nep-hea New Economics Papers
on Health Economics
Issue of 2009‒01‒24
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Medical Demography and Intergenerational inequalities in GPs' earnings By Brigitte Dormont; Anne-Laure Samson
  2. Health and Utilization Effects of Increased Access to Publicly Provided Health Care: Evidence from the U.S. Department of Veterans Affairs By Melissa Boyle
  3. Approaches to Estimating the Health State Dependence of the Utility Function By Finkelstein, Amy; Luttmer, Erzo F.P.; Notowidigdo, Matthew J.
  4. Who Pays What for Primary Health Care? Patterns and Determinants of the Fees Paid by Patients in a Mixed Public-Private Financing Model By Jackie Cumming; Steven Stillman; Michelle Poland
  5. The Effects of Public Place Smoking Restrictions on Individual Smoking Behaviour in Australia By Hong-il Yoo
  6. Health Damage Cost of Automotive Air Pollution: Cost Benefit Analysis of Fuel Quality Upgradation for Indian Cities By Ramprasad Sengupta
  7. Scope, Strategy and Structure: The Dynamics of Knowledge Networks in Medicine By Consoli, Davide; Ramlogan, Ronnie
  8. Public and Private Expenditures on Health in the Presence of Inequality and Endogenous Mortality: A Political Economy Perspective By Radhika Lahiri; Elizabeth Richardson
  9. Determinants of Mammography Usage across Rural and Urban Regions of Canada By James Ted McDonald; Angela Sherman

  1. By: Brigitte Dormont (LEGOS - Université Paris Dauphine - Paris IX, IEMS - Université de Lausanne); Anne-Laure Samson (EconomiX - CNRS : UMR7166 - Université de Paris X - Nanterre)
    Abstract: This article examines the link between restrictions on the number of physicians and general practitioners' earnings. Using a representative panel of 6,016 French self-employed GPs over the years 1983 to 2004, we show that the policies aimed at manipulating the number of places in medical schools strongly affect physicians' permanent level of earnings.We estimate an earnings function to identify experience, time and cohort effects. The cohort effect is very large: the estimated gap in earnings between "good" and "bad" cohorts may reach 25%. GPs beginning during the eighties have the lowest permanent earnings: they belong to the baby-boom numerous cohorts and faced the consequences of an unlimited number of places in medical schools. Conversely, the decrease in the number of places in medical schools led to an increase in permanent earnings of GPs who began their practice in the mid nineties. A stochastic dominance analysis shows that unobserved heterogeneity does not compensate for average differences in earnings between cohorts. These findings suggest that the first years of practice are decisive for a GP. If competition between physicians is too intense at the beginning of career, she will suffer from permanently lower earnings. To conclude, our results show that the policies aimed at reducing the number of medical students succeeded in buoying up physicians' permanent earnings.
    Keywords: General Practitioners; self-employed; longitudinal data; earnings; stochastic dominance
    Date: 2008
  2. By: Melissa Boyle (Department of Economics, College of the Holy Cross)
    Abstract: During the mid-1990s, the U.S. Department of Veterans Affairs overhauled its health care system in an attempt to increase quality and efficiency. The restructuring involved the adoption of a capitated payment system and treatment methods based on the managed care model. This reorganization was accompanied by a major expansion in the population eligible to receive VA care. Using the National Health Interview Survey and VA medical claims data, this study analyzes both the efficiency of providing public health care in a managed care setting and the effectiveness of expanding coverage to healthier and wealthier populations. I estimate that between 35 and 70 percent of new take-up of VA care was the result of individuals dropping private health insurance. While utilization of services increased, estimates of the impact on aggregate veteran health imply that the policy change did not result in net health improvements. Regions providing more care to healthier, newly-eligible veterans had bigger reductions in hospital care and larger increases in outpatient services for previously-eligible veterans. This shift away from specialty care may help to explain the aggregate health declines.
    Keywords: Medicare, elderly, veteran, VA healthcare
    JEL: J2 I18
    Date: 2009–01
  3. By: Finkelstein, Amy (MIT); Luttmer, Erzo F.P. (Harvard University); Notowidigdo, Matthew J. (MIT)
    Abstract: If the marginal utility of consumption depends on health status, this will affect the economic analysis of a number of central problems in public finance, including the optimal structure of health insurance and optimal life cycle savings. In this paper, we describe the promises and challenges of various approaches to estimating the effect of health on the marginal utility of consumption. Our basic conclusion is that while none of these approaches is a panacea, many offer the potential to shed important insights on the nature of health state dependence.
    Keywords: state dependence, health, insurance, marginal utility
    JEL: D12 I1
    Date: 2009–01
  4. By: Jackie Cumming (Victoria University of Wellington); Steven Stillman (Motu Economic and Public Policy Research); Michelle Poland (Motu Economic and Public Policy Research)
    Abstract: The New Zealand government introduced a Primary Health Care Strategy (PHCS) in 2001 aimed at improving access to primary health care, improving health, and reducing inequalities in health. The Strategy represented a substantive increase in health funding by government and a move from a targeted to a universal funding model. This paper uses representative national survey data to examine the distribution of fees paid for primary health care by different individuals under the mixed public-private financing model in place prior to the introduction of PHCS. Using multivariate regression analysis, we find that fees do vary, with people who might be expected to have greater needs paying less. However, apart from people with diabetes, there is no direct link between self-reported health status and fees paid. The findings indicate that a mixed public-private financing model can result in a fee structure which recognises differences across different population groups. The findings also provide a baseline against which changes in funding brought about by the PHCS can be evaluated.
