nep-hea New Economics Papers
on Health Economics
Issue of 2009‒11‒21
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo, USA

  2. The Impact of Chernobyl on Health and Labour Market Performance in the Ukraine By Hartmut Lehmann; Jonathan Wadsworth
  3. Why Are Middle-Aged People so Depressed?: Evidence from West Germany By Hilke Brockmann
  4. Technological adoption in health care By Pedro Pita Barros; Xavier Martinez-Giralt
  5. Mental Health in the Aftermath of Conflict By Quy-Toan Do; Lakshmi Iyer
  6. Child poverty as a determinant of life outcomes: Evidence from nationwide surveys in Japan By Oshio, Takashi; Sano, Shinpei; Kobayashi, Miki
  7. Happiness, self-rated health, and income inequality: Evidence from nationwide surveys in Japan By Oshio, Takashi; Kobayashi, Miki
  8. The effect of smoking on individual well-being: a propensity score matching analysis based on nationwide surveys in Japan By Oshio, Takashi; Kobayashi, Miki
  9. The Association Between Income Inequality and Mental Health: Social Cohesion or Social Infrastructure? By Layte, Richard; Maître, Bertrand
  10. Can Public Private Partnership reduce Maternal Mortality? Assessing Efforts Made by the ‘Chiranjeevi’ Scheme in Gujarat By Akash Acharya
  11. Institutional and Economic Perspectives on Government Capacity to Assume New Roles in the Health Sector: a Review of Experience By Sara Bennett
  12. Start With a Girl: A New Agenda for Global Health By Miriam Temin
  13. Engaging Communities to Improve Health and Nutrition Outcomes: The Role of Community Volunteers in INHP By CARE CARE
  14. The association between remarriage and HIV infection : evidence from national HIV surveys in Africa By de Walque, Damien; Kline, Rachel
  15. Trade in health services: what's in it for developing countries ? By Cattaneo, Olivier
  16. Health Status and Health Care Access of Farm and Rural Populations By Jones, Carol Adaire; Parker, Timothy S.; Ahearn, Mary; Mishra, Ashok K.; Variyam, Jayachandran N.
  17. Intergenerational aspects of health care By Louise Sheiner
  18. Theory Based Medicine and the Role of Evidence: Why the Emperor Needs New Clothes, Again By Mita Giacomini
  19. Preferences over the Fair Division of Goods: Information, Good, and Sample Effects in a Health Context By Jeremiah Hurley; Neil Buckley; Kate Cuff; Mita Giacomini; David Cameron
  20. The Value of Fixed-Reimbursement Healthcare Insurance- Evidence from Cancer Patients in Ontario, Canada By Christopher Longo; Michel Grignon
  21. A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment By Till Bärnighausen; David E. Bloom; Salal Humair

  1. By: Maria De Paola; Valeria Pupo; Vincenzo Scoppa (Dipartimento di Economia e Statistica, Università della Calabria)
    Abstract: In this paper we analyse how the absence behaviour of Italian public sector employees has been affected by a law, passed in June 2008, reducing sick leave compensation and increasing monitoring intensity. We use micro-data on a sample of about 860 workers, employed at an Italian public administration, for years going from 2005 to 2009. We estimate the effect of the reform using linear and non-linear estimators. As predicted by agency theory, individuals react to economic incentives: the employees in our sample have considerably reduced their absences under the new regime. Since the reform has affected employees in a non uniform way, we show that the reduction of absenteeism is significantly stronger for employees suffering higher earning losses. Results also show that while the reform has reduced the duration of short absence spells, the duration of long spells has increased. We argue that this is due to the non-linearity of earning losses introduced by the new law.
