nep-hea New Economics Papers
on Health Economics
Issue of 2009‒10‒31
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. On the fiscal treatment of life expectancy related choices By Julio Davila; Marie-Louise Leroux
  2. Regulating Private Health Insurance in France : New Challenges for Employer-Based Complementary Health Insurance By Monique Kerleau; Anne Fretel; Isabelle Hirtzlin
  3. Catastrophic Health Expenditure and Household Well-Being By Abul Naga, Ramses; Lamiraud, K
  4. Does age matter for the value of life? - Evidence from a choice experiment in rural Bangladesh By Johansson-Stenman, Olof; Mahmud, Minhaj; Martinsson, Peter
  5. Modeling and prediction of surgical procedure times By Stepaniak, P. S.; Heij, C.; Vries, G. de
  6. Innovation Dynamics in Tuberculosis Control in India: The Shift to New Partnerships By Engel, Nora
  7. Relevance of Trained Traditional Birth Attendants in Maternal Health Case Study of Tehri Garhwal District Uttaranchal State By Pratibha Esther Singh
  8. The Pilot Maternal, Neonatal and Child Health Project (MNCH) at Nilphamari: Profiling the Changes During 2006-07 By Shahnawaz Mohammad Rafi
  9. Analysis of National Cancer Control Programmes in Europe By Atun, R; Ogawa, T; Martin-Moreno, JM
  10. Thinking about it: thoughts about health and valuing QALYs By Dolan, P
  11. Economies of scale and scope in the English hospital sector By Miraldo, M
  12. The Size and Service Offering Efficiencies of U.S. Hospitals. By Gary D. Ferrier; Hervé Leleu; James Moises; Vivian Valdmanis
  13. The Value of a Statistical Injury: New Evidence from the Swiss Labor Market By Andreas Kuhn; Oliver Ruf
  14. Paying a Premium on Your Premium? Consolidation in the U.S. Health Insurance Industry By Leemore Dafny; Mark Duggan; Subramaniam Ramanarayanan
  15. Investments in Pharmaceuticals Before and After TRIPS By Margaret Kyle; Anita McGahan
  16. Long Term Effects of Minimum Legal Drinking Age Laws on Adult Alcohol Use and Driving Fatalities By Robert Kaestner; Benjamin Yarnoff

  1. By: Julio Davila (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, CORE - Université Catholique de Louvain); 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.
    Date: 2009–09
  2. By: Monique Kerleau (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I); Anne Fretel (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I); Isabelle Hirtzlin (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I)
    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.
    Date: 2009–09
  3. By: Abul Naga, Ramses; Lamiraud, K
    Abstract: According to the catastrophic health expenditure methodology a house- hold is in catastrophe if its health out-of-pocket budget share exceeds a critical threshold. We develop a conceptual framework for addressing three questions in relation to this methodology, namely: 1. Can a budget share be informative about the sign of a change in welfare? 2. Is there a positive association between a households poverty shortfall and its health out-of- pocket budget share? 3. Does an increase in population coverage of a health insurance scheme always result in a reduction of the prevalence of catastrophic expenditures?
    Keywords: Catastrophic health expenditure; welfare change; poverty; performance of health insurance schemes
    Date: 2009
  4. By: Johansson-Stenman, Olof (Department of Economics, School of Business, Economics and Law, Göteborg University); Mahmud, Minhaj (Queen’s University Belfast); Martinsson, Peter (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: Using a random sample of individuals in rural Bangladesh, this paper investigates people’s preferences regarding relative values of lives when it comes to different ages of the individuals being saved. By assuming that an individual has preferences concerning different states of the world, and that these preferences can be described by an individual social welfare function, the individuals’ preferences for life-saving programs are elicited using a pair-wise choice experiment between different life-saving programs. In the analyses, we calculate the social marginal rates of substitution between saved lives of people of different ages. We also test whether people have preferences for saving more life-years rather than only saving lives. In particular, we test and compare the two hypotheses that only lives matter and that only life-years matter. The results indicate that the value of a saved life decreases rapidly with age and that people have strong preferences for saving life-years rather than lives per se. Overall, the results clearly show the importance of the number of life-years saved in the valuation of life.<p>
    Keywords: social preferences; life-saving programs; choice experiment; relative value of life
    JEL: D63 I18 J17
    Date: 2009–10–19
  5. By: Stepaniak, P. S.; Heij, C.; Vries, G. de (Erasmus Econometric Institute)
    Abstract: Accurate prediction of medical operation times is of crucial importance for cost efficient operation room planning in hospitals. This paper investigates the possible dependence of procedure times on surgeon factors like age, experience, gender, and team composition. The effect of these factors is estimated for over 30 different types of medical operations in two hospitals, by means of ANOVA models for logarithmic case durations. The estimation data set contains about 30,000 observations from 2005 till 2008. The relevance of surgeon factors depends on the type of operation. The factors found most often to be significant are team composition, experience, and daytime. Contrary to widespread opinions among surgeons, gender has nearly never a significant effect. By incorporating surgeon factors, the accuracy of out-of-sample prediction of case durations of about 1,250 surgical operations in 2009 is improved by up to more than 15 percent as compared to current planning procedures.
