nep-hea New Economics Papers
on Health Economics
Issue of 2009‒08‒30
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Starting Sick Leave on Part-Time as a Treatment Method? By Andrén, Daniela; Thomas, Andrén
  2. Part-time sick leave as a treatment method for individuals with musculoskeletal disorders By Andrén, Daniela; Svensson, Mikael
  3. Towards common European health policies: what are the implications for the Nordic countries? By Blomqvist, Paula; Larsson, Jakob
  4. An Analysis of Household's Tobacco Consumption Decisions: Evidence from India By Rijo M John
  5. Targeted Vaccine Subsidies for Healthcare Workers By Troy Tassier; Phillip Polgreen; Alberto Segre
  6. The costs of keeping cool for Australians with Multiple Sclerosis By George Verikios; Michael Summers; Rex Simmons; Zanfina Ademi
  7. The public health costs of job loss By Andreas Kuhn; Rafael Lalive; Josef Zweimüller
  8. Performance and Congestion Analysis of the Portuguese Hospital Services By Simões, Pedro; Cunha Marques, Rui

  1. By: Andrén, Daniela (Department of Business, Economics, Statistics and Informatics); Thomas, Andrén (Konjunkturinstitutet)
    Abstract: This paper analyzes the effects of starting the sick leave on part-time compared to fulltime on the probability to recover (i.e., return to work with full recovery of lost work capacity). Using a discrete choice one-factor model, we estimate mean treatment parameters and distributional treatment parameters from a common set of structural parameters. Our results indicate that part-time sick leave is not an intensive treatment and should not to be used for all from the very beginning of a case. However, when the output is analyzed for time spans longer than three months, the average probability to recover is higher for those who started on part time sick leave. Besides, the share of individuals who are positive indifferent between the two states is large (above 50%), which suggests that there is potential for increasing the share
    Keywords: part-time sick leave; selection; unobserved heterogeneity; treatment effects
    JEL: I12 J21 J28
    Date: 2009–08–17
  2. By: Andrén, Daniela (Department of Business, Economics, Statistics and Informatics); Svensson, Mikael (Department of Business, Economics, Statistics and Informatics)
    Abstract: There is increasing evidence that staying active is an important part of a recovery process for individuals on sick leave due to musculoskeletal disorders (MSDs). It has been suggested that using part-time sick-leave rather than full-time sick leave will enhance the possibility of full recovery to the workforce, and several countries actively favor this policy. However, to date only few studies have estimated the effect of using part-time sick leave in contrast to full-time sick leave. In this paper the effects of being on part-time sick leave compared to full-time sick leave is estimated for the probability of returning to work with full recovery of lost work capacity and uses a sample of 1,170 employees from the RFV-LS database of the Social Insurance Agency of Sweden. A twostage recursive bivariate probit model is used to deal with the endogeneity problem. The first step estimates the probability of being assigned to part-time sick leave, and the second step estimates the likelihood of recovery with part-time sick-leave as an explanatory variable together with a set of other individual characteristics. The results indicate that employees assigned to part-time sick leave do recover to full work capacity with a higher probability than those assigned to full-time sick leave. The average treatment effect of part-time sick leave is 25 percentage points. Considering that it may also be less expensive than assigning individuals to full-time sick leave, this would clearly imply efficiency improvements from assigning individuals, when possible, to part-time sick leave
    Keywords: Sick-leave; Part-time; Musculoskeletal; Endogenous regressors.
    JEL: I12 J21 J28
    Date: 2009–08–18
  3. By: Blomqvist, Paula (Uppsala University, Department of Government); Larsson, Jakob (Institute for Futures Studies)
    Abstract: <p>Health care is an area that remains formally outside the competence of the EU. Despite this, the union’s influence on national health care policies has increased substantially over the past decade. In a series of rulings, the European Court of Justice (ECJ) established a de facto system of patient rights, which, under certain conditions, entitle European citizens to receive health care in other member states at the expense of the social insurance system of their home country. This undermines the autonomy of the member states in the area of health, a key sector in national welfare systems. In 2008, the Commission proposed a new directive on patients’ rights which builds directly on the ECJ rulings, thus consolidating politically the legal precedent set by the Court. The ECJ Court rulings have also spurred the initiation of a so-called OMC process in the area of health care, whereby the member states commit themselves to policy harmonization on a voluntary basis.<p> <p>In this paper, we review the contents of emerging EU policies in the area of health and discuss their implications for the Nordic health care systems. A central question is whether any coherent, common European policy may be discerned and, if so, how it will affect health care systems of the Nordic type, which are tax-based and universalistic in orientation?<p>
    Keywords: European Union; Health care; European Court of Justice; Open Method of Coordination
    JEL: I11 I18
    Date: 2009–08–19
  4. By: Rijo M John
    Abstract: The consumption patterns, socio-economic distribution and the household choice of a variety of tobacco products across rural and urban India are analyzed. Using a Multinomial Logit Model, the choice behavior of a household in deciding whether and which tobacco products to consume analyzed. Household level data from National Sample Survey in India for the year 1999-2000, which has information on 120,309 households, has been used for this purpose. [IGIDR WP-2004-002].
