nep-hea New Economics Papers
on Health Economics
Issue of 2009‒12‒11
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Effects of a Sick Pay Reform on Absence and on Health-Related Outcomes By Puhani, Patrick A.; Sonderhof, Katja
  2. Evaluation of the Impact of the Mother and Infant Health Project in Ukraine By Nizalova, Olena Y.; Vyshnya, Maria
  3. Interrelated Dynamics of Health and Poverty in Australia By Buddelmeyer, Hielke; Cai, Lixin
  4. Moral Hazard in a Mutual Health-Insurance System: German Knappschaften, 1867-1914 By Guinnane, Timothy; Streb, Jochen
  5. Population and Health Policies By Schultz, Paul
  6. The relationship between health and growth:when Lucas meets Nelson-Phelps By Philippe Aghion; Peter Howitt; Fabrice Murtin
  7. Public Private Partnership in Uttar Pradesh Health Care Delivery System- UPHSDP as an Initiative By Bibi ishrat Jahan
  8. The Unequal World of Health Data By Peter Byass
  9. Statistical Trends in Pharmaceutical Research for Poor Countries By Jean O Lanjouw
  10. HIV Prevention in Vulnerable Indian States: Lessons from the chayan Project By CARE CARE
  11. Socioeconomic Determinants of Mortality in Taiwan: Combining Individual Data and Aggregate Data By Roberto Leon Gonzalez; Fu-Min Tseng
  12. The Level and Risk of Out-of-Pocket Health Care Spending By Michael D. Hurd; Susann Rohwedder

  1. By: Puhani, Patrick A. (University of Hannover); Sonderhof, Katja (University of Hannover)
    Abstract: We evaluate the effects of a reduction in sick pay from 100 to 80% of the wage. Unlike previous literature, apart from absence from work, we also consider effects on doctor/hospital visits and subjective health indicators. We also add to the literature by estimating both switch-on and switch-off effects, because the reform was repealed two years later. We find a two-day reduction in the number of days of absence. Quantile regression reveals higher point estimates (both in absolute and relative terms) at higher quantiles, meaning that the reform predominantly reduced long durations of absence. In terms of health, the reform reduced the average number of days spent in hospital by almost half a day, but we cannot find robust evidence for negative effects on health outcomes or perceived liquidity constraints.
    Keywords: sickness pay, absenteeism, health expenditure, hospitalization, difference-in-differences, switch on, switch off, quantile regression, intrinsic motivation
    JEL: I18 J58 J83
    Date: 2009–12
  2. By: Nizalova, Olena Y. (Kyiv School of Economics); Vyshnya, Maria (Kyiv Economics Institute)
    Abstract: This paper exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services on maternal and infant health. Since basic medical care has been universally available in Ukraine, implementation of the Mother and Infant Health Project allows addressing quality rather than quantity effect of medical care. Employing program evaluation methods we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control rayons. Among the infant health outcomes, the MIHP impact is most pronounced for infant mortality resulted from deviations in perinatal period and respiratory system failures. As for the maternal health, the MIHP is the most effective at addressing anemia, blood circulation, and urinary-genital system complications, as well as late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries, and these effects are causal. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 122 taking into account both maternal and infant lives saved as well as cost savings due to changes in labor and delivery practices.
    Keywords: maternal health, maternal mortality, infant health, infant mortality, prenatal care
    JEL: I12 I18
    Date: 2009–11
  3. By: Buddelmeyer, Hielke (Melbourne Institute of Applied Economic and Social Research); Cai, Lixin (Melbourne Institute of Applied Economic and Social Research)
    Abstract: Using the Household, Income and Labour Dynamics in Australia (HILDA) Survey, this study examines the joint dynamics of health and poverty in Australian families. Taking advantage of panel data, the modelling approach used in this study allows a better estimation of the causal relationship between health and poverty. The results indicate that the causality between health and poverty runs both ways and the relationship is confounded by unobserved heterogeneity. In particular, it is found that families headed by a person in ill-health are more likely to be in poverty compared with families headed by a person with good health. On the other hand, a family head whose family is in poverty in the current year is more likely to be in ill-health in the next year compared with a family head whose family is not in poverty. In addition, there is evidence that health and poverty are affected by correlated unobservables, causing health to be endogenous to poverty even in the absence of a reverse effect from poverty on health. Consequently, treating health as exogenous in a poverty equation would produce biased estimates.
