nep-hea New Economics Papers
on Health Economics
Issue of 2010‒04‒17
33 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Can Micro Health Insurance Reduce Poverty? Evidence from Bangladesh By Syed Abdul Hammid; Jennifer Roberts; Paul Mosley
  2. Is more health always better? Exploring public preferences that violate monotonicity By Ignacio Abásolo; Aki Tsuchiya
  3. Measuring the societal value of lifetime health By Aki Tsuchiya; Richard Edlin; Paul Dolan
  4. Origin differences in self-reported health among older migrants living in France By Nicolas Gérard Vaillant; François-Charles Wolff
  5. Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe By Aïda Solé-Auró; Montserrat Guillén; Eileen M. Crimmins
  6. Physician dispensing and antibiotic prescriptions By Massimo Filippini; Giuliano Masiero; Karine Moschetti
  7. Health mobility: implications for efficiency and equity in priority setting By Katharina Hauck; Aki Tsuchiya
  8. A structural equation model of adverse events and length of stay in hospitals By Katharina Hauck; Xueyan Zhao
  9. Adverse events in surgical inpatients: A comparative analysis of public hospitals in Victoria By Katharina Hauck; Xueyan Zhao; Terri Jackson
  10. Medical Consumption over the Life Cycle: Facts from a U.S. Medical Expenditure Panel Survey By Juergen Jung; Chung Tran
  11. Correcting Focal Point Biases in Subjective Health Expectations: An Application to the RAND-HRS Data By Kim P. Huynh; Juergen Jung
  12. Enhanced Fee-for-Service Model and Access to Physician Services: Evidence from Family Health Groups in Ontario By Kantarevic, Jasmin; Kralj, Boris; Weinkauf, Darrel
  13. Racial and Ethnic Disparities in the Use of Drug Therapy By Bowblis, John R.; Yun, Myeong-Su
  14. The Economic Crisis and Medical Care Usage By Annamaria Lusardi; Daniel Schneider; Peter Tufano
  15. Body Image, Peer Effects and Food Disorders: Evidence from a Sample of European Women By Joan Costa-Font; Mireia Jofre-Bonet
  16. Price Sensitivity of Demand for Prescription Drugs: Exploiting a Regression Kink Design By Simonsen, Marianne; Skipper, Lars; Skipper, Niels
  17. Medium-term consequences of low birth weight on health and behavioral deficits – is there a catch-up effect? By Datta Gupta, Nabanita; Deding, Mette; Lausten, Mette
  18. The effect of cigarette and alcohol consumption on birth outcomes By Wüst, Miriam
  19. Analysing catastrophic OOP health expenditure in India: Concepts, determinants and policy implications By Rama Pal
  20. Health at Work and Low-pay:a European Perspective By Elena Cottini; Claudio Lucifora
  21. The toll of fertility on mothers’ wellb<eing By Julio Cáceres-Delpiano; Marianne Simonsen
  22. Equity in Health and Health Care in the Philippines By Son, Hyun
  23. Health Status Determinants in the OECD Countries. A Panel Data Approach with Endogenous Regressors By Ana Poças; Elias Soukiazis
  24. "Mass Privatisation and the Post-Communist Mortality Crisis": Is There Really a Relationship? By John S. Earle; Scott Gehlbach
  25. The Influence of Retiree Health Benefits on Retirement Patterns By James Marton; Stephen A. Woodbury
  26. An assessment of the effects of the 2002 food crisis on children's health in Malawi By Renate Hartwig; Michael Grimm
  27. Appropriate Perspectives for Health Care Decisions By Karl Claxton; Simon Walker; Steven Palmer; Mark Sculpher
  28. Does cost-effectiveness analysis discriminate against patients with short life expectancy? Matters of logic and matters of context By Mike Paulden; Anthony J Culyer
  29. Recent developments in Dutch hospitals; How does competition impact on inpatient care? By Sylvia Meijer; Rudy Douven,; Bernard van den Berg
  30. Selective contracting and foreclosure in health care markets By Michiel Bijlsma; Jan Boone; Gijsbert Zwart
  31. The Effect of Education on Smoking Behaviour By Pierre Koning; Dinand Webbink; Nicholas G. Martin
  32. Has medical innovation reduced cancer mortality? By Frank R. Lichtenberg
  33. The Effect of State Workers' Compensation Program Changes on the Use of Federal Social Security Disability Insurance By Melissa P. McInerney; Kosali I. Simon

  1. By: Syed Abdul Hammid (Department of Economics, The University of Sheffield); Jennifer Roberts (Department of Economics, The University of Sheffield Author-Person=pro228); Paul Mosley (Department of Economics, The University of Sheffield)
    Abstract: This paper examines the impact of micro health insurance on poverty reduction in rural areas of Bangladesh. The research is based on household level primary data collected from the operating areas of the Grameen Bank during 2006. A number of outcome measures relating to poverty status are considered; these include household income, stability of household income via food sufficiency and ownership of non-land assets, and also the probability of being above or below the poverty line. The results show that micro health insurance has a positive association with all of these indicators, and this is statistically significant and quantitatively important for food sufficiency.
