional labels to substantially improve the healthiness of consumers' food and beverage choices. The difficulty for policy-makers is to encapsulate a wide body of scientific knowledge in a labeling scheme that is comprehensible to the average shopper. Here, we describe our method of developing a nutrition metric to fill this void. Methods We asked leading nutrition experts to rate the healthiness of 205 sample foods and beverages, and after verifying the similarity of their responses, we generated a model that calculates the expected average healthiness rating that experts would give to any other product based on its nutrient content. Results The form of the model is a linear regression that places weights on 12 nutritional components (total fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron) to predict the average healthiness rating that experts would give to any food or beverage. We provide sample predictions for other items in our database. Conclusions Major benefits of the model include its basis in expert judgment, its straightforward application, the flexibility of transforming its output ratings to any linear scale, and its ease of interpretation. This metric serves the purpose of distilling expert knowledge into a form usable by consumers so that they are empowered to make healthier decisions.
    Date: 2008–03
  8. By: Thierry Debrand (IRDES institut for research and information in health economics); Pascale Lengagne (IRDES institut for research and information in health economics)
    Abstract: Working conditions have greatly evolved in recent decades in developed countries. This evolution has been accompanied with the appearance of new forms of work organisation that may be sources of stress and health risk for older workers. As populations are ageing, these issues are particularly worrying in terms of the health, labour force participation and Social Security expenditure. This paper focuses on the links between quality of employment and the health of older workers, using the Share 2004 survey. Our research is based on two classical models: the Demand-Control model of Karasek and Theorell (1991) and the Effort-Reward Imbalance model of Siegrist (1996), which highlight three main dimensions: Demand that reflects perceived physical pressure and stress due to a heavy work load; Control that refers to decision latitude at work and the possibilities to develop new skills; and Reward that corresponds to the feeling of receiving a correct salary relatively to efforts made, of having prospects for personal progress and receiving deserved recognition. These models also take into account the notion of support in difficult situations at work and the feeling of job security. Our estimations show that the health status of older workers is related to these factors. Fairly low demand levels and a good level of reward are associated with a good health status, for both men and women. Control only influences the health status of women. Lastly, the results reveal the importance on health of a lack of support at work and the feeling of job insecurity; regardless of gender; these two factors are particularly related to the risk of depression. Thus health status and working conditions are important determinants of the labour force participation of older workers.
    Keywords: Working conditions, Health, Older Workers
    JEL: I10 J28
    Date: 2008–02

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