nep-hea New Economics Papers
on Health Economics
Issue of 2011‒11‒01
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Economics of Information Technology in Public Sector Health Facilities in Developing Countries: The Case of South Africa By Gregory B. Cline; John M. Luiz
  2. Evidence on the Long Shadow of Poor Mental Health across Three Generations By Johnston, David W.; Schurer, Stefanie; Shields, Michael A.
  3. Work-Related Health in Europe: Are Older Workers More at Risk? By Jones, Melanie K.; Latreille, Paul L.; Sloane, Peter J.; Staneva, Anita V.
  4. The Captain of the Men of Death and His Shadow: Long-Run Impacts of Early Life Pneumonia Exposure By Bhalotra, Sonia R.; Venkataramani, Atheendar
  5. The Geographic Accessibility of Child Care Subsidies and Evidence on the Impact of Subsidy Receipt on Childhood Obesity By Herbst, Chris M.; Tekin, Erdal
  6. Geographic differences in hospital waiting times By Meliyanni Johar; Glenn Jones; Michael Keane; Elizabeth Savage; Olena Stavrunova
  7. Discrimination in a universal health system: Explaining socioeconomic waiting time gaps By Meliyanni Johar; Glenn Jones; Michael Keane; Elizabeth Savage; Olena Stavrunova
  8. Explaining the Health Equality Paradox of the Welfare State By Brekke, Kjell Arne; Grünfeld, Leo A.; Kverndokk, Snorre
  9. Does the Minimum Cigarette Purchase Age of 21 Protect Young Mothers from Cigarettes, Help Their Babies? By Ji Yan
  10. Tall claims : mortality selection and the height of children By Alderman, Harold; Lokshin, Michael; Radyakin, Sergiy
  11. The Global Economic Effects of Pandemic Influenza By George Verikios; Maura Sullivan; Pane Stojanovski; James Giesecke; Gordon Woo
  12. Relative mortality improvements as a marker of socio-economic inequality across the developing world, 1990-2009 By Deepankar Basu
  13. The Effect of Health on Income: Quasi-Experimental Evidence from Commuting Accidents By Martin Halla; Martina Zweimüller
  14. Causal effect of income on health: Investigating two closely related policy reforms in Austria By Mario Schnalzenberger
  15. Entry and Exit of Physicians in a two-tiered public/private Health Care System By Martin Gächter; Peter Schwazer; Engelbert Theurl
  16. How Beliefs about HIV Status Affect Risky Behaviors: Evidence from Malawi, Seventh Version By Áureo de Paula; Gil Shapira; Petra E. Todd

  1. By: Gregory B. Cline; John M. Luiz
    Abstract: The public healthcare sector in developing countries face many challenges, including weak healthcare systems and under resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Healthcare delivery, access to healthcare and cost containment has the potential for improvement through more efficient healthcare resource management. Global references demonstrate that information technology (IT) has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of new systems implementations on service delivery, user adoption and organizational culture within the hospital setting in South Africa, as perceived by doctors, nurses and hospital administrators. The research provides some insight into the reasons for investing in system automation, the associated outcomes, and organiztional factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation.
    Keywords: Hospital information systems; healthcare management; electronic health records; South Africa, mixed methods
    Date: 2011
  2. By: Johnston, David W. (Monash University); Schurer, Stefanie (Victoria University of Wellington); Shields, Michael A. (University of Melbourne)
    Abstract: Individuals suffering from mental health problems are often severely limited in their social and economic functioning. Mental health problems can develop early in life, are frequently chronic in nature, and have an established hereditary component. The extent to which mental illness runs in families could therefore help explain the widely discussed intergenerational transmission of socioeconomic disadvantage. Using data from three generations contained in the 1970 British Cohort Study, we estimate the intergenerational correlation of mental health between mothers, their children, and their grandchildren. We find that the intergenerational correlation in mental health is about 0.2, and that the probability of feeling depressed is 63 percent higher for children whose mothers reported the same symptom 20 years earlier. Moreover, grandmother and grandchild mental health are strongly correlated, but this relationship appears to work fully through the mental health of the parent. Using grandmother mental health as an instrument for maternal mental health in a model of grandchild mental health confirms the strong intergenerational correlation. We also find that maternal and own mental health are strong predictors of adulthood socioeconomic outcomes. Even after controlling for parental socioeconomic status, own educational attainment, and own mental health (captured in childhood and adulthood), our results suggest that a one standard deviation reduction in maternal mental health reduces household income for their adult offspring by around 2 percent.