    Keywords: Worker Absenteeism, Moral Hazard, Shirking, Sickness, Insurance Contracts
    JEL: J41 J45 M52 D86 C20
    Date: 2009–10
  2. By: Hartmut Lehmann; Jonathan Wadsworth
    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 selfreported 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, LabourMarket Performance
    JEL: H00 J00
    Date: 2009
  3. By: Hilke Brockmann
    Abstract: Does happiness vary with age? The evidence is inconclusive. Some studies show happiness to increase with age (Diener et al. 1999; Argyle 2001). Others hold that the association is U-shaped with either highest depression rates (Mroczek and Christian, 1998; Blanchflower and Oswald, 2008) or highest happiness levels occurring during middle age (Easterlin, 2006). Current studies suffer from two shortcomings. Firstly, they do not control for three confounding time variables: age, period and cohort effects. Secondly, all empirical research lacks a theoretical explanation as to why age affects happiness. The purpose of our analysis is to contribute to closing both of these research gaps. A social investment model frames the dynamics of happiness across the life-span. The empirical test draws on West German panel data that followed individuals from 1984 to 2005. Descriptive analysis shows a cubic age function with the lowest level at middle age. However, hierarchical three-level variance component models (Rabe-Hesketh and Skrondal, 2005), find significant differences across pre-war and post-war cohorts, baby boomers and offspring of the baby bust as well as deviations during reunification. Yet, cohort and period effects account for less than 10% of the variance. (Un)happiness in midlife is more strongly determined by gender-specific occasional influences and individual characteristics. Both define objective and subjective returns of professional and personal life investments. These social investment decisions date back to early adulthood and bear a high risk of failure during midlife. Unforeseen consequences and long-term private and professional commitments make it costly to adjust, but at the same time new investments may pay off in a pro-longed future. This dilemma turns many middle-aged people into ¿frustrated achievers¿.
    Keywords: Happiness, subjective well-being, gendered life-course, inequality, APC effects (Age-Period-Cohort effects), multi-level analysis, Germany
    Date: 2009
  4. By: Pedro Pita Barros; Xavier Martinez-Giralt
    Abstract: This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients' benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients' benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems.
    Keywords: Health care, technology adoption, payment systems
    JEL: I11 I12 Q33
    Date: 2009–11–09
  5. By: Quy-Toan Do (The World Bank); Lakshmi Iyer (Harvard Business School, (UNIT NAME) Unit)
    Abstract: We survey the recent literature on the mental health effects of conflict. We highlight the methodological challenges faced in this literature, which include the lack of validated mental health scales in a survey context, the difficulties in measuring individual exposure to conflict, and the issues related to making causal inferences from observed correlations. We illustrate how some of these issues can be overcome in a study of mental health in post-conflict Bosnia and Herzegovina. Mental health is measured using a clinically validated scale; conflict exposure is proxied by administrative data on war casualties instead of being self-reported. We find that there are no significant differences in overall mental health across areas which are affected by ethnic conflict to a greater or lesser degree.
    Date: 2009–11
  6. By: Oshio, Takashi; Sano, Shinpei; Kobayashi, Miki
    Abstract: We attempt to examine the extent to which poverty in childhood adversely affects success in adulthood, using micro data from nationwide surveys in Japan and taking into account the recursive structure of life outcomes. We use retrospective assessments of income class at the age of 15, because longitudinal data on household income are not available. After controlling for its endogeneity, we confirm that children from poor families tend to have lower educational attainment, face higher poverty risks, and assess themselves as being less happy and as suffering from poorer health.
    Keywords: Child poverty, Educational attainment, Poverty risk, Happiness, Self-rated health
    Date: 2009–08
  7. By: Oshio, Takashi; Kobayashi, Miki
    Abstract: We examine how regional inequality affects happiness and self-rated health at an individual level by using micro data from nationwide surveys in Japan. Individuals who live in the area of high inequality tend to report themselves as both unhappy and unhealthy, even after controlling for various individual and regional characteristics and taking into account the correlation between the two subjective outcomes. We also investigate how their sensitivities to regional inequality change by key individual attributes. People with an unstable work status are most affected by inequality when assessing both happiness and health.
    Keywords: happiness, self-rated health, income inequality
    Date: 2009–08
  8. By: Oshio, Takashi; Kobayashi, Miki
    Abstract: Background: It is widely known that smokers tend to feel less satisfied than non-smokers with their jobs and life more generally. However, it is not easy to establish a causal relationship between smoking and individual well-being, because of shared associations with socioeconomic or demographic factors. This issue was largely avoided in the present study, which used propensity score matching methods to investigate whether smoking affects the extent to which individuals are satisfied with their job and other aspects of their life. Methods: Using a large-scale Japanese dataset, we first estimated propensity scores for smoking as a function of numerous socioeconomic and demographic factors. We then matched smokers to non-smokers on the basis of these. We subsequently estimated the average treatment effect, considering smoking as a treatment and smokers as the treated group. We used different matching methods to ascertain the robustness of any effects. Results: We found that smoking made both males and females unhappy, and that it reduced both the extent to which they were satisfied with multiple aspects of their lives (including their job, non-working activities, household's financial conditions, family life, friendships, residential area, health and physical conditions) and their level of self-rated health. Some of these effects differed between males and females. Conclusions: Our propensity score matching analyses identified smoking as having direct adverse effects on individual well-being.
