nep-hea New Economics Papers
on Health Economics
Issue of 2008‒08‒14
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health-related Quality of Life of Patients with Generalized Anxiety Disorder By Juan Manuel Cabasés Hita; Eduardo Sánchez Iriso; Joan Rovira i Forns
  2. Longitudinal Data Collection in Continental Europe: Experiences from the Survey of Health, Ageing and Retirement in (SHARE) By Axel Börsch-Supan; Karsten Hank; Hendrik Jürges; Mathis Schröder
  3. Childhood Mortality and Economic Growth By Sonia Bhalotra
  4. Health Status Determinants: Lifestyle, Environment, Health Care Resources and Efficiency By Isabelle Joumard; Christophe André; Chantal Nicq; Olivier Chatal
  5. Self-assessed health as a key determinant of lifestyles: An application to tobacco consumption in Argentina By Mariana Conte Grand; Vanesa D´Elia
  6. A Health Production Function for Sub-Saharan Africa (SSA). By Bichaka Fayissa; Paulos Gutema
  7. Disease Control By Dean Jamison; Prabhat Jha; David E. Bloom
  8. The Mortality and Morbidity Transitions in Sub-Saharan Africa: Evidence from Adult Heights By Yoko Akachi; David Canning
  9. Bayesian Demographic Modeling and Forecasting: An Application to U.S. Mortality By Wolfgang Reichmuth; Samad Sarferaz
  10. Price Adjustment in the Hospital Sector By Marisa Miraldo; Luigi Siciliani; Andrew Street
  11. Integrating Mental Health in Welfare Evaluation: An Empirical Application By Das, Sanghamitra; Mukhopadhyay, Abhiroop; Ray, Tridip
  12. Negative Reality of the HIV Positives: Evaluating Welfare Loss in a Low Prevalence Country By Das, Sanghamitra; Mukhopadhyay, Abhiroop; Ray, Tridip
  13. Social Health Insurance in Vietnam By Giang, Thanh Long

  1. By: Juan Manuel Cabasés Hita (Departamento de Economía-UPNA); Eduardo Sánchez Iriso (Departamento de Economía-UPNA); Joan Rovira i Forns (Universidad de Barcelona)
    Abstract: Aims: To analyze the health-related quality of life of patients with Generalized Anxiety Disorder (GAD), with respect to the population at large and to a control group. The following goals are addressed: 1.- To determine what, if any, differences exist between the health status of patients diagnosed with GAD, the population in general and a group of control patients; 2.- To analyze the relation between the variables age, sex, and health status (as assessed by the patient's GP) measured on the Hamilton anxiety scale, with the quality of life of the GAD patients and of the control group; 3.- To determine whether the variables age, sex, Hamilton scale values and index of quality of life influence the annual cost caused by the illness; 4.- To determine whether there are any differences in the evaluation of the same health status made by GAD patients and by the general population. This study forms part of a broader- ranging one (the ANCORA Study) set up to analyze Generalized Anxiety Disorder (GAD) and the costs and other burdens provoked by this illness in Spain. Material and Methods: Regression models were used to obtain the EQ-5D index ofhealth state (EQindex) and to analyze the above-mentioned variables. The data on patients and on the costs of the illness are those registered in the ANCORA study. Results: The patients with GAD present a self-perceived level of health (EQ-5D) that is conspicuously below that corresponding to the general population, especially in three of the dimensions, namely usual activities, pain/discomfort and anxiety/depression. The mean value of the health index (EQindex) is ten points below that of the general population and that of the control group. Age was found to be negatively related to the health variables, as was a higher score on the Hamilton scale. For the group of patients with GAD, a worse perceived health state and a higher score on the Hamilton scale were associated with higher costs, although in the latter case the explicative power of the model is weak. Finally, the GAD patients assessed their health status more negatively than did the general population, with a visual analogue scale (VAS) result that was four points lower than that made by the general population.
