nep-hea New Economics Papers
on Health Economics
Issue of 2008‒03‒25
28 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Role of Private Insurance in Financing Long-Term Care By Howard Gleckman
  2. Medicare Costs and Retirement Security By Alicia H. Munnell
  3. What Happens to Health Benefits after Retirement By Richard W. Johnson; ; ;
  4. Supplemental health insurance and equality of access in Belgium By Erik Schokkaert; Tom van Ourti; Diane De Grave; Ann Lecluyse; Carine Van De Voorde
  5. Marriage, schooling, and excess mortality in prime-age adults: Evidence from South Africa By Yamauchi, Futoshi
  6. Is HIV/AIDS undermining Botswana's ‘success story'? implications for development strategy: By Thurlow, James
  7. Mortality, mobility, and schooling outcomes among orphans: Evidence from Malawi By Ueyama, Mika
  8. Income growth and gender bias in childhood mortality in developing countries: By Ueyama, Mika
  9. Does a pint a day affect your child’s pay? The effect of prenatal alcohol exposure on adult outcomes By Nilsson, J Peter
  10. The Health Returns to Education: What Can We Learn from Twins? By Lundborg, Petter
  11. Ethnic Differences in Health: Does Immigration Status Matter? By Karen M. Kobayashi; Steven Prus; Zhiqiu Lin
  12. The Impact of Medicare Part D on Pharmaceutical R&D By Margaret E. Blume-Kohout; Neeraj Sood
  13. Is Medicine an Ivory Tower? Induced Innovation, Technological Opportunity, and For-Profit vs. Non-Profit Innovation By Jay Bhattacharya; Mikko Packalen
  14. The Other Ex-Ante Moral Hazard in Health By Jay Bhattacharya; Mikko Packalen
  15. On Inferring Demand for Health Care in the Presence of Anchoring, Acquiescence, and Selection Biases By Jay Bhattacharya; Adam Isen
  16. Differences in Breast Cancer Diagnosis and Treatment:Experiences of Insured and Uninsured Patients in a Safety Net Setting By Cathy J. Bradley; David Neumark; Lisa M. Shickle; Nicholas Farrell
  17. After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays By Douglas Almond; Joseph J. Doyle, Jr.
  18. The Economic Value of Teeth By Sherry Glied; Matthew Neidell
  19. Health Care Financing, Efficiency, and Equity By Sherry A. Glied
  20. Universal Public Health Insurance and Private Coverage: Externalities in Health Care Consumption By Sherry A. Glied
  21. The Transition to Post-industrial BMI Values Among US Children By John Komlos; Ariane Breitfelder; Marco Sunder
  22. The historical foundations of the narcotic drug control regime By Buxton, Julia
  23. Measuring financial protection in health By Wagstaff, Adam
  24. Informal payments and moonlighting in Tajikistan ' s health sector By Wane, Waly; Dabalen, Andrew
  25. Do waiting times reduce hospital costs? By Luigi Siciliani, Anderson Stanciole, Rowena Jacobs
  26. Secessions of Municipal Health Centre Federations: Expenditure and Productivity Effects By Juho Aaltonen; Antti Moisio; Kalevi Luoma
  27. Determinants of Health Care Expenditures in Finnish Hospital Districts 1993-2005 By Juho Aaltonen
  28. Decentralization and Public Delivery of Health Care Services in India By Singh, Nirvikar

  1. By: Howard Gleckman
    Abstract: Private insurance currently plays a small, but potentially important role in financing the long-term care of the elderly in the United States. Some believe it can be a significant element in a restructured long-term care financing system. However, to date, the demand for such insurance has been modest. This brief will discuss the potential benefits of long-term care insurance, review its current structure and status, and explore possible explanations for low takeup rates. Finally, it will consider future issues surrounding the role of this product.
