nep-hea New Economics Papers
on Health Economics
Issue of 2009‒10‒03
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Economies of scale and scope in the provision of diagnostic techniques and therapeutic services in Portuguese hospitals By Ricardo Gonçalves; Pedro Pita Barros
  2. Countering Drug Resistance in the Developing World: An Assessment of Incentives across the Value Chain and Recommendations for Policy Interventions By Prashant Yadav
  3. Did the Celtic Tiger Decrease Socio-Economic Differentials in Perinatal Mortality in Ireland? By Layte, Richard; Clyne, Barbara
  4. Improving the Efficiency of Public Sector Health Services in Developing Countries: Bureaucratic versus Market Approaches By Anne Mills
  5. Dual Practice by Public Health Providers in Shandong and Sichuan Provinces, China By Ying Bian
  6. Doha Declaration and Compulsory License for Access to Medicines By Lalitha N
  7. Situational Analysis of Reporting and Recording of Maternal Deaths in Gandhinagar District, Gujarat State By Tapasvi I Puwar
  8. Paying for Safety: Preferences for Mortality Risk Reductions on Alpine Roads By Christoph M. Rheinberger
  9. The Value of Reducing Cancer Risks at Contaminated Sites: Are More Heavily Exposed People Willing to Pay More? By Anna Alberini; Stefania Tonin; Margherita Turvani
  10. Fertility Decline and the Heights of Children in Britain, 1886-1938 By Timothy J. Hatton; Richard M. Martin
  11. The Role Of Uncertainty On U.S. Obesity: An Application Of Control Theory By Pedro Gomis-Porqueras; Fidel Gonzalez
  12. Payment by results in mental health: A review of the international literature and an economic assessment of the approach in the English NHS By Anne Mason; Maria Goddard
  13. Partnerships for Women's Health - Striving for Best Practice within the UN Global Compact / United Nations University Research Brief 1/2009 ( By Timmermann, Martina; Kruesmann, Monika

  1. By: Ricardo Gonçalves (Faculdade de Economia e Gestão - Universidade Católica Portuguesa (Porto)); Pedro Pita Barros (Faculdade de Economia - Universidade Nova de Lisboa)
    Abstract: This paper analyses the provision of auxiliary clinical services that are typically carried out within the hospital. We estimate a flexible cost function for the three most important (cost- wise) diagnostic techniques and therapeutic services in Portuguese hospitals: Clinical Pathology, Medical Imaging and Physical Medicine and Rehabilitation. Our objective in carrying out this estimation is the evaluation of economies of scale and scope in the provision of these services. For all services, we find evidence of ray economies of scale and some evidence of economies of scope. These results have important policy implications and can be related to the ongoing discussion of where and how should hospitals provide these services.
    Keywords: translog cost function, economies of scale, economies of scope, clinical services, hospitals
    JEL: D24 I12 I18
    Date: 2009–09
  2. By: Prashant Yadav
    Abstract: The emergence and spread of drug resistance is draining available resources and threatening our ability to treat infectious diseases in developing countries. HIV/AIDS, tuberculosis, malaria, diarrhea, and respiratory tract infections continue to be the leading causes of death in many developing countries, many of which have already been exacerbated by resistance. Countering drug resistance often involves complex tradeoffs between activities such as the development of new products; ensuring treatment heterogeneity; and guaranteeing quality and ensuring systemic availability, affordability, compliance, adherence and rational use of drugs and diagnostics. A careful understanding of all the players involved in the resistance problem and their incentives to engage in activities that counter drug resistance is crucial for policymakers and resource managers in a range of institutions and agencies. This paper presents results gathered through quasi-structured interviews to understand these incentives and develop recommendations to better align them with resistance-countering activities.
    Keywords: drug resistance; developing countries; HIV/AIDS; supply chains; drugs; diagnostics; recommendations; policy
    Date: 2009–09
  3. By: Layte, Richard (ESRI); Clyne, Barbara (ESRI)
    Abstract: Irish perinatal mortality rates have been falling steadily for a number of decades but evidence from the 1980s showed pronounced differentials in mortality rates across socio-economic groups. Between 1995 and 2007 Irish gross national product increased from 60 per cent of the EU average to 110 per cent. Real incomes increased across the income distribution during this period but income inequality between the top and bottom income deciles increased. This paper examines whether this increase in affluence led to an overall improvement in Irish perinatal mortality rates and the extent to which any improvement was shared across socio-economic groups. This task is complicated by demographic change in reland since the 1980s and its interaction with the birth registration process. Overall perinatal mortality rates have fallen from 14 per 1,000 in 1984 to 7 per 1,000 in 2006. Without adjusting for demographic change differentials between professional and unskilled/unemployed groups have decreased from 1.99 to 1.79. Adjusted estimates suggest the real differential has decreased to 1.88.
