nep-hea New Economics Papers
on Health Economics
Issue of 2012‒06‒05
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Evaluating the Potential Socio-Economic Impact of Personalized Medicine By Joanne Castonguay; Nathalie de Marcellis-Warin; Natalia Mishagina
  2. Seasonal Effects of Water Quality on Infant and Child Health in India By Brainerd, Elizabeth; Menon, Nidhiya
  3. Nurses' Labour Supply Elasticities: The Importance of Accounting for Extensive Margins By Hanel, Barbara; Kalb, Guyonne; Scott, Anthony
  4. Do Public Health Interventions Crowd Out Private Health Investments? Malaria Control Policies in Eritrea By Carneiro, Pedro; Locatelli, Andrea; Ghebremeskel, Tewolde; Keating, Joseph
  5. The impact of GDP on health care expenditure: the case of Italy (1982-2009) By Silvia Fedeli
  6. Sick leave before, during and after pregnancy By Karsten Marshall Elseth Rieck and Kjetil Telle
  7. Transaction costs and pharmaceutical clinical research: a Data Envelopment Analysis approach By Greta Falavigna; Roberto Ippoliti
  8. Path-breaking innovations for lung cancer: a revolution in clinical practice By Mario Coccia
  9. Mediating role of education and lifestyles in the relationship between early-life conditions and health : evidence from the 1958 British cohort. By Tubeuf, Sandy; Jusot, Florence; Bricard, Damien
  10. The dynamics of causes and conditions: the rareness of diseases in French and Portuguese patients' organizations' engagement in research By Vololona Rabeharisoa; Michel Callon; Angela Marques Filipe; João Arriscado Nunes; Florence Paterson; Frédéric Vergnaud
  11. Hospital Staffing and Local Pay: an Investigation into the Impact of Local variations in the Competitiveness of Nurses Pay on the Staffing of Hospitals in France By Eric Delattre; Jean-Baptiste Combès; Bob Elliott; Diane Skatun
  12. On decomposing the causes of changes in income-related health inequality with longitudinal data By Allanson, Paul; Petrie, Dennis
  13. Eye Care Service in Scotland: Did the Scots Get it Right? By Zangelidis, Alexandros
  14. Bankruptcy as Implicit Health Insurance By Neale Mahoney
  15. Estimating the Tradeoff Between Risk Protection and Moral Hazard with a Nonlinear Budget Set Model of Health Insurance By Amanda E. Kowalski
  16. Health Care Expenditures, Public Administration and the Business Cycle By François Béland and Co-director Solidage

  1. By: Joanne Castonguay; Nathalie de Marcellis-Warin; Natalia Mishagina
    Abstract: Since 2000, Québec and Canada have made significant R&D investments in the area of genomics, with a particular focus on technological platform development and genetics. <p> To justify these and future major investments in genomic research, clear benefits of genomic technologies to society must be demonstrated. <p> The goals of the study are to provide methodology to evaluate potential socio-economic impact of personalized medicines, to demonstrate it on two applications of genomic technology and to summarize obstacles to realize the potential socio-economic benefits of genomic research. <p> The following report is the presentation of the project made at Genome Quebec. <P>Depuis 2000, le Québec et le Canada ont investi considérablement en R.-D. dans le domaine de la génomique, en mettant l’accent sur l’élaboration d’une plateforme technologique et sur la génétique. <p> Afin de justifier ces investissements et d’autres à venir dans la recherche génomique, les bénéfices évidents des technologies génomiques pour la société doivent être démontrés. <p> Les objectifs de notre étude est d’offrir une méthodologie pour évaluer l’impact socioéconomique potentiel de la médecine personnalisée, d’en démontrer la méthodologie à l’aide de deux applications de la technologie génomique et d’en résumer les obstacles à la réalisation des bénéfices liés à la recherche génomique. <p> Le rapport qui suit est la reproduction de la présentation du projet qui a été faite à Génome Québec.
    Date: 2012–05–01
  2. By: Brainerd, Elizabeth (Brandeis University); Menon, Nidhiya (Brandeis University)
    Abstract: This paper examines the impact of fertilizer agrichemicals in water on infant and child health using data on water quality combined with data on the health outcomes of infants and children from the 1992-93, 1998-99, and 2005-06 Demographic and Health Surveys of India. Because fertilizers are applied at specific times in the growing season, the concentrations of agrichemicals in water vary seasonally and by cropped area as some Indian states plant predominantly summer crops while others plant winter crops. Our identification strategy exploits the differing timing of the planting seasons across regions and differing seasonal prenatal exposure to agrichemicals to identify the impact of agrichemical contamination on various measures of child health. The results indicate that children exposed to higher concentrations of agrichemicals during their first month experience worse health outcomes on a variety of measures (infant mortality, neo-natal mortality, height-for-age z scores and weight-for-age z-scores). Disaggregated runs reveal that effects are largest amongst the most vulnerable groups – children of uneducated poor women living in rural India.
