nep-hea New Economics Papers
on Health Economics
Issue of 2011‒03‒19
seventeen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Do Waiting Times Matter in Primary Care? GP Visits and List Sizes in England By Matthew Polisson
  2. Access to Abortion, Investments in Neonatal Health, and Sex-Selection: Evidence from Nepal By Christine Valente
  3. Are Estimates of the Value of a Statistical Life Exaggerated? By Hristos Doucouliagos; T.D. Stanley; Margaret Giles
  4. Pricing of Drugs with Heterogeneous Health Insurance Coverage By Paul Missios; Ida Ferrara
  5. The Value of Medican and Pharmaceutical Interventions for Reducing Obesity By Pierre-Carl Michaud; Dana Goldman; Darius Lakdawalla; Yuhui Zhen; Adam H. Gailey
  6. Interactions between health and farm-labor productivity: By Asenso-Okyere, Kwadwo; Chiang, Catherine; Thangata, Paul; Andam, Kwaw S.
  7. The dependence of health insurance availability on years left before Medicare By Ismail Saglam; Esra Eren Bayindir; Mehmet Yigit Gurdal
  8. Health intervention and decline in infant mortality rates. Milk depots in Spain (1900-1936) By Francisco Muñoz-Pradas
  9. Wars and Child Health: Evidence from the Eritrean-Ethiopian Conflict By Richard Akresh; Leonardo Lucchetti; Harsha Thirumurthy
  10. The Dynamics of Disease in a Regulated Vertically Differentiated Health System By L. Lambertini; A. Tampieri
  11. Optimal Aging and Death: Understanding the Preston Curve By Carl-Johan Dalgaard; Holger Strulik
  12. Self Control and Support for Anti Smoking Policies Among Smokers, Ex Smokers and Non Smokers By Amador, L.B;; Nicolas, A.L;
  13. Employer-Provided Health Insurance and Labor Supply of Married Women By Merve Cebi
  14. Vertical integration and exclusive vertical restraints in health-care markets By Rudy Douven; Victoria Shestalova
  15. Borrowing for hospitalization in India By Pal, Rama
  16. Methods for Evaluating Innovative Health Programs (EIHP): A Multi-Country Study By Thomas, Ranjeeta; Jones, Andrew M; Squire, Lyn
  17. The Dynamics of Economic Epidemiology Equilibria By Aadland, David; Finnoff, David; Huang, Kevin X.D.

  1. By: Matthew Polisson
    Abstract: This paper is largely motivated by the empirical observation that GP visits per person under the NHS have increased in England since the mid-1970s, while list sizes have decreased over the same period A hypothesis consistent with this observation is that larger list sizes are associated with longer waiting times, which reduce the demand for GP visits. Using a time series of repeated cross sections from 1972 to 2004, we construct a pseudopanel of synthetic individuals and find very little evidence that list sizes affect visit frequencies. While there are mild associations consistent with the waiting-time hypothesis among working-age women, there are none for men or the elderly, and no associations are robust to the cohort analysis. The demand for GP visits is most likely driven by health status, and for women, childbirth.
    Keywords: Health, health services, general practitioners, list sizes, waiting times
    JEL: H51 I11
    Date: 2011
  2. By: Christine Valente (Department of Economics, The University of Sheffield)
    Abstract: Every year, over 9 million children die under the age of five in developing countries, where the abortion regime is generally very restrictive. Evidence from the United States suggests that abortion liberalization may be a powerful policy tool in the fight against mortality in early life. In this paper, I consider the impact of providing affordable, legal abortion facilities in the high-fertility, high-mortality context of Nepal, on pregnancy outcomes, antenatal and perinatal health inputs, neonatal mortality, and sex-selection. In order to exploit geographical and time variation in coverage, I combine fertility histories with a unique data set recording geo-referenced coordinates and registration dates of newly introduced legal abortion centers. Consistent with the prediction that proximity to a legal abortion center reduces the cost of abortion, I find that the probability of a pregnancy ending in a live birth decreases by 8.1 percent, for a given mother. However, there is no evidence that improved access to abortion increases observed investments in antenatal and prenatal care or unobserved investments favorable to neonatal survival. Access to these legal, fist-trimester abortion centers does not appear to have led to more sex-selective terminations.
