nep-hea New Economics Papers
on Health Economics
Issue of 2012‒03‒21
39 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Does Job Loss Make You Smoke and Gain Weight? By Jan Marcus
  2. The public economics of increasing longevity By Pierre Pestieau; Grégory Ponthière
  3. Inequities in Noncommunicable Diseases By Ulep, Valerie Gilbert T.; Ortiz, Danica Aisa P.; Go, John Juliard; Aldeon, Melanie; Duante, Charmaine; Gonzales, Rosa C.; Mendoza, Laurita R.; Reyes, Clarissa; Elgo, Frances Rose
  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. The impact of the institutional form on the cost efficiency of nursing homes By Laura Di Giorgio; Massimo Filippini; Giuliano Masiero
  6. Inequalities in life expectancy By Alfonso Rosolia
  7. Public-Private Co-operation for Gas Provision in Poor Neighbourhoods of Buenos Aires: Impact on Housing Improvements and Health By Cynthia Goytia; Ricardo Pasquini; Pablo Sanguinetti
  8. Measuring the child mortality impact of official aid for fighting infectious diseases, 2000-2010 By Roberto Burguet; Marcelo Soto
  9. Ethical and Economic Perspectives on Global Health Interventions By Bhalotra, Sonia R.; Pogge, Thomas
  10. Health Behavior and Accident Risk: Obesity Is Associated with the Future Risk of Heavy Truck Crashes among Newly Recruited Commercial Drivers By Anderson, Jon; Govada, Manjari; Steffen, Tricia K.; Thorne, Chris P.; Varvarigou, Vasileia; Kales, Stefanos N.; Burks, Stephen V.
  11. Cross-Border Health and Productivity Effects of Alcohol Policies By Johansson, Per; Pekkarinen, Tuomas; Verho, Jouko
  12. Health Care Financing Reforms in India. By M. Govinda Rao; Choudhury, Mita
  13. A Life Cycle Model of Health and Retirement: The Case of Swedish Pension Reform By Laun, Tobias; Wallenius, Johanna
  14. Thank you for not smoking: evidence from the Italian smoking ban By Paolo Buonanno; Marco Ranzani
  15. Patient Preferences and Treatment Thresholds under Diagnostic Risk – An Economic Laboratory Experiment By Miriam Krieger; Thomas Mayrhofer
  16. Fall Risk Increasing Drugs: The Effect on Injuries of the Frail Elderly Estimated from Administrative Data By Thomas K. Bauer; Katharina Lindenbaum; Magdalena Stroka; Susanne Ahrens; Frank Verheyen
  17. Impact of hospital provider payment reforms in Croatia By Bogut, Martina; Voncina, Luka; Yeh, Ethan
  18. Sexual behavior change intentions and actions in the context of a randomized trial of a conditional cash transfer for HIV prevention in Tanzania By Packel, Laura; Dow, William H.; de Walque, Damien; Isdahl, Zachary; Majura, Albert
  19. Employed and Happy despite Weak Health? Labour Market Participation and Job Quality of Older Workers with Disabilities By Catherine Pollak
  20. Discounting Health and Cost-Effectiveness Analysis : a response to Nord. By Hammitt, James K.
  21. Valuing Mortality-Risk Reductions: Progress and Challenges. By Cropper, Maureen; Hammitt, James K.; Robinson, Lisa A.
  22. The Income Elasticity of the Value per Statistical Life: Transferring Estimates Between High and Low Income Populations. By Hammitt, James K.; Robinson, Lisa A.
  23. Education, Cognition, Health Knowledge, and Health Behavior By Naci Mocan; Duha T. Altindag
  24. Understanding the vertical equity judgements underpinning health inequality measures By Paul Allanson; Dennis Petrie
  25. A Short Note on Economic Development and Socioeconomic Inequality in Female Body Weight By Deuchert, Eva; Cabus, Sofie J.; Tafreschi, Darjusch
  26. Understanding the Impact of the Economic Crisis on Child and Maternal Health among the Poor : Opportunities for South Asia By Azra Abdul Cader; Lakwimashi Perera
  27. Global burden of disease and economic growth By Alassane DRABO; Pascale COMBES MOTEL; Martine AUDIBERT
  28. Taxes, Cigarette Consumption, and Smoking Intensity: Reply By Jerome Adda; Francesca Cornaglia
  29. Health Selection and the Effect of Smoking on Mortality By Jerome Adda; Valerie Lechene
  30. Earnings Growth versus Measures of Income and Education for Predicting Mortality By Harriet Orcutt Duleep; David Jaeger
  31. Modelling Individual Patient Hospital Expenditure for General Practice Budgets By Hugh Gravelle; Mark Dusheiko; Steve Martin; Pete Smith; Nigel Rice; Jennifer Dixon
  32. Truly inefficient or providing better quality of care? Analysing the relationship between riskadjusted hospital costs and patients’ health outcomes By Nils Gutacker; Chris Bojke; Silvio Daidone; Nancy Devlin; David Parkin; Andrew Street
  33. Uncertainty, evidence and irrecoverable costs: Informing approval, pricing and research decisions for health technologies By Karl Claxton; Stephen Palmer; Louise Longworth; Laura Bojke; Susan Griffin; Claire McKenna; Marta Soares; Eldon Spackman; Jihee Youn
  34. Analysing Hospital Variation in Health Outcome at the Level of EQ-5D Dimensions By Nils Gutacker; Chris Bojke; Silvio Daidone; Nancy Devlin; Andrew Street
  35. Twenty Years of Using Economic Evaluations for Reimbursement Decisions. What Have We Achieved? By Michael Drummond
  36. Effectiveness of foreign aid in the light of millennium development goal on the health sector: a case study of Pakistan By Anwar, Mumtaz; Rashid, Muhammad Khalid
  37. Determinants of health costs due to farmers’ exposure to pesticides: an empirical analysis By Wasantha Athukorala; Clevo Wilson; Tim Robinson
  38. Why Do Life Insurance Policyholders Lapse? The Roles of Income, Health and Bequest Motive Shocks By Hanming Fang; Edward Kung
  39. Instrumental Variable Estimation of the Causal Effect of Hunger Early in Life on Health Later in Life By Berg, Gerard J. van den; Pinger, Pia; Schoch, Johannes

  1. By: Jan Marcus
    Abstract: This paper estimates the effect of involuntary job loss on smoking behavior and body weight using German Socio-Economic Panel Study data. Baseline nonsmokers are more likely to start smoking due to job loss, while smokers do not intensify their smoking. Job loss increases body weight slightly, but significantly. In particular, single individuals as well as those with lower health or socioeconomic status prior to job loss exhibit high rates of smoking initiation. The applied regression-adjusted semiparametric difference-in-difference matching strategy is robust against selection on observables and time-invariant unobservables. This paper provides an indirect test showing that the identifying assumption is not violated in the difference-in-difference estimator. The findings are robust over various matching specifications and different choices of the conditioning variables.
