nep-hea New Economics Papers
on Health Economics
Issue of 2010‒02‒27
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Evaluating the Impact of Health Programmes By Justine Burns; Malcolm Kewsell; Rebecca Thornton
  2. The impact of AIDS on intergenerational support in South Africa: Evidence from the Cape Area Panel Study By Cally Ardington; Anne Case; Mahnaz Islam; David Lam; Murray Leibbrandt; Alicia Menendez; Analia Olgiati
  3. Implications of avian flu for economic development in Kenya: By Thurlow, James
  4. What Do the Bingers Drink? Microeconometric Evidence on Negative Externatilities of Alcohol Consumption by Beverage Types By Preety Srivastava; Xueyan Zhao
  5. Improving China's Health Care System By Richard Herd; Yu-Wei Hu; Vincent Koen
  6. Analysing Catastrophic OOP Health Expenditure in India: Concepts, Determinants and Policy Implications By Rama Pal
  7. A new approach to producing geographic profiles of HIV prevalence : an application to Malawi By Ivaschenko, Oleksiy; Lanjouw, Peter
  8. Remittances, Public Health Spending and Foreign Aid in the Access to Health Care Services in Developing Countries By Alassane DRABO; Christian EBEKE
  9. Evolution of social inequalities in health in Quebec? By Batana, Yélé Maweki

  1. By: Justine Burns; Malcolm Kewsell; Rebecca Thornton
    Abstract: This paper has two broad objectives. The first objective is broadly methodological and deals with some of the more pertinent estimation issues one should be aware of when studying the impact of health status on economic outcomes. We discuss some alternatives for constructing counterfactuals when designing health program evaluations such as randomization, matching and instrumental variables. Our second objective is to present a review of the existing evidence on the impact of health interventions on individual welfare.
    Date: 2009–10
  2. By: Cally Ardington (SALDRU, University of Cape Town); Anne Case; Mahnaz Islam; David Lam; Murray Leibbrandt (SALDRU, University of Cape Town); Alicia Menendez; Analia Olgiati
    Abstract: We use panel data collected in metropolitan Cape Town to document the role played by aging parents in caring for the children of children who die. In addition, we quantify the probabilities that older adults and the older adults' children provide financial support to orphaned grandchildren. We find significant transfers of public and private funds to older adults in households with orphans. Perhaps for this reason, we see no difference in expenditure patterns between households with orphans and other older adult households. With respect to older adults' quality of life, we find no effect of reporting that a child died, or of co-residence with orphaned grandchildren, on the older adults' reports of depression, or on their self-assessed health.
    Date: 2009–02
  3. By: Thurlow, James
    Abstract: Kenya is vulnerable to avian flu given its position along migratory bird routes and proximity to other high-risk countries. This raises concerns about the effect an outbreak could have on economic development. We use a dynamic computable general equilibrium model of Kenya to simulate potential outbreaks of different severities, durations, and geographic spreads. Results indicate that even a severe outbreak does not greatly reduce economic growth. It does, however, significantly worsen poverty, because poultry is an important income source for poor farmers and a major food item in consumers' baskets. Avian flu therefore does pose a threat to future development in Kenya. Reducing the duration and geographic spread of an outbreak is found to substantially lower economic losses. However, losses are still incurred when poultry demand falls, even without a confirmed outbreak but only the threat of an outbreak. Our findings support monitoring poultry production and trade, responding rapidly to possible infections, and improving both farmers' and consumers' awareness of avian flu.
    Keywords: Avian influenza Developing countries, avian flu, economic growth, Poverty, Computable General Equilibrium (CGE) model, Development strategies,
    Date: 2010
  4. By: Preety Srivastava; Xueyan Zhao
    Abstract: The recent debate on alcohol tax reform and recommendations from the Henry Tax Review in Australia have highlighted the need for quantifying externalities of excessive alcohol consumption by beverage types. This paper presents micro-level information from the Australian National Drug Strategy Household Surveys to examine the association between risky drinking behaviour, drinker characteristics, health and labour market status, and types of alcohol beverages consumed. Drinkers of regular strength beer (RSB) and RTDs in a can (RTDC) have the highest incidences of heavy bingeing, and low alcohol beer and fortified and bottled wine least likely. Bottled spirits (BS), RSB and RTDC are most likely linked to risky behaviour such as property damage and physical abuse under alcohol influence. All three spirit products are overwhelmingly the favourable drinks for the underage and young drinkers. Risky drinking behaviour is not found to be strictly associated with the alcohol strength of the products.