    Date: 2007–09
  2. By: Alicia H. Munnell (Center for Retirement Research, Boston College)
    Abstract: Most of the discussion of retirement security focuses on declining Social Security replacement rates, modest 401(k) balances, the low level of saving, and longer life expectancy. Rising health care costs, which seem too amorphous to incorporate into numerical examples, are often characterized as a “wildcard” that could undermine the best laid plans. This brief focuses on just one component of retiree health care costs — the Medicare program. It discusses the impact on future retirees of both rising out-of-pocket payments and higher taxes that will be needed to cover future health care expenditures. The numbers come directly from the 2007 Annual Report issued by the Medicare Trustees. The conclusion is sobering. The growing cost and tax burdens associated with Medicare alone suggest that even the most conservative target replacement rates may be inadequate.
    Date: 2007–08
  3. By: Richard W. Johnson; (Urban Institute); ;
    Abstract: Because most workers receive health benefits from their employers, retirement often disrupts health insurance coverage. Some employers offer health insurance to retirees, but many firms are cutting retiree health benefits by passing more costs to retirees or eliminating benefits altogether. Few alternatives exist. Private nongroup coverage is generally quite expensive, and few people in their 50s and early 60s qualify for publicly financed benefits. Many workers who cannot obtain retiree benefits from their own employers or their spouses’ employers delay retirement to age 65, when Medicare coverage begins. This brief examines the availability and cost of health insurance coverage at ages 55 to 64 and changes in coverage after retirement. Today most workers with employer health benefits retain their coverage when they retire early, although their required premium contributions have increased sharply over the past ten years. In the future, however, steady declines in the share of younger workers with access to retiree health benefits may jeopardize income security for the next generations of retirees.
    Keywords: retirement, health benefits, disrupt, cutting benefits, health insurance coverage
    Date: 2007–02
  4. By: Erik Schokkaert; Tom van Ourti; Diane De Grave; Ann Lecluyse; Carine Van De Voorde
    Abstract: It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.
    Keywords: supplemental insurance, adverse selection, moral hazard, hospital spells, equality of access, health care use.
    Date: 2008–03
  5. By: Yamauchi, Futoshi
    Abstract: "The institution of marriage plays some role in determining one's risk of exposure to HIV. Since the transmission of HIV in the population is mainly through sexual activity, avoiding infection depends on risk-avoiding behavior. Consistently, empirical results show that excess mortality is concentrated in not-yet married adults aged 20-39 among both men and women. Therefore, the choice of when and who to marry appears to be related to risk of exposure. The objective of this paper is to determine the effect that schooling has on HIV/AIDS excess mortality, using panel data from South Africa. This paper tests the hypothesis that schooling affects when and who one marries and thus impacts the risk of mortality from HIV/AIDS. The effect could be negative or positive. On the one hand, since educated agents have incentives to secure returns to their human capital in the future, more education implies earlier marriage, given that the marriage institution effectively decreases the HIV-related mortality risk. On the other hand, education increases the opportunity costs of marriage especially for women, who need to increase their time spent in the household. Thus, schooling may increase mortality risks due to the increased risk of HIV infection... Results show that schooling increases excess mortality among women, but not among men... In sum, schooling increases the opportunity cost of marriage for women, which delays marriage and increases their mortality risks in high HIV-prevalence societies, but has the opposite effect on men. Our analysis demonstrated the need to integrate our understandings of the marriage market, the labor market, schooling investments, and youth behavior to identify the determinants of AIDS-related excess mortality." from Authors' Abstract
    Keywords: Marriage, Schooling, Excess mortality, HIV/AIDS, Gender,
    Date: 2007
  6. By: Thurlow, James
