nep-hea New Economics Papers
on Health Economics
Issue of 2012‒01‒25
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Work Hours Constraints and Health By David Bell; Steffen Otterbach; Alfonso Sousa-Poza
  2. The impact of (early) retirement on the subsequent physical and mental health of the retired: a survey among general practitioners in Belgium. By Maes, Marjan; Stammen, Benjamin
  3. Income shocks and HIV in Sub-Saharan Africa: By Burke, Marshall; Gong, Erick; Jones, Kelly
  4. Using panel data to partially identify HIV prevalence when HIV status is not missing at random By Bruno Arpino; Elisabetta De Cao; Franco Peracchi
  5. Do informed citizens receive more...or pay more ? the impact of radio on the government distribution of public health benefits By Keefer, Philip; Khemani, Stuti
  6. Substance use and high school academic performance By Lionel Perini; Joachim Marti
  7. Health systems and HIV treatment in sub-Saharan Africa: Matching intervention and program evaluation strategies By Till Bärnighausen; David E. Bloom; Salal Humair
  8. From Burden to "Best Buys": Reducing the Economic Impact of Non-Communicable Disease in Low- and Middle-Income Countries By David E. Bloom; Dan Chisholm; Eva Jane-Llopis; Klaus Prettner; Adam Stein; Andrea Feigl
  9. Social Protection of Older People By David E. Bloom; Emmanuel Jimenez; Larry Rosenberg
  10. The Effect of Childhood Measles Vaccination on School Enrollment in Matlab, Bangladesh By Julia Driessen; Abdur Razzaque; Damian Walker; David Canning
  11. Declining fertility and economic well-being: do education and health ride to the rescue? By Klaus Prettner; David E. Bloom; Holger Strulik
  12. Strengthening Health Systems: Perspectives for economic evaluation By Till Bärnighausen; David E. Bloom; Salal Humair
  13. Do Traffic Tickets Reduce Motor Vehicle Accidents? Evidence from a Natural Experiment By Dara Lee
  14. Towards effective emerging infectious disease surveillance: H1N1 in the United States 1976 and Mexico 2009 By Ear, Sophal
  15. Towards effective emerging infectious disease surveillance: Cambodia, Indonesia, and NAMRU-2 By Ear, Sophal
  16. The Effect of Pharmaceutical Innovation on the Functional Limitations of Elderly Americans Evidence from the 2004 National Nursing Home Survey By Frank R. Lichtenberg
  17. Demand and Reimbursement Effects of Healthcare Reform: Health Care Utilization and Infant Mortality in Thailand By Jonathan Gruber; Nathaniel Hendren; Robert Townsend
  18. A Mass Phenomenon: The Social Evolution of Obesity By Strulik, Holger
  19. The Value of Failures in Pharmaceutical R&D By Jing-Yuan Chio; Laura Magazzini; Fabio Pammolli
  20. Dissemination of Regenerative Medicine in Japan: Promoting commercialization under the regulatory system By KURATA Kenji; CHOI Youn-Hee
  21. Health Impacts of Power-Exporting Plants in Northern Mexico By Blackman, Allen; Chandru, Santosh; Mendoza-Domínguez, Alberto; Russell, A.G.

  1. By: David Bell; Steffen Otterbach; Alfonso Sousa-Poza
    Abstract: The issue of whether employees who work more hours than they want to suffer adverse health consequences is important not only at the individual level but also for governmental formation of work time policy. Our study investigates this question by analyzing the impact of the discrepancy between actual and desired work hours on self-perceived health outcomes in Germany and the United Kingdom. Based on nationally representative longitudinal data, our results show that work-hour mismatches (i.e., differences between actual and desired hours) have negative effects on workers´ health. In particular, we show that "overemployment" - working more hours than desired - has negative effects on different measures of self-perceived health.