    Keywords: Microcredit, Micro Health Insurance, Poverty, Grameen Bank
    JEL: O12
    Date: 2010–01
  2. By: Ignacio Abásolo; Aki Tsuchiya (Department of Economics, The University of Sheffield Author-Person=pts38)
    Abstract: Abásolo and Tsuchiya (2004a) report on an empirical study to elicit public preferences regarding the efficiency-equality trade-off in health, where the majority of respondents violated monotonicity. The procedure used has been subject to criticisms regarding potential biases in the results. The aim of this paper is to analyse whether violation of monotonicity remains when a revised questionnaire is used. We test: whether monotonicity is violated when we allow for inequality neutral preferences and also if we allow for preferences that would reject any option which gives no health gain to one group; whether those who violate monotonicity actually have non-monotonic or Rawlsian preferences; whether the titration sequence of the original questionnaire may have biased the results; whether monotonicity is violated when an alternative question is administered. Finally, we also test for symmetry of preferences. The results confirm the evidence of the previous study regarding violation of monotonicity.
    Keywords: Health related social welfare functions, monotonicity, Rawlsian, equality-efficiency trade-off
    JEL: D39 D63 I10
    Date: 2009–08
  3. By: Aki Tsuchiya (Department of Economics, The University of Sheffield Author-Person=pts38); Richard Edlin; Paul Dolan
    Abstract: This paper considers two societal concerns in addition to health maximisation: first, concerns for the societal value of lifetime health for an individual; and second, concerns for the value of lifetime health across individuals. Health-related social welfare functions (HRSWFs) have addressed only the second concern. We propose a model that expresses the former in a metric – the adult healthy-year equivalent (AHYE) – that can be incorporated into standard HRSWFs. An empirical study based on this formulation shows that both factors matter: health losses in childhood are weighted more heavily than losses in adulthood and respondents wish to reduce inequalities in AHYEs.
    Keywords: Health, Social welfare function, monotonicity, Equity
    JEL: D63
    Date: 2009–05
  4. By: Nicolas Gérard Vaillant (LEM - Lille - Economie et Management - CNRS : UMR8179 - Université des Sciences et Technologies de Lille - Lille I - Fédération Universitaire et Polytechnique de Lille); François-Charles Wolff (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272)
    Abstract: Objectives: Little is known about the health status of older migrants living in Europe. Using detailed data collected in 2003, we investigate differences in health status by origin country within the older immigrant population living in France using a self-rated health measure. Study design: The database used in this research is the ‘Passage à la Retraite des Immigrés' survey, conducted from November 2002 to February 2003 on a sample of 6,211 migrants aged 45 to 70 and living in France at the time of survey. Methods: A difficulty with the self-rated outcome is that it may not be comparable between different origin groups, in particular because of cultural and linguistic differences. We thus estimate generalized ordered Probit models and construct for each respondent an indicator of health net of cross-cultural effects. Results: Male immigrants from Southern Africa and Asia and female immigrants from Northern Europe, Southern Africa and Asia are more likely to be in good health, while the health status is lower among immigrants from Eastern Europe living in France. Conclusion: The diversity in health status within the immigrant population is large in France. These results are helpful in order to target the more disadvantaged origin groups and to adjust the provision of health care.
    Date: 2010
  5. By: Aïda Solé-Auró (RFA-IREA, University of Barcelona, Spain); Montserrat Guillén (RFA-IREA, University of Barcelona, Spain); Eileen M. Crimmins (Andrus Gerontology Center. University of Southern California)
    Abstract: Objective: This study examines health care utilization of immigrants relative to the native-born populations aged 50 years and older in eleven European countries. Methods. We analyzed data from the Survey of Health Aging and Retirement in Europe (SHARE) from 2004 for a sample of 27,444 individuals in 11 European countries. Negative Binomial regression was conducted to examine the difference in number of doctor visits, visits to General Practitioners (GPs), and hospital stays between immigrants and the native-born individuals. Results: We find evidence those immigrants above age 50 use health services on average more than the native-born populations with the same characteristics. Our models show immigrants have between 6% and 27% more expected visits to the doctor, GP or hospital stays when compared to native-born populations in a number of European countries. Discussion: Elderly immigrant populations might be using health services more intensively due to cultural reasons.
    Keywords: count data, physician services, immigration.