    Abstract: "Despite its strong growth record, Botswana faces two prominent development challenges: the onslaught of HIV/AIDS and the slowdown in diamond mining. This study estimates the growth and distributional impact of the HIV/AIDS pandemic and considers its implications for the country's development prospects, using a dynamic computable general equilibrium and microsimulation model that accounts for the cost of treatment. The results of this analysis indicate that HIV/AIDS reduces GDP growth by 1.6 percent, increases the absolute poverty headcount by 1.5 percentage points and disproportionately hurts labor-intensive manufacturing. Therefore, while mining has dominated the recent slowdown in Botswana's growth, the present findings suggest that HIV/AIDS is undermining economic diversification. Although providing treatment is projected to reclaim a quarter of the lost growth and a third of the poverty caused by the pandemic, the fiscal burden of treatment will constrain diversification, thus underscoring Botswana's need for development assistance. Furthermore, focusing resources toward treatment may worsen inequality, since the primary beneficiaries will be middle-income and urban households. Therefore, while HIV/AIDS is undermining Botswana's success story, both unemployment and a stagnant rural economy will remain binding constraints against further pro-poor development." from Author's Abstract
    Keywords: Growth, Poverty, Economic development, HIV/AIDS,
    Date: 2007
  7. By: Ueyama, Mika
    Abstract: "A tremendous increase in the number of orphans associated with a sharp rise in prime-age adult mortality due to AIDS has become a serious problem in Sub-Saharan Africa. In fact, more than 30 percent of school-aged children have lost at least one parent in Malawi. Lack of investments in human capital and adverse conditions during childhood are often associated with lower living standards in the future. Therefore, if orphans face an increased risk of poverty, exploitation, malnutrition, and poorer access to health care and schooling, early intervention is critical so as to avoid the potential poverty trap. The purpose of this study is to investigate the impacts of orphanhood/parental death on children's mortality risks, migration behaviors, and schooling outcomes, by using household panel data from Malawi, which has the eighth-highest HIV prevalence rates in the world. A number of studies have analyzed the relationship between parental death and children's school enrollment, but very few have considered mortality and mobility of orphans. This study uses the Malawi Complementary Panel Survey (CPS) conducted by the International Food Policy Research Institute (IFPRI) and another institution between January 2000 and July 2004. Since these panel data do not track individuals that move to other households, we take into account sample attritions of children. This study uses three estimation methodologies to explore different aspects of impacts. First, we analyze regression models with controls for various sets of household and child characteristics and for village fixed effects to examine heterogeneous impacts of orphanhood across different types of households. Second, we employ household fixed-effect models to test the differential effects of orphanhood on welfare outcomes among different types of orphans living in the same household. Third, we examine the impact of recent parental death—parental death between 2000 and 2004—on schooling outcomes. Empirical results show that maternal orphans, as well as double orphans, tend to face higher mortality risks and lower schooling outcomes than paternal and non-orphans do. This is especially so for boys. Similarly, maternal and double orphans tend to move to other households more frequently. Compared to adolescent orphans, the impact on younger orphans who enrolled in school after the introduction of universal free primary education in 1994 is more muted, suggesting that free primary education policies may have mitigated adverse shocks from parental death. More interestingly, the impacts of orphanhood on schooling outcomes are significantly gender-dependent: boys face severer negative impacts of being orphans than girls do. These empirical results are robust to sample attrition due to mortality and mobility." from Authors' Abstract
    Keywords: Orphans, Mortality, HIV/AIDS, Mobility, Sample attrition, Education,
    Date: 2007
  8. By: Ueyama, Mika
    Abstract: "With poverty studies having shifted their focus from household poverty to individual poverty, a number of studies have started to examine intrahousehold resource allocation, especially gender bias within the household as potential causes of poverty. The literature has highlighted the existence of gender inequalities in South Asia, attributed to strong preferences for male offspring stemming from cultural and traditional customs. Only a few studies focused on the regional difference in the extent of gender bias and its response to income growth. To fill a void in previous studies, this study analyzes regional differences in gender discrimination, taking into account time-series variations. Furthermore, we test whether economic factors are responsible for gender bias in child mortality. There are two main objectives in this study. First, through a comprehensive literature review and a careful treatment of data compilation, regional features and recent trends in gender bias in children's health outcomes are updated. We find strong evidence of severe disparity in child health against girls