    Keywords: Job loss, smoking, body weight, health behavior, difference-in-difference, propensity score matching
    JEL: I12 J65
    Date: 2012
  2. By: Pierre Pestieau (CREPP - Center of Research in Public Economics and Population Economics - Université de Liège, PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, CORE - Center of Operation Research and Econometrics [Louvain] - Université Catholique de Louvain, CEPR - Center for Economic Policy Research - CEPR); Grégory Ponthière (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: One of the greatest success stories in our societies is that people are living longer, life expectancy at birth being now above 80 years. Whereas the lengthening of life opens huge opportunities for individuals if extra years are spent in prosperity and good health, it is however often regarded as a source of problems for policy-makers. The goal of this paper is to examine the key policy challenges raised by increasing longevity. For that purpose, we first pay attention to the representation of individual preferences, and to the normative foundations of the economy, and, then, we consider the challenges raised for the design of the social security system, pension policies, preventive health policies, the provision of long term care, as well as for long-run economic growth.
    Keywords: Life Expectancy ; Mortality ; Public Policy
    Date: 2012–03
  3. By: Ulep, Valerie Gilbert T.; Ortiz, Danica Aisa P.; Go, John Juliard; Aldeon, Melanie; Duante, Charmaine; Gonzales, Rosa C.; Mendoza, Laurita R.; Reyes, Clarissa; Elgo, Frances Rose
    Abstract: <p>This report presents the findings of the research conducted by the Philippine Institute for Development Studies (PIDS) on leading noncommunicable diseases (NCDs). With the collaborative efforts of the World Health Organization (WHO) and Food and Nutrition Research Institute (FNRI), this research project was conducted to supplement the Department of Health`s (DOH) initiative in crafting a national strategy in the prevention and control of noncommunicable diseases.</p><p>This study presents evidences on mortality, morbidity, some social determinants, and inequities. Different secondary data sets like the National Nutrition Survey, National Demographic and Health Survey, Death Registry from the National Statistics Office, Family Income and Expenditure Survey and other information obtained from other studies were analyzed to come up with a unified and comprehensive study that depicts the true picture of NCDs epidemic in the country.</p>
    Keywords: Philippines, noncommunicable diseases, cardiovascular diseases, cancer, diabetes mellitus, risk factors, social determinants, inequity
    Date: 2012
  4. By: Bruno Arpino; Elisabetta De Cao; Franco Peracchi
    Abstract: Good estimates of HIV prevalence are important for policy makers in order to plan control programs and interventions. Although population-based surveys are now considered the "gold standard" to monitor the HIV epidemic, they are usually plagued by problems of nonignorable nonresponse. This paper uses the partial identification approach to assess the uncertainty caused by missing HIV status. 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, the Malawi Diffusion and Ideational Change Project (MDICP), our approach results in a reduction of the width of the worst-case bounds by about 18.2 percentage points in 2004, 13.2 percentage points in 2006, and 2.4 percentage points in 2008. We also use plausible instrumental variable and monotone instrumental variable restrictions to further narrow the bounds.
    Keywords: partial identification; nonignorable nonresponse; panel data; HIV prevalence; Malawi Diffusion and Ideational change Project data
    Date: 2011–08
  5. By: Laura Di Giorgio (Department of Economics, University of Lugano); Massimo Filippini (Department of Economics, University of Lugano; ETH, Zurich, Switzerland); Giuliano Masiero (Department of Economics and Technology Management, University of Bergamo, Italy; Department of Econonomics, University of Lugano, Switzerland)
    Abstract: In Switzerland, nursing home services are mainly provided by regulated public and private nonprofit organizations. Some of them are created by local governments as foundations. This provides a unique setting to analyze the impact of the institutional form on the performance of nursing homes. We propose a model where the institutional form is represented as a legal constraint which affects managers in the decison-making process. Considering a sample of 44 Swiss Italian nursing homes over a 7-years period (1999-2005), we then disentangle persistent inefficiency due to differences in the institutional form from unobserved heterogeneity. The applied estimation strategy provides more accurate estimates of the impact of the institutional form on nursing homes efficiency, as compared to previous studies. Our results suggest that governmental nursing homes are more costly than private and public foundations. These results are consistent across different model specifications.
