nep-hea New Economics Papers
on Health Economics
Issue of 2008‒10‒28
seven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Dispensing practices and antibiotic use By Massimo Filippini; Giuliano Masiero; Karine Moschetti
  2. How Do States Formulate Medicaid and SCHIP Policy? Economic and Political Determinants of State Eligibility Levels By Jeffrey Milyo; Reagan Baughman
  3. AIDS, Access to Medicines, and the Different Roles of the Brazilian and South African Governments in Global Health Governance By Jan Peter Wogart; Gilberto Calcagnotto; Wolfgang Hein; Christian von Soest
  4. The link between health care spending and health outcomes for the new English Primary Care Trusts By Stephen Martin; Nigel Rice; Peter C Smith
  5. Noblesse Oblige? Determinants of Survival in a Life and Death Situation By Bruno S. Frey; David A. Savage; Benno Torgler
  6. The impact of Medicare Part D on Medicare-Medicaid Dual-eligible Beneficiaries' Prescription Utilization and Expenditures By Anirban Basu; Wesley Yin; G. Caleb Alexander
  7. The Effects of Maternal Fasting During Ramadan on Birth and Adult Outcomes By Douglas Almond; Bhashkar Mazumder

  1. By: Massimo Filippini (Department of Economics, ETH Zurich, Switzerland); Giuliano Masiero (Department of Economics and Technology Management, University of Bergamo, Italy); Karine Moschetti (Department of Economics, University of Lugano, Switzerland)
    Abstract: The regulation on prescribing and dispensing of antibiotics has a double purpose: to enhance access to antibiotic treatment and to reduce the inappropriate use of drugs. Nevertheless, incentives to dispensing physicians may lead to inefficiencies. We sketch a theoretical model of the market for antibiotic treatment and empirically investigate the impact of self-dispensing on the per capita outpatient antibiotic consumption using data from small geographic areas in Switzerland. We find evidence that a greater proportion of dispensing practices is associated with higher levels of antibiotic use. This suggests that health authorities have a margin to adjust economic incentives on dispensing practices in order to reduce antibiotic misuse.
    Keywords: Dispensing, Antibiotic use
    JEL: I11 I18 D12 D21 D43 D81 D82
    Date: 2008–10
  2. By: Jeffrey Milyo (Department of Economics, University of Missouri-Columbia); Reagan Baughman
    Abstract: We exploit the existence of substantial variation in state policies toward public health insurance for children between 1990 and 2002 to estimate the economic and political determinants of state eligibility levels. Controlling for state and year effects, eligibility levels are not significantly associated with either the percentage of uninsured children in the state or the eligibility policy of neighboring states; further, variation in eligibility levels within state is negatively associated with both the federal matching rate and state fiscal capacity. We also observe that state political preferences, measured by the Democrats share of seats in the lower chamber of the state legislature, are a relatively important a determinant of state eligibility levels. However, other political factors, such as party control of state government, voter turnout, legislative term limits and campaign finance regulations do not influence state eligibility levels.
    Keywords: Medicaid, SCHIP, Political Economy, Race-to-the-Bottom
    JEL: D78 H75
    Date: 2008–10–17
  3. By: Jan Peter Wogart (GIGA German Institute of Global and Area Studies); Gilberto Calcagnotto (GIGA Institute of Latin American Studies); Wolfgang Hein (GIGA Institute of Latin American Studies); Christian von Soest (GIGA Institute of African Affairs)
    Abstract: The present article illustrates how the main actors in global health governance (GHG)— governments, nongovernmental organizations (NGOs), intergovernmental organizations (IOs), and transnational pharmaceutical companies (TNPCs)—have been interacting and, as a result, modifying the global health architecture in general and AIDS treatment in particular. Using the concept of “power types” (Keohane/Martin) and “interfaces” (Norman Long), the authors examine the conflicts among major GHG actors that have arisen surrounding the limited access to medicines for fighting HIV/AIDS basically as a result of the Agreement on Trade Related Intellectual Property Rights (TRIPS), in force since 1995. They then analyze the efforts of Brazil and South Africa to obtain fast and low-cost access to antiretroviral medication against AIDS. They conclude that while policy makers in the two countries have used different approaches to tackle the AIDS problem, they have been able, with the support of NGOs, to modify TRIPS and change some WTO rules at the global level along legal interfaces. At the national level the results of the fight against AIDS have been encouraging for Brazil, but not for South Africa, where authorities denied the challenge for a prolonged period of time. The authors see the different outcomes as a consequence of Brazil’s ability to combine discoursive, legal, administrative, and resource-based interfaces.