in South Asia; in contrast, no such anti-female gender bias exists in Sub-Saharan Africa. Second, this paper empirically tests the relationship between gender biases in child mortality and income growth using carefully-compiled new country-level panel data, paying attention to the possibility that such relationship differs between regions and changes over time. To investigate the relationship, two types of data sets are used: (1) new cross-country panel data of childhood mortality rates by sex, collected from various sources of macro statistics, such as DHS stat and WHO statistics; and (2) our own estimates for age-specific child mortality rates of children, constructed from the retrospective information on birth and death histories included in micro data of each round of the Demographic and Health Surveys (DHS). The empirical result suggests that income growth is correlated with the reduction of the anti-female bias in childhood mortality in most regions of the developing world—including South Asia. This result is reasonable, since income growth leads to an increase in nutrition intake (food consumption) and in health related inputs. In sharp contrast, the regression result does not show any significant correlation between gender biases in child health outcomes and income growth in Sub-Saharan Africa. While previous studies focused on the severe gender bias in South Asia, this study examined the correlation between income growth and gender bias and found a new dimension of regional contrast between Sub-Saharan Africa and other regions." from Authors' Abstract
    Keywords: Gender bias, Intrahousehold resource allocation, Childhood mortality, Sub-Saharan Africa, Developing countries, Poverty reduction,
    Date: 2007
  9. By: Nilsson, J Peter (Institute for Labour Market Policy Evaluation)
    Abstract: This paper utilizes a Swedish alcohol policy experiment conducted in the late 1960s to identify the impact of prenatal alcohol exposure on educational attainments and labor market outcomes. The experiment started in November 1967 and was prematurely discontinued in July 1968 due to a sharp increase in alcohol consumption in the experimental regions, particularly among youths. Using a difference-in-difference-in-differences strategy we find that around age 30 the cohort in utero during the experiment have substantially reduced educational attainments, lower earnings and higher welfare dependency rates compared to the surrounding cohorts. The results indicate that investments in early-life health may have far reaching effects on economic outcomes later in life.
    Keywords: Alcohol policy; infant health; education; earnings
    JEL: I12 I18 J24
    Date: 2008–03–11
  10. By: Lundborg, Petter (Free University of Amsterdam)
    Abstract: This paper estimates the health returns to education, using data on identical twins. I adopt a twin-differences strategy in order to obtain estimates that are not biased by unobserved family background and genetic traits that may affect both education and health. I further investigate to what extent within-twin-pair differences in schooling correlates with within-twin-pair differences in early life health and parent-child relations. The results suggest a causal effect of education on health. Higher educational levels are found to be positively related to self-reported health but negatively related to the number of chronic conditions. Lifestyle factors, such as smoking and overweight, are found to contribute little to the education/health gradient. I am also able to rule out occupational hazards and health insurance coverage as explanations for the gradient. In addition, I find no evidence of heterogenous effects of education by parental education. Finally, the results suggest that factors that may vary within twin pairs, such as birth weight, early life health, parental treatment and relation with parents, do not predict within-twin pair differences in schooling, lending additional credibility to my estimates and to the general validity of using a twin-differences design to study the returns to education.
    Keywords: health production, education, schooling, twins, siblings, returns to education, ability bias
    JEL: I12 I11 J14 J12 C41
    Date: 2008–03
  11. By: Karen M. Kobayashi; Steven Prus; Zhiqiu Lin
    Abstract: This study examines health differences between first-generation immigrant and Canadian-born persons who share the same the ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Data from the 2000/2001 Canadian Community Health Survey show that first generation immigrants of Black and French race/ethnicity tend to have better health than their Canadian-born counterparts, while the opposite is true for those of South Asian, Chinese, and south and east European and Jewish origins. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign- and Canadian-born persons generally converge after adjusting for socio-demographic, SES, and lifestyle factors. Implications for health care policy and program development are discussed.
