nep-hea New Economics Papers
on Health Economics
Issue of 2009‒03‒28
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Responding to financial pressures. The effect of managed care on hospitals' provision of charity care By Mas, Nuria
  2. Use of Discrete Choice Experiments in health economics: An update of the literature By Rochelle Guttmann; Ryan Castle; Denzil G. Fiebig
  3. Happiness and Sex Difference in Life Expectancy By Junji Kageyama
  4. The Effects of the War in Iraq on Nutrition and Health: An Analysis Using Anthropometric Outcomes of Children By Gabriela Guerrero-Serdán
  5. Does remediation save lives? On the cost of cleaning up arsenic-contaminated sites in Sweden By Forslund, Johanna; Samakovlis, Eva; Vredin Johansson, Maria; Barregård, Lars
  6. Risky Sex in a Risky World: Sexual behavior in a HIV/AIDS environment By Mannberg, Andrea
  7. Linking HIV/AIDS, Confict and National Security A Colombian Case Study By Caroline Törnqvist
  8. Will People Be Healthy Enough to Work Longer? By Alicia H. Munnell; Mauricio Soto; Alex Golub-Sass

  1. By: Mas, Nuria (IESE Business School)
    Abstract: The United States relies on charitable medical care to serve the uninsured, most of which is offered by hospitals that act as providers of last resort and that constitute the safety net. Traditionally, these hospitals have been able to finance their provision of unfunded care through a complex system of cross-subsidies. The objective of this paper is to analyze the effects that financial pressures have on the provision of charity care by hospitals. To do so we look at the effect of price pressures and at the cost-controlling mechanisms imposed by managed care. Our hypothesis is that price competition and other forms of financial pressures undermine hospitals' ability to cross-subsidize and so challenges their survival. Our results show that managed care has a disproportionately negative effect on the closure of safety net hospitals. Moreover, amongst those that remain open, in areas where managed care penetration increases the most, safety net hospitals react by closing the health services most commonly used by the uninsured (emergency rooms, obstetrics, and alcohol and drug treatments).
    Keywords: medical; uninsured; hospitals; safety;
    Date: 2009–02–09
  2. By: Rochelle Guttmann; Ryan Castle; Denzil G. Fiebig (CHERE, University of Technology, Sydney)
    Abstract: The vast majority of stated preference research in health economics has been conducted in the random utility model paradigm using discrete choice experiments (DCEs). Ryan and Gerard (2003) have reviewed the applications of DCEs in the field of health economics. We have updated this initial work to include studies published between 2001 and 2007. Following the methods of Ryan and Gerard, we assess the later body of work, with respect to the key characteristics of DCEs such as selection of attributes and levels, experimental design, preference measurement, estimation procedure and validity. Comparisons between the periods are undertaken in order to identify any emerging trends.
    Keywords: discrete choice experiments, health economics
    JEL: I10
    Date: 2009–03
  3. By: Junji Kageyama (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: This paper examines the effects of happiness on the sex gap in life expectancy. Utilizing a cross-country data set, it first inspects the reverse effect of the life expectancy gap on happiness and demonstrates that the life expectancy gap negatively affects happiness through the composition of marital status. Taking this reverse causality into account, it shows that happiness is significant on explaining the differences in the life expectancy gap between countries. As national average happiness increases, the sex difference in life expectancy decreases. This is consistent with the findings that psychological stress (unhappiness)adversely affects survival and that the effect of psychological stress on mortality is more severe for men. This result provides an indirect evidence that happiness affects survival even at the national aggregate level.
    Keywords: economic and social development, life expectancy
    JEL: J1 Z0
    Date: 2009–03
  4. By: Gabriela Guerrero-Serdán (Department of Economics, Royal Holloway, University of London)
    Abstract: The war in Iraq initiated in March 2003 triggered a wave of violence and turmoil in the country, exposing households to insecurity and to instability in daily life. The level of violence has varied across provinces, the south and centre areas being the most affected. Using the different intensities of the conflict across areas and the age at exposure to the war among cohorts, I analyze a possible causal effect of the war on nutritional outcomes of children. I use two empirical strategies, leading to very similar results. Estimates indicate that children born in areas affected by high levels of violence are 0.8 cm shorter than children born in low violence provinces. These results are robust to several specifications. Furthermore, the paper also addresses the channels through which the conflict has affected health and nutrition. The results have not only short-term policy implications, but also, given the empirical evidence of the impact of early child malnutrition on later education, labour and productivity outcomes, the results are of great importance for the future.