    Keywords: constant inefficiency, unobserved heterogeneity, nursing homes, nonprofit, institutional form
    JEL: C23 I18 L20
    Date: 2012–03
  6. By: Alfonso Rosolia (Banca d'Italia)
    Abstract: Broad differences in life expectancy are observed across countries and socio-demographic groups. This paper reviews the evidence for Italy on the level and development of these inequalities and discusses the strength and possible determinants of the relationship between life expectancy and education.
    Keywords: llife expectancy, causes of death, education
    JEL: I0 I14 J1
    Date: 2012–02
  7. By: Cynthia Goytia; Ricardo Pasquini; Pablo Sanguinetti
    Abstract: This study examines the programme Redes Solidarias, a public-private initiative that connected to natural pipelined gas 4,000 households in the Great Buenos Aires Area during 2005. The main features of the institutional framework are described and the main results of an impact estimation analysis are reported. The mechanism of selection of neighbourhoods for the connection represents a ‘natural experiment’, which allows the estimation of the causal effects of the programme on several indicators, including housing improvements, health and happiness related variables. We perform this analysis using data from two surveys we collected on the neighbourhoods in 2006 and 2007. The programme was found to generate improvements on dwelling walls, and the …
    Keywords: infrastructure provision, gas, impact evaluation
    Date: 2011
  8. By: Roberto Burguet; Marcelo Soto
    Abstract: Aid for fighting infectious and parasitic diseases have had a statistically significant role in the under-five mortality reduction in the last decade. Point estimates indicate a country average reduction of 1.4 deaths per thousand under fives live-born attributable to aid at its average level in 2000-2010. The effect would be an average drop of 3.3 in the under-five mortality rate at the aid levels of 2010. By components, a dollar per capita spent in fighting malaria has caused the largest average impact, statistically higher than a dollar per capita spent in STD/HIV control. We do not find statistically significant effects of other infectious disease aid, including aid for the control of tuberculosis.
    Date: 2012–03–05
  9. By: Bhalotra, Sonia R. (University of Bristol); Pogge, Thomas (Yale University)
    Abstract: Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries.
    Keywords: disease-poverty trap, infant mortality, mother-child transmission of health, globalization, patents, justice, Health Impact Fund
    JEL: I2 I18 J18
    Date: 2012–03
  10. By: Anderson, Jon (University of Minnesota, Morris); Govada, Manjari (University of Minnesota, Morris); Steffen, Tricia K. (University of Minnesota, Morris); Thorne, Chris P. (University of Minnesota, Morris); Varvarigou, Vasileia (Harvard School of Public Health); Kales, Stefanos N. (Harvard School of Public Health); Burks, Stephen V. (University of Minnesota, Morris)
    Abstract: This study estimates the dose-response relationship between Body Mass Index (BMI) and crash risk in commercial motor vehicle operators. Intake data was collected on 744 new truck drivers who were training for their commercial driver's licenses at a school operated by the cooperating trucking firm during the first two-week phase of instruction. Drivers were then followed prospectively on the job using the firm's operational data for two years, or until employment separation, whichever came first. Multivariate Poisson regression and Cox proportional hazards models were used to estimate the relationship between crash risk and BMI, controlling for exposure using miles driven, trip segments, and job type. Results from the Poisson regression indicated that the risk ratio (RR) for all crashes was significantly higher for drivers in the obesity Class II and Class III categories: RR= 1.6, confidence interval 1.2-2.1 and RR= 1.49, confidence interval 1.12-1.99, respectively. Similarly, the multivariate Cox Proportional Hazard model results showed that crash risk was significantly higher for obesity class II (BMI 35 to <40; relative risk (RR) = 1.47, P = 0.02) with weaker evidence of increased crash risk for obesity class III (BMI >40; RR = 1.35, P =0.06) when compared to normal BMI (BMI 18.5 to <25). The results of this prospective study establish an association between obesity and crash risk show that driver health behavior has important spillovers for public safety.
    Keywords: body mass index, obesity, traffic accidents, commercial motor vehicle, heavy truck, Poisson regression, Cox proportional hazard, truckload, health behavior
    JEL: I12 J49 R41
    Date: 2012–03
  11. By: Johansson, Per (IFAU); Pekkarinen, Tuomas (Aalto University); Verho, Jouko (Social Insurance Institution of Finland)
    Abstract: This paper studies the cross-border health and productivity effects of alcohol taxes. We estimate the effect of a large cut in the Finnish alcohol tax on mortality, alcohol related illnesses and work absenteeism in Sweden. This tax cut led to large differences in the prices of alcoholic beverages between these two countries and to a considerable increase in cross-border shopping. The effect is identified using differences-in-differences strategy where changes in these outcomes in regions near the Finnish border are compared to changes in other parts of northern Sweden. We use register data where micro level data on deaths, hospitalisations and absenteeism is merged to population-wide micro data on demographics and labour market outcomes. Our results on the effect of the Finnish tax cut on mortality and alcohol-related hospitalisations in Sweden are very imprecise. However, we find that workplace absenteeism increased by 5% for males and by 13% for females near the Finnish border as a result of the tax cut.
