nep-hea New Economics Papers
on Health Economics
Issue of 2009‒08‒02
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Environmental health and education : Towards sustainable growth By Natacha Raffin
  2. GPs' preferences: What price fee-for-service? By Peter Zweifel; Maurus Rischatsch; Angelika Brändle
  3. Physician dispensing and the choice between generic and brand-name drugs – Do margins affect choice? By Maurus Rischatsch; Maria Trottmann
  4. The English National Health Service: An Economic Health Check By Peter Smith; Maria Goddard
  5. The Impact of Private versus Social Health Insurance on Offered Waiting Times in German Acute Care Hospitals By Christoph Schwierz; Ansgar Wübker; Björn A. Kuchinke
  6. Determinants of Avoidable Deaths from Ischaemic Heart Diseases in East and West Germany By Christoph Schwierz; Ansgar Wübker
  7. Ownership and Financial Performance in the German Hospital Sector By Boris Augurzky; Dirk Engel; Christoph M. Schmidt; Christoph Schwierz
  8. Do self-insurance and disability insurance prevent consumption loss on disability? By Steffan G. Ball; Hamish W. Low
  9. Federalism, Party Competition and Budget Outcome: Empirical Findings on Regional Health Expenditure in Italy By Giardina, Emilio; Cavalieri, Marina; Guccio, Calogero; Mazza, Isidoro
  10. Low Life Expectancy in the United States: Is the Health Care System at Fault? By Samuel H. Preston; Jessica Y. Ho
  11. Dynamic Cost-offsets of Prescription Drug Expenditures: Panel Data Analysis Using a Copula-based Hurdle Model By Partha Deb; Pravin K. Trivedi; David M. Zimmer

  1. By: Natacha Raffin (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: This article aims at investigating the interplay between environmental quality, health and development. We consider an OLG model, where human capital dynamics depend on the current environment, through its impact on children's school attendance. In turn, environmental quality dynamics depend on human capital, through maintenance and pollution. This two-way causality generates a co-evolution of human capital and environmental quality and may induce the emergence of an environmental poverty trap characterized by a low level of human capital and deteriorated environmental quality. Our results are consistent with empirical observation about the existence of Environmental Kuznets Curve. Finally, the model allows for the assessment of an environmental policy that would allow to escape the trap.
    Keywords: Education, environmental quality, growth, health.
    Date: 2009–04
  2. By: Peter Zweifel (Socioeconomic Institute, University of Zurich); Maurus Rischatsch (Socioeconomic Institute, University of Zurich); Angelika Brändle
    Abstract: In mixed health care systems a crucial condition for the success of Managed Care (MC) plans is to win over a su±cient number of general practitioners (GPs) acting as gatekeepers. This contribution reports on GPs' willingness-to-accept (WTA) or compensation asked, respectively, for changing from conventional fee-for-service to MC practice. Some 175 Swiss GPs participated in discrete choice experiments which permit to put a money value on their status quo bias. Regardless of whether effects coding or dummy coding is used to measure status quo bias, Swiss GPs require at least 16 percent of their current average income to give up fee-for-service in favor of MC practice.
    Keywords: general practitioners, willingness-to-pay, preferences, market experiments, managed care, effects coding, status quo bias
    JEL: C93 D61 I11 J22
    Date: 2009–07
  3. By: Maurus Rischatsch (Socioeconomic Institute, University of Zurich); Maria Trottmann
    Abstract: Many politicians blame physician dispensing (PD) to increase health care expenditure and to undermine independence of drug prescription and income leading to a suboptimal medication. Therefore, PD is not allowed in most OECD countries. In Switzerland, PD is allowed in some regions depending on the density of pharmacies. This enables to investigate the difference in prescribing behavior between physician which gain income from prescribing a specific drug and their colleagues which prescribe the drug but do not sell it. Because the considered drugs are bioequivalent we focus on the economic consequence of PD. We analyze the prescribing behavior of Swiss physicians using cross-sectional data between 2005 and 2007 for three important agents. The results support our hypothesis that dispensing physicians have a higher probability of prescribing the drug with the (most likely) higher margin compared to non-dispensing physicians. Further, generic drugs are prescribed more often to patients with higher cost-sharing while patients' cost-sharing is less influential with PD. High-income patients face a much higher probability to receive the brand-name drug due to their lower marginal utility of income. Today's administered reimbursement prices for generics seem to be high enough to gain physicians for prescribing generics because of their high margins.
