nep-hea New Economics Papers
on Health Economics
Issue of 2010‒10‒16
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Socioeconomic Gradient of Obesity in Ireland By David Madden
  2. Living Standards and Mortality since the Middle Ages By Morgan Kelly; Cormac Ó Gráda
  3. Physicians self selection of a payment mechanism: Capitation versus fee-for-service By Marie Allard; Izabela Jelovac; Pierre-Thomas Léger
  4. Growth and Welfare under Endogenous Lifetime By Maik T. Schneider; Ralph Winkler
  5. Time discounting (d) and pain anticipation: Experimental evidence By Pablo Brañas-Garza; María Paz Espinosa; María Repolles
  6. Health Care Developments in EU Member States: Regressing Trensds and Institutional Similarity? By Montanari, Ingalill; Nelson, Kenneth
  7. What determines transitions to sick leave? By Andreassen Leif; Kornstad Tom
  9. Marginal benefit incidence of public health spending: evidence from Indonesian sub-national data By Sparrow, R.A.; Pradhan, M.P.; Kruse, I.
  10. An assessment of the effects of the 2002 food crisis on children's health in Malawi By Hartwig, R.; Grimm, M.
  11. Does inequality in health impede growth? By Grimm, M.
  12. Disability and international cooperation and development : a review of policies and practices By Lord, Janet; Posarac, Aleksandra; Nicoli, Marco; Peffley, Karen; Mcclain-Nhlapo, Charlotte; Keogh, Mary
  13. Orphanhood and Critical Periods in Children’s Human Capital Formation: Long-Run Evidence from North-Western Tanzania By Jens Hagen; Toman Omar Mahmoud; Natalia Trofimenko
  14. Health Satisfaction and Energy Spending By Meier, H.
  15. Determinants of Suicides in Denmark: Evidence from Time Series Data By HALICIOGLU, Ferda; Andrés, Antonio
  16. Does Health Insurance Coverage Lead to Better Health and Educational Outcomes? Evidence from Rural China By Yuyu Chen; Ginger Zhe Jin

  1. By: David Madden
    Abstract: Using the nationally representative Slan dataset we calculate concentration indices for the incidence of obesity for men and women. We finder higher concentration indices for women than for men, but we also find that concentration indices fell between 2002 and 2007. However this appears to be owing to an increased incidence of obesity amongst better off people rather than decreased obesity amongst the less well-off. A decomposition of the concentration indices suggest that the greatest contribution to the gradient comes from the combination of lower rates of obesity amongst those with 3rd level education and their higher income.
    Keywords: Obesity, Body Mass Index, Concentration Index,Decomposition
    Date: 2010–10–01
  2. By: Morgan Kelly (University College Dublin); Cormac Ó Gráda (University College Dublin)
    Abstract: Existing studies find little connection between living standards and mortality in England, but go back only to the sixteenth century. Using new data on inheritances, we extend estimates of mortality back to the mid-thirteenth century and find, by contrast, that deaths from unfree tenants to the nobility were strongly affected by harvests. Looking at a large sample of parishes after 1540, we find that the positive check had weakened considerably by 1650 even though real wages were falling, but persisted in London for another century despite its higher wages. In both cases the disappearance of the positive check coincided with the introduction of systematic poor relief, suggesting that government action played a role in breaking the link between harvest failure and mass mortality.
    Keywords: economic growth, economic history, Malthus, demography
    Date: 2010–10–28
  3. By: Marie Allard (HEC Montréal - HEC MONTRÉAL); Izabela Jelovac (GATE Lyon Saint-Etienne - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines); Pierre-Thomas Léger (HEC Montréal - HEC MONTRÉAL, CIRANO - Centre interuniversitaire de recherche en analyse des organisations - Université du Québec à Montréal, CIRPEE - Centre interuniversitaire sur le risque, les politiques économiques et l'emploi - Centre Interuniversitaire sur le Risque, les Politiques Economiques et l'Emploi)
    Abstract: The main question raised in this paper is whether GPs should self select their paymentmechanism or not. To answer it, we model GPs' behavior under the most commonpayment schemes (capitation and fee-for-service) and when GPs can select one amongthose. Our analysis considers GPs heterogeneity in terms of both ability and sense ofprofessional duty. We conclude that when savings on specialists costs are the mainconcern of a regulator, GPs should be paid on a fee-for-service basis. Instead, whenfailures to identify severe conditions are the main concern, then payment self selection byGPs can be optimal.