    Keywords: self-rated health; functional health; ethnicity; race; immigration
    JEL: I18
    Date: 2008–03
  12. By: Margaret E. Blume-Kohout; Neeraj Sood
    Abstract: Recent evidence suggests that Medicare Part D has increased prescription drug use among the elderly, and earlier studies have indicated that increasing market size induces pharmaceutical innovation. This paper assesses the impact of Medicare Part D on pharmaceutical research and development (R&D), using time-series data on the number of drugs in preclinical and clinical development by therapeutic class. We demonstrate that the passage of Medicare Part D was associated with significant increases in pharmaceutical R&D, especially for classes with high elderly market share.
    JEL: H51 I18 O30
    Date: 2008–03
  13. By: Jay Bhattacharya; Mikko Packalen
    Abstract: This paper examines whether the composition of medical research responds to changes in disease incidence and research opportunities. The paper also provides new evidence on induced pharmaceutical innovation. In both cases we use the change in the demographic structure of the market (measured by age structure and obesity prevalence) to test the induced innovation hypothesis. Technological opportunity is calculated from estimates of structural productivity parameters. The extent of inventive activity is measured from the MEDLINE database on 16 million biomedical publications. We match these data with data on disease incidence. We show that medical research responds to changes in disease incidence and research opportunities. We also find that pharmaceutical innovation responds to aging- and obesity-induced changes in potential market size.
    JEL: I1 L31 O33
    Date: 2008–03
  14. By: Jay Bhattacharya; Mikko Packalen
    Abstract: It is well known that public or pooled insurance coverage can induce a form of ex-ante moral hazard: people make inefficiently low investments in self-protective activities. This paper points out another ex-ante moral hazard that arises through an induced innovation externality. This alternative mechanism, by contrast, causes people to devote an inefficiently high level of self-protection. As an empirical example of this externality, we analyze the innovation induced by the obesity epidemic. Obesity is associated with an increase in the incidence of many diseases. The induced innovation hypothesis is that an increase in the incidence of a disease will increase technological innovation specific to that disease. The empirical economics literature has produced substantial evidence in favor of the induced innovation hypothesis. We first estimate the associations between obesity and disease incidence. We then show that if these associations are causal and the pharmaceutical reward system is optimal the magnitude of the induced innovation externality of obesity roughly coincides with the Medicare-induced health insurance externality of obesity. The current Medicare subsidy for obesity therefore appears to be approximately optimal. We also show that the pattern of diseases for obese and normal weight individuals are similar enough that the induced innovation externality of obesity on normal weight individuals is positive as well.
    JEL: I1 O3
    Date: 2008–03
  15. By: Jay Bhattacharya; Adam Isen
    Abstract: In the contingent valuation literature, both anchoring and acquiescence biases pose problems when using an iterative bidding game to infer willingness to pay. Anchoring bias occurs when the willingness to pay estimate is sensitive to the initially presented starting value. Acquiescence bias occurs when survey respondents exhibit a tendency to answer 'yes' to questions, regardless of their true preferences. More generally, whenever a survey format is used and not all of those contacted participate, selection bias raises concerns about the representativeness of the sample. In this paper, we estimate students' willingness to pay for student health care at Stanford University while accounting for all of these biases. As there is no cost sharing for students, we assess willingness to pay by having a random sample of students play an online iterative bidding game. Our main results are that (1) demand for student health care is elastic by conventional standards; (2) ignoring anchoring bias would lead to a substantially biased measure of the demand elasticity; (3) there is evidence for acquiescence bias in student answers to the opening question of the iterative bidding game and failure to address this leads to the biased conclusion that demand is inelastic; and (4) standard selection correction methods indicate no bias from selective non-response and newer bounding methods support this conclusion of elastic demand.
