nep-hea New Economics Papers
on Health Economics
Issue of 2008‒10‒21
nineteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Does a Mature AIDS Epidemic Threaten Growth? By José Cuesta Author-X-Name_First: José Author-X-Name_Last: Cuesta
  2. Perception of Own Death Risk: A Reassessment of Road-Traffic Mortality Risk By Andersson, Henrik
  3. Body image and food disorders: Evidence from a sample of European women By Joan Costa i Font; Mireia Jofre-Bonet
  4. Family migration: a vehicle of child morbidity in the informal settlements of Nairobi city, Kenya? By Adama Konseiga
  5. Improving Cost-Effectiveness in the Health Care Sector in Iceland By Hannes Suppanz
  6. "Stratification and Mortality - A Comparison of Education, Class, Status and Income" By Torssander, Jenny; Erikson, Robert
  7. Healthcare Expenditures of Living with a Disability: Total Expenditures, Out of Pocket Expenses and Burden, 1996-2004 By Sophie Mitra; Patricia A. Findley; Usha Sambamoorthi
  8. Is there Complete, Partial, or No Recovery from Childhood Malnutrition? Empirical Evidence from Indonesia By Subha Mani
  9. Inequality in mortality in Vietnam: unravel the causes By Granlund , David; Chuc , NT; Phuc , HD; Lindholm, Lars
  10. Calories, Obesity and Health in OECD Countries By Mazzocchi, Mario; Traill, W. Bruce
  11. Effects of Changes in Public Policy on Efficiency and Productivity of General Hospitals in Vietnam By Pinar Guven Uslu; Thuy Pham Linh
  12. Sick Pay Provision in Experimental Labor Markets By Peter Dürsch; Jörg Oechssler; Radovan Vadovic
  13. Alcoholic beverages as determinants of traffic fatalities By José Mª Arranz; Ana I. Gil
  14. Urbanization and the spread of diseases of affluence in China By Van der Poel, E; O'Donnell, O; van Doorslaer, E
  15. The state of sexual and reproductive health in Latin America and the Caribbean: An overview By Carmen Elisa Flórez Author-X-Name_First: Carmen Elisa Author-X-Name_Last: Flórez; Victoria Eugenia Soto Author-X-Name_First: Victoria Eugenia Author-X-Name_Last: Soto
  16. Part-Time Sick Leave as a Treatment Method? By Andrén, Daniela; Andrén, Thomas
  17. Tobacco Substitution and the Poor By Steven F. Koch; Gauthier Tshiswaka-Kashalala
  18. How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi By Aureo de Paula; Gil Shapira; Petra Todd
  19. Foot-and-Mouth Disease control costs compared: An Irish case study. By Dillon, Emma; Matthews, Alan; Thorne, Fiona

  1. By: José Cuesta Author-X-Name_First: José Author-X-Name_Last: Cuesta
    Abstract: This paper models the impact on economic growth of HIV/AIDS when the epidemic is in a mature phase, in contrast with previous studies focused on periods of expansion, as in African countries. Simulations for Honduras, the epicenter of the epidemic in Central America, show that AIDS is not likely to threaten economic growth through either labor or capital accumulation channels; impacts are estimated between 0. 007 and 0. 27 percent points of GDP growth annually for the period 2001-10. Likewise, increasing spending on prevention, public treatment subsidies and treatment access will not jeopardize economic growth prospects. Critical factors that slash economic growth in Africa (such as human capital reductions and shifts in relative skills) are not strong in Honduras.
    Date: 2008–02
  2. By: Andersson, Henrik (VTI)
    Abstract: This study examines individuals' perception of their own road-mortality risk. Swedish data on respondents' subjective risk beliefs is used and compared with objective risk estimates. The objective risk is defined as the risk of the respondent's own age and gender group, and it is found that low and high risk groups over- and underassess their risk levels, respectively. This study replicates the analysis used by Andersson and Lundborg (2007) and the pattern of over- and underassessment found confirms their findings. As in their study, risk beliefs are updated in line with the Bayesian learning model, a relationship not statistically significant in this study, though. Regarding results of individual characteristics and risk beliefs in both studies, whereas, e.g., gender effects are robust, other results suggest a weak relationship between the perception of own road-mortality risk and individual characteristics.
