nep-hea New Economics Papers
on Health Economics
Issue of 2009‒10‒24
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health in India Since Independence By Sunil S. Amrith
  2. Economic analysis on the socioeconomic determinants of child malnutrition in Lao PDR By Yusuke Kamiya
  3. Health Inequality and Its Determinants in New York By Kajal Lahiri; Zulkarnain Pulungan
  5. The Impact of Chernobyl on Health and Labour Market Performance in the Ukraine By Lehmann, Hartmut; Wadsworth, Jonathan
  6. Governance in health care delivery : raising performance By Lewis, Maureen; Pettersson, Gunilla
  7. Demographic and socioeconomic patterns of HIV/AIDS prevalence in Africa By Beegle, Kathleen; de Walque, Damien
  8. How to improve public health systems : lessons from Tamil Nadu By Das Gupta, Monica; Desikachari, B.R.; Somanathan, T.V.; Padmanaban, P.
  9. Farm Commodity Policy and Obesity By Alston, Julian; Okrent, Abigail
  10. Food prices and obesity: long-run effect in US metropolitan areas By Xu, Xin; Variyam, Jayachandran N.; Zhao, Jenny; Chaloupka, Frank
  11. Regulating Private Health Insurance in France : New Challenges for Employer-Based Complementary Health Insurance. By Monique Kerleau; Anne Fretel; Isabelle Hirtzlin
  12. On the fiscal treatment of life expectancy related choices. By Julio Davila; Marie-Louise Leroux
  13. Endogenous lifetime in an overlapping generations small open economy By Luciano Fanti and Luca Gori
  14. Endogenous fertility, endogenous lifetime and economic growth: the role of health and child policies By Luciano Fanti and Luca Gori
  15. Tobacco Regulation through Litigation: The Master Settlement Agreement By W. Kip Viscusi; Joni Hersch
  16. Chronic Health Conditions: Changing Prevalence in an Aging Population and Some Implications for the Delivery of Health Care Services By Frank T. Denton; Byron G. Spencer

  1. By: Sunil S. Amrith
    Abstract: This paper suggests that history is essential to an understanding of the challenges facing health policy in India today. Institutional trajectories matter, and the paper tries to show that a history of under-investment and poor health infrastructure in the colonial period continued to shape the conditions of possibility for health policy in India after independence. The focus of the paper is on the insights intellectual history may bring to our understanding of deeply rooted features of public health in India, which continue to characterise the situation confronting policymakers in the field of health today. The ethical and intellectual origins of the Indian state’s founding commitment to improve public health continue to shape a sense of the possible in public health to this day. The paper shows that a top-down, statist approach to public health was not the only option available to India in the 1940s, and that there was a powerful legacy of civic involvement and voluntary activity in the field of public health.
    Date: 2009
  2. By: Yusuke Kamiya (Ph.D candidate, Osaka School of International Public Policy (OSIPP),Osaka University)
    Abstract: The prevalence of stunting and underweight among Lao children is amongst the highest in the region. This paper provides a theoretical framework which integrates the mechanism of child malnutrition and a household decision-making behaviour and investigates the relationship between socioeconomic factors and child health outcomes. Using the Lao Multiple Indicator Cluster Survey 3 dataset, it reveals that motherfs age and education level, ethnicity, household assets and community factors such as water, sanitation and communication infrastructure have a statistically significant impact on child nutritional status. The unobserved heterogeneities of both household and community are also found to be associated with child nutrition production.
