nep-hea New Economics Papers
on Health Economics
Issue of 2011‒07‒27
thirty-two papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Who Searches for Low Prices? Population Characteristics and Price Dispersion in the Market for Prescription Drugs By Adrienne M. Ohler
  2. Accounting for the effects of AIDS on growth in Sub-Saharan Africa By Paul Cahu; Falilou Fall
  3. Child schooling, child health and rainfall shocks: evidence from rural Vietnam By Thuan Quang Thai; Evangelos M. Falaris
  4. Addressing the Role of Adults in Youth Alcohol Consumption By Jarvis, Wade; Pescud, Melanie; Pettigrew, Simone; Webb, Dave
  5. Social Marketing: A Panacea for Adolescent Female Smoking? By Griffin, Barry; Murphy, Maurice
  6. The Influence of Gender & Reference Groups on the Irresponsible Alcohol Consumption Behaviour Model Among Young People By Beerli-Palacio, Asunción; Díaz-Meneses, Gonzalo; Fernández-Monroy, Margarita; Galván-Sánchez, Inmaculada; Martín-Santana, Josefa D.
  7. A Qualitative Investigation of Low Socioeconomic Children's Participation in Physical Activity By Henley, Nadine; Pescud, Melanie; Pettigrew, Simone; Wood, Lisa
  8. Would-Be Doctors on the Communication Components of the Medical Servic e By Vajda, Beata
  9. Ex-ante Moral Hazard and Primary Prevention, evidence from Portugal By Aida Tavares; Pedro Pita Barros
  10. Explaining the Female Black-White Obesity Gap: A Decomposition Analysis of Proximal Causes By Johnston, David W.; Lee, Wang-Sheng
  11. The Effect of an Acute Health Shock on Work Behavior: Evidence from Different Health Care Regimes By Datta Gupta, Nabanita; Kleinjans, Kristin J.; Larsen, Mona
  12. The Impact of the Global Financial Crisis on Education and Healthcare in the Economies of the Former Soviet Union – the Case of Moldova By Nina Cainarean; Eugenia Veverita; Petru Veverita
  13. The Impact of the Food and Financial Crises on Child Mortality: The case of sub-Saharan Africa By Giovanni Andrea Cornia; Luca Tiberti; Stefano Rosignoli; UNICEF Innocenti Research Centre
  14. Nudge to nobesity II: Menu positions influence food orders By Eran Dayan; Maya Bar-Hillel
  15. The Impact of Economic Factors on Food Consumption and Obesity By Rausser, Gordon; Thunström, Linda
  16. Policy Interventions to Address Health Impacts Associated with Air Pollution, Unsafe Water Supply and Sanitation, and Hazardous Chemicals By Alistair Hunt
  17. Health Inequality over the Life-Cycle By Timothy Halliday
  18. The changing role of the state in the Italian healthcare system By Doetter, Lorraine Frisina; Götze, Ralf
  19. Direct and Indirect Determinants of Obesity: The Case of Indonesia By Römling, Cornelia; Qaim, Matin
  20. HIV/AIDS as a Fiscal Liability By Haacker, Markus
  21. Deadly Cities? A Note on Spatial Inequalities in Mortality in Sub-Saharan Africa By Harttgen, Kenneth; Günther, Isabel
  22. Behavioral Response to an Anti Malaria Spraying Campaign, with Evidence from Eritrea By Locatelli, Andreas; Caneiro, Pedro; Gebremeskel, Tewolde; Keating, Joseph
  23. Impact of Health Insurance on Consumption and Saving Behaviours: Evidence from Rural China By Cheung, Diana; Padieu, Ysaline
  24. Is The Captain of the Men of Death Still At Play? Long-Run Impacts of Early Life Pneumonia Exposure during Sulfa Drug Revolution in America By Bhalotra, Sonia; Venkataramani, Atheendar
  25. Competition and Post-Transplant Outcomes in Cadaveric Liver Transplantation under the MELD Scoring System By Harry J. Paarsch; Alberto M. Segre; John P. Roberts; Jeffrey B. Halldorson
  26. Economic Crises, Maternal and Infant Mortality, Low Birth Weight and Enrollment Rates: Evidence from Argentina’s Downturns By Guillermo Cruces; Pablo Glüzman; Luis Felipe López Calva
  27. Estimates of the asset-effect: The search for a causal effect of assets on adult health and employment outcomes By Abigail McKnight
  28. Analyzing the efficiency differences among basic health units in Sargodha District By Abbas, Touqeer; Awan, Masood Sarwar; Aslam, Muhammad Amir; Waqas, Muhammad
  29. Early Maternal Employment and Family Wellbeing By Pinka Chatterji; Sara Markowitz; Jeanne Brooks-Gunn
  30. The Effects of Health Shocks on Employment and Health Insurance: The Role of Employer-Provided Health Insurance By Cathy J. Bradley; David Neumark; Meryl I. Motika
  31. Caution, Drivers! Children Present: Traffic, Pollution, and Infant Health By Christopher R. Knittel; Douglas L. Miller; Nicholas J. Sanders
