nep-hea New Economics Papers
on Health Economics
Issue of 2010‒10‒09
34 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior By Bent Jesper Christensen; Malene Kallestrup Lamb
  2. Political Factors and Health Outcomes: Insight from Argentina's Provinces By James W. McGuire
  3. Pollution Exposure and Infant Health: Evidence from Germany By Katja Coneus; C. Katharina Spieß
  4. Causality test between health care expenditure and GDP in US: comparing periods By Arshia Amiri; Bruno Ventelou
  5. Sexual Risk Taking Among Young Adults in Cape Town: Effects of Expected Health and Income By Mintewab Bezabih; Andrea Mannberg; Martine Visser
  6. When obese people are more patient than non-obese people: a study of post-surgery individuals in a weight loss association By Santiago Budría; Juan A. Lacomba; Francisco Lagos
  7. Mobbing and workers' health: an empirical analysis for Spain By M. Angeles Carnero Fernández; Blanca Martínez; Rocío Sánchez Mangas
  8. Diseases, infection dynamics and development By Chris Papageorgiou; Fidel Pérez Sebastián; Shankha Chakraborty
  9. Longitudinal Studies of Human Growth and Health: A Review of Recent Historical Research By Kris Inwood; Evan Roberts
  10. Parental Job Loss and Infant Health By Lindo, Jason M.
  11. Religion and Child Health By Chiswick, Barry R.; Mirtcheva, Donka M.
  12. The Lasting Impact of Mothers' Fetal Malnutrition on Their Offspring: Evidence from the China Great Leap Forward Famine By Kim, Seonghoon; Deng, Quheng; Fleisher, Belton M.; Li, Shi
  13. Is Employer-Based Health Insurance a Barrier to Entrepreneurship? By Fairlie, Robert W.; Kapur, Kanika; Gates, Susan
  14. Why a positive link between age and income-related health inequality? By Nordin , Martin; Gerdtham , Ulf-G
  15. The Standard Deviation of Life-Length, Retirement Incentives, and Optimal Pension Design By Aronsson, Thomas; Blomquist, Sören
  16. Comparing Price Levels of Hospital Services Across Countries: Results of Pilot Study By Francette Koechlin; Luca Lorenzoni; Paul Schreyer
  17. Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries By Marie-Laure Delamaire; Gaetan Lafortune
  18. Guidelines for Improving the Comparability and Availability of Private Health Expenditures Under the System of Health Accounts Framework By Ravi P. Rannan-Eliya; Luca Lorenzoni
  19. The Challenge of Financing Health Care in the Current Crisis: An Analysis Based on the OECD Data By Peter Scherer; Marion Devaux
  20. Effective Ways to Realise Policy Reforms in Health Systems By Jeremy Hurst
  21. The Wage Elasticity of Informal Care Supply: Evidence from the Health and Retirement Study By Olena Nizalova
  22. Role of Private Hospitals in Kerala : An Exploration By T.R. Dilip
  23. Obesity under affluence varies by welfare regimes: The effect of fast food, insecurity, and inequality.. By Offer, Avner; Pechey, Rachel; Ulijaszek, Stanley
  24. The male-female gap in physician earnings: Evidence from a public health insurance system. By Theurl, Engelbert; Winner, Hannes
  25. Ownership, Incentives and Hospitals By Xavier Fageda; Eva Fiz
  26. Prediction of the economic cost of individual long-term care in the Spanish population By Catalina Bolancé; Ramon Alemany; Montserrat Guillén
  27. Growth and Welfare under Endogenous Lifetime By Maik T. Schneider; Ralph Winkler
  28. The Weight of the Crisis: Evidence From Newborns in Argentina By Carlos Bozzoli; Climent Quintana
  29. Health, disability and pathways into retirement in Spain By Pilar García Gómez; Sergi Jiménez Martín; Judit Vall Castello
  30. A New Avenue for Understanding the Nutritional Health of Children in Guinea By Ohiniba Carole Bruce; Dorothée Boccanfuso
  31. Attrition and Health in Ageing Studies: Evidence from ELSA and HRS By James Banks; Alastair Muriel; James P. Smith
  32. Primary care utilisation and workers’ opportunity costs. Evidence from Italy By De Luca, Giuliana; Ponzo, Michela
  33. A Competing Risk Model for Health and Food Insecurity in the West Bank By Cavatorta, Elisa; Pieroni, Luca
  34. Throwing Foreign Aid at HIV/AIDS in Developing Countries: Missing the Target? By Peter Nunnenkamp; Hannes Öhler

  1. By: Bent Jesper Christensen (School of Economics, Aarhus University and CREATES); Malene Kallestrup Lamb (School of Economics, Aarhus University)
    Abstract: People quit the labor force for many different reasons, voluntarily or not, through various arrangements such as unemployment benefits, disability benefits or specially designed early retirement schemes. This paper complements the existing literature by considering a large, register-based sample including objective medical diagnosis codes. We estimate detailed hazard models of duration until retirement, controlling for unobserved heterogeneity and nonparametric baseline hazards, as well as observed heterogeneity through time-varying explanatory variables. These include diagnosis codes, along with a host of demographic, labor market and financial regressors. The panel structure of the data allows following individuals year by year from the age of 50 and precisely measure changes in objectively measured health and other regressors, as well as labor market status. We consider 12 broad, mutually exclusive and