    Keywords: cross-border shopping, alcohol taxes, health effects of alcohol
    JEL: H23 H73 I18
    Date: 2012–02
  12. By: M. Govinda Rao (National Institute of Public Finance and Policy); Choudhury, Mita (National Institute of Public Finance and Policy)
    Date: 2012–03
  13. By: Laun, Tobias (Dept. of Economics, Stockholm School of Economics); Wallenius, Johanna (Dept. of Economics, Stockholm School of Economics)
    Abstract: In this paper we develop a life cycle model of labor supply and retirement to study the interactions between health and the labor supply behavior of older workers, in particular disability insurance and pension claiming. In our framework, individuals choose when to stop working and, given eligibility criteria, when/if to apply for disability and pension benefits. Individuals care about their health and can partially insure against health shocks by investing in health. We use the model to study the labor supply implications of the recent Swedish pension reform. We find that the new pension system creates big incentives for the continued employment of older workers. In particular, the model predicts an increase in the average retirement age of more than two years.
    Keywords: life cycle; retirement; pension reform; disability insurance; health
    JEL: E24 J22 J26
    Date: 2012–03–06
  14. By: Paolo Buonanno; Marco Ranzani
    Abstract: By 2030, tobacco is expected to be the cause of about 10 million deaths per year worldwide. In Italy tobacco smoking is still a pervasive and relevant phenomenon. Using data from a national health survey, we investigate how individuals react to the introduction of a public smoking ban in Italy. Our estimates suggest that the Italian smoking ban in private places open to the public reduced smoking prevalence by 1.3% and daily cigarettes consumption by 8%. We find heterogeneous effects by gender, marital status, and region of residence.
    Keywords: smoking, public smoking ban, quasi-natural experiment, individual behaviour
    JEL: I18 K32
    Date: 2012
  15. By: Miriam Krieger; Thomas Mayrhofer
    Abstract: We study risk aversion and prudence in medical treatment decisions. In a laboratory experiment, we investigate the frequency and intensity of second- and third-order risk preferences, as well as the effect of the medical decision context. Risk preferences are assessed through treatment thresholds (the indifference point between not treating and treating). Under diagnostic risk, medical decision theory predicts lower thresholds for risk-averse than risk-neutral decision makers. Given a comorbidity risk, prudent individuals have an even lower threshold. Our results demonstrate risk-averse and prudent behavior in medical decisions, which reduce the (average) treatment threshold by 41% relative to risk neutrality (from 50.0% to 29.3% prevalence rate). Risk aversion accounts for 3/4 of this effect, prudence for 1/4. The medical decision framing does not affect risk aversion, but is associated with more and stronger prudent behavior. These findings have consequences for treatment thresholds, diagnostics, and QALYs, and thus for clinical guidelines.
    Keywords: Medical decision making; treatment thresholds; risk aversion; prudence; laboratory experiment
    JEL: I10 C91 D81
    Date: 2012–03
  16. By: Thomas K. Bauer; Katharina Lindenbaum; Magdalena Stroka; Susanne Ahrens; Frank Verheyen
    Abstract: Society benefits on a large scale from improved medical care and pharmaceuticals. The prescription of pharmaceuticals, however, also carries risks such as the possibility of an increased risk of falls, which may lead to severe injuries and increased health expenditures associated with these injuries. This study investigates the influence of several fall risk increasing drugs (FRIDs) on the number of injuries of elderly persons using multivariate regression models. Routine data from the Techniker Krankenkasse (TK) of frail elderly persons aged? 65 years is analyzed for the year 2009 by estimating count data models, in order to take the data generating process of the number of injuries into account. The results of the count data model are compared to those from logistic regressions, which is the default regression model in this field of research. The empirical results suggest that antidepressants, anxiolytics, hypnotics and sedatives, antiarrhythmics, and drugs from the Priscus-list have a significant positive effect on the number of injuries, while anti-hypertensives and anti-parkinsonian agents show no and neuroleptics a significant negative effect. As recurrent injuries are common, the analysis of the number of injuries rather than just the probability of having an injury provides a more informative analysis of FRIDs.
    Keywords: Fall risk increasing drugs; Priscus-List; frail elderly; multivariate regression; count data models
    JEL: I12 I19
    Date: 2011–12
  17. By: Bogut, Martina; Voncina, Luka; Yeh, Ethan
    Abstract: Croatia began to implement case-based provider payment reforms in hospitals beginning in 2002, starting with broad-based categories according to therapeutic procedures. In 2009, formal diagnostic related groups were introduced, known locally as dijagnosticko terapijske skupine. This study examines the efficiency and quality impacts of these provider payment reforms globally on the Croatian health system by analyzing data on five procedures in acute health care for 10 years, between January 2000 and December 2009. The five procedures are cataracts, pneumonia, coronary bypass, appendectomy, and hip replacement. Using data from the Croatian Institute for Health Insurance, this study finds that both broad-based and detailed case-based payment systems have improved efficiency as measured by a reduction in average length of stay, with little impact on the number of cases. These provider payment reforms have had no adverse impact on quality as measured by readmissions. While it is still too early to quantify the impact of Croatia's introduction of formal diagnostic related groups, it appears that the introduction of both broad and detailed case-based payment systems has improved efficiency in acute hospital care.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Disease Control&Prevention,Health Law,Health Economics&Finance
    Date: 2012–03–01
  18. By: Packel, Laura; Dow, William H.; de Walque, Damien; Isdahl, Zachary; Majura, Albert
    Abstract: Information, education, communication and interventions based on behavioral-change communication have had success in increasing the awareness of HIV. But these strategies alone have been less successful in changing risky sexual behavior. This paper addresses this issue by exploring the link between action and the intention to change behaviors. In Africa, uncertainty in the lives of those at risk for HIV may affect how intentions are formed. Characterize this uncertainty by understanding the reasons for discrepancies between intentions and actions may help improve the design of HIV-prevention interventions. Based on an incentives-based HIV prevention trial in Tanzania, the longitudinal dataset in this paper allows the exploration of intended strategies for changing sexual behaviors and their results. The authors find that gender, intervention groups and new positive diagnoses of sexually transmitted infections can significantly predict the link between intent and action. The paper examines potential mediators of these relationships.
