nep-hea New Economics Papers
on Health Economics
Issue of 2011‒07‒13
34 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Does health Matter for Inequality in Transition Countries: The Case of Ukraine By Tamara Podvysotskaya; Elena Osinkina; Larysa Krasnikova; Yuriy Podvysotskiy
  2. Using Geographically Referenced Data on Environmental Exposures for Public Health Research: A Feasibility Study Based on the German Socio-Economic Panel Study (SOEP) By Sven Voigtländer; Jan Goebel; Thomas Claßen; Michael Wurm; Ursula Berger; Achim Strunk; Hendrik Elbern
  3. Malnutrition, subsequent Risk of Mortality and Civil War in Burundi By Philip Verwimp
  4. State of the Evidence on Health as a Determinant of Productivity By Andrew Sharpe; Alexander Murray
  5. Older but Not Wiser- Smokers and Passive Smoking Belief By Grace Lordan
  6. EQIS 1.0 User Guide. By María Errea Rodríguez; Eduardo Sánchez-Iriso
  7. Early Life Health and Adult Earnings: Evidence from a Large Sample of Siblings and Twins By Lundborg, Petter; Nilsson, Anton; Rooth, Dan-Olof
  8. Job Anxiety, Work-Related Psychological Illness and Workplace Performance By Jones, Melanie K.; Latreille, Paul L.; Sloane, Peter J.
  9. Physician-Leaders and Hospital Performance: Is There an Association? By Goodall, Amanda H.
  10. Does Early Life Health Predict Schooling Within Twin Pairs? By Lundborg, Petter; Nilsson, Anton; Rooth, Dan-Olof
  11. JOB CHARACTERISTICS AND EMPLOYEE WELLBEING: A CASE OF MALAYSIAN SMES By Shahrul Nizam Salahudin; Zuliawati Mohamed Saad; Shirley Ken Tzu Ting; Mohd Nur Ruzainy Alwi
  12. Life expectancy and income: The Ben-Porath mechanism revisited By Hansen, Casper Worm; Lønstrup, Lars
  13. The role of GP’s compensation schemes in diabetes care: evidence from panel data By E. Iezzi; M. Lippi Bruni; C. Ugolini
  14. Trends and socioeconomic gradients in adult mortality around the developing world By de Walque, Damien; Filmer, Deon
  15. Antidepressants and Age By Blanchflower, David G; Oswald, Andrew
  16. Health status and retirement decisison for older european couples. By Jiménez-Martín, Sergi; Labeaga, José M.; Martínez-Granado, Maite
  17. A Theory of Socioeconomic Disparities in Health. By Galama, T.J.
  18. Beware of Being Unaware: Racial Disparities in Chronic Illness in the US By Chatterji, P;; Joo, H;; Lahiri, K;
  19. The relationship between happiness and health: evidence from Italy By Sabatini, F;
  20. Effects of Informal Family Care on Formal Health Care: Zero-Inflated Endogenous Count for Censored Response By Lee, M-J;; Kim, Y-S.;
  21. Understanding the Impact of the Economic Crisis on Child and Maternal Health among the Poor: Opportunities for South Asia By Cader, Azra Abdul; Perera, Lakwimashi
  22. The Relative Efficiency of Public and Private Health Care By Tilman Tacke; Robert J Waldmann
  23. The Effect of Health on Income: Quasi-Experimental Evidence from Commuting Accidents By Martin Halla; Martina Zweimüller
  24. Golden-rule social security and public health in a dynastic model with endogenous longevity and fertility By Jie Zhanga; Siew Ling Yew
  25. Interaction between HIV Awareness, Knowledge, Safe Sex Practice and HIV Incidence: Evidence from Botswana By Ranjan Ray; Kompal Sinha
  26. Can We Get Better for Less: Value for Money in Canadian Health Care By Amin Mawani
  27. An Equity Checklist: a Framework for Health Technology Assessments By Anthony J Culyer; Yvonne Bombard
  28. Differences in the effect of social capital on health status between workers and non-workers By Yamamura, Eiji
  29. Status of Health related Quality of life between HBV and HCV Patients of Pakistan By Awan, Masood Sarwar; Waqas, Muhammad; Ali, Mumtaz; Aslam, Muhammad Amir
  30. Cardiovascular Consequences of Unfair Pay By Falk, Armin; Menrath, Ingo; Siegrist, Johannes; Verde, Pablo Emilio
  31. Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates By Katherine L. Milkman; John Beshears; James J. Choi; David Laibson; Brigitte C. Madrian
  32. Regulation and Welfare: Evidence from Paragraph IV Generic Entry in the Pharmaceutical Industry By Lee G. Branstetter; Chirantan Chatterjee; Matthew Higgins
  33. The Oregon Health Insurance Experiment: Evidence from the First Year By Amy Finkelstein; Sarah Taubman; Bill Wright; Mira Bernstein; Jonathan Gruber; Joseph P. Newhouse; Heidi Allen; Katherine Baicker; The Oregon Health Study Group
  34. Pharmaceutical Pricing in Emerging Markets: Effects of Income, Competition and Procurement By Patricia M. Danzon; Andrew W. Mulcahy; Adrian K. Towse

  1. By: Tamara Podvysotskaya; Elena Osinkina; Larysa Krasnikova; Yuriy Podvysotskiy
    Abstract: Significant deterioration in health and income inequality in Ukraine as well as in other CIS countries during the early transition motivated us to investigate the relationship between the two categories. Based on both macro- and micro-data analysis we focused on how different aspects of health affect income inequality in Ukraine. Significant impact of health has been proven on both micro- and macro levels. According to macrolevel results, a 1% increase in life expectancy leads to a 2,1% decrease in income inequality as measured by index Gini. Micro-level research also evidenced significance of different health aspects for income inequality.