    Keywords: Physician dispensing, prescribing behavior, generics, brand-name drugs
    JEL: I10 I18 I19
    Date: 2009–07
  4. By: Peter Smith; Maria Goddard
    Abstract: The government’s health reform programme since 2000 has covered many aspects of the organisation of health care and was accompanied by a sizeable increase in spending on healthcare. Many of these reforms have the potential to improve the efficiency and responsiveness of the health care system and ultimately health outcomes, although it is too early to make definitive judgements on their effectiveness. This chapter provides an overview of the organisation and financing of the National Health Service, reviews its performance, assesses the reforms since the start of the decade and provides recommendations for further development. This Working Paper relates to the 2009 Economic Survey of the United Kingdom (<P>Système national de santé anglais : Bilan de santé économique<BR>Le programme de réformes engagé par le gouvernement depuis 2000 dans le secteur de la santé couvre de nombreux aspects de l’organisation des soins et services de santé et il s’est accompagné d’une augmentation notable des dépenses consacrées à la santé. Nombre de ces réformes sont de nature à améliorer l’efficience et la réactivité du système de santé et, en fin de compte, les résultats sur le plan de la santé, bien qu'il soit trop tôt pour porter des jugements définitifs sur leur efficacité. Ce chapitre donne une vue d’ensemble de l’organisation et du financement du National Health Service ; il en examine les performances et évalue les réformes conduites depuis le début de la décennie, et formule des recommandations pour la poursuite des réformes. Ce document de travail se rapporte à l'Étude économique de l'OCDE de le Royaume-Uni 2009 (
    Keywords: health care reforms, résultats de la santé, health expenditure, dépenses de santé, English health care system, système de soins de santé anglais, health outcomes, réforme du système de soins de santé
    JEL: H51 I12 O57
    Date: 2009–07–22
  5. By: Christoph Schwierz; Ansgar Wübker; Björn A. Kuchinke
    Abstract: This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further,we find that hospitals offering private insurees shorter waiting times as compared to SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.
    Keywords: Private health insurance, waiting time, German acute care hospitals
    JEL: I10 I11 D21
    Date: 2009–07
  6. By: Christoph Schwierz; Ansgar Wübker
    Abstract: The objective of this paper is to identify selected forces of the decrease in the number of avoidable deaths from ischaemic heart diseases (IHD) inWest and East Germany from 1996 to 2004. Our main result reveals that the number of intracardiac catheter facilities,which are an important diagnostic tool for IHD, do significantly account for decreases in avoidable mortality from IHD.This is important, as the modernization of the East German health sector included a considerable catch-up process in the number of IC facilities provided relative to West Germany.
    Keywords: Avoidable deaths, ischaemic heart disease, intracardiac catheters, Germany
    JEL: I12 I19
    Date: 2009–07
  7. By: Boris Augurzky; Dirk Engel; Christoph M. Schmidt; Christoph Schwierz
    Abstract: This paper considers the role of ownership form for the financial performance of German acute care hospitals and its development over time.We measure financial performance by a hospital-specific yearly probability of default (PD). Using a panel of hospital data, our models allow for state dependence in the PD as well as unobserved individual heterogeneity. We find that private ownership is more likely to be associated with sound levels in financial performance than public ownership. Moreover, state dependence in the PD is substantial, albeit not ownership-specific.Finally, our evidence suggests that overall efficiency may be enhanced most by closing down some loss-making public hospitals rather than by their restructuring, especially because the German hospital market has substantial excess capacities.
    Keywords: Hospitals ownership, financial performance, state dependence
    JEL: I11 I18
    Date: 2009–07
  8. By: Steffan G. Ball; Hamish W. Low
    Abstract: In this paper we show the extent to which public insurance and self-insurance mitigate the cost of health shocks that limit the ability to work. We use consumption data from the UK to estimate the insurance provided by the government disability programme and account for the effectiveness of alternative self-insurance mechanisms. Individuals with a work-limiting health condition, but in receipt of disability insurance, have 7 percent lower consumption than those without such a condition. Self-insurance through savings and a working partner each provide some insurance benefit, improving outcomes from 2 percent to 4 percent. Reductions in the generosity of incapacity benefit after 1995 are associated with increases in the consumption loss associated with disability.
    Date: 2009
  9. By: Giardina, Emilio; Cavalieri, Marina; Guccio, Calogero; Mazza, Isidoro
    Abstract: In the last decade, Italy has experienced a considerable decentralization of functions to the regions. This transformation has been especially relevant for the National Health System that has de facto assumed a federal system design. The federal reform aimed at disciplining public health expenditure, which drains a substantial share of the budget of Italian regions and is among the main causes of the regional deficits. Political economic analysis, however, suggests that impact of federalism on public expenditure depends on central and local government strategies to win in the electoral competition. Results derived in this preliminary study indicate that political competition actually works as a tool of fiscal discipline; it shows a restraining effect on public health expenditure.
    Keywords: Fiscal federalism; local budget; multi-level policy-making; public expenditure; political competition; health economics
    JEL: H51 H72 I18 D78 D72
    Date: 2009
  10. By: Samuel H. Preston; Jessica Y. Ho
    Abstract: Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
    JEL: I0 I1 I12 I18 J1 J11 J14 J18
    Date: 2009–07
  11. By: Partha Deb; Pravin K. Trivedi; David M. Zimmer
    Abstract: This paper presents a new multivariate copula-based modeling approach for analyzing cost-offsets between drug and nondrug expenditures. Estimates are based on panel data from the Medical Expenditure Panel Survey (MEPS) with quarterly measures of medical expenditures. The approach allows for nonlinear dynamic dependence between drug and nondrug expenditures as well as asymmetric contemporaneous dependence. The specification uses the standard hurdle model with two significant extensions. First, it is adapted to the bivariate case. Second, because the cost-offset hypothesis is inherently dynamic, the bivariate hurdle framework is extended to accommodate dynamic relationships between drug and nondrug spending. The econometric analysis is implemented for six different groups defined by specific health conditions. There is evidence of modest cost-offsets of expenditures on prescribed drugs.
    JEL: C3 C33 C35 I11
    Date: 2009–07

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