nep-hea New Economics Papers
on Health Economics
Issue of 2008‒07‒20
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Are employers discriminating with respect to weight? European Evidence using Quantile Regression By Vincenzo Atella; Noemi Pace; Daniela Vuri
  2. The Recipient Value and Distributional Impact of the Commonwealth Seniors Health Card in 2007 By Siminski, Peter
  3. Health and Income Poverty in Ireland, 2003-2006 By Madden, D
  4. The Effects of Financial Incentives on Quality of Care: The Case of Diabetes By Scott, A; Schurer, S; Jensen, P H; Sivey, P
  5. Job loss does not cause ill health By Salm, M
  6. Impact of Private Health Insurance on the Choice of Public versus Private Hospital Services By Srivastava, P; Zhao, X
  7. Universities and access to medicines: What is the optimal ‘humanitarian license’? By Annamaria Conti; Patrick Gaulé
  8. Trends in Health Status and Infrastructural Support in Tamil Nadu By Dhas, Albert Christopher; Helen, Mary Jacqueline
  9. Retirement Effects on Health in Europe By Norma B. Coe; Gema Zamarro
  10. Working Paper 04-08 - Estimating private health expenditures within a dynamic consumption allocation model By Peter Willemé
  12. Health status, Neighbourhood effects and Public choice: Evidence from France By Thierry Debrand; Aurélie Pierre; Caroline Allonier; Veronique Lucas-Gabrielli
  13. Social heterogeneity in self-reported health status and measurement of inequalities in health By Sandy Tubeuf; Florence Jusot; Marion Devaux; Catherine Sermet

  1. By: Vincenzo Atella (Faculty of Economics, University of Rome "Tor Vergata"); Noemi Pace (Faculty of Economics, University of Rome "Tor Vergata"); Daniela Vuri (Faculty of Economics, University of Rome "Tor Vergata")
    Abstract: The aim of this research is to investigate the relationship between obesity and wages, using data for nine countries from the European Community Household Panel (ECHP) over the period 1998-2001. We improve upon the existing literature by adopting a Quantile Regression approach to characterize the heterogenous impact of obesity at different points of the wage distribution. Our results show that i) the evidence obtained from mean regression and pooled analysis hides a significant amount of heterogeneity as the relationship between obesity and wages differs across countries and wages quantiles and ii) cultural, environmental or institutional settings do not seem to be able to explain differences among countries, leaving room for a pure discriminatory effect hypothesis.
    Keywords: quantile treatment effect, obesity, wages, endogeneity
    JEL: C12 C21 C23 I10 I18
    Date: 2008–07–14
  2. By: Siminski, Peter (University of Wollongong)
    Abstract: This paper considers the recipient value  and distributional impact of the Common wealth Seniors Health Card (CSHC) by ana lysing a range of possible behavioural r esponses to economic incentives. First,  I estimate the recipient value by consid ering the trade-off between moral hazard  and risk pooling. The utility gain thro ugh risk-pooling is found to be negligib le. The deadweight loss through moral ha zard may be considerable. I also use ill ustrative models to demonstrate the poss ible effects of the CSHC on savings and  labour supply. Whilst the CSHC may induc e some people to save and work more, it  may have the opposite effect on others.
    Keywords: distributional impact, health insurance, recipient value, Australia, retirement 
    JEL: H42 H31 H51 D91
    Date: 2008
  3. By: Madden, D
    Abstract: Recent advances in the measurement of bi-dimensional poverty are applied to a measure of poverty which incorporates income and health poverty. The correlation between income and poverty is examined using the Receiver Operating Characteristics curve. Following from this unidimensional and bi-dimensional poverty indices are calculated for Ireland for the years 2003-2006. Individual and bi-dimensional indices generally show a decline over the period with the biggest decline between 2003 and 2004. The results are generally not sensitive to the degree of poverty aversion or the substitutability between the different dimensions of poverty.
    Keywords: receiver operating characteristic, multidimensional poverty.
    JEL: I12 I31 I32
    Date: 2008–07
  4. By: Scott, A; Schurer, S; Jensen, P H; Sivey, P
    Abstract: Australia introduced an incentive payment scheme for general practitioners to ensure systematic and high quality care in chronic disease management. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect on the quality of care. This paper evaluates the impact of the payment incentives on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a multivariate probit model to control for the simultaneous self-selection process of practices into the payment scheme and larger practices. The study finds that the incentive reform had a positive effect on quality of care in diabetes management and that participation in the scheme is facilitated by the support of Divisions of General Practice.
