nep-hea New Economics Papers
on Health Economics
Issue of 2012‒06‒25
27 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Applying an Equity Lens to Maternal Health Care Practices in Pakistan By Naushin Mahmood; Saima Bashir
  2. Saving lives: Evidence from a micronutrient intervention in Ecuador By Stephan Litschig; Marian Meller
  3. Mortality shocks and the human rate of aging By Virginia Zarulli
  4. Rethinking Age-Period-Cohort Mortality Trend Models By Daniel Alai; Michael Sherris
  5. Life Cycle Effects of Health Risk By Elena Capatina
  6. Genetic Testing and Insurance: The Complexity of Adverse Selection By Maureen Durnin; Michael Hoy; Michael Ruse
  7. Health and Retirement of Older New Zealanders By Emma Gorman; Grant M Scobie; Andy Towers
  8. Is it Necessary to Walk the Talk? The Effects of Maternal Experiences and Communication on the Sexual Behavior of Female Adolescents By Averett, Susan L; Estelle, Sarah M.
  9. Youth Depression and Future Criminal Behavior By Anderson, D. Mark; Cesur, Resul; Tekin, Erdal
  10. Dynamics of Disability and Work in Canada By Oguzoglu, Umut
  11. Medical Marijuana Laws and Teen Marijuana Use By Anderson, D. Mark; Hansen, Benjamin; Rees, Daniel I.
  12. The Demand for Tobacco in Post-Unification Italy By Carlo Ciccarelli; Gianni De Fraja
  13. Using Difference-in-Differences to Estimate Damages in Healthcare Antitrust: A Case Study of Marshfield Clinic By Martha A. Starr; R. Forrest McCluer
  14. The determinants of selection and allocation decisions for health assistance. Which role do health indicators play? By Katharina Stepping
  15. Do poor health conditions lead to higher allocation of development assistance? By Katharina Stepping
  16. Neither Private nor Public: The Effects of Communal Provision of Water on Child Health in Peru By Calzada, Joan; Iranzo Sancho, Susana
  17. Risky Behaviours and Responsibility-Sensitive Fairness in a Non Life-Threatening Health Case: A European Study By Christine Le CLAINCHE; Jerome WITTWER
  18. The Effect of Soft Drinks Taxes on Consumption: Evidence from Scanner Data By Colantuoni, Francesca; Rojas, Christian
  19. How Much DoWe Know about Rural-Urban Health Disparities: Lessons from Four Major Diseases in Virginia By Zeng, Di; You, Wen; Mills, Bradford; Alwang, Jeffrey; Royster, Michael; Studer, Kenneth; Anson-Dwamena, Rexford
  20. Understanding the vertical equity judgements underpinning health inequality measures By Allanson, Paul; Petrie, Dennis
  21. Handling the endogeneity of income to health using a field experiment in Taiwan By Tseng, Fu-Min; Petrie, Dennis
  22. What Drives Differences in Health Care Demand? The Role of Health Insurance and Selection Bias. By Dan Shane;; Pravin Trivedi;
  23. Channels of Stabilization in a System of Local Public Health Insurance: The Case of the National Health Insurance in Japan By Masayoshi Hayashi
  24. Study on workload of public health nurses and other women health workers By Kannan, Srinivasan; Sarma, Sankara P
  25. Effects of health care decentralization in Spain from a citizens’ perspective By Antón, José-Ignacio; Muñoz de Bustillo, Rafael; Fernández-Macías, Enrique; Rivera, Jesús
  26. Health and the Intergenerational Persistence of Inequality and Child Labour By Jayanta Sarkar; Dipanwita Sarkar
  27. Dimensions of health care system quality in Finland By Jenni Pääkkönen; Timo Seppälä

  1. By: Naushin Mahmood (Pakistan Institute of Development Economics, Islamabad.); Saima Bashir (Pakistan Institute of Development Economics, Islamabad.)