    Keywords: Bayesian learning; Overall risk; Peers; Road-traffic risk
    JEL: C21 D81 D83 I18
    Date: 2008–10–07
  3. By: Joan Costa i Font; Mireia Jofre-Bonet
    Abstract: Excessive preoccupation for self-image has been pointed out as an essential factor explaining food disorders. This paper draws upon Akerlof and Kranton (2000) to model how ’self-image’ and others’ appearances influence health related behaviours. We estimate the influence of ’peers’ image’ on the likelihood of anorexia and self-image using data from a cross sectional European representative survey for 2004. We follow a two-step empirical strategy. First, we estimate the probability that a woman is extremely thin and, at the same time, she sees herself as too fat. Our findings reveal that peers’ average Body Mass Index decreases the likelihood of being anorexic. Second, we take apart the two processes and estimate a recursive probit model of being very thin and perceiving one self as being too fat. Although peers’ Body Mass Index decreases the likelihood of being very thin but increases that of seeing one self as too fat, the unobservables explaining both processes are significantly correlated.
    Date: 2008–09
  4. By: Adama Konseiga (GREDI, Département d'économique, Université de Sherbrooke)
    Abstract: Parental migration is often found to be negatively correlated with child health in Africa, yet the causal mechanisms are poorly understood. The paper uses a dataset that provides information from the respondent parent on child morbidity both in the rural and urban settings. Households first endogenously determine whether they will gain from participating in migration and, if they do, whether they will leave the children behind or not. The final choice is made to ensure the optimal survival chances for the child. This paper contributes to understanding the health consequences of raising the children in the context of increasing urban poverty in Nairobi, Kenya. The findings indicate that households who migrated together with their children in the slums of Nairobi experience higher child morbidity (43 per cent have at least one sick child in the last one month) as compared to households who leave children in their upcountry homes (31 per cent of morbidity rate). Even though children of migrants are safer upcountry, not all households can afford this strategy. Households are able to choose this strategy only if they have a strong social support network in their origin community and/or they are big size households. This is an important finding in targeting the Millennium Development Goals.
    Keywords: Childhood morbidity, Split migration, Incidental truncation, Informal settlements Nairobi, Kenya
    JEL: C31 D13 I12 R23
    Date: 2008
  5. By: Hannes Suppanz
    Abstract: Health outcomes and the quality of health care in Iceland are very good by international comparison, while income-related health inequality appears to be smaller than in most other countries. However, the health-care system is costly and, according to OECD estimates, public expenditure on health and long-term care could reach 15% of GDP by 2050 if no restraining measures are taken. This highlights the importance of raising cost-effectiveness and spending efficiency more generally. To this end, it would seem advisable to remove impediments to private provision and open up the health sector to competition. At the same time, the introduction of cost-sharing should be considered where it does not exist (as in hospitals), although concerns about equity need to be taken into account. This would relieve the burden on public finances, as would the introduction of spending ceilings, cost-efficiency analysis and activity-based funding arrangements. The high cost of pharmaceuticals should be reduced by promoting competition and the use of inexpensive generic drugs. <P>Améliorer le rapport coût-efficacité dans le secteur de la santé en Islande <BR>En termes de comparaison internationale, les résultats et la qualité du secteur de la santé sont très satisfaisants en Islande, tandis que les inégalités en matière de santé liées au revenu semblent moindres que dans la plupart des autres pays. Toutefois, le système des soins de santé est onéreux et il ressort des estimations de l’OCDE que les dépenses publiques consacrées à la santé et aux soins de longue durée pourraient atteindre 15 % du PIB d’ici à 2050 en l’absence de mesures d’économie. D’où l’importance d’améliorer le rapport coût-efficacité et, plus généralement, l’efficience des dépenses. Dans ce but, il apparaît souhaitable de lever les obstacles à la prestation des services par le secteur privé et à l’ouverture du secteur de la santé à la concurrence. Parallèlement, il faudrait envisager la mise en place d’un système de partage des coûts là où il n’y en a pas (comme dans les hôpitaux), tout en prenant en compte de considérations d’équité. Ces mesures, de même que l’instauration de plafonds de dépenses, d’un système d’analyse de coût-efficacité et de mécanismes de financement en fonction des activités, permettraient d’atténuer la charge qui pèse sur les finances publiques. Il faudrait également diminuer le coût élevé des produits pharmaceutiques en favorisant la concurrence et le recours à des médicaments génériques peu coûteux.