    Keywords: listas de espera; priorización; modelos de elección discreta
    Date: 2008
  2. By: Axel Börsch-Supan; Karsten Hank; Hendrik Jürges; Mathis Schröder (Mannheim Research Institute for the Economics of Aging (MEA))
    Date: 2008–08–05
  3. By: Sonia Bhalotra
    Abstract: This paper investigates the extent to which the decline in childhood mortality over the last three decades can be attributed to economic growth. In doing this, it exploits the considerable variation in growth over this period, across states and over time. The analysis is able to condition upon a number of economic and demographic variables. The estimates are used to produce a crude estimate of the rate of economic growth that would be necessary to achieve the Millennium Development Goal of reducing the under-5 mortality by two thirds, from its level in 1990, by the year 2015. The main conclusion is that, while growth does have a significant impact on mortality risk, growth alone cannot be relied upon to achieve the goal.
    Keywords: childhood mortality, economic growth, MDGs, India
    JEL: O12 I12 I18 J13
    Date: 2008–01
  4. By: Isabelle Joumard; Christophe André; Chantal Nicq; Olivier Chatal
    Abstract: This paper aims to shed light on the contribution of health care and other determinants to the health status of the population and to provide evidence on whether or not health care resources are producing similar value for money across OECD countries. First, it discusses the pros and cons of various indicators of the health status, concluding that mortality and longevity indicators have some drawbacks but remain the best available proxies. Second, it suggests that changes in health care spending, lifestyle factors (smoking and alcohol consumption as well as diet), education, pollution and income have been important factors behind improvements in health status. Third, it derives estimates of countries’ relative performance in transforming health care resources into longevity from two different methods – panel data regressions and data envelopment analysis – which give remarkably consistent results. The empirical estimates suggest that potential efficiency gains might be large enough to raise life expectancy at birth by almost three years on average for OECD countries, while a 10% increase in total health spending would increase life expectancy by three to four months. <P>Déterminants de l’état de santé : style de vie, environnement socio-économique, ressources <BR>Ce document examine la contribution des soins médicaux ainsi que d’autres facteurs à l’état de santé de la population et tente de déterminer si les dépenses dans le domaine de la santé produisent les mêmes résultats selon les pays de l’OCDE. En premier lieu, il s’interroge sur les avantages et les inconvénients des différents indicateurs de l’état de santé et en conclut que, malgré leurs défauts, les indicateurs de mortalité et de longévité demeurent les meilleures approximations disponibles. Il suggère ensuite que les évolutions des dépenses de santé, des modes de vie (consommation de tabac et d’alcool, régime alimentaire), du niveau d’éducation, de la pollution et des revenus ont été des facteurs importants de l’amélioration de l’état de santé. Enfin, il estime la capacité relative des différents pays à transformer les ressources médicales en accroissement de la longévité, en s’appuyant sur deux méthodes différentes (régressions sur données de panel et analyse d’enveloppement de données) qui donnent des résultats remarquablement similaires. Les estimations empiriques suggèrent que l’espérance de vie pourrait s’accroitre de presque trois ans en moyenne dans les pays de l’OCDE si les ressources médicales disponibles étaient utilisées plus efficacement, tandis qu’une augmentation des dépenses totales de santé de 10% se traduirait par trois à quatre mois d’espérance de vie supplémentaire.
    Keywords: dépenses publiques, public expenditure, data envelopment analysis, analyse par enveloppement des données, healthcare, spending efficiency, panel data regressions, health status, état de santé, système médical, efficacité de la dépense, régressions sur données de panel
    JEL: C23 H51 I12 O57
    Date: 2008–08–04
  5. By: Mariana Conte Grand; Vanesa D´Elia
    Abstract: The relationship between lifestyle choices and health has been widely studied in the epidemiological and economic literature. In the last years, empirical research was directed towards the use of recursive systems with structural equations for a health production function and reduced form equations for lifestyles. As a result, behaviors toward health are taken to be determined by exogenous socio-economic variables. In this article, we show that health is a key determinant of health habits. When people feel well, they adopt less healthy behaviors. We use maximum simulated likelihood for a multivariate 5 equation probit model. In that model, lifestyles (diet, exercise, alcohol consumption and smoking) are a function of exogenous socioeconomic variables and self-reported health. Self-reported health varies with socio-economic characteristics and depends on health indicators that are the consequence of lifestyles undertaken in the past (i.e., overweight, blood pressure, diabetes and cholesterol levels). Data is that of adults in Argentina´s 2005 Risk Factors National Survey. We find that health partial effects on lifestyle are much larger having accounted for health endogeneity. Accounting for unobservable variables that jointly determine all lifestyles does not change much the magnitude of our results. Our findings are robust to different specifications.
