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on Health Economics |
| By: | Georgios Georgiadis (Goethe University Frankfurt); José Pineda (Human Development Report Office at United Nations Development Programme); Francisco Rodríguez (Human Development Report Office at United Nations Development Programme) |
| Abstract: | Three apparently contradictory stylized facts characterize the relationship between per capita incomes and life expectancy: (i) the existence of a strong correlation between the level of life expectancy and the level of per capita income, (ii) the absence of a significant correlation between changes in per capita income and changes in life expectancy, and (iii) the persistence of twin peaks in the distribution of life expectancy, despite their progressive disappearance from the income data. This paper seeks to reconcile these apparently contradictory findings. We argue that a data generating process in which there is a relationship between income and life expectancy for high levels of development but not for low ones can explain these stylized facts, while models that apply a uniform relationship to all countries cannot. We also argue that the slope of the relationship between income and life expectancy is significantly overestimated by standard cross-sectional estimates, with the true slope being much lower for some countries and not statistically significantly different from zero for others. Lastly, we provide evidence from an error-correction model showing that the elasticity of life expectancy to incomes has been declining both for countries at high and low levels of development. We suggest that these results can be interpreted as showing that income matters only for countries that are close enough to the world health technological frontier. |
| Keywords: | Life expectancy, income growth, Preston curve, health determinants, Monte Carlo experiments. |
| JEL: | I1 O15 N30 C15 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:hdr:papers:hdrp-2010-32&r=hea |
| By: | Lant Pritchett (Kennedy School of Government at Harvard University); Martina Viarengo (London School of Economics and Kennedy School of Government at Harvard University) |
| Abstract: | This paper examines the variation across countries and evolution over time of life expectancy. Using historical data going back to the beginning of the 20th century several basic facts about the relationship between national income and life expectancy are established. The paper shows that even by examining the augmented Preston curve there is no indication that the Preston curve is “breaking down” and no indication from over 100 years of data that a very strong relationship between national income and life expectancy will not persist, particularly over the ranges of income of primary interest to the Human Development Report. Empirical findings show that there are actually fewer “puzzles” than might appear while trying to reconcile the strong cross-sectional association with the time evolution of life expectancy in specific countries and most of the existing “puzzles” come from using either very short time-horizons or very small moves in income per capita when the Preston curve is a long-run phenomena. The paper also discusses the phenomena of the cross-national convergence, with the life expectancy of the poorer countries increasing, in absolute terms, faster than those of the rich countries and how the findings about the augmented Preston curve relate to discussions of health policy. |
| Keywords: | economic development, economic growth, health, life expectancy, mortality. |
| JEL: | I10 O1 O40 J11 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:hdr:papers:hdrp-2010-31&r=hea |
| By: | David Canning (Harvard School of Public Health) |
| Abstract: | Health is a key component of the human development index. This paper looks at how health is measured, how the level of health across countries is converging, and which countries are outliers to this global trend. We argue that conceptually health measures should account for illness as well as mortality. However, in practice we show that population mortality and illness measures tend to move closely together, allowing us to use life expectancy as a reasonable proxy for population health. Overall health is improving, and over the last 40 years life expectancy has been converging, with larger gains taking place in countries that initially had lower levels of life expectancy. We show, however, that a detailed analysis gives a more complex picture. Rather than a long term pattern of global convergence we see two distinct groups of countries in the data, clustering around different long run levels of life expectancy. We consider outliers from the general picture found in cross-country analysis. HIV/AIDS plays a large role in explaining the poor health performance of some countries particularly in Sub-Saharan Africa. HIV/AIDS has meant that from 1990 on the process of convergence in health has stopped and is being reversed. Finally we argue that health improvements do not have to wait for national income to rise. Many countries have experienced large health gains without prior income gains, and in countries not affected by HIV/AIDS the last 40 years have largely been a success story in terms of achievements in health. |