    Keywords: Income inequality, health, Ukraine, Ukrainian Longitudinal Monitoring Survey
    Date: 2011–01
  2. By: Sven Voigtländer; Jan Goebel; Thomas Claßen; Michael Wurm; Ursula Berger; Achim Strunk; Hendrik Elbern
    Abstract: Background: In panel datasets information on environmental exposures is scarce. Thus, our goal was to probe the use of area-wide geographically referenced data for air pollution from an external data source in the analysis of physical health. Methods: The study population comprised SOEP respondents in 2004 merged with exposures for NO2, PM10 and O3 based on a multi-year reanalysis of the EURopean Air pollution Dispersion-Inverse Model (EURAD-IM). Apart from bivariate analyses with subjective air pollution we estimated cross-sectional multilevel regression models for physical health as assessed by the SF-12. Results: The variation of average exposure to NO2, PM10 and O3 was small with the interquartile range being less than 10µg/m3 for all pollutants. There was no correlation between subjective air pollution and average exposure to PM10 and O3, while there was a very small positive correlation between the first and NO2. Inclusion of objective air pollution in regression models did not improve the model fit. Conclusions: It is feasible to merge environmental exposures to a nationally representative panel study like the SOEP. However, in our study the spatial resolution of the specific air pollutants has been too little, yet.
    Keywords: SOEP, Geographically Referenced Data, Feasibility Study, Air Pollution, EURAD-IM, Physical Health
    Date: 2011
  3. By: Philip Verwimp
    Abstract: The paper investigates the effect of child malnutrition on the risk of mortality in Burundi, a very poor country heavily affected by civil war. We use anthropometric data from a longitudinal survey (1998-2007). We find that undernourished children, as measured by the height-for-age z-scores (HAZ) in 1998 had a higher probability to die during subsequent years. In order to address the problem of omitted variables correlated with both nutritional status and the risk of mortality, we use the length of exposure to civil war prior to 1998 as a source of exogenous variation in a child’s nutritional status. Children exposed to civil war in their area of residence have worse nutritional status. The paper finds that one year of exposure translates into a 0.15 decrease in the HAZ, resulting in a 10% increase in the probability to die for the whole sample as well as a 0.34 decrease in HAZ per year of exposure for boys only, resulting in 25% increase in the probability to die. We show the robustness of our results. Food and income transfer programs during civil war should be put in place to avoid the long-term effects of malnutrition.
    Keywords: malnutrition; mortality; children; war; Africa; instrumental variables
    Date: 2011–06
  4. By: Andrew Sharpe; Alexander Murray
    Abstract: Canada's labour productivity performance has been abysmal since 2000, both relative to our historical experience and to that in the United States. In theory, a deterioration of the health status of Canadian workers could explain slower productivity growth. However, the evidence does not support this hypothesis. Nevertheless, there is no doubt that illness and disability impose a massive indirect economic burden on the Canadian economy because many persons of working age are unable to work. Canada's potential level of "social productivity" is lower because of this situation. This is an output shortfall issue, not a conventional productivity issue, and it is important not to confuse the two.
