nep-hea New Economics Papers
on Health Economics
Issue of 2011‒01‒16
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Intergenerational persistence in health in developing countries: the penalty of gender inequality By Sonia Bhalotra; Sam Rawlings
  2. Poverty and survival By Sonia Bhalotra
  3. Efficiency of Hospitals in the Czech Republic By Jana Procházková; Lenka Šťastná
  4. The Race Against Drug Resistance By Rachel Nugent
  5. Food crisis, household welfare and HIV/AIDS treatment : evidence from Mozambique By de Walque, Damien; Kazianga, Harounan; Over, Mead; Vaillant, Julia
  6. The impact of medical and nursing home expenses and social insurance By Karen A. Kopecky; Tatyana Koreshkova
  7. Do School Lunch Subsidies Change the Dietary Patterns of Children from Low-Income Households? By Larry L. Howard; Nishith Prakash
  8. Critical Condition: A Historian's Prognosis on Canada's Aging Healthcare System By Michael Bliss
  9. Estimating the Impacts of Climate Change on Mortality in OECD Countries By Chen, Ping-Yu; Chang, Chia-Lin; Chen, Chi-Chung
  10. Is Being in School Better? The Impact of School on Children's BMI When Starting Age is Endogenous By Patricia M. Anderson; Kristin F. Butcher; Elizabeth U. Cascio; Diane Whitmore Schanzenbach
  11. Insurance Mandates and Mammography By Marianne P. Bitler; Christopher S. Carpenter
  12. Transitory shocks and long-term human capital accumulation: the impact of conflict on physical health in Peru By Sanchez, Alan
  13. Price effects of Dutch hospital mergers, An ex post assessment of hip surgery By Ron Kemp; Astrid Severijnen
  14. Quantitative MRI in the diagnosis and monitoring of human prion diseases. By Hyare, H.
  15. Gender Differences in Socioeconomic Status and Health: Evidence from the 2008 Vietnam Household Living Standard Survey By Nidhiya Menon; Yana van der Meulen Rodgers

  1. By: Sonia Bhalotra; Sam Rawlings
    Abstract: This paper is motivated to investigate the often neglected payoff to investments in the health of girls and women in terms of next generation outcomes. This paper investigates the intergenerational persistence of health across time and region as well as across the distribution of maternal health. It uses comparable micro-data on as many as 2.24 million children born of about 0.6 million mothers in 38 developing countries in the 31 year period, 1970-2000. Mother's health is indicated by her height, BMI and anemia status. Child health is indicated by mortality risk and anthropometric failure. We find a positive relationship between maternal and child health across indicators and highlight nonlinearities in these relationships. The results suggest that both contemporary and childhood health of the mother matter and that the benefits to the next generation are likely to be persistent. Averaging across the sample, persistence shows a considerable decline over time. Disaggregation shows that the decline is only significant in Latin America. Persistence has remained largely constant in Asia and has risen in Africa. The paper provides the first cross-country estimates of the intergenerational persistence in health and the first estimates of trends.
    Keywords: intergenerational persistence, mobility, health, developing countries, cohort trends, inequality
    JEL: I10 J11 O57
    Date: 2010–11
  2. By: Sonia Bhalotra
    Abstract: A recent literature highlights the uncertainty concerning whether economic growth has any causal protective effect on health and survival. But equal rates of growth often deliver unequal rates of poverty reduction and absolute deprivation is more clearly relevant. Using state‐level panel data for India, we contribute the first estimates of the impact of changes in poverty on infant survival. We identify a significant within-state relationship which persists conditional upon state income, indicating the size of survival gains from redistribution in favour of households below the poverty line. The poverty elasticity declines over time after 1981. It is invariant to controlling for income inequality but diminished upon controlling for education, fertility and state health expenditure, and eliminated once we introduce controls for omitted trends.
    Keywords: poverty, income, inequality, infant mortality, India, economic reform, state health expenditure, panel data.
    JEL: O15 I12
    Date: 2010–12
  3. By: Jana Procházková (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic); Lenka Šťastná (Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic)
    Abstract: The paper estimates cost efficiency of 99 general hospitals in the Czech Republic during 2001-2008 using Stochastic Frontier Analysis. We estimate a baseline model and also a model accounting for various inefficiency determinants. Group-specific inefficiency is present even having taken care of a number of characteristics. We found that inefficiency increases with teaching status, more than 20,000 treated patients a year, not-for-profit status and a larger share of the elderly in the municipality. Inefficiency decreases with less than 10,000 patients treated a year, larger population, and more hospitals in the region.