    Keywords: Population Policies,HIV AIDS,Adolescent Health,Health Monitoring&Evaluation,Gender and Health
    Date: 2012–03–01
  19. By: Catherine Pollak (IRDES institut for research and information in health economics)
    Abstract: European countries with high senior employment rates have the highest levels of job satisfaction despite an older and more physically limited workforce. In this paper, we argue that this paradox can be explained by heterogeneous levels of job quality: better working conditions may enable older workers with disabilities to remain satisfied and employed. Using panel data from the Survey of Health, Ageing and Retirement in Europe, we find that health status, job satisfaction, but also working conditions, are major individual determinants of early labour market exits. We also show that high intrinsic and extrinsic rewards can mitigate the selective effects of disability. Finally,the comparative analysis reveals that older workers with disabilities are more likely to be employed in countries where they receive higher rewards. The findings therefore indicate that improved job quality is a major factor of successful active ageing strategies.
    Keywords: Job satisfaction, Working conditions, Occupational health, Ageing labour supply.
    JEL: J28 J22 I19
    Date: 2012–03
  20. By: Hammitt, James K.
    Date: 2011–08
  21. By: Cropper, Maureen; Hammitt, James K.; Robinson, Lisa A.
    Abstract: The value of mortality risk reduction is an important component of the benefits of environmental policies. In recent years, the number, scope, and quality of valuation studies have increased dramatically. Revealed-preference studies of wage compensation for occupational risks, on which analysts have primarily relied, have benefited from improved data and statistical methods. Stated-preference research has improved methodologically and expanded dramatically. Studies are now available for several health conditions associated with environmental causes, and researchers have explored many issues concerning the validity of the estimates.With the growing numbers of both types of studies, several meta-analyses have become available that provide insight into the results of both methods. Challenges remain, including better understanding of the persistently smaller estimates from statedpreference than from wage-differential studies and of how valuation depends on the individual’s age, health status, and characteristics of the illnesses most frequently associated with environmental causes.
    Date: 2011–06
  22. By: Hammitt, James K.; Robinson, Lisa A.
    Date: 2011
  23. By: Naci Mocan; Duha T. Altindag
    Abstract: Using data from NLSY97 we analyze the impact of education on health behavior. Controlling for health knowledge does not influence the impact of education on health behavior, supporting the productive efficiency hypothesis. Although cognition, as measured by test scores, appears to have an effect on the relationship between education and health behavior, this effect disappears once the models control for family fixed effects. Similarly, the impact of education on health behavior is the same between those with and without a learning disability, suggesting that cognition is not likely to be a significant factor in explaining the impact of education on health behavior.
    Date: 2012–02
  24. By: Paul Allanson; Dennis Petrie
    Abstract: The choice of income-related health inequality measures in comparative studies is often determined by custom and analytical concerns, without much explicit consideration of the vertical equity judgements underlying alternative measures. This note employs an inequality map to illustrate how it these judgements that affect the ranking of populations by health inequality. In particular, it is shown that relative indices of inequality in health attainments and shortfalls embody distinct vertical equity judgments, where each may represent ethically defensible positions in specific contexts. Further research is needed to explore people’s preferences over distributions of income and health.
    Keywords: health inequality; vertical equity judgements; inequality equivalence criteria; inequality maps
    JEL: D39 D63 I14
    Date: 2012–03
  25. By: Deuchert, Eva; Cabus, Sofie J.; Tafreschi, Darjusch
    Abstract: The origin of the obesity epidemic in developing countries is still poorly understood. It has been prominently argued that economic development provides a natural interpretation of the growth in obesity. This paper tests the main aggregated predictions of the theoretical framework to analyze obesity: Average female body weight is associated with economic development. In relatively poor countries, obesity is a phenomenon of the socioeconomic elite. With economic development, obesity shifts towards individuals with lower socioeconomic status.
    Keywords: Obesity, socioeconomic inequality, economic development
    JEL: I1
    Date: 2012–02
  26. By: Azra Abdul Cader (Asian Development Bank Institute (ADBI)); Lakwimashi Perera
    Abstract: The economic crisis hit many countries in 2007 and the effects are still being felt, especially in poorer developing nations. Much of the debate surrounding the economic crisis and its impacts has focused on the financial and economic aspects—import/export impacts, economic growth losses, labor force cutbacks, and fiscal imbalances. The social impact, especially on poor and vulnerable groups, has received less mention. Yet, if countries are to address the overall impacts of the economic crisis, it is vital that they also consider investing time and money to deal with social impacts more effectively. There are fears, however, that a reduction in spending on vital sectors (including the healthcare sector) to ensure economic recovery could affect poor and vulnerable populations and, in turn, erase the progress that has been made thus far. The decision to reduce such spending could also come from donors, who tend to favor a market-led recovery process in economic crises, thereby neglecting vital social service sectors that cater to the needs of poor populations. This spending can supplement government services or fill resource gaps and as a result reductions could have negative impacts on beneficiary populations, particularly the poor and vulnerable. Addressing child and maternal health issues within the context of the economic crisis is one key area to consider given its short, medium, and long-term effects on populations in developing countries. In South Asian countries, child and maternal health-related indicators tend to be disturbing despite the rapid growth rates in many of these countries. The number of infant deaths is still quite high, nutrition of children and women continues to be problematic, and maternal health and pre/post natal care remains poor. This paper presents an overview of child and maternal health in the South Asia region, but also recommends that interventions take into account a series of factors if the impacts of the economic crisis are to be minimized : There is a need for more information and research on the impacts of the crisis; Investing in social protection and safety nets is imperative; Food security should be integrated into social protection; Vulnerable households require support to cope with the crisis despite their own efforts and coping strategies; State investments that support vulnerable populations should be protected in times of crisis.
