nep-hea New Economics Papers
on Health Economics
Issue of 2009‒12‒05
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Understanding the Southern African Anomaly: Poverty, endemic Disease, and HIV By Larry Sawers; Eileen Stillwaggon
  2. The Public Finance of Healthy Behavior By Robert Rosenman
  3. How might India's public health systems be strengthened ? By Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.
  4. Parental Investment in Children: Differential Pathways of Parental Education and Mental Health By Chikako Yamauchi
  5. Analysis of the Validity of the Vignette Approach to Correct for Heterogeneity in Reporting Health System Responsiveness By Nigel Rice; Silvana Robone; Peter Smith
  6. Slipping Anchor? Testing the Vignettes Approach to Identification and Correction of Reporting Heterogeneity By Bago d'Uva, T; Lindeboom, M; O'Donnell, O; van Doorslaer E
  7. Vignettes and health systems responsiveness in crosscountry comparative analyses By Nigel Rice; Silvana Robone; Peter Smith
  8. Issues and Challenges of Measurement of Health:Implications for Economic Research By Martine AUDIBERT
  9. Selective contracting and foreclosure in health care markets By Bijlsma, Michiel; Boone, Jan; Zwart, Gijsbert

  1. By: Larry Sawers; Eileen Stillwaggon
    Abstract: Background: Adult HIV prevalence in southern Africa is many times greater than prevalence in other low- and middle-income countries. Previous studies argue that the intensity of the HIV epidemic in southern Africa results from regional characteristics, such as apartheid labour regulations and mineral wealth, which contributed to circular migration patterns and highly skewed income distribution, both thought to promote risky sexual behaviour. This study emphasizes the importance of common infectious and parasitic diseases that increase the likelihood of HIV transmission by making HIVinfected persons more contagious and by making uninfected persons more vulnerable.
    Keywords: HIV/AIDS, migration, southern Africa, tropical disease, poverty
    Date: 2009–07
  2. By: Robert Rosenman (School of Economic Sciences, Washington State University)
    Abstract: Lifestyle can often affect the likelihood an individual will have a future illness. Subsidies often mitigate the consequences of poor lifestyle choices. In this paper we explore tax-subsidy policies that lower the consequences of incurring a non-infectious disease. We find that a funding mechanism consistent with current US policy lowers the investment in healthy lifestyles by both the wealthy, who pay taxes, and the poor, who receive subsidies. We also explore alternative policy interventions such as investing in research to lessen the impact or probability of the disease if an individual gets sick.
    Keywords: lifestyle, health, policy, non-infectious diseases
    JEL: I1 H2 H4
    Date: 2009–07
  3. By: Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.
    Abstract: The central government’s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry’s capacity for stewardship of the nation’s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states’ public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting people’s health.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Disease Control&Prevention,Health Economics&Finance
    Date: 2009–11–01
  4. By: Chikako Yamauchi
    Abstract: This paper examines pathways through which parental characteristics might affect children’s cognitive and behavioural outcomes. Using the 2004 LSAC, I show that more educated and mentally healthier parents are likely to have children with better outcomes. While educated parents are more frequently engaged in education-oriented activities with their children, mentally healthier parents exhibit more favourable parenting practices. To the extent that these results reflect causal relationships, they suggest that parental education and mental health affect children’s outcomes through different pathways.
    Keywords: parental education, parental mental health, test score, behavioural outcome, parenting
    JEL: D1 I2 J2
    Date: 2009–09
  5. By: Nigel Rice; Silvana Robone; Peter Smith
    Abstract: Despite the growing popularity of the vignette methodology to deal with self-reported, categorical data, the formal evaluation of the validity of this methodology is still a topic of research. Some critical assumptions need to hold in order for this method to be valid. In this paper we analyse the assumption of “vignette equivalence” using data on health system responsiveness contained within the World Health Survey. We perform several tests to check the assumption of vignette equivalence. First, we use a test based on the global ordering of the vignettes. A minimal condition for the assumption of vignette equivalence to hold is that individual responses are consistent with the global ordering of vignettes. Secondly, using the HOPIT model on the pool of countries, we undertake sensitivity analyses, stratifying countries according to the Inglehart-Welzel scale and the Human Development Index. The results of this analysis are robust, suggesting that the vignette equivalence assumption is not contradicted. Thirdly, we model the reporting behaviour of the respondents through a two-step regression procedure to evaluate whether the vignettes construct is perceived by respondents in different ways. Overall, across the analyses the results do not contradict the assumption of vignette equivalence and accordingly lend support to the use of the vignette methodology when analysing self-reported data and health system responsiveness.