    Keywords: Tobacco, Bidi, Cigarette, Consumption, Multinomial Logit, India, national sample survey, multinominal logit model, household, socio-economic
    Date: 2009
  5. By: Troy Tassier (Fordham University, Department of Economics); Phillip Polgreen (University of Iowa, Carver College of Medicine, Department of Internal Medicine); Alberto Segre (University of Iowa, Department of Computer Science)
    Abstract: We study the public goods problem associated with vaccinations. The externality created by an infection is composed of two parts, the probability of infection and the marginal infections generated if infected. We argue that the key component in a successful vaccination strategy is the second of these items but that current public policy focuses on the first. We use a newly collected data set coupled with agent-based simulations to study the spread of influenza and other infectious diseases in hospitals. We estimate the marginal infections created by various worker groups in a hospital in order to prioritize vaccine allocations across different healthcare worker groups in times of vaccine shortages. One primary focus of this paper is identifying the individual hospital workers who are most important to vaccinate. Surprisingly, we find that many groups with patient care responsibilities, such as physicians, play a small role in spreading influenza while others, such as unit clerks, play a much larger role.
    Keywords: Influenza vaccine, social networks, vaccine subsidies
    Date: 2009
  6. By: George Verikios; Michael Summers; Rex Simmons; Zanfina Ademi
    Abstract: Heat intolerance is a significant medical problem affecting people with Multiple Sclerosis. For people with MS, the costs of running their air conditioners are an additional disease-related expense that must be met on top of other out-of-pocket disease-related expenses. Using the results of the 2008 Keeping Cool Survey, we estimate the relative economic disadvantage faced by MS households in trying to keeping cool. We find that MS households spend around ten times more on keeping cool than the average Australian household. Sensitivity analysis indicates that our results are robust with respect to all key parameters, across regions and nationally. Our results suggest that energy rebates for heat intolerant persons currently in place in Victoria and Western Australia should be implemented in other Australian states and territories.
    Keywords: cooling costs, economic disadvantage, energy rebates, heat intolerance, multiple sclerosis
    JEL: I18
    Date: 2009–08
  7. By: Andreas Kuhn; Rafael Lalive; Josef Zweimüller
    Abstract: We study the short-run effect of involuntary job loss on comprehensive measures of public health costs. We focus on job loss induced by plant closure, thereby addressing the reverse causality problem of deteriorating health leading to job loss as job displacements due to plant closure are unlikely caused by workers' health status, but potentially have important effects on individual workers' health and associated public health costs. Our empirical analysis is based on a rich data set from Austria providing comprehensive information on various types of health care costs and day-by-day work history at the individual level. Our central findings are: (i) overall expenditures on medical treatments (hospitalizations, drug prescriptions, doctor visits) are not strongly aected by job displacement; (ii) job loss increases expenditures for antidepressants and related drugs, as well as for hospitalizations due to mental health problems for men (but not for women); and (iii) sickness benefits strongly increase due to job loss.
    Keywords: Social cost of unemployment, health, job loss, plant closure
    JEL: I12 I19 J28 J65
    Date: 2009–08
  8. By: Simões, Pedro; Cunha Marques, Rui
    Abstract: The health care services have been characterised by a growing demand by the citizens leading to the need of more and more resources. Population aging, new pathologies and drugs as well as new treatments are some of the major factors for this. However, in hospitals, for example, consumption of a large number of inputs frequently has not corresponded to the production of the same or more proportion of outputs. Sometimes, the outputs even decline with the increase of inputs due to the influence of the congestion effect on efficiency. The heavy burden of the health sector on the state budget brings about the interest of research over its efficiency. This paper aims to assess the performance of the Portuguese hospitals and particularly the contribution of the congestion effect. We use the non-parametric technique of data envelopment analysis (DEA) for this purpose and a double-bootstrap procedure to take into account the influence of operational environment on efficiency. Afterwards, by comparing three different approaches we determine the importance of congestion in efficiency measurement and discuss its computation methodologically. The results suggest significant levels of inefficiency in 68 major Portuguese hospitals for the year 2005 and more than half of them were found to be congested.
    Keywords: Hospitals; congestion; efficiency; DEA; Portugal
    JEL: I11 C14 I1 C1
    Date: 2009–08–24

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