nep-hea New Economics Papers
on Health Economics
Issue of 2010‒09‒25
eighteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Do health investments improve agricultural productivity? By McNamara, Paul E.; Ulimwengu, John M.; Leonard, Kenneth L.
  2. The hope for neglected diseases: R&D incentives By Brigitte Granville; Eshref Trushin
  3. Modelling the spatial patterns of influenza incidence in Sweden By Schiöler, Linus
  4. Multivariate outbreak detection By Schiöler, Linus; Frisén, Marianne
  5. Sickness Absence and Local Cultures By Ekblad, Kristin; Bokenblom, Mattias
  6. Working Conditions, Absence and Gender - a Multilevel Study By Bokenblom, Mattias; Ekblad, Kristin
  7. "Waiting for the Other Shoe to Drop": Waiting for Health Care and Duration of Sick Leave By Andrén, Daniela; Granlund, David
  8. Present-Biased Preferences and Publicly Provided Health Care By Aronsson, Thomas; Granlund, David
  9. Evaluating the Effects of Large Scale Health Interventions in Developing Countries: The Zambian Malaria Initiative By Nava Ashraf; Günther Fink; David N. Weil
  10. Orphanhood and Critical Periods in Children's Human Capital Formation: Long-Run Evidence from North-Western Tanzania By Hagen, Jens; Omar Mahmoud, Toman; Trofimenko, Natalia
  11. Does AIDS-Related Mortality Reduce Per-Capita Household Income? Evidence from Rural Zambia By Omar Mahmoud, Toman; Thiele, Rainer
  12. What Causes Obesity? And Why Has it Grown So Much? An Alternative View By John F. Tomer
  13. Is there a Future for Small Hospitals in Germany? By Boris Augurzky; Hendrik Schmitz
  14. Regulation in Health Care in Tamil Nadu (India): A study of the Implementation of Transplantation of Human Organs Act (THOA) 1994, and Consumer Protection Act (CPA) 1986 By Vangal R Muraleedharan; S Ram Prasad
  15. Global Trends in AIDS Mortality By John Bongaarts; François Pelletier; Patrick Gerland
  16. The value of statistical life : a contingent investigation in China By Wang, Hua; He, Jie
  17. Longitudinal analysis of income-related health inequality: welfare foundations and alternative measures By Paul Allanson
  18. Do Initial Endowments Matter Only Initially? The Persistent Effect of Birth Weight on School Achievement By Bharadwaj, Prashant; Eberhard, Juan; Neilson, Christopher

  1. By: McNamara, Paul E.; Ulimwengu, John M.; Leonard, Kenneth L.
    Abstract: Determining the causality between health measures and both income and labor productivity remains an ongoing challenge for economists. This review paper aims to answer the question: Does improved population health lead to higher rates of agricultural growth? In attempting to answer this question, we survey the empirical literature at micro and macro levels concerning the link between health investments and agricultural productivity. The evidence from some micro-level studies suggests that inexpensive health interventions can have a very large impact on labor productivity. The macro-level evidence at the country and global level, however, is mixed at best and in some cases suggests that health care interventions have no impact on income, much less on agricultural productivity. At both micro and macro levels, the literature does not provide a clear-cut answer to the question under investigation. Overall, the review reveals a great deal of heterogeneity in terms of estimation methods, definition and measurement of health variables, choice of economic outcomes, single-equation versus multiple-equation approach, and static versus dynamic approach. The actual magnitude of estimated elasticities is difficult to assess in part due to estimation bias caused by the endogeneity of health outcomes. We also found significant gaps in the literature; for example, very little attention is given to demand for health inputs by rural populations and farmers.
    Keywords: Agriculture, Growth, health, Investment, Nutrition, productivity,
    Date: 2010
  2. By: Brigitte Granville; Eshref Trushin
    Abstract: Neglected diseases are neglected because they cannot generate enough return on R&D to pharmaceutical firms. This paper analyzes and compares existing proposals for public intervention in R&D for neglected diseases. Incentives for neglected diseases are comprehensively evaluated based on seventeen selected criteria grouped into four categories: efficiency, feasibility, fairness, and sustainability. Our conclusion is that public-private partnerships coordinated through a centralized service platform have the highest potential to satisfy the criteria for the successful development..
