nep-hea New Economics Papers
on Health Economics
Issue of 2009‒05‒30
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Hospital financial pressures and the health of the uninsured. Who gets hurt? The case of California By Mas, Nuria
  2. Physicians' working practices : target income, altruistic objectives or a maximization problem ? By Béatrice Desquins; Alberto Holly; Jacques Huguenin
  3. Trends in geographical mortality differentials in India By Nandita Saikia; Domantas Jasilionis; Faujdar Ram; Vladimir M. Shkolnikov
  4. Contagion Nation: A Comparison of Paid Sick Day Policies in 22 Countries By Jody Heymann; Hye Jin Rho; John Schmitt; Alison Earle
  5. Eligibility for Free Primary Care and Avoidable Hospitalisations in Ireland By Anne Nolan
  6. What do we know about adult mortality and data quality in Peru? Mortality coverage levels and trends from recent decades By Mario Piscoya; Bernardo L. Queiroz
  7. Labor Force Participation among Indian Elderly: Does Health Matter? By Manoj K Pandey
  8. Contextualizing The Urban Healthcare System - Methodology for Developing a Geodatabase of Delhi's Healthcare System. By Pierre Chapelet
  9. Examining the Relationship between Income and Health Behavior: Why Do Low Income Consumers Eat Less Healthy Food? By Binkley, James; Chen, Susan; Ling, Jing
  10. Catching the habit: a study of inequality of opportunity in smoking-related mortality By Balia, S; Jones, A.M
  11. Investigating Patient Outcome Measures in Mental Health By Rowena Jacobs
  12. Ageing, marital status and its health implications: evidences from India By Pandey, Manoj K.
  13. Child Care Subsidies and Childhood Obesity By Chris M. Herbst; Erdal Tekin
  14. Differences in the U.S. Trends in the Prevalence of Obesity Based on Body Mass Index and Skinfold Thickness By Richard V. Burkhauser; John Cawley; Maximilian D. Schmeiser
  15. Consumption Insurance against Unforeseen Epidemics:The Case of Avian Influenza in Vietnam By TAMURA Sakuya; SAWADA Yasuyuki

  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. This paper analyzes the effect that hospital financial stress has on the health of the uninsured. In particular we look at managed care. Managed care penetration has often been blamed for increasing financial pressures on hospitals and previous work has shown that safety net hospitals have been affected more severely by it. Our findings are threefold: first, we find that managed care financial pressures encourage charity care patients to concentrate in public hospitals. Second, we find that these hospitals, in turn, see a decrease in their quality of care in areas where managed care penetration is stronger. Finally, we also find that managed care diffusion has a negative effect on the quality of care received by the uninsured - as measured by the probability of dying after a heart attack - and of those that go to government hospitals.
    Keywords: uninsured; hospitals; financial care; quality;
    Date: 2009–03–19
  2. By: Béatrice Desquins; Alberto Holly; Jacques Huguenin
    Abstract: In traditional literature, a number of authors posit that physicians, like a consumer or a firm, adopt maximization behavior, while others claim that they are motivated by the attainment of a target income. These three approaches may seem contradictory, yet the present study aims to show that they are in fact complementary. This paper aims to highlight the overlapping of these approaches by using a theoretical model - the agent model. From this model, we deduce the income effect, the individualistic substitution effect, the monopolistic effect and their respective elasticities to detect target income behavior. We develop also two theoretical models of leisure and income renouncement to determine the priority which the physician gives to consumption and leisure. Unlike other models, our results show that about 20% of physicians prefer to reach an altruistic objective rather than a leisure or an target income. These last result implies a ranking of target priorities. Moreover, we observe that the Slutsky relation cannot be used to determine individualistic substitution, monopolistic substitution and income effects exactly when leisure is an inferior good. Nor can we confirm the adoption of a target income behavior when income and monopolistic elasticities are negative. Renouncement models indicate that between 60% and 67% of GPs have a clear consumption priority and that they accept a renouncement of their leisure in order to maintain their current level of income. Our results demonstrate that it would be necessary to introduce monopolistic power of physicians and their altruistic priority to test inducement demand.