    Keywords: Work time, hours constraints, health, Germany, United Kingdom
    JEL: I10 J21 J22
    Date: 2011
  2. By: Maes, Marjan (Hogeschool-Universiteit Brussel (HUB), Belgium); Stammen, Benjamin
    Abstract: Objectives: to investigate, on the basis of the perceptions of general practitioners (GPs) in Belgium, the impact of (early) retirement on subsequent physical and mental health. Method: A cross-sectional survey on the basis of a self-completed anonymous questionnaire sent at random to 120 GPs in Flanders (Belgium) to which 81 responded. Results: According to GPs, the mere fact of retiring early may be a (very) important cause of mental health problems, in particular depressions (due to the disappearance of social networks) and deterioration of cognitive capacities. GPs claim that most physical health problems that appear after retirement, like obesity and cardiovascular diseases, are due to insufficient adaptation (in terms of food consumption and physical activities) of the retired to a new lifestyle.Conclusion: GPs claim that health problems may frequently arise as a consequence of the retirement event. Since the factors causing these problems point to unhealthy behaviour, there is scope for health improvement: firstly, by stimulating older people to postpone retirement or to continue some professional activities during retirement and secondly, by making them aware of the role of social networks, physical activity and food consumption. At the same time, this would help to control increasing pension and health care expenditures.
    Keywords: cardiovascular disease; obesity; depression; retirement; Belgium; survey
    Date: 2011–03
  3. By: Burke, Marshall; Gong, Erick; Jones, Kelly
    Abstract: Poverty is commonly cited as a key driver of the HIV/AIDS epidemic, yet little causal evidence exists linking economic conditions to actual disease outcomes. Using data on more than 200,000 individuals across 19 Sub-Saharan African countries, we present evidence that negative income shocks can lead to substantial increases in HIV prevalence, particularly for women in rural areas. Building on recent work showing that income shortfalls can induce some women to engage in higher-risk sex, we match data on individuals' HIV status from the Demographic and Health Surveys to data on recent variation in local rainfall, a primary (and exogenous) source of variation in income for rural households in Africa. We find that infection rates for women (men) in HIV-endemic rural areas increase significantly by 14 percent (11 percent) for every drought event experienced in the previous 10 years. Further analysis suggests that women most affected by the shocks (that is, those engaged in agriculture) are driving the women's results; these women are partnering with men least affected (those employed outside agriculture). Our findings suggest a role for formal insurance and social safety nets in tackling the HIV/AIDS epidemic.
    Keywords: HIV/AIDS, Income shocks,
    Date: 2011
  4. By: Bruno Arpino (Department of Decision Sciences and Dondena Centre for Research on Social Dynamics, Bocconi University.); Elisabetta De Cao (Dondena Centre for Research on Social Dynamics, Bocconi University.); Franco Peracchi (Tor Vergata University and EIEF)
    Abstract: Although population-based surveys are now considered the "gold standard" for estimating HIV prevalence, they are usually plagued by problems of nonignorable non- response. This paper uses the partial identification approach to assess the uncertainty caused by missing HIV status due to unit and item nonresponse. We show how to exploit the availability of panel data and the absorbing nature of HIV infection to narrow the worst-case bounds without imposing assumptions on the missing-data mechanism. Applied to longitudinal data from rural Malawi, our approach results in a substantial reduction of the width of the worst-case bounds. We also use plausible instrumental variable and monotone instrumental variable restrictions to further narrow the bounds.
    Date: 2011
  5. By: Keefer, Philip; Khemani, Stuti
    Abstract: The government provision of free or subsidized bed nets to combat malaria in Benin allows the identification of new channels through which mass media affect public policy outcomes. Prior research has concluded that governments provide greater private benefits to better-informed individuals. This paper shows, for the first time, that governments can also respond by exploiting informed individuals'greater willingness to pay for these benefits. Using a"natural experiment"in radio markets in northern Benin, the paper finds that media access increases the likelihood that households pay for the bed nets they receive from government, rather than getting them for free. Households more exposed to radio programming on the benefits of bed nets and the hazards of malaria place a higher value on bed nets. Local government officials exercise significant discretion over bed net pricing and respond to higher demand by selling bed nets that they could have distributed for free. Mass media appears to change the private behavior of citizens -- in this case, to invest more of their own resources on a public health good (bed nets) -- but not their ability to extract greater benefits from government.