  32. Cross-National Evidence on Generic Pharmaceuticals: Pharmacy vs. Physician-Driven Markets By Patricia M. Danzon; Michael F. Furukawa

  1. By: Adrienne M. Ohler (Department of Economics, Illinois State University; Montana State University)
    Abstract: We examine the relationship between population characteristics and price dispersion for 75 prescription drugs in five markets. Based on models of price dispersion, we consider that search costs are likely lower for the elderly, who are repeat purchasers. Expected benefits from search are likely higher for low income households, who lack insurance. Our results are consistent with the hypothesis that for communities with a large percentage of elderly and poor population, search effort is greater for pharmaceutical drugs, causing lower price dispersion. By understanding the characteristics of who searches for low drug prices, we begin to identify the motives of consumers that might also lead to search for the lowest cost healthcare provider or lowest cost insurance. The results suggest that the 2004 Medicare legislation that closed the pharmaceutical donut hole may have reduced search by the elderly, increased price dispersion, and potentially increased the average price of prescription drugs.
    Keywords: search cost; price dispersion; prescription drugs
    JEL: D12 D83 I1
    Date: 2011–07
  2. By: Paul Cahu (The World Bank - The World Bank); Falilou Fall (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I)
    Abstract: In this paper, we first, perform a quantitative assessment of the impact of the HIV/AIDS epidemic on growth. Second, we precisely account for the effects of the epidemic on income per capita through human and physical capital accumulations, population and labor force. That is, we disentangle the effect on the different sources of short and long run growth. Using a dynamic panel of 46 Sub-Saharan African countries over the period 1981-2007, we show that HIV/AIDS has negative, significant and long-lasting effects on demography and growth. According to the estimates presented, GDP per working age population will be 12% lower in the long-run for the average African country than it should be if the epidemic had not spread out. However, the impact is huge for the countries experiencing a high prevalence rate. To tackle the endogeneity issue of HIV/AIDS, we provide a new series of HIV prevalence rate build from the estimation of the propagation dynamic of the epidemic.
    Keywords: Health, AIDS epidemic, human capital, growth, Sub-Saharan Africa.
    Date: 2011–01
  3. By: Thuan Quang Thai (Max Planck Institute for Demographic Research, Rostock, Germany); Evangelos M. Falaris
    Abstract: We study the effect of early life conditions, proxied by rainfall shocks, on schooling and height in rural Vietnam. Our measure of rainfall shock is defined as deviations from the long-run average. Vietnamese rural dwellers engage in rain-fed crop production, mostly irrigated paddy rice. Sufficient annual rainfall could play an important role in the harvest and thus, the household income. Nutritional deficiencies resulting from the household's income shocks may have negative consequences on health. We find that negative rainfall shocks during gestation delays school entry and slows progress through school. In addition, negative rainfall shocks in the third year of life affects adversely both schooling and height. The effects differ by region in ways that reflect differing constraints on families that are shaped by regional economic heterogeneity. We predict that policies that help rural families smooth income shocks will result in increases in human capital and in substantial cumulative returns in productivity over the life course.
    Keywords: Vietnam, child nutrition, early childhood, school enrolment
    JEL: J1 Z0
    Date: 2011–07
  4. By: Jarvis, Wade; Pescud, Melanie; Pettigrew, Simone; Webb, Dave
    Abstract: This paper discusses the role of parents and other adults in preventing and facilitating teen binge drinking. Teens' discussions on Internet websites were accessed to examine their opinions of their alcohol-related interactions with adults. The results show that in the context of a western society such as Australia, the role of adults in endorsing a culture of excessive alcohol consumption may be considerable. As such, social marketing campaigns are needed that sensitise adults to this situation and outline strategies that can be used by adults to reduce negative impacts and enhance their potential to reduce alcohol consumption among young people.
