nep-hea New Economics Papers
on Health Economics
Issue of 2008‒11‒04
twenty-two papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Searching for Innovations ? The Technological Determinants of Acquisitions in the Pharmaceutical Industry By Gautier Duflos; Etienne Pfister
  2. West-East Convergence in the Prevalence of Illicit Drugs: Socioeconomics or Culture? By Harald Tauchmann
  3. Smoking in Germany: Stylized Facts, Behavioral Models, and Health Policy By Silja Göhlmann; Christoph M. Schmidt
  4. Cofactor Infections and HIV Epidemics in Developing Countries: Implications for Treatment By Larry Sawers; Eileen Stillwaggon; Tom Hertz
  5. Discrete Heterogeneity in the Impact of Health Shocks on Labour Market Outcomes By Stefanie Schurer
  6. The costs of risky male behaviour: sex differences in seasonal survival in a small sexually monomorphic primate By Cornelia Kraus; Manfred Eberle; Peter Kappeler
  7. The Sustainability of European Health Care Systems: Beyond Income and Ageing By Fabio Pammolli; Massimo Riccaboni; Laura Magazzini
  8. Health and Wages: Panel Evidence on Men and Women using IV Quantile Regression By Abbi M. Kedir
  9. Life expectancy and the environment By Fabio Mariani; Agustin Pérez-Barahona; Natacha Raffin
  10. Understanding the Southern African‘Anomaly’Poverty, Endemic Disease, and HIV By Larry Sawers; Eileen Stillwaggon
  11. Wealthy and Healthy in the South Pacific By Eliana Jimenez; Ignacio Correa-Valez; Richard P.C. Brown
  12. Income and Body Mass Index in Europe By Jaume Garcia; Climent Quintana
  13. Voluntary Private Health Care Insurance Among the Over Fifties in Europe: A Comparative Analysis of SHARE Data By Omar Paccagnella; Vincenzo Rebba; Guglielmo Weber
  14. Exogenous determinants of early-life conditions, and mortality later in life By Gerard J. van den Berg; Gabriele Doblhammer-Reiter; Kaare Christensen
  15. Choosing and Successfully Sustaining Competitive Strategies in the European Pharmaceutical Industry By Herrmann, Andrea M.
  16. Do Red Herrings Swim in Circles? – Controlling for the Endogeneity of Time to Death By Stefan Felder; Andreas Werblow; Peter Zweifel
  17. Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment. By Etienne Dumont; Bernard Fortin; Nicolas Jacquemet; Bruce Shearer
  18. Being born under adverse economic conditions leads to a higher cardiovascular mortality rate later in life: evidence based on individuals born at different stages of the business cycle By Gerard J. van den Berg; Gabriele Doblhammer-Reiter; Kaare Christensen
  19. A missing composite covariate in survival analysis: a case study of the Chinese Longitudinal Health and Longevity Survey By Francesco Lagona; Zhen Zhang
  20. Policy Analysis in the health-services market: accounting for quality and quantity By Bernard Fortin; Nicolas Jacquemet; Bruce Shearer
  21. Female employment, status and working conditions in French hospitals, a convergence between public and private sector despite differences in industrial relations ? By Philippe Méhaut
  22. Regularities and deviations in mortality trends of the developed world By Elisabetta Barbi

  1. By: Gautier Duflos (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Etienne Pfister (BETA-Règles - Université de Nancy II)
    Abstract: This article analyzes the individual determinants of acquisition activity and target choices in the pharmaceutical industry over the period 1978-2002. The "innovation gap" hypothesis states that acquiring firms lack promising drug compounds and acquire firms with more promising drug prospects. A duration model implemented over a panel of more than 400 firms relates the probabilities of being an purchaser or a target to financial, R&D ant patent data to investigate this explanation more deeply. Results show that purchasers are firms with a lower Tobin's Q and decreasing sales, which could indicate that acquisitions are used to compensate for low internal growth prospects. Firms with a higher proportion of radical patents in their portfolio, especially in pharmaceutical and biothechnological patent classes, face a higher probability of being targeted, indicating that acquiring firms are indeed searching for innovative competencies. However, acquiring firms also present a significant absorptive capacity : their R&D investment increases in the year preceding the operation and their patent stock is larger and more diversified than for non-acquiring firms. Finally, we observe that over the last ten years of the sample period, firms have paid a greater attention to the size of the target's portfolio.