    Keywords: intergenerational transmission, mobility, mental health, economic outcomes
    JEL: I12 J62
    Date: 2011–10
  3. By: Jones, Melanie K. (Swansea University); Latreille, Paul L. (Swansea University); Sloane, Peter J. (Swansea University); Staneva, Anita V. (Swansea University)
    Abstract: This paper uses the fourth European Working Conditions Survey (2005) to address the impact of age on work-related self-reported health outcomes. More specifically, the paper examines whether older workers differ significantly from younger workers regarding their job-related health risk perception, mental and physical health, sickness absence, probability of reporting injury and fatigue. Accounting for the 'healthy worker effect', or sample selection – in so far as unhealthy workers are likely to exit the labour force – we find that as a group, those aged 55-65 years are more 'vulnerable' than younger workers: they are more likely to perceive work-related health and safety risks, and to report mental, physical and fatigue health problems. As previously shown, older workers are more likely to report work-related absence.
    Keywords: endogeneity, fatigue, absence, physical health, mental health, healthy worker selection effect
    JEL: I0 J28 J81 J20
    Date: 2011–10
  4. By: Bhalotra, Sonia R. (University of Bristol); Venkataramani, Atheendar (Massachusetts General Hospital)
    Abstract: We exploit the introduction of sulfa drugs in 1937 to identify the causal 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 levels of pneumonia as these were the areas that benefited most from the availability of sulfa drugs. These estimates are, in general, larger and more robust to specification for men than for women. With the exception of cognitive disability and poverty for men, the estimates for African Americans are smaller and less precisely estimated than those for whites. This is despite our finding that African Americans experienced larger absolute reductions in pneumonia mortality after the arrival of sulfa. We suggest that pre-Civil Rights barriers may have inhibited their translating improved endowments into gains in education and employment.
    Keywords: early childhood, infectious diseases, pneumonia, medical innovation, antibiotics, schooling, income, disability, mortality trends
    JEL: I18 H41
    Date: 2011–10
  5. By: Herbst, Chris M. (Arizona State University); Tekin, Erdal (Georgia State University)
    Abstract: This paper examines the impact of the spatial accessibility of public human services agencies on the likelihood of receiving a child care subsidy among disadvantaged mothers with young children. In particular, we collect data on the location of virtually every human services agency in the U.S. and use this information to calculate the approximate distance that families must travel from home in order to reach the nearest office that administers the subsidy application process. Using data from the Kindergarten cohort of the Early Childhood Longitudinal Study (ECLS-K), our results indicate that an increase in the distance to a public human services agency reduces the likelihood that a family receives a child care subsidy. Specifically, we estimate an elasticity of subsidy receipt with respect to distance of -0.13. The final section of the paper provides an empirical application in which we use variation in families' travel distance to identify the causal effect of child care subsidies on children's weight outcomes. Our instrumental variables estimates suggest that subsidized child care leads to sizeable increases in the prevalence of overweight and obesity among low-income children.
    Keywords: child care, subsidy, obesity
    JEL: I12 I18 J13 R53
    Date: 2011–10
  6. By: Meliyanni Johar (Centre for Health Economics Research and Evaluation, University of Technology, Sydney); Glenn Jones (Department of Economics, Macquarie University); Michael Keane (School of Economics, University of New South Wales); Elizabeth Savage (Centre for Health Economics Research and Evaluation, University of Technology, Sydney); Olena Stavrunova (School of Finance and Economics, University of Technology, Sydney)
    Abstract: Access to elective surgery in Australian public hospitals is rationed using waiting lists. In this paper we undertake a DiNardo-Fortin-Lemieux reweighting approach to attribute variation in waiting time to clinical need or to discrimination. Using data from NSW public patients in 2004-2005, we find the discrimination effect dominates clinical need especially in the upper tail of the waiting time distribution. We find evidence of favourable treatment of patients who reside in remote areas and discrimination in favour of patients residing in particular Area Health Services. These findings have policy implications for the design of equitable quality targets for public hospitals.
    Keywords: Public hospital; waiting time; discrimination; decomposition analysis
    JEL: I11 J7 H51
    Date: 2011–10–21
  7. By: Meliyanni Johar (Centre for Health Economics Research and Evaluation, University of Technology, Sydney); Glenn Jones (Department of Economics, Macquarie University); Michael Keane (School of Economics, University of New South Wales); Elizabeth Savage (Centre for Health Economics Research and Evaluation, University of Technology, Sydney); Olena Stavrunova (School of Finance and Economics, University of Technology, Sydney)
    Abstract: One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the richest patients, especially the least urgent, who can be delayed with lower health risks, thereby allowing more scope for discrimination. The rich also benefit from variation in supply endowments. These results challenge the universal system's core principle of equitable treatment.
