nep-hea New Economics Papers
on Health Economics
Issue of 2010‒05‒29
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Evaluating the Health Effects of Micro Health Insurance Placement: Evidence from Bangladesh By Jennifer Roberts; Paul Mosley; Syed Abdul Hammid
  2. Killing by lung cancer or by diabetes? The trade-off between smoking and obesity By Sergi Jiménez-Martín; Federico A. Todeschini; José María Labeaga
  3. Generic drug pricing in Canada: components of the value-chain By Aidan Hollis
  4. Influenza Immunization Campaigns: Is an Ounce of Prevention Worth a Pound of Cure? By Courtney Ward
  5. Health Care Systems: Efficiency and Institutions By Isabelle Joumard; Christophe André; Chantal Nicq
  6. Characterization of bathtub distributions via percentile residual life functions By Alba M. Franco-Pereira; Rosa E. Lillo; Juan Romo
  7. A Mathematical Model for Estimating the Number of Health Workers Required for Universal Antiretroviral Treatment By Till Bärnighausen; David E. Bloom; Salal Humair
  8. Effects of state-level public spending on health on the mortality probability in India By Mansour Farahani; S. V. Subramanian; David Canning
  9. Short and long-term relationship between physician density on infant mortality: a longitudinal econometric analysis By Mansour Farahani; S. V. Subramanian; David Canning
  10. Did Mass Privatisation really increase Post-Communist male mortality?. By Gerry, C.J.; Mickiewicz, T.M.; Nikoloski, Z.
  11. On the estimation of hospital cost: the approach By Kurup, Hari K K
  12. The Economics of Smoking Bans By Charles A.M. de Bartolome; Ian J. Irvine

  1. By: Jennifer Roberts (Department of Economics, The University of Sheffield Author-Person=pro228); Paul Mosley (Department of Economics, The University of Sheffield); Syed Abdul Hammid
    Abstract: We examine the impact of micro health insurance placement on health awareness, healthcare utilization and health status of microcredit members in rural Bangladesh, using data from 329 households in the operating areas of Grameen Bank. The results are based on econometric analysis conditioned on placement of the scheme, and show that placement has a positive association with all of the outcomes. The results are statistically significant for health awareness and healthcare utilization, but not for heath status. Our study makes an important contribution to the literature as it provides evidence on the impact of MHI on a broad set of health outcomes.
    Keywords: Microcredit, Micro Health Insurance, Grameen Bank, Bangladesh
    JEL: O12
    Date: 2010–04
  2. By: Sergi Jiménez-Martín; Federico A. Todeschini; José María Labeaga
    Abstract: As the prevalence of smoking has decreased to below 20%, health practitioners interest has shifted towards the prevalence of obesity, and reducing it is one of the major health challenges in decades to come. In this paper we study the impact that the final product of the anti-smoking campaign, that is, smokers quitting the habit, had on average weight in the population. To these ends, we use data from the Behavioral Risk Factors Surveillance System, a large series of independent representative cross-sectional surveys. We construct a synthetic panel that allows us to control for unobserved heterogeneity and we exploit the exogenous changes in taxes and regulations to instrument the endogenous decision to give up the habit of smoking. Our estimates, are very close to estimates issued in the ’90s by the US Department of Health, and indicate that a 10% decrease in the incidence of smoking leads to an average weight increase of 2.2 to 3 pounds, depending on choice of specification. In addition, we find evidence that the effect overshoots in the short run, although a significant part remains even after two years. However, when we split the sample between men and women, we only find a significant effect for men. Finally, the implicit elasticity of quitting smoking to the probability of becoming obese is calculated at 0.58. This implies that the net benefit from reducing the incidence of smoking by 1% is positive even though the cost to society is $0.6 billions.
    Date: 2010–05
  3. By: Aidan Hollis
    Abstract: The problem of obtaining fair pricing for generic drugs has led to a series of regulatory measures in Canadian provinces. This paper offers a new way of thinking about the problems that need to be addressed, by considering three core components of the value chain of getting generic drugs to Canadians: litigation, production, and pharmacy services. The paper proposes that each component of this value chain should be paid for separately, using a royalty to reward successful litigation that benefits payers; a competitive market framework to pay for production; and a transparent, independent regulatory process to set dispensing fees for pharmacies. This approach would enable the total expenditures to match costs, would enable provinces to set appropriate quality and convenience standards for pharmacy, and would provide a measure of predictability for investors. The paper emphasizes that it is important to establish a separate mechanism for rewarding litigation that eliminates invalid patents. The savings to Canadians from such litigation exceeds one billion dollars annually. Without addressing the need to reward this valuable activity, it is dangerous for payers to drive down generic prices, since generic firms will lack incentives to invest in costly litigation. The paper also encourages governments to establish independent regulatory authorities to set fair fees for pharmacies by employing processes similar to those used in other price regulation agencies.