    Keywords: neglected diseases, incentives, pharmaceutical R&D, policy analysis
    JEL: I12 I18 H41 H87
    Date: 2010–08
  3. By: Schiöler, Linus (Statistical Research Unit, Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: Information about the spatial spread of epidemics can be useful for many purposes. The spatial aspect of Swedish influenza data was analyzed with the main aim of finding patterns that could be useful for statistical surveillance of the outbreak, i.e. for detecting an increase in incidence as soon as possible. In Sweden, two types of data are collected during the influenza season: laboratory diagnosed cases (LDI), collected by a number of laboratories, and cases of influenza-like illness (ILI), c... merollected by a number of selected physicians. Quality problems were found for both types of data but were most severe for ILI. No evidence for a geographical pattern was found. Instead, it was found that the influenza outbreak starts at about the same time in the major cities and then occurs in the rest of the country. The data were divided into two groups, a metropolitan group representing the major cities and a locality group representing the rest of the country. The properties of the metropolitan group and the locality group were studied and it was found that the time difference in the onset of the outbreak was about one week. Both parametric and nonparametric regression models were suggested.
    Keywords: Influenza; Sweden; onset of outbreak; statistical models; spatial; monitoring
    JEL: C10
    Date: 2010–09–17
  4. By: Schiöler, Linus (Statistical Research Unit, Department of Economics, School of Business, Economics and Law, Göteborg University); Frisén, Marianne (Statistical Research Unit, Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: On-line monitoring is needed to detect outbreaks of diseases like influenza. Surveillance is also needed for other kinds of outbreaks, in the sense of an increasing expected value after a constant period. Information on spatial location or other variables might be available and may be utilized. We adapted a robust method for outbreak detection to a multivariate case. The relation between the times of the onsets of the outbreaks at different locations (or some other variable) was used to determine the sufficient statistic for surveillance. The derived maximum likelihood estimator of the outbreak regression was semi-parametric in the sense that the baseline and the slope were non-parametric while the distribution belonged to the exponential family. The estimator was used in a generalized likelihood ratio surveillance method. The method was evaluated with respect to robustness and efficiency in a simulation study and applied to spatial data for detection of influenza outbreaks in Sweden.
    Keywords: Exponential family; Generalised likelihood; Ordered regression; Regional data; Surveillance
    JEL: C10
    Date: 2010–09–17
  5. By: Ekblad, Kristin (Department of Business, Economics, Statistics and Informatics); Bokenblom, Mattias (Department of Business, Economics, Statistics and Informatics)
    Abstract: Sickness absence has been found to vary substantially across geographical areas. There are large differences between different countries but also between different regions within a particular country. In the literature some of these observed differentials have been suggested to stem from differences in local norms with regard to the legitimacy of living off benefits. The aim of our study is to investigate the effect of geographical and presumed cultural context on sickness absence. In order to identify this effect we compare changes in sickness related absence for individuals who move from one Swedish region to another with those occurring when individuals move within Swedish regions. Our results indicate that the region of residence is important to the individual sickness related absence. Moreover, we cannot rule out the possibility that the observed patterns are caused by local cultures regarding sickness absence and the existence of a so called “cultural illness”.
    Keywords: Sickness absence; social norms; domestic migration
    JEL: J22 R23 Z13
    Date: 2010–09–14
  6. By: Bokenblom, Mattias (Department of Business, Economics, Statistics and Informatics); Ekblad, Kristin (Department of Business, Economics, Statistics and Informatics)
    Abstract: In this paper we use data that combines employment records with employee survey responses to study to what extent psychosocial working conditions, measured at the work group level, relate to individual short-term and long-term sick leave. In order to take interdependencies of workers and work groups into consideration we use multilevel modeling as our modeling strategy. Our results suggest that in order to reduce the number of spells of short-term sick leave (shirking), employers should increase the worker’s job autonomy. This is particularly important for male workers. In addition, increasing work group cohesion is important in order to reduce the number of women being on long-term sick leave.
    Keywords: Working conditions; absence; gender
    JEL: J28 J81
    Date: 2010–09–14
  7. By: Andrén, Daniela (Department of Business, Economics, Statistics and Informatics); Granlund, David (The Swedish Retail Institute (HUI))
    Abstract: This paper uses a labor supply model that incorporates waiting for health care to derive an empirical specification for sick leave and to estimate the impact of waiting for health care on the duration of sick leave. In the estimations, we use the 2002 sample of the RFV-LS register database, supplemented with information from questionnaires. The results indicate that almost all waiting for health care variables have a statistically significant positive impact on the duration of sick leave, and did not induce substantial changes on the impact of traditional variables of the labor supply model.
    Keywords: sick leave; waiting list
    JEL: I12 J21 J28
    Date: 2010–09–10
  8. By: Aronsson, Thomas (Department of Economics, Umeå University); Granlund, David (Department of Economics, Umeå University)
    Abstract: In this paper, we analyze the welfare effects of publicly provided health care in an economy where the consumers have "present-biased" preferences due to quasi-hyperbolic discounting. The analysis is based on a two-type model with asymmetric information between the government and the private sector, and each consumer lives for three periods. We present formal conditions under which public provision to the young and middle-aged generation, respectively, leads to higher welfare. Our results show that quasi-hyperbolic discounting provides a strong incentive for public provision to the young generation; especially if the consumers are naive (instead of sophisticated).
