nep-hea New Economics Papers
on Health Economics
Issue of 2009‒01‒03
23 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Is There Migration-Related Inequity in Access to or in the Utilisation of Health Care in Germany? By Monika Sander
  3. Health shocks, household consumption, and child nutrition By Marcos Vera-Hernández; Aida Galiano
  4. Climbing the Drug Staircase: A Bayesian Analysis of the Initiation of Hard Drug Use By Bretteville-Jensen, Anne Line; Jacobi, Liana
  5. Do People Become Healthier after Being Promoted? By Boyce, Christopher J.; Oswald, Andrew J.
  6. Bounding the Effects of Food Insecurity on Children's Health Outcomes By Gundersen, Craig; Kreider, Brent
  7. Child Mortality in Eastern and Southern Africa By Sudhanshu Handa; Steven F. Koch; Shu Wen Ng
  9. Interface between economic development, health and environment in India: An econometric investigation. By Nagar, A.L.; Shovon Ray, Amit; Sawhney, Aparna; Samanta, Sayan
  10. Patients' Perceptions and Treatment Effectiveness By Sean Murphy; Robert Rosenman; Jon Yoder; Dan Firesner
  11. The effect of parental leave on female employment: evidence from state policies By Ana Espinola-Arredondo; Sunita Mondal
  12. Drivers and Barriers of Innovation Dynamics in Healthcare - Towards a framework for analyzing innovation in Tuberculosis control in India By Engel, Nora
  13. Flexibility and innovation in response to emerging infectious diseases: Reactions to multi-drug resistant Tuberculosis in India By Engel, Nora
  14. The Macroeconomic Impact of Healthcare Financing Alternatives: Reform Options forHong Kong SAR By Nathaniel John Porter; Dennis P. J. Botman
  15. Income-Based Price Subsidies, Parallel Imports and Markets Access to New Drugs for the Poor By Rajat Acharyya; Maria D.C. Garcia-Alonso
  16. Household Expenditure on Cigarettes and Tobacco in Syria By Ahmad Alachkar
  17. Do Optional Deductibles Reduce the Number of Doctor Visits? – Empirical Evidence with German Data By Hendrik Schmitz
  18. Demand, Selection and Patient Outcomes in German Acute Care Hospitals By Christoph Schwierz; Boris Augurzky; Axel Focke; Jürgen Wasem
  19. Birth, Death, and Development: A Simple Unified Growth Theory By Holger Strulik; Jacob Weisdorf
  20. Improving Access to Psychological Therapy: Initial Evaluation of the Two Demonstration Sites By David M. Clark; Richard Layard; Rachel Smithies
  21. Long term care in Spain: Extent, costs and challenges By Pablo Alonso González; Irene Albarrán Lozano
  22. Re-examining the Effects of Medicaid Expansions for Pregnant Women By Dhaval M. Dave; Sandra Decker; Robert Kaestner; Kosali I. Simon
  23. Compensating Differentials and Fringe Benefits: Evidence from the Medical Expenditure Panel Survey 1997-2004 By Jean Abraham; Stéphanie Lluis

  1. By: Monika Sander
    Abstract: This paper analyses immigrants¿ access to health care and utilisation of health care services in Germany. Thereby, it is investigated if there is inequity in access to or in the utilisation of health care services due to a lack of language skills or due to a lack of information about the health care system (approximated by years since migration) among first- and secondgeneration immigrants. The data used are drawn from eleven waves of the SOEP (1995-2006). With regard to the probability to contact a physician (as a proxy for access), German language skills are found to have no significant influence for all groups of immigrants. The hypothesis of inequity in access to health care due to access barriers caused by a lack of German language skills is therefore not supported by the data. However, mother tongue language skills seem to be important for the contact probability of the first- and secondgeneration: Having only good or poor mother tongue language skills reduces the probability of a doctor contact. The effect is found to be significant for first- and second-generation men. For the frequency of doctor visits (utilisation), poor German language skills are found to exert a significant influence: Those reporting poor language skills have a lower expected number of doctor visits. The effect is found to be significant for first-generation men and for secondgeneration men and women. Hence, there seems to be inequity in health care utilisation due to a lack of German language skills. With the exception of first-generation men ¿ where it is found that poor mother tongue language skills reduce the expected number of doctor visits significantly, no significant effect is found for mother tongue language skills. With regard to the duration of residence, the results indicate that years since migration have an impact on the contact decision of first-generation immigrant women, whereby a significant positive influence is found. Hence, missing knowledge about the health care system could create additional access barriers and yield inequity in access to health care in the group of firstgeneration women. The duration of residence seems to have no influence on the frequency decision.
