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on Health Economics |
| By: | Manasan, Rosario G. |
| Abstract: | <p>Highly unequal access to health services and the large share of household out-of-pocket spending in total health expenditures underscore the importance of attaining universal health coverage. This study evaluates the major challenges involved in moving toward universal coverage of the Philippine National Health Insurance Program. The strategic approach of PhilHealth in expanding population coverage has been described as "squeezing the middle:" (i) "squeezing from the top" by expanding the PhilHealth coverage of the group subject to compulsory enrollment, i.e., the Employed Sector Program, (ii) "squeezing from the bottom" by expanding the coverage of the poor households under the Sponsored Program, and (iii) implementing interventions that are directed at expanding the coverage of nonpoor households whose heads are employed in the informal sector under the Individually Paying Program.</p><p>Recently, government decided that the national government counterpart in the premium contributions of members enrolled in the Sponsored Program will only be available for families identified as poor under the National Household Targeting System for Poverty Reduction (NHTS-PR). This decision is anchored on the expectation that the use of the NHTS-PR will improve the targeting performance of the Sponsored Program largely by enabling the government to eliminate political intervention in the selection process.</p><p>While this new policy direction helps promote better targeting of the national government subsidy, it presents distinct challenges to the PhilHealth in moving toward universal coverage. First, ensuring the enrollment in the program of all the households identified under the NHTS-PR is a major hurdle considering that the selection and enrollment of Sponsored Program beneficiaries are largely initiated by the LGUs and considering the extent of political patronage involved in the process. Second, ensuring the continued enrollment in PhilHealth of some 5.1 million households who were enrolled in the Sponsored Program in 2010 but who are not in the NHTS-PR list of poor households even if they are no longer qualified for the national government subsidy is another major challenge.</p><p>The analysis suggests that broadening population coverage of social health insurance program may be difficult to achieve without concomitant reforms in other elements of the program, particularly the payment mechanism.</p> |
| Keywords: | health insurance, Philippines, PhilHealth Sponsored Program, PhilHealth, premium, universal coverage, availment rate, National Household Targeting System for Poverty Reduction (NHTS-PR) |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2011-21&r=hea |
| By: | Tabuga, Aubrey D.; Reyes, Celia M.; Asis, Ronina D.; Datu, Maria Blesila G. |
| Abstract: | Drugs and medicines account for about half of the total medical out-of-pocket expenses of households. This share of drugs to total medical expenses is much higher for the poor than the rich. Thus, affordability of medicines is an important issue in poverty reduction. Recent efforts to improve affordability of medicines in the country were geared toward price mediation, advocacy campaigns for quality generic drugs, and creation of village drugstores (that is, the Botika ng Bayan and Botika ng Barangay), among others. This report shows how some of these efforts have gone as far as lowering the prices is concerned. It likewise examines the extent of establishment of DOH-initiated village drugstores in the effort to improve physical access to essential medicines. The goal is to identify areas with low access to affordable medicines by mapping out the geographic distribution of village drugstores. |
| Keywords: | Philippines, financial crisis, poverty impacts, school-level test scores, affordable medicines, Botika ng Barangay, Botika ng Bayan |
| Date: | 2011 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2011-10&r=hea |
| By: | Lindbeck, Assar (Stockholm University); Palme, Mårten (Stockholm University); Persson, Mats (IIES, Stockholm University) |
| Abstract: | In many countries, sickness absence financed by generous insurance benefits has become an important concern in the policy debate. It turns out that there are strong variations in absence behavior between local geographical areas, and it has been difficult to explain these variations by observable socioeconomic factors. In this paper we investigate whether such variation is related to group effects in the form of social interaction among individuals within neighborhoods. Well-known methodological problems arise when trying to answer such a question. A special feature of our attempt to deal with these problems is that we adopt several alternative approaches to identify group effects. We base the study on a rich set of Swedish panel data, and we find indications of group effects in each one of our approaches. |
| Keywords: | sick-pay insurance, work absence, moral hazard, reflection problem, social norms |
| JEL: | H56 I38 J22 Z13 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp6245&r=hea |
| By: | Bhalotra, Sonia R. (University of Bristol); Clots-Figueras, Irma (Universidad Carlos III de Madrid) |