    Keywords: socio-economic status, poverty, health, recursive models, panel data
    JEL: I12 I32 C35
    Date: 2009–11
  4. By: Guinnane, Timothy (Yale University); Streb, Jochen (University of Hohenheim)
    Abstract: This paper studies moral hazard in a sickness-insurance fund that provided the model for social-insurance schemes around the world. The German Knappschaften were formed in the medieval period to provide sickness, accident, and death benefits for miners. By the mid-nineteenth century, participation in the Knappschaft was compulsory for workers in mines and related occupations, and the range and generosity of benefits had expanded considerably. Each Knappschaft was locally controlled and self-funded, and their admirers saw in them the ability to use local knowledge and good incentives to deliver benefits at low costs. The Knappschaft underlies Bismarck's sickness and accident insurance legislation (1883 and 1884), which in turn forms the basis of the German social-insurance system today and, indirectly, many social-insurance systems around the world. This paper focuses on a problem central to any insurance system, and one that plagued the Knappschaften as they grew larger in the later nineteenth century: the problem of moral hazard. Replacement pay for sick miners made it attractive, on the margin, for miners to invent or exaggerate conditions that made it impossible for them to work. Here we outline the moral hazard problem the Knappschaften faced as well as the internal mechanisms they devised to control it. We then use econometric models to demonstrate that those mechanisms were at best imperfect.
    JEL: H53 H55 I18 N33 N43
    Date: 2009–09
  5. By: Schultz, Paul (Yale University)
    Abstract: The program evaluation literature for population and health policies is in flux, with many disciplines documenting biological and behavioral linkages from fetal development to late life mortality, chronic disease, and disability, though their implications for policy remain uncertain. Both macro and micro economics seek to understand and incorporate connections between economic development and the demographic transition. The focus here is on research methods, findings, and questions that economists can clarify regarding the causal relationships between economic development, health outcomes, and reproductive behavior, which operate in many directions, posing problems for identifying causal pathways. The connection between conditions under which people live and their expected lifespan and health status refers to "health production functions". The relationships between an individual's stock of health and productivity, well being, and duration of life encompasses the "returns to health human capital". The control of reproduction improves directly the well being of women, and the economic opportunities of her offspring. The choice of population policies may be country specific and conditional on institutional setting, even though many advances in biomedical and public health knowledge, including modern methods of birth control, are now widely available. Evaluation of a policy intervention in terms of cost-effectiveness is typically more than a question of technological efficiency, but also the motivation for adoption, and the behavioral responsiveness to the intervention of individuals, families, networks, and communities. Well-specified research strategies are required to address (1) the economic production of health capacities from conception to old age, (2) the wage returns to increasing health status attributable to policy interventions, (3) the conditions affecting fertility, family time allocation, and human capital investments, and (4) the consequences for women and their families of policies which change the timing as well as number of births.
    JEL: D13 I18 J13 O12
    Date: 2009–07
  6. By: Philippe Aghion (Harvard University); Peter Howitt (Brown University); Fabrice Murtin (OECD)
    Date: 2009–11
  7. By: Bibi ishrat Jahan
    Abstract: The objective of the study is to find out the primary reason to encourage public private participation in health care delivery system in Uttar Pradesh and the study also aim to analyse UPHSDP -a World Bank project.
    Keywords: public, private, participation, health care delivery system, uttar pradesh, world bank, PPP, mortality rates, birth rates, india, health indicators, HDI, infant mortality rates, Expenditure, income, Infrastructure, male female, PHCs, hospitals, dispensaries, states,
    Date: 2009
  8. By: Peter Byass
    Abstract: Health data, poverty, and inequality exist in a complex global co-dependency, therefore making meaningful comparisons of health across widely different settings challenging. Less data exist on the health of the poor than of the rich, which in turn raises important questions as to how representative available data are in relation to populations that go uncounted. Alternative strategies are needed to fill in inequitable gaps in data. Poverty either in physical terms or in data does not justify the use of impoverished research methods or ethical standards. Reasonable, realistic, and contextually appropriate approaches to research are needed. [Plos Medicine, November 2009].