    Date: 2010–01–17
  4. By: Courtney Ward (Department of Economics, Dalhousie University)
    Keywords: influenza; immunization; health; work absence; respiratory illness; hospital admission; JEL: I1, J22
    Date: 2010–03–15
  5. By: Isabelle Joumard; Christophe André; Chantal Nicq
    Abstract: This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money. The empirical analysis suggests that there is room in all countries surveyed to improve the effectiveness of health care spending; there is no health care system that performs systematically better in delivering cost-effective health care – big-bang reforms are therefore not warranted; increasing the coherence of policy settings, by adopting best policy practices within a similar system and borrowing the most appropriate elements from other systems will likely be more practical and effective to raise health care spending efficiency.<P>Systèmes de santé : efficacité et institutions<BR>Ce document présente un ensemble d’indicateurs afin d’évaluer la performance des systèmes de santé. Il présente aussi de nouvelles données comparatives sur les politiques et les institutions dans le domaine de la santé pour les différents pays de l’OCDE. Cet ensemble d’indicateurs permet de caractériser empiriquement les systèmes de santé en identifiant des groupes de pays ayant des politiques et institutions comparables. Il permet aussi de mettre en valeur les forces et les faiblesses du système de santé de chaque pays et de déterminer les gains potentiels d’efficacité. L’analyse empirique montre que dans chacun des pays étudiés l’efficacité des dépenses de santé peut être améliorée; qu’il n’existe pas de système qui, pour un coût donné, produit systématiquement des meilleurs résultats – des réformes radicales en faveur d’un système de santé ne sont donc pas nécessaires ; accroitre la cohérence des politiques en matière de santé en adoptant les politiques les plus performantes à l’intérieur d’un système similaire et en empruntant les éléments les plus appropriés aux autres systèmes s’avérera vraisemblablement plus réaliste et plus efficace pour améliorer l’efficacité de la dépense en matière de santé.
    Keywords: public spending, efficiency, health care system, health institutions and policies, dépenses publiques, système de santé, efficacité, institutions et politiques de santé
    JEL: H21 H51 I11 I12 I18
    Date: 2010–05–19
  6. By: Alba M. Franco-Pereira; Rosa E. Lillo; Juan Romo
    Abstract: In reliability theory and survival analysis, many set of data are generated by distributions with bathtub shaped hazard rate functions. Launer (1993) established several relations between the behaviour of the hazard rate function and the percentile residual life function. In particular, necessary conditions were given for a special type of bathtub distributions in terms of percentile residual life functions. The purpose of this paper is to complete the study initiated by Launer (1993) and to characterize (necessary and sufficient conditions) all types of bathtub distributions.
    Keywords: Percentile residual life, Bathtub hazard rate, Aging notions,
    Date: 2010–05
  7. By: Till Bärnighausen (Harvard School of Public Health); David E. Bloom (Harvard School of Public Health); Salal Humair (Harvard School of Public Health)
    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 HIVpositive 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.
    Keywords: Mathematical model, health workers, universal antiretroviral treatment
    Date: 2009–12
  8. By: Mansour Farahani (Harvard School of Public Health); S. V. Subramanian (Harvard School of Public Health); David Canning (Harvard School of Public Health)
    Abstract: This study uses the second National Family Health Survey (NFHS-2) of India to estimate the effect of state public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state’s gross fiscal deficit as an instrument for its health spending. Our study shows a 10 % increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities.
    Keywords: Public spending, health, mortality probability, India
    Date: 2009–06
  9. By: Mansour Farahani (Harvard School of Public Health); S. V. Subramanian (Harvard School of Public Health); David Canning (Harvard School of Public Health)
    Abstract: While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We provide estimates of short-run and long-term effects of physician density on infant mortality. We use a dynamic regression model that allows an estimation of both short- and long-run effects of physician density on infant mortality. We also used instrumental variables analysis to identify the causal effect of physician density on health. We estimate that increasing the number of physicians by one per 1,000 population decreases the infant mortality rate by 15% within five years and by 45% in the long-run. We find all countries are moving towards their own steady state at around 3% a year and are only half way there after 15 years. We conclude that the long-run effects of human resources for health are substantially larger than previously estimated. Our results suggest that health sector inputs can play a role in reducing infant mortality. However, meeting the Millennium Development Goal of reducing child mortality rate by two thirds from 1990 to 2015 would have required much earlier action.
    Keywords: Physician density, infant mortality, longitudinal, eocnometric
    Date: 2009–06
  10. By: Gerry, C.J.; Mickiewicz, T.M.; Nikoloski, Z.
    Abstract: A recent article in the Lancet, by David Stuckler, Larry King and Martin McKee, investigated anew the fluctuations in adult male mortality rates that have come to characterise the so-called post-communist mortality crisis. Adopting a cross-country, time-series perspective the authors examined how the economic policy strategies of the 1990s impacted upon observed fluctuations in mortality. They conclude that the adoption of a strategy of rapid (mass) privatisation contributed to the adverse mortality trends. We subject that finding to closer scrutiny using the same data from which the Stuckler et al claim stems. We find that their claim that mass privatisation adversely affected male mortality trends in the post-Communist world does not stand up to closer examination. It is not supported empirically and is at odds with what we know about both transition in the post-communist world and about health trends over time in this region.
    Date: 2010–02
  11. By: Kurup, Hari K K
    Abstract: There has been a huge interest during the last decade on modelling hospital cost. Now that there is a fare amount of clarity achieved in estimating cost functions of hospitals, it is time to take stock of the existing methodologies. This article through a brief review of the past studies attempts to bring to light the issues and methodology related to cost estimation in health care provision, keeping in mind the increasing interest towards health insurance in developing countries. These include problems related to output measurement, definition of input prices and definition of cost and its components. The focus of the review is more on the statistical cost functions than on the accounting based cost calculations.
    Keywords: hospital cost; cost estimation; multiproduct analysis
    JEL: I11 D24
    Date: 2010–05–18
  12. By: Charles A.M. de Bartolome (University of Colorado); Ian J. Irvine (Concordia University, Montreal)
    Abstract: While the empirical literature on smoking bans is extensive, little theory has been developed. This paper examines the welfare impact of smoking bans in an economy where smokers’ utility is reduced by a workplace/public place ban. The government has two instruments - increasing the price through taxation, or limiting when the product can be consumed through a ban. Its ability to reduce smoking through taxation is limited by a black market where cigarettes are not taxed. We show that the quantity instrument (ban) is always welfareenhancing. The model has application to other addictive activities.
    Keywords: smoking, workplace ban, public place ban, government control, taxation
    Date: 2010–05–01

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