    Keywords: labour productivity, health status, absenteeism, presenteeism, Canada
    JEL: I12 J24
    Date: 2011–06
  5. By: Grace Lordan (School of Economics, The University of Queensland)
    Abstract: In recent years the proportion of people who smoke in developed countries has reached a plateau, even though countries like the UK continue to run anti-smoking campaigns. We aim to inform UK policy makers about the effects of anti-smoking campaigns by looking at the beliefs that smokers and non-smokers have about the dangers of passive smoking, with particular interest in whether these beliefs vary amongst smokers of different ages. We envisage two groups of potential smokers. There are the altruists, who are less likely to start to smoke once they are fully aware of the dangers of passive smoking; and there are the non-altruists for whom the effects of passive smoking are an irrelevancy. We hypothesis that anti-smoking campaigns have managed to dissuade the altruists of later generations from ever starting to smoke, but are having no effect on the behavior of the non-altruists and hence the plateau. The older smoking altruists are then captive to their smoking behavior and have to rationalize their smoking behavior by downplaying the effects of passive smoking. Using data from the Health Survey for England we find strong evidence that it is the older smokers who are less prone to believe in the dangers of passive smoking whilst younger smokers essentially have the same beliefs as nonsmokers: a young uneducated smoker is more aware of the dangers of passive smoking than a highly educated older smoker. This conclusion is robust to a number of sensitivity analyses. We conclude that the main effect of current campaigns is the continuing deterrence of potential young altruist smokers.
    Date: 2011
  6. By: María Errea Rodríguez (Departamento de Economía-UPNA); Eduardo Sánchez-Iriso (Departamento de Economía-UPNA)
    Abstract: Where is QALY? The search of values for QALYs (Quality Adjusted Life Years) in the field of Health Economics is not easy. Economic Evaluations, particularly cost-utility analysis, should be of standard practice, but the tools to implement them are rare and require of specific expertise. In many occasions, colleagues approached to us to ask for measures of effectiveness that are used, and show interest in how to obtain it. Such a motivation has led us to generate EQIS 1.0, the friendly software that allows calculating Health Related Quality of Life weights. The following pages introduce EQIS 1.0, and are thought for a quick start using the software. Please do not hesitate to contact the authors for comments, suggestions or any problem you find in the program.
    Date: 2011
  7. By: Lundborg, Petter (Lund University); Nilsson, Anton (Lund University); Rooth, Dan-Olof (Linneaus University)
    Abstract: We study the relationship between early life health and adult earnings using a unique dataset that covers almost the entire population of Swedish males born between 1950 and 1970. The health information is obtained from medical examinations during the mandatory military enlistment tests at age 18, which we have further linked to register data on adult earnings. We find that most types of major diagnoses have long-run effects on future earnings with the largest effects resulting from mental conditions. Including sibling fixed effects or twin-pair fixed effects reduces the magnitudes of the estimates, although remaining substantial.
    Keywords: earnings, health, specific conditions, siblings, twins
    JEL: I1 J24 J31
    Date: 2011–06
  8. By: Jones, Melanie K. (Swansea University); Latreille, Paul L. (Swansea University); Sloane, Peter J. (Swansea University)
    Abstract: This paper uses matched employee-employer data from the British Workplace Employment Relations Survey (WERS) 2004 to examine the determinants of employee job anxiety and work-related psychological illness. Job anxiety is found to be strongly related to the demands of the job as measured by factors such as occupation, education and hours of work. Average levels of employee job anxiety, in turn, are positively associated with work-related psychological illness among the workforce as reported by managers. The paper goes on to consider the relationship between psychological illness and workplace performance as measured by absence, turnover and labour productivity. Work-related psychological illness is found to be negatively associated with several measures of workplace performance.
    Keywords: job anxiety, stress, absence, labour productivity
    JEL: I0 J28 J81 J20
    Date: 2011–06
  9. By: Goodall, Amanda H. (IZA)
    Abstract: Although it has long been conjectured that having physicians in leadership positions is valuable for hospital performance, there is no published empirical work on the hypothesis. This cross-sectional study reports the first evidence. Data are collected on the top-100 U.S. hospitals in 2009, as identified by a widely-used media-generated ranking of quality, in three specialties: Cancer, Digestive Disorders, and Heart and Heart Surgery. The personal histories of the 300 chief executive officers of these hospitals are then traced by hand. The CEOs are classified into physicians and non-physician managers. The paper finds a strong positive association between the ranked quality of a hospital and whether the CEO is a physician (p<0.001). This kind of cross-sectional evidence does not establish that physician-leaders outperform professional managers, but it is consistent with such claims and suggests that this area is now an important one for systematic future research.