    Keywords: GPs; gatekeeping; payment scheme; self selection; ability; professional duty
    Date: 2010
  4. By: Maik T. Schneider; Ralph Winkler
    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
  5. By: Pablo Brañas-Garza (GLOBE and Universidad de Granada); María Paz Espinosa (Universidad del País Vasco); María Repolles (GLOBE and Universidad de Granada and Virgen de las Nieves Hospital, Granada)
    Abstract: This paper deals with pain anticipation experienced before medical procedures. Our experimental results show that individuals with lower discount factors are more prone to suffer pain in advance. We provide a framework to rationalize the connection between pain anticipation and impatience. In this set up, more impatient subjects, who only value very near events, take into account mainly the negative effects of medical procedures (just the costs) whereas more patient individuals have a net positive valuation of medical events (given that they value both the cost incurred now and all the benefits accrued in the future).
    Date: 2010–10–01
  6. By: Montanari, Ingalill (Stockolm University: Swedish Institute for Social Research); Nelson, Kenneth (Stockholm University: Swedish Institute for Social Research)
    Abstract: <p> Due to various structural pressures predictions of retrenchment and conformity of social policies have been legion, both in terms of expenditure and institutional set-up. Recent research has focused on changes in cash benefits. Comparative analyses of changes in services, the other pillar of social policy, have however so far been limited to a few countries. The purpose of this paper is to perform a diachronical cross-national analysis of health care services. We thus raise questions of decline and convergence of European health care systems. Contrary to previous claims we find that European health care systems are not particularly hit by retrenchment and convergence is absent in key health care dimensions, namely coverage, financing and provision. The empirical analysis is based on institutional indicators rather than expenditure levels. We utilize OECD Health Data and provide both a descriptive analysis and multi-level regressions. <p>
    Keywords: Health care; Citizenship rights; EU; welfare
    JEL: I11 I18 I38
    Date: 2010–10–05
  7. By: Andreassen Leif; Kornstad Tom (University of Turin)
    Abstract: The paper discusses some of the possible determinants of sick leave. The underlying medical health of workers is of course important, but other factors also determine if they manage to function at work. For example the degree to which workers are willing to endure discomfort at work and the demands for efficiency at work can be important. Also of importance is the ease with which workers can change jobs and whether increases in employment bring in marginal, less healthy, workers. Finally, one must take into consideration the ability of firms to accommodate workers with health problems, the age of the work force and the situation workers face at home. As an illustration, we discuss how these factors have influenced married women in ages 35 to 44 using a multinomial model. The main finding is that changes in wages has had a very strong effect on transitions to sick leave in the 90’s. In our estimation they explain almost all the change in the group.
    Date: 2010–09
  8. By: Mario Garcia-Molina; Liliana Alejandra Chicaiza; Oscar Gamboa
    Abstract: Introduction: An estimated 1,399 new cases of pancreatic cancer (PC) and 1,406 deaths from the same cause occurred in Colombia in 2002. We evaluate the cost-effectiveness of multidetector computed tomography (CT), endoscopic ultrasonography (EUS) and positron emission tomography with computed tomography (PET/CT) in diagnosis and staging of patients with clinical suspicion of PC. Materials and methods: We conducted a cost-effectiveness analysis based upon a systematic search to determine the strategies’ sensitivity and specificity. The costs of administering and monitoring were taken from the official tariff manuals. The results were assessed in terms of number of correct behaviours. We performed deterministic and probabilistic sensitivity analyses. Results: CT showed the best cost-effectiveness indicator (Col$ 3,397,163 for each appropriate behaviour). The cost of changing the strategy to that of CT plus EUS was Col$ 7,893,573 for each additional appropriate behavior. In the probabilistic analysis the cost-effective strategy was USE for a willingness to pay higher than Col$ 9,000,000 per additional unit, or TAC for smaller values. Conclusion: The cost-effective strategy in the evaluation of patients suspected PCis the multidetector CT. For values of willingness to pay more than Col$ 7,893,573 and Col$ 9,000,000 per additional unit cost-effective alternatives are EUS or CT plus EUS in series.
