nep-hea New Economics Papers
on Health Economics
Issue of 2010‒08‒21
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Running and Jumping Variables in RD Designs: Evidence Based on Race, Socioeconomic Status, and Birth Weights By Barreca, Alan; Guldi, Melanie; Lindo, Jason M.; Waddell, Glen R.
  2. Health Insurance Competition: The Effect of Group Contracts By Boone, J.; Douven, R.C.M.H.; Droge, C.; Mosca, I.
  3. Climate change, economic growth, and health By Masako Ikefuji; Jan R. Magnus; Hiroaki Sakamoto
  4. Addressing Key Issues in the Light of Structural Adjustment Programme (SAP) in Health and Family Welfare Sector in India By Samir K. Mondal; Vineeta Kanwal
  5. The Changing Role of Auxiliary Nurse Midwife (ANM) in India: Implications for Maternal and Child Health (MCH) By Dileep V. Mavalankar; Kranti Suresh Vora
  6. Cost Effectiveness of VCT and PITC in a Hospital Based Clinic in Indonesia A Preliminary Results By Adiatma Y.M Siregar; Dindin Komarudin; Pipit Pitriyan
  7. Wages, BMI, and Age By Gregory, Christian
  8. Obesity under affluence varies by welfare regimes: the effect of fast food, insecurity, and inequality By Avner Offer; Rachel Pechey; Stanley Ulijaszek
  9. The determinants of health expenditure in Malaysia: A time series analysis By Tang, Chor Foon

  1. By: Barreca, Alan (Tulane University); Guldi, Melanie (Mount Holyoke College); Lindo, Jason M. (University of Oregon); Waddell, Glen R. (University of Oregon)
    Abstract: Throughout the years spanned by the U.S. Vital Statistics Linked Birth and Infant Death Data (1983-2002), birth weights are measured most precisely for children of white and highly educated mothers. As a result, less healthy children, who are more likely to be of low socioeconomic status, are disproportionately represented at multiples of round numbers. This has crucial implications for any study using a regression discontinuity design in which birth weights are used as the running variable. For example, estimates will be biased in a manner that leads one to conclude that it is “good” to be strictly to the left of any 100-gram cutoff. As such, prior estimates of the effects of very low birth weight classification (Almond, Doyle, Kowalski, and Williams 2010) have been overstated and appear to be zero. This analysis highlights a more general problem that can afflict regression discontinuity designs. In cases where attributes related to the outcomes of interest predict heaping in the running variable, estimated effects are likely to be biased. We discuss approaches to diagnosing and correcting for this type of problem.
    Keywords: regression discontinuity, donut RD, birth weight, infant mortality
    JEL: C21 C14 I12
    Date: 2010–08
  2. By: Boone, J.; Douven, R.C.M.H.; Droge, C.; Mosca, I. (Tilburg University, Center for Economic Research)
    Abstract: In countries like the US and the Netherlands health insurance is provided by private firms. These private firms can offer both individual and group contracts. The strategic and welfare implications of such group contracts are not well understood. Using a Dutch data set of about 700 group health insurance contracts over the period 2007-2008, we estimate a model to determine which factors explain the price of group contracts. We find that groups that are located close to an insurers’ home turf pay a higher premium than other groups. This finding is not consistent with the bargaining argument in the literature as it implies that concentrated groups close to an insurer’s home turf should get (if any) a larger discount than other groups. A simple Hotelling model, however, does explain our empirical results.
    Keywords: health insurance;health-plan choice;managed competition
    JEL: I11 L13
    Date: 2010
  3. By: Masako Ikefuji; Jan R. Magnus; Hiroaki Sakamoto
    Abstract: This paper studies the interplay between climate, health, and the economy in a stylized world with four heterogeneous regions, labeled 'West' (cold and rich), 'China' (cold and poor), 'India' (warm and poor), and 'Africa' (warm and very poor). We introduce health impacts into a simple integrated assessment model where both the local cooling effect of aerosols as well as the global warming effect of CO2 are endogenous, and investigate how those factors affect the equilibrium path. We show how some of the important aspects of the equilibrium, including emission abatement rates, health costs, and economic growth, depend on the economic and geographical characteristics of each region.