exhaustive categories of health diagnoses defined by aggregation across ICD codes. The use of objective medical diagnosis codes should eliminate the justification bias due to self-reports of health, and the large sample size obtained by using register rather than survey data should mitigate the e¤ect of any remaining mismeasurement of true work incapacity. Together, these improvements should help distinguish empirically important effects of health and economic variables on retirement. We distinguish a number of alternative exit routes, in particular, disability, early retirement, unemployment, and others (including out of the labor force and welfare). We estimate both single risk models, lumping all retirement states, and competing risk specifications, including all separate exit routes. Throughout, females are included in the estimations, and we present separate results by gender. We find sizeable differences in retirement behavior across marital status, gender, labor market attachment, occupation, income, and in particular health. We find that the disability retirement exit route that requires specific medical criteria to be met is different from the early retirement route. The latter shares similarities with private pension schemes in a number of countries, including the U.S., where benefits are tied to previous wages, and employers also contribute to this retirement scheme. These differences are pronounced within labor market attachment, income, and in particular health. Furthermore, unemployment followed by early retirement is different from unemployment followed by other programs regarding marital status, gender, income, and health. These comparisons hinge on the competing risk framework. Finally, even when using objective medical diagnosis measures we still find significant effects from health on retirement. Thus, not all health impact on retirement reported in earlier literature was due to justification bias.
    Keywords: Competing risks, Duration analysis, Grouped data, Justification bias, Objective medical diagnosis codes, Retirement, Unobserved heterogeneity.
    JEL: I18 J26 C41
    Date: 2010–09–01
  2. By: James W. McGuire (Department of Government at Wesleyan University)
    Abstract: This paper explores whether political factors were associated with health outcomes across Argentina's 23 provinces and Federal Capital from 1983 to 2005, controlling for national trends, per capita economic output, and other provincial specificities. The introduction of a gender quota for the lower house of the provincial legislature is found to have a statistically significant and substantively strong association with lower infant mortality. Most other political factors are found to be unassociated with the health share of provincial spending, attendance at birth by trained personnel, or infant survival. This lack of association stands in contrast to the findings of the cross-national literature, in which political factors are often found to be associated with health care spending, health service utilization, and health status. Differences in level of analysis (national vs. subnational) and in statistical technique help to explain these contrasting findings. Still, the analysis suggests that relations between political factors and health outcomes may be weaker than is sometimes suggested. As Amartya Sen has noted, democratic freedoms (and other political factors) create opportunities to improve other dimensions of human development. Whether these opportunities are seized depends on the actions of citizens and governments.
    Keywords: human development, democracy, mortality, health care, gender, subnational, Argentina.
    JEL: O15 N46 I12 I18 J16 H51 O54
    Date: 2010–09
  3. By: Katja Coneus; C. Katharina Spieß
    Abstract: This paper examines the impact of outdoor and indoor pollution on children¿s health from birth until the age of three years in Germany. We use representative data from the German Socio-Economic Panel (SOEP), combined with five air pollution levels. These data come from the Federal Environment Agency and cover the years 2002-2007. Our work offers three important contributions. Firstly, we use accurate measures for five different pollutants (CO, NO2, SO2, O3, and PM10) on a (half-)hourly basis. Secondly, we are able to follow the effect of pollution exposure on a child¿s health during the first three years of life, accounting for time-invariant and unobserved neighborhood and mother-specific characteristics. Thirdly, we calculate different pollution intensity measures. Instead of relying solely on mean pollution levels, we are able to use (half-)hourly pollution levels as well as indoor pollution as meas-urements for the total latent pollution exposure. Our results suggest a significantly negative impact for some pollutants on infant health during early childhood. In comparison to outdoor pollution, indoor pollution seems to be more harmful directly after birth, while the relation-ship between indoor and outdoor pollution changes later in childhood. Since smoking is one source of producing carbon monoxide and thus affects child health negatively, our results further support the advice to parents of young children not to smoke.