    Keywords: Health Monitoring&Evaluation,Population Policies,Knowledge Economy,Education For All,Malaria
    Date: 2012–01–01
  6. By: Lionel Perini; Joachim Marti (Institute of economic research IRENE, Faculty of Economics, University of Neuchâtel, Switzerland; Yale School of Public Health, Division of Health Policy and Administration, New Haven, USA)
    Abstract: The consumption of addictive products, such as tobacco, alcohol or cannabis, is most often experimented during adolescence. Besides the widely documented impact of these behaviors on later consumption patterns and health, it has been shown that they may impair academic performance and therefore the accumulation of human capital. Using data from a Swiss longitudinal survey on a thousand high school students, we investigate the influence of these three substances on intermediate educational outcomes and on school drop-out. Using fixed- and random-effects specifications and focusing on the impact of lagged consumption to avoid two potential sources of bias, we find that regular cannabis consumption has a strong impact on truancy and on the probability of getting poor grades. Occasional alcohol con- sumption has a small but significant impact on school difficulties and on getting poor grades. While we find no evidence that substance use impacts drop-out directly, we show that there is an indirect impact trough intermediate outcomes.
    Keywords: substance use, school dropout, fixed effects, discrete time models.
    JEL: I12 J24
    Date: 2011–12
  7. By: Till Bärnighausen (Harvard School of Public Health); David E. Bloom (Harvard School of Public Health); Salal Humair (Harvard School of Public Health)
    Abstract: Objectives International donors financing the delivery of antiretroviral treatment (ART) in developing countries have recently emphasized their commitment to rigorous evaluation of ART impact on population health. In the same time frame but different contexts, they have announced that they will shift funding from vertically-structured (i.e., disease-specific) interventions to horizontally-structured interventions (i.e., staff, systems and infrastructure that can deliver care for many diseases). We analyze likely effects of the latter shift on the feasibility of impact evaluation. Methods We examine the effect of the shift in intervention strategy on (i) outcome measurement, (ii) cost measurement, (iii) study-design options, and the (iv) technical and (v) political feasibility of program evaluation. Results As intervention structure changes from vertical to horizontal, outcome and cost measurement are likely to become more difficult (because the number of relevant outcomes and costs increases and the sources holding data on these measures become more diverse); study design options become more limited (because it is often impossible to identify a rigorously defined counterfactual in horizontal interventions); the technical feasibility of interventions is reduced (because lag times between intervention and impact increase in length and effect mediating and modifying factors increase in number); and political feasibility of evaluation is decreased (because national policymakers may be reluctant to support the evaluation). Conclusions In the choice of intervention strategy, policymakers need to consider the effect of intervention strategy on impact evaluation. Methodological studies are needed to identify the best approaches to evaluate the population health impact of horizontal interventions.
    Keywords: Impact evaluation, health systems, HIV, antiretroviral treatment, Africa
    Date: 2012–01
  8. By: David E. Bloom (Harvard School of Public Health); Dan Chisholm (World Health Organization); Eva Jane-Llopis (World Economic Forum); Klaus Prettner; Adam Stein; Andrea Feigl
    Abstract: There is growing awareness and concern about the large and escalating burden of chronic, non-communicable diseases (NCDs) not just from the public health perspective but also from the economic one. The social burdens associated with the four diseases that are the focus of the UN High-Level Meeting on NCDs – cardiovascular disease, diabetes, cancer and chronic respiratory diseases – include prolonged disability, diminished resources within families and reduced productivity, in addition to tremendous demands on health systems. This report addresses current information gaps in our understanding of how to mitigate these challenges by highlighting recent findings about the social costs of NCDs and the resource needs for managing these conditions. Specifically, the report brings together findings from two new studies aimed at equipping decision-makers in government, civil society and the private sector with key economic insights needed to help reduce the growing burden of NCDs: A global analysis of the economic impact of NCDs by the World Economic Forum and the Harvard School of Public Health An analysis of the costs of scaling up a core intervention package in low- and middle-income countries by the World Health Organization The economic consequences of NCDs are staggering. Under a “business as usual” scenario where intervention efforts remain static and rates of NCDs continue to increase as populations grow and age, cumulative economic losses to low- and middle-income countries (LMICs) from the four diseases are estimated to surpass US$ 7 trillion over the period 2011-2025 (an average of nearly US$ 500 billion per year). This yearly loss is equivalent to approximately 4% of these countries’ current annual output. On a per-person basis, the annual losses amount to an average of US $25 in low-income countries, US$ 50 in lower middle-income countries and US$ 139 in upper middle-income countries. By contrast, findings from the second study by the WHO indicate that the price tag for scaled-up implementation of a core set of NCD “best buy” intervention strategies is comparatively low. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs – less than US$ 0.40 per person. Individual-based NCD “best buy” interventions – which range from counselling and drug therapy for cardiovascular disease to measures to prevent cervical cancer – bring the total annual cost to US$ 11.4 billion. On a per-person basis, the annual investment ranges from under US$ 1 in low-income countries to US$ 3 in upper middle-income countries. In health terms, the return on this investment will be many millions of avoided premature deaths. In economic terms, the return will be many billions of dollars of additional output. For example, reducing the mortality rate for ischaemic heart disease and stroke by 10% would reduce economic losses in LMICs by an estimated US$ 25 billion per year, which is three times greater than the investment needed for the measures to achieve these benefits. Policy-makers, members of civil society and business leaders all face the issue of how best to respond to the challenges posed by NCDs. This overview of two recent reports supplements existing knowledge by demonstrating not only the economic harm done by NCDs but also the costs and benefits related to addressing them.