    Keywords: fertilizer agrichemicals, water pollutants, child health, infant mortality, India, fertilizers
    JEL: O12 I15 Q53 Q56
    Date: 2012–05
  3. By: Hanel, Barbara (Melbourne Institute of Applied Economic and Social Research); Kalb, Guyonne (Melbourne Institute of Applied Economic and Social Research); Scott, Anthony (Melbourne Institute of Applied Economic and Social Research)
    Abstract: Many countries face a continuing shortage in nurses' labour supply. Previous research suggests that nurses respond only weakly to changes in wages. We estimate a multi-sector model of nursing qualification holders' labour supply in different occupations. A structural approach allows us to model the labour force participation decision, the occupational and shift-type choice, and the decision about hours worked as a joint outcome following from maximizing a utility function. Disutility from work is allowed to vary by occupation and also by shift type in the utility function. Furthermore, we allow the preference parameters in the utility function to vary by certain family characteristics and personality. Our results suggest that average wage elasticities might be higher than previous research has found. This is mainly due to the effect of wages on the decision to enter or exit the profession, which was not included in the previous literature, rather than from its effect on increased working hours for those who already work in the profession. We find that the negative labour supply elasticities with respect to income are higher for nurses with children, while the positive elasticities with respect to wages are higher for low-qualified, older and childless nurses. Elasticities do not appear to vary by personality trait.
    Keywords: nursing, labour supply, shift work, wage elasticities
    JEL: J22 J24 I10 I11
    Date: 2012–05
  4. By: Carneiro, Pedro (University College London); Locatelli, Andrea (University College London); Ghebremeskel, Tewolde (Ministry of Health); Keating, Joseph (Tulane University)
    Abstract: It is often argued that engaging in indoor residual spraying (IRS) in areas with high coverage of mosquito bed nets may discourage net ownership and use. This is just a case of a public program inducing perverse incentives. We analyze new data from a randomized control trial conducted in Eritrea which surprisingly shows the opposite: IRS encouraged net acquisition and use. Our evidence points to the role of imperfect information. The introduction of IRS may have made the problem of malaria more salient, leading to a change in beliefs about its importance and to an increase in private health investments.
    Keywords: crowding out, behavior, beliefs, information, indoor residual spray, bed nets, malaria, health, developing countries
    JEL: D12 D83 H42 I10 I12
    Date: 2012–05
  5. By: Silvia Fedeli
    Abstract: The Italian health care expenditures, HCE, have been basically explained with two main groups of theories. (1) Those explaining the peculiarity of the HCE growth as depending on demand and supply factors, such as ageing population, public finance share of health care, number of practising physicians per capita, mix of public and private hospitals, number of hospital beds... (2) The theories explaining the growth of total public expenditure, per se, as a common feature of the industrialized countries. In this respect, a huge empirical literature on HCE has emphasised the role of GDP and/or other structural/institutional variables as the main determinants of HCE across countries. In order to reassess previous findings, here we test for cointegration the regional Italian data on HCE and GDP. The results shows that HCE and GDP are cointegrated. The long and the short term dynamics of HCE are estimated, taking into account for cross-section correlation.
    Keywords: Italian health care regional expenditures, panel cointegration analysis, cross-section correlation
    JEL: I10 I19 H51 C23
    Date: 2012–05
  6. By: Karsten Marshall Elseth Rieck and Kjetil Telle (Statistics Norway)
    Abstract: Using registry data on every employed Norwegian woman giving birth to her first child during the period 1995–2008, we describe patterns of certified and paid sick leave before, during and after pregnancy. By following the same women over time, we can explore how observed sick leave patterns are – or are not – related to the women’s exiting (or reentering) employment. The results show that sick leave increases abruptly in the month of conception, and continues to grow throughout the term of pregnancy. Sick leave during pregnancy has been rising substantially compared with pre-pregnancy levels over the period 1995–2008, but this increase seems unrelated to women’s growing age at first birth. In line with hypotheses of women’s “double burden”, observed sick leave rates increase in the years after birth. However, when we handle some obvious selection issues – like sick leave during a succeeding pregnancy – the increase in women’s sick leave in the years after birth dissolves. Overall, we find little, if any, sign of the relevance of “double burden” hypotheses in explaining the excessive sick leave of women compared with men.