    Keywords: modelling; social marketing; blog; adults; youth; binge drinking; Alco hol
    Date: 2011
  5. By: Griffin, Barry; Murphy, Maurice
    Abstract: Initiation into smoking is largely a childhood phenomenon, with more than 75% of all smokers in Ireland starting smoking before they reach the age of 18. Focus groups were conducted, where teenage girls were shown various anti-smoking advertisements and cigarette packages containing anti-smoking pictures on packets. Interviews were also held with leading social marketers and anti-tobacco campaigners. Results indicate that physical threat appeals are more effective than social threat appeals as a smoking deterrent. Anti-smoking advertisements should contain physical threat appeals which deal with the physical, visual, cosmetic appearance of the smoker as a result of smoking. Packaging images should reflect this fear of physical disfigurement as a result of smoking, in an integrated marketing communications method.
    Keywords: Packaging; Fear Appeals; Adolescent Female Smoking; Social Marketing
    Date: 2011
  6. By: Beerli-Palacio, Asunción; Díaz-Meneses, Gonzalo; Fernández-Monroy, Margarita; Galván-Sánchez, Inmaculada; Martín-Santana, Josefa D.
    Abstract: This research work sets out the objective of developing and estimating the young alcohol adoption model. This model points out the importance of values, moreover it meassures how influence values over attitudes, beliefs and emotions. The obtained results point out not only the antecedent role played by values but also the causal effect played by attitudes on beliefs, plus emotions on irresponsibles alcohol consumption behaviours. In addition, it is analised how reference group and gender are important exogenus variables in this model. Finally, some practical implications are drawn regarding responsability and hedonism values, moreover some beliefs about normality, health and social disaprobal.
    Keywords: Youth; Cannabis; Alcohol; Reference Group; Gender; Beliefs; Attitude; Values; Social Marketing
    Date: 2011
  7. By: Henley, Nadine; Pescud, Melanie; Pettigrew, Simone; Wood, Lisa
    Abstract: In terms of health, children living in low socioeconomic families are disadvantaged relative to higher socioeconomic groups. Obtaining data to help improve health outcomes in this segment is challenging. Interviews were used to collect data from a sample of 36 low socioeconomic parents with overweight primary school children to identify the barriers to their children's participation in physical activity. Identified barriers included financial, parent, child, and environmental factors. The participants recognised the importance of physical activity for their children and many expressed guilt at not being able to ensure their children engaged in adequate exercise. Recommendations for future physical activity interventions for this target group are provided.
    Keywords: health; barriers; physical activity; children; Socioeconomic status
    Date: 2011
  8. By: Vajda, Beata
    Abstract: While moving towards a bio-psycho-social model in healthcare systems is an international tendency, our preliminary research had shown high acceptance of paternalistic communication style in a Hungarian setting. In this paper, the observations of medical students about doctor-patient consultations (from a relationship and communication aspect, on the basis of formerly given viewpoints) are analysed. The method used is qualitative; we have prepared a content analysis of the written, semi-structured papers of students. The results support our assumptions of communication style being an important factor in patient compliance. Would-be doctors' approach to the topic is highly important, as doctors were found to be the primarily influential on how consultations happen.
    Keywords: medical students; compliance; communication; Doctor-patient relationsh ip
    Date: 2011
  9. By: Aida Tavares (Departamento de Economia e Gestão Industrial, GOVCOPP, Universidade de Aveiro); Pedro Pita Barros (Economics Faculty of Universidade Nova de Lisboa - Portugal, and CEPR (London))
    Abstract: This paper provides evidence on ex-ante moral hazard in Portugal. The issue is addressed in a setting where people buy voluntary private health insurance, on top of existing Government coverage. We identify the main factors that lead people to adopt healthy lifestyles, such as taking up sports and not smoking, which are associated with primary prevention. Moreover, it allows for an inference of the role of risk aversion of individuals in these decisions. We use a GHK recursive simulator of multivariate probit for insurance demand, smoking and sporting decisions, to provide joint estimates taking into consideration potential endogeneity of these decisions. Our results indicate that there is some evidence of ex-ante moral hazard with respect to primary prevention behaviors. Di¤erences in risk aversion across individuals do not seem to play a primary role in explaining distinct life styles.
    Keywords: ex-ante moral hazard, prevention, lifestyles
    JEL: I10 D82 D12
    Date: 2011–07
  10. By: Johnston, David W. (Monash University); Lee, Wang-Sheng (RMIT University)
    Abstract: There exists remarkably large differences in body weights and obesity prevalence between black and white women in the US, and crucially these differences are a significant contributor to black-white inequalities in health. In this paper, we investigate the most proximal explanations for the weight gap, namely differences in diet and exercise. More specifically, we decompose black-white differences in body mass index and waist-to-height ratio into components reflecting black-white differences in energy intake and energy expenditure. The analysis indicates that over consumption is much more important than a lack of exercise in explaining the weight gap, which suggests that diet interventions will have to play a fundamental role if the weight gap between black and white women is to decline.