    Keywords: non-communicable diseases, low-income countries, middle-income countries
    Date: 2011–10
  9. By: David E. Bloom (Harvard School of Public Health); Emmanuel Jimenez (World Economic Forum); Larry Rosenberg (Harvard School of Public Health)
    Abstract: Social protection is a major arena of government activity aimed at ensuring that vulnerable population groups receive appropriate and effective public support to ensure their financial security and to safeguard their health. However, despite the growth and extent of social protection programs in both developed and developing countries, most emerging economies have nascent systems and only a small portion of all such efforts address the specific vulnerabilities and needs of older people. This paper (a) discusses the vulnerabilities of older people and the benefits of crafting social programs to address them; (b) describes the nature of social protection and the forms it can take to address those vulnerabilities; (c) reports descriptive evidence on the availability and use of social protection programs; and (d) delineates steps that can be taken to remedy the shortfalls experienced by older people.
    Keywords: aging, social protection
    Date: 2011–11
  10. By: Julia Driessen (University of Pittsburgh); Abdur Razzaque (International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh); Damian Walker (Johns Hopkins University); David Canning (Harvard School of Public Health)
    Abstract: There is increasing evidence that early childhood health interventions have long term effects on cognitive development, educational achievement, and adult productivity. We examine the effect of measles vaccination on the school enrollment of children in Matlab, Bangladesh. An intensive measles vaccination program was introduced in two areas of Matlab in 1982, and extended to two more areas in 1985. Using this staggered rollout as an instrument for vaccination, we find that age appropriate vaccination raises the probability that a boy has enrolled in school by 9.5 percentage points but appears to have no effect on girls' enrollment.
    Keywords: health, measles vaccination, school enrollment, Matlab
    Date: 2011–11
  11. By: Klaus Prettner (Harvard Center for Population and Development Studies); David E. Bloom (Harvard School of Public Health); Holger Strulik
    Abstract: It is widely argued that declining fertility slows the pace of economic growth through its negative effect on labor supply. There are, however, theoretical arguments suggesting that the effect of falling fertility on effective labor supply can be offset by the associated behavioral changes. We formalize these arguments by setting forth a dynamic consumer optimization model that incorporates endogenous fertility as well as endogenous educational and health investments. The model shows that a fertility decline induces higher education and health investments that are able to compensate for declining fertility under certain circumstances. We assess the theoretical implications by investigating panel data for 118 countries over the period 1980 to 2005 and show that behavioral changes partly mitigate the negative impact of declining fertility on effective labor supply.
    Keywords: demographic change, effective labor supply, human capital,population health, economic growth
    Date: 2012–01
  12. By: Till Bärnighausen (Harvard School of Public Health); David E. Bloom (Harvard School of Public Health); Salal Humair (Harvard School of Public Health)
    Keywords: economic evaluation, health systems, HIV, antiretroviral treatment, Africa
    Date: 2012–01
  13. By: Dara Lee (Department of Economics, University of Missouri-Columbia)
    Abstract: This paper analyzes the effect of traffic tickets on motor vehicle accidents. OLS estimates may be upward-biased because police officers tend to focus on areas where and periods when there is heavy traffic and thus higher rates of accidents. This paper exploits the dramatic increase in tickets during the Click-it-or-Ticket campaign to identify the causal impact of tickets on accidents using data from Massachusetts. I find that tickets significantly reduce accidents and non-fatal injuries. However, there is limited evidence that tickets lead to fewer fatalities. I provide suggestive evidence that tickets have a larger impact at night and on female drivers.