    Keywords: Indoor and outdoor pollution, health, early childhood
    JEL: I12 Q53 J13
    Date: 2010
  4. By: Arshia Amiri (Department of Agricultural Economics - Shiraz University); Bruno Ventelou (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - CNRS : UMR6579)
    Abstract: In the literature dedicated to the “health as a luxury good” question, health care expenditure (HCE) is hypothesized to be a function of GDP without considering any other relationships. In this paper, we argue that this could be a bilateral relationship: good health is considered as an input of the macroeconomic production function, stimulating the GDP. A modified version of the Granger (1969) causality test proposed by Toda and Yamamoto (1995) is investigated between GDP per capita and HCE per capita in United States for comparing the periods of 1965_1984, 1975_1994, 1985_2004 and 1965_2004. Results show these three periods have different causal relationships. At the beginning for 1965_1984, there exists a bilateral relationship. For the following period, there is a unidirectional relationship from HCE to GDP, and for the 1985_2004, a unidirectional GDP_HCE is significant. From the start to end of periods (1965_2004), a unidirectional relation from HCE to GDP is existed.
    Keywords: Health care expenditure per capita; per capital GDP; Toda-Yamamoto causality; United States
    Date: 2010–09–22
  5. By: Mintewab Bezabih; Andrea Mannberg; Martine Visser (SALDRU, School of Economics, University of Cape Town)
    Abstract: The wide prevalence of HIV in Africa has long been associated with seemingly irrational levels of sexual risk taking. Hence understanding the rationale behind risky sexual behavior is critical for designing effective prevention policies. This paper empirically assesses links between expectations of future health and income on sexual risk taking. An important contribution of the paper lies in combining a wide range of variables measuring risky sexual behavior such that the maximum information possible is extracted from, and adequate weights are attached to each measure, as opposed to previous studies that are based on individual measures or arbitrary aggregations. The findings indicate that expected income and health and future uncertainty are significant determinants of current patterns of sexual risk taking. From a policy perspective, the results suggest that reducing poverty and improving social insurance as well as reducing the taboo related to talking about HIV, and further investigating the relatively low degree of condom use of women may constitute important issues to be addressed.
    Date: 2010–05
  6. By: Santiago Budría (Department of Management and Economics, University of Madeira); Juan A. Lacomba (Department of Economic Theory and Economic History, University of Granada, GLOBE); Francisco Lagos (Department of Economic Theory and Economic History, University of Granada, GLOBE)
    Date: 2010–09–01
  7. By: M. Angeles Carnero Fernández (Universidad de Alicante); Blanca Martínez (Universidad de Alicante); Rocío Sánchez Mangas (Dpto. Análisis Económico: Economía Cuantitativa)
    Abstract: his paper analyzes empirically the impact of mobbing on the health of workers in Spain. Based on the Sixth Spanish Survey on Working Conditions, we first describe the differences in health among mobbed and not mobbed workers, sing two different indicators: the worker's self-perception that work affects health and the presence of bad health symptoms. The descriptive evidence shows that mobbing victims perform worse on such health indicators. We estimate the effect of being mobbed on the probability of suffering from health problems, taking into account the potential endogeneity of mobbing. Our estimates show that being a mobbing victim increases significantly the probability of having bad health, independently on the indicator used. Moreover, when bad health is measured by the perception indicator, we find that the effect of mobbing is underestimated if endogeneity is not accounted for.
    Keywords: bullying at workplace, moral harassment
    JEL: C20 I10 J28
    Date: 2010–09
  8. By: Chris Papageorgiou (Louisiana State University); Fidel Pérez Sebastián (Universidad de Alicante); Shankha Chakraborty (Department of Economics)
    Abstract: We propose an economic theory of infectious disease transmission and rational behavior. Diseases are costly due to mortality (premature death) and morbidity (lower productivity and quality of life). The theory offers three main insights. First, higher disease prevalence implies lower saving-investment propensity. Preventive behavior can partially offset this when the prevalence rate and negative disease externality are relatively low. Secondly, infectious diseases can generate a low-growth trap where income alone cannot push an economy out of underdevelopment, a result that differs from development traps in the existing literature. Since income per se does not cause health in this equilibrium, successful interventions have to be health specific. Thirdly, a more favorable disease ecology propels the economy to a higher growth path where infectious diseases are eradicated. Even so, diseases can significantly slow down convergence to this growth path. Taken together, our results suggest that the empirical relationship between health and income at the aggregate level may be more nuanced than realized.
    Keywords: Infectious Disease, Rational Disease Behavior, Morbidity, Mortality, Productivity, Economic Development
    JEL: O40 O47
    Date: 2010–09
  9. By: Kris Inwood (Department of Economics,University of Guelph); Evan Roberts (Department of History, University of Minnesota.)