    Keywords: decomposition, obesity
    JEL: I1 J11
    Date: 2011–07
  11. By: Datta Gupta, Nabanita (Aarhus School of Business); Kleinjans, Kristin J. (California State University, Fullerton); Larsen, Mona (SFI - Danish National Centre for Social Research)
    Abstract: We study how severe acute health shocks affect the probability of not working in the U. S. versus in Denmark. The results not only provide insight into how relative disease risk affects labor force participation at older ages, but also into how different types of health care and health insurance systems affect individual decisions of labor force participation. We find that the effect of an acute health shock on labor force participation is stronger in the U.S. than in Denmark, and provide compelling evidence that this is the result of health care system-related differential mortality and baseline health differences.
    Keywords: health shock, health care regimes, work
    JEL: I12 I18 J26
    Date: 2011–07
  12. By: Nina Cainarean; Eugenia Veverita; Petru Veverita
    Abstract: This study reviews the impact of the global financial crisis on public service delivery in the Republic of Moldova. It provides a background of the country’s development in the period prior to the crisis (2000 to 2007/2008) and presents the factors which determined the country’s fiscal performance during the crisis (2008-2010). The main aim of the study is to describe the changes in education and health financing and the associated changes in service delivery during the crisis. The presentation of the reforms in the social sector is necessary to set the stage for discussion and is not a primary goal of this study. In particular, the study analyzes the size and dynamics of public financing of education and healthcare and their intra-sector structure, as well as crisis management. It measures the impact the financial crisis had on the quality and reliability of public services and analyzes policy measures undertaken by the government to mitigate crisis’ impact. Conclusions and recommendations derived from the study should enable national policy-makers and international institutions supporting public finance reforms to improve the targeting of limited public resources both between and within individual sectors.
    Keywords: Economic Crisis, Economic Development, Fiscal Policy, Education, Healthcare
    JEL: E62 O10
    Date: 2011
  13. By: Giovanni Andrea Cornia; Luca Tiberti; Stefano Rosignoli; UNICEF Innocenti Research Centre
    Abstract: The years 2000-2007 witnessed an average decline in U5MR in sub-Saharan Africa (SSA) faster than that recorded during the prior two decades, including in countries with high HIV prevalence rates due to the spread of preventative and curative measures. Despite their gravity, a comprehensive analysis of the impact of the 2008-2009 crises on child mortality is still lacking, and estimates of the number of additional child deaths caused by the crises in SSA vary enormously.
    Keywords: economic crisis; food shortage; infant mortality;
    JEL: C1
    Date: 2011
  14. By: Eran Dayan; Maya Bar-Hillel
    Abstract: "Very small but cumulated decreases in food intake may be sufficient to have significant effects, even erasing obesity over a period of years" (Rozin et al., 2011). In two studies, one a lab study and the other a real-world study, we examine the effect of manipulating the position of different foods on a restaurant menu. Items placed at the beginning or the end of the list of their category options were up to twice as popular as when they were placed in the center of the list. Given this effect, placing healthier menu items at the top or bottom of item lists and less healthy ones in their center (e.g., sugared drinks vs. calorie-free drinks) should result in some increase in favor of healthier food choices.
    Date: 2011–07
  15. By: Rausser, Gordon (University of California); Thunström, Linda (The Swedish Retail Institute (HUI))
    Abstract: This paper contains a review of the emerging literature on the contribution of economic factors to the increased prevalence of food related illnesses and the impact of economic policies designed to promote health (e.g. fat taxes). A few results stand out. Studies show that technological change, resulting in falling relative prices of food, greater access to ready meals and less physical activity in production, is the main driver behind the dramatic increase in obesity over the last few decades. In order to counteract the increase in food related illnesses, food tax reforms would need to be substantial, due to the inelastic demand for food. However, more research is needed on the distributional effects of food tax reforms designed to improve health, over income groups and groups of varying health status, and age groups, to ensure that target groups benefit appropriately from the reforms.
