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on Health Economics |
| 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 feefor-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. <P>Cet article présente une analyse de l’impact du mode de rémunération des médecins spécialistes sur la durée de séjour de leurs patients à l’hôpital et sur leur risque de ré-hospitalisation. À cette fin, nous exploitons une réforme majeure mise en place au Québec en 1999. Le gouvernement du Québec a introduit un mode de rémunération mixte optionnel pour les spécialistes travaillant en établissement. Ce mode de paiement combine un per diem fixe et une rémunération à l’acte partielle, comme alternative à la rémunération à l’acte traditionnelle. Nous développons d’abord un simple modèle théorique de la décision du médecin de choisir ou non la rémunération mixte. Nous montrons qu’un médecin qui adhère à la rémunération mixte sera incité à accroître le temps qu’il consacre par acte. Nous démontrons que dans la mesure où cet effet n’améliore pas la santé du patient au-delà d’un certain niveau critique, ce dernier séjournera plus longtemps à l’hôpital au cours de la période. Au niveau empirique, à l’aide d’une vaste base de données longitudinales dénominalisées portant sur des patients du Centre Hospitalier de l’Université de Sherbrooke, nous estimons un modèle de durée à l’hôpital et hors hôpital analogue à une approche différence-en-différences. Notre méthode d’estimation se fonde sur un modèle de risque proportionnel mixte à deux états. Selon nos résultats, la durée de séjour des patients traités par des médecins qui ont passé à la rémunération mixte se serait accrue en moyenne de 10,8 % (0,71 jour). Cependant, le risque de ré-hospitalisation dans un même département avec le même diagnostic n’aurait pas été affecté par la réforme au niveau global. |
| Keywords: | Physician payment mechanisms, mixed compensation, hospital length of stay, risk of re-hospitalisation; duration model, natural experiment., Mécanismes de rémunération des médecins, rémunération mixte, durée du séjour à de l'hôpital de séjour, risque de re-hospitalisation. |
| JEL: | I10 I12 I18 C41 |
| Date: | 2011–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2011s-44&r=hea |
| By: | Nicholas Wilson (Williams College) |
| Abstract: | Copper mining is among the largest economic activities in Zambia, comprising close to ten percent of GDP. Between 2003 and 2008, the price of copper increased by over 400 percent. In response, copper production in Zambia grew by 70 percent and employment in copper mining increased by nearly 200 percent. This paper examines the effect of this large and sustained economic shock on sexual behavior and the spread of HIV/AIDS in Zambia. I use nationally representative survey data on sexual behavior before and during the copper boom in conjunction with detailed spatial data on the location of survey respondents and copper mines. The results indicate that the copper boom substantially reduced rates of transactional sex and multiple partnerships in the copper mining cities. These effects were partly concentrated among young adults and copper boom induced in-migration to mining areas appears to have contributed to these reductions. |
| Keywords: | commodity shocks, copper mining, economic growth, HIV/AIDS, Zambia |
| JEL: | I18 J10 O12 O40 |
| Date: | 2010–07 |
| URL: | http://d.repec.org/n?u=RePEc:wil:wilcde:2011-04&r=hea |
| By: | Huffman, Sonya K.; Rizov, Marian |
| Abstract: | This paper estimates the impacts of weight, measured by body mass index (BMI), on employment, wages, and missed work due to illness for Russian adults by gender, in order to better understand the mechanisms through which obesity affects employment, wages, and sick-leave days using recent panel data (1994-2005) from the nationally representative Russian Longitudinal Monitoring Survey (RLMS). We employ econometric techniques to control for unobserved heterogeneity and potential biases due to endogeneity in BMI. The results show an inverted U-shaped effect of BMI on probability of employment for men and women. We did not find evidence of wage penalty for higher BMI. In fact, the wages for overweighed men are higher. However, having a BMI above 28.3 increases the number of days missing work days due to health problems for men. Overall, we find negative effects of obesity (BMI above 30) on employment only for women but not on wages. During the transition in Russia, the increasingly competitive pressure in the labour market combined with economic insecurity faced by the population has lead to a muted impact of an individual’s weight on labour market outcomes. |
| Keywords: | Russia; BMI; Labour outcomes |
| JEL: | D12 J71 O51 |
| Date: | 2011–05–05 |
| URL: | http://d.repec.org/n?u=RePEc:isu:genres:33665&r=hea |
| By: | Boone, J.; Ours, J.C. van; Wuellrich, J.P.; Zweimuller, J. (Tilburg University, Center for Economic Research) |
| Abstract: | Workplace accidents are an important economic phenomenon. Yet, the pro-cyclical fl uctuations in workplace accidents are not well understood. They could be related to fluctuations in effort and working hours, but workplace accidents may also be affected by reporting behavior. Our paper uses unique data on workplace accidents from an Austrian matched worker-firm dataset to study in detail how economic incentives affect workplace accidents. We find that workers who reported an accident in a particular period of time are more likely to be tired later on. And, we find support for the idea that recessions in fluence the reporting of moderate workplace accidents: if workers think the probability of dismissals at the firm level is high, they are less likely to report a moderate workplace accident. |