    Date: 2010–10–05
  9. By: Sparrow, R.A.; Pradhan, M.P.; Kruse, I.
    Abstract: We examine the marginal effects of decentralized public health spending by incorporating estimates of behavioural responses to changes in public health spending through benefit incidence analysis. The analysis is based on a panel dataset of 207 Indonesian districts over a 4-year period from 2001 to 2004. We show that district-level public health spending is largely driven by central government transfers, with an elasticity of public health spending with respect to district revenues of around 0.9. We find a positive effect of public health spending on utilization of outpatient care in the public sector for the poorest two quartiles. We find no evidence that public expenditures crowd oututilization of private services or household health spending. Our analysis suggests that increased public health spending improves targeting to the poor, as behavioural changes in public health care utilization are pro-poor. Nonetheless, most of the benefits of the additional spending accrued to existing users of services, as initial utilization shares outweigh the behavioural responses.
    Keywords: decentralization;public spending;health care utilization;benefit incidence;Indonesia.
    Date: 2009–12–01
  10. By: Hartwig, R.; Grimm, M.
    Abstract: In 2002 Malawi experienced a serious shortage of cereals due to adverse climatic conditions. The World Food Programme assumed that about 2.1 to 3.2 million people were threatened of starvation at that time. However, not much research has been undertaken to investigate the actual consequences of this crisis. In particular, little is known about how the crisis affected the health status of children. Obviously, quantifying the health impact of such a crisis is a serious task given the lack of data and the more general problem of relating outcomes to specific shocks and policies. In this paper a difference-in-difference estimator is used to quantify the impact of the food crisis on the health status of children. The findings suggest that at least in the short run, there was neither a significant impact on child mortality nor on malnutrition. This would suggest that the shock might have been less severe than initially assumed and that the various policy interventions undertaken at the time have been effective or at least sufficient to counteract the immediate effects of the crisis.
    Keywords: child mortality;malnutrition;food crisis;Malawi
    Date: 2010–01–01
  11. By: Grimm, M.
    Abstract: This paper investigates the effects of inequality in health on economic growth in low and middle income countries. The empirical part of the paper uses an original cross-national panel data set covering 62 low and middle income countries over the period 1985 to 2007. I find a substantial and relatively robust negative effect of health inequality on income levels and income growth controlling for life expectancy, country and time fixed-effects and a large number of other effects that have been shown to matter for growth. The effect also holds if health inequality is instrumented to circumvent a potential problem of reverse causality. Hence, increasing access to health care for the poor can make a substantial contribution to economic growth not only through its effect on life expectancy but also through its effect on reduced health inequality.