| Keywords: | health, life expectancy, human development. |
| JEL: | I10 I30 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:hdr:papers:hdrp-2010-43&r=hea |
| By: | Katherine Owen; Marion Haas (CHERE, University of Technology, Sydney); TL Pettman; Rosalie Viney (CHERE, University of Technology, Sydney) |
| Abstract: | While there is increasing evidence that group-based lifestyle-focussed interventions may provide more realistic, effective and cost-effective alternatives to intensive, individualised dietary counselling and exercise training, relatively little is known about individuals’ preferences for and perceptions of these programs. This paper reports the results of qualitative interviews conducted with participants of a lifestyle intervention trial (Shape up for Life© (SufL) aimed to improve body composition and metabolic health through long-term non-restrictive behaviour modification. Purposive sampling was used to identify 22 participants who participated in detailed interviews regarding their expectations of the intervention, perceptions of benefits and their experience post-intervention and capacity to maintain the lifestyle changes. The results indicate that in general participants are focussed on weight loss as a goal, even when the intervention offered and provided other benefits such as improved fitness and body shape and composition. The individuals who benefited most from the intervention typically had lower baseline knowledge about dietary and exercise guidelines. While the relatively non-restrictive nature of SufL provided flexibility for participants, many participants perceived that a more structured program may have assisted in achieving weight loss goals. |
| Keywords: | Obesity, lifestyle intervention, weight loss, metabolic syndrome |
| JEL: | I19 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:her:chewps:2010/11&r=hea |
| By: | Rebecca Reeve (CHERE, University of Technology, Sydney); Kees van Gool (CHERE, University of Technology, Sydney) |
| Abstract: | There are approximately 55,000 substantiated child abuse or neglect cases in Australia each year, according to Australian Institute of Health and Welfare data, 2005-06 to 2008-09 (AIHW2010). In 2008-09, one third of child maltreatment cases related to physical or sexual abuse. Our paper examines the relationship between physical and sexual abuse of children and adult physical and mental health conditions and associated health care costs in Australia. The analysis utilises confidentialised unit record file data from the National Survey of Mental Health and Wellbeing 2007, which includes 8841 persons aged from 16 to 85. The econometric results indicate that Australians with a history of being abused as a child suffer from significantly more physical and mental health conditions as adults and incur higher annual health care costs. In addition, we investigate the associations between child abuse, incarceration and self harm and the intergenerational impact of abuse, to extend the understanding of the long run costs of child abuse in Australia. We conclude that prevention child abuse is expected to generate long term socio-economic benefits. |
| Keywords: | child abuse, mental health, costs, australia |
| JEL: | I30 I10 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:her:chewps:2010/10&r=hea |
| By: | Nicholas Wilson (Williams College) |
| Abstract: | Copper mining is among the largest economic activities in Zambia, comprising close to ten percent of GDP. Between 2003 and 2008, the price of copper increased by over 400 percent. In response, copper production in Zambia increased by 70 percent and employment in copper mining increased by nearly 200 percent. This paper examines the effect of this large and sustained economic shock on sexual behavior and the spread of HIV/AIDS in Zambia. I use nationally representative survey data on sexual behavior before and during the copper boom in conjunction with detailed spatial data on the location of survey respondents and copper mines. The results indicate that the copper boom reduced transactional sex, multiple partnerships, alcohol use at sex, coital frequency, pregnancy rates, and marital rates in the copper mining cities. These effects were concentrated among young adults and selective in-migration to the copper mining cities appears to have contributed to the reduction in sexual activity. |
| Keywords: | commodity shocks, copper mining, HIV/AIDS, Zambia |
| JEL: | I18 J10 O12 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:wil:wileco:2010-23&r=hea |
| By: | Nicholas Wilson (Williams College) |