    Keywords: Child malnutrition, Anthropometrics, Stunting, Wasting, Underweight, Social determinants of health, Millennium Development Goal (MDG), Health policies, Lao PDR (Laos)
    JEL: I18 O15 O21
    Date: 2009–10
  3. By: Kajal Lahiri; Zulkarnain Pulungan
    Abstract: Self-assessed health status conditioned by several objective measures of health and socio-demographic characteristics are used to measure health inequality. We compare the quality of health and health inequality among different racial/ethnic groups as well as across 17 regions in New York State. In terms of average health and health inequality, American Indian/Alaskan Natives and Hispanics are found to be the worst, and North Country, Bronx County, and Richmond County lag behind the rest of the State. Three major contributing factors to health inequality are found to be employment status, education, and income. However, the contribution of each of these determinants varies significantly among racial/ethnic groups as well as across regions, suggesting targeted public health initiatives for vulnerable populations to eliminate overall health disparity.
    Date: 2009
  4. By: Roberto Serrano (Brown University); Roland Pongou (Brown University)
    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, in the long run, 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 (weakly) 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 formation models.
    JEL: A14 C7 I12 J00
    Date: 2009–09
  5. By: Lehmann, Hartmut (University of Bologna); Wadsworth, Jonathan (Royal Holloway, University of London)
    Abstract: Using longitudinal data from the Ukraine we examine the extent of any long-lasting effects of radiation exposure from the Chernobyl disaster on the health and labour market performance of the adult workforce. The variation in the local area level of radiation fallout from the Chernobyl accident is considered as a potential instrument to try to establish the causal impact of poor health on labour force participation, hours worked and wages. There appears to be a significant positive association between local area-level radiation dosage and health perception based on self-reported poor health status, though much weaker associations between local area-level dosage and other specific health conditions or labour market performance. Any effects on negative health perceptions appear to be stronger among women and older individuals.
    Keywords: Chernobyl, health, labour market performance
    JEL: H00 J00
    Date: 2009–10
  6. By: Lewis, Maureen; Pettersson, Gunilla
    Abstract: The impacts of health care investments in developing and transition countries are typically measured by inputs and general health outcomes. Missing from the health agenda are measures of performance that reflect whether health systems are meeting their objectives; public resources are being used appropriately; and the priorities of governments are being implemented. This paper suggests that good governance is central to raising performance in health care delivery. Crucial to high performance are standards, information, incentives and accountability. This paper provides a definition of good governance in health and a framework for thinking about governance issues as a way of improving performance in the health sector. Performance indicators that offer the potential for tracking relative health performance are proposed, and provide the context for the discussion of good governance in health service delivery in the areas of budget and resource management, individual provider performance, health facility performance, informal payments, and corruption perceptions. What we do and do not know about effective solutions to advance good governance and performance in health is presented for each area, drawing on existing research and documented experiences.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Public Sector Expenditure Policy,Health Economics&Finance,Health Law
    Date: 2009–10–01
  7. By: Beegle, Kathleen; de Walque, Damien
    Abstract: Understanding the demographic and socioeconomic patterns of the prevalence and incidence of HIV/AIDS in Sub-Saharan Africa is crucial for developing programs and policies to combat HIV/AIDS. This paper looks critically at the methods and analytical challenges to study the links between socioeconomic and demographic status and HIV/AIDS. Some of the misconceptions about the HIV/AIDS epidemic are discussed and unusual empirical evidence from the existing body of work is presented. Several important messages emerge from the results. First, the study of the link between socioeconomic status and HIV faces a range of challenges related to definitions, samples, and empirical methods. Second, given the large gaps in evidence and the changing nature of the epidemic, there is a need to continue to improve the evidence base on the link between demographic and socioeconomic status and the prevalence and incidence of HIV/AIDS. Finally, it is difficult to generalize results across countries. As the results presented here and in other studies based on Demographic and Health Survey datasets show, few consistent and significant patterns of prevalence by socioeconomic and demographic status are evident.
