nep-hea New Economics Papers
on Health Economics
Issue of 2010‒12‒11
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Efficiency and Technological Change in Health Care Services in Ontario By H. Chowdhury; V. Zelenyuk; W. Wodchis; A. Laporte
  2. Work, Risk and Health: Differences between Immigrants and Natives in Spain By Solé, Meritxell; Diaz-Serrano, Luis; Rodriguez Martinez, Marisol
  3. Alcohol consumption and liver cirrhosis mortality: New evidence from a panel data analysis for sixteen European countries By Bentzen, Jan; Smith, Valdemar
  4. Health Systems Institutional Characteristics: A Survey of 29 OECD Countries By Valérie Paris; Marion Devaux; Lihan Wei
  5. Comparing Price Levels of Hospital Services Across Countries: Results of a Pilot Study By OECD
  6. Don´t Drink and... Avoid Risky Sex of Your Peers: The Influence of Alcohol Consumption of Opposite-Gender Peers on Youth Risky Sexual Behavior By Filip Pertold
  7. Pollution exposure and infant health: Evidence from Germany By Coneus, Katja; Spiess, C. Katharina
  8. Antiretroviral therapy awareness and risky sexual behaviors : evidence from Mozambique By de Walque, Damien; Kazianga, Harounan; Over, Mead
  9. Optimal Aging and Death By Carl-Johan Dalgaardy; Sebastian Vollmer
  10. Infrequency of Purchase, Individual Heterogeneity an and Rational Addiction in Single Households’ Estimates of Alcohol Consumption. By Pierpaolo Pierani; Silvia Tiezzi
  11. Optimal sequential sampling rules for the economic evaluation of health technologies By Paolo Pertile; Martin Forster; Davide La Torre
  12. Scarring and Mortality Selection Among Civil War POWs: A Long-Term Mortality, Morbidity and Socioeconomic Follow-Up By Dora L. Costa
  13. Beware of Unawareness: Racial/Ethnic Disparities in Awareness of Chronic Diseases By Pinka Chatterji; Heesoo Joo; Kajal Lahiri

  1. By: H. Chowdhury (CEPA - School of Economics, The University of Queensland); V. Zelenyuk (CEPA - School of Economics, The University of Queensland); W. Wodchis (CEPA - School of Economics, The University of Queensland); A. Laporte (CEPA - School of Economics, The University of Queensland)
    Abstract: This paper presents productivity measurement results for hospital services using panel data for Ontario hospitals between 2003 and 2006. The study uses the Malmquist Productivity index (MPI) obtained through the application of Data Envelopment Analysis (DEA) which is decomposed into efficiency change (ECH), i.e., movement towards the best practice frontier and technological change (TCH), i.e., movement of the frontier itself (Färe et al. [12]). The study also uses kernel density estimation techniques for analysis of efficiency distributions of the productivity scores and their components across different types of hospitals (e.g. small /large and rural /urban) and over time. Our results suggest that in addition to average productivity it is important to examine distributions of productivity and of its components which we find differs by hospital type and over time. We find that productivity growth occurred mostly through improvement in technology and in spite of declining efficiency. The results provide useful insight into the underlying mechanisms of observed changes in overall productivity, in technological change and in technical efficiency change in this vital sector of the health care market.
    Date: 2010–11
  2. By: Solé, Meritxell (CREB, Barcelona); Diaz-Serrano, Luis (Universitat Rovira i Virgili); Rodriguez Martinez, Marisol (University of Barcelona)
    Abstract: We analyze the impact of working and contractual conditions, particularly exposure to job risks, on the probability of acquiring a disability. We postulate a model in which this impact is mediated by the choice of occupation, with a level of risk associated to it. We assume this choice is endogenous, and that it depends on preferences and opportunities in the labour market, both of which may differ between immigrants and natives. To test this hypothesis we use data from the Continuous Sample of Working Lives of the Spanish SS system. It contains individual, job and firm information of over a million workers, including a representative sample of immigrants. We find that risk exposure increases the probability of permanent disability by 5.3%; temporary employment also influences health. Migrant status – with differences among regions of origin – significantly affects both disability and the probability of being employed in a risky occupation. Most groups of immigrants work in riskier jobs, but have lower probability of becoming disabled. Nevertheless, our theoretical hypothesis that disability and risk are jointly determined is not valid for immigrants: i.e. for them working conditions is not a matter of choice in terms of health.