    Keywords: Iceland, health care, dépenses publiques, public spending, Islande, spending efficiency, health status, état de santé, système médical, efficacité de la dépense
    JEL: C23 H51 H73 I12 O57
    Date: 2008–10–15
  6. By: Torssander, Jenny (Swedish Institute for Social Research, Stockholm University); Erikson, Robert (Swedish Institute for Social Research, Stockholm University)
    Abstract: In many analyses of social inequality in health, different dimensions of social stratification have been used more or less interchangeably as measures of the individual’s general social standing. This procedure, however, has been questioned in previous studies, most of them comparing education, class and/or income. In the present article, the importance of education and income as well as two aspects of occupation – class and status – are examined. The results are based on register data and refer to all Swedish employees in the age range 35-59 years. There are clear gradients in total death risk for all socioeconomic factors except for income from work among women. The size of the independent effects of education, class, status and income differ between men and women. For both sexes, there are clear net associations between education and mortality. Class and income show independent effects on mortality only for men and status shows an independent effect only for women. While different stratification dimensions – education, social class, income, status – all can be used to show a “social gradient” with mortality, each of them seems to have a specific effect in addition to the general effect related to the stratification of society for either men or women.
    Keywords: -
    Date: 2008–10–07
  7. By: Sophie Mitra (Fordham University, Department of Economics); Patricia A. Findley (Rutgers University, School of Social Work); Usha Sambamoorthi (UMASS Medical School, Worcester, Department of Psychiatry, and Morehouse School of Medicine, Department of Community Health and Preventive Medicine)
    Abstract: Objective--This paper estimates the healthcare expenditures associated with a disability at the individual level and their recent trends. Design--Retrospective analysis of survey data. Participants--Data from multiple years (1996 through 2004) of the Medical Expenditure Panel Survey (MEPS) for a nationally representative sample of civilian, non-institutionalized US population. Interventions--Not applicable. Main Outcome Measures--Healthcare expenditures consisted of: total healthcare expenditures, total out-of-pocket spending (OOP), and burden (the ratio of OOP to individual income). All the analyses accounted for the complex survey design of the MEPS. Results--Between 1996 and 2004, 6% to 9% of individuals in the working age group (21-61 years) were identified as having a disability. Persons with disabilities consistently had higher total health expenditures, OOP and burden compared to their counterparts without disabilities. In 2004, the average total expenditures were estimated at $10,508 for persons with disabilities and at $2,256 for those without disabilities. In a multiple regression framework, persons with disabilities were consistently found to have higher expenditures and OOP between 1996 and 2004. Although expenditures, OOP and burden increased over time, after controlling for demographic, socio-economic, and health status, these three healthcare costs were not found to increase disproportionately for individuals with disability. Conclusions--Over the 1996-2004 period, persons with disabilities are consistently found to have significantly higher health expenditures and OOP compared to their counterparts without disabilities, which may adversely affect their health and standard of living.