    JEL: I12 J13 J16
    Date: 2011–03
  3. By: Hristos Doucouliagos; T.D. Stanley; Margaret Giles
    Abstract: The magnitude of the value of a statistical life (VSL) is critical to the evaluation of many health and safety initiatives. To date, the large and rigorous VSL research literature has not explicitly accommodated publication selectivity bias (i.e., the reduced probability that insignificant or negative VSL values are reported). This study demonstrates that doing so is essential. For studies that employ hedonic wage equations to estimate VSL, correction for selection bias reduces the average value of a statistical life by seventy to eighty percent. Our meta-regression analysis also identifies several sources for the wide heterogeneity found among reported VSL estimates.
    Keywords: Value of statistical life; meta-regression analysis; selectivity bias
    JEL: J17 J18 J31 C12 I10 D61
    Date: 2011–03–11
  4. By: Paul Missios (Department of Economics, Ryerson University, Toronto, Canada); Ida Ferrara (DEpartment of Economics, York University, Toronto, Canada)
    Abstract: In this paper, we examine the role of insurance coverage in explaining the generic competition paradox in a two-stage game involving a single producer of brand-name drugs and n quantity-competing producers of generic drugs. Independently of brand loyalty, which some studies rely upon to explain the paradox, we show that heterogene- ity in insurance coverage may result in higher prices of brand-name drugs following generic entry. With market segmentation based on insurance coverage present in both the pre- and post-entry stages, the paradox can arise when the two types of drugs are highly substitutable and the market is quite pro?table but does not have to arise when the two types of drugs are highly di¤erentiated. However, with market segmentation occuring only after generic entry, the paradox can arise when the two types of drugs are weakly substituables, provided, however, that the industry is not very pro?table. In both cases, that is, when market segmentation is present in the pre-entry stage and when it is not, the paradox becomes more likely to arise as the market expands and/or insurance companies decrease deductables applied on the purchase of generic drugs.
    Keywords: brand-name pricing; generic entry; generic competition paradox; health insurance; health economics.
    JEL: L11 L13 I12
    Date: 2010–10
  5. By: Pierre-Carl Michaud; Dana Goldman; Darius Lakdawalla; Yuhui Zhen; Adam H. Gailey
    Abstract: This paper attempts to quantify the private and public economic value of reducing obesity through pharmaceutical and medical interventions. We find that the economic value of such treatments, in particular bariatric surgery, is large for treated patients, with incremental cost-effectiveness ratios typically under $20,000 per life-year saved. Our approach accounts for competing risks to life expectancy, health care cost savings, and other non-medical fiscal consequences. Most of the therapeutic value is generated by longer healthy life expectancy, with modest contributions from health spending, taxes and other spending. Obesity treatment generates substantial per-period savings in medical costs, but it also raises lifetime medical and annuity costs by extending life. On balance, treatment generates substantial private economic value and lowers the prevalence of obesity, but the aggregate fiscal effects on the public-sector are small.
    Keywords: Obesity, health spending, ageing, microsimulation
    JEL: I10 I38 J26
    Date: 2011
  6. By: Asenso-Okyere, Kwadwo; Chiang, Catherine; Thangata, Paul; Andam, Kwaw S.
    Abstract: In the 21st century, agriculture remains fundamental to economic growth, poverty alleviation, improvement in rural livelihood, and environmental sustainability (World Bank 2007). Three-quarters of the world's poor live in rural areas, particularly in Asia and Africa (Ravallion, Chen, and Sangraula 2007), and depend on agriculture as their primary source of livelihood. This report provides an overview of current knowledge of the impact of health issues on farm-level productivity and decisionmaking, and the impact of agriculture on health. Findings are based on a review of the relevant studies of agricultural regions throughout the developing world. Two conceptual frameworks are used to frame this research: (1) Examining the two-way linkages between agriculture and health (2) Tracking the pathway from a disease condition to its effects, including impacts on household decisionmaking and ultimate impacts on livelihood. Agriculture underpins the health of rural households. It provides income that makes households resilient to health shocks; it provides food to meet their nutrient and energy needs; and it provides medicinal plants for treating ailments. But agricultural systems can also have negative effects on health. Agricultural development may lead to environmental change with adverse health impacts: for example, irrigation dams that create suitable conditions for mosquitoes may lead to increased incidence of malaria locally. The use of agricultural inputs such as pesticides by untrained farm personnel often causes illness. Improper food harvesting and storage practices allow mycotoxins to flourish. Lack of diet diversity can lead to malnutrition. Certain animal diseases also can infect humans. Labor migration (including agricultural labor migration) can contribute to high incidence of HIV infection. The effects of ill health on farm households include three broad impacts: absenteeism from work due to morbidity (and eventual death); family time diverted to caring for the sick; and loss of savings and assets in dealing with disease and its consequences. The long-term impacts of ill health include loss of farming knowledge, reduction of land under cultivation, planting of less labor-intensive crops, reduction of variety of crops planted, and reduction of livestock. The ultimate impact of ill health is a decline in household income and possible food insecurity—that is, a severe deterioration in household livelihood. The research found that the household's ability to cope with a shock reflected both its asset portfolio—including human, physical, and financial assets—and its intangible social resources. Good health must be seen as both an investment and consumption asset, like agricultural production, in that it has compounding returns. Health problems, conversely, may trigger a cycle of lowered agricultural productivity and poor health. At the household level, the investment in health can improve resilience and enhance the ability to cope with emergencies, including ill health. But an investment in health in turn requires an adequate livelihood. Access to appropriate inputs (knowledge, land, tools, fertilizer, and seeds) and remunerative markets is necessary to improve the productivity, health, and resilience of farm households.
