nep-hea New Economics Papers
on Health Economics
Issue of 2010‒08‒28
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health at work - indicators and determinants : a revised literature and data review for Germany By Schneider, Julia; Beblo, Miriam
  2. Projecting future health care expenditure at European level: drivers, methodology and main results. By Bartosz Przywara
  3. Does More Money Make You Fat? The Effects of Quasi-Experimental Income Transfers on Adolescent and Young Adult Obesity By Akee, Randall K. Q.; Simeonova, Emilia; Copeland, William; Angold, Adrian; Costello, Jane E.
  4. Bridging the Gap: Improving Clinical Development and the Regulatory Pathways for Health Products for Neglected Diseases By Thomas J. Bollyky
  5. How to Pay “Cash-on-Delivery” for HIV Infections Averted: Two Measurement Approaches and Ten Payout Functions By Timothy B. Hallett and Mead Over
  6. Concurrent Sexual Partnerships Do Not Explain the HIV Epidemics in Africa: A Systematic Review of the Evidence By Larry Sawers; Eileen Stillwaggon
  7. HEALTH EFFECTS OF TRANSPORT EMISSIONS - A review of the state of the art of methods and data used for external costs calculations By Mellin, Anna; Nerhagen, Lena
  8. Evaluating human life using court decisions on damages for pain and suffering By Leiter, Andrea M.; Thöni, Magdalena; Winner, Hannes
  9. Health Insurance Availability and Entrepreneurship By Philip DeCicca
  10. Easy Money? Health and 401(k) Loans By Christian E. Weller; Jeffrey Wenger
  11. Socioeconomic Status and Overweight and Obesity: How Does the Gradient Change with Age? New Evidence from China. By Bing Ma
  12. A Theory of Socioeconomic Disparities in Health Over the Life Cycle By Titus Galama; Hans van Kippersluis
  13. Throwing Foreign Aid at HIV/AIDS in Developing Countries: Missing the Target? By Peter Nunnenkamp; Hannes Öhler

  1. By: Schneider, Julia (Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany]); Beblo, Miriam
    Abstract: "In this paper, the current knowledge and issues regarding the economic impact of health at work in Germany is reviewed as a part of the EU project 'An inquiry into health and safety at work: a European Union perspective' (acronym: HEALTHat-WORK), After a description of the German institutional framework for occupational safety and health (OSH), it presents indicators of health and safety at work - such as sickness absences, occupational accidents and diseases, disability rents, working conditions, and OSH policy. The paper's major contribution is a review of economic research on the determinants of OSH indicators in Germany, and a review of the data sets that have been or may be used. The aim is to identify the main issues addressed in the literature, the approaches adopted, the data analyzed, and the research gaps that still exist with respect to analyzing health at work in Germany." (author's abstract, IAB-Doku) ((en))
    JEL: I18 J80
    Date: 2010–08–18
  2. By: Bartosz Przywara
    Abstract: Summary for non-specialistsTo correctly assess the demography-related risks facing public finances in the EU over the next couple of decades and establish adequate policy responses to the demographic, social and economic developments, it is essential to devise a reliable method to estimate future health care expenditure. To tackle this issue, the European Commission and the Economic Policy Committee projected future public health care expenditure in all EU Member States over the period 2007-2060. A unique internationally comparable database has been established and a model built allowing to project health care spending in a common, coherent framework of macroeconomic variables. The model incorporates the most recent developments in demography and epidemiology and draws on new insights from health economics, allowing the comparison of the challenges facing both individual countries' health care systems and European society in its entirety.
