nep-hea New Economics Papers
on Health Economics
Issue of 2008‒04‒04
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. When Does Improving Health Raise GDP? By Quamrul Ashraf; Ashley Lester; David Weil
  2. The Impact on Child Health from Access to Water and Sanitation and Other Socioeconomic Factors By Gauri Khanna
  3. The Changing Role of Auxiliary Nurse Midwife (ANM) in India: Implications for Maternal and Child Health (MCH) By Mavalankar Dileep;
  4. Maternal Health Situation in India: A Case Study By Ramani K.V.; Sharma Bharati
  5. Tobacco and Alcohol: Complements or Substitutes? A Structural Model Approach By Tauchmann, Harald; Göhlmann, Silja; Requate, Till; Schmidt, Christoph M.
  6. The Value of Statistical Life and Cost-Benefit Evaluations of Landmine Clearance in Cambodia By Michael Cameron; John Gibson; Kent Helmers; Steven Lim; John Tressler; Kien Vaddanak
  7. Can production and trafficking of illicit drugs be reduced or merely shifted ? By Reuter, Peter
  8. Evo, Pablo, Tony, Diego, and Sonny - general equilibrium analysis of the illegal drugs market By Chumacero, Romulo A.
  9. Work Disability, Health, and Incentive Effects By Börsch-Supan, Axel
  10. The measurement and comparison of health system responsiveness By Rice, N; Robone, S; Smith, P.C
  11. West-East Convergence in the Prevalence of Illicit Drugs: Socioeconomics or Culture? By Tauchmann, Harald

  1. By: Quamrul Ashraf; Ashley Lester; David Weil
    Abstract: We assess quantitatively the effect of exogenous health improvements on output, through demographic channels and changes in worker productivity. We consider both changes in general health, proxied by changes in life expectancy, and changes in the prevalence of two particular diseases: malaria and tuberculosis. In general, we find that the effects of health improvements on income are substantially lower than those that are often quoted by policy-makers, and may not emerge at all for a third of a century or more after the initial improvement in health.
    Date: 2008
  2. By: Gauri Khanna (IUHEI, The Graduate Institute of International Studies, Geneva)
    Abstract: In this paper we examine the impacts on child health, using diarrhoe as the health outcome (amongst children living in households), with access to different types of water and sanitation facilities, and from other socio-economic and child specific factors. Using cross-sectional health survey data for India, we employ the propensity score method to match children belonging to different treatment groups, defined by water types and sanitation facilities, with children in a control group. We also employ non-matching techniques to compare our results and to check for their robustness. Our results indicate that disease-specific awareness has strong marginal effects on reducing the predicted probabilities of diarrhoeal outcomes in young children, which are consistent across the models utilised. We also find disease-specific awareness to have the largest impact on reducing the burden of disease from diarrhoea across a select group of predictors.
    Keywords: Diarrhoea, Water, Sanitation, Propensity Score, Matching Techniques
    JEL: I1 D1 C35
    Date: 2008–01
  3. By: Mavalankar Dileep;
    Abstract: The world’s democracy and its second most populous country, India was the first developing country to have a national family planning program and has implemented countrywide reproductive health programs such as RCH I. India’s primary health care and the family planning programs have come a long way after the independence in improving health indicators in general, yet it has high material and under five mortality rates. The country has developed an extensive network of primary health centers and sub- to provide basic medical care to huge (80%) rural population. In the rural health care system, the ANM is the key field level functionary who interacts directly with the community and has been the central focus of all the reproductive child health programs. In contrast with resident ANM of sixties who was providing delivery and basic curative services to the community, today’s commuting multi purpose worker is more involved in family planning and preventive services. This has implications on the implementation and coutcomes of maternal health programs in rural India. The midwifery role of the ANM should be restored if the goal of dcreasing maternal mortality has to be met. The priority will have to change from family planning immunization to comprehensive reproductive health including maternal and neonatal care. These changes will require sustained and careful planning/resource allocation. Increasing resources along with systemic reforms will improve health status for women and children who are the focus of Reproductive Child Health programs.
