nep-hea New Economics Papers
on Health Economics
Issue of 2008‒07‒30
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Nurse-To-Patient Ratios in Hospital Staffing: A Queueing Perspective By Francis de Véricourt,; Otis B. Jennings
  2. The Effect of Expansions in Maternity Leave Coverage on Children's Long-Term Outcomes By Dustmann, Christian; Schönberg, Uta
  3. The Recent Decline in the Employment of Persons with Disabilities in South Africa, 1998-2006 By Sophie Mitra
  4. Contractual Conditions, Working conditions, Health and Well-Being in the British Household Panel Survey By Robone, S; Jones, A. M; Rice, N
  5. Modelling and Measuring Inequality of Opportunity in Health: Evidence from a Cohort Study By Rosa Dias, P
  6. Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies By Manca, A; Austin, P. C
  7. Higher Education, the Health Care Industry, and Metropolitan Regional Economic Development: What Can “Eds & Meds” Do for the Economic Fortunes of a Metro Area’s Residents? By Timothy J. Bartik; George Erickcek
  8. Remittances and the household’s expenditures on health By Valero-Gil, Jorge
  9. Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams By Joseph J. Doyle, Jr.; Steven M. Ewer; Todd H. Wagner

  1. By: Francis de Véricourt, (ESMT European School of Management and Technology); Otis B. Jennings (Duke University)
    Abstract: The immediate motivation of this paper is California Bill AB 394, legislation which mandates fixed nurse-to-patient staffing ratios as a means to address the current crisis in the quality of health care delivery. Modeling medical units as closed queueing systems, we seek to determine whether or not ratio policies are effective at managing nurse workload. Our many-server asymptotic results suggest that ratio policies cannot provide consistently high service quality across medical units of different sizes. As a remedy, we recommend policies that deviate from the restrictive linear nature of ratio policies, employing the "square root rule" commonly used to staff large service systems. Under some quality of care assumptions, our policies exhibit a type of "super" pooling effect, in which, for large systems, the requisite workforce is significantly smaller than the nominal patient load.
    Keywords: queueing system, health care, public policy, nursing, staffing, manyserver limit theorems
    Date: 2008–07–03
  2. By: Dustmann, Christian (University College London); Schönberg, Uta (University of Rochester)
    Abstract: This paper evaluates the impact of three major expansions in leave coverage in Germany on the long-run education and labor market outcomes of children. Evaluation of three policy reforms as opposed to a single reform enables us to analyze whether the impact of paid leave differs from that of unpaid leave, and whether an expansion of a relatively short leave period is more beneficial to child development than an expansion of an already long leave period. Our empirical analysis combines two large administrative data sources on wages, unemployment, and school outcomes. We identify the causal impact of the reforms by comparing outcomes of children born shortly before and shortly after a change in maternity leave legislation, and therefore require substantially weaker assumptions for identification than existing studies. We find little support for the hypothesis that an expansion in maternity leave legislation improves children’s outcomes. Given the precision of our estimates, we can statistically rule out the hypothesis that the expansion in paid leave from 2 to 6 (unpaid leave from 18 to 36) months raised wages (attendance at high track schools) by more than 0.3 % (0.1 %).
    Keywords: child development, maternity leave
    JEL: J13 H52 J2
    Date: 2008–07
  3. By: Sophie Mitra (Fordham University, Department of Economics)
    Abstract: This paper shows that there has been a significant decline in the employment and labor force participation of persons with disabilities in South Africa over the 1998 through 2006 period. Disability is defined based on activity limitations. Data are from the October and the General Household Surveys. The paper also deals with the possible causes of the decline. While several causes can be invoked, preliminary evidence suggests that the rise of the Disability Grant program might be responsible for a part of the decline. Recommendations are made for future research and data collection on disability and employment.
    Date: 2008
  4. By: Robone, S; Jones, A. M; Rice, N
    Abstract: We consider the effects of contractual and working conditions on self-assessed health and psychological well-being using twelve waves (1991/92 – 2002/2003) of the British Household Panel Survey. While one branch of the literature suggests that “atypical” contractual conditions have a significant impact on health and well-being, another suggests that health is damaged by adverse working conditions. As far as we are aware, previous studies have not explicitly considered the two factors jointly. Our aim is to combine the two branches of the literature to assess the distinct effects of contractual and working conditions on health and psychological well-being and how these effects vary across individuals. For self-assessed health the dependent variable is categorical, and we estimate non-linear dynamic panel ordered probit models, while for psychological well-being we estimate a dynamic linear specification. Our estimates show that being unsatisfied with the number of hours worked has a negative influence on the health of individuals who have a part-time job. Having a high level of employability appears to influence positively the health and psychological well-being of individuals with temporary job arrangements. Family structure appears to influence the health and well-being of workers with atypical contractual conditions.