    Keywords: Disability, Health Expenditures, Out of Pocket Expenditures, Burden
    Date: 2008
  8. By: Subha Mani (Fordham University, Department of Economics)
    Abstract: In Indonesia, more than 30% of children under the age of 5 years suffer from chronic malnourishment. The long-term consequences of childhood malnutrition are well established in the literature. Yet, little is known about the extent to which these children are able to recover from some of the long-term deficits in health outcomes caused by childhood undernourishment. To capture the association between nutritional deficiency at young ages and subsequent health status, a panel data is constructed using observations on children between the age of 3 and 59 months in 1993 who are followed through the 1997 and 2000 waves of the Indonesian Family Life Survey. A dynamic conditional health demand function is estimated, where the coefficient on the one-period lagged health status captures the extent of recovery, if any, from childhood malnutrition. This coefficient is also known as the ‘catch-up’ term. Variants of the IV/GMM estimation strategy are used here to obtain an unbiased and consistent coefficient estimate on the lagged dependent variable. While the OLS coefficient estimate on the one-period lagged health status is 0.53, it is only 0.23 in a first-difference GMM framework, indicating an upward bias in the OLS parameter estimate. A coefficient of 0.23 on the one-period lagged health status indicates that poor nutrition at young ages will cause some, but not severe, retardation in the growth of future height indicating partial catch-up effects. In the absence of any catch-up, by adolescence, a malnourished child will grow to be 4.15 cm shorter than a well-nourished child. However, a coefficient of 0.23 as estimated here indicates that by adolescence, a malnourished child will grow to be only 0.95 cm shorter than a well-nourished child. The first-difference GMM estimation strategy used here is especially attractive as it relies on much weaker stochastic assumptions than earlier papers and addresses both omitted variables bias and measurement error bias in data.
    Keywords: Child health, Lagged dependent variable, First-difference, Indonesia
    JEL: I10 R20 D10
    Date: 2008
  9. By: Granlund , David (Department of Economics, Umeå University); Chuc , NT (Faculty of Public Health); Phuc , HD (Institute of Mathematics); Lindholm, Lars (Department of Public Health and Clinical Medicine)
    Abstract: The association between socioeconomic variables and mortality for 41 000 adults Vietnamese followed from January 1999 to March 2008 are estimated using Cox's proportionally hazard models. Also, we use decomposition techniques to investigate the relative importance of socioeconomic factors for explaining total inequality in age-standardized mortality risk. The results confirm previously found negative association between mortality and income and education, for both men and women. The decomposition, however, shows that these variables together explain less than one third of the inequality, suggesting that it is important to also consider other dimensions of socioeconomic status, such as occupation and marital status. Finally, estimation results for relative education variables suggest that there exist positive spillover of education, meaning that that higher education of one's neighbors or spouse might reduce ones mortality risk.
    Keywords: Health inequality; Socioeconomic status; Mortality risk; Decomposition; Vietnam
    JEL: D30 D63 I10 I30
    Date: 2008–10–10
  10. By: Mazzocchi, Mario; Traill, W. Bruce
    Abstract: Theoretical models suggest that decisions about diet, weight and health status are endogenous within a utility maximisation framework. In this paper, we model these behavioural relationships in a fixed-effect panel setting using a simultaneous equation system, with a view to determining whether economic variables can explain the trends in calorie consumption, obesity and health in OECD countries and the large differences among countries. The empirical model shows that progress in medical treatment and health expenditure mitigates mortality from diet-related diseases, despite rising obesity rates. While the model accounts for endogeneity and serial correlation, results are affected by data limitations.
    Keywords: food consumption, obesity, overweight, health, Health Economics and Policy, I12, C33,
    Date: 2008–01–14
  11. By: Pinar Guven Uslu (Norwich Business School and ESRC Centre for Competition Policy, University of East Anglia); Thuy Pham Linh (Norwich Business School, University of East Anglia)
    Abstract: The health sector reform programme which began in Vietnam in 1989 in order to improve the efficiency of the health system has altered the way in which Vietnamese hospitals operate. The programme put the spotlight on input savings. This study aims to examine the relative efficiency of hospitals during the health reform process and assess - by looking at the relative efficiency of hospitals - the effects of the regulatory changes. The study employs the DEA two-stage approach referring to data from 101 general public hospitals over the period 1998-2006. The study revealed that there was evidence of improvement in the productivity of Vietnamese hospitals over the period 1998-2006, with a progress in total factor productivity of 1.4% per year. Furthermore, the differences in hospital efficiency can be attributed to both the regulatory changes and hospital-specific characteristics. The user feesand autonomy measures were found to increase technical efficiency. Provincial hospitals were revealed to be more technically efficient than their central counterparts and hospitals located in the North East, South East and Mekong River Delta regions performed better that hospitals from other regions.