    Keywords: Efficiency, hospitals, stochastic frontier analysis
    JEL: D24 I11
    Date: 2011–01
  4. By: Rachel Nugent
    Abstract: The Center for Global Development’s Drug Resistance Working Group urges pharmaceutical companies, governments, donors, global health institutions, health providers, and patients to collectively and immediately tackle the global problem of drug resistance. Some recommendations have been suggested.
    Keywords: drug resistance, global, development, patients, companies, developing world, donors, health institutions
    Date: 2011
  5. By: de Walque, Damien; Kazianga, Harounan; Over, Mead; Vaillant, Julia
    Abstract: Using panel data from Mozambique collected in 2007 and 2008, the authors explore the impact of the food crisis on the welfare of households living with HIV/AIDS. The analysis finds that there has been a real deterioration of welfare in terms of income, food consumption, and nutritional status in Mozambique between 2007 and 2008, among both HIV and comparison households. However, HIV households have not suffered more from the crisis than others. Results on the evolution of labor force participation suggest that initiation of treatment and better services in health facilities have counter-balanced the effect of the crisis by improving the health of patients and their labor force participation. In addition, the authors look at the effect of the change in welfare on the frequency of visits to a health facility of patients and on their treatment outcomes. Both variables can proxy for adherence to treatment. This is a particularly crucial issue as it affects both the health of the patient and public health, because sub-optimal adherence leads to the development of resistant forms of the virus. The paper finds no effect of the change in welfare on the frequency of visits, but does find that people who experienced a negative income shock also experienced a reduction or a slower progression in treatment outcomes.
    Keywords: Health Monitoring&Evaluation,Disease Control&Prevention,Food&Beverage Industry,Gender and Health,Food Security
    Date: 2011–01–01
  6. By: Karen A. Kopecky; Tatyana Koreshkova
    Abstract: We consider a life-cycle model with idiosyncratic risk in labor earnings, out-of-pocket medical and nursing home expenses, and survival. Partial insurance is available through welfare, Medicaid, and social security. Calibrating the model to the United States, we find that 12 percent of aggregate savings is accumulated to finance and self-insure against old-age health expenses given the absence of complete public health care for the elderly and that nursing home expenses play an important role in the savings of the wealthy and on aggregate. Moreover, we find that the aggregate and distributional effects of public health care provision are highly dependent on the availability of other programs making up the social insurance system.
    Date: 2010
  7. By: Larry L. Howard (California State University, Fullerton); Nishith Prakash (Cornell University, CReAM, and IZA)
    Abstract: This article examines the effects of school lunch subsidies provided through the meanstested component of the National School Lunch Program on the dietary patterns of children age 10- to 13 yr in the USA. Analyzing data on 5,140 public school children in 5th grade during spring 2004, we find significant increases in the number of servings of fruit, green salad, carrots, other vegetables, and 100 percent fruit juice consumed in one week for subsidized children relative to unsubsidized children. The effects on fruit and other vegetable consumption are stronger among the children receiving a full subsidy, as opposed to only a partial subsidy, and indicate the size of the subsidy is an important policy lever underlying the program's effectiveness. Overall, the findings provide the strongest empirical evidence to date that the means-tested school lunch subsidies increase children’s consumption over a time period longer than one school day.
    Keywords: National School Lunch Program, Dietary Patterns, Means-Tested Subsidies.
    JEL: H51 I12 I38
    Date: 2011–01
  8. By: Michael Bliss
    Keywords: Canada, public healthcare, universality, financial need, Canada's healthcare system
    JEL: H51 I11 I18
    Date: 2010–11
  9. By: Chen, Ping-Yu; Chang, Chia-Lin; Chen, Chi-Chung
    Abstract: The major contribution of this study is to combines both climatic and macroeconomic factors simultaneously in the estimation of mortality using the capital city of 22 OECD countries from the period 1990 to 2008. The empirical results provide strong evidences that higher income and a lower unemployment rate could reduce mortality rates, while the increases in precipitation and temperature variation have significantly positive impacts on the mortality rates. The effects of changing average temperature on mortality rates in summer and winter are asymmetrical and also depend on the location. Combining the future climate change scenarios with the estimation outcomes show that mortality rates in OECD countries in 2100 will be increased by 3.77% to 5.89%.
    Keywords: Climate change; mortality; panel data model
    JEL: I12 Q54
    Date: 2010–12
  10. By: Patricia M. Anderson; Kristin F. Butcher; Elizabeth U. Cascio; Diane Whitmore Schanzenbach
    Abstract: In this paper, we investigate the impact of attending school on body weight and obesity. We use school starting age cutoff dates to compare weight outcomes for similar age children with different years of school exposure. As is the case with academic outcomes, school exposure is related to unobserved determinants of weight outcomes because some families choose to have their child start school late (or early). If one does not account for this endogeneity, it appears that an additional year of school exposure results in a greater BMI and a higher probability of being overweight or obese. When actual exposure is instrumented with expected exposure based on school starting dates and birthday, the significant positive effects disappear, and most point estimates become negative and insignificant. However, for children not eating the school lunch, there is a significant negative effect on the probability of being overweight.