    Keywords: health, Labor, productivity,
    Date: 2011
  7. By: Ismail Saglam (Department of Economics, TOBB University of Economics and Technology, Ankara); Esra Eren Bayindir; Mehmet Yigit Gurdal
    Abstract: We study the dependence of health insurance availability of near-elderly inpatients in the United States with respect to their ages. We show that the likelihood that near-elderly inpatients are uninsured continuously declines until the early ages of 60 but the trend is reversed for the last few years preceding Medicare coverage. In addition, compared to those covered by Medicaid or private insurance, the uninsured patients are more likely to be admitted into hospitals as emergency cases.
    Keywords: Health insurance; Medicare
    JEL: I11
    Date: 2011–03
  8. By: Francisco Muñoz-Pradas (Departament de Geografia, Universitat Autònoma de Barcelona)
    Abstract: The role of public health has been a central topic on the classical debate about the historical mortality decline in Europe. One of these health initiatives were the Milk Depots. Spain set up those centres from the late 19th century until the beginning of the Civil War. The goal of this paper is to evaluate the effect of this health intervention on the infant mortality decline during this period. This study works out three kinds of sources: Statistical Yearbooks, Official documents and local records produced by the same Milk Depot. It analyses data available for all the country and one local case such as the Barcelona’s Milk Depot (1904-1935). The main methodological issue deals with the measurement of the effect of the Milk Depot activities on the pattern of changes of infant mortality. Results suggest that Milk Depots have a positive but quite moderate effect on the improving of overall levels of child survival.
    Date: 2011–02
  9. By: Richard Akresh (University of Illinois at Urbana-Champaign); Leonardo Lucchetti (University of Illinois at Urbana-Champaign); Harsha Thirumurthy (University of North Carolina at Chapel Hill)
    Abstract: This is the first paper using household survey data from two countries involved in an international war (Eritrea and Ethiopia) to measure the conflict’s impact on children’s health in both nations. The identification strategy uses event data to exploit exogenous variation in the conflict’s geographic extent and timing and the exposure of different children’s birth cohorts to the fighting. The paper uniquely incorporates GPS information on the distance between survey villages and conflict sites to more accurately measure a child’s war exposure. War-exposed children in both countries have lower height-for-age Z-scores, with the children in the warinstigating and losing country (Eritrea) suffering more than the winning nation (Ethiopia). Negative impacts on boys and girls of being born during the conflict are comparable to impacts for children alive at the time of the war. Effects are robust to including region-specific time trends, alternative conflict exposure measures, and an instrumental variables strategy.
    Date: 2010–12
  10. By: L. Lambertini; A. Tampieri
    Abstract: We build up a differential game to investigate the interplay between the quality of health care and the presence of an evolving disease in a duopoly where patients are heterogeneous along the income dimension. We prove unicity, stability and perfection of the open-loop Nash solution. Moreover, we identify the admissible parameter region wherein price regulation achieves the twofold objectives of ensuring cares to all patients and eradicating the disease.
    JEL: C73 H42 I11 I18 L13
    Date: 2011–03
  11. By: Carl-Johan Dalgaard (Department of Economics, University of Copenhagen); Holger Strulik (University of Hannover)
    Abstract: The present study examines whether the Preston curve reflects a causal impact of income on longevity or, for example, factors correlated with both income and life expectancy. In order to understand the Preston curve better, we develop a model of optimal intertemporal consumption in which the representative consumer is subject to physiological aging. In modeling aging we draw on recent research in the fields of biology and medicine. The speed of the aging process, and thus the time of death, are endogenously determined by optimal health investments. We calibrate the model to US data and proceed to show that the model accounts for nearly 80% of the cross-country differences in life expectancy that the Preston curve captures.