    Keywords: Smoking, Happiness, Job satisfaction, Self-rated Health, Propensity score matching
    Date: 2009–08
  9. By: Layte, Richard; Maître, Bertrand
    Abstract: A large literature has emerged around the strong association between income inequality and average life expectancy and a range of health outcomes including mental well being. Three possible explanations for the association have been offered: that the association is a statistical artefact; the 'social cohesion hypothesis' and lastly, the 'neo-materialist hypothesis'. We examine the ability of these hypotheses to explain the link between income inequality and mental well being in data from 30 countries from the European Quality of Life Survey (2007). Our results offer support to the social cohesion and neo-materialist explanations but evidence for the neo-materialist hypothesis is strongest. Measures of expenditure on social protection and the quality of a range of social services reduce the coefficient measuring income inequality by over two thirds and render it insignificant. However, variables measuring social cohesion such as trust in others, civic participation and social contact reduce the income inequality coefficient by 44% and provide the best fitting model as measured by AIC value.
    Date: 2009–11
  10. By: Akash Acharya
    Abstract: The Chiranjeevi Yojna is considered to be a successful PPP model and has also received a prestigious Asian Innovations Award by the Wall Street Journal. It is a flagship scheme of the Gujarat state ministry of health and family welfare and is being recommended for up scaling-up at the national level. It has been claimed by the government that maternal as well as neonatal deaths have been substantially reduced under the scheme.
    Keywords: maternal, neonatal deaths, India, scheme, chiranjeevi yojana, PPP model, asian, gujarat, health, family welfare, national level,
    Date: 2009
  11. By: Sara Bennett
    Abstract: This review paper provides the background to research that will take place in four country case-studies to examine these issues. A key focus of this paper concerns government's capacity to fulfil the new roles expected of it. The paper selects four important new reform arrangements: autonomous hospitals; user fees; contracting out; and regulation or enablement of the private sector, since these represent different dimensions of the public/private mix. The rationale for each reform, the extent of change and lessons learned are briefly reviewed. [HEFP WP No. 01/96].
    Keywords: reform, enablement, BUREAUCRATIC COMMERCIALIZATION, autonomous,financing, NGO, health care, community actors, government, capacity, autonomous, hospitals, public, private, sector, user fess, regulation,
    Date: 2009
  12. By: Miriam Temin
    Abstract: Sheds light on the realities of girls' health and wellbeing in developing countries, on the links between the health of girls and the prospects for their families, and on the specific actions that will improve health prospects for millions. This report describes the most prevalent and serious health problems adolescent girls face in developing countries, linking them to a combination of specific public-health risks and social determinants of health. It highlights the diverse ways in which governments and non-governmental organizations have sought—often successfully, albeit on small scale—to break vicious cycles of ill health. It also lays out an ambitious yet feasible agenda for governments, donors, the private sector, and civil society organizations—complete with estimates of indicative costs. [CGD].
    Keywords: global health, girl, health, social, adolescent, private sector, maternal, society, public health risks, developing countries, families, marriage, innovation, secondary school, young women, HIV,
    Date: 2009
  13. By: CARE CARE
    Abstract: INHP adopted a multiple volunteer per village model, with one volunteer serving the immediate neighborhood of about 20-30 households to rationalize volunteer workloads and to ensure cultural compatibility. Capacities of these volunteers, called Change Agents, were built through a mix of structured training events and on-thejob support by AWW of the ICDS program and ANM of the health programs. This paper details the RACHNA’s experience with Change Agents and discusses the relevance of the experience for other large-scale community volunteer programs, particularly within the context of Maternal and Child Health and Nutrition (MCHN). [CARE WP No. 11].