    Keywords: economic crisis, impact assessment, Child and maternal health, the poor, South Asia
    JEL: I10 Y20
    Date: 2011–07
  27. By: Alassane DRABO; Pascale COMBES MOTEL (Centre d'Etudes et de Recherches sur le Développement International); Martine AUDIBERT (Centre d'Etudes et de Recherches sur le Développement International)
    Abstract: Relationships between health and economic prosperity or economic growth are difficult to assess. The direction of the causality is often questioned and the subject of a vigorous debate. For some authors, diseases or poor health had contributed to poor growth performances especially in low-income countries. For other authors, the effect of health on growth is relatively small, even if one considers that human capital accumulation needs also health investments. It is argued in this paper that commonly used health indicators in macroeconomic studies (e. g. life expectancy, infant mortality or prevalence rates for specific diseases such as malaria or HIV/AIDS) imperfectly represent the global health status of population. Health is rather a complex notion and includes several dimensions which concern fatal (deaths) and non-fatal issues (prevalence and severity of cases) of illness. The reported effects of health on economic growth vary accordingly with health indicators and countries included in existing analyses. The purpose of the paper is to assess the effect of health on growth, by using a global health indicator, the so-called disability-adjusted life year (DALY) that was proposed by the World Bank and the WHO in 1993. Growth convergence equations are run on 159 countries over the 1999-2004's period, where the potential endogeneity of the health indicator is dealt for. The negative effect of poor health on economic growth is not rejected thus reinforcing the importance of achieving MDGs.
    Keywords: Disease Global Burden, DALYs, economic growth, macroeconomic health impact, cross-country analysis
    JEL: O47 I18 I19 E24 E22
    Date: 2012
  28. By: Jerome Adda; Francesca Cornaglia
    Abstract: This paper shows that smoking intensity, i.e. the amount of nicotine extracted per cigarette smoked, responds to changes in excise taxes and tobacco prices. We exploit data covering the period 1988 to 2006 across many US states. Moreover, we provide new evidence on the importance of cotinine measures in explaining long-run smoking behavior and we investigate the sensitivity of smoking cessation to changes in excise taxes and their interaction with smoking intensity.
    Keywords: tobacco, public health, compensatory behavior, excise taxes
    JEL: D12 H25 I12
    Date: 2011
  29. By: Jerome Adda; Valerie Lechene
    Abstract: We show that individuals who are in poorer health, independently from smoking, are more likely to start smoking and to smoke more cigarettes than those with better non-smoking health. We present evidence of selection, relying on extensive data on morbidity and mortality. We show that health based selection into smoking has in- creased over the last fifty years with knowledge of its health effects. We show that the effect of smoking on mortality is higher for high educated individuals and for individuals in good non-smoking health.
    Date: 2012
  30. By: Harriet Orcutt Duleep (Research Professor of Public Policy, Thomas Jefferson Program in Public Policy, The College of William & Mary); David Jaeger (Professor of Economics, The Graduate Center, City University of New York)
    Abstract: This paper begins an exploration to determine whether earnings growth, as a measure of the propensity to invest in human capital, is a valuable variable for predicting mortality. To insure its robustness and general applicability to ongoing Social Security models, the usefulness of earnings growth as a predictor of mortality will be explored in multiple time periods. This paper begins that process by reporting preliminary results for an early time period using the 1973 CPS-SSA-IRS Exact Match file. In addition to presenting preliminary results, the paper also describes how data challenges associated with the pre-1978 administrative record data on earnings and mortality are met.
    Date: 2011–09
  31. By: Hugh Gravelle (Centre for Health Economics, University of York, UK); Mark Dusheiko (Centre for Health Economics, University of York, UK); Steve Martin (Department of Economics and Related Studies, University of York); Pete Smith (Imperial College, University of London); Nigel Rice (Centre for Health Economics, University of York, UK); Jennifer Dixon (Nuffield Trust, London)
    Abstract: The English NHS has introduced a system of budgets for general practices covering hospital expenditure for the patients on their lists. We model individual expenditure using diagnostic information from previous hospital spells, plus a large set of attributed variables measuring population, general practice, and local hospital characteristics. We show that, despite the large proportion of zero expenditures and the heavy right tail of expenditures, estimating models of untransformed expenditure via OLS yields better predictions at practice level than one or two part models using OLS with transformed expenditure or Generalised Linear Models. We describe a procedure for setting budgets for general practices which reduces the problem of the lags in the available data. We examine the distinction between need and nonneed variables and the incentive implications of allowing past numbers of hospital encounters to determine practice budgets.
    Date: 2011–12
  32. By: Nils Gutacker (Centre for Health Economics, University of York, UK); Chris Bojke (Centre for Health Economics, University of York, UK); Silvio Daidone (Centre for Health Economics, University of York, UK); Nancy Devlin (Office for Health Economics, London, UK); David Parkin (NHS South East Cost, Horley, UK); Andrew Street (Centre for Health Economics, University of York, UK)
    Abstract: Accounting for variation in the quality of care is a major challenge for the assessment of hospital cost performance. Because data on patients’ health improvement are generally not available, existing studies have resorted to inherently incomplete outcome measures such as mortality or re-admission rates. This opens up the possibility that providers of high quality care are falsely deemed inefficient and vice versa. This study makes use of a novel dataset of routinely collected patient-reported outcomes measures (PROMs) to i) assess the degree to which cost variation is associated with variation in patients’ health gain and ii) explore how far judgement about hospital cost performance changes when health outcomes are accounted for. We use multilevel modelling to address the clustering of patients in providers and isolate unexplained cost variation. Our results provide some evidence of a U-shaped relationship between risk-adjusted costs and outcomes for hip replacement surgery. For the other three investigated procedures, the estimated relationship is sensitive to the choice of PROM instrument. We do not observe substantial changes in estimates of cost performance when outcomes are explicitly accounted for.
