nep-hea New Economics Papers
on Health Economics
Issue of 2011‒05‒07
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Non-Existence of Steady State Equilibrium in the Neoclassical Growth Model with a Longevity Trend By Mikkel Nørlem Hermansen
  2. Representative Ryan’s $30 Trillion Medicare Waste Tax By David Rosnick; Dean Baker
  3. Physician Payment Mechanisms, Hospital Length of Stay and Risk of Readmission: a Natural Experiment By Damien Échevin; Bernard Fortin
  4. "Half empty or half full": The importance of the definition of part-time sick leave when estimating its effects By Andrén, Daniela
  5. Quitting behaviour of cigarette smokers. Are there direct effects of a screening program? By Line Bretteville-Jensen, Anne; Biørn, Erik; Selmer, Randi
  6. Income shocks and adolescent mental health By Baird, Sarah; de Hoop, Jacobus; Ozler, Berk
  7. BMI changes in Russian adults: the role of lifestyles and spousal relationships By Huffman, Sonya K.
  8. Collaboration between Public Institution and Hospital-Japanese styled collaborative model for promotion of innovation in life sciences- By Yuko Ito; Hiroshi Nagano

  1. By: Mikkel Nørlem Hermansen (School of Economics and Management, Aarhus University, Denmark)
    Abstract: Longevity has been increasing in the developed countries for almost two centuries and further increases are expected in the future. In the neoclassical growth models the case of population growth driven by fertility is well-known, whereas the properties of population growth caused by persistently declining mortality rates have received little attention. Furthermore, the economic literature on the consequences of changing longevity has relied almost entirely on analysis applying a once and for all change in the survival probability. This paper raises concern about such an approach of comparison of steady state equilibrium when considering the empirically observed trend in longevity. We extend a standard continuous time overlapping generations model by a longevity trend and are thereby able to study the properties of mortality-driven population growth. This turns out to be exceedingly complicated to handle, and it is shown that in general no steady state equilibrium exists. Consequently analytical results and long run implications cannot be obtained in a setting with a realistic demographic setup.
    Keywords: Longevity, Population growth, Overlapping generations models, Steady state equilibrium, Existence
    JEL: J11 C62 O41 E13
    Date: 2011–04–18
  2. By: David Rosnick; Dean Baker
    Abstract: Representative Ryan’s proposal to replace the current Medicare systemwith a system of vouchers or premium supports has been widely described as shifting costs from the government to beneficiaries. However, the size of this shift is actually small relative to the projected increase in costs that would result from having Medicare provided by private insurers instead of the government-run Medicare system. The Congressional Budget Office’s (CBO) projections imply that the Ryan plan would add more than $30 trillion to the cost of providing Medicare equivalent policies over the program’s 75-year planning period. This increase in costs – from waste associated with using a less efficient health care delivery system – has not received the attention that it deserves in the public debate.
    Keywords: Medicare, Ryan, budget
    JEL: E E6 E62 I I1 I18 H H5 H51 H6 H63 H68
    Date: 2011–04
  3. By: Damien Échevin; Bernard Fortin
    Abstract: We provide an analysis of the effect of physician payment methods on their hospital patients’ length of stay and risk of readmission. To do so, we exploit a major reform implemented in Quebec (Canada) in 1999. The Quebec Government introduced an optional mixed compensation (MC) scheme for specialist physicians working in hospital. This scheme combines a fixed per diem with a reduced fee for services provided, as an alternative to the traditional fee-for-service system. We develop a simple theoretical model of a physician’s decision to choose the MC scheme. We show that a physician who adopts this system will have incentives to increase his time per clinical service provided. We demonstrate that as long as this effect does not improve his patients’ health by more than a critical level, they will stay more days in hospital over the period. At the empirical level, using a large patient-level administrative panel data set from a major teaching hospital, we estimate a model of transition between spells in and out of hospital analog to a difference-in-differences method. The model is based on a two-state Mixed Proportional Hazard approach. We find that the hospital length of stay of patients treated in departments that opted for the MC system increased on average by 10.8% (0.71 days). However, the risk of readmission to the same department with the same diagnosis does not appear to be overall affected by the reform.