    Keywords: Pay-for-performance, multivariate probit models, health care systems.
    JEL: I11 C21
    Date: 2008–07
  5. By: Salm, M
    Abstract: I use longitudinal data from the Health and Retirement Study to estimate the effect of job loss on health for near elderly employees. Job loss is a major cause of economic insecurity for working age individuals, and can cause reduction in income, and loss of health insurance. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers’ business. I find that the unemployed are in worse health than employees, and that health reasons are a common cause of job termination. In contrast, I find no causal effect of exogenous job loss on various measures of health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality. I also use instrumental variable regression to estimate the effect of loss of health insurance, loss of income, and re-employment on health, and again find no statistically significant effects.
    Date: 2008–07
  6. By: Srivastava, P; Zhao, X
    Abstract: The Australian health system is characterised by a mix of public and private service and private health insurance is used in addition to a compulsory universal public insurance to finance health services. A series of reforms have been implemented over the years in order to expand the private sector with the objective to relieve the overburdened public health care system. While private coverage has expanded, a large proportion of the privately insured still opt for public treatment in hospitals. The objective of this paper is to investigate the determinants of individuals’ choice between public and private hospital services, in particular, the impact of private health insurance status. It estimates a recursive trivariate probit system model with partial observability that allows for endogeneity of private insurance participation and potential selection bias as we only observe individuals’ public/private choices for those who have visited a hospital in the past 12 months. Relative to the prevailing two-step estimation for sample selection or endogenous treatment, our full information maximum likelihood (FIML) approach is both consistent and efficient. The study identifies private health insurance status and income as important determinants of private hospital care utilisation. An individual with a private hospital cover has nearly 70 per cent higher chance to opt for private treatment in a hospital and a person within the tenth income decile group has 46 per cent higher probability to seek private hospital care than someone who falls in the third or lower income decile groups. To some extent other factors such as perceived quality of care in the public sector and cost of access are also found to have some impact on the use of private hospital care.
    Keywords: Hospital utilisation, Public/Private health care, Private health insurance, FIML
    Date: 2008–07
  7. By: Annamaria Conti (Chaire en Economie et Management de l'Innovation, Collège du Management de la Technologie, Ecole Polytechnique Fédérale de Lausanne); Patrick Gaulé (Chaire en Economie et Management de l'Innovation, Collège du Management de la Technologie, Ecole Polytechnique Fédérale de Lausanne)
    Abstract: This paper seeks to add an economic contribution to the current debate on using university licensing contracts to improve access to medicines in developing countries. We build a simple model in which we have a university licensing out an academic invention to a profit-maximizing pharmaceutical company. We compare three different types of licensing contracts that the university might use to enhance access to pharmaceuticals in the South: (1) an exclusive license limited to the North; (2) an exclusive license worldwide with a price cap in the South; and (3) an exclusive license worldwide with a price cap in the South and a clause specifying that the licensee would lose its exclusivity in the South if it does not supply the Southern market. We show that in a simple model with asymmetric information on production costs the latter type of contract dominates the two others.
    Keywords: technology licensing, university licensing, access to medicines
    JEL: L3 O32 O34 O38
    Date: 2008–02
  8. By: Dhas, Albert Christopher; Helen, Mary Jacqueline
    Abstract: This paper aimed at examining the health status in Tamil Nadu and to highlight the major issues on it. The health scenario of Tamil Nadu was examined, based on certain selected health indicators and the extent of health infrastructure available in the state and its utilisation were also discussed The study observed that there is a reduction in the vital statistics such as birth rate, death rate and infant mortality rate and an increase in the life expectancy at birth in Tamil Nadu during the last three decades. These trends indicated the developments in the health status of the people and the steady progress in the health indicators. The study argued that though the demographic indicators and vital statistics indicate very high of Tamil Nadu in terms of health performance, there are several areas in which improvements are possible. To conclude, Tamil Nadu seems to have performed better compared to All India average in demographic and several health indicators. However, Tamil Nadu is capable of much higher levels of achievements with its knowledge base, administrative and institutional strength and its growth potentials.
    Keywords: Health Status; Health Infrastructure; Health Issues; Health Scenario; Birth Rate; Death Rate; Infant Mortality; Life Expectancy; Infant Mortality; Mortality Rate;Tamil Nadu
    JEL: H51 H75 R5
    Date: 2008–07–10
  9. By: Norma B. Coe; Gema Zamarro
    Abstract: What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual as well as government budgets. The authors use the Survey of Health, Aging and Retirement in Europe (SHARE) dataset to address this question in a multicountry setting. Statutory retirement ages clearly induce retirement, but are not related to an individual's health. The authors find significant evidence that retirement has a health-preserving effect on overall general health but no evidence that retiring at younger ages has a health-preserving effect.