    Abstract: The focus of this study is to see how equitable the access and utilisation of health services are among married women in Pakistan. It examines the changes in the pattern of maternal health care practices and the extent to which inequities in access to those services have changed over the past two decades. Using two datasets—the Pakistan Demographic and Health Surveys (PDHS) of 1990-91 and 2006-07, the overall findings indicate that there is an improvement in inequity patterns of health care among married women beginning in the urban areas and more recently spreading to rural areas. Among the factors explaining the health care differentials, the effect of wealth and socio-economic status are significant, especially when examined for use of private and public health facilities. It is further noted that increased educational attainment level of women improves utilisation of maternal health care services. The inequity pattern disfavouring the poor and the large majority of uneducated women is likely to jeopardise achievement of goals 4 and 5 of the Millennium Development Goals and other national and regional targets of maternal and child health care programmes.
    Keywords: Equity, Maternal Health, Poverty
    Date: 2012
  2. By: Stephan Litschig; Marian Meller
    Abstract: Many governments in developing countries implement programs that aim to address nutrional failures in early childhood, yet credible evidence on the effectiveness of these interventions is scant. In this paper, we evaluate the impact of a large-scale, government-run, food fortification program -the Programa de Alimentación y Nutrición Nacional (PANN) 2000- on child mortality in Ecuador. The program was implemented by regular administrative staff at local public health posts and consisted of offering free micronutrient-fortified powder, Mi Papilla, for children aged 6 to 24 months in exchange for health check-ups for the children. Our regression discontinuity design exploits the fact that at its inception, the PANN 2000 was running for about eight months only in the poorest communities (parroquias) of the country. Our main result is that the presence of the program reduced child mortality in the exposed cohort from a level of about 2.5 percent by 1 to 1.5 percentage points. Consistent with this effect, we also find evidence that the number of check-ups at health posts increased in treatment parroquias, even if only in the Sierra region, where check-ups were lower to start with.
    Keywords: early childhood nutrition, mortality, nutritional interventions, regression discontinuity, Ecuador
    JEL: I15 I18
    Date: 2012–02
  3. By: Virginia Zarulli (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Investigating the effect of mortality shocks on humans is difficult in the absence of laboratory experiments. However, some events in human history serve as natural experiments. Using data for Australian prisoners during WWII and for the Ukrainian Famine in 1933, I analyzed the effect of sudden changes in external conditions on the rate of aging. This may help to decide whether the rate of aging is sensitive to the environment or is stable. The mortality of the prisoners of war was higher during the imprisonment but the slope of the curve did not change. During the Ukrainian Famine, the curves in the years of crisis converged at old ages. By adopting a cohort perspective I found evidence of selection that could be the cause of the convergence. The analysis suggests that sudden and transitory exposure to severe conditions shifts the mortality curve upward proportionally at all ages, leaving the rate of aging unchanged.
    JEL: J1 Z0
    Date: 2012–04
  4. By: Daniel Alai (ARC Centre of Excellence in Population Ageing Research, Australian School of Business, University of New South Wales); Michael Sherris (School of Risk and Actuarial Studies and ARC Centre of Excellence in Population Ageing Research, Australian School of Business, University of New South Wales)
    Abstract: Longevity risk arising from uncertain mortality improvement is one of the major risks facing annuity providers and pension funds. In this paper we show how applying trend models from non-life claims reserving to age-period-cohort mortality trends provides new insight in estimating mortality improvement and quantifying its uncertainty. Age, period, and cohort trends are modelled with distinct effects for each age, calendar year, and birth year in a generalized linear models framework. The effects are distinct in the sense that they are not conjoined with age coefficients, borrowing from regression terminology, we denote them as main effects. Mortality models in this framework for age-period, age-cohort, and age-period-cohort effects are assessed using national population mortality data from Norway and Australia to show the relative significance of cohort effects as compared to period effects. Results are compared with the traditional Lee-Carter model. The bilinear period effect in the Lee-Carter model is shown to resemble a main cohort effect in these trend models. However the approach avoids the limitations of the Lee-Carter model when forecasting with the age-cohort trend model.