    Keywords: Utilisation of health care, inequity, immigrants, SOEP
    JEL: C23 D63 I10
    Date: 2008
  2. By: Stephen Bazen (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales - CNRS : UMR6579); Claire Salmon (IREGE - Université de Savoie)
    Abstract: Using data for Bangladesh we find evidence of added worker effects resulting from father's health problems on both children's and (to a lesser extent) spouse's labor supply. In particular, when illness is short-lived or if treatment is required (when there are "health shocks") children's participation tends to increase. Our results suggest that income replacement through sickness benefit could significantly reduce child labor.
    Keywords: child labor; health shocks; added worker effects
    Date: 2008–12–30
  3. By: Marcos Vera-Hernández (Institute for Fiscal Studies); Aida Galiano (Universidad de Zaragoza)
    Abstract: This paper investigates the effect of health shocks on household consumption and child nutrition. Using longitudinal data from rural Colombia we find that several items of household consumption, including medical expenditure, food consumption, and total consumption, increase following a recent illness event of an adult usually active in the labour market. In contrast to this, we find that girls¿ weight is negatively affected, as a consequence of the same illness event. The results on nutrition present an interesting gender bias, since we do not find any evidence that boys¿ nutritional status deteriorates. Our conclusion is that households make difficult intrahousehold choices when an illness shock hit them. The results have implications for the literature on testing for full insurance because it usually relies on household consumption net of medical expenditures as a measure of welfare. This fact shows that this literature might has underestimated the effects of health shocks on welfare. Este artículo investiga los efectos de los shock de salud sobre el consumo de los hogares y la nutrición infantil. A partir de una base de datos longitudinal que corresponde a datos del área rural de Colombia encontramos que varios elementos del consumo de los hogares, incluidos gastos médicos, consumo de alimentos y consumo total del hogar, aumentan después de que una reciente enfermedad afecte a un adulto del hogar activo en el mercado de trabajo. En contraposición a este resultado, encontramos que la nutrición de los niños se ve negativamente afectada. En concreto el peso de las niñas se reduce tras este shock de salud. Este resultado sobre nutrición presenta un interesante sesgo de género, ya que no encontramos evidencia de un deterioro nutricional en los niños. Nuestra conclusión es que los hogares tienen difícil elecciones dentro de los hogares cuando un shock de salud les sacude. Este resultado tiene implicaciones para la literatura que prueba la cobertura total de los hogares ya que esta atiende únicamente al consumo de los hogares, neto de los gastos médicos, como medida de bienestar. Este hecho muestra que esta literatura podría estar subestimando los efectos de los shock de salud sobre el bienestar de los hogares.
    Keywords: Riesgo compartido, Nutrición infantil, Consumo del hogar, Shock de salud. Risk sharing, Child nutrition, Household Consumption, Intrahousehold, Health Shocks.