    Keywords: M&A, pharmaceutical, innovations, patent citations.
    Date: 2008–09
  2. By: Harald Tauchmann
    Abstract: In contrast to West-Germany, illicit drugs were virtually absent in East-Germany until 1990. Yet, after the collapse of the former GDR, East-Germany was expected to encounter a sharp increase in the prevalence of substance abuse.By analyzing individual data,we find that East-Germany largely caught up withWest-Germany’s ever-growing prevalence of illicit drugs within a single decade.We decompose the west-east difference in prevalence rates into an explained and an unexplained part using a modified Blinder-Oaxaca procedure. This decomposition suggests that the observed convergence is just weakly related to socioeconomic characteristics and therefore remains mainly unexplained. That is, West- and East-Germans seem to have become more alike per se. We conclude that both parts of the country have converged in terms of the culture of drug consumption.
    Keywords: Illicit drugs, west-east convergence, decomposition
    JEL: I12 P36 P23
    Date: 2008–08
  3. By: Silja Göhlmann; Christoph M. Schmidt
    Abstract: It is well known that smoking causes severe adverse health effects, and it seems evident that governments are justified or even obliged to implement measures of tobacco control to mitigate these effects.Yet, as this paper argues with a distinct focus on Germany, the three most important and still largely open questions in the design and implementation of economic and health policy are, whether government action is justified at all, what behavioral patterns this policy should try to alter, and whether the policy measures chosen indeed exert any substantial effects on the targeted outcomes.We conclude that the case for control measures aiming at the prevention of smoking initiation among adolescents is indeed strong, but also that their proper design would benefit from a better understanding of behavioral issues and that their empirical evaluation requires (non-experimental) study designs that facilitate the identification of causal effects.
    Keywords: Tobacco, tobacco control, rational addiction
    JEL: I11 I12 I18
    Date: 2008–08
  4. By: Larry Sawers; Eileen Stillwaggon; Tom Hertz
    Abstract: This article shows that the burden of certain tropical disease infections, after controlling for other factors, is positively correlated with HIV prevalence. Using cross-national data and multivariate linear regression analysis, we investigate the determinants of HIV prevalence in low- and middle-income countries. We begin with social and economic variables used in other crossnational studies and then incorporate data on parasitic and infectious diseases endemic in poor populations, which are found to be strongly and significantly correlated with—and are potent predictors of—HIV prevalence. The paper concludes by arguing that treating tropical diseases may be a cost-effective addon to HIV prevention and treatment programs, thus slowing the spread of HIV in disease-burdened populations.
    Date: 2008–01
  5. By: Stefanie Schurer
    Abstract: Empirical evidence from the psychology literature suggests that reactions towards health shocks depend strongly on the personality trait of locus of control, which is usually unobservable to the analyst. In this paper, the role of this discrete heterogeneity in shaping the effects of health shocks on labour supply is theoretically modelled by adopting the Grossman (1972) model. Using German longitudinal data, the predictions of the theoretical model are tested with a latent class binary choice model and an alternative identification strategy.A robust result across both specifications for various definitions of locus of control, health shocks and labour market outcomes is that internals have a smaller probability of leaving the labour market after experiencing a health shock than externals.
    Keywords: Health shocks, heterogeneity, Grossman model, finite mixture models, personality traits
    JEL: I12 D01 C25
    Date: 2008–09
  6. By: Cornelia Kraus (Max Planck Institute for Demographic Research, Rostock, Germany); Manfred Eberle; Peter Kappeler
    Abstract: Male excess mortality is widespread among mammals and frequently interpreted as a cost of sexually selected traits that enhance male reproductive success. Sex differences in the propensity to engage in risky behaviours are often invoked to explain the sex gap in survival. Here we aim to isolate and quantify the survival consequences of two potentially risky male behavioural strategies in a small sexually monomorphic primate, the grey mouse lemur Microcebus murinus: (1) Most females hibernate during a large part of the austral winter, whereas most males remain active, and (2) during the brief annual mating season males roam widely in search for receptive females. Using a 10-year capture-mark-recapture data set from a population of M. murinus in Kirindy Forest, western Madagascar, we statistically modelled sex-specific seasonal survival probabilities. Surprisingly, we did not find any evidence for direct survival benefits of hibernation – winter survival did not differ between males and females. In contrast, during the breeding season males survived less well than females (sex gap: 16%). Consistent with the “risky male behaviour”-hypothesis, the period for lowered male survival was restricted to the short mating season. Thus, sex differences in survival can be substantial even in the absence of sexual dimorphism.