    Abstract: This paper reviews recent literature using stature and weight as measures of human welfare with a particular interest in cliometric or historical research. We begin with an overview of anthropometric evidence of living standards and the new but fast-growing field of anthropometric history. This literature is always implicitly and often explicitly longitudinal in nature. We then discuss (i) systematic empirical research into the relationship between conditions in early life and later life health and mortality and (ii) historical evidence on the relationship between body mass, morbidity and mortality. We conclude with a discussion of the importance of historical sources and understandings to health economics and population health.
    Keywords: Anthropometric history; Biological standard of living; Height; Obesity; Physical stature; Well-being
    JEL: I12 J11 N30 N31 N32 N33 O15
    Date: 2010
  10. By: Lindo, Jason M. (University of Oregon)
    Abstract: Although there exists a large literature documenting various consequences of job loss, this paper is the first to explore the extent to which the health effects of job displacement extend to the children of displaced workers and also the first to consider whether there are any harmful effects for children who are not yet born when the separation occurs. I use detailed work and fertility histories from the Panel Study of Income Dynamics to estimate the effect of parents' job displacements on children's birth weights. These data allow for an identification strategy that essentially compares the outcomes of children born after a displacement to the outcomes of their siblings born before using mother fixed effects. I find that husbands’ job losses have significant negative effects on infant health. They reduce birth weights by approximately four and a half percent with suggestive evidence that the effect is concentrated on the lower half of the birth weight distribution.
    Keywords: children, infant health, job loss, displacement
    JEL: I10 J13 J63
    Date: 2010–09
  11. By: Chiswick, Barry R. (University of Illinois at Chicago); Mirtcheva, Donka M. (The College of New Jersey)
    Abstract: This paper examines the determinants of the health of children ages 6 to 19, as reported in the Child Development Supplements (CDS) to the Panel Study of Income Dynamics (PSID). The primary focus is on the effect of religion on the reported overall health and psychological health of the child. Three measures of religion/religiosity of the child are employed: whether there is a religious affiliation (and what kind), the importance of religion, and the frequency of church attendance. Other variables the same, the analysis reveals that there appears to be a positive association between both measures of health and the three measures of religion/religiosity. Those children (self-report or primary caregiver report) who have identified a religious affiliation, who view religion as very important, compared to those who view it as unimportant, and who attend church at least weekly compared to those who do not or seldom attend have higher levels of overall health and psychological health. When the analysis of affiliation is done by denomination, the primary difference is between those who report a religious affiliation and those who do not.
    Keywords: health, religion, religiosity, children, adolescents
    JEL: I1 I18 I12 Z12
    Date: 2010–09
  12. By: Kim, Seonghoon (Ohio State University); Deng, Quheng (Chinese Academy of Social Sciences); Fleisher, Belton M. (Ohio State University); Li, Shi (Beijing Normal University)
    Abstract: We find that second-generation effects of in utero and early childhood malnutrition on the school participation of the offspring of mothers who experienced the China Great Leap Forward Famine. The direct impact on entrance to senior high school is also negative, but smaller in magnitude than that on entrance to junior high school. Given that entering senior high school is contingent on completion of junior high school, the direct impact on entrance to senior high school obviously understates the total impact on the second generation’s accumulation of human capital. Our estimation results are generally robust to IV estimation.
    Keywords: malnutrition, health, schooling, Barker hypothesis, China Famine
    JEL: I12 J16 P36
    Date: 2010–09
  13. By: Fairlie, Robert W. (University of California, Santa Cruz); Kapur, Kanika (University College Dublin); Gates, Susan (RAND)
    Abstract: The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of "entrepreneurship lock" by using recent panel data from matched Current Population Surveys. We use difference-indifference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on business creation for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages business creation by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. We also do not find evidence from the previous literature and additional estimates that other confounding factors such as retirement, partial retirement, social security and pension eligibility are responsible for the increase in business ownership in the month individuals turn 65. Our estimates provide some evidence that "entrepreneurship lock" exists, which raises concerns that the bundling of health insurance and employment may create an inefficient level of business creation.
    Keywords: entrepreneurship, health insurance, medicare, job lock
    JEL: L26 I1
    Date: 2010–09
  14. By: Nordin , Martin (Department of Economics, Lund University); Gerdtham , Ulf-G (Department of Economics, Lund University)
    Abstract: This study uses Swedish data to analyze why the SES-health gradient increases with ageing. Since different measures of SES and health capture different aspects, we use this information to explore the age increase in health inequality and to discriminate between three types of explanations, namely: i) age increase in the causal SES effect; ii) reversed health effect on SES, and iii) lifecycle variation in the measurement errors in SES and health. <p>Thus, our analysis points in the direction that the age increase in health inequality is primarily caused by a reversed causality going from health to annual income, and the probable mechanism is health affecting the labour supply of the individual. In addition the study report that the age variation in health inequality seem to have increased over time, and during the 1980th the age variation was rather limited. The evidence in our study is not conclusive, but all evidence documented agrees and supports this conclusion.