    JEL: C23 C81 D13
    Date: 2008–12
  4. By: Bretteville-Jensen, Anne Line (Norwegian Institute for Alcohol and Drug Research (SIRUS)); Jacobi, Liana (University of Melbourne)
    Abstract: Empirical studies have found that cannabis commonly precedes consumption of drugs like amphetamine, ecstasy, cocaine and heroin. As a result a causal linkage between cannabis and subsequent hard drug use has been hypothesized. Despite mixed empirical evidence and a limited understanding of possible transmission mechanisms, the causal gateway hypothesis has been influential in formulating a strict drug policy in many western countries. Individual differences in proneness and accessibility, however, provide alternative, non-causal explanations for the observed "staircase" pattern and yield potentially different policy implications. We propose a Bayesian estimation and predictive framework to analyze the effects and relative importance of previous cannabis use, proneness and accessibility factors on hard drug initiation and to explore potential policy implications, using data from a unique recent survey of young adults in Norway. Motivated by the gateway transmission channels proposed in the literature, our model allows for a constant and a heterogeneous effect of previous cannabis use on hard drug initiation and, also, a more flexible correlation pattern for the unobservables. We find that proneness, accessibility and previous cannabis use contribute to the observed higher drug use pattern among cannabis users. The latter has the largest effect and is driven by various transmission channels.
    Keywords: accessibility, Bayesian prior-posterior analysis, Bayesian predictive analysis, cannabis gateway, cannabis use, hard drug use, Markov Chain Monte Carlo, policy, proneness
    JEL: C11 C35 D12 I19
    Date: 2008–12
  5. By: Boyce, Christopher J. (University of Warwick); Oswald, Andrew J. (University of Warwick)
    Abstract: This paper uses longitudinal data to explore whether greater job status makes a person healthier. Taking the evidence as a whole, promotees do not exhibit a health improvement after promotion. Instead the data suggest that workers with good health are more likely to be promoted. In the private sector, we find that job promotion significantly worsens people's psychological strain (on a GHQ score). For the public sector, there are some tentative signs of the reverse. We discuss caveats to our conclusions, suggest caution in their interpretation, and argue that further longitudinal studies are needed.
    Keywords: health, Whitehall studies, GHQ, locus of control, job satisfaction, mortality, status
    JEL: I1
    Date: 2008–12
  6. By: Gundersen, Craig; Kreider, Brent
    Abstract: Previous research has estimated that food insecure children are more likely to suffer from a wide array of negative health outcomes than food secure children, leading many to claim that alleviating food insecurity would lead to better health outcomes. Identifying the causal impacts is problematic, however, given endogenous selection into food security status and potential classification errors in measuring true food security status. Using recently developed nonparametric bounding methods and data from the 2001-2006 National Health and Nutritional Examination Survey (NHANES), we assess what can be identified about the effects of food insecurity on child health outcomes in the presence of nonrandom selection and nonclassical measurement error. Under relatively weak monotonicity assumptions, we can identify that food security has a statistically significant positive impact on good general health and being a healthy weight. Our work suggests that previous research has more likely underestimated than overestimated the causal impacts on health.
    Keywords: food insecurity; health outcomes; nonclassical measurement error; nonparametric bounds; average treatment effect
    JEL: I1 I3
    Date: 2008–12–13
  7. By: Sudhanshu Handa (Public Policy, University of North Carolina at Chapel Hill); Steven F. Koch (Department of Economics, University of Pretoria); Shu Wen Ng (Public Policy, University of North Carolina at Chapel Hill)
    Abstract: High rates of infant mortality in Africa continue to be a major public health concern today, despite the fact that most deaths can be prevented from well known, relatively low cost technologies. Using multiple years of DHS from four countries, we estimate the change in the relative risk of death as well as the main contributions to the change in mortality over time. We find significant declines in the mortality hazard in each of the 4 countries, with the largest declines in Malawi (44 percent) and Tanzania (22 percent) between the mid 1990s to mid 2000s, although there is significant variation by age group in the hazard rate across time. In Zambia for example, the hazard increased for children ages 25-60 months in spite of on overall decline in mortality, while in Mozambique the largest decline in mortality was exactly among this age group. The decomposition analysis illustrates that some of the main correlates of mortality did not contribute to overall declines over time, because the levels of these correlates did not change during the study period. This is particularly true for birth spacing, attended births and breastfeeding. The analysis also demonstrates the overall lack of explanatory power of the individual and household level variables available for use in the DHS, indicating the need to collect complementary supply side information, through community questionnaires for example, that can be linked to DHS households and thus expand the set of covariates available for modeling child survival and other health outcomes.