| Keywords: | Workplace accidents;economic incentives;cyclical fl uctuations. |
| JEL: | I10 J60 J81 |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:kubcen:2011050&r=hea |
| By: | Jishnu Das |
| Abstract: | The excellent systematic review in this week’s PLoS Medicine by Paul Garner and colleagues focuses discussion on this critical issue. Their finding of poor quality in both the public and private sectors along different dimensions (competence is similar in both, but the private sector is more patient centered) brings much needed evidence to an ongoing debate. The review reflects a logical initial focus in the literature on individual providers rather than the interactions between providers; going forward, broadening the discussion on quality to health care markets can generate valuable insights for policy. URL:[http://www.plosmedicine.org/article /info%3Adoi%2F10.1371%2Fjournal.pmed.100 0432]. |
| Keywords: | providers, low and middle income coutries, LMICs, rural areas, utilization rates, public and private sectors, Delhi, India, health care, markets, medical care, Low-Income Countries, |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:ess:wpaper:id:3955&r=hea |
| By: | Rodriguez-Garcia, Rosalia; Gaillard, Michel Eric; Lissi, Alejandra Suarez; Condarco, Pedro Magne |
| Keywords: | Population Policies,Health Monitoring&Evaluation,Information Security&Privacy,Poverty Monitoring&Analysis,HIV AIDS |
| Date: | 2011–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:5653&r=hea |
| By: | Marc Klemp (Department of Economics, University of Copenhagen); Jacob Weisdorf (Department of Economics, University of Copenhagen) |
| Abstract: | This paper explores the long-term impact on mortality of exposure to early-life hardship. Using survival analysis, we document that birth during the great English famine of the late 1720s manifest itself in an increased death risk throughout life among those who survive the famine years. Using demographic data from the Cambridge Group’s Population History of England, we find that the death risk of affected individuals who survived to age 10 is up to 66 percent higher than that of their control–group counterparts (those born in the five years following the famine). This corresponds to a loss of life-expectancy of more than 12 years. We find that effects differ geographically as well as with the socioeconomic status of the household, with less well-off (manual-worker) families and families living in the English Midlands being hit the hardest. Evidence does not suggest, however, that children born in the five years prior to the famine suffered increased death risk. |
| Keywords: | Death Risk; Malthus; Longevity; Positive Checks; Scarring Effect; Selection Effect |
| Date: | 2011–05 |
| URL: | http://d.repec.org/n?u=RePEc:kud:kuiedp:1114&r=hea |
| By: | Gitto, Lara (University of Catania, Department of Economics and Quantitative Methods) |
| Abstract: | Multiple sclerosis (MS) is a chronic, disabling, and progressive illness, representing one of the most common causes of neurological disability in young and middle-aged adults. There is not a definitive treatment for MS yet. However, disease-modifying drugs (DMDs) for MS, which include interferon-beta and copolymer-1 have shown to be effective in reducing the frequency and severity of relapses and the progression of disability. The clinical efficacy of such therapies has been well documented in the medical literature. Instead, the factors underlying the decision to start the pharmacological treatment, to continue it or to drop out, have not been studied so far. Adverse drug effects, as well as patients’ emotional states, therapeutic expectations, the need to assume the medicines very often, and lack of communication with medical staff, are some of the elements affecting patients’ adherence to the therapy. Data from medical records of 567 MS patients referred to the MS Centre of the IRCCS Centro Studi Neurolesi (Messina) between the years 2001-2008 have been retrospectively analyzed in a first phase. Factors influencing patient decision to start a pharmacological treatment with DMDs, in agreement with the neurologist suggestion, have been evaluated by applying a multinomial logit model. The second phase of the study was cross-sectional and analyzed the data obtained through a questionnaire administered to consecutive outpatients referred to Centro Studi Neurolesi within March and May 2009 (n = 143). The probability to proceed in the treatment or to drop out was estimated through a probit model. The present research constitutes a novelty among the existing economic and medical literature: in fact, there are no, so far, studies evaluating factors underlying MS patients’ decision to undergo a pharmacological treatment and to proceed it according to medical protocols. Moreover, a significant expenditure for health care systems is associated to MS treatment, both for patients who undergo the treatment (cost of medicines, productivity losses for patients who experience severe side effects, etc.) and for those who do not take the medicine or take it discontinuously. Given the documented evidence of augmenting costs (direct and indirect) with increasing disease severity, the ability of the DMDs to reduce relapse rates and slow the progression of MS may help to offset the cost of these therapies. Conversely, delayed treatment or poor compliance can dramatically increase costs and reduce benefits. |