    Keywords: health inequality; socioeconomic status; income; education
    JEL: D30 D31 I10 I12
    Date: 2010–09–29
  15. By: Aronsson, Thomas (Umeå University); Blomquist, Sören (Uppsala Center for Fiscal Studies)
    Abstract: In this paper, we consider how the retirement age as well as a tax financed pension system ought to respond to a change in the standard deviation of the length of life. In a first best framework, where a benevolent government exercises perfect control over the individuals’ labor supply and retirement-decisions, the results show that a decrease in the standard deviation of life-length leads to an increase in the optimal retirement age and vice versa, if the preferences for “the number of years spent in retirement” are characterized by constant or decreasing absolute risk aversion. A similar result follows in a second best setting, where the government raises revenue via a proportional tax (or pension fee) to finance a lump-sum benefit per year spent in retirement. We consider two versions of this model, one with a mandatory retirement age decided upon by the government and the other where the retirement age is a private decision-variable.
    Keywords: Uncertain lifetime; retirement; pension system
    JEL: D61 D80 H21 H55
    Date: 2010–09–30
  16. By: Francette Koechlin; Luca Lorenzoni; Paul Schreyer
    Abstract: Health services account for a large and increasing share of production and expenditure in OECD countries but there are also noticeable differences between countries in expenditure per capita. Whether such differences are due to more services consumed in some countries than in others or whether they reflect differences in the price of services is a question of significant policy relevance. Yet, cross-country comparisons of the price of health services are rare and fraught with measurement issues. This paper presents a new set of comparative prices for hospital services in a selection of OECD countries. The data is novel in that it reflects quasi-prices (negotiated or administrative prices or tariffs) of the output of hospital services. Traditionally, prices of outputs have been compared by comparing prices of inputs such as wage rates of medical personnel. The new methodology moves away from the input perspective towards an output perspective. This should allow productivity differences between countries to be captured and paves the way for more meaningful comparisons of the volume of health services provided to consumers in the different countries. One of the key findings of the pilot study is that the price level of hospital services in the United States is more than 60 % above that of the average price level of 12 countries included in the study. Price levels turn out to be significantly below average in Korea, Israel and Slovenia.<BR>Les services de santé représentent une part importante et croissante de la production et des dépenses dans les pays de l’OCDE mais avec des différences notables entre pays dans les dépenses par habitant. Savoir si de telles différences sont dues aux quantités de services consommés dans tel ou tel pays ou reflètent des différences dans les prix des services est une question fondamentale pour mener une politique pertinente. Jusqu’à présent, les comparaisons entre pays du prix des services de santé sont rares et rendues difficiles par les problèmes de mesure. Cet article présente un ensemble de prix comparatifs pour les services hospitaliers dans une sélection de pays de l'OCDE. Ces données sont inédites car elles reflètent « les quasi-prix » (prix négociés ou réglementés ou tarifs) de la production de services hospitaliers. Traditionnellement, les prix de ces produits étaient comparés en utilisant les prix des « input » (approche par les coûts) tels que les taux de salaire du personnel médical. La nouvelle méthodologie s’écarte de cette approche pour tendre vers une approche « output ». Cela devrait permettre de saisir les différences de productivité entre les pays et d’ouvrir la voie à des comparaisons plus significatives du volume des services de santé fournis aux consommateurs dans les différents pays. Un des résultats clés de cette étude pilote est que le niveau de prix des services hospitaliers aux États -Unis est de plus de 60% supérieur au niveau de prix moyen des 12 pays inclus dans l’étude. En revanche, les niveaux de prix sont significativement plus bas en Corée, en Israël et en Slovénie.
    JEL: C43 I10 M41
    Date: 2010–07–08
  17. By: Marie-Laure Delamaire; Gaetan Lafortune
    Abstract: Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors. This paper reviews the development of advanced practice nurses in 12 countries (Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States), with a particular focus on their roles in primary care. It also reviews the evaluations of impacts on patient care and cost. The development of new nursing roles varies greatly. The United States and Canada established “nurse practitioners” in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. Although development in Australia and Ireland is more recent, these two countries have been very active in establishing higher education programmes and posts for advanced practice nurses in recent years. In other countries, the formal recognition of advanced practice nurses is still in its infancy, although unofficial advanced practices may already exist in reality. Evaluations show that using advanced practice nurses can improve access to services and reduce waiting times. Advanced practice nurses are able to deliver the same quality of care as doctors for a range of patients, including those with minor illnesses and those requiring routine follow-up. Most evaluations find a high patient satisfaction rate, mainly because nurses tend to spend more time with patients, and provide information and counselling. Some evaluations have tried to estimate the impact of advanced practice nursing on cost. When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses’ salaries – as opposed to doctors – can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing.
