nep-hea New Economics Papers
on Health Economics
Issue of 2009‒06‒10
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Explaining Structural Change in Cardiovascular Mortality in Ireland 1995-2005: A Time Series Analysis By Richard Layte; Sinead O'Hara; Kathleen Bennett
  2. A Dynamic Theory of Fidelity Networks with an Application to the Spread of HIV/AIDS By Roland Pongou; Roberto Serrano
  3. Database for Disease Burden Estimation Malaria, Filaria, Dengue & Diarrhoeal Diseases By Indian Council of Medical Research ICMR
  4. Improving the Efficiency of Public Sector Health Services in Developing Countries: Bureaucratic versus Market Approaches By Anne Mills
  5. Cost and Effectiveness of Regulating Infectious Disease Control in Rural China By Qingyue Meng
  6. Health Economics for Developing Countries: A Survival Kit By Anne Mills
  7. A Primary Evaluation of Service Delivery under the National Rural Health Mission (NRHM): Findings from a Study in Andhra Pradesh, Uttar Pradesh, Bihar and Rajasthan By Kaveri Gill
  8. The Relationship Between Socio-Economic Status and Malaria: A Review of the Literature By Eve Worrall
  9. Run for Cover Now or Later? The impact of premiums, threats and deadlines on supplementary private health insurance in Australia By Randall P. Ellis; Elizabeth Savage
  10. Does service-level spending show evidence of selection across health plan types? By Shenyi Jiang; Randall P. Ellis; Tzu-chun Kuo
  11. Trading-off health risk and latency: Evidence from water pollution in Bangladesh By David Maddison; Eleanor Field; Zubaida Choudhury; Unai Pascual
  12. Would Functional Agricultural Foods Improve Human Health? By Traill, Bruce W.; Arnoult, M.H.P.; Chambers, S.A.; Deaville, E.R.; Gordon, M.H.; John, P.; Jones, P.J.; Kliem, K.E.; Mortimer, S.R.; Tiffin, J.R.

  1. By: Richard Layte (ESRI); Sinead O'Hara (ESRI); Kathleen Bennett (Department of Pharmacology and Therapeutics, St. James's Hospital)
    Abstract: Background: Deaths from circulatory respiratory causes among older age groups in Ireland fell sharply between 1995 and 2005 as did the seasonality of deaths from these causes.Objective:To examine whether a structural break has occurred in deaths from circulatory causes in Ireland between 1995 and 2005 and test whether this can be explained by changes in the prescribing of cardiovascular medications during the same period controlling for weather trends. Methods: Grouped logit Time series models were used to identify if and at which quarter a structural break occurred in Irish circulatory deaths between 1995 and 2005. Data on cardiovascular prescribing and temperature within the quarter were entered into the trend-break model to examine whether the structural break could be explained. Results: There was a reduction in circulatory deaths of 0.82%/quarter among men 1995-2005 which increased by 0.5%/quarter after the final quarter of 1999. The 25% excess winter deaths among men fell by 9% after Q4 1999. Among women the long term decline in deaths of 0.53%/quarter increased by 0.48% after Q1 2000 and seasonality was reduced by 6.8%. The structural break in trend and seasonality was higher among those aged 85+. Controlling for temperature, beta-blocker, ace-inhibitor and aspirin medications rendered the structural break indicator insignificant among all age groups for men. Diuretic, statin and calcium channel blocker medications could not explain the break point for men aged 75 to 84. Beta blocker, aspirin and calcium channel blocker medications explained mortality trends among all age groups among women. Ace inhibitor and statin could not explain trends amongst women aged 65-74 and nitrates and diuretics did not explain trends for any age group. Conclusions: Models suggest that cardiovascular prescribing significantly reduced circulatory mortality among men and women aged 65+ after 1999 in Ireland but the effect of prescribing was lower among women than men. Beta-blocker, ace inhibitor and aspirin medications were more successful than statin, diuretic and nitrates at explaining trends.
    Date: 2009–06
  2. By: Roland Pongou; Roberto Serrano
    Abstract: We study the dynamic stability of fidelity networks, which are networks that form in a mating economy of agents of two types (say men and women), where each agent desires direct links with opposite type agents, while engaging in multiple partnerships is considered an act of infidelity. Infidelity is punished more severely for women than for men. We consider two stochastic processes in which agents form and sever links over time based on the reward from doing so, but may also take non-beneficial actions with small probability. In the first process, an agent who invests more time in a relationship makes it stronger and harder to break by his/her partner; in the second, such an agent is perceived as weak. Under the first process, only egalitarian pairwise stable networks (in which all agents have the same number of partners) are visited in the long run, while under the second, only anti-egalitarian pairwise stable networks (in which all women are matched to a small number of men) are. Next, we apply these results to find that under the first process, HIV/AIDS is equally prevalent among men and women, while under the second, women bear a greater burden. The key message is that anti-female discrimination does not necessarily lead to higher HIV/AIDS prevalence among women in the short run, but it does in the long run.