| Keywords: | disease modifying drugs (DMDs); compliance; multinomial logit; probit. |
| JEL: | C35 D89 I19 |
| Date: | 2010–03 |
| URL: | http://d.repec.org/n?u=RePEc:ris:demqwp:2010_003&r=hea |
| By: | Laura Dague; Thomas DeLeire; Donna Friedsam; Daphne Kuo; Lindsey Leininger; Sarah Meier; Kristen Voskuil |
| Abstract: | We use a combination of administrative and survey data to estimate the fraction of individuals newly enrolled in public health coverage (Wisconsin’s combined Medicaid and CHIP program) that had access to private, employer-sponsored health insurance at the time of their enrollment and the fraction that dropped this coverage. We estimate that after expansion of eligibility for public coverage, approximately 20% of new enrollees had access to private health insurance at the time of enrollment and that only 8% dropped this coverage (with the remaining 12% having both private and public coverage). We also identify an “upper bound” estimate, which suggests that the percentage of new enrollees with private insurance coverage at the time of enrollment is, at most, 27%. These estimates of crowd-out are relatively low compared with estimates from the literature based on Medicaid and CHIP expansions, although based both on different data and on a different method. |
| JEL: | I18 |
| Date: | 2011–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17009&r=hea |
| By: | Joseph P. Ferrie; Karen Rolf |
| Abstract: | The link between circumstances faced by individuals early in life (including those encountered in utero) and later life outcomes has been of increasing interest since the work of Barker in the 1970s on birth weight and adult disease. We provide such a life course perspective for the U.S. by following 45,000 U.S.-born males from the household where they resided before age 5 until their death and analyzing the link between the characteristics of their childhood environment – particularly, its socioeconomic status – and their longevity and specific cause of death. Individuals living before age 5 in lower SES households (measured by father’s occupation and family home ownership) die younger and are more likely to die from heart disease than those living in higher SES households. The pathways potentially generating these effects are discussed. |
| JEL: | I1 J1 N31 N32 |
| Date: | 2011–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17016&r=hea |
| By: | Anup Malani; Tomas J. Philipson |
| Abstract: | Improvements in health have been a major contributor to gains in overall economic welfare. In this paper, we argue that previous economic research on R&D has overlooked an important difference between medical R&D and R&D in other sectors. The health care sector exhibits a unique linkage between product development and output markets. Participants in clinical trials for new medical products are also potential consumers of existing approved medical products. This overlap between input supply and output demand has non-standard effects on innovative returns over time and across geography. First, medical R&D has a self-limiting effect. Contemporary innovation discourages trial participation and slows down development necessary for future innovation. Thus, medical R&D suffers increasing costs over time, driven by improvements in the standard of care. Second, policies that affect output markets, such as universal coverage and price controls, affect the returns to innovation, not only by altering the firm’s variable profits, but also by increasing the length and cost of development. Third, the amount of medical R&D in a location is driven, not only by the local relative R&D talent, but also by consumer demographics and output market policies in that location. We provide evidence of the input-output linkage for the break-through HIV therapies introduced in 1996. We document the substantial drop in trial recruitment induced by these new innovations and argue that this has slowed down development and lowered returns to subsequent HIV-related innovations. |
| JEL: | I1 I11 |
| Date: | 2011–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17011&r=hea |
| By: | Blackman, Allen (Resources for the Future); Chandru, Santosh; Mendoza-Dominguez, Alberto; Russell, A.G. |
| Abstract: | In the past two decades, rapid population and economic growth on the U.S.–Mexico border has spurred a dramatic increase in electricity demand. In response, American energy multinationals have built power plants just south of the border that sell most of their electricity to the United States. This development has heightened concern about border area’s already-poor air quality because these plants effectively skirt U.S. environmental regulations. Yet to our knowledge, this concern has not been subjected to rigorous scrutiny. This paper uses a suite of air dispersion, health impacts, and valuation models to assess the benefits of offsetting polluting emissions from two power-exporting plants in Mexicali, Baja California. We find that these plants have extensive health impacts, including more than 1.9 short-term mortalities and hundreds of respiratory hospital admissions per year, which we value at almost US$8 million. The vast majority of these health impacts are associated with ozone pollution in the United States caused by one of the two plants’ emissions. These findings bolster the case for changing U.S. law either to require power-exporting plants to reduce or offset their emissions or to provide incentives for them to do so. |
| Keywords: | electricity, air pollution, Mexico |
| JEL: | Q48 Q51 Q53 |
| Date: | 2011–04–08 |
| URL: | http://d.repec.org/n?u=RePEc:rff:dpaper:dp-11-18&r=hea |