    Keywords: community, child health, nutrition, maternal, MCHN, change agents, village model, households, cultural, AWW, ICDS,
    Date: 2009
  14. By: de Walque, Damien; Kline, Rachel
    Abstract: The literature shows that divorced, separated, and widowed individuals in Africa are at significantly increased risk for HIV. Using nationally representative data from 13 countries in Sub-Saharan Africa, this paper confirms that formerly married individuals are at significantly higher risk for HIV. The study goes further by examining individuals who have remarried. The results show that remarried individuals form a large portion of the population - usually larger than the divorced, separated, or widowed - and that they also have higher than average HIV prevalence. This large number of high-risk remarried individuals is an important source of vulnerability and further infection that needs to be acknowledged and taken into account in prevention strategies.
    Keywords: Disease Control&Prevention,Population Policies,Gender and Health,HIV AIDS,HIV AIDS and Business
    Date: 2009–11–01
  15. By: Cattaneo, Olivier
    Abstract: This study summarizes the existing knowledge and relevant abstracts and case-studies on the design of health and/or trade reforms and policies. The study aims to contribute to the understanding of the potential benefits and risks - and ways to maximize the former and minimize the latter - of trade in the health sector. It is designed for non-trade (health) experts to understand how trade can help to improve health systems and access to health services, and for trade specialists to understand the specific characteristics of the health sector.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Law,Disease Control&Prevention,Health Economics&Finance
    Date: 2009–11–01
  16. By: Jones, Carol Adaire; Parker, Timothy S.; Ahearn, Mary; Mishra, Ashok K.; Variyam, Jayachandran N.
    Abstract: Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts, though mortality and disability rates vary more by region than by metro status. Contributing negatively to the health status of rural residents are their lower socioeconomic status, higher incidence of both smoking and obesity, and lower levels of physical activity. Contributing negatively to the health status of farmers are the high risks from workplace hazards, which also affect other members of farm families who live on the premises and often share in the work; contributing positively are farmersâ higher socioeconomic status, lower incidence of smoking, and more active lifestyle. Both farm and rural populations experience lower access to health care along the dimensions of affordability, proximity, and quality, compared with their nonfarm and urban counterparts.
    Keywords: Health Economics and Policy, agriculture safety and health, electronic health records, farmer health, health, health care access, health care affordability, health care quality, health disparities, health IT, health status, mortality, rural health, telehealth, uninsured,
    Date: 2009–08
  17. By: Louise Sheiner
    Abstract: The physical process of aging means that the use of health services varies significantly by age. This association between age and health care consumption raises a number of issues related to intergenerational and intragenerational equity, including the allocation of societal resources across age groups and the effects of population aging and health cost growth on public sector health care burdens and, hence, on intergenerational redistribution. This working paper (forthcoming as a chapter in the Oxford Handbook of Health Economics) provides a detailed look at the theoretical and empirical relationships between health spending and age, both in the US and internationally, and reviews the evidence on the intergenerational redistribution associated with public health spending over time.
    Date: 2009
  18. By: Mita Giacomini (Department of Clinical Epidemiology and Bioistatistics, Centre for Health Economics and Policy Analysis, McMaster University)
    Abstract: The evidence based medicine movement ("EBM") was established to combat capricious reasoning in clinical care, particularly arguments from authority. Critique of authority and appraisal of evidence remain EBM's core values, and should be revisited in this current era of EBM's maturity and considerable influence. At this stage, we encounter a new form of under-questioned authority: evidence from well-designed and metholodically appraised RCTs. RCT evidence is now prized even on some occasions when it is incapable of providing meaningful information - in particular, when underlying casual theory is inscrutable. This is the case with many health interventions whose mechanisms remain "black boxes" without compelling explanations. A review of recent clinical trials of remote intercessory prayer illustrates this problem. The findings of these trials are uninterpretable and inapplicable, due to unresolved and fundamental theoretical problems with their hypotheses and premises. Yet this trial evidence has gained remarkable scientific credibility and high profile dissemination, largely on the warrant of rigorous RCT methodology. The case of remote intercessory prayer evidence helps to identify some systematic blind spots in the institutions of EBM. As EBM has long counseled, clinicians and policy makers should indeed be skeptical of casual arguments in the absence of empirical evidence. However, empirical evidence in the absence of good casual argument is likewise occasion for skepticism. Medicine - even evidence-based medicine - is theory-based at its core. EBM must cultivate greater capacity to address the crucial role of theory, in both the generation and the use of experimental evidence.