    Keywords: poverty, birth, verbal autopsy, VA, hdemographic parameters, climate change, health data, inequality, global, poor, rich, population, research methods, ethical standards,
    Date: 2009
  9. By: Jean O Lanjouw
    Abstract: Introducing patent rights in developing country markets might stimulate greater R and D investment targeting their specific health needs – areas long neglected. This paper examines this argument using statistical data and survey evidence. We identify a set of diseases where 99 per cent of the burden is estimated to fall in lower income countries. Because science gaps and market potential will influence R and D priorities, this group is broke into a subset that already have low-cost and effect treatments, and those that to not.
    Keywords: R and D, investment, health, statistical data, survey, diseases, burden, lower income countries, science, market potential, low cost, treatments, Pharmaceutical Research, poor countries, innovative, India, R&D, developing drugs, drugs
    Date: 2009
  10. By: CARE CARE
    Abstract: This document highlights the results and associated processes from Chayan’s implementation experience under the RACHNA program. The programmatic framework, designed for low-prevalence contexts in India, draws on standard targeted intervention approaches but is grounded in community-based methods unique to local contexts. The fi ndings from the Behavior Surveillance Survey (BSS) conducted by CARE in 2006 and the external review indicate encouraging results as compared to BSS in 2003. [CARE Wp no. 9].
    Keywords: behavior, India, HIV, prevention, community- based methods, local, NGO, mobilization, epidemic, AIDS, women, child development, girl's education, infrastructure, health, vulnerable states
    Date: 2009
  11. By: Roberto Leon Gonzalez (National Graduate Institute for Policy Studies); Fu-Min Tseng (University of Nottingham)
    Abstract: There is a very large literature that examines the relationship between health and income. Two main hypotheses have been investigated: the relative income hypothesis and the absolute income hypothesis. Most of previous studies that used mortality data have been criticized for estimating an aggregate model that does not account for non-linear links between health and income at the individual level. In this paper we follow a novel approach to avoid this bias, combining aggregate mortality data with individual level data on socio-economic characteristics. We test the relative and absolute income hypotheses using county level mortality data from Life Statistic of Department of Health and individual level data from Taiwan census FIES for 1976-2003. We find that there is no strong evidence supporting either hypothesis in the case of the general population. In contrast, we find strong evidence that education does have significant effects on individuals’ health and the estimates are not sensitive to income equivalent scales.
    Keywords: mortality, relative income hypothesis, aggregation bias
    Date: 2009–04
  12. By: Michael D. Hurd (RAND); Susann Rohwedder (RAND)
    Abstract: The Health and Retirement Study (HRS) is a long-running panel survey with good measures of economic status, so it is the pre-eminent data set for studies about the economic status of the older population and economic preparation for retirement. However, the HRS expends considerably fewer resources on the measurement of out-of-pocket spending than other surveys such as the Medical Expenditure Panel Survey (MEPS) and the Medicare Current Beneficiary Survey (MCBS), which may result in its having relatively less accurate measurement of such spending. We compare the level and distribution of out-of-pocket spending in the HRS with similar measures in MEPS and MCBS in the population aged 65 or older. We find that the measures of out-of-pocket spending in the HRS are about 50% greater than those in MEPS at the mean, and very much greater at the upper points of the distribution. HRS and MCBS are in better agreement, although the HRS is higher at the mean and at the top of the distribution. The implication is that the level and risk of out-of-pocket spending on health care are exaggerated in HRS. Observation error in the HRS measurement relative to MEPS and MCBS is to be expected, but this does not explain the apparent bias. We conclude that researchers who use HRS 2004 or earlier should examine health care spending carefully, even on a case-by-case basis.
    Date: 2009–09

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