    Date: 2009–10
  6. By: Massimo Filippini (Department of Management, Technology and Economics, ETH Zurich; Institute of Economics, University of Lugano, Switzerland); Giuliano Masiero (Department of Economics and Technology Management, University of Bergamo, Italy; Institute of Economics, University of Lugano, Switzerland); Karine Moschetti (IEMS, University of Lausanne; Institute of Economics, University of Lugano, Switzerland)
    Abstract: The regulation on prescribing and dispensing of antibiotics has a double purpose: to enhance access to antibiotic treatment and to reduce the inappropriate use of drugs. Nevertheless, incentives to dispensing physicians may lead to inefficiencies. We sketch a theoretical model of the market for antibiotic treatment and empirically investigate the impact of self-dispensing on the per capita outpatient antibiotic consumption using data from small geographic areas in Switzerland. We find evidence that a greater proportion of dispensing practices is associated with higher levels of antibiotic use. This suggests that health authorities have a margin to adjust economic incentives on dispensing practices in order to reduce antibiotic misuse.
    Keywords: Physician dispensing, Antibiotic use
    JEL: I11 I18 D12 D21 D43 D81 D82
    Date: 2009–11
  7. By: Katharina Hauck; Aki Tsuchiya
    Abstract: Adverse Health mobility is a statistical measure of inter-temporal fluctuations in health of a group of individuals. Increased availability of panel data has led to a number of studies which analyse and compare health mobility across subgroups. Mobility can differ systematically across patient subgroups, even if prevalence measured at one point in time is the same. There is a lack of discussion regarding whether health mobility is a relevant concept for resource allocation decisions. In this think piece, we explore whether and how health mobility is incorporated in cost-effectiveness analysis (CEA). CEA takes health mobility into account where it matters in terms of efficiency and -depending on treatment programs- either favours groups with low mobility or gives equal priority to groups of differing levels of mobility. However, CEA fails to take into account the equity dimension of mobility. There is qualitative research to suggest that some members of the public find that patient groups with low health mobility should be given priority even if some efficiency was sacrificed. Results also indicate that this may depend on the nature of the condition, the actual lengths involved and the magnitude of the efficiency sacrifice. Health mobility may also have political implications which affect resource allocation decisions, possibly in opposing directions. Further research is required to investigate the extent to which the public is concerned with health mobility, to determine conditions for which health mobility matters most, and to explore ways of how the equity dimension of health mobility can be incorporated into CEA.
    Keywords: Health mobility, health dynamics, panel data, resource allocation, cost effectiveness analysis, equity
    JEL: I10 I18 D6 H4 C0
    Date: 2010–02
  8. By: Katharina Hauck; Xueyan Zhao
    Abstract: Adverse events in hospitals cause significant morbidity and mortality, and considerable effort has been invested into analysing their incidence and preventability. An unresolved issue in models of medical adverse events is potential endogeneity of length of stay (LOS): whilst the probability of suffering a medical adverse event during the episode is likely to increase as a patient stays longer, there are a range of unobservable patient and hospital factors affecting both the occurrence of adverse events and LOS, such as unobserved patient complexity and hospital management. Therefore, statistical models of adverse events which do not account for the potential endogeneity of LOS may generate biased estimates. Our objective is to examine the effects of risk factors on the incidence of adverse events using structural equation models and accounting for endogeneity of LOS. We estimate separate models for three of the most common and serious types of medical adverse events: adverse drug reactions, hospital acquired infections, and pressure ulcers. We use episode level administrative hospital data from public hospitals in the state of Victoria, Australia, for the years 2004/05 and 2005/06 with detailed information on patients, in particular medical complexity and adverse events suffered during admission. We use days and months of discharge as instruments for LOS. Our research helps assessing the costs and benefits of additional days spent in hospital. For example, it can contribute to identifying the ideal time of discharge of patients, or inform whether 'hospital at home' programs reduce rates of hospital acquired infections.