    Date: 2009
  19. By: Jeremiah Hurley (Department of Economics, Centre for Health Economics and Policy Analysis, McMaster University, Department of Clinical Epidemiology and Biostatistics, McMaster University); Neil Buckley (Department of Economics, York University); Kate Cuff (Department of Economics, McMaster University); Mita Giacomini (Department of Clinical Epidemiology and Bioistatistics, Centre for Health Economics and Policy Analysis, McMaster University); David Cameron (Department of Economics, McMaster University, Centre for Health Economics and Policy Analysis, McMaster University)
    Abstract: Greater recognition by economists of the influential role that concern for distributional equity exerts on decision making in a variety of economic contexts has spurred interest in empirical research on the public judgments of fair distribution. Using a stated-preference experimental design, this paper contributes to the growing literature on fair division by investigating the empirical support for each of five distributional principles — equal division among recipients, Rawlsian maximin, total benefit maximization, equal benefit for recipients, and allocation according to relative need among recipients — in the division of a fixed bundle of a good across settings that differ with respect to the good being allocated (a health care good — pills, and non-health care but still health-affecting good — apples) and the way that alternative possible divisions of the good are described (quantitative information only, verbal information only, and both). It also offers new evidence on sample effects (university sample vs. community samples) and how the aggregate ranking of principles is affected by alternative vote-scoring methods. We find important information effects. When presented with quantitative information only, support for the division to equalize benefit across recipients is consistent with that found in previous research; changing to verbal descriptions causes a notable shift in support among principles, especially between equal division of the goods and total benefit maximization. The judgments made when presented with both quantitative and verbal information match more closely those made with quantitative-only descriptions rather than verbal-only descriptions, suggesting that the quantitative information dominates. The information effects we observe are consistent with a lack of understanding among participants as to the relationship between the principles and the associated quantitative allocations. We also find modest good effects in the expected direction: the fair division of pills is tied more closely to benefit-related criterion than is the fair division of apples (even though both produce health benefits). We find evidence of only small differences between the university and community samples and important sex-information interactions.
    Keywords: Distributive justice, equity, resource allocation, health care
    JEL: C9 D63 I1
    Date: 2009
  20. By: Christopher Longo (Health Services Management, Degroote School of Business, Centre for Health Economics and Policy Analysis, McMaster University); Michel Grignon (Department of Economics, Centre for Health Economics and Policy Analysis, McMaster University)
    Abstract: Critical illness insurance (CII) is a fixed-reimbursement scheme conditioned on the event of a loss, not the size of the loss. We investigate demand for CII. Consumers will be willing to purchase CII depending on their degree of risk aversion to the cost of treating illness, their forgone income, and desire for being compensated for utility loss when sick. Using a theoretical model based on Eeckhoudt (2003), we run simulations using Canadian data for CII policy reimbursement dollar values of purchases, family income, cancer expenditure, and net wealth. We then evaluate how well these models predict actual CII purchases.
    Keywords: health insurance, healthcare insurance, fixed-reimbursement insurance, state-utility transfer, expected utility, cancer
    Date: 2009
  21. By: Till Bärnighausen; David E. Bloom; Salal Humair
    Abstract: Despite recent international efforts to increase antiretroviral treatment (ART) coverage, it is estimated that more than 5 million people who need ART in developing countries do not receive such treatment. Shortages of human resources to treat HIV/AIDS (HRHA) are one of the main constraints to scaling up ART. We develop a discrete-time Markovian model to project the numbers of HRHA required to achieve universal ART coverage, taking into account the positive feedback from HRHA numbers to future HRHA need. Feedback occurs because ART is effective in prolonging the lives of HIV-positive people who need treatment, so that an increase in the number of people receiving treatment leads to an increase in the number of people needing it in future periods. We investigate the steady-state behavior of our model and apply it to different regions in the developing world. We find that taking into account the feedback from the current supply of HRHA to the future HRHA need substantially increases the projected numbers of HRHA required to achieve universal ART coverage. We discuss the policy implications of our model.
    JEL: I10 I11 I18 J20 J21
    Date: 2009–11

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