    Keywords: Population Policies,Disease Control&Prevention,HIV AIDS,Gender and Health,Health Monitoring&Evaluation
    Date: 2009–10–01
  8. By: Das Gupta, Monica; Desikachari, B.R.; Somanathan, T.V.; Padmanaban, P.
    Abstract: Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems’ broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists—with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system’s shortfalls. Tamil Nadu’s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people’s health.<BR>
    Keywords: Health Monitoring&Evaluation,Disease Control&Prevention,Health Systems Development&Reform,Population Policies,Health Economics&Finance
    Date: 2009–10–01
  9. By: Alston, Julian; Okrent, Abigail
    Abstract: Many commentators have claimed that farm subsidies have contributed significantly to the âobesity epidemicâ by making fattening foods relatively cheap and abundant and, symmetrically, that taxing âunhealthyâ commodities or subsidizing âhealthyâ commodities would contribute to reducing obesity rates. This paper makes three contributions. First, we review evidence from the literature on the impacts on food consumption and obesity resulting from subsidies applied in the past to production or consumption of farm commodities. Second, we develop and present new arguments and preliminary evidence on the impacts of past government investments in agricultural R&D on food consumption and obesityâthrough research-induced increases in agricultural productivity and the consequences for prices, production, and consumption of farm commodities. Third, we consider and compare the economic efficiency of hypothetical agricultural research policies (changing the orientation of agricultural research investments) versus hypothetical agricultural commodity subsidies and taxes as alternative mechanisms for encouraging consumption of healthy food or discouraging consumption of unhealthy food, or both.
    Keywords: Demand and Price Analysis, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,
    Date: 2009–08
  10. By: Xu, Xin; Variyam, Jayachandran N.; Zhao, Jenny; Chaloupka, Frank
    Abstract: Once considered as a serious public health issue only in developed countries, now overweight and obesity have dramatically increased in low- and middle-income countries, especially in urban settings (WHO, 2008). The main purpose of this study is to explore the economic incentives for this rapid growth in obesity rates, by studying variations in obesity over time and across geographic regions in the United States. Although a number of researchers and policymakers have devoted significant resources to address the recent rapid rise in obesity in the United States, âthe prevalence of overweight and obesity has increased sharply since the mid 1970sâ (Centers for Disease Control, 2008) and most of this increase occurred in the 1980s and 1990s (Cutler, et al., 2003). More importantly, changes in food prices have also occurred over the past 30 years and have occurred simultaneously with the obesity epidemic (Finkelstein, et al., 2005). In this study, we investigate how the decline in food prices in the last three decades affects the long-run growth of obesity rates. We take the advantage of the large panel data that cover for the time periods with the fastest growth of obesity rates, by using metropolitan samples from the National Health Interview Survey (NHIS) and information on prices of food at home and food away from home from these major metropolitan areas for years 1976 to 2001. Specifically, instead of using absolute food prices, we explore the impacts from changes in relative prices of food at home and food away from home (i.e. food prices relative to prices for a market basket of consumer goods and services in these metropolitan areas), as well as changes in prices of food at home and food away from home on the growth in obesity rates during this time frame. We also control for the changes in contextual factors and changes in value of female in these metropolitan areas. Our findings reveal the important fact that changes in relative food prices can explain about 20 percent of the obesity growth during this time period and such effect is more pronounced for the low-educated. The results of the study provide an interpretation of the long-run growth of obesity rates in urban settings.
    Keywords: Consumer/Household Economics, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,
    Date: 2009–08
  11. By: Monique Kerleau (Centre d'Economie de la Sorbonne); Anne Fretel (Centre d'Economie de la Sorbonne); Isabelle Hirtzlin (Centre d'Economie de la Sorbonne)
    Abstract: In France, people obtain basic health insurance coverage through a public health insurance system. Although public coverage is comprehensive, substantial co-payments and deductibles are more and more required and individuals become increasingly dependant on private complementary health insurance, to be better reimbursed. In the context of strengthened constraints to control public health spending, the market for complementary cover is indeed likely to develop. This expansion has several implications for the regulation of private health insurance. Starting in the early 2000s, public policies have emphasized tools that directly motivate employers to provide group-insurance schemes. These include subsidies to employers for offering complulsory, supplementary coverage, and mandating social partners to negociate the implementation of health coverage in every compagny, whatever its size or activity. Such changes tend, to some extent, to "re-couple" health insurance with companies. This paper explores the implications of this experience for France.