    Keywords: organizational performance, expert leaders, hospitals, physicians, professional managers
    JEL: I19 M12 M51
    Date: 2011–07
  10. By: Lundborg, Petter (Lund University); Nilsson, Anton (Lund University); Rooth, Dan-Olof (Linneaus University)
    Abstract: A large number of studies in labor economics estimate the returns to schooling using data on monozygotic twins, under the assumption that educational attainment is random within twin pairs. This exogeneity assumption has been commonly questioned, however, but there is to date little evidence on the topic. Using a large dataset of twins, including comprehensive information on their health status at the age of 18 and later educational attainment, we investigate whether educational attainment is related to early health status within monozygotic twin pairs. In general, we obtain no indication of this being so. As a result, we find little evidence that early health differences between twins would bias the estimates of the returns to schooling available in the literature.
    Keywords: twins, twin-fixed effects, schooling, returns to schooling, ability bias, health
    JEL: I1 I2
    Date: 2011–06
  11. By: Shahrul Nizam Salahudin; Zuliawati Mohamed Saad; Shirley Ken Tzu Ting; Mohd Nur Ruzainy Alwi (College of Business Management and Accounting, UNITEN)
    Abstract: Malaysia has a vision of becoming a developed nation by the year 2020. In line with this vision the country has also recently acknowledged that the best way forward is through higher productivity by its total workforce. Hence, the need of assuring employees wellbeing arises. The purpose of this research paper is to find out empirically the relationship between job content factors and employees’ well-beings in Malaysia’s small and medium enterprises (SMEs). This paper uses structural equation modeling in determining the path and degree of relationship between the said variables. Interestingly, the study found that the employees’ well-being both psychologically and physiologically were unexpectedly low. Also, it was found that the relationship between job characteristics and employees well-being do exist and with high significance levels. Based on the results, this study offers fascinating insights on employees’ well-beings in Malaysian SMEs and the factors that are associated with it
    Keywords: Job Characteristics, Employee Wellbeing, SMEs, General Health
    JEL: M00
    Date: 2011–06
  12. By: Hansen, Casper Worm (Department of Business and Economics); Lønstrup, Lars (Department of Business and Economics)
    Abstract: In this paper we show that it may be optimal for individuals to educate themselves more and decrease future labor supply (choose earlier retirement) when life expectancy increases. This result reconciles the findings of Hazan [Hazan, M., 2009. Longevity and Lifetime Labor Supply: Evidence and Implications. Econometrica 77, 1829.1863] with theory. Further, the paper contributes to a better understanding of the conflicting empirical findings on the causal effect on income per capita from increased life expectancy.
    Keywords: Life-cycle model; life expectancy; schooling; retirement
    JEL: D91 J22 J24 J26 O11
    Date: 2011–02–16
  13. By: E. Iezzi; M. Lippi Bruni; C. Ugolini
    Abstract: The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.
    JEL: I11 I18 C31
    Date: 2011–06
  14. By: de Walque, Damien; Filmer, Deon
    Abstract: The authors combine data from 84 Demographic and Health Surveys from 46 countries to analyze trends and socioeconomic differences in adult mortality, calculating mortality based on the sibling mortality reports collected from female respondents aged 15-49. The analysis yields four main findings. First, adult mortality is different from child mortality: while under-5 mortality shows a definite improving trend over time, adult mortality does not, especially in Sub-Saharan Africa. The second main finding is the increase in adult mortality in Sub-Saharan African countries. The increase is dramatic among those most affected by the HIV/AIDS pandemic. Mortality rates in the highest HIV-prevalence countries of southern Africa exceed those in countries that experienced episodes of civil war. Third, even in Sub-Saharan countries where HIV-prevalence is not as high, mortality rates appear to be at best stagnating, and even increasing in several cases. Finally, the main socioeconomic dimension along which mortality appears to differ in the aggregate is gender. Adult mortality rates in Sub-Saharan Africa have risen substantially higher for men than for women—especially so in the high HIV-prevalence countries. On the whole, the data do not show large gaps by urban/rural residence or by school attainment.