    Date: 2008–10
  8. By: Olufunke A. Alaba (Department of Economics, University of Pretoria); Steven F. Koch (Department of Economics, University of Pretoria)
    Abstract: A large number of child deaths in developing countries could be averted if ill children received care sooner rather than later. However, analysis in these developing countries rarely considers the pathway, through which, health care is sought at the household level. This paper considers two separate pathways of health-seeking decisions and finds that household controls affect decisions in different ways across the pathway; for example, different measures of female empowerment increase treatment, as well as preferences for private care along the pathway, but not consistently.
    JEL: I12 D13 C35
    Date: 2008–10
  9. By: Nagar, A.L. (National Institute of Public Finance and Policy); Shovon Ray, Amit; Sawhney, Aparna; Samanta, Sayan
    Abstract: This paper analyses interrelationships between `economic development', `health', and `environment' in a simultaneous equations framework. Four structural equations have been postulated to explain changes in four endogenous variables in terms of several predetermined variables. The endogenous variables chosen for the model are GDPPC (per capita gross domestic product), LE (life expectancy), NOCRD (number of cases of respiratory diseases) and PM10 (respirable suspended particulate matter). We assume that GDPPC describes economic development prominently and, therefore, use it as one of the endogenous variables in lieu of economic development. LE and NOCRD are assumed to reflect health effects in the economy, and PM10 is used as a proxy of environmental stress. The four endogenous variables are supposed to be jointly determined in terms of several exogenous variables represented through indices of physical infrastructure (PI), social infrastructure (SI) and air pollution index (API). We construct the three indices by the principal components method and thus effectively use only these three predetermined (exogenous) variables to simultaneously determine changes in the four endogenous variables listed above. The model is postulated in loglinear form and estimated by the two-stage least-squares method using data from the Indian economy 1980-81 to 2004-05. It follows from the estimated structural equations that while physical infrastructure is significant in determining GDPPC, the GDPPC is also directly influenced by improved health outcomes like longevity (LE) and lower morbidity from respiratory diseases (NOCRD). The long term health outcome (LE) is determined by the level of per capita GDP and it is positively affected by social infrastructure. The third structural equation shows that the immediate, or short run, health outcomes like morbidity from respiratory disorders are influenced by environmental stress (PM10) besides the level of GDPPC. Finally, the environmental stress (PM10) is determined by the level of per capita GDP and the air pollution index (API) representing various sources of air pollution. It is true that our simplified model illustrates the effects of specific type of air pollutant, viz., respirable particulate matter, however, it is among the most significant environmental problems threatening human health in India. Nevertheless, there is scope to build more comprehensive environmental stress indices which reflect surface water quality, ground water quality, soil pollution etc. which have feedback effects with health and economic development. Also many of the components of PI, SI and API may not be truly exogenous in a larger model (e.g. transport and communication in PI, education and health care systems in SI, and industrial production, vehicular traffic, urbanisation in API.) The two weaknesses of our model stem from data limitation and a concern to simplify the model. Although our model is highly simplified, nonetheless, it provides key insights into the nature of economic development in India during the last 25 years: First, the environmental stress has had a high cost on income and health . from the derived reduced form, a 1 percent increase in the air pollution index leads to a decrease of about 8 percent in the per capita income, a decrease of about 0.7 percent in the life expectancy, and an increase of about 19 percent in the number of cases of respiratory diseases. Second, the social infrastructure plays a more vital role in economic development, health, and environment than the physical infrastructure, since the absolute values of elasticities of endogenous variables with respect to SI are invariably greater than those with respect to PI. Although physical infrastructure is important for economic development, it comes in the last of our preference order. In the final run-up, there is need to pay more attention to provide better social infrastructure and to reduce air pollution.