    Keywords: Medical errors, complications of care, adverse drug reactions, infections, ulcers, hospital quality
    JEL: I11 D21 C3 H4 L3
    Date: 2010–02
  9. By: Katharina Hauck; Xueyan Zhao; Terri Jackson
    Abstract: We compare adverse event rates for surgical inpatients across 36 public hospitals in the state of Victoria, Australia, conditioning on differences in patient complexity across hospitals. We estimate separate models for elective and emergency patients which stay at least one night in hospitals, using fixed effects complementary log-log models to estimate AEs as a function of patient and episode characteristics, and hospital effects. We use 4 years of patient level administrative hospital data (2002/03 to 2005/06), and estimate separate models for each year. Averaged over four years, we find that adverse event rates are 12% for elective surgical inpatients, and 12.5% for emergency surgical inpatients. Most teaching hospitals have surprisingly low adverse event rates, at least after adjusting for the higher medical complexity of their patients. Some larger regional hospitals have high adverse events rates, in particular after adjusting for the below average complexity of their patients. Also, some suburban hospitals have high rates, especially the ones located in areas of low socioeconomic profile. We speculate that high rates may be due to factors beyond the control of the hospitals, such as staff shortages. We conclude that at present, care should be taken when using adverse event rates as indicators of hospital quality
    Keywords: Adverse events, hospital performance, hospital quality, patient complexity
    JEL: I11 D21 C2 H4 L3
    Date: 2010–02
  10. By: Juergen Jung (Department of Economics, Towson University); Chung Tran (Department of Economics, University of New South Wales)
    Abstract: In this paper we construct life-cycle profiles of health care spending and financing using data from the Medical Expenditure Panel Survey (MEPS). We separate pure age effects from time and cohort effects by estimating a seminonparametric partial linear model. After controlling for time and cohort effects, we find that medical expenditure age profiles follow an upward trend whereas private insurance take-up profiles over age exhibit a hump-shape. In addition, we find that time effects (i.e. productivity effects, business cycle effects, etc.) dominate cohort effects (i.e. initial condition effects) in size despite the fact that we adjust for inflation in the variables measuring medical expenditures. Health expenditure profiles based on simple inflation adjusted values therefore overpredict the effects of age on health expenditures, especially for agents older than 60.
    Keywords: Age dependent U.S. health care spending, U.S. health expenditure decomposition, life-cycle profiles, partial linear models, pseudo panels, medical expenditure panel survey (MEPS).
    JEL: I10 I11 C14 C23 D12 D91 J10
    Date: 2010–04
  11. By: Kim P. Huynh (Department of Economics, Indiana University - Bloomington); Juergen Jung (Department of Economics, Towson University)
    Abstract: Subjective health expectations are derived using the RAND-HRS dataset. We use a Bayesian updating mechanism to correct for focal point responses and reporting errors of the original health expectations variable. We then test the quality of the health expectations measure and describe its correlation with various health indicators and other individual characteristics. Our results indicate that subjective health expectations do contain additional information that is not incorporated in subjective mortality expectations and that the rational expectations assumption cannot be rejected for subjective health expectations. Finally, the data suggest that individuals younger than 70 years of age seem to be more pessimistic about their health than individuals in their 70's.
    Keywords: Subjective Health Expectations, Rational Health Expectations, Work Limiting Health Problems, Bayesian Updating of Expectations.
    JEL: I10 D84 C11 C23
    Date: 2010–03
  12. By: Kantarevic, Jasmin (Ontario Medical Assocation); Kralj, Boris (Ontario Medical Assocation); Weinkauf, Darrel (Ontario Medical Assocation)
    Abstract: We study an enhanced fee-for-service model for primary care physicians in the Family Health Groups (FHG) in Ontario, Canada. In contrast to the traditional fee-for-service (FFS) model, the FHG model includes targeted fee increases, extended hours, performance-based initiatives, and patient enrolment. Using a long panel of claims data, we find that the FHG model significantly increases physician productivity relative to the FFS model, as measured by the number of services, patient visits, and distinct patients seen. We also find that the FHG physicians have lower referral rates and treat slightly more complex patients than the comparable FFS physicians. These results suggest that the FHG model offers a promising alternative to the FFS model for improving access to physician services.
    Keywords: access to physician services, physician productivity, remuneration, primary care, Family Health Groups, Ontario, Canada
    JEL: I10 I12 I18
    Date: 2010–04
  13. By: Bowblis, John R. (Miami University); Yun, Myeong-Su (Tulane University)
    Abstract: The purpose of this research is to explain the variation in the utilization of drug therapy for the medical conditions of depression, high cholesterol, and hypertension between Hispanics, non-Hispanic blacks, and non-Hispanics whites using Oaxaca-type decomposition analysis based on logit estimates. We find that almost the entire share of the utilization differences in drug therapy between blacks and whites can be explained by the differences in the coefficients of observable characteristics, while the sources of the utilization difference between the whites and Hispanics are split between the differences in the observable characteristics and the coefficient estimates. This result implies that strategies to improve racial and ethnic disparities need to be tailored to each group by focusing on the specific factors that are attributed to causing the disparity.
    Keywords: racial and ethnic disparities, drug therapy, depression, high cholesterol, hypertension, Oaxaca decomposition
    JEL: I11 I12
    Date: 2010–03
  14. By: Annamaria Lusardi (Department of Economics, Dartmouth College); Daniel Schneider (Department of Sociology and Office of Population Research, Princeton University,); Peter Tufano (Harvard Business School, Finance Unit)
    Abstract: We use a unique, nationally representative cross-national dataset to document the reduction in individuals' usage of routine non-emergency medical care in the midst of the economic crisis. A substantially larger fraction of Americans have reduced medical care than have individuals in Great Britain, Canada, France, and Germany, all countries with universal health care systems. At the national level, reductions in medical care are related to the degree to which individuals must pay for it, and within countries are strongly associated with exogenous shocks to wealth and employment.