    Keywords: global health governance; HIV/AIDS in Brazil and South Africa; discoursive, legal, organizational and resource-based interfaces; WTO; transnational pharmaceutical companies; NGOs
    Date: 2008–09
  4. By: Stephen Martin (Department of Economics, University of York); Nigel Rice (Centre for Health Economics, University of York); Peter C Smith (Centre for Health Economics, University of York)
    Abstract: English programme budgeting data have yielded major new insights into the link between health care spending and health outcomes. This paper updates two recent studies that have used programme budgeting data for 295 Primary Care Trusts (PCTs) in England to examine the link between spending and outcomes for several programmes of care. We use the same economic model employed in the two previous studies. It focuses on a decision maker who must allocate a fixed budget across programmes of care so as to maximize social welfare given a health production function for each programme. Two equations – a health outcome equation and an expenditure equation – are estimated for each programme (data permitting). The two previous studies employed expenditure data for 2004/05 and 2005/06 for 295 health authorities and found that in several care programmes – cancer, circulation problems, respiratory problems, gastro-intestinal problems, trauma burns and injury, and diabetes – expenditure had the anticipated negative effect on the mortality rate. Each health outcome equation was used to estimate the marginal cost of a life year saved. In 2006/07 the number of PCTs in England was reduced to 152, largely through a series of mergers. In addition, several changes were made to the methods employed to construct the programme budgeting data. This paper employs updated budgeting and mortality data for the new 152 PCTs to re-estimate health production and expenditure functions, and also presents updated estimates of the marginal cost of a life year saved in each programme. Although there are some differences, the results obtained are broadly similar to those presented in our two previous studies.
    Date: 2008–10
  5. By: Bruno S. Frey; David A. Savage; Benno Torgler
    Abstract: This paper explored the determinants of survival in a life and death situation created by an external and unpredictable shock. We are interested to see whether pro-social behaviour matters in such extreme situations. We therefore focus on the sinking of the RMS Titanic as a quasi-natural experiment do provide behavioural evidence which is rare in such a controlled and life threatening event. The empirical results support that social norm such as “women and children first” survive in such an environment. We also observe that women of reproductive age have a higher probability of surviving among women. On the other hand, we observe that crew members used their information advantage and their better access to resources (e.g. lifeboats) to generate a higher probability of surviving. The paper also finds that passenger class, fitness, group size, and cultural background matter.
    Keywords: Decision under Pressure, Altruism, Social Norms, Interdependent Preferences, Excess of Demand
    JEL: D63 D64 D71 D81
    Date: 2008–10–23
  6. By: Anirban Basu; Wesley Yin; G. Caleb Alexander
    Abstract: Features of Part D gave rise to broad concern that the drug benefit would negatively impact prescription utilization among the six million dual eligible beneficiaries, either during the transition from state Medicaid to Part D coverage, or in the long-run. At the same time, Part D contained other features, such as its auto-enrollment and premium subsidization policies, which were designed to safeguard utilization for this vulnerable group. Using national retail pharmacy claims, we examine the experience of dual eligibles during the first 18 months of Part D. We find no evidence that Part D adversely affected pharmaceutical utilization or out-of-pocket expenditures in the transition period, or in the 18 months subsequent to Part D implementation.
    JEL: H42 I11 I18
    Date: 2008–10
  7. By: Douglas Almond; Bhashkar Mazumder
    Abstract: We use the Islamic holy month of Ramadan as a natural experiment for evaluating the short and long-term effects of fasting during pregnancy. Using Michigan natality data we show that in utero exposure to Ramadan among Arab births results in lower birthweight and reduced gestation length. Preconception exposure to Ramadan is also associated with fewer male births. Using Census data in Uganda we also find that Muslims who were born nine months after Ramadan are 22 percent (p =0.02) more likely to be disabled as adults. Effects are found for vision, hearing, and especially for mental (or learning) disabilities. This may reflect the persistent effect of disruptions to early fetal development. We find no evidence that negative selection in conceptions during Ramadan accounts for our results. Nevertheless, caution in interpreting these results is warranted until our findings are corroborated in other settings.
    JEL: I1 I12 J1 J14
    Date: 2008–10

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