    Keywords: changes in public policy, health services, data envelopment analysis, hospital, regulatory changes
    JEL: I18 I19
    Date: 2008–10
  12. By: Peter Dürsch (University of Heidelberg, Department of Economics); Jörg Oechssler (University of Heidelberg, Department of Economics); Radovan Vadovic (ITAM, Department of Economics)
    Abstract: Sick pay is a common provision in most labor contracts. This paper employs an experimental gift-exchange environment to explore two related questions using both managers and undergraduates as subjects. First, do workers reciprocate sick pay in the same way as they reciprocate wage payments? Second, do firms benefit from offering sick pay? Firms may benefit in two different ways: directly, from workers reciprocating higher sick pay with higher efforts; and indirectly, from self-selection of reciprocal workers into contracts with higher sick pay. Our main finding is that the direct effect is rather weak in terms of effort and negative in terms of profits. However, when there is competition among firms for workers, sick pay can become an important advantage. Consequently, competition leads to a higher provision of sick pay relative to a monopsonistic labor market.
    Keywords: sick pay, sick leave, experiment, gift exchange
    JEL: C72 C91 C92 D43 L13
    Date: 2008–10
  13. By: José Mª Arranz (Departamento de Estadística, Estructura y O.E.I. Universidad de Alcalá.); Ana I. Gil (Universidad Autónoma de Madrid.)
    Abstract: The most important contribution of this research lies in considering the impact of wine, beer and liquors on the ratio of traffic fatalities because each kind of alcoholic beverage is characterized by different ethanol content. The data, drawn for case of Spain, validate our theoretical hypothesis. Our findings support the strategy of incrementing alcohol taxes in order to reduce the negative externalities of alcohol abuse. However, it is necessary to implement non-economic policies because of the existence of collateral effects (positive crossed price elasticities).
    Keywords: Fatalities, Alcoholic beverages, Sanctions.
    JEL: I1 H2
    Date: 2008
  14. By: Van der Poel, E; O'Donnell, O; van Doorslaer, E
    Abstract: A new methodology is used to quantify, track and explain the distribution of obesity and hypertension across areas differentiated by their degree of urbanicity. We construct an index of urbanicity from longitudinal data on community characteristics from the China Health and Nutrition Survey and compute a rank-based measure of inequality in disease risk factors by degree of urbanicity. Prevalence rates almost doubled over the period 1991-2004 and the risk factors became less concentrated in more urbanized areas. Decomposition analysis shows that urbanicity-related inequalities are mostly attributable to differences in community level characteristics and to disparities in incomes and in the physical and farming activity of individuals.
    Keywords: China, urbanization, health inequalities, obesity, hypertension, decomposition
    Date: 2008–10
  15. By: Carmen Elisa Flórez Author-X-Name_First: Carmen Elisa Author-X-Name_Last: Flórez; Victoria Eugenia Soto Author-X-Name_First: Victoria Eugenia Author-X-Name_Last: Soto
    Abstract: This paper reviews the state of sexual and reproductive health inseveral countries in Latin America and the Caribbean using the Demographic and Health Surveys to select countries according to their stage in the demographic transition. The results indicate advances in some areas, the most favorable being in countries with low fertility and among higher social classes. However, there are still important challenges, especially in countries whose transition has lagged. The evidence suggests that lack of information and access to reproductive services as well as social and cultural barriers, limits the exercise of a full reproductive life of women in high fertility countries and among underprivileged groups.