    Keywords: Health system responsiveness; Anchoring vignettes; Vignette Equivalence
    Date: 2009–08
  6. By: Bago d'Uva, T; Lindeboom, M; O'Donnell, O; van Doorslaer E
    Abstract: Anchoring vignettes are increasingly used to identify and correct heterogeneity in the reporting of health, work disability, life satisfaction, political efficacy, etc. with the aim of improving interpersonal comparability of subjective indicators of these constructs. The method relies on two assumptions: vignette equivalence – the vignette description is perceived by all to correspond to the same state; and, response consistency - individuals use the same response scales to rate the vignettes and their own situation. We propose tests of these assumptions. For vignette equivalence, we test a necessary condition of no systematic variation with observed characteristics in the perceived difference in states corresponding to any two vignettes. To test response consistency we rely on the assumption that objective indicators fully capture the covariation between the construct of interest and observed individual characteristics, and so offer an alternative way to identify response scales, which can then be compared with those identified from the vignettes. We also introduce a weaker test that is valid under a less stringent assumption. We apply these tests to cognitive functioning and mobility related health problems using data from the English Longitudinal Survey of Ageing. Response consistency is rejected for both health domains according to the first test, but the weaker test does not reject for cognitive functioning. The necessary condition for vignette equivalence is rejected for both health domains. These results cast some doubt on the validity of the vignettes approach, at least as applied to these health domains.
    Keywords: Reporting heterogeneity; Survey methods; Vignettes; Health; Cognition
    JEL: C35 C42 I12
    Date: 2009–10
  7. By: Nigel Rice; Silvana Robone; Peter Smith
    Abstract: This paper explores the use of anchoring vignettes as a means to adjust survey reports of health system performance for differential reporting behaviour using data contained within the World Health Survey (WHS). Survey respondents are asked to rate their experiences of health systems across a number of domains on a five-point categorical scale. Using data provided through a set of vignettes we investigate variations in reporting of interactions with health services across both socio-demographic groups and countries. We show how the method of anchoring vignettes can be used to enhance cross-country comparability of performance. Our results show large differences in the rankings of country performance once adjustment for systematic country-level reporting behaviour has been undertaken compared to a ranking based on raw unadjusted data.
    Keywords: Anchoring vignettes; Cross-country comparison; Health care responsiveness; Health system performance
    Date: 2009–10
  8. By: Martine AUDIBERT (Centre d'Etudes et de Recherches sur le Développement International)
    Abstract: According to the human capital theory, health is a determinant of the economic development and should play a role in the fight against poverty. On the other side, the economic growth, by supplying better sanitation, water quality and hygiene, better education and income, may improve population's health. Economists, in investigating the relations between development and health, asked for valid and relevant health status measurement. But, on the other hand, the health concept is complex as health includes several dimensions, and researchers face a battery of health indicators. The purpose of this study is to discuss, specifically for economic research, the particularity of each health indicator, the potential bias of their measurement, their advantages, disadvantages, and interest. As health indicators are too numerous, a selection was done and the analysis concerns the most frequent indicators, but also those which should be more used into the economic research perspective. Discussed health indicators are life expectancy and healthy life expectancy at birth, mortality rates (maternal and infant mortality included), cause-specific morbidity rates, Dalys and Qalys.
    Date: 2009
  9. By: Bijlsma, Michiel; Boone, Jan; Zwart, Gijsbert
    Abstract: We analyze exclusive contracts between health care providers and insurers in a model where some consumers choose to stay uninsured. In case of a monopoly insurer, exclusion of a provider changes the distribution of consumers who choose not to insure. Although the foreclosed care provider remains active in the market for the non-insured, we show that exclusion leads to anti-competitive effects on this non-insured market. As a consequence exclusion can raise industry profits, and then occurs in equilibrium. Under competitive insurance markets, the anticompetitive exclusive equilibrium survives. Uninsured consumers, however, are now not better off without exclusion. Competition among insurers raises prices in equilibria without exclusion, as a result of a horizontal analogue to the double marginalization effect. Instead, under competitive insurance markets exclusion is desirable as long as no provider is excluded by all insurers.
    Keywords: anti-competitive effects; exclusion; foreclosure; health insurance; selective contracting; uninsured
    JEL: G22 I11 L42
    Date: 2009–11

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