    Keywords: Public provision of private goods; hyperbolic discounting; intertemporal model; asymmetric information
    JEL: D61 H42
    Date: 2010–09–17
  9. By: Nava Ashraf; Günther Fink; David N. Weil
    Abstract: Since 2003, Zambia has been engaged in a large-scale, centrally coordinated national anti- Malaria campaign which has become a model in sub-Saharan Africa. This paper aims at quantifying the individual and macro level benefits of this campaign, which involved mass distribution of insecticide treated mosquito nets, intermittent preventive treatment for pregnant women, indoor residual spraying, rapid diagnostic tests, and artemisinin-based combination therapy. We discuss the timing and regional coverage of the program, and critically review the available health and program rollout data. To estimate the health benefits associated with the program rollout, we use both population based morbidity measures from the Demographic and Health Surveys and health facility based mortality data as reported in the national Health Management Information System. While we find rather robust correlations between the rollout of bed nets and subsequent improvements in our health measures, the link between regional spraying and individual level health appears rather weak in the data.
    Date: 2010
  10. By: Hagen, Jens; Omar Mahmoud, Toman; Trofimenko, Natalia
    Abstract: Losing a parent is a trauma that has consequences for human capital formation. Does it matter at what age this trauma occurs? Using longitudinal data from the Kagera region in Tanzania that span thirteen years from 1991-2004, we find considerable impact heterogeneity across age at bereavement, but less so for the death of opposite-sex parents. In terms of long-term health status as measured by body height, children who lose their same-sex parent before teenage years are hit hardest. Regarding years of formal education attained in young adulthood, boys whose fathers die before adolescence suffer the most. Maternal bereavement does not fit into this pattern as it affects educational attainment of boys and girls in a similar way. The generally strong interaction between age at parental death and sex of the late parent suggests that the preferences of the surviving parent partly protect same-sex children from orphanhoods detrimental effects on human capital accumulation. --
    Keywords: orphans,health,education,timing of parental death,child development,HIV/AIDS
    JEL: I31 J19 C14 C23
    Date: 2010
  11. By: Omar Mahmoud, Toman; Thiele, Rainer
    Abstract: --
    Keywords: HIV/AIDS,prime-age mortality,per-adult equivalent income,difference-in-difference,propensity score matching,spillovers,Zambia
    JEL: I31 J19 C14 C23
    Date: 2010
  12. By: John F. Tomer
    Abstract: The purpose of this paper is to explain the main social and economic facts concerning obesity in a way that substantially improves upon existing economic theory. In contrast to existing theory, a number of recent health science writers have explained persuasively that weight gain or loss is not strictly determined by net calorie consumption. These writers have explained that what food people eat and the effect these foods have on hormones such as insulin and hormonal balance are the crucial factors. To understand the rising prevalence of obesity, it is necessary to take into account the growing infrastructure of obesity. This infrastructure includes food processing firms, notably their behavior relating to the qualities of processed food, their marketing of "junk food" and fast food, and their food cost reducing technological changes. Another factor in rising obesity levels are the human capital resources of people, most notably their social capital, personal capital, and health capital. There is evidence that people who are poor in these intangible capacities are the ones with the highest rates of obesity. The essence of the theory is that obesity is the expected result when vulnerable people with low intangible capital resources encounter the many influences of the infrastructure of obesity. These people have gotten stuck in dysfunctional eating and exercise patterns which societal influences have unfortunately encouraged.
    Keywords: Length 39 pages
    Date: 2010–09
  13. By: Boris Augurzky; Hendrik Schmitz
    Abstract: We analyse the fi nancial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of fi nancial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We fi nd that, on average, small hospitals have more fi nancial diffi culties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profi t hospitals tend to perform very well, small public hospitals face considerable fi nancial problems. Apart from ownership, we fi nd that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better fi nancial performance.
    Keywords: Hospital ownership; fi nancial performance
    JEL: I11 I18
    Date: 2010–08
  14. By: Vangal R Muraleedharan; S Ram Prasad
    Abstract: The functioning of healthcare sector could be substantially influenced by the design and implementation of regulatory policies that govern the behaviour of various stakeholders. The empirical challenge is to assess whether and how far have regulations brought about “desirable and intended†changes in the functioning of the healthcare delivery system. Tthe experience of the Consumer Protection Act (1986) and the Transplantation of Human Organs Act (1995) is analysed. [HEFP WP No. 08/03].