    Keywords: Population Policies,Health Monitoring&Evaluation,Demographics,Statistical&Mathematical Sciences,Early Child and Children's Health
    Date: 2011–06–01
  15. By: Blanchflower, David G; Oswald, Andrew (Dartmouth; University of Warwick)
    Abstract: Antidepressants as a commodity have been remarkably little-studied by economists. This study shows in new data for 27 European countries that 8% of people (and 10% of those middle-aged) take antidepressants each year. The probability of antidepressant use is greatest among those who are middle-aged, female, unemployed, poorly educated, and divorced or separated. A hill-shaped age pattern is found. The adjusted probability of using antidepressants reaches a peak -- approximately doubling -- in people?s late 40s. This finding is consistent with, and provides a new and independent form of corroboration of, recent claims in the research literature that human well-being follows a U-shape through life
    Keywords: Well-being; aging; mental health; depression; happiness; Easterlin paradox
  16. By: Jiménez-Martín, Sergi; Labeaga, José M.; Martínez-Granado, Maite
    Abstract: In this paper we use data the European Community Household Panel (ECHP) to describe and analyse the dynamics of joint labour force behaviour of older couples for the EUI2 countries. We focus on three main issues: the relanvance of joint retirement across EUI2 countries, the existence of complementarities in leisure and/or assortative matting and the effects of health variables. Concerning the evidence, we first find that a working spouse is more likely to retire the more recently the other spouse has retired; this effect is stronger if the wife is the working spouse. Second, there is evidence of assortative mating and/or complementarities in leisure; the effects of all relevant factors on the retirement decision of one spouse depend strongly on whether the other one is working, unemployed, or retired. Third, besides the standard evidence that poor health increases the retirement probabiliby, we find that the husband's health affects the couple's retirement decisions much more strongly than the wife's health does. Additional asymmetric effects are detected with respect to income related variables.
    Keywords: Joint retirement decisions; Labour force transitions; Health variables; Asymmetric effects;
  17. By: Galama, T.J.
    Date: 2011
  18. By: Chatterji, P;; Joo, H;; Lahiri, K;
    Abstract: We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 HRS. We explore two alternative definitions of awareness, and estimate a 3-step sequential model which accounts for selection along measured and unmeasured factors into: (1) participating in biomarker collection, (2) having illness (hypertension or diabetes), and (3) being aware of illness. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness that is used. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after self-selection and severity are considered. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African- Americans and Latinos are less aware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness – the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if s/he actually has the disease but self-reports not having it, we find striking racial/ethnic disparities in awareness.
    Date: 2011–07
  19. By: Sabatini, F;
    Abstract: We test the relationship between happiness and self-rated health in Italy. The analysis relies on a unique dataset collected through the administration of a questionnaire to a representative sample (n = 817) of the population of the Italian Province of Trento in March 2011. Based on probit regressions, instrumental variables estimates and structural equations modelling, we find that happiness is strongly correlated with perceived good health, after controlling for a number of relevant socio-economic phenomena. Health inequalities based on income, work status and education are relatively contained in respect to the rest of Italy. As expected, this scales down the role of social capital.
    Keywords: cooperative enterprises; happiness; health; instrumental variables; Italy; life satisfaction; non-profit; social capital; structural equations modelling.
    JEL: I12 I18 Z1
    Date: 2011–06
  20. By: Lee, M-J;; Kim, Y-S.;
    Abstract: Whether informal family health care is a substitute or complement for formal health care has been debated in the literature. If it is a substitute, then there is a scope to reduce formal health care cost by promoting informal family health care. Using Korean survey data for the elderly of age 65 or higher, this paper estimates the effect of informal family health care on formal health care, where the former is measured by the number of family health care givers and the latter is measured by the (logarithm of) formal health care expenditure. This task, however, poses a number of difficulties. The first is that the number of the family care givers is an endogenous count regressor. The second is that there seem to be too many zeros in the count (85%). The third is that the response variable also has a non-trivial proportion of zeros (14%). This paper overcomes these problems by combining a semiparametric estimator for a censored response with the idea of “zero-inflated†counts. The resulting two-stage procedure avoids strong parametric assumptions and behaves well computationally. Our main empirical finding is that informal family health care has a large substitute effect for diabetics that is statistically significant and large in magnitude, but the other effects are statistically insignificant for our given data size of about 3000
    Keywords: informal health care, formal health care, count variable, zero-inflated Poisson, control function approach, censored model.