    Date: 2010–03
  15. By: Joan Costa-Font (London School of Economics); Mireia Jofre-Bonet (Department of Economics, City University, London)
    Abstract: Excessive preoccupation with self-image has been pinpointed as a factor contributing to the proliferation of food disorders, especially among young women. To provide an economic basis for this argument this paper models how ‘self-image’ and ‘other people’s appearance’ influence health-related behaviour. Self-image (identity) is claimed to be biased towards anorexic women by social norms and peer pressure, increasing the probability of women experiencing a food disorder. This paper empirically tests this claim using data from a representative, cross-sectional European survey for 2004. A two-step empirical strategy was used. First, the probability was estimated of a woman ‘being extremely thin’ and at the same time ‘seeing herself as too fat’. The findings revealed robust evidence suggesting that (different definitions of) peer effects average out, and that a larger peer body-mass decreases the likelihood of being anorexic. Second, the two processes were estimated separately, using a recursive system, which suggested that self-image was associated with body weight when unobservable variables explaining both processes were controlled for. (These processes were found to be positively and significantly correlated). As expected, several definitions of peers’ body mass were found to decrease the likelihood of women being thin or extremely thin, when common unobservable variables were controlled for.
    Keywords: self-image, identity, body image, eating disorders, anorexia
    JEL: I12 Q18
    Date: 2010–01
  16. By: Simonsen, Marianne (School of Economics and Management); Skipper, Lars (Department of Economics, Aarhus School of Business); Skipper, Niels (School of Economics and Management)
    Abstract: This paper investigates price sensitivity of demand for prescription drugs using drug purchase records for at 20% random sample of the Danish population. We identify price responsiveness by exploiting exogenous variation in prices caused by kinked reimbursement schemes and implement a regression kink design. Thus, within a unifying framework we uncover price sensitivity for different subpopulations and types of drugs. The results suggest low average price responsiveness with corresponding price elasticities ranging from -0.08 to -0.25, implying that demand is inelastic. Individuals with lower education and income are, however, more responsive to the price. Also, essential drugs that prevent deterioration in health and prolong life have lower associated average price sensitivity.
    Keywords: Prescription drugs; price; reimbursement schemes; regression kink design
    JEL: I11 I18
    Date: 2010–01–15
  17. By: Datta Gupta, Nabanita (Department of Economics, Aarhus School of Business); Deding, Mette (The Danish National Centre for Social Research); Lausten, Mette (The Danish National Centre for Social Research)
    Abstract: A number of studies have documented negative long term effects of low birth weight. Yet, not much is known about the dynamics of the process leading to adverse health and educational outcomes in the long-run. While some studies find effects of the same size at both school age and young adulthood, others find a diminishing negative effect over time due to a catching-up process. The purpose of this paper is to try to resolve this puzzle by analyzing the medium term consequences of low birth weight measured as various child outcomes at ages 6 months, 3, 7 and 11, using data from the Danish Longitudinal Survey of Children. Observing the same children at different points in time allows us to chart the evolution of health and behavioral deficits among children born with low birth weight and helps inform the nature and timing of interventions
    Keywords: low birth weight; medium term effects; health and behavioral outcomes; longitudinal child-mother survey
    JEL: I12
    Date: 2010–01–01
  18. By: Wüst, Miriam (Department of Economics, Aarhus School of Business)
    Abstract: This paper uses Danish survey and register data to examine the effect of maternal inputs on child health at birth. The paper adds to the literature in several ways: First, while previous studies mainly have focused on maternal smoking, this paper factors in a larger number of maternal health behaviors, most importantly prenatal alcohol consumption. Second, it uses prenatal maternal reports on inputs and objective administrative data on child outcomes. Both features of the data reduce the threat of recall bias and measurement error. Third, the paper identifies the effect of health behaviors by exploiting variation between siblings. The results of the paper confirm and extend earlier findings. Maternal smoking decreases birth weight and fetal growth, with smaller effects in sibling models. The negative alcohol effect on birth outcomes is pronounced and remains intact in sibling models. Both effects suggest a dose-response relationship. Robustness checks suggest that the sibling sample represents the population of multiple mothers well and that smoking results are not driven by misclassification of smoking status.