    Keywords: Health; tax reforms; food related illness
    JEL: P36 P46
    Date: 2011–03–01
  16. By: Alistair Hunt
    Abstract: The purpose of the paper is to review the recent empirical literature relating to the quantification and valuation of the human health impacts of air pollution, hazardous chemicals, and unsafe water and sanitation, and their use in cost-benefit analysis, as an input to environmental policy decision-making. For each of these three environmental hazards, the nature and range of these health impacts are identified. The extent to which these impacts can, and have been, quantified and valued in monetary terms, is described. The use of this data in public policy-centred CBA is evaluated.<p>The health impacts associated with particulates and low-level ozone, and quantified on the basis of epidemiological evidence, ranges from minor respiratory conditions to cardio-pulmonary related mortality. CBA that includes these impacts is an established feature of air quality regulation formulation in North America and Europe. Indeed, reduced mortality impacts have dominated the benefits included in many recent appraisals of such policy development, though the robust valuation of these impacts is still evolving.<p>Heavy metals are associated with a variety of cancer impacts as well as on neurological development, renal dysfunction and a number of other impacts. These impacts are increasing being quantified and valued, in response to the requirement for more rigour arising from regulatory agencies in OECD countries. Increasingly sophisticated approaches to deal with the current attendant uncertainties are also being utilised.<p>The health risks from unsafe water and sanitation derive from faecal contamination, bacteria and viruses and include gastroenteritis, diarrhoea amongst others. OECD countries use of quantified information relating to these risks in CBA is currently in the context of wastewater management, where benefit-cost ratios are sometimes found to be less than one. In contrast, in developing countries, health risks are included in the appraisal of water supply investments. In these countries, health risks are significant but generally not as important as time savings in the benefits side of the CBA, though the quantification and monetisation of health risks is often rather partial.
    Keywords: health, environment, transport, value of statistical life, meta-analysis, policy implication
    JEL: D4 Q25 Q51 Q52 Q53
    Date: 2011–06–21
  17. By: Timothy Halliday (Department of Economics, University of Hawaii at Manoa)
    Abstract: We consider the covariance structure of health. Agents report their health status on the basis of a latent health stock that is determined by permanent and transitory shocks, and time invariant fixed effects. At age 25, permanent shocks account for 5% to 10% of the variation in health. At age 60, this percentage rise to between 60% and 80%. We document a gradient in which permanent shocks matter less for college-educated people and for women.
    Keywords: health, dynamic panel data models, variance decomposition
    JEL: I1 C5
    Date: 2011–06–20
  18. By: Doetter, Lorraine Frisina; Götze, Ralf
    Abstract: The present study describes and explains the changing role of the state in the Italian healthcare system since the beginning of the 1970s, with a particular focus on developments following 1978 when the healthcare system was transformed from a social insurance system into a national health service. In order to address these changes in a systematic way, we track healthcare system development along three dimensions: regulation, financing, and service provision. With regard to regulation, we observe a relative retreat of the state due to decentralization processes and internal market mechanisms. Quantitative measures for the financing and service provision dimension also indicate a modest relative retreat of the state. Taking regional data into account, we identify a clear North-South-divide in the public/private mix of financing and service provision. Although the focus of the paper is to describe the changing role of the state in the Italian healthcare system, we also offer preliminary explanations. We seek to identify the role of exogenous shocks such as economic crises versus endogenous stressors specific to the healthcare system itself (i.e. inherent inefficiencies) on healthcare system change. Therefore, the paper aims to provide a tentative, yet dynamic account of healthcare system change that is both descriptive and explanatory. -- Dieses Papier behandelt die veränderte Rolle des Staates im italienischen Gesundheitssystem seit den 1970er Jahren. Italien vollzog zum Beginn des Untersuchungszeitraums einen Systemwechsel von einem Sozialversicherungssystem zu einem Nationalen Gesundheitsdienst. Um die anschließenden Wandlungsprozesse in systematischer Form zu erfassen, unterscheiden wir zwischen drei Dimensionen von Staatstätigkeit im Gesundheitswesen: Regulierung, Finanzierung und Leistungserbringung. In der Regulierung beobachten wir einen relativen Rückzug des Staates durch Dezentralisierungsprozesse und die partielle Einführung interner Märkte. Dieser Befund deckt sich auch mit den quantitativen Analysen zur Finanzierung und Leistungserbringung. Durch die Einbeziehung regionaler Daten zeigt sich zudem ein klares Nord-Süd-Gefälle, das sich sowohl im öffentlichen Anteil an der Finanzierung als auch an der Leistungserbringung widerspiegelt. Das Papier beschränkt sich nicht auf die Beschreibung des Staatswandels, sondern bietet auch erste Erklärungen für diese Beobachtungen. Dazu werden sowohl exogene Faktoren wie wirtschaftliche Krisen oder Europäisierung als auch endogene Stressoren wie systeminhärente Defizite betrachtet.