    Keywords: primary care, OECD countries, skills, nurses, advanced roles, nurse practitioners, clinical nurse specialists
    JEL: I10 I18 J2
    Date: 2010–07–08
  18. By: Ravi P. Rannan-Eliya; Luca Lorenzoni
    Abstract: This paper reports on a project to improve the comparability and availability of private health expenditure under the joint health accounts questionnaire (JHAQ) data collection. The JHAQ is a framework for joint data collection in the area of health expenditure data developed by OECD, Eurostat, and WHO. In particular, the study questions were: How to overcome the inherent tendency for much private health care financing to occur without the generation of linked, reliable, and comprehensive routine data? How to tackle the issue of private providers likely to operate without reporting of routine data to statistical agencies?
    JEL: C81 I10 N41
    Date: 2010–05–26
  19. By: Peter Scherer; Marion Devaux
    Abstract: The ratio of health expenditure to GDP, which in macroeconomic terms is an indicator which summarises the financing needs of a national health system, is likely to rise in countries for which the GDP falls. Over the past four decades, health expenditure has risen in most countries at a faster rate than GDP, leading to a rise in the expenditure ratio. Fluctuations in this ratio can come about through fluctuations in either of its components. In some cases, notably the USA, GDP variation is the main origin of changes in the ratio, but in the majority of countries health expenditure variation is more important. The experience of countries which did reduce health expenditure after previous recessions suggests that such reductions are short-lived, and demand for health services results over time in a revival of health expenditure growth.<BR>La proportion des dépenses de santé par rapport au PIB, qui en termes macro-économiques est un indicateur récapitulant les besoins de financement d'un système de santé national, va probablement monter dans des pays où le PIB chute. Pendant les quatre dernières décennies, les dépenses de santé ont augmenté dans la plupart des pays plus rapidement que le PIB, menant à une hausse de la proportion des dépenses. Des fluctuations dans cette proportion peuvent survenir à la suite de variations dans l’une ou l’autre de ses composantes. Dans quelques cas, notamment aux États-Unis, la variation du PIB est à l'origine même de la différence du ratio, mais dans la majorité des pays, les variations de dépense de santé sont plus importantes. L'expérience des pays qui ont vraiment réduit leurs dépenses de santé après des récessions laisse à penser que de telles réductions sont de courte durée et que la demande de résultats en matière de services de la santé signifie à la longue une reprise de la croissance des dépenses de santé.
    JEL: H51 I18 N00
    Date: 2010–05–21
  20. By: Jeremy Hurst
    Abstract: Sometimes it is argued that the content of a reform is less important in determining whether or not it receives public and legislative approval than the timing of the proposal; the way in which the reform is presented; the discussions with stakeholders; and a multitude of other factors. The OECD has a crosscutting project on these issues, entitled Making Reform Happen. A number of OECD directorates are considering the factors lying behind successful implementation of reforms in their different policy areas, including tax, environment, agriculture, trade, competition, education, health, pensions, product markets and labour markets.<BR>D’aucuns arguent parfois que le contenu d’une réforme est moins important pour déterminer son acceptation par le public et par le législateur que le timing de la proposition, la manière dont la réforme est présentée, les discussions avec les parties prenantes et une multitude d’autres facteurs. L’OCDE a lancé un projet transversal sur ces questions sous le titre Making Reform Happen. Un certain nombre de Directions à l’OCDE étudient les facteurs qui sous-tendent le succès des réformes dans leurs différents domaines, notamment la fiscalité, l’environnement, l’agriculture, le commerce, la concurrence et l’éducation, la santé, les réformes des retraites, des marchés de produits et des marchés du travail.