    Keywords: retirement, health, behaviors
    JEL: I10 J26 C21
    Date: 2008–06
  10. By: Peter Willemé
    Abstract: This paper presents a model of Belgian household consumption, with a focus on private health expenditures. To do so, we have formulated and estimated an extension of the classic Almost Ideal Demand System. The original model has been modified by introducing a dynamic adjustment mechanism and by the inclusion of demographic variables. These were expected to capture shifts in consumption patterns related to the changing age composition of the population. The results confirm the expected effects: the ageing of the population is likely to increase the share of private health expenditures (and consumer durables) in the household budget over the coming decades.
    JEL: C8 E24 J23
    Date: 2008–02–18
  11. By: Olufunke A. Alaba (Department of Economics, University of Pretoria); Steven F. Koch (Department of Economics, University of Pretoria)
    Abstract: In developing countries, health insurance is not a commonly purchased nancial instrument. Recent debates have revolved around extending health insurance coverage to a wider range of the population, primarily via compulsory insurance schemes. However, the debate rarely considers the competing demands placed on the family budget. In this paper, we have examined expenditure substitution patterns for both insured and uninsured households in a highly unequal developing country allowing for selection on insurance status. Our analysis suggests that expansion of health insurance coverage via compulsory schemes will create additional burdens for households, especially in terms of food purchases, and are, therefore, likely to require simultaneously implemented welfare or subsidy policies in order to be eective. It is not clear, then, that the benets of a compulsory insurance scheme will outweigh the additional costs in terms of behavioural constraints, scal constraints and public sector service delivery capacity constraints.
    Keywords: Treatment Effects, Hazard
    JEL: I11 G22 D14
    Date: 2008–07
  12. By: Thierry Debrand (IRDES institut for research and information in health economics); Aurélie Pierre (IRDES institut for research and information in health economics); Caroline Allonier (IRDES institut for research and information in health economics); Veronique Lucas-Gabrielli (IRDES institut for research and information in health economics)
    Abstract: Observation of socioeconomic statistics between different neighbourhoods highlights significant differences for economic indicators, social indicators and health indicators. The issue faced here is determining the origins of health inequalities: individual effects and neighbourhood effects. Using National Health Survey and French census data from the period 2002-2003, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors called: "economic and social condition", "mobility" and "generational" and show that these contextual factors are correlated with individual SRHs. Since the 80s, different French governments have formulated public policies in order to take into account the specific problems of disadvantaged and deprived neighbourhoods. In view to concentrating national assistance, the French government has created "zones urbaines sensibles" (ZUS) [Critical Urban Areas, CUA]. Our research shows that in spite of implementing public policy in France to combat health inequalities, by only taking into account the CUA criterion (the fact of being in a CUA or not), many inequalities remain ignored and thus hidden.
    Keywords: Health, Neighbourhood Effect, Housing policy
    JEL: I10 I30 R2
    Date: 2008–06
  13. By: Sandy Tubeuf (Leeds Institute of Health Sciences, Academic Unit of Health Economics); Florence Jusot (IRDES institut for research and information in health economics); Marion Devaux (IRDES institut for research and information in health economics); Catherine Sermet (IRDES institut for research and information in health economics)
    Abstract: This study aims to analyse the impact of the measurement of health status on socioeconomic inequalities in health. A MIMIC model with structural equations is used to create a latent variable of health status from four health indicators: self-assessed health, report of chronic diseases, report of activity limitations and mental health. Then, we disentangle the impact of sociodemographic characteristics on latent health from their direct impact on each heath indicator and discuss their effects on the assessment of socioeconomic inequalities in health. This study emphasises differences in inequalities in health according to latent health. In addition, it suggests the existence of reporting heterogeneity biases. For a given latent health status, women and old people are more likely to report chronic diseases. Mental health problems are over-reported by women and isolated people and under-reported by the oldest people. Active and retired people as well as non manual workers in the top of the social hierarchy more often report activity limitations. Finally, highly educated and socially advantaged people more often report chronic diseases whereas less educated people under-report a poor self-assessed health. To conclude, the four health indicators suffer from reporting heterogeneity biases and the report of chronic diseases is the indicator which biases the most the measurement of socioeconomic inequalities in health.
    Keywords: inequalities in health - MIMIC - reporting bias - structural equations
    JEL: C51 I10
    Date: 2008–06

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