    Date: 2011
  19. By: Römling, Cornelia; Qaim, Matin
    Abstract: Overweight and obesity are becoming serious issues in many developing countries. Since undernutrition is not completely eradicated yet, these countries face a dual burden that obstructs economic development. We analyze the nutrition transition in Indonesia using longitudinal data from the Indonesian Family and Life Survey, covering the period between 1993 and 2007. Obesity has been increasing remarkably across all population groups, including rural and low income strata. Prevalence rates are particularly high for women. We also develop a framework to analyze direct and indirect determinants of body mass index. This differentiation has rarely been made in previous research, but appears useful for policy making purposes. Regression models show that changing food consumption patterns coupled with decreasing physical activity levels during work and leisure time directly contribute to increasing obesity. Education, income, and marital status are significant determinants that influence nutritional status more indirectly. Change regressions underline that there are important path-dependencies. From a policy perspective, nutrition awareness and education campaigns, combined with programs to support leisure time exercise, seem to be most promising to contain the obesity pandemic. Women should be at the center of policy attention. --
    Keywords: Obesity,Overweight,Nutrition Transition,Asia,Indonesia
    JEL: I10 O12
    Date: 2011
  20. By: Haacker, Markus
    Abstract: The costs of HIV/AIDS programs are significant from a macroeconomic or fiscal perspective in a number of countries. Assessing the fiscal implications is complicated by the long lags between infection and the need for HIV/AIDS-related services, and the long duration over which these services (notably treatment) are required. The paper interprets the fiscal costs of HIV/AIDS programs as quasi-liabilities, which are incurred by HIV infections and are paid off as HIV/AIDS-related services are delivered. On the microeconomic level, the analysis yields estimates of the costs incurred by single HIV infections, which - together with other criteria - can be used in assessing the effectiveness of HIV/AIDS program allocations. On the macroeconomic level, the analysis highlights the large magnitude of the HIV/AIDS quasi-liability (according to criteria for the sustainability of public debt), and quantifies the fiscal savings achieved or projected as a consequence of declining HIV incidence. --
    Keywords: HIV/AIDS,health shocks,health expenditures,social expenditures,fiscal space,debt sustainability,quasi?liabilities,Africa,Botswana,South Africa,Swaziland,Uganda
    JEL: H5 H6 I1
    Date: 2011
  21. By: Harttgen, Kenneth; Günther, Isabel
    Abstract: In this paper we analyze if an 'urban mortality penalty' exists for today's developing countries, repeating the history of industrialized nations during the 19th century. We analyze the Demographic and Health Survey (DHS) of 19 Sub-Saharan African countries for differences in child and adult mortality between rural and urban areas. Our findings indicate that child mortality is higher in rural areas for almost all countries. On average child mortality rates are 13.6 percent in rural areas and 'only' 10.8 percent in urban areas. In contrast, average urban adult mortality rates (on average 14.5 percent) have indeed exceeded rural adult mortality rates (on average 12.8 percent) in many of our sample countries in the 2000s. For many countries high child mortality pockets do, however, exist in slum areas within cities. Child mortality rates in slum areas are on average 1.65 times higher than in the formal settlements of cities, but still lower than in rural areas. --
    Keywords: mortality,urban,slum,inequality
    JEL: I10 I30 J10 R00
    Date: 2011
  22. By: Locatelli, Andreas; Caneiro, Pedro; Gebremeskel, Tewolde; Keating, Joseph
    Abstract: It is sometimes argued that introducing Indoor Residual Spray (IRS) in areas with high coverage of mosquito bed nets may discourage net ownership and use, which would hinder Malaria eradication rather than promote it. We analyze new data from a Randomized Control Trial conducted in Eritrea in 2009, and we show that this does not happen in practice. IRS actually induced households to acquire more nets and even led to increased net use among certain demographic groups. IRS was further not associated to any perverse behavioral response. We explore two arguments that can explain this. The IRS campaign may have conveyed information about the importance of preventing Malaria and about how to do so, and people adjusted their behavior accordingly. Alternatively, people may perceive bed nets and spray as complements, even though they are substitutes. Further research is needed to disentangle these two effects. --
    Keywords: Malaria,Bednets,Spray,Information,Beliefs,Behavior
    JEL: D12 D83 H42 I12
    Date: 2011
  23. By: Cheung, Diana; Padieu, Ysaline