| Abstract: | This paper examines the effects of antiretroviral therapy (ART) on demand for HIV testing and of ART-induced testing on demand for risky sexual behavior. I provide a model of sexual behavior decision-making under uncertainty and estimate the structural parameters of the model using nationally representative survey data from Zambia on HIV testing decisions before and after the introduction of ART. The empirical results indicate that although the introduction of ART increased demand for HIV testing, the ART allocation process limited the prevention benefit of ART-induced testing. Simulation results show that eliminating this prevention inefficiency while holding the supply of ART constant would increase the prevention impact of ART-induced testing more than four-fold. More generally, the analysis indicates that existing studies which examine "universal" testing or quasi-experimental testing programs understate the efficacy of standard voluntary counseling and testing programs. |
| Keywords: | HIV/AIDS, Beliefs, Selection, Rationing, Zambia |
| JEL: | D45 I18 O12 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:wil:wileco:2010-25&r=hea |
| By: | Origo, Federica (University of Bergamo); Lucifora, Claudio (Università Cattolica del Sacro Cuore) |
| Abstract: | In recent years many countries of the European Union (EU) have implemented comprehensive smoking bans to reduce exposure to tobacco smoke in public places and all indoor workplaces. Despite the intense public debate, research on the impact of smoking regulation on health, particularly within the workplace, is still very limited. In this paper, we use a Diff-in-Diff approach and comparable micro-data – for a large number of European countries – to evaluate the impact of national comprehensive smoking bans on both perceived workers' health and presence of respiratory problems within workplaces. Results show that the introduction of comprehensive smoking bans has a significant effect on workers' perceived health, particularly on the probability of exposure to smoke and fumes, also controlling for risk exposure. We also highlight some unintended effects of smoking bans in terms of mental distress, which counteract the positive impact on risk exposure and physical health. The impact across countries is shown to vary with the degree of strictness of the bans. |
| Keywords: | smoking bans, workers health, difference-in-differences |
| JEL: | I18 J28 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp5290&r=hea |
| By: | Joseph J. Capuno (School of Economics, University of the Philippines Diliman); Aleli D. Kraft (School of Economics, University of the Philippines Diliman) |
| Abstract: | In developing countries like the Philippines, a major policy concern is the inequity in access to health and education services. In this paper, we investigate the effects of factors over which households have control ("choices") or none ("circumstances") on their access to basic services. Our logit regression analyses of two nationwide household surveys reveal that household income and composition, mother's age and education status, and the child's age and gender are critical. The circumstance factors -- Philhealth coverage and some area-level characteristics of health and education services -- also matter in improving overall access, but not necessarily its equity. |
| Keywords: | Households, equity, health, education, Philippines |
| JEL: | I18 I28 I38 |
| Date: | 2010–11 |
| URL: | http://d.repec.org/n?u=RePEc:phs:dpaper:201011&r=hea |
| By: | Rasha Khatib; Awad Mataria (Institute of Community and Public Health, Birzeit University) |
| Abstract: | This paper employs a Benefit Incidence Analysis (BIA) framework of health care financing in the occupied Palestinian territory to trace the distribution of public spending on health care, and to provide some elements of response that would complement, and integrate with, the findings from previous literature on the topic for the case of the occupied Palestinian territory. With this aim in mind, the present paper attempts to address the following objectives: (i) to assess the budget and financing structure of the different health care providers in the occupied Palestinian territory, as related to various socioeconomic, locality, and ailment groups of the population; (ii) to assess the health status of the Palestinian population and its distribution over different: demographic, geographic and socio-economic groups, using generic mortality and morbidity indicators; and (iii) to assess how benefits of public spending are distributed across different groups of the population. The occupied Palestinian territory is not a classical example of a developing country aiming to improve equity in the health system and thus such evaluation will take into consideration the political instability of the country and its influence on the financing of the health care system. |
| Date: | 2010–11 |
| URL: | http://d.repec.org/n?u=RePEc:erg:wpaper:564&r=hea |
| By: | Alain Jousten; Mathieu Lefebvre; Sergio Perelman |
| Abstract: | The paper provides a perspective on the development of the Belgian disability insurance system. Using both survey and administrative data, it sketches a picture of the (changing) factors leading towards disability, as well as the outcomes in terms of program participation. The paper shows the key role of integrating other forms of early retirement programs into the analysis. The main findings are an unspectacular trend in the number of DI beneficiaries over time combined with a strong expansion of (early-) retirement schemes. |