    Keywords: Private health care insurance, complementary employer-provided health insurance.
    JEL: I18 G22 G28 J33
    Date: 2009–09
  12. By: Julio Davila (Centre d'Economie de la Sorbonne - Paris School of Economics and CORE); Marie-Louise Leroux (CORE - Université Catholique de Louvain)
    Abstract: In an overlapping generations economy setup we show that, if individuals can improve their life expectancy by exerting some effort, costly in terms of either resources or utility, the competitive equilibrium steady state differs from the first best steady state. This is due to the fact that under perfect competition individuals fail to anticipate the impact of their longevity-enhancing effort on the return of their annuitized savings. We indentify the policy instruments required to implement the first-best into a competitive equilibrium and show that they are specific to the form, whether utility or resources, that the effort takes.
    Keywords: Life expectancy, health expenditures, taxation.
    JEL: H21 D91
    Date: 2009–09
  13. By: Luciano Fanti and Luca Gori
    Abstract: Using a simple overlapping generations small open economy, we show that endogenous longevity – through public health expenditure – may reduce both the saving rate and per capita domestic income, while increasing the per capita foreign debt in a country. Moreover, despite funding public health capital is always beneficial for life expectancy, it may or may not represent a Pareto improvement with respect to the laissez-faire solution depending on whether the world interest rate is high or low enough, respectively.
    Keywords: Health; Life expectancy; OLG model; Small open economy.
    JEL: I18 O41
    Date: 2009–10–15
  14. By: Luciano Fanti and Luca Gori
    Abstract: In this paper we link endogenous fertility, endogenous longevity, economic growth and public policies – represented by public health investments and child policies – in a basic overlapping generations model. We found that there even exist four equilibria, and thus low and high development regimes, which may be, however, determined by government policies, and concluded that when fertility is endogenous, increasing public health is always beneficial allowing economies to escape from poverty and, hence, to prosper. The same conclusion holds for the child tax policy. In particular, the latter result may be in accord with, for instance, the tremendous development experienced by China where a restrictive one child per family policy forced by the government planned and restricted the size of Chinese families, probably allowing some geographic areas within China to escape from poverty.
    Keywords: Child policy; Endogenous fertility; Health; Life expectancy; OLG model.
    JEL: I1 J13 O4
    Date: 2009–10–15
  15. By: W. Kip Viscusi; Joni Hersch
    Abstract: The 1998 Master Settlement Agreement resolved the unprecedented litigation in which the states sought to recoup the cigarette-related Medicaid costs. The litigation was settled through a combination of negotiated regulatory requirements and financial payments of about $250 billion over 25 years. Settlement payments received by states are strongly related to smoking-related medical costs but are also related to political factors. The payments largely took the form of an excise tax equivalent, raising potential antitrust concerns. The regulatory restrictions imposed by the agreement also raised antitrust concerns. However, there has been no evident shift in industry concentration. The increase in advertising and marketing expenses has largely taken the form of price discounts. The settlement sidestepped the usual procedures pertaining to the imposition of taxes and the promulgation of new regulations.
    JEL: H2 I18 K0 K13
    Date: 2009–10
  16. By: Frank T. Denton; Byron G. Spencer
    Abstract: Since the prevalence of many chronic health conditions increases with age we might anticipate that as the population ages the proportion with one or more such conditions would rise, as would the cost of treatment. We ask three questions: How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase in those circumstances? How much difference would it make to those requirements if people had fewer chronic conditions? We conclude that the overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 percent and that health care requirements would grow more rapidly than the population – more than twice as rapidly in the case of hospital stays – if the rates for each age group remained constant. We conclude also that even modest reductions in the average number of conditions at each age could result in substantial savings.
    Keywords: Chronic conditions, aging population, health care resources
    JEL: I10 J14
    Date: 2009–10

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