    Abstract: By reducing risk on income, health insurance may reduce household precautionary behaviours and boost consumption. This paper evaluates the impact of a subsidized public health insurance scheme designed for rural residents, the New Cooperative Medical Scheme (NCMS), on consumption and saving behaviours in rural China. To do so, we use socioeconomic and demographic data from the China Health and Nutrition Survey and implement OLS, IV and Propensity Score Matching. We find that NCMS helps lowering household savings by enhancing total consumption expenditures, in particular food consumption and bride expenses with OLS and IV estimations. However, when we implement a propensity score matching coupled with a difference-in-difference approach to control for time-invariant unobservables, these results no longer hold. Thus, the scheme does not have a disincentive effect on savings nor an incentive effect on consumption, suggesting that the implementation of the insurance is too recent in 2006 to be trusted by rural Chinese households, to reduce income risk and enable them to lower their precautionary savings. --
    Keywords: Rural China,New Cooperative Medical Scheme,Saving,Consumption Propensity Score Matching,Difference-in-Difference
    JEL: C21 D1 I18 O53
    Date: 2011
  24. By: Bhalotra, Sonia; Venkataramani, Atheendar
    Abstract: We exploit the introduction of sulfa drugs in 1937 to identify the impact of exposure to pneumonia in infancy on later life well-being and productivity in the United States. Using census data from 1980-2000, we find that cohorts born after the introduction of sulfa experienced increases in schooling, income, and the probability of employment, and reductions in disability rates. These improvements were larger for those born in states with higher pre-intervention pneumonia mortality rates, the areas that benefited most from the availability of sulfa drugs. Men and women show similar improvements on most indicators but the estimates for men are more persistently robust to the inclusion of birth state specific time trends. With the exception of cognitive disabilities for men and, in some specifications, work disability for men and family income, estimates for African Americans tend to be smaller and less precisely estimated than those for whites. Since African Americans exhibit larger absolute reductions in pneumonia mortality after the arrival of sulfa, we suggest that the absence of consistent discernible long run benefits may reflect barriers they encountered in translating improved endowments into gains in education and employment in the pre- Civil Rights Era. --
    Keywords: early childhood,infectious diseases,pneumonia,medical innovation,antibiotics,schooling,income,disability,mortality trends
    JEL: I18 H41
    Date: 2011
  25. By: Harry J. Paarsch; Alberto M. Segre; John P. Roberts; Jeffrey B. Halldorson
    Abstract: Previous researchers have modelled the decision to accept a donor organ for transplantation as a Markov decision problem, the solution to which is often a control-limit optimal policy: accept any organ whose match quality exceeds some health-dependent threshold; otherwise, wait for another. When competing transplant centers vie for the same organs, the decision rule changes relative to no competition; the relative size of competing centers affects the decision rules as well. Using center-specific graft and patient survival-rate data for cadaveric adult livers in the United States, we have found empirical evidence supporting these predictions.
    Keywords: liver transplantation; competition; optimal stopping
    JEL: C14 I12 L1
    Date: 2011
  26. By: Guillermo Cruces (CEDLAS-FCE-UNLP, CONICET and IZA); Pablo Glüzman (CEDLASFCE-UNLP and CONICET); Luis Felipe López Calva (The World Bank, Poverty and gender unit, Latin America and the Caribbean)
    Abstract: Este estudio investiga el impacto de las recientes crisis en Argentina (incluyendo la grave recesión de 2001-2002) en la salud y la educación. La estrategia de identificación se basa en la covarianza entre los cambios en el PIB regional y los resultados por provincia en términos intertemporales e interprovinciales. Estos resultados indican efectos significativos e importantes de las fluctuaciones agregadas en la mortalidad materna e infantil y en el bajo peso al nacer, así como un patrón contracíclico aunque no significativo para las tasas de matrícula. Finalmente, el gasto público provincial en salud y educación se correlacionan con la incidencia del bajo peso al nacer y la matriculación escolar de los adolescentes, con peores resultados ante una disminución del PIB.
    Keywords: crisis, infant mortality, maternal mortality, low birth weight, poverty, Argentina
    Date: 2011–07
  27. By: Abigail McKnight
    Abstract: In this paper we seek to determine the effect of assets held in early adult life on later outcomes. We specifically look at wages, employment prospects, general health and Malaise. The identification of an asset-effect throws up a number of statistical challenges as asset holding is not random. We employ a number of statistical techniques in our search for the causal effect of assets on adult health and employment outcomes. We find that simple Ordinary Least Squares and probit estimates of the asset effect are indeed biased in many cases. However, after applying a battery of techniques to remove such biases, the conclusion is that within the cohort examined (born in 1958), early asset holding does have positive effects on later wages, employment prospects, excellent general health and in reducing malaise.