    JEL: C42 C81 C9 I1
    Date: 2008–03
  16. By: Cathy J. Bradley; David Neumark; Lisa M. Shickle; Nicholas Farrell
    Abstract: To explore how well the safety net performs at eliminating differences in diagnosis and treatment of insured and uninsured women with breast cancer, we compared insured and uninsured women treated in a safety net setting. Controlling for socioeconomic characteristics, uninsured women are more likely to be diagnosed with advanced disease, requiring more extensive treatment relative to insured women, and also experience delays in initiating and completing treatment. The findings suggest that, despite the safety net system, uninsured women with breast cancer are likely to require more costly treatment and to have worse outcomes, relative to insured women with breast cancer.
    JEL: I18
    Date: 2008–03
  17. By: Douglas Almond; Joseph J. Doyle, Jr.
    Abstract: Patients who receive more hospital treatment tend to have worse underlying health, confounding estimates of the returns to such care. This paper compares the costs and benefits of extending the length of hospital stay following delivery using a discontinuity in stay length for infants born close to midnight. Third-party reimbursement rules in California entitle newborns to a minimum number of hospital "days," counted as the number of midnights in care. A newborn delivered at 12:05 a.m. will have an extra night of reimbursable care compared to an infant born minutes earlier. We use a dataset of all California births from 1991-2002, including nearly 100,000 births within 20 minutes of midnight, and find that children born just prior to midnight have significantly shorter lengths of stay than those born just after midnight, despite similar observable characteristics. Furthermore, a law change in 1997 entitled newborns to a minimum of 2 days in care. The midnight discontinuity can therefore be used to consider two distinct treatments: increasing stay length from one to two nights (prior to the law change) and from two to three nights (following the law change). On both margins, we find no effect of stay length on readmissions or mortality for either the infant or the mother, and the estimates are precise. The results suggest that for uncomplicated births, longer hospitals stays incur substantial costs without apparent health benefits.
    JEL: H51 I11 I12 J13
    Date: 2008–03
  18. By: Sherry Glied; Matthew Neidell
    Abstract: Healthy teeth are a vital and visible component of general well-being, but there is little systematic evidence to demonstrate their economic value. In this paper, we examine one element of that value, the effect of oral health on labor market outcomes, by exploiting variation in access to fluoridated water during childhood. The politics surrounding the adoption of water fluoridation by local water districts suggests exposure to fluoride during childhood is exogenous to other factors affecting earnings. We find that women who resided in communities with fluoridated water during childhood earn approximately 4% more than women who did not, but we find no effect of fluoridation for men. Furthermore, the effect is almost exclusively concentrated amongst women from families of low socioeconomic status. We find little evidence to support occupational sorting, statistical discrimination, and productivity as potential channels of these effects, suggesting consumer and employer discrimination are the likely driving factors whereby oral health affects earnings
    JEL: I12 I18
    Date: 2008–03
  19. By: Sherry A. Glied
    Abstract: This paper examines the efficiency and equity implications of alternative health care system financing strategies. Using data across the OECD, I find that almost all financing choices are compatible with efficiency in the delivery of health care, and that there has been no consistent and systematic relationship between financing and cost containment. Using data on expenditures and life expectancy by income quintile from the Canadian health care system, I find that universal, publicly-funded health insurance is modestly redistributive. Putting $1 of tax funds into the public health insurance system effectively channels between $0.23 and $0.26 toward the lowest income quintile people, and about $0.50 to the bottom two income quintiles. Finally, a review of the literature across the OECD suggests that the progressivity of financing of the health insurance system has limited implications for overall income inequality, particularly over time.
    JEL: H42 H51 I18
    Date: 2008–03
  20. By: Sherry A. Glied
    Abstract: Inequality in access to health care services, through private purchase, appears to pose policy challenges greater than inequality in other spheres. This paper explores how inequality in access to health care services relates to social welfare. I examine the sources of private demand for health insurance and the ramifications of this demand for health, for patterns for government spending on health care services, and for individual and social well-being. Finally, I evaluate the implications of a health tax as a response to the externalities of health service consumption, and provide a rough measure of the tax in the context of the Canadian publicly-financed health care system.