    Date: 2009–09
  4. By: Anne Mills
    Abstract: Given the substantial public finance that exists for health care in many developing countries, whether this is most efficiently employed in financing a public health bureaucracy, or whether there are arguments in favour of a pro-competition strategy? The main concern of the paper is with how to improve efficiency, though equity concerns are not completely ignored. In terms of efficiency, the concern is as much with how to use existing resources to greater effect as with simple cost savings. [HEFP working paper 01/95]
    Keywords: public finance, health care, public health, bureaucracy, savings, technical efficiency, developing countries, income, wealth, inheritance, hospitals,
    Date: 2009
  5. By: Ying Bian
    Abstract: Private practice in the health sector was re-introduced from 1980, when China began its economic reform from a planned economy to a market economy. But today the total number of private sector providers is quite few, because the government does not encourage the growth of private sector providers. However, dual practice (DP) is quite common and a major concern from the point of view of health policy- making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions. [HEFP working paper 07/03].
    Keywords: hospitals, doctor, income, private sector, health, china, economic reform, planned economy, market, government, health policy, physician,
    Date: 2009
  6. By: Lalitha N
    Abstract: The Doha Declaration provides for access to medicines particularly by simplifying the compulsory licensing (CL) clause. This paper tries to provide a comprehensive review of the working of CL in the developed and developing countries with some useful case studies. [GIDR WP No. 184].
    Keywords: compulsory licensing, CL, HIV AIDS, developed, developing countries, case studies, medicines, doha, declaration, Indian companies, drugs, patients, India, Anti-cancer drugs, prices
    Date: 2009
  7. By: Tapasvi I Puwar
    Abstract: A situational analysis of recording and reporting maternal deaths in Gandhinagar district, Gujarat, India and to suggest improvements in the system for reporting and recording maternal deaths based on the findings. This qualitative study was conducted during June-August 2008 and analyzed maternal deaths occurred during April 2007–March 2008. To understand the current reporting system of maternal deaths, semi-structured interviews were conducted with all the concerned officials and offices. Forms and formats relating to death registration and registers containing information on deaths in the villages and towns were studied. Deaths of women in reproductive age group (15-49), reported by the district for the same year were also analyzed. Analysis of 15 verbal autopsy forms filled by the Medical Officers and Block Health Officers was also carried out using Epi Info software. Verbal autopsy method was used for in-depth understanding the circumstances and issues relating to 2 maternal deaths occurred during the study period and its reporting. A group meeting was conducted with Anganwadi workers to understand the reporting of maternal deaths through ICDS.
    Keywords: maternal deaths, autopsy, Mumbai, gujarat state, maternal mortality ratio, MMR, south asia, NFHS, births, MDGs, Anganwadi workers, ICDS,women, reproductive age group,
    Date: 2009
  8. By: Christoph M. Rheinberger (WSL Institute for Snow and Avalanche Research and IED Institute for Environmental Decisions)
    Abstract: This paper presents a choice experiment, which values reductions in mortality risk on Alpine roads. These roads are on one hand threatened by common road hazards, on the other hand they are also endangered by natural hazards such as avalanches and rockfalls. Drawing on choice data from frequently exposed and barely exposed respondents, we are not only able to estimate the VSL but to explore how the respondents differ in their individual willingness-to-pay depending on personal characteristics. To address heterogeneity in preferences for risk reduction, we use a non-linear conditional logit model with interaction effects. The best estimate of the VSL in the context of fatal accidents on Alpine roads is in the range of €4.9–5.4 million with distinct differences between the urban and the mountain sample groups. We find the VSL to be significantly altered by socio-economic factors but only marginally altered by the type of hazard.
    Keywords: Value of Statistical Life, Choice Experiment, Natural Hazard Mitigation, Traffic Safety
    JEL: D81 J17 R42
    Date: 2009–09
  9. By: Anna Alberini (University of Maryland); Stefania Tonin (University IUAV); Margherita Turvani (University IUAV)
    Abstract: We use conjoint choice questions to investigate people’s tastes for cancer risk reductions and income in the context of public programs that would provide for remediation at abandoned industrial contaminated sites. Our survey was self-administered using the computer by persons living in the vicinity of an important contaminated site on the Italian National Priority List. The value of a prevented case of cancer is €2.6 million, but this figure does vary with income, perceived exposure to contaminants, and opinions about priorities that should be pursued by cleanup programs.
