nep-hea New Economics Papers
on Health Economics
Issue of 2010‒12‒23
six papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Are Assets in Medical Savings Accounts Discounted? Evidence from a Natural Experiment in China By Maoyong Fan; Zhen Lei; Guoen Liu
  2. Determinants of Health in Developing Countries:Cross-Country Evidence By Yusuke Kamiya
  3. Endogenous Womenfs Autonomy and the Use of Reproductive Health Services: Empirical Evidence from Tajikistan By Yusuke Kamiya
  4. Hygiene, Sanitation, and Water: Forgotten Foundations of Health By Jamie Bartram; Sandy Cairncross
  5. Can We Count on Global Health Estimates? By PLoS Medicine
  6. Subscribing to Supplemental Health Insurance in France: A Dynamic Analysis of Adverse Selection By Carine Franc; Marc Perronnin; Aurélie Pierre

  1. By: Maoyong Fan (Department of Economics, Ball State University); Zhen Lei (Department of Energy and Mineral Engineering, Penn State University); Guoen Liu (Guanghua School of Management at Peking University)
    Abstract: In China, Medical Savings Accounts (MSAs) are a major tool financing health care consumption in urban areas. Whether MSAs control medical expenditures and encourage saving is based on an assumption that enrollees treat the MSA money the same as their pocket money. This assumption has never been tested. Given the mandatory and restrictive nature of MSAs in China, we hypothesize that enrollees may discount their MSAs and spend them prematurely. To test whether assets in MSAs are discounted, we take advantage of a policy change as a natural experiment in city of Zhenjiang. The policy change affected different age cohorts differently in terms of financial contributions to MSAs. Empirical results show that a reduction in MSAs caused enrollees to reduce their annual medical expenditures by more than the amount of the MSA reduction. The effect was largest for those with intermediate medical expenditures, who were more likely to exhaust their MSAs and pay out-of-pocket expenses. The results are consistent with the hypothesis that enrollees discount their MSAs. The smaller their MSAs are, the higher the chance of paying medical expenditures out-of-pocket (the "true" price): when forced to pay the "true" price of medical services, they consume less.
    Keywords: Medical Savings Account, Natural Experiment, Medical Expenditures, Health
    JEL: I11 I18 O12
    Date: 2010–12
  2. By: Yusuke Kamiya (Ph.D candidate, Osaka School of International Public Policy (OSIPP))
    Abstract: There is a growing consensus that stronger health systems are crucial to achieving a further reduction in child mortality. On the other hand, socioeconomic status has also long been considered to be a crucial factor to affect peoplefs health status. Nevertheless, there exists no consistent empirical evidence on whether or not and how health systems and socioeconomic factors affect health outcomes. This paper applies system Generalised Method of Moments (system GMM) to estimate the determinants of under-five mortality for cross-country panel data from 141 developing countries. Empirical results show that GDP per capita and the access to improved sanitation have statistically significant and favourable effects in reducing child mortality. In contrast, health system factors, which are measured by government health spending, the coverage of immunisation and skilled birth attendants, and the number of physicians per 1,000 people, do not lead to mortality reduction.
    Keywords: Determinants of health, child health, health systems, System GMM
    JEL: I12 I18 O15
    Date: 2010–12
  3. By: Yusuke Kamiya (Ph.D candidate, Osaka School of International Public Policy (OSIPP))
    Abstract: Though gender equity is widely considered to be a key to improving maternal health in developing countries, little empirical evidence has been presented to support this claim. This paper investigates whether or not and how female autonomy within the household affects womenfs use of reproductive health care in Tajikistan, where the situation of maternal health and gender equity is worse compared with neighbouring countries. Estimation is performed using bivariate probit models in which womanfs use of health services and the level of female autonomy are recursively and simultaneously determined. Empirical results reveal that female autonomy measured by womenfs decision-making on child wellbeing and on economic affairs within the household increases the probability of receiving both antenatal and delivery care. Policymakers need to address womenfs empowerment in the household in addition to implementing direct health interventions towards improvement of maternal health.
    Keywords: Female autonomy; Antenatal care; Delivery care; Reproductive health services; Tajikistan; Bivariate probit model
    JEL: J12 J13 J16
    Date: 2010–12
  4. By: Jamie Bartram; Sandy Cairncross
    Abstract: Health evidence confirms that the burden of disease associated with inadequate Hygience, Sanitation, Water (HSW) is overwhelmingly (although not exclusively) carried by the poor and disadvantaged in the developing world and is a major contributor to the cycle of poverty.
    Keywords: HSW, population, health, sanitation, water, developing world, poverty, burden of disease, poor, health
    Date: 2010
  5. By: PLoS Medicine
    Abstract: Even with advanced statistical techniques and complex modeling tools it is often frustratingly difficult to interpret and judge that the global estimates results complete accuracy.
    Keywords: statistical estmates, complete acuracy, medeling, health estimates, UN, medical journals, WHO, research,
    Date: 2010
  6. By: Carine Franc (Cermes, Inserm U988, CNRS UMR8211, IRDES); Marc Perronnin (IRDES institut for research and information in health economics); Aurélie Pierre (IRDES institut for research and information in health economics)
    Abstract: Adverse selection, which is well described in the theoretical literature on insurance, remains relatively difficult to study empirically. The traditional approach, which focuses on the binary decision of “covered” or “not”, potentially misses the main effects because heterogeneity may be very high among the insured. In the French context, which is characterized by universal but incomplete public health insurance (PHI), we study the determinants of the decision to subscribe to supplemental health insurance (SHI) in addition to complementary health insurance (CHI). This work permits to analyze health insurance demand at the margin. Using a panelized dataset, we study the effects of both individual state of health, which is measured by age and previous individual health spending, and timing on the decision to subscribe. One striking result is the changing role of health risk over time, illustrating that adverse selection occurs immediately after the introduction of SHI. After the initial period, the effects of health risks (such as doctors’ previous health expenditures) diminish over time and financial risks (such as dental and optical expenses and income) remain significant. These results may highlight the inconsistent effects of health risks on the demand for insurance and the challenges of studying adverse selection.
    Keywords: Supplemental health insurance, adverse selection, health insurance demand, longitudinal analysis.
    JEL: C23 D82 G22 I11
    Date: 2010–12

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