    Keywords: asset effect, wealth, asset-based welfare
    Date: 2011–06
  28. By: Abbas, Touqeer; Awan, Masood Sarwar; Aslam, Muhammad Amir; Waqas, Muhammad
    Abstract: Pakistan has adequate infrastructure for health services delivery at primary level. The study aims to calculate the technical efficiency of Basic Health Units (BHUs) in Sargodha by using the Data Envelopment Analysis (DEA) with the choice of inputs and outputs being specific to BHUs operation. DEA model results reveals that the mean technical efficiency under, Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS) was 0.719 and 0.807 while the mean scale efficiency was 0.88. Study exposed that 77 % BHUs were technically inefficient under CRS while 66 % BHUs were technically inefficient under VRS modal. Overall 76% BHUs were inefficient and destructing the infrastructure. Moreover, findings evidently point to adverse inefficiency of BHUs in health services delivery. Study concluded that existing high level of inefficiency in BHUs needs institutional fascination for scaling up BHUs to meet both regional as well international targets such as Millennium Development Goals (MDGs) and recommended such measures that may curb the waste.
    Keywords: Basic Health Units; Technical Efficiency; Data Envelopment Analysis; Pakistan
    JEL: I11 H51 I18 H75
    Date: 2011
  29. By: Pinka Chatterji; Sara Markowitz; Jeanne Brooks-Gunn
    Abstract: This study uses longitudinal data from the NICHD Study on Early Child Care (SECC) to examine the effects of maternal employment on family well-being, measured by maternal mental and overall health, parenting stress, and parenting quality. First, we estimate the effects of maternal employment on these outcomes measured when children are 6 months old. Next, we use dynamic panel data models to examine the effects of maternal employment on family outcomes during the first 4.5 years of children’s lives. Among mothers of six month old infants, maternal work hours are positively associated with depressive symptoms and self-reported parenting stress, and negatively associated with self-rated overall health among mothers. Compared to mothers who are on leave 3 months after childbirth, mothers who are working full-time score 22 percent higher on the CES-D scale of depressive symptoms. However, maternal employment is not associated with the quality of parenting at 6 months, based on trained assessors’ observations of maternal sensitivity. Moreover, during the first 4.5 years of life as a whole, we find only weak evidence that maternal work hours are associated with maternal health, and no evidence that maternal employment is associated with parenting stress and quality. We find that unobserved heterogeneity is an important factor in modeling family outcomes.
    JEL: I1
    Date: 2011–07
  30. By: Cathy J. Bradley; David Neumark; Meryl I. Motika
    Abstract: We study how men’s dependence on their own employer for health insurance affects labor supply responses and loss of health insurance coverage when faced with a serious health shock. Men with employment-contingent health insurance (ECHI) are more likely to remain working following some kinds of adverse health shocks, and are more likely to lose insurance. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.
    JEL: I18 J22 J38
    Date: 2011–07
  31. By: Christopher R. Knittel; Douglas L. Miller; Nicholas J. Sanders
    Abstract: Since the Clean Air Act Amendments of 1990 (CAAA), atmospheric concentration of local pollutants has fallen drastically. A natural question is whether further reductions will yield additional health benefits. We further this research by addressing two related research questions: (1) what is the impact of automobile driving (and especially congestion) on ambient air pollution levels, and (2) what is the impact of modern air pollution levels on infant health? Our setting is California (with a focus on the Central Valley and Southern California) in the years 2002-2007. Using an instrumental variables approach that exploits the relationship between traffic, ambient weather conditions, and various pollutants, our findings suggest that ambient pollution levels, specifically particulate matter, still have large impacts on weekly infant mortality rates. Our results also illustrate the importance of weather controls in measuring pollution’s impact on infant mortality.
    JEL: I18 Q51 Q53
    Date: 2011–07
  32. By: Patricia M. Danzon; Michael F. Furukawa
    Abstract: This paper examines the role of regulation and competition in generic markets. Generics offer large potential savings to payers and consumers of pharmaceuticals. Whether the potential savings are realized depends on the extent of generic entry and uptake and the level of generic prices. In the U.S., the regulatory, legal and incentive structures encourage prompt entry, aggressive price competition and patient switching to generics. Key features are that pharmacists are authorized and incentivized to switch patients to cheap generics. By contrast, in many other high and middle income countries, generics traditionally competed on brand rather than price because physicians rather than pharmacies are the decision-makers. Physician-driven generic markets tend to have higher generic prices and may have lower generic uptake, depending on regulations and incentives. Using IMS data to analyze generic markets in the U.S., Canada, France, Germany, U.K., Italy, Spain, Japan, Australia, Mexico, Chile, Brazil over the period 1998-2009, we estimate a three-equation model for number of generic entrants, generic prices and generic volume shares. We find little effect of originator defense strategies, significant differences between unbranded and unbranded generics, variation across countries in volume response to prices. Policy changes adopted to stimulate generic uptake and reduce generic prices have been successful in some E.U. countries.
    JEL: I11 I18 K2 L5 L65
    Date: 2011–07

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.