nep-hea New Economics Papers
on Health Economics
Issue of 2011‒01‒30
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Assessing the Effectiveness of Health Care Cost Containment Measures By Nicolas R. Ziebarth
  2. Survival Convergence: Specification Matters By Christopher Grigoriou
  3. How Macroeconomic Instability Lowers Child Survival By Patrick Guillaumont; Catherine Korachais; Julie Subervie
  4. Child Mortality Reacts to Relative Prices By Christopher Grigoriou; Patrick Guillaumont
  5. Disability and social security reforms: The French case By Luc Behaghel; Didier Blanchet; Thierry Debrand; Muriel Roger
  6. Time-Bound Opportunity Costs of Informal Care: Consequences for Access to Professional Care, Caregiver Support, and Labour Supply Estimates By Hassink, Wolter; van den Berg, Bernard
  7. Spillover Effects in Healthcare Programs: Evidence on Social Norms and Information Sharing By Ciro Avitabile; Vincenzo Di Maro
  8. Towards a Better and Sustainable Health Care System ? Resource Allocation and Financing Issues for Ireland By Ruane, Frances
  9. Does fiscal discipline towards sub-national governments affect citizens’ well-being? evidence on health By Massimiliano Piacenza; Gilberto Turati
  10. Analyzing community responses to HIV and AIDS : operational framework and typology By Rodriguez-Garcia, Rosalia; Bonnel, Rene; N'Jie, N'Della; Olivier, Jill; Pascual, F. Brian; Wodon, Quentin
  11. Equity and public governance in health system reform : challenges and opportunities for China By Brixi, Hana; Mu, Yan; Targa, Beatrice; Hipgrave, David
  12. Health, Lifestyle and Growth By COPPOLA, Gianluigi
  13. Household Portfolio Choices, Health status and Health Care Systems A Cross-Country Analysis Based on SHARE By Vincenzo Atella; Marianna Brunetti; Nicole Maestas
  14. Disability and Low Income Persistence in Italian Households By Parodi, Giuliana; Sciulli, Dario
  15. Nonlinear dynamics in an OLG growth model with young and old age labour supply: the role of public health expenditure By Gori, Luca; Sodini, Mauro
  16. Managing Environmental, Health, and Safety Risks: A Comparative Assessment of the Minerals Management Service and Other Agencies By Scarlett, Lynn; Fraas, Arthur; Morgenstern, Richard; Murphy, Timothy

  1. By: Nicolas R. Ziebarth
    Abstract: Using SOEP panel data and difference-in-differences methods, this study is the first to empirically evaluate the effectiveness of four different health care cost containment measures within an integrated framework. The four measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for convalescent care. Doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in demand of about 20 percent. Indirect measures such as allowing employers to cut statutory sick pay or paid vacation during health spa stays did not significantly reduce demand.
    Keywords: health expenditures, cost containment measures, copayment, convalescent care, SOEP
    JEL: H51 I11 I18 J22
    Date: 2011
  2. By: Christopher Grigoriou (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)
    Abstract: Retaining as a “Millennium Development Goal” a decrease by two thirds in child mortality whatever its initial level assumes that the target elasticity of child mortality may be the same in all the developing countries. We show that such an assumption is not perfectly consistent with the bounded characteristic of the child mortality indicator. We propose to use the logit transformation of such bounded human development indicators to have appropriate estimates of human convergence: this provides the best specification of the overall change in child survival among countries. Applied to child survival on a cross-section basis for 166 countries and over a thirty-year period (1970-99), this measure shows no evidence of absolute convergence but on the contrary a highly significant divergence.
    Keywords: developing countries;Child mortality rate;Convergence;Millenniums Goals
    Date: 2011–01–17
  3. By: Patrick Guillaumont (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Catherine Korachais (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Julie Subervie (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)
    Abstract: The reduction of child mortality is one of the most universally accepted millennium goals. However, a significant debate came out on the means of reaching it and on its realism with regard to the situation of most of the least developed countries. The recommendations made for the achievement of this are mainly medical ones. However, without underestimating the importance of these measures, in particular vaccinations, it seems increasingly obvious that the rate of reduction of child mortality is mainly determined by the evolution of macroeconomic environment. The influence of per capita income level on mortality is frequently underlined. But a given income growth does not have the same effect on child survival whether it is stable or unstable. Indeed, rises and falls of income probably have asymmetrical effects on mortality. The purpose of this analysis is precisely to show how macroeconomic instability influences the evolution of child mortality. The analysis is based on a panel sample of 97 developing countries over the period 1980-1999. The effect of exogenous shocks is first examined through a variable of income instability. The study of the relation is then deepened with "primary instabilities": instability of world agricultural commodity prices, instability of exports of goods and services and instability of agricultural production.