    Date: 2011–06
  21. By: Cader, Azra Abdul (Asian Development Bank Institute); Perera, Lakwimashi (Asian Development Bank Institute)
    Abstract: The economic crisis hit many countries in 2007 and the effects are still being felt, especially in poorer developing nations. Much of the debate surrounding the economic crisis and its impacts has focused on the financial and economic aspects—import/export impacts, economic growth losses, labor force cutbacks, and fiscal imbalances. The social impact, especially on poor and vulnerable groups, has received less mention. Yet, if countries are to address the overall impacts of the economic crisis, it is vital that they also consider investing time and money to deal with social impacts more effectively. There are fears, however, that a reduction in spending on vital sectors (including the healthcare sector) to ensure economic recovery could affect poor and vulnerable populations and, in turn, erase the progress that has been made thus far. The decision to reduce such spending could also come from donors, who tend to favor a market-led recovery process in economic crises, thereby neglecting vital social service sectors that cater to the needs of poor populations. This spending can supplement government services or fill resource gaps and as a result reductions could have negative impacts on beneficiary populations, particularly the poor and vulnerable. Addressing child and maternal health issues within the context of the economic crisis is one key area to consider given its short, medium, and long-term effects on populations in developing countries. In South Asian countries, child and maternal health-related indicators tend to be disturbing despite the rapid growth rates in many of these countries. The number of infant deaths is still quite high, nutrition of children and women continues to be problematic, and maternal health and pre/post natal care remains poor. This paper presents an overview of child and maternal health in the South Asia region, but also recommends that interventions take into account a series of factors if the impacts of the economic crisis are to be minimized: There is a need for more information and research on the impacts of the crisis; Investing in social protection and safety nets is imperative; Food security should be integrated into social protection; Vulnerable households require support to cope with the crisis despite their own efforts and coping strategies; State investments that support vulnerable populations should be protected in times of crisis.
    Keywords: poverty reduction; economic crisis impact; social impact; child maternal health; south asia poverty; social protection
    JEL: I10 Y20
    Date: 2011–07–01
  22. By: Tilman Tacke (Faculty of Economics, University of Rome "Tor Vergata"); Robert J Waldmann (Faculty of Economics, University of Rome "Tor Vergata")
    Abstract: A health care system is efficient when an increase in spending results in significant improvements in the health of a population. We test the relative efficiency of public and private health care spending in reducing infant and child mortality using cross-national data for 163 countries. There are two remarkable findings: First, an increase in public funds is both, significantly correlated with a lower mortality and significantly more efficient in reducing mortality than private health care expenditure. Second, private health care expenditure is in all estimations associated with higher, not lower, mortality, although this association is often not statistically significant. The results suggest, holding total health care expenditure constant, a potential decrease in total infant mortality in the 163 countries from 6.9 million deaths (2002) to 4.2-5.3 million deaths for completely publicly financed health care systems, but an increase to 9.0-10.0 million deaths for completely privately financed health care. We can explain some of the estimated difference in the efficiency of public and private health care expenditure by geographies and socioeconomic factors such as HIV prevalence, sanitation standards, corruption, and income distribution. However, the efficiency dfference remains large and statistically significant in all regressions.
    Date: 2011–06–30
  23. By: Martin Halla; Martina Zweimüller
    Abstract: This paper interprets accidents occurring on the way to and from work as negative health shocks to identify the causal effect of health on labor market outcomes. We argue that in our sample of exactly matched treated and control workers, these health shocks are quasi-randomly assigned. A fixed-effects difference-in-differences approach estimates a negative and persistent effect on subsequent employment and income. After initial periods with a higher incidence of sick leave, treated workers are more likely unemployed, and a growing share of them leaves the labor market via disability retirement. Those treated workers, who manage to stay in employment, incur persistent income losses. The effects are stronger for sub-groups of workers who are typically less attached to the labor market.
    Keywords: Health, employment, income
    JEL: I10 J22 D31 J31 J24 J26 J64 J28
    Date: 2011–06
  24. By: Jie Zhanga; Siew Ling Yew
    Abstract: In this paper we investigate long-run optimal social security and public health and their effects on fertility, longevity, capital intensity, output per worker and welfare in a dynastic model with altruistic bequests. Under empirically plausible conditions, social security and public health reduce fertility and raise longevity, capital intensity and output per worker. The effects of social security, except that on longevity, are stronger than those of public health. Numerically, they can improve welfare (better when they are used together than used separately). We also illustrate numerically that there exists a unique convergent solution in the dynamic system at the steady state.
    Keywords: Social security; Public health; Life expectancy; Fertility
    JEL: H55 J13 O41
    Date: 2011–06
  25. By: Ranjan Ray; Kompal Sinha
    Abstract: This paper makes methodological and empirical contributions to the study of HIV awareness, knowledge, incidence and safe sex practice in the context of Botswana, one of the most HIV prone countries in the world. While the focus is on Botswana, the paper presents comparable evidence from India to put the Botswana results in perspective. The results point to the strong role played by affluence and education in increasing HIV knowledge, promoting safe sex and reducing HIV incidence. The study presents African evidence on the role played by the empowerment of women in promoting safe sex practices such as condom use. The Botswana results show however that simply increasing HIV knowledge may not be effective in lowering HIV incidence unless people are also made fully aware of the lethal nature of the disease. The lack of significant association between HIV incidence and safe sex practice points to the danger of HIV infected individuals spreading the disease through multiple sex partners and unprotected sex. This danger is underlined by the result that females with multiple sex partners are at higher risk of being infected with HIV.