    Date: 2009–04
  3. By: Nandita Saikia (Max Planck Institute for Demographic Research, Rostock, Germany); Domantas Jasilionis (Max Planck Institute for Demographic Research, Rostock, Germany); Faujdar Ram; Vladimir M. Shkolnikov (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: This study examines the variation in mortality and mortality trends among different regions in India since the 1970s using data from the Sample Registration System (SRS). Evaluation of the SRS data quality confirms reliability for children and adults under the age of 60 years. Analysis of temporary life expectancy between the exact ages of 0 and 60 years shows that, after significant progress during the 1970s and 1980s, improvements in longevity slowed down in the 1990s and 2000s. The Gini coefficient and dispersion measure of mortality confirm the convergence of mortality across the regions in India between 1971–1975 and 2000–2004. In spite of this trend, a substantial difference between higher longevity in the south and lower longevity in the north was noteworthy in 2001–2004. Age decomposition of temporary life expectancy by age group 0–14 years and 15–59 years suggests that the steep longevity increase in the 1970s and 1980s was largely driven by a reduction in mortality in children under the age of 15 years. In the 1990s and early 2000s, the contribution of both young and adult age groups to longevity increase has diminished. India faces difficulties in making progress in further reductions of infant deaths to the minimum levels and also in fighting chronic and man-made diseases in individuals within older age groups.
    Keywords: India, differential mortality, mortality
    JEL: J1 Z0
    Date: 2009–05
  4. By: Jody Heymann; Hye Jin Rho; John Schmitt; Alison Earle
    Abstract: This report finds that the U.S. is the only country among 22 countries ranked highly in terms of economic and human development that does not guarantee that workers receive paid sick days or paid sick leave. Under current U.S. labor law, employers are not required to provide short-term paid sick days or longer-term paid sick leave. By relying solely on voluntary employer policies to provide paid sick days or leave to employees, tens of millions of U.S. workers are without paid sick days or leave. As a result, each year millions of American workers go to work sick, lowering productivity and potentially spreading illness to their coworkers and customers.
    Keywords: paid time off, paid sick leave, productivity
    JEL: O O51 O52 O57 I I18 H H5 H51
    Date: 2009–05
  5. By: Anne Nolan (ESRI)
    Abstract: Using hospital discharge data covering the period 1999-2004, the purpose of this paper is to examine the determinants of avoidable hospitalisations in Ireland, with a particular focus on the role of eligibility for free primary health care. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services and/or that can be treated more appropriately in a primary care setting, and are often used as an indicator of access to primary care. The issue is particularly relevant for Ireland, where access to free primary care is restricted to those on low incomes (with approximately 30 per cent of the population currently eligible). The results indicate that eligibility for free GP services, as well as GP availability, is significant in explaining the probability of being in hospital with an avoidable condition.
    Date: 2009–05
  6. By: Mario Piscoya (Cedeplar-UFMG); Bernardo L. Queiroz (Cedeplar-UFMG)
    Abstract: Accurate knowledge of adult mortality levels and trends in the developing world is hampered by its widespread lack of complete vital registration systems. Although knowledge of infant and child mortality was once affect by the same problem, survey-based techniques have been more successful in estimating child and infant than adult mortality. The main objective of this paper is to estimate mortality rates for the population aged 5 and above, in Peru by sex. The study evaluates the degree of coverage, and corrects the level of mortality, when necessary, using different methodologies. The literature does not indicate the best method to investigate mortality data problems. Thus, the implementation of alternative methods will improve the understanding of the mortality levels and trends in Peru in recent decades.