    Keywords: No; keywords
    JEL: I10
    Date: 2010–01–01
  19. By: Rama Pal (Indira Gandhi Institute of Development Research; Institute of Economic Growth)
    Abstract: The present paper attempts to modify definition of catastrophic out-of-pocket health expenditure by characterising it based on consumption of necessities. In literature, catastrophic expenditure is defined as that level of OOP health expenditure which exceeds some fixed proportion of household income or household's capacity to pay. In the present paper, 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. Findings suggest that it is important to carefully revise the concept of catastrophic health care spending and the method developed in this paper can be considered as one of the possible alternatives. We find that education is one of the important policy instruments that can be used to reduce incidence of catastrophic spending in India. The findings also suggest that even after efforts to reduce differences among various social classes in India, socially deprived classes are still vulnerable as they are more likely to experience financial catastrophe due to illness.
    Keywords: Catastrophic health expenditure; Consumption of Necessities
    JEL: I12 I19
    Date: 2010–02
  20. By: Elena Cottini; Claudio Lucifora (DISCE, Università Cattolica)
    Abstract: This study investigates the relationship between health, working conditions and pay in Europe. In particular, we measure health at work using self-assessed indicators for overall, as well as physical and mental health, using the 2005 wave of the EWCS (European Working Conditions Survey) for 15 EU countries. We find that, controlling for personal characteristics, (adverse) working conditions are associated with poor health status – both physical and mental. Low pay plays a role, mainly for men and when interacted with working conditions, suggesting that stigma and deprivation effects may be correlated with health at work. We also account for the potential endogeneity arising from workers sorting by firms and job types with different working conditions, and provide evidence of a causal effect of (adverse) working conditions and (low) pay on health at the workplace.
    Keywords: working conditions, physical and mental health, low-pay employment
    JEL: I10 J41 J81
    Date: 2009–12
  21. By: Julio Cáceres-Delpiano; Marianne Simonsen
    Abstract: In this paper we study the impact of fertility on the overall wellbeing of mothers First, using US Census data for the year 1980, we study the impact of number of children on family arrangements, welfare participation and poverty status. Second, using the National Health Interview Survey (NHIS) for the period 1982-2003, we study the impact on a series of health risk factors. The findings reveal, first, that a raise in family size increases the likelihood of marital breakdown measured by the likelihood of divorce or the likelihood of the mother not living with the children’s father. Second, we find evidence that mothers facing an increase in family size are not only more likely to live with other family members such as grandparents, aunts and uncles, they are also more likely to receive help from welfare programs. Third, consistent with an increase in welfare participation, families (mothers) are more likely to fall below the poverty line, and they face a reduction in total family income. The results using NHIS confirm a negative impact of fertility on marriage stability and an increase in welfare participation measured by an increase in the likelihood of using Medicaid and for some samples a reduction in the take-up of private health insurance. Finally, we find evidence that a shock in fertility increases the likelihood for mothers to suffer from high blood pressure during the last 12 months and also increases the propensity to smoke and risk of being obese
    Keywords: Fertility, Family arrangements, Poverty, Welfare participation, Health insurance, Obesity
    JEL: J12 J13 I3
    Date: 2010–01
  22. By: Son, Hyun (Asian Development Bank)
    Abstract: Equity is an abstract concept covering philosophical issues such as fairness and social justice, making its definition and measurement very complex. This study attempts to define and measure equity in health status and health care utilization using the equity index of opportunity. The study introduces a methodology to explain equity in terms of between- and within-group equity. While the between-group equity implies equal treatment for equal needs, the within-group equity implies that individuals with unequal needs should be treated unequally according to their different needs. The proposed methodology can be applied to any socioeconomic and demographic group. Empirical analysis is carried out using Demographic and Health Surveys and Annual Poverty Indicator Surveys conducted in the Philippines.
    Date: 2009–09
  23. By: Ana Poças (Polytechnic Institute of Guarda); Elias Soukiazis (Faculty of Economics University of Coimbra and GEMF)
    Abstract: The purpose of this study is to analyse the determinants of life expectancy as proxy for health status of the OECD countries‘ population. A production function of health is used to explain life expectancy at birth for total and ageing population and according to gender. Socio-economic factors, health resources and lifestyles are defined as the main determinants of heath status. The estimation approach assumes that income and education are endogenous and a panel data approach is used to control for this problem. Our evidence shows that income, education and health resources (through consultations) are important factors affecting positively life expectancy and risky lifestyles (tobacco and alcohol consumption) are harmful to health. However there are differences between males and females. Income and lifestyles are the major determinants affecting men‘s health while for women education and the effective use of health services (through consultations) explain mostly life expectancy both at birth and late age.