    Keywords: sick leave; pregnancy; female employment; double burden.
    JEL: C23 H55 I18 J13 J22
    Date: 2012–05
  7. By: Greta Falavigna (Ceris - Institute for Economic Research on Firms and Growth,Turin,Italy); Roberto Ippoliti (IEL International Program in Institutions, Economics and Law)
    Abstract: Taking human experimentation into account, this work aims at estimating the relationship between transaction costs, which are related to the protection system of patients’ rights, and localization of pharmaceutical industry’s testing phase. Assuming that the competitiveness of the protection system is based on the time required to obtain an authorization or an experimental activity, pharmaceutical clinical research should be positively affected by a process aimed at internalizing the review process, if efficient. By analyzing said system with operational research, this paper concludes suggesting the potentiality of a competitive system of reviewers, that is to say, the efficiency of that internalization process is performed by medical centers in which the experimental treatments are proposed to subjects.
    JEL: I18 L51
    Date: 2012–06
  8. By: Mario Coccia (Ceris - Institute for Economic Research on Firms and Growth,Turin, Italy)
    Abstract: Lung cancer is one of main cause of death worldwide and traditional chemotherapy agents have reached the maturity phase in the treatment of advanced non-small cell lung cancer. The purpose of this paper is to analyse the evolutionary growth of knowledge patterns of vital radical innovations to treat lung cancer, driven by new technological paradigm of the targeted therapy, that have generating a revolution in clinical practice, increasing the overall survival of patients and quality of life. This new scientific pathway has evolving with an allometric process that involves a disproportionate growth of targeted therapy in relation to standard platinum-based chemotherapy alone.
    JEL: O33 I1 L65
    Date: 2012–06
  9. By: Tubeuf, Sandy; Jusot, Florence; Bricard, Damien
    Abstract: The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health accounting for almost 20% of explained health inequality when mediating effects are identified. The contribution of lifestyles reduces from 32% down to 25% when indirect effects of early-life conditions and education are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.
    Keywords: Cohort; early-life conditions; education; lifestyles; random effects;
    JEL: I12 D63
    Date: 2012–06
  10. By: Vololona Rabeharisoa (Centre de Sociologie de l'Innovation, Mines ParisTech); Michel Callon (Centre de Sociologie de l'Innovation, Mines ParisTech); Angela Marques Filipe (BIOS, London School of Economics and Political Sciences); João Arriscado Nunes (Centre for Social Studies, University of Coimbra); Florence Paterson (Centre de Sociologie de l'Innovation, Mines ParisTech); Frédéric Vergnaud (Centre de Sociologie de l'Innovation, Mines ParisTech)
    Abstract: Highlights the emergence of a "hybrid collective model" of collaboration between patients and experts through a systematic study in the field of rare diseases in France and Portugal, with attention to the reflexive work carried out by patients' organizations on the notion of rareness.
    Keywords: patients’ organizations; rare diseases; France; Portugal; hybrid collective model; delegation model; singularization-generalization
    JEL: Z10 I10
    Date: 2012–05
  11. By: Eric Delattre; Jean-Baptiste Combès; Bob Elliott; Diane Skatun (THEMA, Universite de Cergy-Pontoise; Health Economics Research Unit, University of Aberdeen; Health Economics Research Unit, University of Aberdeen; Health Economics Research Unit, University of Aberdeen)
    Abstract: Research has shown that where nurses’ wages are regulated but wages in other sectors are not this results in spatial variations in the competitiveness of nurses pay and that in England these are correlated with spatial differences in nurses’ labour supply. In France there is general regulation of wages and public hospitals compete with the private hospital and non hospital sectors for nurses. We construct and employ a unique dataset on nurses pay and the characteristics of hospitals in France. We undertake the first study of the impact of spatial wage differentials on nursing supply to French public hospitals. We show that nurse assistants’ labour supply is sensitive to spatial wage differentials, the more competitive their pay the smaller the shortage of nurse assistants, and that registered nurses and nurse assistants labour supply are interdependent, the greater the supply of nurse assistants the greater the supply of registered nurses.