    Keywords: operation room;surgeon factors;lognormal distribution;ANOVA model;planning;European hospital;health care management;current procedure terminology (CPT)
    Date: 2009–10–19
  6. By: Engel, Nora (UNU-MERIT)
    Abstract: Innovation dynamics in Tuberculosis control in India: The shift to new partnerships Tuberculosis remains the biggest infectious killer in India and worldwide, and it has recently regained substantial international attention with its come-back in drug resistant forms. The environment, the disease and the societal response to it are changing and with it challenges and opportunities to control the disease. Innovation in a variety of areas such as improved diagnostic tests, drugs, delivery mechanisms, service processes, institutions and treatment regimes is needed in order to be able to respond to the changing public health challenge. Recent developments in the literature emphasize that innovation is a complex endeavour that includes processes of negotiation, learning and alignment amongst researchers, health practitioners, firms and public authorities. The ground level realities for innovation in countries such as India where TB is a social as much as a clinical problem are complicated with challenges and constraints inherent to the health and wider social system that hamper learning, experimenting and thus innovation. Based on preliminary results from qualitative fieldwork in India this paper will examine the innovation dynamics in one of the recent policy changes in TB control in India: the emergence of new partnerships between private medical providers, NGOs and the government. The paper traces where new ideas come from, how they make their way through the existing control structure and how the existing efforts to control TB respond to and cope with these new developments. The central argument is that the dynamics of innovation in a complex, conflicting and confusing setting like TB control can be understood as a continuous evolution of problems, promises and solutions.
    Keywords: Innovation dynamics, public-private mix, Tuberculosis, India
    JEL: I18 O31 O38
    Date: 2009
  7. By: Pratibha Esther Singh
    Abstract: The methodology had two parts - secondary data analysis and a descriptive cross sectional study. Secondary date analysis was carried our using a sample of 1,028 men and 1,028 women in the reproductive ages drawn from the phase-2 RCH survey. The RCH surveys consist of sample sizes adequate at the district level to obtain estimates of reproductive morbidity. The primary data collection for this study was conducted in the Tehri Garhwal district of UA. The sampling frame consisted of all trained Traaditional Birth Attendants (TBAs) in six of nine blocks in the chosen district. Several NGOs have undertaken TBA training in Tehri Garhwal. [WP no. 11]
    Keywords: women, reproductive ages, RCH sirveys, birth attendants, TBAs, uttaranchal, child survial, health workers, Indian, morbidity,
    Date: 2009
  8. By: Shahnawaz Mohammad Rafi
    Abstract: BRAC health programme (BHP) initiated a pilot maternal, neonatal and child health project (MNCH) in Nilphamari in 2006 to improve the health status of women of reproductive age including neonates and children, through instituting necessary systems and measures. Before launching the programme, a baseline survey was done to help design intervention and future impact evaluation of the project. Subsequently, a follow-up survey was done during middle of 2007 to assess the changes, if any, taking place as a result of the MNCH intervention over the period 2006-‘07. This report presents key findings from this comparison of baseline and follow-up survey. [BRAC-RED WP No. 5].
    Keywords: Post-natal care, Reproductive history, abortion, women, Socio-demographic profile, Community Health Worker, bangladesh, death, children, neo-natal, care, Delivery,
    Date: 2009
  9. By: Atun, R; Ogawa, T; Martin-Moreno, JM
    Date: 2009–06–18
  10. By: Dolan, P
    Abstract: When valuing health states, health economists often ask respondents how many years of life in poor health they would be willing to trade off in order to live in full health. There are many problems inherent in eliciting preferences of this kind that have led us to advocate more direct measures of experienced utility. Yet individuals are often willing to make large sacrifices in life expectancy to alleviate conditions for which there is a considerable degree of hedonic adaptation. The purpose of this study is to investigate this important discrepancy in more detail. Data from 1173 internet and telephone surveys in the United States suggest that frequent and negative thoughts about health are significant in explaining time trade-off responses. We discuss some of the implications of these results for the measurement and valuation of health.
    Date: 2009–05
  11. By: Miraldo, M
    Abstract: In this paper we estimate hospital costs and evaluate economies of scale and scope using a generalised multiproduct cost function and a sample of English NHS Trusts with different types of ownership, namely Foundation Trusts and non Foundation Trusts. Evaluating the behaviour of different types of hospitals separately might be particularly helpful for the design, and future developments, of the optimal provider reimbursement tariff. Also it might shed some light on the ability of different types of hospitals pro t from the existence of economies of scale and scope. Results show that, even though these two group of providers do not exhibit differences regarding economies of scale, Foundation Trusts exhibit global diseconomies of scope while non Foundation Trusts exhibit global scope economies.