    JEL: H51 I12 I18 C23
    Date: 2010–03
  24. By: John S. Earle (W.E. Upjohn Institute for Employment Research and Central European University); Scott Gehlbach (University of Wisconsin, Madison)
    Abstract: We reexamine the well-publicized claim that "rapid mass privatisation [of state-owned enterprises] . . . was a crucial determinant of differences in adult mortality trends in postcommunist countries" (Stuckler, King and McKee, 2009). Our analysis shows that the estimated correlation of privatization and mortality in country-level data is not robust to recomputing the mass-privatization measure, to assuming a short lag for economic policies to affect mortality, and to controlling for country-specific mortality trends. Further, in an analysis of the determinants of mortality in Russian regions, we find no evidence that privatization increased mortality during the early 1990s. Finally, we reanalyze the relationship between privatization and unemployment in postcommunist countries, showing that there is little support for the proposed mechanism by which privatization might have increased mortality.
    Keywords: privatization, mortality, health, shock therapy, unemployment, Eastern Europe, Former Soviet Union, Lancet
    JEL: I18 L33 P2 P31 O57
    Date: 2010–02
  25. By: James Marton (Georgia State University); Stephen A. Woodbury (W.E. Upjohn Institute and Michigan State University)
    Abstract: We estimate the effect of employer offers of retiree health benefits (RHBs) on the timing of retirement using a sample of Health and Retirement Study (HRS) men observed over a period of up to 12 years. We hypothesize that the effect of RHBs differs for workers of different ages—a hypothesis we can test now that the main HRS cohort has aged sufficiently. We apply three wellknown panel data estimators and find that, for men in their 50s, RHBs have little or no effect on retirement decisions; however, a substantial effect emerges for men in their early 60s. We use simulations to illustrate how RHBs alter retirement patterns.
    Keywords: Retirement, Health Insurance, Employee Benefits, Panel Data
    JEL: J26 I18 D14
    Date: 2010–02
  26. By: Renate Hartwig; Michael Grimm
    Abstract: In 2002 Malawi experienced a serious shortage of cereals due to adverse climatic conditions. The World Food Programme assumed that about 2.1 to 3.2 million people were threatened of starvation at that time. However, not much research has been undertaken to investigate the actual consequences of this crisis. In particular, little is known about how the crisis affected the health status of children. Obviously, quantifying the health impact of such a crisis is a serious task given the lack of data and the more general problem of relating outcomes to specific shocks and policies. In this paper a difference-in-difference estimator is used to quantify the impact of the food crisis on the health status of children. The findings suggest that at least in the short run, there was neither a significant impact on child mortality nor on malnutrition. This would suggest that the shock might have been less severe than initially assumed and that the various policy interventions undertaken at the time have been effective or at least sufficient to counteract the immediate effects of the crisis.
    Keywords: child mortality, malnutrition, food crisis, Malawi
    Date: 2010
  27. By: Karl Claxton (Centre for Health Economics, University of York, UK and Department of Economics and Related Studies, University of York, UK); Simon Walker (Centre for Health Economics, University of York, UK); Steven Palmer (Centre for Health Economics, University of York, UK); Mark Sculpher (Centre for Health Economics, University of York, UK)
    Abstract: NICE uses cost-effectiveness analysis to compare the health benefits expected to be gained by using a technology with the health that is likely to be forgone due to additional costs falling on the health care budget and displacing other activities that improve health. This approach to informing decisions will be appropriate if the social objective is to improve health, the measure of health is adequate and the budget for health care can reasonably be regarded as fixed. If NICE were to recommend a broader =societal perspective‘, wider effects impacting on other areas of the public sector and the wider economy would be formally incorporated into analyses and decisions. The problem for policy is that, in the face of budgets legitimately set by government, it is not clear how or whether a societal perspective can be implemented, particularly if transfers between sectors are not possible. It poses the question of how the trade-offs between health, consumption and other social arguments, as well as the valuation of market and non market activities, ought to be undertaken.
    Keywords: Perspective. Cost-effectiveness analysis. Economic evaluation.
    Date: 2010–01
  28. By: Mike Paulden (Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Canada); Anthony J Culyer (Department of Health Policy, Management and Evaluation, University of Toronto, Canada. Department of Economics and Related Studies, University of York, UK and Centre for Health Economics, University of York, UK)
    Abstract: The aim of this paper is to explore the claim of ageism made against the National Institute for Health & Clinical Excellence and like organisations, and to identify circumstances under which ageist discrimination might arise. We adopt a broad definition of ageism as representing any discrimination against individuals or groups of individuals solely on the basis that they have shorter life expectancy than others. A simple model of NICE?s decision making process is developed which demonstrates that NICE?s recommendations do not inherently discriminate on the basis of life expectancy per se but that scope for discrimination may arise in the case of specific technologies having identifiable characteristics. Such discrimination may favour patients with either longer or shorter life expectancy. It is shown that NICE?s policies, procedures and the context in which NICE makes its decisions not only reduce the scope for discriminatory recommendations but also – in the case of “end of life” treatments – increase the likelihood that NICE?s recommendations favour those with shorter, rather than longer, life expectancy.