    Keywords: Fidelity networks; anti-female discrimination; stochastic stability; HIV/AIDS; union formationmodels
    Date: 2009
  3. By: Indian Council of Medical Research ICMR
    Abstract: The Report of the study is in two parts – Part A gives the findings of the literature survey, the limitations of the database and the data gaps for each infection; Part B is the annotated bibliography for each of the four infections. The centres reviewed the published and unpublished information on the four identified infections. The review showed several limitations of the available data. Valid and reliable cause of death is an essential input for estimation of disease burden. In India, cause of death statistics is incomplete. Some information on cause of death for rural areas used to be collected for rural areas through the Survey of Cause of Death –rural scheme which operated till 1998. Thereafter cause of death was to be incorporated as a component of Sample Registration scheme.[ICMR & WHO 2006]
    Keywords: Malaria; Filaria; Dengue; Diarhoeal Diseases; Literature Survey; Syndrome; Fever; Death; Mortality Ratio; Lymphatic Filariasis; National Vector Borne Disease Control Programme
    Date: 2009
  4. By: Anne Mills
    Abstract: There is widespread concern over the efficiency of public sector health services in developing countries. To some the main problem is allocative efficiency: the distribution of resources between different health interventions and the over-provision of less cost-effective interventions. To others the main problem is technical efficiency: for example the widespread waste of resources because of poor purchasing and distribution systems and overstaffing. The purpose of this paper is to raise the question of the best means of remedying the widely acknowledged inefficiencies of the public health systems in developing countries, and in particular to ask whether improvement is best pursued by a continuation and reinforcing of attempts to improve government policy-making, planning and management structures relating to public provision, or whether there is value in market-oriented reforms that retain public financing but encourage competition between providers. The latter option draws on current reforms in developed countries, particularly in Western Europe, which seek to create quasi-markets/provider markets in health care in order to harness the benefits to be expected from competition (Le Grand and Bartlett 1993). These reforms are being reflected in some of the recent thinking of agencies such as the World Bank and ODA[HEFP WP NO 01/95]
    Keywords: health provision; technical efficiency; Government regulations; Bureaucratic approaches; structural changes; market approaches; Market structure
    Date: 2009
  5. By: Qingyue Meng
    Abstract: Infectious diseases are still recognized as severe public health problems at present in China, especially in poor rural areas. Since the late 1970s, the changing social and economic contexts have encouraged the government to adopt legislative instruments rather than sole political command system in steering and administering infectious disease control programs. However, little is known about the effectiveness and costs of implementing regulatory activities in infectious disease control. This study was undertaken to assess the effectiveness of selected infectious disease control legislation and to estimate actual and required costs for implementing the regulation.[HEFP WP NO 03/03]
    Keywords: AIDC; DALY; mortality rate; Sexually transmitted infectious; China; anti-epidemic stations; China’s National People’s Congress; Act of Food Hygiene; Ministry of Health; Shandong; Shanxi provinces; regulation; cost; epidemic
    Date: 2009
  6. By: Anne Mills
    Abstract: Health economics is increasingly recognized as a discipline that has much to offer developing countries in addressing these problems, but how can it help? What economic concepts and tools can be applied to the health sector? A wider understanding of the discipline is required if it is to support health sectors, rather than remaining the preserve of a few specialists.This publication provides an introduction to health economics for health professionals and students with no previous economic background. It aims to present basic economic concepts in a clear manner and to demonstrate their potential application to the health sector, particularly within developing countries. [HEFP WP NO 01/88]
    Keywords: Health Economics; Health Planning; Financing Economic; Economic Efficiency; Health Indicators; Health Sector; Budgetary Procedures; Financial Planning; Financial Master Plan; Health Sector Finance
    Date: 2009
  7. By: Kaveri Gill
    Abstract: This paper seeks to evaluate quantity and quality of service delivery in rural public health facilities under NRHM. On appropriate and feasible measures, the former is assessed on the static and dynamic condition of physical infrastructure; by the numbers of paramedical, technician and medical staff employed, as well as figures for attendance and gender breakdown; by the supply, quality and range of drugs; by availability and usage of decentralised untied and maintenance funding of centres; and by actual availability of laboratory, diagnostic and service facilities. Quality is defined in relation to the condition of the above tangibles, as also supplemented by subjective data on intangibles, such as patient satisfaction, gathered from the exit interviews.[PEO WP NO 1/2009]
    Keywords: National Rural Health Mission; Service Delivery; Fieldsite Selection; Descriptive Characteristics; Research Design; Physical Infrastructure; Human Resources; Medicines
    Date: 2009
  8. By: Eve Worrall
    Abstract: Malaria is frequently referred to as a disease of the poor or a disease of poverty. A better understanding of the linkages between malaria and poverty is needed to guide the design of coherent and effective policies and tools to tackle malaria and poverty together. While recognising that there are a large number of dimensions of potential vulnerability to malaria that encompass social, demographic and geographic elements, the key focus of this work is on differences among socio-economic groups. The aim of this review was to document and review critically the evidence available on two key issues: malaria incidence or vulnerability to the effects of malaria by socio-economic status (SES); and the utilisation, effectiveness and accessibility of malaria control interventions by SES.[HEFP WP NO 01/03]
    Keywords: Demographic surveillance system; Focus group discussions; Chloroquine; Insecticide treated nets; London School of Hygiene and Tropical Medicine; Demographic and health survey; Inter-American Development Bank; Gross domestic product; Disability adjusted life years; Pan American Health Organization
    Date: 2009
  9. By: Randall P. Ellis (Boston University, Department of Economics); Elizabeth Savage (University of Technology Sydney, Centre for Health Economics Research and Evaluation, Sydney, Australia)
    Abstract: Between 1997 and 2000 the Australian government introduced three policy reforms that aimed to increase private health insurance coverage and reduce public hospital demand. The first provided income-based tax incentives; the second gave an across-the-board 30% premium subsidy; and the third introduced selective age-based premium increases for those enrolling after a deadline. Together the reforms increased enrolment by 50% and reduced the average age of enrollees. The deadline appeared to induce consumers to enroll now rather than delay. We estimate a model of individual insurance decisions and examine the effects of the reforms on the age and income distribution of those with private cover. We interpret the major driver of the increased enrollment as a response to a deadline and an advertising blitz, rather than a pure price response.