    Keywords: Peru, adult mortality, demographic methods
    JEL: J10 J11 J19
    Date: 2009–05
  7. By: Manoj K Pandey
    Abstract: The paper analyzes the effect of health status on labour force participation for aged Indians. The potential endogeneity in health and labour force participation has been taken care of by using full information maximum likelihood (FIML) and estimation results are compared with alternative two-stage methods. Results show that health has a significant and positive effect on labour force participation of the aged. In order to keep enough supply of elderly in the labour market, sufficient health care is necessary and hence more investment in this sector is imperative.[MPRA Paper No. 15394]
    Keywords: self-reported health status; labour force participation; elderly; endogeneity; exogeneity; simultaneous equation model
    Date: 2009
  8. By: Pierre Chapelet
    Abstract: This paper introduces the setting up of a Geographical Information System on Delhi for studies in the Social Sciences. Through an explaination of their methodological procedure and demonstration of thematic applications focusing on the healthcare system's spatial organization, the authors lead us through the inherent difficulties of building a GIS in an emerging country like India. They also attempt to demonstrate that this kind of tool remains, however, a relevant support for research in the Social Sciences as long as it is used with care and knowledge of the dataset frame. From this perspective, Exploratory Data Analysis coupled with the play of scales provide powerful ways to assess socio-spatial dynamics taking place in the Indian capital. [CSH OP 11]
    Keywords: GIS; Social sciences; healthcare system; data exploratory analysis; multiscalar; Delhi, Census 1991/2001
    Date: 2009
  9. By: Binkley, James; Chen, Susan; Ling, Jing
    Abstract: Low income individuals are more likely to have less nutritious diets, a result usually attributed to their inability to pay the cost of nutritious foods. While this has obvious plausibility, it is not consistent with all the evidence. In particular low nutrition is just one example of poor health behavior by low income individuals. They are also less likely to exercise and, most importantly, more likely to indulge in costly unhealthy behavior such as smoking. The main aim of this research is to explore the relationship between income and eating behavior. To do this we will examine food categories with varieties that significantly differ in nutritional and taste characteristics with only modest differences in cost. For example, soft drinks and milk have varieties with differences in health qualities but either no differences in cost or lower cost for the healthier types. Examining food choices when there are no measurable cost differences but clear health differences can help determine whether cost is in fact a barrier to healthy eating by low income consumers.
    Keywords: soft drink, milk, healthy eating, low income, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, I12, I18,
    Date: 2009–05–01
  10. By: Balia, S; Jones, A.M
    Abstract: This paper investigates inequality in smoking-related mortality risk, focusing on the intergenerational transmission of smoking. We estimate a latent factor model for smoking initiation, cessation and mortality risk using the British Health and Lifestyle Survey (HALS). The empirical analysis includes counterfactual simulations. The Gini coffcient for inequality in overall mortality risk, Sen's welfare index and generalised Lorenz curves are computed for the baseline model and for counterfactual scenarios that compare individual types that di®er in their circumstances and effort. Results confirm a clear socioeconomic gradient in smoking initiation and cessation as well as for mortality. Furthermore, we find that parental smoking behaviour plays an important role in smoking and indirectly affects mortality: it lowers the age at starting by about 2 years, increases smoking duration by about 12 years and lowers median lifespan by about 5 years. There is a large difference between current and never smokers in their median lifespan, which is exacerbated by parental smoking. Inequality in smoking-related mortality decreases if individuals adopt the best level of effort (not smoking) or, alternatively, if circumstances are favourable (parents are non-smokers). The health gain from not smoking (not attributable to parental smoking behaviour) is about 13 per cent in terms of mean survival probability and 5 per cent in terms of median predicted lifespan, a net gain of 3.4 years.