    JEL: J1 Z0
    Date: 2008–02
  7. By: Fabio Pammolli (Corresponding author, IMT Lucca Institute for Advanced Studies, Lucca, Italy, and Fondazione CERM, Roma, Italy); Massimo Riccaboni; Laura Magazzini
    Abstract: During the last thirty years health care expenditure (HCE) has been growing much more rapidly than GDP in all OECD countries posing increasing concern on the long-term sustainability of current trends. Against this background, we look at the determinants of HCE in European countries, explicitly taking into account the role of income, the effect of ageing population, life habits, technological progress, as well as institutional and budgetary variables. Our results show that the current trend of increasing HCE is rooted in a set of highly differentiated factors. Ageing population is usually regarded as a key driver of HCE in Europe. However, increased life expectancy and decreased fertility rate only tells part of the story. Increased income levels also lead to higher HCE, and the magnitude of the estimated elasticity poses serious concerns about sustainability of current trends. Besides, our results show the deep influence of technological uptake and diffusion, as well as the institutional framework and budget constraints as important factors in explaining HCE growth dynamics. We further control for health habits of the population by looking at the consumption of sugar and of fruits and vegetables. Our results reinforce the need for a political debate at the European level aimed at assuring long-term sustainability and prosperity. The key challenge for Governments is to design pluralistic systems of health care delivery and financing, where a well-balanced mix of public and private financing would put at work market forces to promote investment and innovation, without imposing unsustainable burdens on public budgets or denying care to the disadvantaged population.
    Keywords: health care expenditure, sustainability, ageing population, income elasticity, welfare
    JEL: H51
    Date: 2008–10
  8. By: Abbi M. Kedir
    Abstract: Using panel data from a developing country on individuals aged 16 to 59 who reported their monthly wages, we estimated a relationship between health (nutrition) measures (i.e. height and BMI) and wages (which proxies productivity/growth). We controlled for endogeneity of BMI and found heterogeneous returns to different human capital indicators. Our findings indicate that productivity is positively and significantly affected by education, height and BMI. The return to BMI is important both at the lower and upper end of the wage distribution for men while women at the upper end of the distribution suffer a wage penalty due to BMI. Height has been a significant factor affecting men’s productivity but not women. The results in general support the high-nutrition and high- productivity equilibrium story. Returns to schooling showed a declining trend as we move from lower to higher quantiles for both sub-samples. This might suggest that schooling is more beneficial for the less able. In addition, the returns to schooling of women are higher than men. The results have important implications for policy making in the form of nutrition interventions and targeted education on women.
    Keywords: height; BMI; schooling; heterogeneity; endogeneity; quantile; IV
    JEL: C23 I12 J24 O12
    Date: 2008–10
  9. By: Fabio Mariani (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Agustin Pérez-Barahona (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I); Natacha Raffin (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: We present an OLG model in which life expectancy and environmental quality dynamics are jointly determined. Agents may invest in environmental quality, depending on how much they expect to live, but also in order to leave good environmental conditions to future generations. In turn, environmental conditions affects life expectancy. The model produces multiple steady states development regimes) and initial conditions do matter. In particular, some countries may be trapped in a low life expectancy /low environmental quality trap. This outcome is consistent with stylized facts relating life expectancy and environmental performance measures. Possible strategies to escape from this kind of trap are also discussed. Finally, this result is robust to the introduction of human capital through parental education expenditures.
    Keywords: Environmental quality; life expectancy; poverty traps.