    JEL: D72 D78 I18
    Date: 2010–03–29
  21. By: Olena Nizalova
    Abstract: This paper focuses on the relationship between wages and supply of informal care to elderly parents. Unlike most of the previous research estimating wage elasticities of informal care supply, this study employs instrumental variable technique to account for the fact that the wage rate is likely to be correlated with omitted variables. Based on the data from the 1998 wave of the Health and Retirement Study, the results show that the wage elasticity of informal care supply is negative and larger in magnitude than has been found previously. [IZA Discussion Paper No. 5192]
    Keywords: wage elasticity, informal care supply, labor supply, elderly care, family obligations
    Date: 2010
  22. By: T.R. Dilip
    Abstract: This is an attempt to understand the characteristics of private hospitals and the equity in accessing their services, using secondary data available for the period 1986-2004. The data indicates that private hospitals did not expand in numbers but a strong consolidation by large hospitals has taken place. [Working Paper No. 400]
    Keywords: Privatehospitals,healthsystem,equity,Kerala
    Date: 2010
  23. By: Offer, Avner; Pechey, Rachel; Ulijaszek, Stanley
    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
  24. By: Theurl, Engelbert (Department of Economics and Statistics, University of Innsbruck); Winner, Hannes (University of Salzburg)
    Abstract: Empirical evidence from U.S. studies suggests that female physicians earn less than their male counterparts, on average. The earnings gap does not disappear when individual and market characteristics are controlled for. This paper investigates whether a gender earnings difference can also be observed in a health care system predominantly financed by public insurance companies. Using a unique data set of physicians’ earnings recorded by a public social security agency in an Austrian province between 2000 and 2004, we find a gender gap in average earnings of about 32 percent. A substantial share of this gap (20 to 47 percent) cannot be explained by individual and market characteristics, leaving labor market discrimination as one possible explanation for the observed gender earnings difference of physicians.
    Keywords: Health care financing; physician earnings; wage composition
    JEL: I11 I18 J31 J71
    Date: 2010–09–30
  25. By: Xavier Fageda (Faculty of Economics, University of Barcelona); Eva Fiz (Faculty of Economics, University of Barcelona)
    Abstract: This article analyzes hospital privatization by comparing costs and quality between different ownership forms. We put the attention on the distinction between public hospitals and private hospitals with public funding. Using information about Spanish hospitals, we have found that private hospitals provide services at a lower cost at expenses of lower quality. We observe that property rights theory is fulfilled at least for the Spanish hospital market. The way that Heath Authorities finance publicly funded hospitals may be responsible for the differences in incentives between public and private centers. We argue that the trade-off between costs and quality could be minimized by designing financing contracts with fixed and variable components.
    Keywords: Privatization, Hospitals, Costs, Quality. JEL classification:I11; L15; L33
    Date: 2010–09
  26. By: Catalina Bolancé (Faculty of Economics, University of Barcelona); Ramon Alemany; Montserrat Guillén (Faculty of Economics, University of Barcelona)
    Abstract: Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pen- sion with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mor- tality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statis- tics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable cate- gories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.
    Keywords: JEL classification:
    Date: 2010–09
  27. By: Maik T. Schneider (CER-ETH - Center of Economic Research at ETH Zurich, Switzerland); Ralph Winkler (Department of Economics and Oeschger Centre for Climate Change Research, University of Bern)
    Abstract: We develop a perpetual youth model to investigate how longevity affects economic growth and welfare. Life expectancy is determined by individuals’ investments in healthcare. We find that improvements in the healthcare technology always increase the steady state growth rate. Although the effect is small, even for large increases in longevity, welfare gains may be substantial depending on the type of the technological improvement. We identify two externalities associated with healthcare investments and provide a condition when healthcare expenditures are inefficiently low in the market equilibrium. Finally, we discuss our results with respect to alternative spillover specifications in the production sector.
    Keywords: economic growth, endogenous longevity, healthcare expenditures, healthcare technology, quality-quantity trade-off
    JEL: O40 I10 J10
    Date: 2010–09
  28. By: Carlos Bozzoli; Climent Quintana
    Abstract: Argentina hit world news headlines in 2002 due to the largest debt-default in history and a sudden economic collapse reminiscent of economic statistics from the Great Depression. In this article, we focus on other consequences of the crisis that are notso obvious, but that may linger for decades on. Combining macroeconomic indicatorswith the Argentine national registry of live births, approximately 1.9 million live birthsoccurring between 2001 and 2003, we show that the crisis led to an average birth weightloss of 30 grams. Our estimate is robust to di¤erent identi…cation strategies. This deterioration in birth weight occurred in just about 6 months, and represents one sixth of the difference in average birth weight between American and Pakistani babies. We also find that the crisis affected particularly the weight of babies born from low-socioeconomicstatus mothers. In an attempt to estimate the long-lasting economic cost of the crisis,we simulate the average loss of future individual earnings due to the reduction in averagebirth weight: about 500 US dollars per live birth in present value.