| Abstract: | We investigate whether politician gender influences policy outcomes in India. We focus upon antenatal and postnatal public health provision since the costs of poor services in this domain are disproportionately borne by women. Accounting for potential endogeneity of politician gender and the sample composition of births, we find that a one standard deviation increase in women's political representation results in a 1.5 percentage point reduction in neonatal mortality. Women politicians are more likely to build public health facilities and encourage antenatal care, institutional delivery and immunization. The results are topical given that a bill proposing quotas for women in state assemblies is currently pending in the Indian Parliament. |
| Keywords: | political identity, gender, mortality, health, social preferences, India |
| JEL: | H41 I18 O15 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp6216&r=hea |
| By: | Canta, Chiara; Dubois, Pierre |
| Abstract: | This paper studies spousal peer effects on the smoking behaviour and their implication for the health of children through passive smoking. Smoking decisions are modeled as equilibrium strategies of an incomplete information game within the couple. Using data from the French Health Survey 2002-2003, we identify two distinct effects linked to spousal behaviour: a smoking enhancing effect of smoking partners and a smoking deterring effect of non smoking partners. On the one hand, having a smoking partner might make smoking more valuable because of the possibility of smoking together. On the other hand, having a non smoking partner might reduce the utility of smoking because the smoker partially internalises the nuisance imposed on the partner. An implication of these findings is that the smoking behaviour could differ qualitatively in couples in which both partners smoke and in which just one partner smokes. This interpretation is supported by our finding that the respiratory health of children is negatively affected only if both parents smoke. |
| Keywords: | Smoking, Social Interaction, Simultaneous Game Model, Health |
| JEL: | C31 D10 I12 |
| Date: | 2011–10 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:25234&r=hea |
| By: | Anabela Botelho (NIMA, Universidade do Minho); Micaela M. Pinho; Paula Veiga (NIMA, Universidade do Minho) |
| Abstract: | This article provides highlights of the evolution of the health care rationing debate towards a more transparent and open approach involving public participation. Discretionary models that have dominated health sector decision-making are being questioned by different sectors of society. Using data from 442 college students, we explore public’s views on its involvement in health care rationing decisions. Findings suggest that although citizens wish to be consulted, they believe doctors should play the most important role on the rationing decisions. Nonetheless, the confidence in doctors is not independent of the criteria used to support their decisions. |
| Keywords: | Priorities setting, Public involvement; Explicit rationing; Health-care. |
| JEL: | I10 I18 I19 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:nim:nimawp:43/2011&r=hea |
| By: | Hermann Pythagore Pierre Donfouet, CREM, UMR 6211, University of Rennes I, France; Pierre-Alexandre Mahieu, LEMNA, University of Nantes, France; P. Wilner Jeanty, Kinder Institute for Urban Research, Rice University, Houston, Texas, US |
| Abstract: | Contingent valuation method is commonly used in the field of health economics in an attempt to help policy maker in taking decisions. The use of the double-bounded dichotomous choice format results in a substantial gain in statistical efficiency over the single bounded dichotomous choice format. Yet, this efficiency gain comes at the cost of biasness known as internal inconsistency. This paper aims at reducing this internal inconsistency in double-bounded dichotomous choice by using the certainty calibration technique in a community-based health insurance study. Findings confirm the internal inconsistency between the initial and the follow-up responses and the statistical efficiency gains of the double-bounded dichotomous choice over the single-bounded dichotomous choice. Furthermore, the use of certainty calibration reduces this internal inconsistent pattern in responses and still maintains efficiency gain. We further discuss the policy implications. |
| Keywords: | Contingent valuation; internal inconsistency; certainty calibration; community-based health insurance |
| JEL: | C15 D6 I38 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:tut:cremwp:201130&r=hea |
| By: | Asadul Islam; Paul A. Raschky; Russell Smyth |
| Abstract: | There is much interest in the causes of several adverse health outcomes in middle and old age. In searching for new explanations for adverse health outcomes later in life, researchers have started to look beyond behavioural risk factors to examine the effect of shocks to health in utero and in childhood on health in old age. In this paper we extend this literature to examine the long-term health effects of mass political violence experienced in utero and in childhood using China’s Cultural Revolution as a natural experiment. We find that individuals who were in utero in the Cultural Revolution have reduced lung capacity later in life, but we find no evidence that being in utero has adverse effects on other health indicators later in life. We find more evidence that being an adolescent in the Cultural Revolution has an adverse effect on health later in life. Specifically, we find that individuals who were adolescents in the Cultural Revolution have higher blood pressure and reduced ability to engage in activities of daily living later in life. We also find that males who were adolescents in the Cultural Revolution have reduced cognitive skills later in life, while females who were adolescents in the Cultural Revolution have reduced lung capacity in middle and old age. specific recommendations for the Canadian context. |