    Keywords: disability, working conditions, immigration, Spain, MCVL
    JEL: J28 J61 J81
    Date: 2010–11
  3. By: Bentzen, Jan (Department of Economics, Aarhus School of Business); Smith, Valdemar (Department of Economics, Aarhus School of Business)
    Abstract: Empirical evidence gives strong support to a close association between liver cirrhosis mortality and the intake of alcohol and most often a log-linear relationship is assumed in the econometric modeling. The present analysis investigates for unit roots in a panel data set for sixteen European countries – covering the period 1970-2006 - where both alcohol consumption and liver cirrhosis seem best described as trend-stationary variables. Therefore a fixed effects model including individual trends is applied in the analysis but also a more flexible non-linear functional form with fewer restrictions on the relationship between liver cirrhosis mortality and alcohol consumption is included. The conclusion is that the total level of alcohol consumption as well as the specific beverages – beer, wine and spirits – contributes to liver cirrhosis mortality, but the present study also reveals that directly addressing the question of panel unit roots and in this case subsequently applying a trend-stationary modeling methodology reduces the estimates of the impacts from alcohol consumption to liver cirrhosis. Finally, more restrictive alcohol policies seem to have positively influenced the country-specific development in cirrhosis mortality.
    Keywords: Alcohol consumption; Liver cirrhosis mortality; Trend-stationary panel data; Non-linear modelling
    JEL: I10
    Date: 2010–10–01
  4. By: Valérie Paris; Marion Devaux; Lihan Wei
    Abstract: In 2008, the OECD launched a survey to collect information on the health systems characteristics of member countries. This paper presents the informaton provided by 29 of these countries in 2009. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending. It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of heallth care suppply and prices. Finally, this document provides information on governnance and resource allocation in health systems (decentralisation in decisionmaking, nature of budget constraints and priority setting).<BR>En 2008, l’OCDE a lancé une enquête auprès de ses pays membres pour recueillir une information sur les caractéristiques des systèmes de santé. Ce document présente l’information fournie par 29 pays en 2009. Il décrit comment chaque pays organise la couverture de la population contre les risques liés à la santé et le financement des dépenses de santé. Il dépeint l’organisation des soins, à travers le caractère public/privé de l’offre de soins, les modes de paiement des prestataires, le choix de l’usager et la concurrence entre prestataires, ainsi que la régulation de l’offre et des prix. Finalement, il donne une information sur la gouvernance et l’allocation des ressources dans les systèmes de santé (décentralisation, nature de la contrainte budgétaire et établissement des priorités).
    JEL: I1 I10 I18
    Date: 2010–04–28
  5. By: OECD
    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.
    Date: 2010–07–09
  6. By: Filip Pertold
    Abstract: I estimate the effect of opposite-gender peer drinking on individual risky sexual behavior among Czech youth. The identification strategy relies on two main controls for individual and group-specific unobservables. First, younger schoolmates’ sexual behavior is a control for school-specific attitudes toward sexual behavior. Second, pre-determined individual presecondary- school alcohol consumption is used to control for self-selection into schools of individuals with specific attitudes toward alcohol. As opposed to Waddell (2010), I find that female drinking affects the male propensity to have unprotected sex, while male drinking does not have such an effect on female behavior. This finding corresponds to the fact that females have usually older sexual partners than males.
    Keywords: peer effects; sexual behavior; drinking
    JEL: J24 J31
    Date: 2010–10
  7. By: Coneus, Katja; Spiess, C. Katharina
    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 measurements 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 relationship 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
  8. By: de Walque, Damien; Kazianga, Harounan; Over, Mead
    Abstract: This paper studies the effect of increased access to antiretroviral therapy on risky sexual behavior, using data collected in Mozambique in 2007 and 2008. The survey sampled both households of randomly selected HIV positive individuals and households from the general population. Controlling for unobserved individual characteristics, the findings support the hypothesis of disinhibition behaviors, whereby risky sexual behaviors increase in response to the perceived changes in risk associated with increased access to antiretroviral therapy. Furthermore, men and women respond differently to the perceived changes in risk. In particular, risky behaviors increase for men who believe, wrongly, that AIDS can be cured, while risky behaviors increase for women who believe, correctly, that antiretroviral therapy can treat AIDS but cannot cure it. The findings suggest that scaling up access to antiretroviral therapy without prevention programs may not be optimal if the objective is to contain the disease, since people would adjust their sexual behavior in response to the perceived changes in risk. Therefore, prevention programs need to include educational messages about antiretroviral therapy, and address the changing beliefs about HIV in the era of increasing antiretroviral therapy availability.