    Keywords: Value of a Statistical Case of Cancer, Conjoint Choice Experiments, Contaminated Sites, Abandoned Sites, Reuse, Remediation
    JEL: J17 I18 K32 Q51 Q53
    Date: 2009–07
  10. By: Timothy J. Hatton; Richard M. Martin
    Abstract: In this paper we argue that the fertility decline that began around 1880 had substantial positive effects on the health of children, as the quality-quantity trade-off would suggest. We use microdata from a unique survey from 1930s Britain to analyze the relationship between the standardized heights of children and the number of children in the family. Our results suggest that heights are influenced positively by family income per capita and negatively by the number of children or the degree of crowding in the household. The evidence suggests that family size affected the health of children through its influence on both nutrition and disease. Applying our results to long-term trends, we find that rising household income and falling family size contributed significantly to improving child health between 1886 and 1938. Between 1906 and 1938 these variables account for nearly half of the increase in heights, and much of this effect is due to falling family size. We conclude that the fertility decline is a neglected source of the rapid improvement in health in the first half of the twentieth century.
    Keywords: fertility decline, heights of children, health in Britain
    JEL: I32 J13 N33 N34
    Date: 2009–07
  11. By: Pedro Gomis-Porqueras; Fidel Gonzalez
    Abstract: This paper considers the problem of a consumer that cares about her health, which we proxy by deviations from current weight to ideal weight, and derives utility from eating and disutility from performing physical activity while taking into account the uncertainty associated with calorie consumption and physical activity. Using U.S. data, we find that uncertainty regarding the effectiveness of physical activity produces a larger cautionary response. Moreover, it is harder to learn and is more important to the agent than the uncertainty regarding the calorie content of food. These results can help policymakers design more cost effective policies.
    JEL: C61 I18
    Date: 2009–09
  12. By: Anne Mason (Centre for Health Economics, University of York, UK); Maria Goddard (Centre for Health Economics, University of York, UK)
    Abstract: The use of casemix-based funding mechanisms is increasing internationally. This funding approach potentially offers incentives for a range of diverse objectives, including improvements in efficiency, quality of care and patient choice. However, to date, the application of this approach to mental health care has been limited and there is no long-term experience to inform policy and practice. In England, the Department of Health plans to extend the scope of Payment by Results, an activitybased funding approach, to mental health. The Care Pathways and Packages Clusters comprise a set of 21 ‘care clusters’ that together form ‘currencies’, or units for contracting and commissioning mental health services. Each cluster defines a package of care for a group of service users who are relatively similar in their care needs and therefore resource requirements. At the time of writing, the currencies are being refined and tested at several sites in England. In addition, costing exercises are underway to investigate the resource implications of the currencies. The intention is that from April 2010 these currencies can be used for commissioning and benchmarking, using local prices agreed between commissioners and providers. Options for moving to a national tariff will also be explored, although its feasibility is unclear. The University of York was asked by the Department of Health to assess the Care Pathways and Packages Clusters from an economic perspective. This report examines the international literature on payment mechanisms for mental healthcare services. These approaches are described and critiqued, drawing on relevant theoretical and empirical research to explore the strengths and weaknesses of payment mechanisms. Implications for the proposed Care Pathways and Packages Clusters are explored and recommendations are outlined.
    Date: 2009–08
  13. By: Timmermann, Martina; Kruesmann, Monika
    Abstract: Every minute, at least one woman dies from pregnancy and childbirth complications; a further 20 suffer injury, infection or disease. Despite medical advances, and years of policy declarations, this tragic situation remains particularly severe in developing countries, violating a fundamental human right. Is a new approach possible, one that looks beyond common project paradigms and standards? What could such an approach look like, how might it operate, and what might be its effect? The Women’s Health Initiative, an innovative public private partnership that drew reference from the UN Global Compact, provides a possible model.
    Keywords: Women's maternal mortality; women's health; reproductive health; Millennium Development Goals; human right to best attainable health care; India; endoscopy; minimal invasive surgery; access to health; SME; PPP; UN Global Compact; corporate social responsibility; costs; infrastructure; medical training; capacity building; poverty.
    JEL: I11 J13 D63 I12 H41 J16 H51 A13 I18 A12 D78 D61 L33
    Date: 2009–09–15

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