    Date: 2008–10
  10. By: Sean Murphy; Robert Rosenman; Jon Yoder; Dan Firesner (School of Economic Sciences, Washington State University)
    Abstract: An extensive literature relating patients’ expectations to treatment outcomes has not addressed the determinants of these expectations. We argue that treatment history is part of a reference point that influences patients’ expectations of how effective further treatment might be, thus influencing whether to proceed with additional treatment or not. We hypothesize that those patients with unsuccessful prior treatments have diminished expected improvement from subsequent treatments. Prospect theory provides a theoretical foundation for reference frame effects, and the model is tested with data on patients diagnosed with idiopathic intracranial hypertension. Our results support the reference frame hypothesis.
    Keywords: Prospect Theory, Treatment Outcomes, Treatment History, Misclassification, Monotone Rank Estimator
    JEL: C14 C25 I12
    Date: 2008–09
  11. By: Ana Espinola-Arredondo; Sunita Mondal (School of Economic Sciences, Washington State University)
    Abstract: This paper analyzes the e¤ect of federal and state maternity leave policies on female employ- ment. We analyze if the enactment of the federal Family Medical Leave Act (FMLA) di¤erently a¤ected states which previously implemented maternity leave laws at the state level than those states which did not. Additionally, we study whether FMLA has provoked an increase in the female employment and labor force participation in those states which expanded its bene?ts and relaxed the eligibility criteria than in those which did not expand them. Finally, we analyze the Paid Family Leave program in California, comparing how the change in female employment dif- fers from those states which have FMLA alone and those which have complemented the bene?ts of FMLA. Using March CPS data available from the Integrated Public Use Micro data Series (IPUMS), our results suggest that the change in female employment is positive and signi?cant when states complement the bene?ts and eligibility criteria of FMLA.
    Keywords: Family Medical Leave Act, Temporary Disability Insurance, Female Employment.
    JEL: J48 K31
    Date: 2008–08
  12. By: Engel, Nora (UNU-MERIT)
    Abstract: Tuberculosis remains the biggest infectious killer in India and worldwide, and it has recently regained substantial international attention with its come-back in drug resistant forms. The environment, the disease and the societal response to it are changing and with it challenges and opportunities to control the disease. Innovation in a variety of areas such as improved diagnostic tests, drugs, delivery mechanisms, service processes, institutions and treatment regimes is needed in order to be able to respond to the changing public health challenge. This paper reviews theoretical approaches to innovation of direct relevance to the case and examines what theoretical framework is useful to look at the problem of innovation in public health in India. Such an analysis can reveal drivers and barriers of change within the context of the Indian health system in a comprehensive, problem-oriented way and is thus able to add to existing research done on TB. However, given that TB control is a public health challenge, concerned with problems of delivery and implementation, the concept of innovation has to go beyond technological innovation and the private sector. Therefore it is argued that the case can simultaneously contribute to innovation theory in order to better understand what change processes and innovation for concrete public health challenges in a country such as India mean. After a short description of recent changes in TB control based on fieldwork in India the paper proceeds with an examination of existing frameworks on healthcare innovation upon their usefulness for such a case. The paper concludes with a proposal for a theoretical framework and areas for further empirical fieldwork.
    Keywords: Innovation, Healthcare, Tuberculosis, Disease control, India
    JEL: I18 O31 O38
    Date: 2008
  13. By: Engel, Nora (UNU-MERIT)
    Abstract: Emerging infectious diseases regained substantial international attention in recent years and it has been argued that flexibility and innovation in public health systems is needed in order to react to changing challenges. This paper will take these policy claims as a starting point to examine the case of multi-drug resistant Tuberculosis (MDR-TB) in India. Based on fieldwork results it will be examined how the existing control efforts of TB in India respond to the emergence of MDR-TB, what solutions are discussed for diagnosing, treating and preventing MDR-TB and what can be learned from that with regard to innovation and flexibility of a public health system in a country like India. The discussions and reactions to MDR-TB indicate that arguments for flexibility meet constraints of the existing control system and the Indian public health and wider social system. However, the flexibility that is argued for goes beyond what has been envisaged in international policy arenas (mainly focusing on preparation of various capacities in surveillance, detection and research). Rather it involves localized learning and experimenting within existing control structures that are claimed to have become too rigid in trying to keep up quality standards faced with a weakening public health system. Furthermore, the case shows that existing challenges in TB control resurface with the emergence of MDR-TB and reflect a difficult balancing act between biomedical values, socio-cultural values and operational feasibility. However, various actors are striving for change and it is in these instances that one can start to understand what flexibility and innovation could mean for a public health challenge such as TB in India. The paper concludes with an argument for a detailed analysis of these changes from an innovation perspective.