    Keywords: General Practitioner, Primary Health Care, Doctor Fees, Health User-Charge, New Zealand
    JEL: I11 I18 H51
    Date: 2009–01
  5. By: Hong-il Yoo (School of Economics, University of New South Wales)
    Abstract: While smoking remains the leading preventable cause of death in Australia, existing policy options, except for bans on smoking at public places, seem to have limited scope for expansion. Eight new smoking bans, introduced in six different Australian jurisdictions over 2003 and 2005, provide a basis for evaluation. The analysis extends a popular two-part model of smoking behaviour by GLM and correlated random effect models. Difference-in-differences estimation using 4 waves of the Household, Income, Labour Dynamics Australia Survey indicates that neither the probability nor the intensity of smoking was affected. The results are robust to alternative specifications and estimation methods.
    Keywords: smoking; smoke-free law; tobacco regulation
    JEL: I12 I18
    Date: 2008–11
  6. By: Ramprasad Sengupta
    Abstract: An analysis of the economic implication of judicial activism of the apex court of India in the regulation of automotive air pollution is analysed. It estimates the health damage cost of urban air pollution for 35 major urban agglomerations of India arising from automotive emissions and the savings that can be achieved by the regulation of fuel quality so as to conform to the Euro norms. It has used the results of some US based study and has applied the transfer of benefit method from the US to the Indian situation for the purpose. The paper finally makes a benefit cost analysis of refinery upgradation for such improvement of fuel quality.
    Keywords: fuel quality, health, urban pollution, air, cost benefit analysis, US, Indian, ecoomic implication, automotive, Euro, ,
    Date: 2009
  7. By: Consoli, Davide; Ramlogan, Ronnie
    Abstract: The objective of this paper is to analyse the dynamics of networks in which new knowledge emerges and through which it is exchanged. Our conjecture is that the structure of a network cannot be divorced from the dynamics of the knowledge underpinning its activities. In so doing we look beyond studies based on the assumption of exogenous networks and delve into the mechanisms that stimulate their creation and transformation. In the first part the paper adopts a functional perspective and views networks as constructs aimed at the coordination of knowledge; accordingly, network structure is an emerging property that reflects the employment of an agreed strategy to achieve a collective scope. In the second part these themes are articulated in relation to the dynamics of medical innovation and enriched by an empirical study on the long-term evolution of medical research in Ophthalmology. This exercise highlights the connection between changes in scientific and practical knowledge and the reconfigurations of the epistemic network over a forty-year period. By mapping different network structures we capture variety in the gateways of knowledge creation – that is, the network participants – as well as in the pathways – that is, the inter-organisational collaborations. Our goal is to analyse how these patterns of interaction emerge and transform over time.
    Keywords: Innovation; Network analysis; Inter-organizational Relationships
    JEL: D83 O33 D85 O31
    Date: 2009–01–15
  8. By: Radhika Lahiri; Elizabeth Richardson
    Abstract: In this paper we study an overlapping-generations model in which agents’ mortality risks, and consequently impatience, are endogenously determined by private and public investment in health care. The proportion of revenues allocated for public health care is also endogenous, determined as the outcome of a voting process. Higher substitutability between public and private health is associated with a “crowding-out” effect which leads to lower public expenditures on health care in the political equilibrium. This in turn impacts on mortality risks and impatience leading to a greater persistence in inequality and long run distributions of wealth that are bimodal.
    Keywords: health; inequality; political economy; income distribution dynamics
    JEL: I12 I20 O5
    Date: 2008–12–15
  9. By: James Ted McDonald; Angela Sherman
    Abstract: Breast cancer is a leading source of mortality among Canadian women; however early detection via mammography considerably improves survival rates. Accordingly, national guidelines advocate biennial screening for asymptomatic women aged 50 to 69 years. Unfortunately many women do not abide by such recommendations, and there is some evidence that compliance rates are lower in rural areas. This report explores the extent of regional variation within and between Canadian provinces using a new and more detailed set of rural indicators based on economic zones of influence. We find the incidence of ever having a mammogram and screening within the last two years are significantly lower for women most removed from large urban centers. This result is obtained after controlling for demographic and socio-economic characteristics, concentration of physicians and specialists in the local area and whether the woman has a regular family doctor. An important reason for the observed differences across rural and urban areas is found to be awareness of the need for regular screening. We also observe that differences in mammography usage between rural and urban areas vary significantly across Canadian provinces.
    Keywords: mammography, cancer screening, rural health, women's health
    JEL: I18 I19 R23
    Date: 2008–12

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