    Keywords: health; nutrition; shocks; war; children; Iraq
    JEL: I10 J10 O15
    Date: 2009–03
  5. By: Forslund, Johanna (National Institute of Economic Research); Samakovlis, Eva (National Institute of Economic Research); Vredin Johansson, Maria (National Institute of Economic Research); Barregård, Lars (National Institute of Economic Research)
    Abstract: Swedish environmental policy is based on 16 environmental quality objectives (Gov. Bill 2000/01:130 and Gov.Bill 2004/05:150).1 One of the most challenging objectives,‘A non toxic environment’, has two interim targets that concern remediation of contaminated sites. In sum, they state that the highest priority should be given to sites posing the highest risks to human health and the environment.2 By eliminating pollutants in soil, groundwater and sediment, the interim targets aim to reduce risks to human health and the environment. In Sweden, 83,000 sites are potentially contaminated due to previous industrial activities. According to the Swedish Environmental Protection Agency (EPA), the administrator of the governmental funds for remediation, approximately 1500 of these sites contain contaminant concentrations that could seriously harm human health and the environment (Swedish EPA, 2008a). To reach the interim targets, all these sites need to be remediated by 2050. Remediation of contaminated sites has so far cost more than SEK 3,000 million.3 The approximated cost to mitigate the potential risks at the most harmful sites is estimated at SEK 60,000 million.4 The Swedish government’s funding for remediation presently comes in the form of a directed grant (sakanslag). The directed grant, administrated by the Swedish EPA, subsidises remediation of contaminated sites that were contaminated prior to modern environmental legislation (in 1969) or for which no liable party can be found. The directed grant amounts to approximately 455 millions annually, which corresponds to about 10 percent of the annual national funds for environmental protection (Gov. Bill 2007/08:1). To make it possible to prioritise among contaminated sites, the Swedish EPA has developed a method for risk assessment called the ‘MIFO’ (i.e. the Method for Inventory of Contaminated Sites). The risk assessment does not take into account the actual exposure at a contaminated site. Risk is instead assessed based on divergence from guideline values for acceptable concentrations given a standardised (i.e. worst case) exposure situation on an individual level. This means that a site can be remediated without any individuals actually being exposed. The expected risk reduction is consequently not quantified. This eliminates the possibility of valuing the risk reduction, which should be weighed against the remediation cost.<p><p> The purpose of this paper is to analyse how health effects, in the form of cancer risks, from sites contaminated by arsenic are valued implicitly in remediation. By using an environmental medicine approach that takes exposure into account, and without underestimating the potential health consequences of arsenic exposure, our purpose is to place arsenic risk management in the overall picture of live-saving interventions. In the case of cancer prevention, it is necessary to recognise that focus on an environmental carcinogen like arsenic may draw public attention – and funding – away from mental health risks like ambient air pollution and indoor radon. Although environmental pollution accounts for less than ten percent of all cancer cases (Harvard Centre for Cancer Prevention, 1996; Saracci and Vineis, 2007), environmental factors are important to recognize since they may be preventable. We emphasise, however, the inefficiency in becoming overly concerned about small risks while, at the same time, losing sight of the large risks. If society’s spending on lifesaving measures with small effects (i.e. a small number of lives saved) crowds out spending on lifesaving measures with large effects, then remediation can, in fact, even be said to waste lives.<p><p>By using data on 23 arsenic-contaminated sites in Sweden, we estimate the sitespecific cancer risks and calculate the cost per life saved by using the sites’ remediation costs. Our results show that the cost per life saved through remediation is much higher than that associated with other primary prevention measures, indicating that the ambition level of Swedish remediation may be too high.
    Date: 2009–02–28
  6. By: Mannberg, Andrea (Department of Economics, Umeå University)
    Abstract: In spite of increased awareness of HIV/AIDS and the lack of retroviral drugs, unprotected casual sex is still widespread in many HIV infected countries. In this paper, a two-period model for sexual decisions under uncertainty is developed. The results suggest that uncertainty of future health may be an important factor driving unsafe sex practices in countries in which access to HIV drugs is limited. Furthermore, the more efficient HIV treatment becomes, the more important will health related interventions become. The results support the empirical finding of a weak link between sexual behavior, HIV frequency and HIV knowledge in poor countries, and suggest that AIDS policy needs to be calibrated to fit within different social contexts.
    Keywords: HIV/AIDS; sexual behavior; uncertainty; risk aversion; health risk
    JEL: D81 D91 I10
    Date: 2009–03–18
  7. By: Caroline Törnqvist
    Abstract: Abstract An estimated 33 million people are today infected with HIV. The majority of these people live in developing countries, and many in countries experiencing armed conflict or instability. This paper examines the linkages between HIV/AIDS, conflict and national security applying existing theories to the Colombian context and asking whether HIV/AIDS should be securitized in order to reduce the negative cause and effect relationship. It finds that the linkages are definitely present in Colombia and concludes that HIV/AIDS should be politicised at the national level and securitized at international level. **** Resumen Aproximadamente 33 millones personas están hoy en día infectadas con el VIH. La mayoría de ellos viven en países en vía de desarrollo y muchos de estos países están sufriendo conflictos armados o inestabilidades políticas. En el presente documento se examina los vínculos entre VIH/SIDA, conflicto y seguridad nacional, aplicando las teorías existentes al contexto colombiano y haciendo la pregunta si se debería tratar el VIH/SIDA como una cuestión de seguridad nacional para reducir la relación causa y efecto negativa. En el documento se descubre que estos vínculos están presentes en Colombia y concluye que a nivel nacional se debería buscar un reconocimiento político del tema VIH/SIDA, mientras a nivel internacional sería pertinente tratarlo como una cuestión de seguridad.
    Date: 2008–12–30
  8. By: Alicia H. Munnell; Mauricio Soto; Alex Golub-Sass
    Abstract: If Americans continue to retire at age 63, a great many will risk income shortfalls especially at older ages. Because work directly increases current income, Social Security benefits, retirement saving, and decreases the length of retirement, a logical solution would be to increase the age of retirement. But are Americans healthy enough to work longer? Using the National Health Interview Study, this paper shows that healthy life expectancy increased by about three years over 1970-2000 for the average 50-year old man. This increase is largely the result of men moving up the education ladder, with minimal increases within educational groups. Moreover, major disparities in healthy life expectancy remain between those in the bottom and top quartiles of the population. And these disparities mean that a vulnerable portion of the population – perhaps those who most need to work longer – might not be able to extend their work lives.
    Date: 2008–07

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