    Keywords: Population Policies,HIV AIDS,Disease Control&Prevention,Gender and Health,Adolescent Health
    Date: 2010–11–01
  9. By: Carl-Johan Dalgaardy; Sebastian Vollmer (Harvard School of Public Health)
    Abstract: This study introduces physiological aging into a simple model of optimal in- tertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal health investments. At the same time, physiological aspects of the aging process infuence optimal savings and health investment. We calibrate the model for the average US male in 2000 and proceed to show that the calibrated model accounts well for the cross-country link between labor productivity and life expectancy in the same year (\the Preston curve"); cross-country income dierences can explain dierences in life expectancy at age 20 of up to a decade. Moreover, techno- logical change in health care of about 1.1% per year can account for the observed shift in the Preston curve between 1980 and 2000.
    Keywords: aging, death, optimal intertemporal consumption
    Date: 2010–07
  10. By: Pierpaolo Pierani; Silvia Tiezzi
    Abstract: A panel of Italian single households is used to test for rational addiction in alcohol consumption. These monthly consumption data raise problems of measurement errors and unobservable heterogeneity. To deal with the zeros in the dependent variable we adopt a specification based on infrequency of purchase. GMM estimators are used to deal with errors in variables and unobserved heterogeneity. There is evidence that alcohol consumers are actually forward-looking. Past consumption is also significant in explaining current consumption thus detecting the addictive nature of alcohol. Discount rates, the strength of addiction, short and long run price and income elasticities are significant and in line with the theoretical predictions. These results and the inclusion of a number of demographic and geographic characters deliver valuable information for public policy purposes and suggest significant differences driven by individual heterogeneity.
    Keywords: rational addiction; infrequency of purchase; GMM
    JEL: C23 D12
    Date: 2010–11
  11. By: Paolo Pertile; Martin Forster; Davide La Torre
    Abstract: Referring to the literature on optimal stopping under sequential sampling developed by Chernoff and collaborators, we solve a dynamic model of the economic evaluation of a new health technology, deriving optimal rules for technology adoption, research abandonment and continuation as functions of sample size. The model extends the existing literature to the case where an adoption decision can be deferred and involves a degree of irreversibility. We explore the model's applicability in a case study of the economic evaluation of Drug Eluting Stents (DES), deriving dynamic adoption and abandonment thresholds which are a function of the model's economic parameters. A key result is that referring to a single cost-effectiveness threshold may be sub-optimal.
    Keywords: Cost-effectiveness analysis, Sequential sampling, Dynamic programming
    JEL: I10 D92 C61
    Date: 2010–12
  12. By: Dora L. Costa
    Abstract: Debilitating events could leave either frailer or more robust survivors, depending on the extent of scarring and mortality selection. The majority of empirical analyses find frailer survivors. I find heterogeneous effects. Among severely stressed former Union Army POWs, which effect dominates 35 years after the end of the Civil War depends on age at imprisonment. Among survivors to 1900, those younger than 30 at imprisonment faced higher older age mortality and morbidity and worse socioeconomic outcomes than non-POW and other POW controls whereas those older than 30 at imprisonment faced a lower older age death risk than the controls.
    JEL: J1 J14 N31
    Date: 2010–12
  13. By: Pinka Chatterji; Heesoo Joo; Kajal Lahiri
    Abstract: This paper studies racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 HRS. We estimate a 3-step sequential probit model which accounts for selection into: (1) participating in biomarker collection; (2) having illness (hypertension or diabetes); (3) being aware of illness. Contrary to studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion holds after self-selection and severity are considered. Likewise, African-Americans and Latinos are less aware of having diabetes compared to non-Latino whites. Disparities in unawareness are exacerbated when we limit the sample to untreated respondents.
    JEL: I1
    Date: 2010–12

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