    Keywords: Healths Ageing Demography Budgetary projection Public finances Health care expenditure
    JEL: H51 I18 J11 J14
    Date: 2010–07
  3. By: Akee, Randall K. Q. (Tufts University); Simeonova, Emilia (Tufts University); Copeland, William (Duke University); Angold, Adrian (Duke University); Costello, Jane E. (Duke University)
    Abstract: This paper examines how exogenous income transfers during adolescence affect contemporaneous body mass index (BMI) measures and young adult obesity rates using evidence from the Great Smoky Mountains Study of Youth. The effects of extra income differ depending on the households’ initial socio-economic status, tracing out an inverted U-shaped relationship between initial income and BMI. Youths who resided in families that had high pre-treatment annual incomes experience no change in young adult obesity rates as a result of the income transfers, while the BMI of poorer children increases. Part of this effect is due to differential increases in height, as well as weight. An exogenous annual transfer of $4,000 per adult family member results in an almost 4 cm gain in height-for-age. Adolescents coming from worse-off households experience an increase in weight only, without the corresponding change in height. The cumulative effects of the increase in household income persist for several years into young adulthood.
    Keywords: obesity, health, cash transfer, adolescents, indigenous peoples
    JEL: I10 I12 I38
    Date: 2010–08
  4. By: Thomas J. Bollyky
    Abstract: There has been tremendous progress over the last decade in the development of health products for neglected diseases. These include drugs, vaccines, and diagnostics for malaria and tuberculosis, which kill millions of people annually, plus other diseases like chagas and dengue fever, which may less familiar, but nonetheless exact a large and often lethal toll in the world’s poorest communities. Led by product development publicprivate partnerships (PDPs) and fueled by the support of the Bill & Melinda Gates Foundation, the National Institutes of Health, and other donors, there are now dozens of candidate products in the pipeline. Two substantial bottlenecks, however, threaten our capacity to bring these products to those in need. First, the research and regulatory capacity in many neglected disease-endemic settings is not adequate to support the clinical trials that need to occur there in order to complete the development of these products. Second, even with expected attrition in the pipeline, current levels of financing are insufficient to support the clinical development of these products under current cost assumptions. Addressing these related challenges requires not only increased funding for large scale clinical trials and capacity building, but also greater attention to how these trials and their regulatory pathways can be improved to reduce unnecessary costs, delays, and risks to trial subjects.
    Keywords: clinical trials, neglected diseases, vaccines, malaria, TB
    Date: 2010–06
  5. By: Timothy B. Hallett and Mead Over
    Abstract: In contrast to current donor policy, which funds a recipient country’s national AIDS control program, this paper proposes a measurement strategy to enable a donor to reward a recipient country’s success at HIV prevention, irrespective of the inputs, activities, or who gets the credit. In accordance with the “cash-on-delivery” model of foreign assistance, the objective is not to replace traditional input- or activity-oriented aid, but to complement it by enhancing the motivation for local actors and their partners (including the traditional bilateral and multilateral funding agencies and their agents) to achieve measurable reductions in the rate of new HIV infections. This paper proposes two approaches to measuring the number of HIV infections averted between a baseline survey and a follow-up survey and explores the properties of ten alternative “payout functions” which would link measured epidemic changes to the size of the reward to be paid. All measurement approaches include the possibility of statistical error and thus a risk of rewarding the country too little or too much. This risk depends on the initial rate of infection and on HIV prevention success and can be reduced by either increasing the survey sample size or increasing the interval between surveys. By negotiating in advance the choice of one of these measurement approaches and one of a menu of payout functions, the donor and recipient agree on the recipient’s incentive structure with respect to the magnitude and precision of the estimated reduction in the rate of new infection.
    Keywords: HIV, AIDS, cash-on-delivery, foreign assistance, outputs, payout functions
    Date: 2010–04
  6. By: Larry Sawers; Eileen Stillwaggon
    Abstract: Background-- The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region's high HIV prevalence is accepted by many as conventional wisdom. Methods-- We evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis. Results: We find-- 1) Research seeking to establish a statistical correlation between concurrency and HIV prevalence is either flawed or finds no correlation. 2) In order to generate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual contact, gender symmetry, levels of concurrency, and per-act transmission rates. 3) Quantitative evidence cited by proponents of the concurrency hypothesis is unconvincing since they ignore DHS and other data showing concurrency in Africa is low, make broad statements about non-African concurrency based on very few surveys, report data incorrectly, report data from studies that have no information about concurrency as though it supported the hypothesis, report incomparable data in ways that misrepresent the evidence, and cite unpublished or unavailable studies. 4) Qualitative evidence offered by proponents of the hypothesis is irrelevant since there is no comparison of Africa with other regions and for other reasons. Conclusions-- Promoters of the concurrency hypothesis have failed to establish that concurrency is unusually prevalent in Africa or that the kinds of concurrent partnerships found in Africa produce more rapid spread of HIV than other forms of sexual behavior. Policy makers should turn attention to drivers of African HIV epidemics that are policy-sensitive and for which there is substantial biomedical evidence.