    Keywords: child survival;macroeconomic instability
    Date: 2011–01–18
  4. By: Christopher Grigoriou (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Patrick Guillaumont (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)
    Abstract: This paper argues that, for a given average level of income per capita, the real currency depreciation has a negative impact on child survival, due to higher relative prices of tradable goods such as food and drug. This assumption is significantly tested from a dynamic panel model covering about one hundred developing countries and the period 1965-1999 and using a logit measure of child survival. Moreover, it appears that this effect of a real depreciation decreases when the rate of urbanisation increases, suggesting that rural and urban areas do not react similarly: dynamic panel estimates on a sub sample of 21 sub-Saharan African countries for which rural and urban data are available confirms that only in rural areas child survival is negatively affected by real depreciation. These estimates also shed light on an international convergence process for child survival which is limited to urban areas.
    Keywords: developing countries;Child mortality rate;Convergence;Millennium Development Goals;Exchange rate
    Date: 2011–01–17
  5. By: Luc Behaghel (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Didier Blanchet (INSEE-D3E - Département des études économiques d'ensemble - INSEE); Thierry Debrand (IRDES - Institut de recherche et documentation en économie de la santé - IRDES); Muriel Roger (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, INSEE-D3E - Département des études économiques d'ensemble - INSEE)
    Abstract: The French pattern of early transitions out of employment is basically explained by the low age at “normal” retirement and by the importance of transitions through unemployment insurance and early-retirement schemes before access to normal retirement. These routes have exempted French workers from massively relying on disability motives for early exits, contrarily to the situation that prevails in some other countries where normal ages are high, unemployment benefits low and early-retirement schemes almost non-existent. Yet the role of disability remains interesting to examine in the French case, at least for prospective reasons in a context of decreasing generosity of other programs. The study of the past reforms of the pension system underlines that disability routes have often acted as a substitute to other retirement routes. Changes in the claiming of invalidity benefits seem to match changes in pension schemes or controls more than changes in such health indicators as the mortality rates. However, our results suggest that increases in average health levels over the past two decades have come along with increased disparities. In that context, less generous pensions may induce an increase in the claiming of invalidity benefits partly because of substitution effects, but also because the share of people with poor health increases.
    Keywords: Pensions ; Social Security ; Disability ; Early Retirement ; Unemployment ; Senior
    Date: 2011–01
  6. By: Hassink, Wolter (Utrecht University); van den Berg, Bernard (University of York)
    Abstract: Patterns of informal care are documented throughout the day with Dutch time use diary data. The diary data enable us to identify a, so far overlooked, source of opportunity costs of informal care, i.e. the necessity to perform particular tasks of informal care at specific moments of the day. Some care tasks are relatively unshiftable, while other tasks are shiftable implying that they can be performed at other moments of the day or even on different days. In particular, household and organization activities seem to be shiftable for employed caregivers, while personal care seems to contain unshiftable activities. This implies an additional opportunity cost of providing personal care tasks. As the care recipient’s need for care may be related to the possibility to shift informal care throughout the day, we conclude that one should be careful with using care need as an instrument of informal care in labour supply equations.
    Keywords: use of time, joint production, informal care, paid work, opportunity cost, labor supply
    JEL: J2 I3
    Date: 2011–01
  7. By: Ciro Avitabile (Università di Napoli Federico II and CSEF); Vincenzo Di Maro (Inter-American Development Bank)
    Abstract: Cervical cancer is considered to be one of the most preventable types of cancer, but cervical cancer mortality rates in Mexico have been dramatically high by international standards for many years. This paper exploits the randomized research design of a large welfare program - Progresa - to study the size and determinants of spillover effects in cervical cancer screening in rural Mexico. We find significant evidence of spillover effects in demand for Papanicolaou cervical cancer screening, yet there is no evidence of similar spillovers in non-gender specific tests, such as blood pressure and blood sugar. When we study the mechanisms that drive spillover effects we are able to distinguish between the roles of social norms and information sharing. For women living in male headed households there is increased demand for screening as Progresa undermines the social norm associated with husbands' opposition. Among women in female headed households screening is more frequent as a result of information sharing between those eligible and those not eligible for the program.