    Date: 2008–09
  10. By: Larry Sawers; Eileen Stillwaggon
    Abstract: Background: Adult HIV prevalence in the nine countries of southern Africa averages more than 16 times the prevalence in other low- and middle-income countries. Previous studies argue that the intensity of the HIV epidemic in southern Africa results from regional characteristics, such as apartheid labor regulations and regional mineral wealth, which contributed to circular migration patterns and highly skewed income distribution. The present study also emphasizes the importance of cofactor diseases, which are suspected of raising HIV prevalence by increasing HIV viral load in infected persons or by making uninfected persons more vulnerable to HIV infection through lower immunity or genital lesions and/or inflammation. Method: the study uses multiple regression analysis on country-level data with HIV prevalence as the dependent variable. Regressors are ten socio-economic variables used in most previous cross-national analyses of HIV, two measures of cross-border migration, and measures of six cofactor infections. Results: The 10 socio-economic variables “explain” statistically only 25% of the difference in HIV prevalence between southern Africa and other low- and middle-income countries, but adding the four cofactor infection variables to the model allows us to “explain” 80% of the southern Africa difference in HIV prevalence. Conclusion: The relative affluence of southern Africa and historical migration patterns have tended to mask the vulnerability of the majority of the population who are poor and who have very high prevalence of infectious and parasitic diseases. Those diseases replicate a cycle of poverty that can lead not just to social vulnerability to HIV through risky behaviors but also to biological vulnerability through coinfections. An important implication of this research is that integrating treatment of endemic diseases with other HIVprevention policies may be necessary to slow the spread of HIV. Treatment of cofactor infections is a lowcost, policy-sensitive, high-impact variable.
    Date: 2008–07
  11. By: Eliana Jimenez; Ignacio Correa-Valez; Richard P.C. Brown (School of Economics, The University of Queensland)
    Abstract: Objectives- The main aim of this paper is to analyse the relationship between socio-economic status and health status at the household level in Fiji, a developing country in the South Pacific, based on original household survey data compiled by the authors Method- We exploit the geographic conditions of Viti Levu, the relatively small main island of Fiji, to isolate the effects of household wealth on health. For households on this island physical distance is not a significant impediment for access to health care and other publicly-provided services. We use a constructed index of household wealth in place of the more commonly used income measure of socio-economic status. To control for reverse causality and other possible sources of endogeneity we use an Instrumental Variable strategy in the regression analysis. Findings- We find that a household’s socio-economic status, as measured by a constructed wealth index, has a substantial impact on the household’s health status. We estimate that if a household's wealth increased from the minimum to the maximum level, this would decrease its probability of being afflicted by an incapacitating illness by almost 50 per cent. Conclusions- Health outcomes from existing health services can therefore be improved by raising the economic well-being of poor households. Conversely, the provision of additional health services alone may not necessarily improve health outcomes for the poorest.
    Date: 2008
  12. By: Jaume Garcia; Climent Quintana
    Abstract: The problem of obesity is alarming public health authorities around the world. Therefore, it is important to study its determinants. In this paper we explore the empirical relationship between household income and body mass index (BMI) in nine European Union countries. Our findings suggest that the association is negative for women, but we find no statistically significant relationship for men. However, we show that the different relationship for men and women appears to be driven by the negative relationship for women between BMI and individual income from work. We tentatively conclude that the negative relationship between household income and BMI for women may simply be capturing the wage penalty that obese women suffer in the labor market.
    Date: 2008–05
  13. By: Omar Paccagnella (University of Padua); Vincenzo Rebba (University of Padua); Guglielmo Weber (University of Padua)
    Abstract: Using data from SHARE (Survey of Health, Ageing and Retirement in Europe), we analyze the effect of having a voluntary health insurance policy (VPHI) on out-of-pocket (OOP) health spending for individuals aged 50 or more in a host of European countries. We control for self selection into VPHI policy holding, and find that VPHI policy holders do not have lower OOP's than the rest of the population. In Southern European countries and Austria they even spend more. We also find that the main determinants of VPHI are different in each country and this reflects the differences in the underlying health care systems.
    Date: 2008–10
  14. By: Gerard J. van den Berg; Gabriele Doblhammer-Reiter (Max Planck Institute for Demographic Research, Rostock, Germany); Kaare Christensen
    Abstract: We analyze causal effects of conditions early in life on the individual mortality rate later in life. Conditions early in life are captured by transitory features of the macro environment around birth, notably the state of the business cycle around birth, but also food price deviations, weather indicators, and demographic indicators. We argue that these features can only affect high-age mortality by way of the individual early-life conditions. Moreover, they are exogenous from the individual point of view, which is a methodological advantage compared to the use of unique characteristics of the newborn individual or his family or household as early-life indicators. We collected national annual time-series data on the above-mentioned indicators, and we combine these to the individual data records from the Danish Twin Registry covering births in 1873-1906. The empirical analyses (mostly based on the estimation of duration models) indicate a significant negative causal effect of economic conditions early in life on individual mortality rates at higher ages. If the national economic performance in the year of birth exceeds its trend value (i.e., if the business cycle is favorable) then the mortality rate later in life is lower. The implied effect on the median lifetime of those who survive until age 35 is about 10 months. A systematic empirical exploration of all macro indicators reveals that economic conditions in the first years after birth also affect mortality rates later in life.