    Keywords: Alcohol consumption, alcohol tax, binge drinking, beer, wine and spirits
    JEL: C10 D10 H20 I10 J10
    Date: 2010–01
  5. By: Richard Herd; Yu-Wei Hu; Vincent Koen
    Abstract: Overall, health outcomes in China have improved tremendously over the past three decades, especially thanks to the reduction in some traditional infectious diseases. However, death rates from chronic diseases have been on the rise, not least owing to changes in life styles and deteriorating environmental conditions. Supply of health care is overwhelmingly provided publicly and hospitals have been absorbing a growing share of the resources. The number of doctors has increased fast but the level of qualification of incumbent doctors is often modest. Demand for care has risen rapidly, in line with incomes, and the relative price of care soared through the early 2000s. Hospital budgets and their doctors’ pay are partly based on the pharmaceuticals they prescribe and sell, whose prices are regulated and involve considerable cross-subsidisation. Faced with these problems, the government has launched a number of reforms. New insurance schemes have been rolled out both in rural and urban areas. As a result, coverage and use of medical facilities has increased a lot, except for migrants. In practice, however, catastrophic but also chronic illnesses continue to push people into poverty, especially in the poorer regions, given limited risk pooling at the national level. A new set of reforms was announced in 2009, aiming at universal, safe, affordable and effective basic health care by 2020. They involve investment in medical infrastructure, generalising coverage, more focus on prevention, a new essential drugs system and far-reaching reorganisation, including hospital reform. It will be important to make sure that primary care plays a greater role and that hospitals are managed more efficiently with less of a hierarchical structure. Progress will also require changes in the relative prices of treatments and higher doctors’ wages and tobacco prices.<P>Améliorer le système de santé chinois<BR>Dans l’ensemble, les résultats de la Chine en matière de santé se sont considérablement améliorés au cours des trente dernières années, surtout par suite du recul de certaines maladies infectieuses classiques. Toutefois, les taux de mortalité par maladies chroniques sont en progression, en particulier à cause de l’évolution des modes de vie et de la détérioration de l’environnement. L’offre de soins de santé est essentiellement publique et les hôpitaux absorbent une part grandissante des ressources. Le nombre de médecins a vite augmenté, mais leur niveau de formation est souvent peu élevé. La demande de soins s’est rapidement accrue, parallèlement aux revenus, et leur prix relatif s’est envolé jusqu’au début des années 2000. Les budgets des hôpitaux et la rémunération de leurs médecins dépendent en partie des produits pharmaceutiques qu’ils prescrivent et vendent, dont les prix sont réglementés et donnent lieu à un important financement croisé. Face à ces problèmes, les pouvoirs publics ont lancé des réformes. De nouveaux dispositifs d’assurance ont été mis en place dans les zones rurales et urbaines. Par conséquent, la population couverte et l’utilisation des équipements médicaux se sont beaucoup accrues, sauf dans le cas des migrants. Toutefois, dans les faits, les maladies catastrophiques, mais aussi les affections chroniques, continuent de faire tomber dans la pauvreté ceux qu’elles touchent, surtout dans les régions déshéritées, la mutualisation des risques à l’échelle nationale demeurant limitée. En 2009 a été annoncée la mise en oeuvre d’une nouvelle série de réformes dont le but est d’assurer un accès universel à des soins de santé de base à la fois sûrs, d’un coût abordable et efficaces d’ici à 2020. Ces mesures prévoient des investissements dans les infrastructures médicales, la généralisation de la couverture maladie, une intensification des efforts de prévention, l’instauration d’un nouveau dispositif pour les médicaments essentiels et des restructurations d’envergure, dont une réforme des hôpitaux. Il importera de faire en sorte que le rôle des soins primaires soit renforcé et que les hôpitaux soient gérés de façon plus rationnelle dans le cadre d’un système moins hiérarchisé. Il faudra en outre modifier les prix relatifs des traitements et augmenter la rémunération des médecins, ainsi que le prix du tabac.