    Keywords: Tuberculosis, Multi-drug resistance, India, Innovation, Flexibility
    JEL: I18 O38
    Date: 2008
  14. By: Nathaniel John Porter; Dennis P. J. Botman
    Abstract: With much healthcare publicly funded, Hong Kong's rapidly aging population will significant raise fiscal pressure over coming decades. We ask what the implications are of meeting these costs by public funding, or private funding voluntarily or through mandates. Our simulations suggest that without early reform, these costs quickly become unsustainable. Prefunding is key. Whether this is done through the public system or through mandatory private provision is less important. Voluntary schemes are likely to result in insufficient savings without tax incentives. Even then, voluntary accounts are unlikely to yield better macroeconomic outcomes, while mandates tend to produce more equitable consumption.
    Keywords: Health care , Hong Kong Special Administrative Region of China , Public finance , Aging , Fiscal reforms , Tax incentives ,
    Date: 2008–12–08
  15. By: Rajat Acharyya; Maria D.C. Garcia-Alonso
    Abstract: In health markets, government policies tend to subsidise poorer groups. The purpose of this paper is to analyse the implications of an income-based subsidy policy on the incentives of countries to implement price arbitrage and of firms to provide market access to poorer groups.
    Keywords: Pharmaceuticals; Income Based Subsidies; Parallel Imports; Market Access
    JEL: D4 L1 I1
    Date: 2008–12
  16. By: Ahmad Alachkar
    Abstract: The study uses average data from Household Income and Expenditure Survey 2004 in Syria to examine monthly household expenditure on cigarettes and tobacco and its relationships with a group of socioeconomic variables. It is found that this expenditure increases by average household income. This increase, however, is relatively small; the percent of total expenditure allocated to smoking is much higher among the poor compared to the rich. Expenditure on smoking is negatively affected by the improvements in educational conditions. Household expenditure on domestic cigarettes does not vary by household income; it is positively correlated with characteristics of the place of residence, particularly with illiteracy, polygamy; and negatively with developed educational structure. Expenditure on foreign cigarettes is spread mostly in governorate centers and among rich households. The study deduces that people with low income cannot smoke unless they decrease their monthly expenditure on basic requirements. In order to decrease smoking, two recommendations are made, developing the educational structure and eradicating illiteracy and launching concentrated campaigns to raise awareness against smoking.
    Keywords: Household Economics; Social Policy; Poverty
    JEL: C21 D12
    Date: 2008–12
  17. By: Hendrik Schmitz
    Abstract: Deductibles in health insurance are often regarded as a means to contain health care costs when individuals exhibit moral hazard. However, in the absence of moral hazard, voluntarily chosen deductibles may instead lead to self-selection into different insurance contracts.We use a set of new variables in the German Socioeconomic Panel for the years 2002, 2004, and 2006 that measure individual health more accurately and include risk-attitudes towards health in order to determine the price elasticity of demand for health care.A latent class approach that takes into account the panel structure of the data reveals that the effect of deductibles on the number of doctor visits is negligible. Private add-on insurance increases the number of doctor visits.However, altogether the effects of the insurance state on the demand for doctor visits are small in magnitude.
    Keywords: Health insurance, deductibles, add-on insurance, count data, latent class panel model
    JEL: I11 I18 G22
    Date: 2008–11
  18. By: Christoph Schwierz; Boris Augurzky; Axel Focke; Jürgen Wasem
    Abstract: In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically.We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days without excess demand.We find that when this variation is ignored in the regression framework, the effect of demand on outcomes is biased upwards. The reason is that when demand is high more patients with a higher unobservable frailty are admitted to the hospitals. After having controlled for this selection of patients, excess demand does not negatively affect patient outcomes.