    Date: 2010–09
  29. By: Pilar García Gómez; Sergi Jiménez Martín; Judit Vall Castello
    Abstract: In this paper we analyze the trends in labor force participation and transitions to benefit programs of older workers in relation to health trends as well as recent Social Security reforms. Our preliminary conclusions are pessimistic regarding the effect of health improvements on the labor market attachment of older workers since we show that despite the large improvements in the mortality rates among older individuals in Spain, the employment rates of individuals older than fifty-five remain lower than the ones observed in the late 1970s. Some caution should remain in our conclusions as the evidence on health trends is inconclusive. Regarding the effect of Social Security reforms, we find that both the 1997 and the 2002 reform decreased the stock into old-age benefits at the cost of an increased share of the participation into disability. Finally, we find that there was a significant increase in the outflow from employment into disability after the 2002 reform.
    Date: 2010–09
  30. By: Ohiniba Carole Bruce (GREDI, Faculte d'administration, Université de Sherbrooke); Dorothée Boccanfuso (GREDI, Faculte d'administration, Université de Sherbrooke)
    Abstract: In spite of notable progress in medicine, infant-juvenile mortality remains a major issue in developing countries. One of the main causes of this mortality, namely malnutrition, continues to be a serious problem, and its reduction remains the primary target of many health policies developed in a number of countries and organizations. In Guinea, contrary to certain other African countries, the rate of growth retardation for children under 5 years old has risen from 26 to 35% and that of underweight from 23 to 26% between 1999 and 2005. To be able to recommend policies seeking to improve the nutritional status of Guinean children, we use an approach based on the decomposition of Yun (2005) to decompose the gap of the nutritional status of Guinean children that was observed between 1999 and 2005 into the detailed effect of its characteristics and that of the coefficients of the characteristics. In our study, the health status of children is represented by two indicators, namely the Z-score height-for-age and the Z-score weight-for-age of children. The results stemming from the decomposition of Yun (2005) indicate that, regardless of the health indicator considered, the aggregate effect of the coefficients is substantially stronger than that of the characteristics. Our study is a pioneering one for Africa insofar as it seeks to fill gaps in studies along similar lines, which very often limit themselves to explaining the health status of children in a given period, or comparing the health status of children between two periods.
    Keywords: Children’s health, anthropometric indicators, Millennium Development Goals, Guinea
    JEL: I10 O12 O55 P46
    Date: 2010–09–27
  31. By: James Banks; Alastair Muriel; James P. Smith
    Abstract: In this paper the authors present results of an investigation into observable characteristics associated with attrition in ELSA and the HRS, with a particular focus on whether attrition is systematically related to health outcomes and socioeconomic status (SES). Investigating the links between health and SES is one of the primary goals of the ELSA and HRS, so attrition correlated with these outcomes is a critical concern. They explored some possible reasons for these differences. Survey maturity, mobility, respondent burden, interviewer quality, and differing sampling methods all fail to account for the gap. Differential respondent incentives may play some role, but the impact of respondent incentive is difficult to test. Apparently, cultural differences between the US and Europe population in agreeing to participate and remain in scientific surveys are a more likely explanation.
    Date: 2010–09
  32. By: De Luca, Giuliana; Ponzo, Michela
    Abstract: This paper analyses the effects of employment condition and work hours on the utilisation of primary care services in Italy. Although the Italian NHS provides free and equitable access to primary care, type of occupation and labour contracts may still deter workers to attend medical appointments. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian National Institute of Statistics (ISTAT), we estimate a negative binomial model of GP visits as a function of employment related variables, individual characteristics, supply factors and geographical effects. We find that selfemployed workers, managers and cadres have relatively low demand compared to white and blue collars. We conclude that the former, bearing higher opportunity costs, suffer more from the loss of earnings related to the absence from work than the latter.
    Keywords: Opportunity cost; hours of work; utilisation of GP; employment status.
    JEL: J10 I18 J21 J20
    Date: 2010
  33. By: Cavatorta, Elisa; Pieroni, Luca
    Abstract: This paper explores the interactions between the risk of food insecurity and the decision to health insure in the Palestinian Territories. The risk of adverse health conditions is insurable; the risk of food insecurity is a background risk and no market insurance exists. The vulnerability to food insecurity influences the individual utility from health insuring. We present a competing risk model to reveal this interdependence. We specify the empirical model as a bivariate probit model and evaluate the impact of food insecurity on the household decision to health insure. We find evidence of significant complementarity between the risk of food insecurity and the propensity to health insure. The predicted conditional probabilities reveal that the propensity to health insure is higher in presence of food insecurity among Palestinian households. This study shows that, in presence of a background risk, there are complementarities among risks that policy should be mindful of.
    Keywords: Food insecurity; Health insurance; Competing risks; Bivariate Probit
    JEL: I11 O15 C35
    Date: 2010–09–07
  34. By: Peter Nunnenkamp (Kiel Institute for the World Economy); Hannes Öhler (Georg-August-University Göttingen)
    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: 2010–08–31

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