    Keywords: hospital costs, efficiency, patient outcomes, PROMs, cost-quality relationship
    Date: 2011–10
  33. By: Karl Claxton (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK); Stephen Palmer (Centre for Health Economics, University of York, UK); Louise Longworth (Health Economics Research Group, Brunel University, UK); Laura Bojke (Centre for Health Economics, University of York, UK); Susan Griffin (Centre for Health Economics, University of York, UK); Claire McKenna (Centre for Health Economics, University of York, UK); Marta Soares (Centre for Health Economics, University of York, UK); Eldon Spackman (Centre for Health Economics, University of York, UK); Jihee Youn (Health Economics Research Group, Brunel University, UK)
    Abstract: The general issue of balancing the value of evidence about the performance of a technology and the value of access to a technology can be seen as central to a number of policy questions. Establishing the key principles of what assessments are needed, as well as how they should be made, will enable them to be addressed in an explicit and transparent manner. This report presents the key finding from MRC and NHIR funded research which aimed to: i) Establish the key principles of what assessments are needed to inform an only in research (OIR) or Approval with Research (AWR) recommendation. ii) Evaluate previous NICE guidance where OIR or AWR recommendations were made or considered. iii) Evaluate a range of alternative options to establish the criteria, additional information and/or analysis which could be made available to help the assessment needed to inform an OIR or AWR recommendation. iv) Provide a series of final recommendations, with the involvement of key stakeholders, establishing both the key principles and associated criteria that might guide OIR and AWR recommendations, identifying what, if any, additional information or analysis might be included in the Technology Appraisal process and how such recommendations might be more likely to be implemented through publicly funded and sponsored research. The key principles and the assessments and judgments required are discussed in Section 2. The sequence of assessment and judgment is represented as an algorithm, which can also be summarised as a simple set of explicit criteria or a seven point checklist of assessments. The application of the check list of assessment to a series of four case studies in Section 3 can inform considerations of whether such assessments can be made based on existing information and analysis in current NICE appraisal and in what circumstances could additional information and/or analysis be useful. In Section 4, some of the implications that this more explicit assessment of OIR and AWR might have for policy (e.g., NICE guidance and drug pricing), the process of appraisal (e.g., greater involvement of research commissioners) and methods of appraisal (e.g., should additional information, evidence and analysis be required) are drawn together.
    Date: 2011–10
  34. By: Nils Gutacker (Centre for Health Economics, University of York, UK); Chris Bojke (Centre for Health Economics, University of York, UK); Silvio Daidone (Centre for Health Economics, University of York, UK); Nancy Devlin (Office for Health Economics, London, UK); Andrew Street (Centre for Health Economics, University of York, UK)
    Abstract: The English Department of Health has introduced routine collection of patient-reported health outcome data for selected surgical procedures (hip and knee replacement, hernia repair, varicose vein surgery) to facilitate patient choice and increase provider accountability. The EQ-5D has been chosen as the preferred generic instrument and the current risk-adjustment methodology is based on the EQ-5D index score to measure variation across hospital providers. There are two potential problems with this. First, using a population value set to generate the index score may not be appropriate for purposes of provider performance assessment because it introduces an exogenous source of variation and assumes identical preferences for health dimensions among patients. Second, the multimodal distribution of the index score creates statistical problems that are not yet resolved. Analysing variation for each dimension of the EQ-5D dimensions (mobility, self care, usual activities, pain/discomfort, anxiety/depression) seems therefore more appropriate and promising. For hip replacement surgery, we explore a) the impact of treatment on each EQ-5D dimension b) the extent to which treatment impact varies across providers c) the extent to which treatment impact across EQ-5D dimensions is correlated within providers. We combine information on pre- and post-operative EQ-5D outcomes with Hospital Episode Statistics for the financial year 2009/10. The overall sample consists of 25k patients with complete pre- and post-operative responses. We employ multilevel ordered probit models that recognise the hierarchical nature of the data (measurement points nested in patients, which themselves are nested in hospital providers) and the response distributions. The treatment impact is modelled as a random coefficient that varies at hospital-level. We obtain provider-specific Empirical Bayes (EB) estimates of this coefficient. We estimate separate models for each of the five EQ-5D dimensions and analyse correlations of the EB estimates across dimensions. Our analysis suggests that hospital treatment is indeed associated with improvements in health and that variability in treatment impact is generally more pronounced on the dimensions mobility, usual activity and pain/discomfort than on others. The pairwise correlation between the provider EB estimates is substantial, suggesting a) that certain providers are better in improving health across multiple EQ-5D dimensions than others and b) multivariate models are appropriate and should be further investigated.