    Keywords: traffic tickets, motor vehicle accidents, natural experiment
    JEL: K32 K42 I18 R41
    Date: 2011–10–05
  14. By: Ear, Sophal
    Abstract: The comparison of Mexico’s 2009 A/H1N1 outbreak with the U.S. H1N1 outbreak of 1976 provides notable observations—based on the strengths and weaknesses of each country’s response—that can be used as a starting point of discussion for the design of effective Emerging Infectious Diseases (EIDs) surveillance programs in developing and middle-income countries. Strengths Mexico’s strongest characteristics were its transparency, as well as the cooperation the country exhibited with other nations, particularly the U.S. and Canada. These were the result of Mexico’s existing professional relationships with other scientific communities—informal networks, existing without institutional ties, which proved highly beneficial. Mexico also showed savvy in its effective management of public and media relations. By maintaining transparency and a united political front as it disseminated public health information, Mexico was able to mobilize in this area—something the U.S. handled less effectively in 1976. Uneven economic development was a barrier that prevented full dissemination across more rural regions of Mexico, but on a larger scale, public relations were handled relatively well. In the U.S., the speed and efficiency of the 1976 U.S. mobilization against H1N1 was laudable. Although the U.S. response to the outbreak is seldom praised, the unity of the scientific and political communities demonstrated the national ability to respond to the situation. In parallel, Mexico also effectively responded to the situation, but in addition it had a preparedness plan for such a pandemic or bio-safety threat, which highlights the necessity of working out such strategies ahead of time. Mexico’s effective pandemic-preparedness plan was comprehensive, but it was also based on simple issues: logistics, administrative structure, and information. The questions it answered included: Is there a national database on the cases of the virus at hand? Is there a network or panel of specialists that the government can pull to their aid? Who is maintaining this network? Are there designated transportation routes and potential central facilities to hold vaccines? Is there a designated individual who reviews the plan? Weaknesses In the U.S., the major weakness was turning the response to the outbreak into a single go-or-no-go decision instead of splitting the decision into smaller action tasks or phases of implementation from which decisions could then be made. What made this situation more difficult was the unquestioning support of the Center for Disease Control’s (CDC) decision to execute a massive immunization campaign. While then President Ford and CDC Director David Sencer may have acted reasonably considering the circumstances, the move to immunize has since been much criticized, especially owing to the following rise in cases of Guillain-Barré Syndrome and the fact that H1N1 was never identified outside the Fort Dix, New Jersey, army base where it was first detected. In Mexico, despite the country’s overall success in handling A/H1N1, there were myriad political weaknesses that hampered efforts, and these problems persist. Loyalty to political groups is prized above competence. In addition, individuals who are qualified for their position are perennially moved or must leave when there is a change in government, causing the loss of valuable institutional knowledge and relationships. These issues are hardly unique to Mexico, and will be especially important for countries developing EID surveillance tools to address in the coming years. An even greater challenge for Mexico was an inflexible workplace culture that did not encourage workers to report abnormalities in patients and therefore delayed the identification of A/H1N1. Inefficiencies can be eliminated if laboratory employees are given the freedom to question situations and are provided with the hardware and tools for executing their duties. Worker compensation, relatively low for an Organization for Economic Cooperation and Development member country, could be an important factor as well.