    Keywords: Cervical cancer, Social norm, Information sharing, Progresa, Indirect treatment effect
    JEL: D83 I12 J16
    Date: 2011–01–19
  8. By: Ruane, Frances
    Keywords: Ireland
    Date: 2010–10
  9. By: Massimiliano Piacenza (University of Torino & HERMES); Gilberto Turati (University of Torino & HERMES)
    Abstract: This paper aims at assessing the impact on citizens’ well-being of fiscal discipline imposed by Central Government to sub-national governments. Since health care policies involve strategic interactions between different layers of governments in many different countries, we focus on a particular dimension of well-being, namely citizens’ health. We model fiscal discipline by considering sub-national governments expectations of future deficit bailouts from the Central Government. We then study how these bailout expectations affect the expenditure for health care policies carried out by decentralized governments. To investigate this issue, we separate efficient health spending from inefficiencies by estimating an input requirement frontier. This allow us to assess the effects of bailout expectations on both the structural component of health expenditure and its deviations from the ‘best practice’. The evidence from the 15 Italian Ordinary Statute Regions (observed from 1993 to 2006) points out that bailout expectations do not significantly influence the position of the frontier, thus do not affect citizens’ health. However, they appear to exert a remarkable impact on excess spending.
    Keywords: Intergovernmental relationships, soft budget constraint, bailout expectations,health care policy, spending efficiency.
    JEL: H11 H75 H77 I12 I18
    Date: 2010
  10. By: Rodriguez-Garcia, Rosalia; Bonnel, Rene; N'Jie, N'Della; Olivier, Jill; Pascual, F. Brian; Wodon, Quentin
    Abstract: This paper presents a framework for analyzing the community response to HIV and AIDS. On the basis of a review of the literature, six criteria are proposed for characterizing such community responses: (1) the types of organizations and structures implementing the response, (2) the types of activities or services implemented and the beneficiaries of these, (3) the actors involved in and driving community responses, (4) the contextual factors that influence community responses, (5) the extent of community involvement in the response, and (6) the extent to which community responses involve wider partnerships and collaboration.
    Keywords: Disability,Civil Society,Community Development and Empowerment,HIV AIDS,Health Monitoring&Evaluation
    Date: 2011–01–01
  11. By: Brixi, Hana; Mu, Yan; Targa, Beatrice; Hipgrave, David
    Abstract: Achieving the objective of China's current health system reform, namely equitable improvements in health outcomes, will be difficult not least because of the continuously growing income disparities in the country. The analysis in this paper shows that since 2000, disparity in selected health outcomes has been declining across provinces, largely due to earmarked central government allocations. By contrast, public expenditure on health is increasingly regressive (positively correlated with local income per capita) across provinces, and across prefectures and lower levels within provinces. The increasing inequity in public expenditure at sub-national levels indicates that incentives, responsibilities, and resources at sub-national levels are not well aligned with China's national priorities. To address the weaknesses in equity and efficiency that characterize China's health system and health outcomes, China's health system reform may require complementary reforms to improve governance for public service delivery across sectors.
    Keywords: Health Monitoring&Evaluation,Population Policies,Public Sector Economics,Health Systems Development&Reform,Health Economics&Finance
    Date: 2011–01–01
  12. By: COPPOLA, Gianluigi (CELPE (Centre of Labour Economics and Economic Policy), University of Salerno, Italy)
    Abstract: In this paper I will try to explain why lifestyle may have a positive impact on economic growth. First of all, I consider health affecting consumer’s utility and then define a Health Production Function where health is the output and consumer good the input. In this approach a parameter named Lifestyle Return to Scale (LRS) is defined. The first result is that an increase of consumer’s personal income may have a positive or a negative effect on health. In other words health may be a normal or an inferior good. It depends on Lifestyle Return to Scale- According to this result, I compute a health multiplier and then modify the Solow Growth Model in which health is labour-augmenting. The result is a model in which the Lifestyle Return to Scale positively affects the income per capita and the income per capita growth.