    Date: 2008–03–14
  4. By: Ramani K.V.; Sharma Bharati
    Abstract: Maternal Health Services are one of the basic health services to be provided by nay government health system as pregnant women are one of the most vulnerable victims of dysfunctional health system, India, in spite of rapid economic progress is still farm away from the goal of lowering maternal mortality to less than 100 per 100,000 live births. It still accounts for 25.7% maternal deaths. The maternal mortality in India varies across the states. Geographical vastness and socio-cultural diversity make implementation of health sector reforms a difficult task. The chapter analyses the trends in maternal mortality and various maternal health programs implemented over the years including the maternal health care delivery system at various levels including the recent innovative strategies. It also identifies the reasons for limited success in maternal health and suggests measures to improve the current maternal health situation. It recommends improvement in maternal death reporting, evidence based, focused, long term strategy along with effective monitoring of implementation for improving Maternal Health situation. It also stress the need for regulation of private sector and proper Public Private Partnership (PPP) policy together with a strong political will for improving Maternal Health.
    Date: 2008–03–14
  5. By: Tauchmann, Harald (RWI Essen); Göhlmann, Silja (RWI Essen); Requate, Till (University of Kiel); Schmidt, Christoph M. (RWI Essen)
    Abstract: The question of whether two drugs – namely alcohol and tobacco – are used as complements or substitutes is of crucial interest if side-effects of anti-smoking policies are considered. Numerous papers have empirically addressed this issue by estimating demand systems for alcohol and tobacco and subsequently calculating cross-price effects. However, this traditional approach often is seriously hampered by insufficient price-variation observed in survey data. We therefore suggest an alternative instrumental variables approach that statistically mimics an experimental study and does not rely on prices as explanatory variables. This approach is applied to German survey data. Our estimation results suggest that a reduction in tobacco consumption results in a moderate reduction in alcohol consumption. It is shown theoretically that this implies that alcohol and tobacco are complements. Hence, we conclude that successful anti-smoking policies will not result in the unintended side-effect of an increased (ab)use of alcohol.
    Keywords: complements or substitutes, interdependence in consumption, tobacco and alcohol, insufficient price-variation, instrumental variables approach
    JEL: C31 D12 I12
    Date: 2008–03
  6. By: Michael Cameron (University of Waikato); John Gibson (University of Waikato); Kent Helmers (Independent Consultant); Steven Lim (University of Waikato); John Tressler (University of Waikato); Kien Vaddanak (Cambodian Red Cross)
    Abstract: Development agencies spend approximately US$400 million per year on landmine clearance. Yet many cost-benefit evaluations suggest that landmine clearance is socially wasteful because costs appear to far outweigh social benefits. This paper presents new estimates of the benefits of clearing landmines based on a contingent valuation survey in two provinces in rural Cambodia where we asked respondents questions that elicit their tradeoffs between money and the risk of death from landmine accidents. The estimated Value of a Statistical Life (VSL) is US$0.4 million. In contrast, most previous studies of landmine clearance use foregone income or average GDP per capita, which has a lifetime value of only US$2,000 in Cambodia. Humanitarian landmine clearance emerges as a more attractive rural development policy when appropriate estimates of the VSL are used.
    Keywords: benefit-cost analysis; contingent valuation; landmines; value of statistical life
    JEL: J17 O22
    Date: 2008–03–25
  7. By: Reuter, Peter
    Abstract: The production of cocaine and heroin, the two most important drugs economically, has been concentrated in a small number of poor nations for 25 years. A slightly larger number of developing nations have been affected by large-scale trafficking in these two drugs. This paper reviews what is known about drug control programs and considers non-traditional options. The usual array of programs for suppressing drug problems, enforcement, treatment, harm reduction and prevention have been assessed almost exclusively in wealthy nations. Although treatment has been shown to be cost-effective, it is of minimal relevance for reducing the drug problems of nations such as Afghanistan, Colombia, Mexico or Tajikistan, which are primarily harmed by production and trafficking rather than consumption. Efforts to reduce drug production and trafficking have not been subject to systematic evaluation but the best interpretation of the available evidence is that they have had minimal effect on the quantities produced or trafficked. It is reasonable to conclude that international drug control efforts can do more to affect where these drugs are produced rather than the quantity. If that is the case, and given that spreading a specific level of production or trafficking to more rather than fewer nations probably decreases global welfare, it may be appropriate to consider a less aggressive stance to current producers and to make strategic decisions about the location of an industry producing a global bad.