| Date: | 2010 |
| URL: | http://d.repec.org/n?u=RePEc:rpp:wpaper:1006&r=hea |
| By: | Alfredo Burlando (University of Oregon Economics Department) |
| Abstract: | Do transitory income shocks affect infant health? I find evidence that birth weights fell following a temporary income reduction caused by an unexpected, month-long blackout in Zanzibar. Relying on 350 household surveys collected during field work, I show that the 2008 blackout reduced labor supply of workers in electricity-dependent jobs by an average of 25%, with no effect on workers in other sectors. The income shock was temporary. Using over 20,000 birth records from a maternity ward, I document a reduction in the average birth weight of children exposed to the blackout while in utero, and an increase in the probability of low birth weight. Supporting a causal interpretation of these results, the reduction in weights is correlated with measures of maternal exposure to the blackout. In particular, reductions in birth weights were largest among children from wards with intermediate levels of employment in electrified sectors. The two causes that are most consistent with these results are a blackout-induced decline in maternal nutrition, and maternal stress. Alternative explanations are examined, including the possible effects of a temporary fertility shift. It is shown that the blackout increased births, but that selection into pregnancy cannot explain the drop in birth weights. |
| Keywords: | Neonatal health, Birthweights, Nutrition, Fertility, Transitory income, Blackouts, Africa |
| JEL: | O15 O14 J29 I12 |
| Date: | 2010–10–02 |
| URL: | http://d.repec.org/n?u=RePEc:ore:uoecwp:2010-1&r=hea |
| By: | Xiaoyan Lei; Nina Yin; Yaohui Zhao (China Center for Economic Research) |
| Abstract: | The epidemiological transition, which has already passed the developed world, is still progressing in many developing countries. A particular problem associated with this transition is the under-diagnosis and lack of treatment of chronic diseases, and these may exhibit SES gradients and exacerbate social inequality. Using hypertension as an example and data from China (CHNS), we find that the prevalence of hypertension in China is already close to levels in developed countries, under-diagnosis is pervasive, treatment is rare, and failure to control is widespread. Consistent with the literature, we find no income and education gradients in the prevalence of hypertension. However, there are strong education gradients in diagnosis and treatment in urban areas. The income gradients in all aspects of hypertension are relatively weak and sometimes nonexistent. Interestingly, we find that access to health care does not contribute to the diagnosis of hypertension, nor does it aid much in the treatment and control of hypertension. Our results suggest that the epidemiological transition has indeed occurred, but both the Chinese public and its health care system are ill-prepared. There is an urgent need to educate the public on chronic illnesses, and to raise the quality of health care so that patients receive proper diagnoses and guidance on how to treat and control those chronic illnesses. |
| Keywords: | Epidemiological transition, Under-diagnosis, SES health gradients |
| JEL: | I10 |
| Date: | 2010 |
| URL: | http://d.repec.org/n?u=RePEc:eab:develo:2333&r=hea |
| By: | Ting Wang; Virginia R. Young |
| Abstract: | In recent years, a market for mortality derivatives began developing as a way to handle systematic mortality risk, which is inherent in life insurance and annuity contracts. Systematic mortality risk is due to the uncertain development of future mortality intensities, or {\it hazard rates}. In this paper, we develop a theory for pricing pure endowments when hedging with a mortality forward is allowed. The hazard rate associated with the pure endowment and the reference hazard rate for the mortality forward are correlated and are modeled by diffusion processes. We price the pure endowment by assuming that the issuing company hedges its contract with the mortality forward and requires compensation for the unhedgeable part of the mortality risk in the form of a pre-specified instantaneous Sharpe ratio. The major result of this paper is that the value per contract solves a linear partial differential equation as the number of contracts approaches infinity. One can represent the limiting price as an expectation under an equivalent martingale measure. Another important result is that hedging with the mortality forward may raise or lower the price of this pure endowment comparing to its price without hedging, as determined in Bayraktar et al. [2009]. The market price of the reference mortality risk and the correlation between the two portfolios jointly determine the cost of hedging. We demonstrate our results using numerical examples. |
| Date: | 2010–11 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:1011.0248&r=hea |
| By: | Margherita Grasso; Matteo Manera; Aline Chiabai; Anil Markandya |