    JEL: H23 I18
    Date: 2008–03
  21. By: John Komlos; Ariane Breitfelder; Marco Sunder
    Abstract: In our opinion, the trend in the BMI values of US children has not been estimated accurately. We use five models to estimate the BMI trends of non-Hispanic US-born black and white children and adolescents ages 2-19 born 1941-2006 on the basis of all NHES and NHANES data sets. We also use some historical BMI values for comparison. The increase in BMIZ values during the period considered was on average 1.3σ (95% CI: 1.16σ; 1.44σ) among black girls, 0.8σ for black boys, 0.7σ for white boys, and 0.6σ for white girls. This translates into an increase in BMI values of some 5.6, 3.3, 2.4, and 1.5 units respectively. While the increase in BMI values started among the birth cohorts of the 1940s among black females, the rate of increase tended to accelerate among all four groups born in the mid-1950s to early-1960s with the contemporaneous spread of TV viewing. The rate of increase levelled off somewhat thereafter. There is some indication that among black boys and white girls born after c. 1990 adiposity has remained unchanged or perhaps even declined. The affects of the IT revolution of the last two decades of the century is less evident. Some regional evidence leads to the speculation that the spread of automobiles and radios affected the BMI values of boys already in the interwar period. We infer that the incremental weight increases are associated with the labor-saving technological developments of the 20th century which brought about many faceted cultural and nutritional revolutions.
    JEL: I10
    Date: 2008–03
  22. By: Buxton, Julia
    Abstract: This paper outlines the institutional history of the international narcotic drug control regime. It details the evolution of the control system, from its foundations at the beginning of the twentieth century - a period of mass, unregulated narcotic drug use - to the current period. The paper argues that the contemporary control model is ill-positioned to address the dynamic and rapidly changing nature of the global narcotics trade. The persistence of anachronistic guiding first principles, specifically the utopian idea of pr ohibition, is identified as the key impediment to the adoption of a more humane and effective policy approach. But while there is growing pressure for a revision of founding ideas, this is not supported by a host of powerful actors that includes the United States.
    Keywords: Crime and Society,Post Conflict Reconstruction,Alcohol and Substance Abuse,Pharmaceuticals & Pharmacoeconomics,Pharmaceuticals Industry
    Date: 2008–03–01
  23. By: Wagstaff, Adam
    Abstract: Health systems are not just about improving health: good ones also ensure that people are protected from the financial consequences of receiving medical care. Anecdotal evidence suggests health systems often perform badly in this respect, apparently with devastating consequences for households, especially poor ones and near-poor ones. Two principal methods have been used to measure financial protection in health. Both relate a household ' s out-of-pocket spending to a threshold defined in terms of living standards in the absence of the spending: the first defines spending as catastrophic if it exceeds a certain percentage of the living standards measure; the second defines spending as impoverishing if it makes the difference between a household being above and below the poverty line. The paper provides an overview of the methods and issues arising in each case, and presents empirical work in the area of financial protection in health, including the impacts of government policy. The paper also reviews a recent critique of the methods used to measure financial protection.