    Keywords: hospital care, patient outcomes, PROMs, EQ-5D, performance assessment, provider profiling, hierarchical ordered probit
    Date: 2012–01
  35. By: Michael Drummond (Centre for Health Economics, University of York, UK)
    Abstract: The objective of this paper is to examine the impact of economic evaluation on the reimbursement process for pharmaceuticals. Before the introduction of economic evaluation, a range of arrangements existed across different jurisdictions, varying from reimbursement based on clinical criteria alone and price controls, to a total absence of controls over price or reimbursement. The changes in the structure of reimbursement policies necessary to incorporate economic evaluation have been accomplished without major difficulty in most jurisdictions. However, several methodological differences in international guidelines for economic evaluation exist, only some of which can easily be justified. A number of beneficial changes in reimbursement processes have also been observed, such as a trend towards requiring the measurement of more meaningful clinical endpoints and increased engagement between manufacturers, drug regulators and payers. A consistent finding in studies of reimbursement decisions is that economic considerations have been influential, second only to the strength of the clinical evidence for the drug of interest. The impact of economic evaluation on the allocation of healthcare resources is hard to ascertain because of the difficulties in specifying the counterfactual and the fact that little is known about the extent to which reimbursement decisions actually lead to changes in healthcare practice. However, there is evidence that economic evaluation has assisted price negotiations and enabled reimbursement agencies to target drugs to those patients who will benefit the most. In publicly financed healthcare systems, an evidence-based system of pricing and reimbursement for drugs, considering societal willingness-topay, is a reasonable policy objective to pursue.
    Date: 2012–02
  36. By: Anwar, Mumtaz; Rashid, Muhammad Khalid
    Abstract: Most of the developing countries are becoming more aid dependent with the passage of time. This bleak reality provokes debate on aid effectiveness. This paper analyzes the effectiveness of aid on the health sector of Pakistan over the period 1973-2008. The study focuses on the health sector in the light of Millennium Development Goal; reducing child mortality. We estimate an econometric model to test the short and long run relationship between foreign aid and infant mortality rate in the health sector. In this context, different tests i.e. Augumented Dickey Fuller test, Johansen Likelihood Ratio test and Vector Error Correction Method are used. The results indicate that there is short run and long run relationship between foreign aid and infant mortality rate. The results show that one percent increase in foreign aid will decrease the infant mortality rate by 0.4 percent. This study suggests that an increase aid in this sector will result in better health conditions.
    Keywords: Infant Mortality rate; Millennium Development Goal; Foreign Aid
    JEL: F35 I10
    Date: 2011–06–01
  37. By: Wasantha Athukorala (QUT); Clevo Wilson (QUT); Tim Robinson (QUT)
    Abstract: Pesticide spraying by farmers has an adverse impact on their health. However, in studies to date examining farmers' exposure to pesticides, the costs of ill-health and their determinants have been based on information provided by farmers themselves. Some doubt has therefore been cast on the reliability of these estimates. In this study, we address this by conducting surveys among two groups of farmers who use pesticides on a regular basis. The first group is made up of farmers who perceive that their ill-health is due to exposure to pesticides and have obtained at least some form of treatment (described in this paper as the 'general farmer group'). The second group is composed of farmers whose ill-health has been diagnosed by doctors and who have been treated in hospital for exposure to pesticides (described here as the 'hospitalised farmer group'). Cost comparisons are made between the two groups of farmers. Regression analysis of the determinants of health costs show that the most important determinants of medical costs for both samples are the defensive expenditure, the quantity of pesticides used per acre per month, frequency of pesticide use and number of pesticides used per hour per day. The results have important policy implications.
    Keywords: Pesticides, agriculture, cost of illness, Sri Lanka
    Date: 2012–03–14
  38. By: Hanming Fang; Edward Kung
    Abstract: Previous research has shown that the reasons for lapsation have important implications regarding the effects of the emerging life settlement market on consumer welfare. We present and empirically implement a dynamic discrete choice model of life insurance decisions to assess the importance of various factors in explaining life insurance lapsations. In order to explain some key features in the data, our model incorporates serially correlated unobservable state variables which we deal with using posterior distributions of the unobservables simulated from Sequential Monte Carlo (SMC) method. We estimate the model using the life insurance holding information from the Health and Retirement Study (HRS) data. Counterfactual simulations using the estimates of our model suggest that a large fraction of life insurance lapsations are driven by i.i.d choice specific shocks, particularly when policyholders are relatively young. But as the remaining policyholders get older, the role of such i.i.d. shocks gets smaller, and more of their lapsations are driven either by income, health or bequest motive shocks. Income and health shocks are relatively more important than bequest motive shocks in explaining lapsations when policyholders are young, but as they age, the bequest motive shocks play a more important role. We also suggest the implications of these findings regarding the effects of the emerging life settlement market on consumer welfare.
    JEL: G22 H31 L11
    Date: 2012–03
  39. By: Berg, Gerard J. van den; Pinger, Pia; Schoch, Johannes
    Abstract: Numerous studies have evaluated the effect of nutrition early in life on health much later in life by comparing individuals born during a famine to others. Nutritional intake is typically unobserved and endogenous, whereas famines arguably provide exogenous variation in the provision of nutrition. However, living through a famine early in life does not necessarily imply a lack of nutrition during that age interval, and vice versa, and in this sense the observed difference at most provides a qualitative assessment of the average causal effect of a nutritional shortage, which is the parameter of interest. In this paper we estimate this average causal effect on health outcomes later in life, by applying instrumental variable estimation, using data with self-reported periods of hunger earlier in life, with famines as instruments. The data contain samples from European countries and include birth cohorts exposed to various famines in the 20th century. We use two-sample IV estimation to deal with imperfect recollection of conditions at very early stages of life. The estimated average causal effects often exceed famine effects by a factor three.
    Keywords: Nutrition , famine , ageing , developmental origins , height , blood pressure , obesity , twosample IV
    JEL: I12 J11 C21 C26
    Date: 2012

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