    Keywords: tamil nadu, patient, india, organ, transplantation, health care, sector, delivery, consumer protection, human,
    Date: 2010
  15. By: John Bongaarts; François Pelletier; Patrick Gerland
    Abstract: This paper reviews the evolution of the HIV/AIDS epidemic and provides estimates of past trends and future projections of AIDS mortality indicators, including numbers of AIDS deaths, the proportion of all deaths that are due to AIDS, and life expectancy. In 2007, a total of 2.0 million men, women, and children died of AIDS worldwide. The death toll will remain high in the future because 33 million individuals are currently infected and about 2.7 million new HIV infections occur each year. A cumulative total of 24 million people have died from AIDS between 1980 and 2007, and by 2030 this total is projected to reach 75 million. Despite the rapid spread of this new disease during the 1980s and 1990s, the epidemic has reached a major turning point in recent years as the rate of new infections peaked and began a decline. Worldwide, the proportion of all deaths caused by AIDS reached 3.9 percent in 2004. This proportion varies widely from a high of 15 percent in sub-Saharan Africa to around one percent in Asia and other regions. In the future, the number of AIDS deaths and the proportion of deaths due to AIDS are projected to remain approximately at their current levels. [Working Paper No. 16]
    Keywords: HIV/AIDS, mortality, proportion, life expectancy, sub-Saharan,
    Date: 2010
  16. By: Wang, Hua; He, Jie
    Abstract: Economic analyses of development projects and policies often involve assigning an economic value to changes in the risk of loss of human life. A typical term used in the economic analyses is the value of statistical life, which reflects the aggregation of individuals'willingness to pay for fatal risk reduction and therefore the economic value to society to reduce the statistical incidence of premature death in the population by one. Studies on the value of a statistical life have been extensively conducted in the developed world; however, few such studies can be found for developing countries. This paper presents a study that estimates individuals'willingness to pay for cancer risk prevention in three provinces of China. The results imply that the mean value of willingness to pay for a cancer vaccine that is effective for one year is 759 yuan, with a much lower median value of 171 yuan. The estimated income elasticity of willingness to pay is 0.42. Using data on the incidence of cancer illness and death in the population, these willingness to pay figures imply that the marginal value of reducing the anticipated incidence of cancer mortality by one in the population is 73,000 yuan and an average value of 795,000 yuan, which are about six and 60 times average household annual income, respectively. The big difference between the marginal value and the average value of fatal risk reduction corresponds to a very low estimated elasticity of willingness to pay with respect to fatal risk reduction. This finding challenges the validity of previous studies of the value of a statistical life, which are mostly based on average willingness-to-pay values of mortality risk reduction.
    Keywords: Environmental Economics&Policies,Health Monitoring&Evaluation,Labor Policies,Population Policies,Economic Theory&Research
    Date: 2010–09–01
  17. By: Paul Allanson
    Abstract: This paper elaborates the approach to the longitudinal analysis of income-related health inequalities first proposed in Allanson, Gerdtham and Petrie (2010). In particular, the paper establishes the normative basis of their mobility indices by embedding their decomposition of the change in the health concentration index within a broader analysis of the change in “health achievement” or wellbeing. The paper further shows that their decomposition procedure can also be used to analyse the change in a range of other commonly-used incomerelated health inequality measures, including the generalised concentration index and the relative inequality index. We illustrate our work by extending their investigation of mobility in the General Health Questionnaire measure of psychological well-being over the first nine waves of the British Household Panel Survey from 1991 to 1999.
    Keywords: income-related health inequality, mobility analysis, longitudinal data
    JEL: D39 D63 I18
    Date: 2010–08
  18. By: Bharadwaj, Prashant; Eberhard, Juan; Neilson, Christopher
    Abstract: This paper investigates the causal relationship between birth weight and school achievement among children in grades 1 through 8. We find that birth weight significantly affects performance on both math and language test scores in school. Children with higher birth weight do better - a 10% increase in birth weight improves performance in math by nearly 0.05 standard deviations in 1st grade. Children who are born at a weight less than 1500 grams (very low birth weight) have scores in math that are 0.15 standard deviations less in 1st grade. We exploit repeated observations on children to show that birth weight has a persistent effect that does not deteriorate as children advance through grades (upto 8th grade). Children with greater birth weight are also less likely to have ever repeated a grade. The causal link is identified by using a twins estimator - we collected birth weight and basic demographic data on all twins born in Chile between 1992-2000 and match these twin pairs to administrative school records between 2002-2008. There are no differences in school attendance by birth weight, suggesting that missing school perhaps due to health problems is likely not a channel via which test score differentials arise.
    Keywords: school achievement, birth weight
    Date: 2010–09–16

This nep-hea issue is ©2010 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.