    Date: 2010–07
  7. By: Mellin, Anna (VTI); Nerhagen, Lena (VTI)
    Abstract: The purpose is to provide a background for a discussion concerning the methods and values used in cost-benefit analysis in Sweden for air pollutions', from traffic, impact on human health and the research needs in this area. We provide an overview of the current state of the art of models used for and input needed for external cost calculations of the health impacts. The calculations are not straightforward and depend on the collaboration between several research disciplines. In the ExternE projects, which have been used as a reference point in this study, there are still uncertainties concerning which pollutants to take into consideration. <p> Regarding the health impacts, we have recapitulated some of the main conclusions in a review by the American Heart Association (2010). They state that e.g. the following issues need further research: the importance of ultrafine particles, what constituent parts make traffic related air pollution more harmful than PM2.5 in general and the importance of coarse particles. <p> Concerning external cost calculations these can be of help to reveal important health aspects to consider in further research, if done in a transparent way. Some pollutants which are very harmful are released in such small concentrations that the overall effect is still relative limited. Hence, undertaking external cost calculations gives an indication of which pollutants to cover in the models and analyses to make them relevant but at the same time manageable. <p> Further, there are the questions of how to handle the relationship between Value of a Statistical Life and age, and of which values that should be used for children. This is an area where little research has been carried out. One important area is how to use discounting to account for the time dimension since current air pollution may influence children’s health in the future. More research is also needed regarding the valuation of morbidity. Here there are two issues to consider, the value of the welfare loss from being ill and the cost of illness. We have not found reliable estimates of these components for Sweden.
    Keywords: Health effects; External cost calculations; ExternE; Emissions; Transport
    JEL: H23
    Date: 2010–08–18
  8. By: Leiter, Andrea M. (Department of Economics and Statistics, University of Innsbruck); Thöni, Magdalena (Department for Human and Economic Sciences, University of Health Sciences, Medical Informatics and Technology (UMIT)); Winner, Hannes (University of Salzburg)
    Abstract: This paper provides a framework to evaluate human life based on court decisions on damages for pain and suffering. Using judgements from Germany and Austria over the last 25 years, we calculate an average Value of Damages for Pain and Suffering (VDPS) of about EUR 1.79 millions, with a minimum (maximum) of around EUR 0.67 (4.62) millions. These values are broadly in line with the ones from previous studies. However, our approach also allows to calculate the value of body parts and body functions, which might be of interest if information on the benefit of an individual’s change in life quality is not (entirely) available (e.g., decisions to provide specific health services).
    Keywords: Value of life; quality adjusted life years; value of body parts; tort law; pain and suffering
    JEL: I10 J17 K13
    Date: 2010–08–15
  9. By: Philip DeCicca (McMaster University)
    Abstract: Despite a strong interest in entrepreneurship, economists have devoted little attention to the role of health insurance availability. I investigate the impact of a unique policy experiment—New Jersey’s Individual Health Coverage Plan—on self-employment. Implemented in August 1993, the IHCP included an extensive set of reforms that loosened the historical connection between traditional employment and health insurance by facilitating access to coverage that was not employer-linked. I find evidence that the IHCP increased self-employment among New Jersey residents, relative to various sets of comparison states. Consistent with key policy features, including pure community rating of premiums, I find larger behavioral responses for unmarried, older, and observably less-healthy individuals.