    Date: 2010–02
  29. By: Sylvia Meijer; Rudy Douven,; Bernard van den Berg
    Abstract: The aim of this research was to explore the effect of the introduction of managed competition in Dutch inpatient hospital care. Firstly, we performed a literature study to determine competitive forces that have played a role in the US hospital market. Next, we discussed these forces with Dutch hospital board members to ascertain their relevance to the Dutch hospital market. The interviews revealed that Dutch insurers are cautiously initiating new initiatives such as selective contracting and united purchase combinations, and fiercely negotiate on price when buying hospital care. The board members suggested that the way to raise turnover is to increase hospital production. This resulted in growing quality competition between hospitals through the purchase of new technology and the launch of outpatient centres for specific treatments. Other forces that may have increased hospital production are the fee-for-service payment system of medical specialists and the practice of defensive medicine. As health insurers are apparently still unable to directly steer and control volume, this may result in more treatments by hospitals.
    Date: 2010–03
  30. By: Michiel Bijlsma; Jan Boone; Gijsbert Zwart
    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: health insurance; uninsured; selective contracting; exclusion; foreclosure; anti-competitive effects
    JEL: L42 I11 G22
    Date: 2010–02
  31. By: Pierre Koning; Dinand Webbink; Nicholas G. Martin
    Abstract: This paper analyses the causal effect of education on starting and quitting smoking, using longitudinal data of Australian twins. The endogeneity of education, censoring of smoking durations and the timing of starting smoking versus the timing of completion of education are taken into account by using the flexible Mixed Proportional Hazard (MPH) specification. Unobserved effects in the specification are assumed to be twin specific and possibly correlated with completed education years. In addition, we use various unique control indicators reflecting the discounting behaviour of individuals that may affect both the smoking decision and the number of education years. In contrast to previous studies in our model specification, differences in the number of education years cannot explain differences in smoking behaviour at young ages. We find one additional year of education to reduce the duration of smoking with 9 months, but no significant effect of education on starting smoking. The effect of education on quitting smoking largely confines to male twins. This suggests that education policies that succeed in raising the level of education may improve public health through an increase of smoking cessation, but are not effective in preventing smoking at young ages.
    Keywords: Smoking; duration models; education
    JEL: C41 I21
    Date: 2010–02
  32. By: Frank R. Lichtenberg
    Abstract: We examine the effects of two important types of medical innovation—diagnostic imaging innovation and pharmaceutical innovation—and cancer incidence rates on U.S. cancer mortality rates during the period 1996-2006. The outcome measure we use is not subject to lead-time bias, and our measures of medical innovation are based on extensive data on treatments given to large numbers of patients with different types of cancer. We estimate difference-in-difference models of the age-adjusted cancer mortality rate using longitudinal, annual, cancer-site-level data on over 60 cancer sites. There is a significant inverse relationship between the cancer mortality rate and both lagged imaging innovation and contemporaneous drug innovation, and a significant positive relationship between the cancer mortality rate and the lagged incidence rate. Imaging innovation, drug innovation, and declining incidence jointly explain about three-fourths of the decline in cancer mortality. Only 7% of the mortality decline is attributable to the decline in (lagged) incidence. About one-fourth of the mortality decline is attributable to drug innovation, and 40% of the decline is attributable to (lagged) imaging innovation. Life expectancy at birth may have been increased by almost three months between 1996 and 2006 by the combined effects of cancer imaging and cancer drug innovation.
    JEL: C23 C33 I12 J1 L64 L65 O33
    Date: 2010–04
  33. By: Melissa P. McInerney; Kosali I. Simon
    Abstract: In addition to traditional forms of private and public medical insurance, two other large programs help pay for costs associated with ill health. In 2007, Workers Compensation (WC) insurance provided $55.4 billion in medical care and cash benefits to employees who are injured at work or contract a work-related illness, and Social Security Disability Insurance (DI) provided $99 billion to individuals who suffer from permanent disabilities and are unable to engage in substantial gainful activity. During the 1990s, real DI outlays increased nearly 70 percent, whereas real WC cash benefit spending fell by 12 percent. There has been concern that part of this relationship between two of the nation’s largest social insurance programs may be due to individuals substituting towards DI as state WC policies tightened. We test this hypothesis using a number of different WC and DI program parameters. We first show that this negative correlation between the national series does not hold over time within states, the level at which a causal relationship should operate. We then test how regulatory changes in state WC program parameters impact WC outcomes (intended effect) and DI outcomes (unintended effect). We find no compelling evidence of WC tightening causing DI rolls to increase, and conclude it is unlikely that state WC changes were a meaningful factor in explaining the rise in DI.
    JEL: I1 I28 J28 J78
    Date: 2010–04

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