    Keywords: working conditions, contractual conditions, self assessed health, psychological well-being, dynamic panel data models
    JEL: C23 I10 J41 J81
    Date: 2008–07
  5. By: Rosa Dias, P
    Abstract: This paper uses data from the National Child Development Study to propose an empirical implementation of the concept of inequality of opportunity in health. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socio-economic status and childhood health; effort is proxied by health-related lifestyles and educational attainment. The paper is divided in three parts. First, a set of stochastic dominance tests is used to detect inequality of opportunity in the conditional distributions of self-assessed health in adulthood. Second, relying on a comprehensive set of circumstances, two alternative approaches are used to measure inequality of opportunity in health. Finally, in order to illuminate the triangular relationship between circumstances, effort and health, a structural model which relates selfassessed health in adulthood to lifestyles and educational attainment is considered. A recursive system of equations for self-assessed health, lifestyles and educational attainment is estimated by full information maximum likelihood to unveil the causal relationships at stake. The results indicate the existence of considerable and persistent inequality of opportunity in health. They also suggest that circumstances affect health in adulthood both directly and through effort factors such as educational attainment. This indicates that, while the influence of some unjust circumstances can only be tackled during childhood, the implementation of complementary educational policies may be of paramount importance to reduce health inequalities.
    Date: 2008–05
  6. By: Manca, A; Austin, P. C
    Abstract: The methodology relating to the statistical analysis of individual patient-level cost-effectiveness data collected alongside randomised controlled trials (RCTs) has evolved dramatically in the last ten years. This body of techniques has been developed and applied mainly in the context of the randomised clinical trial design. There are, however, many situations in which a trial is neither the most suitable nor the most efficient vehicle for the evaluation. This paper provides a tutorial-like discussion of the ways in which propensity score methods could be used to assist in the analysis of observational individual patient-level cost-effectiveness data. As a motivating example, we assessed the cost-effectiveness of CABG versus PTCA – one year post procedure - in a cohort of individuals who received the intervention within 365 days of their index admission for AMI. The data used for this paper were obtained from the Ontario Myocardial Infarction Database (OMID), linking these with data from the Canadian Institute for Health Information (CIHI), the Ontario Health Insurance Plan (OHIP), the Ontario Drug Benefit (ODB) program, and Ontario Registered Persons Database (RPDB). We discuss three ways in which propensity score can be used to control for confounding in the estimation of average cost-effectiveness, and provide syntax codes for both propensity score matching and cost-effectiveness modelling.
    Keywords: Cost, cost-effectiveness, propensity score, revascularisation, statistical methods
    Date: 2008–07
  7. By: Timothy J. Bartik (W.E. Upjohn Institute for Employment Research); George Erickcek (W.E. Upjohn Institute for Employment Research)
    Abstract: This paper examines the effects of expansions in higher educational institutions and the medical service industry on the economic development of a metropolitan area. This examination pulls together previous research and provides some new empirical evidence. We provide quantitative evidence of the magnitude of economic effects of higher education and medical service industries that occur through the mechanism of providing some export-base demand stimulus to a metropolitan economy. We also provide quantitative evidence on how much higher education institutions can boost a metropolitan economy through increasing the educational attainment of local residence. We estimate that medical service industries pay above average wages, holding worker characteristics constant, whereas the higher education industry pays below average wages; the wage standards of these industries may affect overall metropolitan wages. We also discuss other mechanisms by which these two industries may boost a metropolitan economy, including: increasing local amenities, generating R&D spillovers, increasing the rate of entrepreneurship in local businesses, and helping provide local leadership on development and growth issues. Finally, the paper discusses possible effects of these two industries on disparities between the central city and suburbs in a metropolitan area.
    Keywords: higher, education, medical, service, industry, regional, economic, development
    JEL: R58 R11 R23 R53
    Date: 2007–02
  8. By: Valero-Gil, Jorge
    Abstract: This paper considers the effect of remittances on the share of health expenditures to total household expenditure. The main purpose of this paper is to investigate whether remittances are especially targeted towards household’s health in Mexico. We use a Tobit model with random effects and find a statistically significant effect of remittances on the proportion of health expenditures for households that do not have access to employment’s medical insurance: Our results suggest that around 10% of changes in remittances are devoted to health expenditure.
    Keywords: Health expenditure; Remittances; Tobit; Health related consumption
    JEL: D12 I12 F24
    Date: 2008–06–24
  9. By: Joseph J. Doyle, Jr.; Steven M. Ewer; Todd H. Wagner
    Abstract: Patient sorting can confound estimates of the returns to physician human capital. This paper compares nearly 30,000 patients who were randomly assigned to clinical teams from one of two academic institutions. One institution is among the top medical schools in the country, while the other institution is ranked lower in the quality distribution. Patients treated by the two teams have identical observable characteristics and have access to a single set of facilities and ancillary staff. Those treated by physicians from the higher-ranked institution have 10-25% shorter and less expensive stays than patients assigned to the lower-ranked institution. Health outcomes are not related to the physician team assignment, and the estimates are precise. Procedure differences across the teams are consistent with the ability of physicians in the lower-ranked institution to substitute time and diagnostic tests for the faster judgments of physicians from the top-ranked institution.
    JEL: I12 J24
    Date: 2008–07

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