    Keywords: Crime and Society,Economic Theory & Research,Markets and Market Access,Alcohol and Substance Abuse,Post Conflict Reconstruction
    Date: 2008–03–01
  8. By: Chumacero, Romulo A.
    Abstract: This paper presents a general equilibrium model for the production, trafficking, and consumption of illegal drugs which endogenously determines relative prices and quantities. The model is calibrated to characterize the market for cocaine and is used to analyze the effects of three types of policies: making the illegal activities riskier, increasing the penalties for conducting illegal activities, and legalizing previously illegal activities. Assessing the effects of these policies using the powerful tool of a general equilibrium model provides illuminating (and in cases surprising) results.
    Keywords: Economic Theory & Research,Debt Markets,Markets and Market Access,Consumption,Currencies and Exchange Rates
    Date: 2008–03–01
  9. By: Börsch-Supan, Axel (Sonderforschungsbereich 504)
    Abstract: Disability insurance – the insurance against the loss of the ability to work – is a substantial part of social security expenditures in many countries. The enrolment rates in disability insurance vary strik-ingly across European countries and the US. This paper investigates the extent of, and the causes for, this variation, using data from SHARE, ELSA and HRS. We show that even after controlling for differences in the demographic structure and health status these differences remain. In turn, indicators of disability insurance generosity explain 75% of the cross-national variation. We conclude that country-specific disability insurance rules are a prime can-didate to explain the observed cross-country variation in disability insurance enrolment.
    Date: 2007–05–08
  10. By: Rice, N; Robone, S; Smith, P.C
    Abstract: Measuring the performance of health systems has become a key tool in aiding decision makers to describe, analyze, compare and ultimately improve the delivery and outcomes achieved by a system. The World Health Organization’s (WHO) framework for assessing performance includes three intrinsic goals of health systems, namely health improvement, fairness in financial contribution and responsiveness to user preferences. Broadly speaking health system responsiveness can be defined as the way in which individuals are treated and the environment in which they are treated, encompassing the notion of patient experience. Perhaps the most ambitious attempt to implement a cross-country comparative instrument aimed at measuring health system performance is the World Health Survey (WHS). The modules on responsiveness and health ask respondents to rate their experiences using a 5-point categorical scale (e.g. “very good” to “very bad”). A common problem with self-reported data is that individuals, when faced with the instrument, are likely to interpret the meaning of the response categories in a way that systematically differs across populations or population sub-groups. In such cases the ordinal response categories will not be cross-population comparable since they will not imply the same underlying level of the construct. Recently the method of anchoring vignettes has been promoted as a means for controlling for systematic differences across socioeconomic groups in preferences, expectations and norms when responding to survey questions. This paper applies the method of anchoring vignettes to adjust survey reports of responsiveness for reporting heterogeneity. We present preliminary results for a selected number of domains and countries to illustrate the approach and find systematic reporting by income and education, but not by age and gender. Further analysis will extend the method to a larger set of countries and domains to investigate more fully the application of the approach for international comparative analysis of health system performance.
    Date: 2008–03
  11. By: Tauchmann, Harald
    Abstract: In contrast to West-Germany, illicit drugs were virtually absent in the East-Germany until 1990. Yet, after the collapse of the former GDR, East-Germany was expected to encounter a sharp increase in the prevalence of substance abuse. By analyzing individual data, we find that East-Germany largely caught up with West-Germany’s ever-growing prevalence of illicit drugs within a single decade. We decompose the west-east difference in prevalence rates into an explained and an unexplained part using a modified Blinder-Oaxaca procedure. This decomposition suggests that the observed convergence is just weakly related to socioeconomic characteristics and therefore remains mainly unexplained. That is, West- and East-Germans seem to have become more alike per se. We conclude that both parts of the country have converged in terms of the culture of drug consumption.
    Keywords: illicit drugs, west-east convergence, decomposition
    JEL: I12 P23 P36
    Date: 2008

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