    Keywords: Health Insurance, Entrepreneurship, Job Lock
    JEL: I18 J32 J62
    Date: 2010–04
  10. By: Christian E. Weller; Jeffrey Wenger
    Abstract: Rising health care costs and declining personal savings rates are nearly synonymous with household medical debt. For some, defined contribution (DC) retirement savings plans provide a ready source of funds to meet these medical debts. We examine whether health status and health insurance coverage predict the likelihood of having a DC loan using data from the Federal Reserve’s triennial Survey of Consumer Finances from 1989 to 2007. We find that poor health raises the likelihood that a household will borrow from their DC plans, even controlling for other forms of debt, access to credit, and whether households are covered by health insurance. Our estimates of the amount of the DC loan, taking selection effects into account, indicates that DC loan amounts are also influenced by health status; those with poor health borrow more from their DC plans. Apart from health status, once a household decides to borrow from their retirement funds, race and education also influence how much to borrow. We argue that public policy can improve the long-term financial retirement security of households by offering more opportunities to save for medical emergencies, while cautiously maintaining the opportunity to borrow from DC plans.<span> </span><p> </p>
    Keywords: Defined contribution retirement savings plans; pension debt; health insurance coverage; health status
    Date: 2010
  11. By: Bing Ma (UMBC)
    Abstract: This paper presents a systematic analysis of the impact of socioeconomic status (SES) on overweight and obesity in China and investigates how and why the SES-obesity gradient differs with age. Using a longitudinal sample drawn from the China Health and Nutrition Survey (CHNS), I find that body mass index (BMI) is predicted to increase with age and is positively associated with SES during early childhood but becomes adversely related to childhood SES as children age into adulthood. Estimation results show that children from low SES families are less likely to be overweight or obese than their median and high SES peers. The results from subsamples stratified by living areas (rural vs. urban) reveal that the SES gaps of overweight and obesity are generally larger for urban residents than rural residents. My study indicates that females are significantly less likely to be overweight than males in China. The SES during childhood has independent effects after controlling for respondents’ contemporaneous SES. Interestingly, the relationship between the contemporaneous SES of a male adult and his chance of being overweight or obese is significantly positive. In this instance, early childhood SES becomes insignificant. On the contrary, the contemporaneous SES of a female adult is negatively related with her chance of being overweight or obese.
    Keywords: Overweight and Obesity, Socioeconomic Status, China
    JEL: I10 I18
    Date: 2010–07–15
  12. By: Titus Galama; Hans van Kippersluis
    Abstract: Understanding of the substantial disparity in health between low and high socioeconomic status (SES) groups is hampered by the lack of a sufficiently comprehensive theoretical framework to interpret empirical facts and to predict yet untested relations. The authors present a life-cycle model that incorporates multiple mechanisms explaining (jointly) a large part of the observed disparities in health by SES. In their model, lifestyle factors, working conditions, retirement, living conditions and curative care are mechanisms through which SES, health and mortality are related. Their model predicts a widening and possibly a subsequent narrowing with age of the gradient in health by SES.
    Keywords: socioeconomic status, education, health, demand for health, health capital, medical care, life cycle, age, labor, retirement, mortality
    JEL: D91 I10 I12 J00 J24
    Date: 2010–07
  13. By: Peter Nunnenkamp; Hannes Öhler
    Abstract: We assess empirically whether foreign official development assistance (ODA) has been effective in alleviating HIV/AIDS epidemics, which figures prominently among the Millennium Development Goals. We employ a difference-in-difference-in-differences approach to identify the treatment effect of ODA specifically meant to fight sexually transmitted diseases on HIV/AIDS-related outcome variables. We do not find that ODA has prevented new infections to an extent that would have reduced the number of people living with HIV. By contrast, ODA has contributed effectively to the medical care of infected people. However, conclusive evidence on significant treatment effects on AIDS-related deaths only exists for the major bilateral source of ODA, the United States. In particular, targeted US assistance programs appear to be more effective than the activities of multilateral organizations
    Keywords: HIV prevalence, AIDS-related deaths, official development assistance, aid effectiveness, major donors, difference-in-difference-in-differences
    JEL: F35 I19
    Date: 2010–08

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