    Keywords: lifestyles, health
    JEL: I10 I12
    Date: 2008–07
  6. By: Bichaka Fayissa; Paulos Gutema
    Abstract: The paper estimates a health production function for Sub-Saharan Africa based on the Grossman (1972) theoretical model that treats social, economic, and environmental factors as inputs of the production system. In estimating this function, socioeconomic and environmental factors such as income per capita, illiteracy rate, food availability, ratio of health expenditure to GDP, urbanization rate, and carbon dioxide emission per worker are specified as determinants of health status, proxied by life expectancy at birth. The parameters of the function are estimated by a method of one-way and two-way panel data analyses. The results obtained from two-way random effect model suggest that an increase in income per capita, a decrease in illiteracy rate, an increase in food availability are well associated with improvement in life expectancy at birth. Overall results suggest that a health policy, which may focus on the provision of health, services, family planning programs, and emergency aids to the exclusion of other socioeconomic aspects may do little in efforts directed toward improving the current health status of the region.
    Keywords: Sub-Saharan Africa, Health expenditure, Production function, Medical care, Panel data.
    JEL: I12 I18
    Date: 2008–08
  7. By: Dean Jamison (Harvard Kennedy Schhol and School of Public Health); Prabhat Jha (Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Canada); David E. Bloom (Harvard School of Public Health)
    Abstract: This paper identifies priorities for disease control as an input into the Copenhagen Consensus effort for 2008 (CC08). As such, it updates the evidence and differs somewhat in its conclusions from the communicable disease paper (Mills and Shilcutt, 2004) prepared for Copenhagen Consensus 2004, which Lomborg (2006) summarizes.
    Keywords: Disease, control, global health, Copenhagen Consensus.
    Date: 2008–06
  8. By: Yoko Akachi (European University Institute); David Canning (Harvard School of Public Health)
    Abstract: In most developing countries, rising levels of nutrition and improvements in public health have led to declines in infant mortality and rising adult heights. In Sub-Saharan Africa we see a different pattern. Sub-Saharan Africa has seen large reductions in infant mortality over the last fifty years, but without any increase in protein and energy intake and against a background of stagnant, or declining, adult height. Adult height is a sensitive indicator of the nutrition and morbidity prevailing during the childhood of the cohort and can be taken as a measure of health human capital. Declining infant mortality rates in Sub-Saharan Africa appear to be driven by medical interventions that reduce infant mortality, rather than by broad based improvements in nutrition and public health measures, and may not be reflective of broad based health improvements.
    Keywords: mortality, Sub-Saharan, morbidity, heights
    Date: 2008–05
  9. By: Wolfgang Reichmuth; Samad Sarferaz
    Abstract: We present a new way to model age-specific demographic variables with the example of age-specific mortality in the U.S., building on the Lee-Carter approach and extending it in several dimensions. We incorporate covariates and model their dynamics jointly with the latent variables underlying mortality of all age classes. In contrast to previous models, a similar development of adjacent age groups is assured allowing for consistent forecasts. We develop an appropriate Markov Chain Monte Carlo algorithm to estimate the parameters and the latent variables in an efficient one-step procedure. Via the Bayesian approach we are able to asses uncertainty intuitively by constructing error bands for the forecasts. We observe that in particular parameter uncertainty is important for long-run forecasts. This implies that hitherto existing forecasting methods, which ignore certain sources of uncertainty, may yield misleadingly sure predictions. To test the forecast ability of our model we perform in-sample and out-of-sample forecasts up to 2050, revealing that covariates can help to improve the forecasts for particular age classes. A structural analysis of the relationship between age-specific mortality and covariates is conducted in a companion paper.