    JEL: J1 Z0
    Date: 2008–04
  15. By: Herrmann, Andrea M.
    Abstract: Abstract It is a central claim of the national competitiveness literature that firms exploit the comparative advantages of their environment by choosing to pursue the product market strategy that is facilitated by national financial- and labour-market institutions. Other­wise, so goes the argument, firms are punished in that strategies receiving no institutional support are less successful and therefore not sustainable in the long run. My analyses of pharmaceutical firms in Germany, Italy and the United Kingdom challenge these arguments on the choice and success of competitive strategies. Given that different measures of strategy success do not indicate that the latter is in line with national institutional advantages, I develop an alternative explanation for the strategy choices of firms. On the basis of my qualitative interviews with managers, I argue that technological opportunities to transform inventions or imitations into marketable products are a primary concern when entrepreneurs choose their firm’s strategy. Zusammenfassung Es ist ein zentrales Argument der Literatur zur nationalen Wettbewerbsfähigkeit von Unternehmen, dass sich letztere die Wettbewerbsvorteile ihrer institutionellen Umgebung zu Nutze machen, indem sie diejenigen Produktstrategien wählen, die durch die jeweiligen nationalen Finanz- und Arbeitsmarktinstitutionen gefördert werden. Ansonsten, so ein weiteres Argument der Literatur, werden Firmen dadurch abgestraft, dass institutionell nicht gestützte Strategien langfristig weniger erfolgreich und daher nicht von Bestand sind. Die im Rahmen dieses Projekts durchgeführten Untersuchungen von Pharmazieunternehmen in Deutschland, Italien und Großbritannien lassen Zweifel an diesen Argumenten zu Wahl und Erfolg von Wettbewerbsstrategien entstehen. Da verschiedene Indikatoren von Strategieerfolg nicht darauf hindeuten, dass nationale Wettbewerbsvorteile die Strategiewahl beeinflussen, wird eine alternative Erklärung entwickelt, wie Unternehmen Wettbewerbsstrategien wählen. Auf der Grundlage von qualitativen Interviews mit Managern wird aufgezeigt, dass die technologischen Möglichkeiten eines Unternehmens, Erfindungen oder Imitationen in marktfähige Produkte zu verwandeln, von wesentlicher Bedeutung dafür sind, welche Strategie ein Unternehmer wählt.
    Keywords: political economy; institutions; institutionalism; pharmaceutical industry; U.K.; Germany; Italy
    Date: 2008–10–21
  16. By: Stefan Felder; Andreas Werblow; Peter Zweifel
    Abstract: Studies on the effect of ageing on health care expenditures (HCE) have revealed the importance of controlling for time-to-death (TTD). These studies, however, are subject to possible endogeneity if HCE influences remaining life expectancy.This paper introduces a ten year observational period on monthly HCE, socioeconomic characteristics, and survivor status to first predict TTD and then uses predicted values of TTD as an instrument in the regression for HCE.While exogeneity of TTD has to be rejected, core results concerning the role of TTD rather than age as a determinant of HCE (the “red herring” hypothesis) are confirmed.
    Keywords: Health care expenditure, proximity to death, ageing, “red herring” hypothesis
    JEL: I10 D12
    Date: 2008–10
  17. By: Etienne Dumont (CIRPEE - Université Laval); Bernard Fortin (CIRPEE - Université Laval); Nicolas Jacquemet (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Bruce Shearer (CIRPEE - Université Laval)
    Abstract: We analyse how physicians respond to contractual changes and incentives within a multitaskingenvironment. In 1999 the Quebec government (Canada) introduced an optional mixed compensationsystem, combining a xed per diem with a partial (relative to the traditional fee-for-service system)fee for services provided. We combine panel survey and administrative data on Quebec physiciansto evaluate the impact of this change in incentives on their practice choices. We highlight thedierentiated impact of incentives on various dimensions of physician behaviour by considering awide range of labour supply variables: time spent on seeing patients, time devoted to teaching,administrative tasks or research, as well as the volume of clinical services and average time perclinical service. Our results show that, on average, the reform induced physicians who changedfrom FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours ofwork spent on seeing patients by 2.57%. Their average time spent per service increased by 3.58%,suggesting a potential quality-quantity substitution. Also the reform induced these physicians toincrease their time spent on teaching and administrative duties (tasks not remunerated under thefee-for-service system) by 7.9%.