| Keywords: | Health, Idiosyncratic Shocks, Cultural Revolution, Long-term effects |
| JEL: | I15 J14 O12 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:mos:moswps:2011-32&r=hea |
| By: | Guy E.J. Faulkner; Paul Grootendorst; Van Hai Nguyen; Tatiana Andreyeva; Kelly Arbour-Nicitopoulos; Chris Auld; Sean B. Cash; John Cawley; Peter Donnelly; Adam Drewnowski; Laurette Dubé; Roberta Ferrence; Ian Janssen; Jeffrey LaFrance; Darius Lakdawalla; Rena Mendelsen; Lisa Powell; W. Bruce Traill; Frank Windmeijer |
| Abstract: | Comprehensive, multi-level approaches are required to address obesity. One important target for intervention is the economic domain. The purpose of this study was to synthesize existing evidence regarding the impact of economic policies targeting obesity and its causal behaviours (diet, physical activity), and to make specific recommendations for the Canadian context. |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:mos:moswps:2011-31&r=hea |
| By: | Philip J. Cook; Christine Piette Durrance |
| Abstract: | On January 1, 1991, the federal excise tax on beer doubled, and the tax rates on wine and liquor increased as well. These changes are larger than the typical state-level changes that have been used to study the effect of price on alcohol abuse and its consequences. In this paper, we develop a method to estimate some important effects of those large 1991 changes, exploiting the interstate differences in alcohol consumption. We demonstrate that the relative importance of drinking in traffic fatalities is closely tied to per capita alcohol consumption across states. As a result, we expect that the proportional effects of the federal tax increase on traffic fatalities would be positively correlated with per capita consumption. We demonstrate that this is indeed the case, and infer estimates of the price elasticity and lives saved in each state. We repeat this exercise for other injury-fatality rates, and for nine categories of crime. For each outcome, the estimated effect of the tax increase is negatively related to average consumption, and that relationship is highly significant for the overall injury death rate, the violent crime rate, and the property crime rate. A conservative estimate is that the federal tax reduced injury deaths by 4.7%, or almost 7,000, in 1991. |
| JEL: | H2 H23 I12 K42 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17709&r=hea |
| By: | Steven Nyce; Sylvester Schieber; John B. Shoven; Sita Slavov; David A. Wise |
| Abstract: | The strong link between health insurance and employment in the United States may cause workers to delay retirement until they become eligible for Medicare at age 65. However, some employers extend health insurance benefits to their retirees, and individuals who are eligible for such retiree health benefits need not wait until age 65 to retire with group health coverage. We investigate the impact of retiree health insurance on early retirement using employee-level data from 64 diverse firms that are clients of Towers Watson, a leading benefits consulting firm. We find that retiree health coverage has its strongest effects at ages 62 and 63, resulting in a 3.7 percentage point (21.2 percent) increase in the probability of turnover at age 62 and a 5.1 percentage point (32.2 percent) increase in the probability of turnover at age 63; it has a more modest effects for individuals under the age of 62. A more generous employer contribution of 50 percent or more raises turnover by 1-3 percentage points at ages 56-61, by 5.9 percentage points (33.7 percent) at age 62, and by 6.9 percentage points (43.7 percent) at age 63. Overall, an employer contribution of 50 percent or more reduces the total number of person-years worked between ages 56 and 64 by 9.6 percent relative to no coverage. |
| JEL: | I11 J26 J32 J63 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17703&r=hea |
| By: | Douglas Almond; Bhashkar Mazumder; Reyn van Ewijk |
| Abstract: | We consider the effects of daytime fasting by pregnant women during the lunar month of Ramadan on their children's test scores at age seven. Using English register data, we find that scores are .05 to .08 standard deviations lower for Pakistani and Bangladeshi students exposed to Ramadan in early pregnancy. These estimates are downward biased to the extent that Ramadan is not universally observed. We conclude that the effects of prenatal investments on test scores are comparable to many conventional educational interventions but are likely to be more cost effective and less subject to "fade out". |
| JEL: | I12 I14 I24 J15 |
| Date: | 2011–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:17713&r=hea |