    Keywords: aging; longevity; health investments; savings; Preston curve
    JEL: D91 J17 J26 I12
    Date: 2010–07
  12. By: Amador, L.B;; Nicolas, A.L;
    Abstract: In this paper we sustain that non smokers who might be at risk of starting to smoke or relapsing can benefit from anti smoking policies such as tax hikes and smoking bans because these are mechanisms that enhance their self control with regard to tobacco consumption. We formalise this conjecture by proposing a model where starting/relapsing might result from time inconsistent preferences in a way that mirrors the inability of some smokers to carry out the decision to quit. We test the implications of this model using rich information on smoking behaviour from the Catalan Health Survey of 2006. The empirical results support our hypothesis and suggest that the welfare gains derived from the reinforcement of self control caused by tax hikes and smoking bans will accrue not only to smokers but also to the rest of the population.
    Keywords: time inconsistencies; smoking bans; tobacco taxes; Spain
    Date: 2011–02
  13. By: Merve Cebi (University of Massachusetts - Dartmouth; W.E. Upjohn Institute for Employment Research)
    Abstract: This work presents new evidence on the effect of husbands’ health insurance on wives’ labor supply. Previous cross-sectional studies have estimated a significant negative effect of spousal coverage on wives’ labor supply. However, these estimates potentially suffer from bias due to the simultaneity of wives’ labor supply and the health insurance status of their husbands. This paper attempts to obtain consistent estimates by using several panel data methods. In particular, the likely correlation between unobserved personal characteristics of husbands and wives—such as preferences for work—and potential joint job choice decisions can be controlled by using panel data on intact marriages. The findings, using data from the National Longitudinal Survey of Youth and the Current Population Survey, suggest that the negative effect of spousal coverage on labor supply found in cross-sections results mainly from spousal sorting and selection. Once unobserved heterogeneity is controlled for, a relatively smaller estimated effect of spousal coverage on wives’ labor supply remains.
    Keywords: Health insurance, Labor supply, Marriage, Panel data
    JEL: J22 J32 I18
    Date: 2011–03
  14. By: Rudy Douven; Victoria Shestalova
    Abstract: We examine vertical integration and exclusive vertical restraints in health-care markets where insurers and hospitals bilaterally bargain over contracts.
    JEL: G22 G34 I11 L14 L42
    Date: 2011–03
  15. By: Pal, Rama
    Abstract: Borrowing to cover hospital costs is a major concern in developing countries, like India, as it may push households into despairs of poverty and indebtedness. The present study examines factors that lead to borrowing for hospitalization in case of Indian households. For this purpose, we use sample selection model. The analysis points out vulnerability of households from deprived sections of society and uneducated households, as they are more likely to borrow. Moreover, higher availability of public hospitals lowers probability of borrowing in rural areas. Thus, increasing coverage of public hospitals in rural areas might prove to be helpful.
    Keywords: Hospital costs; Borrowing; Sample Selection Model
    JEL: I18 I19
    Date: 2010–08–18
  16. By: Thomas, Ranjeeta; Jones, Andrew M; Squire, Lyn
    Abstract: Designed as a global research initiative, the EIHP project aims at adding to the evidence base of health interventions that have the potential to improve health outcomes in Africa and Asia. The project focuses on rigorous, quantitative evaluations of innovative local initiatives that address the Millennium Development Goals for health: reductions in child and maternal mortality and communicable diseases. This overview brings together the outcomes and lessons from the project for evaluation methods. It draws together the methodological implications of carrying out impact evaluations under very different settings and emphasizes the need to build in evaluations in project designs.
    Keywords: Millennium Development Goals; child and maternal health; communicable diseases; impact evaluation; capacity building; Asia; Africa; Latin America
    JEL: C31 H53
    Date: 2010–07
  17. By: Aadland, David; Finnoff, David; Huang, Kevin X.D.
    Abstract: In this paper, we investigate the nature of rational expectations equilibria for economic epidemiological models. Unlike mathematical epidemiological models, economic epidemiological models can produce regions of indeterminacy or instability around the endemic steady state. We consider SI, SIS, SIR and SIRS versions of economic compartmental models and show how well-intentioned public policy may contribute to disease instability and uncertainty.
    Keywords: economic epidemiology; equilibria; dynamics; disease; indeterminacy; rational expectations
    JEL: D1 I1
    Date: 2011–01–01

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