    Keywords: health; lifestyles; growth
    JEL: I10 O40
    Date: 2011–01–18
  13. By: Vincenzo Atella (Faculty of Economics, University of Rome "Tor Vergata"); Marianna Brunetti (Faculty of Economics, University of Rome "Tor Vergata"); Nicole Maestas (RAND)
    Abstract: Health risk is increasingly viewed as an important form of background risk that affects household portfolio decisions. However, its role might be mediated by the presence of a protective full-coverage National Health System that could reduce households’ probability of incurring current and future out-of-pocket medical expenditures. In this paper, we first sketch a theoretical framework in which household portfolio decisions are a function of both individual and systemic characteristics. Then, we test its main implications based on SHARE data, studying the influence of current health status and future health risk on the decision to hold risky assets, across 10 European countries with different health care systems, each offering a different degree of protection against out-of-pocket medical expenditures. We find robust empirical confirmation of our model implications, since perceived health condition matters more than objective health condition and, consistent with the theoretical underpinnings of background risk, health risk affects portfolio choices only in countries with less protective healthcare systems. Furthermore, portfolio decisions consistent with background risk models are observed only with respect to middle-aged and highlyeducated investors.
    Keywords: Household portfolios, health status, national health care systems
    JEL: D8 E2 G1
    Date: 2011–01–21
  14. By: Parodi, Giuliana; Sciulli, Dario
    Abstract: We apply dynamic probit models allowing for unobserved heterogeneity and endogenous initial conditions to IT-SILC data to investigate the low income persistence of households with disabled members. We find that their probability of being in a low income state is higher when compared with households without disabled members. In both cases household head’s characteristics, as employment status and education, contribute to determine low income positions. Our results also support the hypothesis of endogenous initial conditions. Both unobserved heterogeneity and state dependence are important to determine low income positions. Our findings suggest that a structural intervention geared at lifting households out of low income in future requires to get them out of low income at present. Moreover, preventing rather than rescuing actions are preferable.
    Keywords: Income persistence; disability; dynamic probit model; initial conditions.
    JEL: J14 C23 I32
    Date: 2010–09
  15. By: Gori, Luca; Sodini, Mauro
    Abstract: This paper analyses the dynamics of a two-dimensional overlapping generations model with young and old age labour supply. It is shown that the public provision of health investments, which, in turn, affects the demand for material consumption, may represent a source of local indeterminacy, nonlinear dynamics and multiplicity of equilibria. Furthermore, global indeterminacy may also occur because of the co-existence of two attractors with tangled basins of attraction.
    Keywords: Chaos; Labour supply; OLG model; Public health expenditure
    JEL: C68 O41 I18 J22 C62
    Date: 2011–01–17
  16. By: Scarlett, Lynn (Resources for the Future); Fraas, Arthur (Resources for the Future); Morgenstern, Richard (Resources for the Future); Murphy, Timothy
    Abstract: This study compares and contrasts regulatory and related practices—in particular, regulatory decisionmaking, risk assessment and planning processes, inspection and compliance, and organization structure, budgets, and training—of the Minerals Management Service (MMS, now the Bureau of Ocean Energy Management, Regulation, and Enforcement, or BOEMRE) with those of the Federal Aviation Administration (FAA) and the Environmental Protection Agency (EPA). Comparing MMS practices with those of other federal agencies that also manage low-probability but high-consequence environmental risks provides a basis for identifying opportunities for enhancing regulatory capacity and safety performance in managing deepwater energy exploration and production. Our research finds important differences in processes for setting standards; peer review contribution to the rulemaking process; establishment of tolerable risk thresholds; and training of key staff. The paper concludes with several recommendations for how various EPA and FAA practices might be modified and used at BOEMRE to strengthen its regulatory and risk management processes.
    Keywords: Minerals Management Service, Federal Aviation Administration, Environmental Protection Agency, risk management
    Date: 2011–01–12

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