    Keywords: Hospital staffing, inpatient outcomes
    JEL: I12 I18
    Date: 2008–10
  19. By: Holger Strulik (University of Hannover); Jacob Weisdorf (Department of Economics, University of Copenhagen)
    Abstract: This study provides a unified growth theory to correctly predict the initially negative and subsequently positive relationship between child mortality and net reproduction observed in industrialized countries over the course of their demographic transitions. The model captures the intricate interplay between technological progress, mortality, fertility and economic growth in the transition from Malthusian stagnation to modern growth. It identifies a number of structural breaks over the course of development, suggesting a high degree of complexity regarding the relationships between various economic and demographic variables.
    Keywords: economic growth; mortality; fertility; structural change; industrial revolution
    JEL: O11 O14 J10 J13
    Date: 2008–12
  20. By: David M. Clark; Richard Layard; Rachel Smithies
    Abstract: The Government's Improving Access to Psychological Therapy (IAPT) programme aims toimplement NICE Guidance for people with depression and anxiety disorders. In the firstphase of the programme, two demonstration sites were established in Doncaster and Newhamwith funding to provide increased availability of cognitive-behaviour therapy-based (CBT)services to those in the community who need them. The services opened in late summer2006. This paper documents the achievements of the sites up to September 2007 (roughlytheir first year of operation) and makes recommendations for the future roll out of IAPTservices.
    Keywords: Cognitive Behavioural Therapy, CBT, Psychological therapy, Evaluation, Cost benefit analysis, IAPT
    JEL: I12
    Date: 2008–11
  21. By: Pablo Alonso González (Departamento de Estadística, Estructura y O.E.I. Universidad de Alcalá.); Irene Albarrán Lozano (Departamento de Estadística, Universidad Carlos III de Madrid.)
    Abstract: The passing of Act 39/2006, of 14th December, on the Promotion of Personal Autonomy and Care for Dependent Persons (known as the Dependent Care Law) has created the fourth pillar of Welfare State in Spain. In order to achieve its efficient implementation, we need to know who and how many individuals should be attended and how much money is needed for the attention. However, the answers to these two questions given until now suggest that a lot of work is still to be done in order to reach the objectives proposed by the Law.
    Keywords: Long term care insurance, dependence, costs, public funds.
    JEL: G22 J11 H68 H72
    Date: 2008
  22. By: Dhaval M. Dave; Sandra Decker; Robert Kaestner; Kosali I. Simon
    Abstract: This paper analyzes the effect of Medicaid eligibility expansions on the health insurance coverage of women giving birth and on the use of prenatal care and infant health, controlling for year and state effects and state-specific trends that may be correlated with expansions in Medicaid eligibility. We combine estimates from the two sets of analyses to construct estimates of the effect of health insurance on use of prenatal care and infant health. We find that the eligibility expansions reduced the proportion of pregnant women who were uninsured by approximately 10 percent, although this decrease in uninsured came with the expense of a substantial reduction in private insurance coverage. Changes in Medicaid eligibility were associated with very small and statistically insignificant changes in prenatal care use, birth weight, and incidence of low-birth weight.
    JEL: I11 I12 I18 I28 I38
    Date: 2008–12
  23. By: Jean Abraham (Division of Health Policy and Management, University of Minnesota); Stéphanie Lluis (Department of Economics, University of Waterloo)
    Abstract: In this paper, we revisited the question of the existence of a tradeoff between wages and health insurance by extending previous work in the following way: 1) we exploit richer information on health insurance in terms of whether the worker holds health insurance or whether it is offered at the firm but he/she does not hold it, 2) we analyze possible combinations of health insurance with other fringe benefits (retirement, sick leave and paid vacation), 3) we include information on workers health (self-reported) as a determinants of workers wage and mobility decision, and 4) we use an econometric framework and GMM estimations which allow us to treat the issues of endogenous choice of benefits and mobility into benefits sectors encountered in the literature and estimate the extent of worker selection into jobs with/without benefits based on unobserved individual-specific traits, skills and health status.
    Date: 2008–12

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