    Keywords: Public hospital; waiting time; discrimination; decomposition analysis
    JEL: I11 J7 H51
    Date: 2011–10–21
  8. By: Brekke, Kjell Arne (Department of Economics, University of Oslo); Grünfeld, Leo A. (Oslo School of Management & MENON Business Economics); Kverndokk, Snorre (Ragnar Frisch Centre for Economic Research, UiO)
    Abstract: A growing body of empirical studies have reported that social inequalities in health are as large (or even larger) in the Nordic welfare states than in many less egalitarian societies. This is highly surprising since the welfare state is rooted in income equality, free access to education and health services, and a generous social benefit system. This paper reviews this literature, and provides an explanation of this paradox based on the most common causal mechanism studied, namely the one that goes from income (or another socio economic variable) to health. <p> <p> We start by showing that the concentration index is much more sensitive to health contingent income transfers than income contingent health transfers. Then, we introduce a simple model where health is caused by status (relative income) and show that there actually exists as possibility that stratified societies may have lower health inequality than egalitarian societies, everything else equal, if class is unobservable. Thus, there may be a tradeoff between income and health equality. However, due to the insensitivity of the concentration index of health transfers, this tradeoff may not be shown by such inequality measures. A higher social health inequality as found in empirical studies, may therefore just be a sign of a more equal income distribution. <p> <p>
    Keywords: Income inequality; health inequality; socioeconomic status; welfare states; concentration index
    JEL: D31 I12
    Date: 2011–10–25
  9. By: Ji Yan
    Abstract: A key target of the U.S. health policies is to reduce costly adverse birth outcomes to which prenatal smoking is one of the most signicant contributors. This paper represents the rst attempt to examine whether implementing the minimum cigarette purchase age of 21 can curb smoking among young mothers and thus improve their newborn's health. The research question is crucial because young mothers are heavily engaged in smoking and have poorer birth outcomes, and because the smoking prevalence and intensity among Pennsylvania young childbearing women have also exceeded the national average. I nd robust evidence that the 21 smoking age leads to a 15 percent decline in the daily cigarettes smoked, a 19 percent decrease in the probability of having a low birth weight baby among all the mothers, and improvements on other birth outcomes such as longer gestation and higher APGAR scores. Such results contribute to the growing literature on the important role of a healthy fetal en- vironment in the newborn well-beings. The uncovered large intergenerational benets due to this regulation also shed new light on the current political debate in many states on whether shifting the legal smoking age up to 21. Key Words: Prenatal Smoking, Infant Health, Minimum Cigarette Purchase Age
    JEL: I12 I18
    Date: 2011
  10. By: Alderman, Harold; Lokshin, Michael; Radyakin, Sergiy
    Abstract: Data from three rounds of nationally representative health surveys in India are used to assess the impact of selective mortality on children’s anthropometrics. The nutritional status of the child population was simulated under the counterfactual scenario that all children who died in the first three years of life were alive at the time of measurement. The simulations demonstrate that the difference in anthropometrics due to selective mortality would be large only if there were very large differences in anthropometrics between the children who died and those who survived. Differences of this size are not substantiated by the research on the degree of association between mortality and malnutrition. The study shows that although mortality risk is higher among malnourished children, selective mortality has only a minor impact on the measured nutritional status of children or on that status distinguished by gender.
    Keywords: Health Monitoring&Evaluation,Population Policies,Youth and Governance,Adolescent Health,Early Child and Children's Health
    Date: 2011–10–01
  11. By: George Verikios; Maura Sullivan; Pane Stojanovski; James Giesecke; Gordon Woo
    Abstract: We analyse the global economic effects of two influenza pandemics that represent extremes along the virulence-infectiousness continuum of possible pandemics: a high virulence-low infectiousness event and a low virulence-high infectiousness event. We do this by applying results from a susceptible-infected-recovered epidemiological model to a detailed, quarterly computable general equilibrium model. Our findings indicate that global economic activity will be more strongly affected by a pandemic with high infection rates rather than high virulence rates, all else being equal. At the regional level, regions with a higher degree of economic integration with the world economy will be affected more strongly than less integrated regions.