| Abstract: | In recent years there has been a large scientific and public debate on climate change and its direct as well as indirect effects on human health. According to World Health Organization (WHO, 2006), some 2.5 million people die every year from non-infectious diseases directly attributable to environmental factors such as air pollution, stressful conditions in the workplace, exposure to chemicals such as lead, and exposure to environmental tobacco smoke. Changes in climatic conditions and climate variability can also affect human health both directly and indirectly, via changes in biological and ecological processes that influence the transmission of several infectious diseases (WHO, 2003). In the past fifteen years a large amount of research on the effects of climate changes on human health has addressed two fundamental questions (WHO, 2003). First, can historical data be of some help in revealing how short-run or long-run climate variations affect the occurrence of infectious diseases? Second, is it possible to build more accurate statistical models which are capable of predicting the future effects of different climate conditions on the transmissibility of particularly dangerous infectious diseases? The primary goal of this paper is to review the most relevant contributions which have directly tackled those questions, both with respect to the effects of climate changes on the diffusion of non-infectious and infectious diseases. Specific attention will be drawn on the methodological aspects of each study, which will be classified according to the type of statistical model considered. Additional aspects such as characteristics of the dependent and independent variables, number and type of countries investigated, data frequency, temporal period spanned by the analysis, and robustness of the empirical findings are examined. <br /> |
| Keywords: | Climate change; Health; Statistical models; Non-infectious diseases; Infectious diseases; Malaria; Cardiovascular diseases |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:bcc:wpaper:2010-16&r=hea |
| By: | Pieroni, Luca; Salmasi, Luca |
| Abstract: | This work examines the socio-economic determinants of body weight in the United Kingdom by means of two recent waves from the British Household Panel Survey. While the patterns of overweight and obesity have drawn economists’ interest in recent years, our main contribution is to examine the weight determinants on the conditional distribution of body weight across individuals. Are there differing socio-economic causes for gaining weight in highly overweight people compared with underweight ones? For instance, we examine whether reduction in smoking affects differently individuals located among the most and the least of the weight distributions. Our results for significant determinants support some findings in the literature, but also point to new conclusions. In many cases, quantile regression estimates are quite different from OLS regressions ones. Among obese people, our results reveal that they are less so as males do not spend extra-time at work or females increases physical activities. Furthermore, smoking cessation may lead to moderate effects on weight increases only for underweight and normalweight subjects but they are not significant for people affected by higher obesity prevalence rates. |
| Keywords: | Body Mass Index; Overweight and Obesity; Quantile regression; Elasticity |
| JEL: | I12 I18 I10 |
| Date: | 2010–11–04 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:26434&r=hea |
| By: | Scott E. Carrell; Mark Hoekstra; James E. West |
| Abstract: | The increase in obesity over the past thirty years has led researchers to investigate the role of social networks as a contributing factor. However, several challenges make it difficult to demonstrate a causal link between friends’ physical fitness and own fitness using observational data. To overcome these problems, we exploit data from a unique setting in which individuals are randomly assigned to peer groups. We find statistically significant peer effects that are 40 to 70 percent as large as the own effect of prior fitness scores on current fitness outcomes. Evidence suggests that the effects are caused primarily by friends who were the least fit, thus supporting the provocative notion that poor physical fitness spreads on a person-to-person basis. |
| JEL: | I18 I2 Z13 |
| Date: | 2010–11 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:16518&r=hea |
| By: | Greenstein, Shane |