    Date: 2009–07
  12. By: Gary D. Ferrier (Walton College of Business, University of Arkansas); Hervé Leleu (LEM-CNRS (UMR 8179), IÉSEG School of Management); James Moises (Department of Emergency Medicine, Tulane University); Vivian Valdmanis (Department of Health Policy and Public Health, University of the Sciences in Philadelphia)
    Abstract: Hospital productivity has been a research topic for over two decades. We expand on this research to include measures of dis/economies of scope. By using the Free Coordination Hull (FCH) we are able to determine if hospitals in our sample can become more efficient if they provide more services (diseconomies of scope) or if two smaller hospitals with a reallocation of resources could become more efficient (economies of scope). Using data from the American Hospital Association for the years 2004-2007, we found variations among hospital markets (measured by the Core Based Statistical Area). We can determine whether dis/economies of scope exist by comparing the results from two linear programming problems. Focusing on four markets: Los Angeles, Philadelphia, Madison, WI, and New Orleans we found variations in how best these hospitals operating in these markets could change in order to increase both scale and scope efficiencies. This approach could be used by policy makers and managers in order to reduce costs by sharing, reducing, or expanding services in hospitals. Findings from a study such as this should aid reform programs by providing more information on the sources of hospital inefficiency.
    Keywords: Hospital, Efficiency, Economies of Scope, Hospital Markets
    Date: 2009–09
  13. By: Andreas Kuhn (Institute for Empirical Research in Economics, University of Zurich, Switzerland); Oliver Ruf
    Abstract: We study the monetary compensation for non-fatal accident risk in Switzerland using the number of accidents within cells defined over industry x skill-level of the job and capitalizing on the partial panel structure of our data which allows us to empirically isolate the wage component specific to the employer. Our results show that using accident risk at a lower level of aggregation, using narrower samples of workers, and using the wage component that is specific to the firm all yield higher estimates of risk compensation. Our preferred estimate gives an estimate of about 36,000 Swiss francs per prevented injury per year.
    Keywords: Compensating wage differentials, value of a statistical injury, risk measurement
    JEL: J17 J28 J31
    Date: 2009–09
  14. By: Leemore Dafny; Mark Duggan; Subramaniam Ramanarayanan
    Abstract: We examine whether and to what extent consolidation in the U.S. health insurance industry is leading to higher employer-sponsored insurance premiums. We make use of a proprietary, panel dataset of employer-sponsored healthplans enrolling over 10 million Americans annually between 1998 and 2006 to explore the relationship between premium growth and changes in market concentration. We exploit the differential impact of a large national merger of two insurance firms across local markets to estimate the causal effect of concentration on market-level premiums. We estimate real premiums increased by 2 percentage points (in a typical market) due to the rise in concentration during our study period. We also find evidence that consolidation facilitates the exercise of monopsonistic power vis a vis physicians, whose absolute employment and relative earnings decline in its wake.
    JEL: I11 L1 L4
    Date: 2009–10
  15. By: Margaret Kyle; Anita McGahan
    Abstract: We examine the relationship between patent protection for pharmaceuticals and investment in development of new drugs. Patent protection has increased around the world as a consequence of the TRIPS Agreement, which specifies minimum levels of intellectual property protection for members of the World Trade Organization. It is generally argued that patents are critical for pharmaceutical research efforts, and so greater patent protection in developing and least-developed countries might result in greater effort by pharmaceutical firms to develop drugs that are especially needed in those countries. Since patents also have the potential to reduce access to treatments through higher prices, it is imperative to assess whether the benefits of increased incentives have materialized in research on diseases that particularly affect the poor. We find that patent protection is associated with increases in research and development (R&D) effort when adopted in high income countries. However, the introduction of patents in developing countries has not been followed by greater investment. Particularly for diseases that primarily affect the poorest countries, our results suggest that alternative mechanisms for inducing R&D may be more appropriate than patents.
    JEL: F13 I11 L65 O34
    Date: 2009–10
  16. By: Robert Kaestner; Benjamin Yarnoff
    Abstract: We examine whether adult alcohol consumption and traffic fatalities are associated with the legal drinking environment when a person was between the ages of 18 and 20. We find that moving from an environment in which a person was never allowed to drink legally to one in which a person could always drink legally was associated with a 20 to 30 percent increase in alcohol consumption and a ten percent increase in fatal accidents for adult males. There were no statistically significant or practically important associations between the legal drinking environment when young and adult female alcohol consumption and driving fatalities.
    JEL: I12 I18 K32
    Date: 2009–10

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