    Keywords: physician payment mechanisms; multitasking; mixed-payment systems; incentive con-tracts; labour supply; self-selection; panel estimation.
    Date: 2008
  18. By: Gerard J. van den Berg; Gabriele Doblhammer-Reiter (Max Planck Institute for Demographic Research, Rostock, Germany); Kaare Christensen
    Abstract: -
    JEL: J1 Z0
    Date: 2008–10
  19. By: Francesco Lagona (Max Planck Institute for Demographic Research, Rostock, Germany); Zhen Zhang (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: We estimate a Cox proportional hazards model where one of the covariates measures the level of a subject´s cognitive functioning by grading the total score obtained by the subject on the items of a questionnaire. A case study is presented where the sample includes partial respondents, who did not answer some or all of the questionnaire items. The total score takes hence the form of an interval-censored variable and, as a result, the level of cognitive functioning is missing on some subjects. We handle partial respondents by taking a likelihood-based approach where survival time is jointly modelled with the censored total score and the size of the censoring interval. Parameter estimates are obtained by an E-M-type algorithm that essentially reduces to the iterative maximization of three complete log-likelihood functions derived from two augmented datasets with case weights, alternated with weights updating. This methodology is exploited to assess the Mini Mental State Examination index as a prognostic factor of survival in a sample of Chinese older adults.
    Keywords: China, health
    JEL: J1 Z0
    Date: 2008–09
  20. By: Bernard Fortin (CIRPEE - Université Laval); Nicolas Jacquemet (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Bruce Shearer (CIRPEE - Université Laval)
    Abstract: We provide a theoretical and empirical framework for evaluating the eects of policyreforms on physician labor supply. We argue that any policy evaluation must account forboth the quality and the quantity of services provided. The introduction of quality intothe analysis has implications for both the theoretical and empirical analysis of labor supply,and consequently policy evaluation. In particular, endogenous quality choices introduce non-linearities into the budget constraint since the marginal return to an hour of work dependson the quality of services provided. We illustrate by considering a particular example: therecent reform in compensation contracts for specialist physicians in the province of Quebec(Canada). Prior to 1999, most Quebec specialist physicians were paid fee-for-service con-tracts; they received a piece rate for each clinical service provided. In 1999, the governmentintroduced a mixed remuneration system, under which physicians received a base (half-dailyor daily) wage, independent of services provided, and a reduced fee-for-service. Moreover,the government allowed physicians to choose their contract. We derive theoretical results forthe eect of the reform on the quantity and quality of services supplied by analyzing localprices and virtual income. We propose discretizing the choice set as an empirical approachto policy evaluation in the presence of non-linear budget constraints.
    Keywords: Health production, Quality of health services, Discretized models
    Date: 2008
  21. By: Philippe Méhaut (LEST - Laboratoire d'économie et de sociologie du travail - CNRS : UMR6123 - Université de Provence - Aix-Marseille I - Université de la Méditerranée - Aix-Marseille II)
    Abstract: The French hospitals sector is split between sub-sectors, with different employment status (civil servant versus private employment contract). Industrial relations differs. Nevertheless, differences between the sub-sectors are not very important. Quality rules and health regulation could explain why different labour market institutions do not lead to a strong divide in employment and working conditions.
    Keywords: iinternal labour market, collective agreement, flexibility
    Date: 2008–10–28
  22. By: Elisabetta Barbi (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: By the second half of the 20th century, mortality patterns in industrialized countries showed a continuous tendency of reduction at all ages, even at the oldest ones. However, the pace of mortality decline considerably varies depending on the country. Furthermore, in a few cases, stagnation and even an unexpected reversed pattern have been observed in more recent years. In this paper a comparative analysis of mortality trends in several developed countries is performed. The aim of the paper is to locate deviations from expected mortality patterns, and to understand the reasons for these deviations. As a first step of the analysis, a new two-dimensional relational model is applied to mortality surfaces of the selected developed countries, between 1960 and 1999, for the age range 50-99. In the second step, mortality by cause of the countries with particular structural features is analyzed through the surfaces of leading causes of death.
    Keywords: mortality trends
    JEL: J1 Z0
    Date: 2008–03

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