    Date: 2008–02
  16. By: Andrén, Daniela (Department of Economics, School of Business, Economics and Law, Göteborg University); Andrén, Thomas (National Institute of Economic Research)
    Abstract: This paper analyzes the effects of being on part-time sick leave compared to full-time sick leave on the probability of recovering (i.e., returning to work with full recovery of lost work capacity). Using a discrete choice one-factor model, we estimate mean treatment parameters and distributional treatment parameters from a common set of structural parameters. Our results show that part-time sick leave increases the likelihood of recovering and dominates full-time sick leave for sickness spells of 150 days or longer. For these long spells, the probability of recovering increases by 10 percentage points.
    Keywords: part-time sick leave; selection; unobserved heterogeneity; treatment effects
    JEL: I12 J21 J28
    Date: 2008–10–09
  17. By: Steven F. Koch (Department of Economics, University of Pretoria); Gauthier Tshiswaka-Kashalala (Department of Transportation, South Africa)
    Abstract: Tobacco control policies have effectively raised the price of cigarettes and other tobacco products. However, these price increases have been shown to disproportionately fall upon poorer households, with fewer resources. In this analysis, we provide an initial indication of the effect increased prices might have on household allocations, by considering substitution and complementation related to tobacco consumption. Our results show substitution between tobacco and most household consumption items, although elasticities tend to be highest amongst the poorest households.
    Keywords: Crowd-out, Crowd-in, 3SLS, Tobacco Substitution Elasticity
    JEL: D12 C32
    Date: 2008–10
  18. By: Aureo de Paula (Department of Economics, University of Pennsylvania); Gil Shapira (Department of Economics, University of Pennsylvania); Petra Todd (Department of Economics, University of Pennsylvania)
    Abstract: Many HIV testing programs in Africa and elsewhere aim to reduce risk-taking behaviors by providing individuals with information about their own HIV status. This paper examines how beliefs about own HIV status affect risky sexual behavior using data from married couples living in three regions of Malawi. Risky behavior is measured as the propensity to engage in extramarital affairs or to not use condoms. The empirical analysis is based on two panel surveys for years 2004 and 2006 from the Malawi Diffusion and Ideational Change Project (MDICP) and from an experimental HIV testing intervention carried out in 2004 that provided randomized incentives for picking up test results. Most individuals participating in the MDICP testing learned that they were HIV negative and a small fraction that they were positive. Controlling for potential endogeneity between beliefs and risk-taking, we find that downward revisions in the subjective belief of being HIV positive lead to decreases in the propensity to engage in extra-marital affairs but have no effect on condom use. These results are generally supported by survey questions that directly elicited from respondents how participating in testing altered their behavior. We show that the estimates provide a lower bound in the presence of measurement error in extra-marital affairs.
    Keywords: Beliefs, AIDS, Malawi
    JEL: I12
    Date: 2008–10–03
  19. By: Dillon, Emma; Matthews, Alan; Thorne, Fiona
    Abstract: The primary objective of this paper is to evaluate alternative control strategies for a number of simulated outbreaks of Foot-and-Mouth Disease (FMD) in four agriculturally diverse Irish regions, examining for the first time, the potential role of emergency vaccination in the country. The recent EU Directive (2003/85/EC) on FMD control permits the use of emergency vaccination as part of an FMD control strategy. While the slaughter of infected animals and “dangerous contacts” (susceptible animals on epidemiologically linked holdings) remains the principal tool for tackling an outbreak, the potential use of vaccination as an adjunct to the basic culling policy is now being considered. Using an integrated approach, combining epidemiological and economic modules, the alternatives of stamping-out both alone and in conjunction with emergency vaccination are examined using hypothetical outbreaks and their control costs compared. Overall, it cannot be said, a priori, that one control option is better than the other. Choice of control strategy would appear to be highly dependent on herd density, production type and other region specific issues. This analysis has focused on control costs only; taking wider economy costs into account may however change this overall conclusion.
    Keywords: Foot-and-Mouth disease, alternative control strategies, transboundary animal diseases, emergency vaccination, Livestock Production/Industries, Q1, Q17, Q58,
    Date: 2008–01–14

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