    Keywords: Wage regulation, local pay, standardised spatial wage differentials, nursing shortage, nursing labour supply
    JEL: I12 I18 J31
    Date: 2012
  12. By: Allanson, Paul; Petrie, Dennis
    Abstract: Regression-based decomposition procedures are used to both standardise the concentration index and to determine the contribution of inequalities in the individual health determinants to the overall value of the index. The main contribution of this paper is to develop analogous procedures to decompose the income-related health mobility and health-related income mobility indices first proposed in Allanson, Gerdtham and Petrie (2010) and subsequently extended in Petrie, Allanson and Gerdtham (2010) to account for deaths. The application of the procedures is illustrated by an empirical study that uses British Household Panel Survey (BHPS) data to analyse the performance of Scotland in tackling income-related health inequalities relative to England & Wales over the five year period 1999 to 2004.
    Date: 2011
  13. By: Zangelidis, Alexandros
    Abstract: In March 2004, the Scottish government announced a review of eye care services in Scotland, which culminated in the introduction of free eye examinations from 1st April 2006. This free eye examination is not just a sight test; it is a thorough examination to check the health of the patient’s eyes and to look for signs of other health problems. The Scottish government commissioned private ophthalmic optician practices to perform these eye examinations. Consequently, since April 2006 individuals in Scotland could walk into any high street optometry practice and get a ‘free’ eye examination funded under the NHS.
    Keywords: health economics,
    Date: 2011
  14. By: Neale Mahoney
    Abstract: This paper examines the implicit health insurance households receive from the ability to declare bankruptcy. Exploiting cross-state and within-state variation in asset exemption law, I show that uninsured households with greater seizable assets make higher out-of-pocket medical payments, conditional on the amount of care received. In turn, I find that households with greater wealth-at-risk are more likely to hold health insurance. The implicit insurance from bankruptcy distorts the insurance coverage decision. Using a microsimulation model, I calculate that the optimal Pigovian penalties are similar on average to the penalties under the Affordable Care Act (ACA).
    JEL: H51 K35
    Date: 2012–05
  15. By: Amanda E. Kowalski
    Abstract: Insurance induces a well-known tradeoff between the welfare gains from risk protection and the welfare losses from moral hazard. Empirical work traditionally estimates each side of the tradeoff separately, potentially yielding mutually inconsistent results. I develop a nonlinear budget set model of health insurance that allows for the calculation of both sides of the tradeoff simultaneously, allowing for a relationship between moral hazard and risk protection. An important feature of this model is that it considers nonlinearities in the consumer budget set that arise from deductibles, coinsurance rates, and stoplosses that alter moral hazard as well as risk protection relative to no insurance. I illustrate the properties of my model by estimating it using data on employer sponsored health insurance from a large firm. Within my empirical context, the average deadweight losses from moral hazard substantially outweigh the average welfare gains from risk protection. However, the welfare impact of moral hazard and risk protection are both small relative to transfers from the government through the tax preference for employer sponsored health insurance and transfers from some agents to other agents through a common premium.
    JEL: H00
    Date: 2012–05
  16. By: François Béland and Co-director Solidage
    Abstract: Claims of the unsustainability of Medicare abound and have been fuelled by the consequences of the 2008-09 economic recession. The looming question for Canadian public health care services is "How will public administrations in Canada sustain their health care expenditures during the next few years, given the pressure from debt recovery and the new federal payment transfer for health care?” To examine these issues, variations from 1989 to 2009 in Canadian public administration health care expenditures (HCE) are compared with variations in GDP, in public administration revenue, their expenditures on items other than health care, transfer payments for health from the federal government to provinces, and debt charges. Since the turn of the millennium, Canadian public administrations have increased HCE in constant dollars in context of: 1) decreasing share of public revenue and expenditures in terms of GDP; 2) constant share (70%), since 1996, of expenditures for items other than health care on total expenditures ; 3) parallel trends, with a 3 year lag, for GDP and expenditures for services covered by Medicare; 4) constant share of total HCE in terms of public administration total revenues from 2003 to 2007; 5) constant share of federal transfers for health on provincial public administration expenditures for total health care and for Medicare; and 6) reverse trends for share of HCE and debt charges. Given this context, the rhetoric of apocalyptic share of HCE on public administration budget is having a boost, while increases in this share has more to do with the factors included in the denominator rather than with those in the numerator.
    Keywords: Healthcare expenditures, public administration, sustainability, federal transfers, debt charges
    JEL: H51 H75 H83 I18
    Date: 2012–05

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