nep-hea New Economics Papers
on Health Economics
Issue of 2009‒07‒17
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. To what extent do rising mortality inequalities by education and marital status attenuate the general mortality decline? The case of Finland in 1971-2030 By Vladimir M. Shkolnikov; Evgueni M. Andreev; Dmitri A. Jdanov; Domantas Jasilionis; Tapani Valkonen
  2. Hospital Markets and the Effect of Competition on Quality By Alfons Palangkaraya; Jongsay Yong
  3. Enhancing Newborn Care By Rachna Program
  4. Schools’ Mental Health Services and Young Children’s Emotions, Behavior, and Learning By Randall Reback
  7. Immigrant-Native Fertility and Mortality Differentials in the United States By Pervi Sevak; Lucie Schmidt
  8. The Impact of Medical and Nursing Home Expenses and Social Insurance Policies on Savings and Inequality By Kopecky, Karen A.; Koreshkova, Tatyana
  9. Cancer-related health behaviors and health service use among Inuit and other residents of Canada’s north By James Ted McDonald; Ryan Trenholm
  10. Cohort Working Life Tables for Older Canadians By Frank T. Denton; Christine H. Feaver; Byron G. Spencer

  1. By: Vladimir M. Shkolnikov (Max Planck Institute for Demographic Research, Rostock, Germany); Evgueni M. Andreev (Max Planck Institute for Demographic Research, Rostock, Germany); Dmitri A. Jdanov (Max Planck Institute for Demographic Research, Rostock, Germany); Domantas Jasilionis (Max Planck Institute for Demographic Research, Rostock, Germany); Tapani Valkonen
    Abstract: This study examines the relationship between growing inequality within the population, and the general mortality decline in Finland after 1971. The general mortality trend is considered as a simultaneous shift of population groups toward lower mortality over time, with the group-specific mortality rates linked to the mortality trend in the best practice (vanguard) group. The inequality measure accounting for all groups and their population weights reveals increases in both relative and absolute mortality inequalities. Changes in population composition by education and by marital status tend to compensate each other and the combined change does not produce significant effect on the total mortality. The widening of mortality inequalities produces important impact on the total mortality trend. The modeling allows to quantify this impact. If mortality inequalities remained frozen after 2000, the total mortality in 2026-30 would be by about one quarter lower compared to trend-based expectations.
    Keywords: Finland, differential mortality, education, marital status
    JEL: J1 Z0
    Date: 2009–06
  2. By: Alfons Palangkaraya (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Jongsay Yong (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: This paper investigates the effects of competition on hospital quality. It proposes to extend the Elzinga-Hogarty quantity flow approach of defining markets by first determining the trading cluster to which each hospital belongs and then delineating markets using patient flow information. After defining hospital markets and computing measures of competition, this paper examines the effect of competition on hospital quality using hospital administration data from the state of Victoria, Australia. We approximate quality using two indicators, namely mortality within 30 days of discharge and unplanned readmission within 28 days of discharge. For each quality indicator, a random intercept logit model is estimated. Two main findings are reported. First, the boundaries of markets and hence the degree of competition depend on the nature of the medical services provided. Second, competition is found to have a mixed effect on quality of hospital care–increasing the number of private hospitals appears to lower quality, while increasing the number of public hospitals has the opposite effect. The intensity of competition, on the other hand, does not appear to have a statistically significant effect on quality.
    Keywords: Hospital markets; Elzinga-Hogarty; Hospital competition; Hospital Quality.
    JEL: I11 D24
    Date: 2009–06
  3. By: Rachna Program
    Abstract: INHP-II promoted a set of simple interventions to influence neonatal outcomes, including antenatal tetanus toxoid, clean delivery and core care, early and exclusive breastfeeding and thermal care, as well as the identification and intensive home care of the low birth weight and premature babies. Implementation strategies included mainly the strengthening of the Integrated Child Development Services (ICDS) program and the programs of the Health Department, particularly at the frontline and supervisory levels, emphasizing timely home visits and counseling during late pregnancy and immediately at and after childbirth. All interventions were implemented at the full project scale of 78 districts across nine states. This paper describes the results and lessons from this experience.
    Keywords: Care; Neonatal Health; Mortality; RACHNA; Periodic Rapid Assessment; Baseline survey; Endline survey; Antenatal; Antenatal Tetanus Toxoid; Childbirth; Newborn Care
    Date: 2009
  4. By: Randall Reback (Barnard College, Columbia University)
    Abstract: Recent empirical research has found that children’s non-cognitive skills play a critical role in their own success, that young children’s behavioral and psychological disorders can severely harm their future outcomes, and that disruptive students harm the behavior and learning of their classmates. Yet relatively little is known about wide-scale interventions designed to improve children’s behavior and mental health. This is the first nationally representative study of the provision, financing, and impact of school-site mental health services for young children. Elementary school counselors are school employees who provide mental health services to all types of students, typically meeting with students one-on-one or in small groups. It is particularly challenging to estimate the impact of these counselors on student outcomes, given counselors’ non-random assignment to schools. First, cross-state differences in policies provide descriptive evidence that students in states with more aggressive elementary counseling policies make greater test score gains and are less likely to report internalizing or externalizing problem behaviors compared to students with similar observed characteristics in similar schools in other states. Next, difference-in-differences estimates exploiting both the timing and the targeted-grade-levels of states’ counseling policy changes provide evidence that elementary counselors substantially influence teachers’ perceptions of school climate. The adoption of state-funded counselor subsidies or minimum counselorstudent ratios reduces the fraction of teachers reporting that their instruction suffers due to student misbehavior and reduces the fractions reporting problems with students physically fighting each other, cutting class, stealing, or using drugs. These findings imply that there may be substantial public and private benefits derived from providing additional elementary school counselors.