    Keywords: private health insurance, financial incentives, behavioural decisionmaking
    JEL: D12 I11 I18
    Date: 2008–09
  10. By: Shenyi Jiang (Department of Economics, Boston University); Randall P. Ellis (Department of Economics, Boston University); Tzu-chun Kuo (DxCG, Inc.)
    Abstract: The paper examines whether patterns of service level spending in capitated managed care plans differ from those in traditional non-managed care health plans. We apply the service selection model of Ellis and McGuire (2007) to recent, highly disaggregated commercial insurance data from Medstat MarketScan. Rankings of services by selection incentives give largely the same rankings as the EM results for Medicare. We next calculate selection indices separately for four types of health plans: non-managed care comprehensive, preferred provider organization (PPO) plans, managed care point of service (POS) and health maintenance organization (HMO) plans. Our results imply high correlations and similar rankings of selection indices across plan types. We then test whether services predicted to be underprovided indeed have less than average rates of spending by managed care plans, while non-managed care plans have above average rates of spending. Stronger evidence of selection distortions among the four plan types is found when decomposing spending by type of service and provider specialty than by place of service.
    Keywords: Health plans; Adverse selection; Managed care
    JEL: I11 C21 D12
    Date: 2007–12
  11. By: David Maddison; Eleanor Field; Zubaida Choudhury (Department of Land Economy, University of Cambridge); Unai Pascual (Department of Land Economy, University of Cambridge)
    Abstract: The Ganges Delta of Bangladesh faces a major environmental and development problem from arsenic groundwater contamination. Here we address the rural population’s health preferences and estimate how much a given risk of arsenicosis would have to be postponed to make that risk acceptable. We also derive implicit rates of time preference associated with this health hazard based on an experimental field study in Bangladesh. Results suggest that households exposed to arsenic contaminated water do trade-off risk against latency of developing arsenicosis. The results can also be interpreted as if households face a time-varying (hyperbolic) pure rate of time preference.
    Keywords: Time varying discounting, Water pollution, Arsenic contamination, Bangladesh
    Date: 2009
  12. By: Traill, Bruce W.; Arnoult, M.H.P.; Chambers, S.A.; Deaville, E.R.; Gordon, M.H.; John, P.; Jones, P.J.; Kliem, K.E.; Mortimer, S.R.; Tiffin, J.R.
    Abstract: Concern over diet-health relationships has moved to the forefront of public health concerns in the UK and much of the developed world. It has been estimated, for example, that obesity costs the UK National Health Service up to £6b per year (Rayner and Scarborough, 2005), but if all consumers were to follow recommended healthy eating guidelines there would be major implications for food consumption, land use and international trade (Srinivasan et al, 2006). This is unlikely to happen, at least in the short term, but it is realistic to anticipate some dietary adjustment toward the recommendations, resulting in an improvement in diet quality (Mazzocchi et al, 2007). Although consumers are reluctant to make major changes to their diets, they may be prepared to substitute existing foods for healthier alternatives. Three of the most prominent nutritional recommendations are to consume more fruit and vegetables, which contain phytochemicals beneficial to health, reduce consumption of saturated fatty acids (SFA) and increase intake of long-chain n-3 fatty acids (FA). In the first case, consumption of fruit and vegetables has been stable at around three 80 g portions per person per day according to the Health Survey for England. It is estimated that 42,200 deaths per year could be avoided in England and 411,000 Quality Adjusted Life Years (QALYs) could be saved if fruit and vegetable consumption were increased to the recommended 5 portions per day (Ofcom 2006). As well as continuing to encourage people to eat more, it could be desirable to âintensifyâ the beneficial phytochemical content of existing fruit and vegetables.
    Keywords: Agribusiness, Agricultural and Food Policy, Farm Management, Food Consumption/Nutrition/Food Safety, Industrial Organization,
    Date: 2008–10

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