    Keywords: Mexico; USA; H1N1; Swine Flu; Political Economy; Emerging Infectious Diseases Surveillance
    JEL: K32 N32 H51 I18 N36
    Date: 2011–10–26
  15. By: Ear, Sophal
    Abstract: Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this report: What infrastructure is necessary to enable EID surveillance in developing countries? What are the cultural, political, and economic challenges that are faced? Are there generalizations that may be made to inform engagement with developing countries and support EID surveillance infrastructure? Using the U.S. Naval Area Medical Research Unit No. 2 (NAMRU-2) as a common denominator, this report compares barriers to EID surveillance in Cambodia and in Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries, poor staff and human resources management and the effect of patronage networks, a culture of donor dependence, contrasting priorities between the government and international donors, and the lack of compensation for animal culling. Cambodian authorities have resisted a compensation scheme thus far, with speculation suggesting that the reason for this is the government’s concern that the possibility for corruption among poultry-holders is too great a risk. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants (including laboratory employees funded by the Global Fund to Fight Aids, Tuberculosis and Malaria) after the military is alleged to have demanded similar pay incentives which donors had no interest in funding. In Indonesia, the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian Authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for culling; and difficulties incentivizing local-level reporting in an era of decentralization. Conflict between external and host actors was given the greatest emphasis, with “viral sovereignty” the primary problem. The Indonesian government perceived unfair treatment when it was asked to pay millions of dollars for a vaccine developed from a sample it originally provided for diagnostic purposes to the U.S. government through NAMRU-2. A poor host-donor relationship is a major barrier in Indonesia, which exhibits greater political and financial autonomy than Cambodia and other less-developed countries. Ultimately these differences are symptomatic of Cambodia’s and Indonesia’s different levels of development and their roles within the international community. This context demonstrates the primary difference in existing barriers to surveillance between the countries. Thus, it is reasonable to hypothesize that other developing countries face similar barriers along a continuum from one extreme (Cambodia, where a genocide resulted in the death of a quarter of the population) to another (Indonesia, where state-of-the-art-labs can be run by Indonesians educated in countries such as France and Australia with some donor funds). Scientists are fully capable of fixing technical problems in surveillance systems, but non-technical barriers have been more difficult to confront. Not surprisingly, the primary challenges impeding surveillance are observed on the human resources side of the equation. When it comes to viral sovereignty, technology transfer has been proposed as a possible solution to enable resource-constrained countries to produce their own vaccines. Yet this is easier said than done; international development has tried for more than six decades to raise living standards with limited success. What is certain is that Indonesia’s human resources are already capable of producing some vaccines given sufficient technology, while Cambodia will require a decade or more to develop such a capability. It is clear that in Cambodia, technology transfer is necessary but not sufficient. Many of the key factors emerging from interviews with in-country practitioners are the direct result of the existing level of development and, as such, are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, greater understanding is a critical first step in mitigating negative outcomes.
    Keywords: Cambodia; Indonesia; Namru-2; Avian Influenza; H5N1; Political Economy
    JEL: K32 N35 H51 I18
    Date: 2011–10–08
  16. By: Frank R. Lichtenberg
    Abstract: I examine the effect of pharmaceutical innovation on the functional status of nursing home residents using cross-sectional, patient-level data from the 2004 National Nursing Home Survey. This was the first public-use survey of nursing homes that contains detailed information about medication use, and it contains better data on functional status than previous surveys. Residents using newer medications and a higher proportion of priority-review medications were more able to perform all five activities of daily living (ADLs), controlling for age, sex, race, marital status, veteran status, where the resident lived prior to admission, primary diagnosis at the time of admission, up to 16 diagnoses at the time of the interview, sources of payment, and facility fixed effects. The ability of nursing home residents to perform activities of daily living is positively related to the number of “new” (post-1990) medications they consume, but unrelated to the number of old medications they consume. If 2004 nursing home residents had used only old medications, the fraction of residents with all five ADL dependencies would have been 58%, instead of 50%. During the period 1990-2004, pharmaceutical innovation reduced the functional limitations of nursing home residents by between 1.2% and 2.1% per year.
    JEL: I12 L65 O33
    Date: 2012–01
  17. By: Jonathan Gruber; Nathaniel Hendren; Robert Townsend
    Abstract: The Thai 30 Baht program was one of the largest health system reforms ever undertaken by a low-middle income country. In addition to lowering the cost of care for the previously uninsured in public facilities, it also entailed a fourfold increase in funding provided to hospitals to care for the poorest 30% of the population (who were already publicly insured). For the previously uninsured, we find that the 30 Baht program led to increased health care utilization, as well as a shift from private to public sources of care. But, we find a larger increase for the poor who were previously publicly insured, especially amongst infants and women of childbearing age. Using vital statistics records, we find that the increased access to healthcare by the publicly insured poor led to a reduction in their infant mortality of at least 6.5 per 1,000 births. This suggests significant improvements in infant mortality rates can be achieved through increased access to healthcare services for the poor and marginalized groups.