    Keywords: HIV incidence, Female Empowerment, Safe Sex Methods, Finite Mixture Models, Principal Components Analysis.
    JEL: C01 D13 I18 O55
    Date: 2011–06
  26. By: Amin Mawani (York University)
    Abstract: Over the past decade, Canadian health care expenditures have grown at a rate significantly higher than that of the growth in the economy and the growth in combined federal-provincial tax revenues. However, allocating an increasing amount of resources to health care does not necessarily lead to better health care, and despite significant investment, Canadians do not seem to receive sufficient value from the health care system. This paper aims to analyze the prospective rationale for emphasizing the concept of value-for-money in the largest segment of the Canadian health care system – hospitals. The results of the analysis show that a lack of activity-based or patient-based funding historically may have limited hospitals’ ability to assess their own effectiveness and efficiency. A focus on outcome measures alone may not be sufficient to assess and evaluate management for the stewardship of resources allocated to them. Outcome measures may not reflect how much value-for-money results from health care spending, while introducing incentives for improving quality of health care is not sufficient to improve efficiency of health care delivery.
    Keywords: health care, hospitals, value-for-money measurement
    JEL: H61 H62 H63 H68 H21 H27
    Date: 2011–05
  27. By: Anthony J Culyer (Department of Health Policy, Management and Evaluation, University of Toronto, Canada; Centre for Health Economics and Department of Economics and Related Studies, University of York, UK); Yvonne Bombard (Department of Health Policy, Management and Evaluation, University of Toronto, Canada)
    Abstract: Despite the inclusion of equity ideals in the design of many health care systems, pragmatic tools for integrating them into the efficiency categories of cost-effectiveness in HTA remain under-developed. This paper reviews approaches used to incorporate equity in HTA methods and develops a framework to help decision makers supplement the standard efficiency criteria of HTA and avoid building inequities, explicit or implicit, into their methodology. A ‘checklist’ is provided to alert decision makers to a wide range of equity considerations for HTA. This checklist is intended to be used as part of the process through which advisory bodies receive their terms of reference; the scoping of the agenda prior to the selection of a candidate intervention and its comparators for HTA; the accompanying background briefing for decision makers; and as a tool to help to structure the discussion and composition of professional and ‘lay’ advisory groups during the assessment process. The checklist is offered as only a beginning of an on-going process of deliberation and consultation, through which the matters covered can be expected to become more comprehensive and the record of past decisions and their contexts in any jurisdiction adopting the tool can serve to guide subsequent evidence gathering and decisions. In these ways, it may be hoped that equity will be more systematically and fully considered and implemented in both the procedures and decisions of HTA.
    Date: 2011–05
  28. By: Yamamura, Eiji
    Abstract: This paper explores the relationship between social capital and self-rated health status in Japan, and how this is affected by the labor market. Data of 3075 adult participants in the 2000 Social Policy and Social Consciousness (SPSC) survey were used. Controlling for endogenous bias, the main finding is that social capital has a significant positive influence on health status for people without a job but not for those with. This empirical study provides evidence that people without a job can afford to allocate time to accumulate social capital and thereby improve their health status.
    Keywords: health status; social capital; labor market.
    JEL: I19 J22 Z13
    Date: 2011–07–02
  29. By: Awan, Masood Sarwar; Waqas, Muhammad; Ali, Mumtaz; Aslam, Muhammad Amir
    Abstract: The aim of the study is to explore the factors those differentiate health related quality of life (HRQOL) among hepatitis B (HBV) and hepatitis C (HCV) patients. Different public and private hospitals of Sargodha district were visited and 120 patients of hepatitis B and C were interviewed. World health related quality of life-BREF (WHOQOL-BREF) questionnaire was used to construct HRQOL instrument. Multiple regression analysis was performed to observe the collision of demographic, medical, economic and physical and psychological factors on patients HRQOL. Results showed that HBV patients enjoyed better HRQOL then HCV patients. 86.4% HCV patients faces death threat while, 67.3% HBV faces this threat. 93.5% HBV patients feels depression while, 97.8% HCV patients feels depression. Urban patients HRQOL scores were superior then rural patients in both HCV and HBV case. Moreover, male patients HRQOL scores were better as compared to female patients. Age of the patient, disease severity, use of drug, pain, depression, financial hindrance and threat of death negatively influence the HRQOL of both HBV and HCV patients while, vaccination, income, sleep, opportunity of leisure and better living condition were positively related to HRQOL.