    Date: 2010–08
  4. By: Samir K. Mondal; Vineeta Kanwal
    Abstract: The policies including that of ‘World Bank’ and the recent ‘Indian Health Report (WHO) 2000’, now recognise the importance of investing in health & also providing for a ‘safety net’ for the poor and vulnerable to promote economic development and reduce poverty. So, there is an urgent need to address several issues to revamp the entire health sector in India. The paper, apart from an extensive review of India’s health scenario also identifies the potential areas where further studies need to be undertaken for accelerating the reforms process in the desired direction. [Working Paper No. 97]
    Keywords: World Bank, health, safety-net, vulnerable, economic development, poverty
    Date: 2010
  5. By: Dileep V. Mavalankar; Kranti Suresh Vora
    Abstract: The world’s democracy and its second most populous country, India was the first developing country to have a national family planning program and has implemented countrywide reproductive health programs such as RCH I. India’s primary health care and the family planning programs have come a long way after the independence in improving health indicators in general, yet it has high material and under five mortality rates. The country has developed an extensive network of primary health centers and sub- to provide basic medical care to huge (80%) rural population. In the rural health care system, the ANM is the key field level functionary who interacts directly with the community and has been the central focus of all the reproductive child health programs. In contrast with resident ANM of sixties who was providing delivery and basic curative services to the community, today’s commuting multi purpose worker is more involved in family planning and preventive services. This has implications on the implementation and outcomes of maternal health programs in rural India. The midwifery role of the ANM should be restored if the goal of decreasing maternal mortality has to be met. The priority will have to change from family planning immunization to comprehensive reproductive health including maternal and neonatal care. These changes will require sustained and careful planning/resource allocation. Increasing resources along with systemic reforms will improve health status for women and children who are the focus of Reproductive Child Health programs. [Working Paper No. W.P. No.2008-03-01]
    Keywords: resident, Reproductive Child Health programs, goal, preventive service
    Date: 2010
  6. By: Adiatma Y.M Siregar (Department of Economics, Padjadjaran University); Dindin Komarudin (Integrated Management for Prevention and Control and Treatment of HIV/AIDS(IMPACT)); Pipit Pitriyan
    Abstract: Background: The HIV epidemic in Indonesia is among the fastest growing in Asia and call for interventions scaling up. Two current adapted interventions are Voluntary Counselling and Testing (VCT) and Provider Initiated Counselling and Testing (PICT). Scaling up these two interventions, however, must be analysed using economic evaluation given the limited existing budget. Two concerns prevail: 1) the economic evaluation studies on both interventions are limited, and 2) there is a question on extending the coverage of VCT through PICT which has not been economically analysed. Methods: The cost estimation is based on a previous study on the costs of delivering VCT which is adapted to estimate the cost of delivering hospital based VCT and PICT. The effectiveness study is also adapted from a previous study on the natural decline of CD 4 cell count on HIV (+) clients for intravenous drug user (IDU) and non IDU, related to the life years gained. Results: Most clients are on their productive age. The unit cost per HIV (+) detected differ by US$37. The time gain of performing VCT compared to PICT for IDU is shorter than that of the non-IDU. The Incremental Cost Effectiveness Ratio (ICER) of performing VCT compared to PICT for unit cost per HIV (+) case is higher for non IDU compared to IDU. Discussion: VCT has the benefit of early detection compared to PICT. The unit costs of VCT and PICT per HIV (+) cases for each service shows higher costs for PICT than VCT. The ICER based on unit costs per HIV (+) case for both IDU and non – IDU shows that providing VCT will result in less cost in gaining more life years. Although the results show that VCT seems to be more cost effective than PICT, the unique characteristics of PICT should also be considered. We recommend that PICT should not be made as the scaling up measure of VCT, but should stay as a complementary.
    Keywords: HIV, Cost Effectiveness, Economic Evaluation, IDU, VCT, PICT
    JEL: I18
    Date: 2010–08
  7. By: Gregory, Christian (University of North Carolina at Greensboro, Department of Economics)
    Abstract: Previous research generally finds that obesity negatively affects wages for women and does not affect wages for men. But this literature has for the most part focused on young workers and has not examined whether the effect of obesity might change as people age. In this essay, I examine the effect of obesity -- and body mass more generally -- on wages across the age distribution, using conventional parametric and flexible semiparametric fixed effect models. The model results suggest two contributions to previous literature. First, the parametric results indicate that, in failing to stratify by age, the literature may overstate the effect of BMI and obesity on wages for women and almost certainly understates any negative association for men. Secondly, the semiparametric models indicate that the wage function isn't really changing as either men or women age: the differences that we observe in the linear specifications are almost all due to the change in the distribution of BMI, rather than a change in the effect of BMI itself on wages.
    Keywords: Wages; BMI; Semiparametric; Appearance
    JEL: C14 I00 J30
    Date: 2010–08–10
  8. By: Avner Offer (All Souls College, University of Oxford, OX1 4AL, UK); Rachel Pechey (Institute of Social and Cultural Anthropology, University of Oxford, OX2 6PE, UK); Stanley Ulijaszek (Institute of Social and Cultural Anthropology, University of Oxford, OX2 6PE, UK)
    Abstract: Among affluent countries, those with market-liberal welfare regimes (which are also English-speaking) tend to have the highest prevalence of obesity. The impact of cheap, accessible high-energy food is often invoked in explanation. An alternative approach is that overeating is a response to stress, and that competition, uncertainty and inequality make market-liberal societies more stressful. This ecological regression meta-study pools 96 body-weight surveys from 11 countries c. 1994-2004. The fast-food ‘shock’ impact is found to work most strongly in market liberal countries. Economic insecurity, measured in several different ways, was almost twice as powerful, while the impact of inequality was weak, and went in the opposite direction.
    Date: 2010–07–15
  9. By: Tang, Chor Foon
    Abstract: The purpose of this study is to investigate the determinants of health expenditure in Malaysia within the time series framework from 1967 to 2007. This study employed the Johansen-Juselius cointegration test to examine the cointegration relationship. The results showed that health expenditure and its determinants are cointegrated. Consistent with economic theory, the TYDL and variance decomposition analysis reveals that the key explanatory variables in Malaysia’s health expenditure model are income, health care price and the proportion of population aged more than 65 years old. Moreover, the TYDL causality indicates that health expenditure and income is bi-directional in nature, thus policies initiative to promote health expenditure should be implemented to achieve sustainable economic growth and development.
    Keywords: Cointegration; Health; Income; Malaysia; TYDL
    JEL: H51 I18 C22 C01
    Date: 2010

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