    Keywords: computable general equilibrium, pandemic influenza, quarterly periodicity
    JEL: C68 E37 I18
    Date: 2011–10
  12. By: Deepankar Basu (University of Massachusetts Amherst)
    Abstract: Using cross country regressions, this paper constructs a novel distance-to-frontier metric for tracking broad socio-onomic inequality (including access of the poor to health infrastructure) over time for individual countries. Given the unavailability of reliable and consistent direct measures of inequality for most poor countries, especially related to non-income aspects of living standards, the metric developed in this paper can be used as an alternative indirect measure that is intuitive and easy to compute. To highlight its potential use, the metric is used to rank countries in terms of improvements in socio-economic inequality for the period since 1990. Notable examples of poor performance are displayed by China, Thailand, Kenya and India. JEL Categories: I14, O57, I32.
    Keywords: life expectancy at birth, Preston regression, socio-economic inequality
    Date: 2011–10
  13. 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
  14. By: Mario Schnalzenberger (Department of Economics, Johannes Kepler University Linz, Austria)
    Abstract: I investigate the effect of income on mortality of the pensioners, comparing three subsequent policy periods in Austria. The pensioners who retired in the second period received 25% lower pension than those in the first period. This reduction in income was removed in the third policy period. These two reforms allow a causal identification of the effect of income on health. I estimate that lower pension did not change the mortality rate. The results are confirmed using both experiments and different methods of estimation. Furthermore, with regard to the expenditure on health services, I get that only prescribed drug consumption increased, with the remaining analyzed factors being unaffected.
    Keywords: Income, Mortality, Health, Expenditure
    JEL: I12 J14 H55
    Date: 2011–07
  15. By: Martin Gächter (University of Innsbruck / Institute for Public Economics); Peter Schwazer (University of Innsbruck / Institute for Management and Economics in the Health Sector); Engelbert Theurl
    Abstract: Firm turnover has recently attracted increased interest in economic research. The entry of new firms increases competition and promises efficiency gains. Moreover, changes in the market structure influence productivity growth, because firm entry usually leads to increased innovation. The health care market exhibits important differences as compared to other markets, including various forms of market failure and, as a consequence, extensive market regulation. Thus, the economic effects of entries and exits in health care markets are less obvious. The following paper studies the determinants of entry and exit decisions of physicians in the private sector of the outpatient part of the Austrian health care system. We apply a Poisson panel estimation to a data set of 2,379 local communities and 121 districts in Austria in the time period 2002 - 2008. We are particularly interested in the question how public physicians (GPs/specialists) and their private counterparts influence the entrance and exit of private physicians. We find a significantly negative effect of existing capacities, measured by both private and public physician density of the same specialty, on the entry of new private physicians. On the contrary, we find a significantly positive effect of private GPs on the entry of private specialists. Interestingly, this cooperation/network effect also works in the other direction, as a higher density of private specialists increases the probability of the market entry of private GPs. Based on the results of previous literature, we thus conclude that private physicians establish networks to cooperate in terms of mutual referrals etc. Our estimations for market exits basically confirm the entry results, as higher competitive forces positively influence the market exit of private physicians.
    Keywords: Entry, Exit, Health Care, Physician location
    JEL: I11 I18 L14
    Date: 2011–01
  16. By: Áureo de Paula (Department of Economics, University of Pennsylvania); Gil Shapira (Department of Economics, University of Pennsylvania); Petra E. Todd (Department of Economics, University of Pennsylvania)
    Abstract: This paper examines how beliefs about own HIV status affect decisions to engage in risky sexual behavior, as measured by having extramarital sex and/or multiple sex partners. The empirical analysis is based on a panel survey of males from the 2006 and 2008 rounds of the Malawi Diffusion and Ideational Change Project (MDICP). The paper first develops a behavioral model of the belief-risky behavior relationship. It then estimates the causal effect of beliefs on risky behavior in a way that takes into account the belief updating mechanisms implied by the model. In particular, the Arellano and Carrasco (2003) semiparametric panel data estimator that is used accommodates both unobserved heterogeneity and belief endogeneity, arising from dependence of current beliefs on past risky behavior. Results show that downward revisions in the belief assigned to being HIV positive increase risky behavior and upward revisions decrease it. We estimate for example that a change in the perceived probability of being HIV positive from 0 to 100% reduces risky behavior between 13.7 and 36.4 percentage points depending on the risky behavior definition and year. Implementation of a modified estimator that allows for misreporting of risky behavior finds the estimates to be downward biased but relatively robust to a wide range of plausible misreporting levels.
    Keywords: Malawi,HIV,beliefs
    JEL: I12
    Date: 2011–02–21

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