| Abstract: | What are the signs of healthy behavior in an innovative industry? This seemingly simple question isn’t so simple to answer in a quickly evolving industry such as the Internet. Commercial behavior resides inside a complex value chain, which is a set of interrelated activities that produces a final product for end users. No single firm controls the value chain, and the quality, price, and user experience arise from the complex interactions between those participants. Moreover, over time many parts of this value chain have undergone innovative improvements, and no reasonable observer expects those improvements to cease tomorrow. There is no agreement about which criteria observers and policy makers should use to assess the performance of the commercial Internet. Ever since the commercial Internet first emerged, there have been arguments about how to best organize its value chain to achieve maximum value for the most users. Disagreements have not diminished with time. If anything, this debate has grown shrill as the number of commercial interests and business commentators have grown. This essay makes a novel contribution to this topic. It identifies patterns of healthy commercial behavior indicative of an innovative industry, and illustrates how to observe signs of such behavior in information technology markets, such as the Internet. Stated broadly, the essay identifies healthy behavior that correlates with desirable marketwide outcomes, such as improvement in products, lower prices, new capabilities, or other innovations that lead to productivity improvements among business users. |
| Date: | 2010–01 |
| URL: | http://d.repec.org/n?u=RePEc:reg:wpaper:577&r=hea |
| By: | Natasha Fernandes; Byron G. Spencer |
| Abstract: | Canadians expect the same access to health care whether they are rich or poor, and wherever they live, often without direct charge at the point of service. However, we find that the private cost of long-term care differs greatly across the country, and within provinces, we find substantial variation, depending on income level, marital status, and, in Quebec alone, on assets owned. A non-married person with average income would pay more than twice as much in the Atlantic provinces as in Quebec, while a couple with one in care would pay almost four times as much in Newfoundland as in Alberta. |
| Keywords: | long-term care , private cost |
| JEL: | I11 J14 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:443&r=hea |
| By: | Michel Grignon; Byron G. Spencer; Li Wang |
| Abstract: | In this article we analyse the rates at which those admitted to hospital with acute myocardial infarction (AMI) receive aggressive treatment, assess how those rates have changed over time, and ask whether there is evidence of age discrepancies. Estimates made on the basis of data from an administrative database that includes discharges from all acute care hospitals in Ontario for selected years, from 1995 to 2005, indicate that there are strong and persistent age patterns in the application of medical technology. Results showed that to be true even after controlling for the higher rates of co-morbidities among older patients and variations across hospitals in practice patterns. |
| Keywords: | treatment of AMI, age pattern |
| JEL: | I11 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:444&r=hea |
| By: | Kathi Wilson; Mark W. Rosenberg; Sylvia Abonyi; Robert Lovelace |
| Abstract: | The Aboriginal population in Canada, much younger than the general population, has experienced a trend towards aging over the past decade. Using data from the 2001 Aboriginal Peoples Survey (APS) and the 2000/2001 Canadian Community Health Survey (CCHS), this article examines differences in health status and the determinants of health and health care use between the 55-and-older Aboriginal population and non-Aboriginal population. The results show that the older Aboriginal population is unhealthier than the non-Aboriginal population across all age groups; differences in health status, however, appear to converge as age increases. Among those aged 55 to 64, 7 per cent of the Aboriginal population report three or more chronic conditions compared with 2 per cent of the non-Aboriginal population. Yet, among those aged 75 and older, 51 per cent of the Aboriginal population report three or more chronic conditions in comparison with 23 per cent of the non-Aboriginal population. |
| Keywords: | Aboriginal people, health status, health care use |
| JEL: | I10 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:sedapp:279&r=hea |
| By: | Steven G. Prus; Rania Tfaily; Zhiqiu Li |
| Abstract: | Little comparative research exists on health experiences and conditions of minority groups in Canada and the United States, despite both countries having a racially diverse population with a signifi cant proportion of immigrants. This article explores race and immigrant disparities in health and health care access across the two countries. The study focus was on middle and old age given the change and increasing diversity in health and health care policy, such as Medicare. Logistic regression analysis of data from the 2002–2003 Joint Canada/United States Survey of Health shows that the joint effect of race and nativity on health outcomes – health differences between native and foreign-born Whites and non- Whites – is largely insignifi cant in Canada but considerable in the U.S. Non-White native and foreign-born Americans within both 45-to-64 and 65-and-over age groups experience signifi cant disadvantage in health status and access to care, irrespective of health insurance coverage, demographic, socio-economic, and lifestyle factors. |
| Keywords: | health, obesity, health care, race, immigrant, Canada, United States |
| JEL: | I12 |
| Date: | 2010–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:sedapp:280&r=hea |