    JEL: I12 I21
    Date: 2011–01
  11. By: Marianne P. Bitler; Christopher S. Carpenter
    Abstract: Recently adopted federal health reform requires insurers to cover mammograms without cost-sharing. We examine similar state insurance mandates that vary substantially in the timing of adoption and in specifying the ages of women eligible for different mammography benefits. In triple differences models we find that mandates requiring coverage of annual mammograms significantly increased past year mammography screenings by about 8 percent, representing over 800,000 additional women screened from 1987-2000. Mandates that explicitly prohibit deductibles are especially effective at increasing screenings among high school dropouts, suggesting that federal health reform is likely to further increase use of screening mammography.
    JEL: I1 I18
    Date: 2011–01
  12. By: Sanchez, Alan (Banco Central de Reserva del Perú)
    Abstract: The recent literature on human capital highlights the importance of investments during the first few years after birth as a determinant of economic outcomes later in life, including labour productivity. This paper assesses the relationship between conflict exposure -a transitory, aggregate, shock- and early nutrition. The relationship between conflict exposure and human capital outcomes can be put into doubt due to the endogenous nature of conflict. In this paper I use a rich dataset that permits me to trace the intensity of a country-specific, large-scale, conflict across regions and over time at the monthly frequency over a 20-year period. I use this data to link conflict exposure prevalent around the time of birth to child-level outcomes of birth cohorts born over an analogous time period. The identification strategy exploits differences in the intensity of exposure between siblings in turn determined by year-month of birth. Results show that, on average, early exposure to conflict did not have an effect on infant mortality but had large negative effects on short-term nutritional outcomes, particularly for the poor. These results suggest that, unless compensatory investments were at place, the Peruvian conflict might have had long-term effects on human capital accumulation through a nutritional channel.
    Keywords: Health Production, Human Capital, Conflict, Children
    JEL: I12 J24 J13 O15
    Date: 2010–12
  13. By: Ron Kemp (Netherlands Competition Authority); Astrid Severijnen (Netherlands Competition Authority)
    Abstract: This study analyses price effects of two mergers in the Dutch healthcare industry. We investigate whether the merging hospitals raised their prices for hip surgery after the merger and, if so, how patients react to this higher price. For the Ziekenhuis Hilversum – Ziekenhuis Gooi-Noord merger, we found a statistically significant price increase for hip surgery, whereas for the Erasmus MC ziekenhuis – Havenziekenhuis Rotterdam merger, we did not find a significant price increase due to the merger. For both mergers, travel behaviour of patients prior and after the merger increased only slightly. As we studied only one treatment, hip surgery, we cannot draw conclusions on the overall price effect of the mergers.
    JEL: C13 I11 I18 L13
    Date: 2010–10
  14. By: Hyare, H.
    Abstract: This thesis examines the application of cerebral diffusion weighted imaging (DWI) and short echo time (TE) proton magnetic resonance spectroscopy (1H-MRS) for the evaluation of patients with different forms of human prion disease. Human prion diseases are progressive, uniformly fatal neurodegenerative diseases and as treatments are developed, early diagnosis is essential. Particularly important is the diagnosis of presymptomatic cases and prediction of disease onset in these individuals. In this thesis I demonstrate that MRI measures of Apparent Diffusion Coefficient (ADC) at low and high b-value and short TE 1H-MRS are potential neuroimaging biomarkers of prion disease activity. I show that ex-vivo MRI at high field provides important insights into the microstructural changes underlying the sensitivity of some of these quantitative MRI methods to prion disease pathology. The findings presented here exemplify the potential of quantitative MRI in both increasing our understanding of the pathophysiology of prion diseases and in providing neuroimaging biomarkers which will be of great importance for the future evaluation of treatment efficacy.
    Date: 2010–09
  15. By: Nidhiya Menon (Department of Economics, Brandeis University); Yana van der Meulen Rodgers (Rutgers University)
    Abstract: The study provides new evidence on gender differences in educational attainment, labor market status, health status, and land titling in Vietnam. Up-to-date statistical evidence on household well-being in Vietnam is particularly important given the heavy weight the government has placed on meeting the needs of vulnerable members of the population, reducing overall poverty, and improving societal well-being. Vietnam’s government has placed priority emphasis on achieving gender equality in the 2006 Law on Gender Equality. One of the major themes addressed in this report is Vietnam’s demonstrated progress in achieving social development targets. The study also identifies a few areas where female outcomes lag those of men, and suggests policies that might help to reduce the observed gaps.
    Date: 2010–11

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