    Keywords: Physician payment mechanisms, mixed compensation, hospital length of stay, risk of re-hospitalisation, duration model, natural experiment
    JEL: I10 I12 I18 C41
    Date: 2011
  4. By: Andrén, Daniela (Department of Business, Economics, Statistics and Informatics)
    Abstract: This paper analyzes the impact of the definition of part-time sick leave (PTSL) when analyzing the effect of PTSL on employees’ probability to fully recover lost work capacity. Using a random sample of 3,607 employees, we estimate an econometric model that aims to answer the hypothetical question of what happens to an employee who has lost his/her work capacity if he/she instead of continuing to be sicklisted full time starts working some hours. The estimated treatment parameters vary across definitions, yet all results show that, regardless of the timing of the intervention, PTSL had a positive effect on the probability of full recovery of lost work capacity one year after the spell started. Moreover, the most attractive definition shows the highest impact: About 48% of those with a reduced degree of sick leave from full time to part time during the spell were recovered about one year after the spell started, and only about 6% of them would have been better off had they remained on full-time.
    Keywords: part-time sick leave; full-time sick leave; selection; treatment and control groups; unobserved heterogeneity; treatment effects
    JEL: I12 J21 J28
    Date: 2011–03–15
  5. By: Line Bretteville-Jensen, Anne (Norwegian Institute for Alcohol and Drug Research (SIRUS) and Institute of Health Management and Health Economics, University of Oslo); Biørn, Erik (Dept. of Economics, University of Oslo); Selmer, Randi (Norwegian Institute for Public Health)
    Abstract: This paper aims at i) providing effect estimates of a wide range of covariates and traditional policy means to increase the smoking cessation rate, ii) offering evidence on alternative interventions for health authorities, and iii) examining and comparing three groups of smokers with varying lengths of their smoking career (including one group that has smoked 25 years). All smokers have been subject to a three-wave cardiovascular screening and followed up over a maximum of 14 years. This rich panel data set has been merged with administrative registers. A flexible discrete-time duration model is used to examine the effect of 5 categories of explanatory variables: personal characteristics; indicators of addiction status; economic factors; health and health shock variables; governmental interventions. Most covariates differ across groups, but for all groups did the screening participation years stand out as important. Possible policy implications for future cessation interventions are discussed.
    Keywords: Smoking behaviour; Cigarette cessation; Duration model; Quitting hazard; Long-term smokers; Health status and shocks; Screening; Policy intervention; Panel data
    JEL: C23 C24 C41 I12 I18
    Date: 2011–04–28
  6. By: Baird, Sarah; de Hoop, Jacobus; Ozler, Berk
    Abstract: In this paper, the authors investigate the effect of positive income shocks on the mental health of adolescent girls using experimental evidence from a cash transfer program in Malawi. They find that the provision of monthly cash transfers had a strong beneficial impact on the mental health of school-age girls during the two-year intervention. Among baseline schoolgirls who were offered unconditional cash transfers, the likelihood of suffering from psychological distress was 38 percent lower than the control group, while the same figure was 17 percent if the cash transfers offers were made conditional on regular school attendance. The authors find no impact on the mental health of girls who had already dropped out of school at baseline. The beneficial effects of cash transfers were limited to the intervention period and dissipated quickly after the program ended.
    Keywords: Health Monitoring&Evaluation,Disease Control&Prevention,Health Systems Development&Reform,Mental Health,Population Policies
    Date: 2011–04–01
  7. By: Huffman, Sonya K.
    Keywords: BMI, Russia, lifestyle, Consumer/Household Economics, Health Economics and Policy,
    Date: 2011
  8. By: Yuko Ito (National Graduate Institute for Policy Studies); Hiroshi Nagano (National Graduate Institute for Policy Studies)
    Abstract: Accountability for investment of public funds is required and it is necessary to explain the social contribution or social return of research based on evidence. In case of life sciences R&D, we consider that the innovation in the medical treatment (drug discovery) is its goal, which will contribute to the furtherance of public health. Therefore, collaborative research between public institutions and hospitals is regarded to be crucial. We conducted an on-line survey among hospital physicians. The results indicated that physicians in national/incorporated administrative agency hospitals seem to act as a mediator between basic research and clinical trial (such as those willing to conduct clinical research or clinical trial, who have the ability to publish paper written in foreign language, etc.). In addition, we examined collaborative models between public institutes (NIH, INSERM) and hospitals abroad. Based on these models, we propose that the collaboration between the RIKEN Institute and the National Hospital Organization may create Japanese styled collaborative model covering from basic research to clinical (phase II), similar to the NIH in the United States.
    Keywords: translational research, public institutes, social return, hospital physicians,collaboration
    Date: 2011–04

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