    Keywords: health, insurance, hospital, pharmaceuticals, China, life expectancy, diseases, doctors, migrants, tobacco, santé, assurance, espérance de vie, Chine, hôpital, maladies, médecins, migrants, tabac, médicaments
    JEL: D19 H41 H51 I18 J61 J71 O15 O53 P21 P36
    Date: 2010–02–01
  6. By: Rama Pal
    Abstract: The present paper attempts to modify definition of catastrophic out-of-pocket health expenditure by characterising it based on consumption of necessities. Catastrophic health expenditure is defined as one which reduces the non-health expenditure to a level where household is unable to maintain consumption of necessities. Based on this definition of catastrophic health expenditure, the paper examines determinants of catastrophic OOP health expenditure in India.
    Keywords: Catastrophic health expenditure; Consumption of Necessities; India, OOP health expenditure, economic wellbeing, household
    Date: 2010
  7. By: Ivaschenko, Oleksiy; Lanjouw, Peter
    Abstract: Sub-national estimates of HIV prevalence can inform the design of policy responses to the HIV epidemic. Such responses also benefit from a better understanding of the correlates of HIV status, including the association between HIV and geographical characteristics of localities. In recent years, several countries in Africa have implemented household surveys (such as Demographic and Health Surveys) that include HIV testing of the adult population, providing estimates of HIV prevalence rates at the sub-national level. These surveys are known to suffer from non-response bias, but are nonetheless thought to represent a marked improvement over alternatives such as sentinel surveys. At present, however, most countries are not in a position to regularly field such household surveys. This paper proposes a new approach to the estimation of HIV prevalence for relatively small geographic areas in settings where national population-based surveys of prevalence are not available. The proposed approach aims to overcome some of the difficulties with prevailing methods of deriving HIV prevalence estimates (at both national and sub-national levels) directly from sentinel surveys. The paper also outlines some of the limitations of the proposed approach.
    Keywords: Population Policies,Disease Control&Prevention,HIV AIDS,Gender and Health,Scientific Research&Science Parks
    Date: 2010–02–01
  8. By: Alassane DRABO; Christian EBEKE
    Abstract: The aim of this paper is to analyze the respective impacts of remittances, health aid and public spending on the access to health care services in developing countries. The specific objectives are threefold. Firstly, we quantify the differential impacts of remittances on the access to public and private health care services. Secondly, we determine whether remittances and foreign health aid are complements or substitutes in the access to health care services. Lastly, we evaluate the heterogeneity of the impact of remittances in the access to public and private health care services by quintile of income. We provide a rigorous econometric analysis by controlling for the endogeneity of remittances, public spending and foreign aid. We find that remittances, health aid and public spending are important determinants of access to health services in recipients' countries. Another interesting result comes from the fact that, remittances lead to a sectorial glide in the uses of health care services from the public to the private sector for the intermediate income class. This result holds also for the richer quintiles that are the major recipients of remittances in developing countries. Moreover, remittances and foreign health aid are complements for the access to health care services in "low" income countries. Finally, these results suggest that policies aiming at increasing remittances are appropriate for developing countries but also that, the "optimal" therapy for the "low" income countries is the combination of remittances and foreign aid.
    Keywords: Remittances, access to health care services, developing countries, health aid, instrumental variables method, public spending
    Date: 2010
  9. By: Batana, Yélé Maweki
    Abstract: This paper, based on data from the National Population Health Surveys (NPHS) from 1994 to 2007, analyzes the evolution of social inequalities in health in Quebec since the mid-1990s using two health measures namely self-assessed health (SAH) and health utility index (HUI). Two methods are used. The first is based on concentration indices and their decompositions while the second is based on the income-health matrices. The results confirm the existence of persistent health gradients, but with some variations over time. The findings also suggest an increase, on average, in health inequalities during the period with a peak during the years 2002/2003. These variations appear especially stronger for low-income individuals.
    Keywords: Concentration indices; decomposition analysis; self-assessed health; health utility index; income-health matrices; dominance analysis
    JEL: D31 D63 I12 J60 C21 C25
    Date: 2010–02

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