    Keywords: Demography, Age-specific, Mortality, Lee-Carter, Stochastic, Bayesian, State Space Models, Forecasts
    JEL: C11 C32 C53 I10 J11
    Date: 2008–07
  10. By: Marisa Miraldo (Centre for Health Economics, University of York); Luigi Siciliani (Centre for Health Economics and Department of Economics and Realted Studies, University of York and CEPR, London); Andrew Street (Centre for Health Economics, University of York)
    Abstract: Prospective payment systems are currently used in many OECD countries, where hospitals are paid a fixed price for each patient treated. We develop a theoretical model to analyse the properties of the optimal fixed prices to be paid to hospitals when no lump-sum transfers are allowed and when the price can differ across providers to reflect observable exogenous differences in costs (for example land, building and staff costs). We find that: a) when the marginal benefit from treatment is decreasing and the cost function is the (commonly used) power function, the optimal price adjustment for hospitals with higher costs is positive but partial; if the marginal benefit from treatment is constant, then the price is identical across providers; b) if the cost function is exponential, then the price adjustment is positive even when the marginal benefit from treatment is constant; c) the optimal price is lower when lump-sum transfers are not allowed, compared to when they are allowed; d) higher inequality aversion of the purchaser is associated with an increase in the price for the high-cost providers and a reduction in the price of the low-cost providers.
    Keywords: Price adjustment, Hospitals, DRGs.
    JEL: I11 I18
    Date: 2008–08
  11. By: Das, Sanghamitra; Mukhopadhyay, Abhiroop; Ray, Tridip
    Abstract: This paper presents simple measures of individual and family mental health indices based on axiomatic foundations and integrates mental health into a neoclassical model that allows for proper substitution possibilities in the family preferences and quantifies its significance in family utility. We find that mental health effects are far more important than the effect of consumption or children’s schooling in determining family utility. We illustrate the usefulness of our approach by considering the case of HIV/AIDS experience in India. Using our approach, we find that while there are no significant differences in per capita consumption and schooling between HIV and NON HIV families, the cost of HIV/AIDS are still considerably large due to the inclusion of mental health. Integrating mental health in a utility maximization framework helps us quantify these costs.
    JEL: C10 I31 I10
    Date: 2007–08–16
  12. By: Das, Sanghamitra; Mukhopadhyay, Abhiroop; Ray, Tridip
    Abstract: Using primary household data from India we estimate family utility function parameters that measure the relative importance of consumption, schooling of children and health (both physical and mental) and find that mental health is far more important than consumption or children’s schooling in determining household utility. We then estimate that the monetary equivalent of the welfare loss to an HIV family is Rs. 66,039 per month, whereas the losses to an HIV male and female are Rs. 67,601 and Rs. 65,120 per month respectively. These figures are huge given that the average per capita consumption expenditure of the families in our sample is just Rs. 1,019 per month. This huge magnitude is not surprising as it includes private valuation of one’s own life as well as the cost of stigma for being HIV positive. In addition, the annual loss from external transfers (through debt, sale of assets and social insurance) accounts for 2.6% of annual health expenditure and 0.12% of GDP in 2004. The significance of mental health in welfare evaluation can be gauged from the fact that, for an average HIV family, a whopping 74% of the welfare loss comes from aspects of mental health.
    Keywords: HIV/AIDS; Mental Health; Physical Health; Welfare Loss; Family Preference.
    JEL: C10 O10 D10 I10
    Date: 2008–02–27
  13. By: Giang, Thanh Long
    Abstract: This paper aims to provide an overview of the social health insurance scheme in Vietnam, including historical development and current policy issues. It shows that the scheme has significantly contributed to the impressive progresses of the country’s health sector, but it also will face a variety of administrative and financial challenges posed by labor mobility, widening inequality, poverty severity, and expected aging population. The paper also discusses some policy recommendations to improve effectiveness of the scheme, as well as to cope with challenges for further development.
    Keywords: social health insurance; health care financing; Vietnam
    JEL: I18 I19
    Date: 2008–05

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