    Keywords: Health Monitoring & Evaluation,Health Systems Development & Reform,Health Economics & Finance,,Rural Poverty Reduction
    Date: 2008–03–01
  24. By: Wane, Waly; Dabalen, Andrew
    Abstract: This paper studies the relationship between gender and corruption in the health sector. It uses data collected directly from health workers, during a recent public expenditure tracking survey in Tajikistan ' s health sector. Using informal payments as an indicator of corruption, women seem at first significantly less corrupt than men as consistently suggested by the literature. However, once power conferred by position is controlled for, women appear in fact equally likely to take advantage of corruption opportunities as men. Female-headed facilities also are not less likely to experience informal charging than facilities managed by men. However, women are significantly less aggressive in the amount they extract from patients. The paper provides evidence that workers are more likely to engage in informal charging the farther they fall short of their perceived fair-wage, adding weight to the fair wage-corruption hypothesis. Finally, there is some evidence that health workers who feel that health care should be provided for a fee are more likely to informally charge patients. Contrary to informal charging, moonlighting behavior displays strong gender differences. Women are significantly less likely to work outside the facility on average and across types of health workers.
    Keywords: Health Monitoring & Evaluation,Gender and Health,Access to Finance,Health Law,Health Economics & Finance
    Date: 2008–03–01
  25. By: Luigi Siciliani, Anderson Stanciole, Rowena Jacobs
    Abstract: Using a sample of 137 hospitals over the period 1998-2002 in the English National Health Service, we estimate the elasticity of hospital costs with respect to waiting times. Our cross-sectional and panel-data results suggest that at the sample mean (103 days), waiting times have no significant effect on hospital, costs or, at most, a positive one. If significant, the elasticity of cost with respect to waiting time from our cross-sectional estimates is in the range 0.4-1. The elasticity is still positive but lower in our fixed-effects specifications (0.2-0.4). In all specifications, the effect of waiting time on cost is non-linear, suggesting a U-shaped relationship between hospital costs and waiting times: the level of waiting time which minimises total costs is always below ten days.
    JEL: I11 I18
    Date: 2008–02
  26. By: Juho Aaltonen; Antti Moisio; Kalevi Luoma
    Abstract: We examine the expenditure and efficiency effects of secessions of health centre federations between 1990 and 2003. Using both regression and matching techniques we find statistically significant effects. According to results, the per capita primary health care expenditure growth is approximately five percent higher in seceded health centres compared to all non-seceded health centres. Using nearest neighbour matching, we find that the average secession effect is eight percent on per capita primary health care expenditures. We find no effect on specialised health care expenditures. Using an indicator of health centre service volume, we find that secessions had no positive effects on the productivity development in the long term. The rapid expenditure growth of seceded health centres can thus be explained both by increasing service volume and decreasing productivity. Key words: Health care expenditures, health centre secessions, economies of scale
    Keywords: Health care expenditures, health centre secessions, economies of scale
    Date: 2007–09–13
  27. By: Juho Aaltonen
    Abstract: This study assesses which factors explain the development of health care expenditures in Finnish hospital districts during 1993?2005. According to the results, real health care expenditures in hospital districts during the study period increased by 25%, but four fifths of this increase could be explained by the economic situation of the municipalities, demographic factors, the morbidity of the population and registered alcohol consumption. The increase in taxable income in municipalities and the number of diagnosed diabetes patients had a clear positive effect on health care expenditures. With favourable development of local economy municipalities increased health care resources, but this has not led to a respective growth in the service output. The relative size of the Swedishspeaking population and expenditures were also positively associated. In addition, the increase in alcohol consumption had a significant effect on expenditures. Respectively, the decrease in the proportion of disability pensioners had a modest restraining effect on expenditures.
    Keywords: Health care expenditures, hospital districts
    Date: 2007–11–08
  28. By: Singh, Nirvikar
    Abstract: This paper examines delivery of public health care services in India, in the broader context of decentralization. It provides an overview of the basic features and recent developments in intergovernmental fiscal relations and accountability mechanisms, and examines the implications of these institutions for the quality of public service delivery. It then addresses recent policy proposals on the public provision of health care, in the context of decentralization. Finally, it makes suggestions for reform priorities to improve public health care delivery.
    Keywords: federalism; decentralization; intergovernmental relations; accountability; service delivery; health care
    JEL: H1 H7 P35 P26
    Date: 2008–03–20

This nep-hea issue is ©2008 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.