    Keywords: Sargodha; HBV; HCV; Pakistan
    JEL: H75 I18 I1
    Date: 2011
  30. By: Falk, Armin; Menrath, Ingo; Siegrist, Johannes; Verde, Pablo Emilio
    Abstract: This paper investigates physiological responses to perceptions of unfair pay. In a simple principal agent experiment agents produce revenue by working on a tedious task. Principals decide how this revenue is allocated between themselves and their agents. In this environment unfairness can arise if an agent's reward expectation is not met. Throughout the experiment we record agents' heart rate variability. The latter is an indicator of stress-related impaired cardiac autonomic control, which has been shown to predict coronary heart diseases in the long run. Establishing a causal link between unfair pay and heart rate variability therefore uncovers a mechanism of how perceptions of unfairness can adversely affect cardiovascular health. We further test potential adverse health effects of unfair pay using data from a large representative data set. Complementary to our experimental findings we find a strong and highly significant association between health outcomes, in particular cardiovascular health, and fairness of pay.
    Keywords: experiments; fairness; health; heart rate variability; inequality; social preferences; SOEP
    JEL: C91 D63
    Date: 2011–06
  31. By: Katherine L. Milkman; John Beshears; James J. Choi; David Laibson; Brigitte C. Madrian
    Abstract: We evaluate the results of a field experiment designed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes. The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees. All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics. Mailings to employees randomly assigned to the treatment conditions additionally included a prompt to write down either (1) the date the employee planned to be vaccinated or (2) the date and time the employee planned to be vaccinated. Vaccination rates increased when these implementation intentions prompts were included in the mailing. The vaccination rate among control condition employees was 33.1%. Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group, a difference that is not statistically significant. Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate, a difference that is both statistically significant and of meaningful magnitude.
    JEL: I10 J18
    Date: 2011–06
  32. By: Lee G. Branstetter; Chirantan Chatterjee; Matthew Higgins
    Abstract: With increasing frequency, generic drug manufacturers in the United States are able to challenge the monopoly status of patent-protected drugs even before their patents expire. The legal foundation for these challenges is found in Paragraph IV of the Hatch-Waxman Act. If successful, these Paragraph IV challenges generally lead to large market share losses for incumbents and sharp declines in average market prices. This paper estimates, for the first time, the welfare effects of accelerated generic entry via these challenges. Using aggregate brand level sales data between 1997 and 2008 for hypertension drugs in the U.S. we estimate demand using a nested logit model in order to back out cumulated consumer surplus, which we find to be approximately $270 billion. We then undertake a counterfactual analysis, removing the stream of Paragraph IV facilitated generic products, finding a corresponding cumulated consumer surplus of $177 billion. This implies that gains flowing to consumers as a result of this regulatory mechanism amount to around $92 billion or about $133 per consumer in this market. These gains come at the expense to producers who lose, approximately, $14 billion. This suggests that net short-term social gains stands at around $78 billion. We also demonstrate significant cross-molecular substitution within the market and discuss the possible appropriation of consumer rents by the insurance industry. Policy and innovation implications are also discussed.
    JEL: I11 I38 O3
    Date: 2011–06
  33. By: Amy Finkelstein; Sarah Taubman; Bill Wright; Mira Bernstein; Jonathan Gruber; Joseph P. Newhouse; Heidi Allen; Katherine Baicker; The Oregon Health Study Group
    Abstract: In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.
    JEL: H51 H75 I1
    Date: 2011–07
  34. By: Patricia M. Danzon; Andrew W. Mulcahy; Adrian K. Towse
    Abstract: This paper analyzes determinants of ex-manufacturer prices for originator and generic drugs across a large sample of countries. We focus on drugs to treat HIV/AIDS, TB and malaria in middle and low income countries (MLICs), with robustness checks to other therapeutic categories and other countries. We examine effects of per capita income, income dispersion, number and type of therapeutic and generic competitors, and whether the drugs are sold to retail pharmacies vs. tendered procurement by NGOs. The cross-national income elasticity of prices is 0.4 across high and low income countries, but is only 0.15 between MLICs, implying that drugs are least affordable relative to income in the lowest income countries. Within-country income inequality contributes to relatively high prices in MLICs. Number of therapeutic and generic competitors only weakly affects prices to retail pharmacies, plausibly because uncertain quality leads to competition on brand rather than price. Tendered procurement attracts multi-national generic suppliers and significantly reduces prices for originators and generics, compared to prices to retail pharmacies.
    JEL: I11 L11 O14 O25
    Date: 2011–06

This nep-hea issue is ©2011 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.