    JEL: I0 I1
    Date: 2012–01
  18. By: Strulik, Holger
    Abstract: This paper proposes a theory for the social evolution of obesity. It considers a society, in which individuals experience utility from consumption of food and non-food, the state of their health, and the evaluation of their appearance by others. The theory explains why, ceteris paribus, poor persons are more prone to be severely overweight although eating is expensive and how obesity occurs as a social phenomenon such that body mass continues to rise long after the initial cause (e.g. a lower price of food) is gone. The paper investigates the determinants of a steady-state at which the median citizen is overweight and how an originally lean society arrives at such a steady-state. Extensions of the theory towards dietary choice and the possibility to exercise in order to loose weight demonstrate robustness of the basic mechanism and provide further interesting results.
    Keywords: Obesity Epidemic, Social Dynamics, Social Multiplier, Income Gradient, Feeling Fat, Feeling Unhealthy, Fat Tax
    JEL: D11 I14 Z13
    Date: 2012–01
  19. By: Jing-Yuan Chio (IMT Lucca Institute for Advanced Studies); Laura Magazzini (Department of Economics, University of Verona); Fabio Pammolli (IMT Lucca Institute for Advanced Studies and CERM Foundation; IMT Lucca Institute for Advanced Studies and Department of Managerial Economics, Strategy and Innovation, K.U. Leuven)
    Abstract: We build a cumulative innovation model in which both success and failure provide valuable information for future research. To test this learning mechanism, we use a dataset covering outcomes of world-wide R&D projects in the pharmaceutical industry, and proxy knowledge flows with forward citations received by patents associated with each project. Empirical results confirm theoretical predictions that patents associated with successfully completed projects (i.e., leading to drug launch on the market) receive more citations than those associated to failed (terminated) projects, which in turn are cited more often than patents lacking clinical or preclinical information. We therefore offer evidence of the value of failures as research inputs in (pharmaceutical) innovation
    Keywords: R&D competition, patent policy, pharmaceutical industry
    JEL: D23 D83 O3
    Date: 2011–12
  20. By: KURATA Kenji; CHOI Youn-Hee
    Abstract: Though Japan has surpassed South Korea in terms of research and development (R&D) in the area of regenerative medicine, South Korea has been more successful at commercialization. This paper focuses on the setup and operation of actual systems that consider the promotion of regenerative medicine in Japan. Analysis of the regulatory systems in Japan and South Korea shows a clear difference between the two countries, although their systems are basically the same. There are two pathways for applying unapproved drugs in clinical research, including regenerative medicine, to human subjects in Japan, whereas there is only one pathway in South Korea, where the Korea Food and Drug Administration (KFDA) is the only authority through which approval can be obtained. Japan has an additional pathway besides approval through the Pharmaceuticals and Medical Devices Agency (PMDA), if the clinical research is conducted within the framework of the Medical Practitioners Law.
    Date: 2012–01
  21. By: Blackman, Allen (Resources for the Future); Chandru, Santosh; Mendoza-Domínguez, Alberto; Russell, A.G.
    Abstract: In the past two decades, rapid population and economic growth on the U.S.–Mexico border has spurred a dramatic increase in electricity demand. In response, American energy multinationals have built power plants just south of the border that export most of their electricity to the United States. This development has stirred considerable controversy because these plants effectively skirt U.S. environmental air pollution regulations in a severely degraded international airshed. Yet to our knowledge, this concern has not been subjected to rigorous scrutiny. This paper uses a suite of air dispersion, health impacts, and valuation models to assess the human health damages in the United States and Mexico caused by air emissions from two power-exporting plants in Mexicali, Baja California. We find that these emissions have limited but nontrivial health impacts, mostly by exacerbating particulate pollution in the United States, and we value these damages at more than half a million dollars per year. These findings demonstrate that power-exporting plants can have cross-border health effects and bolster the case for systematically evaluating their environmental impacts.
    Keywords: electricity, air pollution, Mexico
    JEL: Q48 Q51 Q53
    Date: 2012–01–09

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