    Keywords: smoking; mortality; inequality of opportunity; duration analysis; latent factors
    JEL: I1 C10 C41
    Date: 2009–05
  11. By: Rowena Jacobs (Centre for Health Economics, University of York, UK)
    Abstract: This report examines the feasibility of incorporating patient outcomes in mental health into a productivity measure. It examines which outcome measures are most commonly used in mental health, the practical issues about collecting these outcome measures, whether they can be converted into a generic measure, whether there is a time series of data available, and whether the data exists to examine changes in the mix of treatments over time. The criteria that were assumed to be important for an outcome measure to be included in a productivity index, were that it should have wide coverage, should be routinely collected, could readily be linked to activity data, could potentially be converted to a generic outcome measure, and would be available as a time-series. The report focuses predominantly on mental health outcomes within the working age population. Literature searches on outcome measurement in mental health covered numerous databases and retrieved over 1500 records. Around 170 full papers were obtained.
    Date: 2009–05
  12. By: Pandey, Manoj K.
    Abstract: The paper examines the association between marital status and self-reported health status of Indian men and women of different ages. Estimation results reveal linkages between marital status and health and show that this relationship is sensitive to the age and gender. Based on findings, the paper argues that a specific marital status in a particular stage of life could be an important target group for health policy intervention.
    Keywords: Ageing; Self-reported Health Status; Marital Status; Ordered Probit Regression
    JEL: J14 J12 C31 J16 I10
    Date: 2008–10–26
  13. By: Chris M. Herbst; Erdal Tekin
    Abstract: Child care subsidies play a critical role in facilitating the transition of disadvantaged mothers from welfare to work. However, little is known about the influence of these policies on children’s health and well-being. In this paper, we study the impact of subsidy receipt on low-income children’s weight outcomes in the fall and spring of kindergarten. The goals of our empirical analysis are twofold. We first utilize standard OLS and fixed effects methods to explore body mass index as well as measures of overweight and obesity. We then turn to quantile regression to address the possibility that subsidy receipt has heterogeneous effects on children’s weight at different points in the BMI distribution. Results suggest that subsidy receipt is associated with increases in BMI and a greater likelihood of being overweight and obese. We also find substantial variation in subsidy effects across the BMI distribution. In particular, child care subsidies have no effect on BMI at the lower end of the distribution, inconsistent effects in the middle of the distribution, and large effects at the top of the distribution. Our results point to the use of non-parental child care, particularly centerbased services, as the key mechanism through which subsidies influence children’s weight outcomes.
    JEL: I12 I18 J13
    Date: 2009–05
  14. By: Richard V. Burkhauser; John Cawley; Maximilian D. Schmeiser
    Abstract: There are several ways to measure fatness and obesity, each with its own strengths and weaknesses. The primary measure for tracking the prevalence of obesity has historically been body mass index (BMI). This paper compares long-run trends in the prevalence of obesity when obesity is defined using skinfold thickness instead of body mass index (BMI), using data from the full series of U.S. National Health Examination Surveys. The results indicate that when one uses skinfold thicknesses rather than BMI to define obesity, the rise in the prevalence of obesity is detectable ten to twenty years earlier. This underscores the importance of examining multiple measures of fatness when monitoring or otherwise studying obesity.
    JEL: I1 J11
    Date: 2009–05
  15. By: TAMURA Sakuya; SAWADA Yasuyuki
    Abstract: We examine how households protected their livelihood against an unexpected negative shock caused by the highly pathogenic avian influenza (HPAI). We also compare HPAI with other shocks such as sickness, ceremonial events, typhoons, floods, droughts, and unemployment. We apply the augmented testing framework of the canonical consumption risk-sharing hypothesis developed by Fafchamps and Lund (2003) to our unique household panel data that was collected in two Vietnamese villages exclusively for this study. While we reject the full consumption risk-sharing hypothesis strongly, our empirical results reveal that informal credit transactions played an important role for those affected by HPAI in coping with the unforeseen negative asset shock that it created. Moreover, our result suggests that the informal and/or formal insurance network against an unforeseen event has been strengthened after awhile.
    Date: 2009–05

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