    Keywords: health inequality;health gradient;economic growth
    Date: 2010–05–01
  12. By: Lord, Janet; Posarac, Aleksandra; Nicoli, Marco; Peffley, Karen; Mcclain-Nhlapo, Charlotte; Keogh, Mary
    Abstract: The purpose of this review is to canvas policies and, to the extent possible, practices of major multilateral and bilateral development agencies, aimed at including disability in development. Development that includes disability, as referenced in this review, is understood as development in which persons with disabilities participate as both actors and beneficiaries. It can be achieved by disability specific initiatives, by adding disability-specific components to development programs, by fully inclusive programming, designed to include disability concerns into all development processes, or by a combination of these approaches. While this review does not claim to be exhaustive, it does attempt to provide as comprehensive as possible an overview of policies and practices on disability and development (D&D), both within and among the United Nations (UN) system, and among major bilateral development agencies. It should be noted that this is a dynamic issue and thus many development agencies are either in the process of crafting new disability policies or strategies or are currently reviewing their existing approaches with a view to modifying or amending them. Section two of this report reviews the international legal and policy framework pertinent to the consideration of D&D with particular attention to the Convention on the Rights of Persons with Disabilities (CRPD) and Millennium Development Goals (MDGs). Section three reviews multilateral agencies and structures, particularly those within the UN system, and reviews their existing policies and/or practices related to D&D. Section four includes coverage of regional structures supporting the inclusion of disability in development. Section five identifies bilateral development agencies that, either as matter of written policy or as evidenced through practice, have taken steps to design and implement programs and practices that are inclusive of disability. Section six provides conclusions.
    Keywords: Population Policies,Disability,Social Cohesion,Health Monitoring&Evaluation,Gender and Law
    Date: 2010–05–01
  13. By: Jens Hagen; Toman Omar Mahmoud; Natalia Trofimenko
    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 younger and older children 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 orphanhood’s detrimental effects on human capital accumulation
    Keywords: orphans, health, education, timing of parental death, child development, Tanzania
    JEL: I10 I21 J19 C23
    Date: 2010–09
  14. By: Meier, H.
    Abstract: This study explores the link between energy spending and health satisfaction. We aim to show that energy spending is a driver of health satisfaction and therefore of the overall quality of life of individuals. This has important implications for policy makers especially in the context of fuel poor and low-income households. The analysis tests the hypothesis that health satisfaction decreases with increasing energy spending per room. Households with high energy spending tend to live in inefficiently insulated homes that are not heated adequately. We use a British panel household survey dataset with more than 60,000 observations covering the period 1997 to 2007. We apply a fixed effects econometric model which enables us to take unobservable heterogeneity between households into account.
    Keywords: Health satisfaction, energy spending
    JEL: C23 D1 P36 Q41
    Date: 2010–10–01
  15. By: HALICIOGLU, Ferda; Andrés, Antonio
    Abstract: This research examines empirically the determinants of suicides in Denmark over the period 1970-2006. To our knowledge, there exist no previous study that estimates a dynamic econometric model of suicides on the basis of time series data and cointegration framework at disaggregate level. Our results indicate that suicide is associated with a range of socio-economic factors but the strength of the association can differ by gender. In particular, we find that a rise in real per capita income and fertility rate decreases suicides for males and females. Divorce is positively associated with suicides and this effect seems to be stronger for men. A fall in unemployment rates seems to lower significantly suicides in males and females. Policy implications of suicides are discussed with some appropriate recommendations.
    Keywords: Suicide; Denmark; Time Series; Cointegration
    JEL: C51 C22 A2 A14
    Date: 2010
  16. By: Yuyu Chen; Ginger Zhe Jin
    Abstract: Many governments advocate nationwide health insurance coverage but the effects of such a program are less known in developing countries. We use part of the 2006 China Agricultural Census (CAC) to examine whether the recent health insurance coverage in rural China has affected children mortality, pregnancy mortality, and the school enrollment of the 6-16 year old. Our data represent a census of 5.9 million people living in eight low-income rural counties, four of which have adopted the New Cooperative Medical System (NCMS) by 2006 and the other four did not adopt NCMS until 2007. In the counties that offer NCMS, a household may take or not take the insurance. A first look of the data suggests that enrolling in NCMS is associated with better school enrollment and lower mortality of young children and pregnant women. However, using a difference-in-difference propensity score method, we find most of these differences are driven by the endogenous introduction and take up of NCMS, and classical propensity score matching fails to address the selection bias. While NCMS does not show beneficial impacts on the average population, we find some evidence that NCMS helps improve the school enrollment of six-year-olds.
    JEL: I18 I21 I38
    Date: 2010–09

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