    Keywords: education, counselors, student behavior, mental health
    JEL: I22 I10
    Date: 2009–06
  5. By: Asadul Islam; Pushkar Maitra
    Abstract: This paper estimates, using a large panel data set from rural Bangladesh, the effects of health shocks on household consumption and how access to microcredit affects households' response to such shocks. Our results suggest that even though in general consumption remains stable in many cases when households are exposed to health shocks, households that have access to microcredit appear to cope (slightly) better. The most important instrument used by households appear be sales of productive assets (livestock) and there is a significant mitigating effect of microcredit: households that have access to microcredit do not need to sell livestock to the extent households that do not have access to microcredit need to, in order to insure consumption against health shocks. The results suggest that microcredit organizations and microcredit per se have an insurance role to play, an aspect that has not been analyzed previously.
    Keywords: Health Shocks, Microcredit, Consumption Insurance, Bangladesh.
    JEL: O12 I10 C23
    Date: 2009–06
  6. By: Guang-Zhen Sun; Yew-Kwang Ng
    Abstract: In this short paper, we investigate the behavior of the age-dependent value of a statistical life (VSL) within a lifecycle framework with a finite maximal possible lifespan. Some existing results, obtained under the unrealistic assumption of an infinite life expectancy, are reversed. In particular, we show that when the market interest rate is equal to (or less than) the sum of age-specific mortality rate and the discounting rate in time preference at any age over the remaining lifetime, then VSL declines. We also show that an inverted-U shape of VSL profile over the life cycle emerges under realistically plausible circumstances. An innovation is that we characterize the changes in optimal consumption and instantaneous utility with age, showing that such changes are proportionate to the difference between the sum of age-specific mortality rate and the discounting rate in time preference and the market interest rate, which may prove to be useful in addressing other issues related to VSL.
    Keywords: Value of life; life expectancy; interest rates; time preference; mortality.
    JEL: J17 D91
    Date: 2009–06
  7. By: Pervi Sevak (Hunter College); Lucie Schmidt (Williams College)
    Abstract: Immigrants have been discussed as a means of alleviating fiscal pressures on Social Security. Their long-term impact on the Social Security system depends critically on their fertility and mortality patterns. In this paper, we examine the fertility and mortality patterns of immigrants to the United States and compare these patterns with those of non-immigrants. We find that both the recent and cumulative fertility of immigrant women is higher than that of native-born women, but that a large share of these differentials can be “explained” by differences in age structures, race and ethnicity, years in the United States, and country of origin. Using a synthetic cohort approach, we examine the role of years in the United States in more detail, and find no evidence of assimilation towards native-born fertility patterns. Consistent with previous research, we find evidence of a disruption effect on fertility – the fertility of immigrant women in the most recent arrival cohorts is low, but increases at a faster rate relative to both the fertility of immigrants from earlier cohorts and relative to the fertility of natives. We find that immigrants experience lower mortality than native-born individuals in the United States, and these differences remain even after controlling for underlying differences in observable characteristics. However we find that they do not exhibit differences in their subjective expectations of their mortality.
    Date: 2008–09
  8. By: Kopecky, Karen A.; Koreshkova, Tatyana
    Abstract: We consider a life-cycle model with idiosyncratic risk in labor earnings, out-of-pocket medical and nursing home expenses, and survival. Partial insurance is available through welfare, Medicaid, and social security. Calibrating the model to the U.S., we find that nursing home expenses play an important role in the savings of the wealthy. In our policy analysis, we find that elimination of out-of-pocket expenses through public health care would reduce the capital stock by 12 percent, Medicaid and old-age welfare programs crowd out 44 percent of savings and greatly increase wealth inequality, and social security effects are influenced by out-of-pocket health expenses.
    Keywords: social insurance; medical expenses; nursing home expenses; wealth inequality; savings
    JEL: I18 E21
    Date: 2009–06
  9. By: James Ted McDonald; Ryan Trenholm
    Keywords: Inuit, aboriginal, cancer screening, smoking, health
    JEL: I12 I18 J61 A A A A A A
    Date: 2009–06
  10. By: Frank T. Denton; Christine H. Feaver; Byron G. Spencer
    Keywords: cohort working life tables
    JEL: J10 J26 A
    Date: 2009–06

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