    Keywords: Mortality Modelling, Age-Period-Cohort Models, Generalized Linear Models, Lee-Carter Models
    JEL: G22 G23 C51 C18
    Date: 2012–05
  5. By: Elena Capatina (ARC Centre of Excellence in Population Ageing Research, Australian School of Business, University of New South Wales)
    Abstract: This paper studies four channels through which health affects individuals: (1) productivity, (2) medical expenditures, (3) available time and (4) survival probabilities, and assesses their roles in determining labor supply, asset accumulation and welfare. Using a life-cycle model calibrated to the U.S. for different education groups, I evaluate the relative importance of each channel and quantify the interactions between them. First, all four channels are important for the macroeconomic variables studied, but the productivity and time endowment channels are the most dominant. I also show that due to significant interactions between channels, they need to be studied within a unified framework over the entire life-cycle. Second, health has larger effects for the non-college than college educated, explaining 35% and 31% of the differences in labor supply and degree of reliance on government transfers across groups, respectively. Health risk accounts for 9% of disposable income inequality for the non-college educated, leading to larger fractions of precautionary savings for this group despite the presence of a consumption floor.
    Keywords: Health, Life Cycle Models, Precautionary Saving, Welfare
    JEL: D91 E21 I14 I31
    Date: 2012–05
  6. By: Maureen Durnin (Independent Researcher, Guelph, Ontario); Michael Hoy (Department of Economics, University of Guelph); Michael Ruse (Department of Philosophy, Florida State University)
    Abstract: The debate on whether insurance companies should be allowed to use results of individuals’ genetic tests for underwriting purposes has been both lively and increasingly relevant over the past two decades. Yet there appears to be no widely agreed upon resolution regarding appropriate and effective regulation. There exists today a gamut of recommendations and actual practices addressing this phenomenon ranging from laissez faire to voluntary industry moratoria to strict legal prohibition. One obvious reason for such a variance in views and approaches is that there are competing norms for evaluating the outcomes of restricting insurers’ use of such information. For example, an outright ban on the use of genetic test results may seem the best method for protecting against unfair discrimination while allowing their use may seem to be the best way to foster efficiency in the market for insurance. However, there is also a lack of understanding about how restricting the use of genetic information would play out in the market through the so-called phenomenon of adverse selection. Using economic analysis, we discuss how the type of adverse selection that occurs in insurance markets affects various arguments both in favour and against an outright ban on insurers’ use of genetic tests for pricing insurance. We review arguments based on moral principles (i.e., a concern with unfair discrimination as well as welfarist analysis related to distributive justice). The practical concerns from the insurance industry based on actuarial principles and economic efficiency are also compared. Each perspective is shown to lead to a range of conflicting recommendations about how genetic information should be regulated and these conclusions depend critically on whether one conducts the analysis from the ex ante temporal perspective (i.e., before individuals know their risk type), from the interim temporal perspective (i.e., after individuals know their risk type but before they purchase their insurance policies), or from the ex post temporal perspective (i.e., after all uncertainty is resolved including the claims status of each policyholder).
    Keywords: insurance; genetic discrimination; regulation; privacy
    JEL: D82 D63
    Date: 2012
  7. By: Emma Gorman; Grant M Scobie; Andy Towers (The Treasury)
    Abstract: Increasing life expectancies and uncertainty about future retirement incomes are likely to lead to various changes in behaviour. As expectations are revised, one potentially important adjustment mechanism is in labour force participation rates. There is already evidence these are rising for those beyond the age of eligibility for New Zealand Superannuation. This paper uses a new source of longitudinal data on the health, labour force participation and retirement decisions of older New Zealanders. The central question addressed is the extent to which labour force participation of older New Zealanders is influenced by their health status (both mental and physical), in addition to a wide range of economic, social and demographic variables. Discrete choice models are employed, and particular attention is given to the potential effects of unobserved heterogeneity. We find a range of factors to be associated with the decision to retire, notably health status, marital status and financial incentives. After accounting for the confounding influence of unobservables, we find that physical health remains a determinant of labour force exit for older males. Further, we estimate both the marginal and aggregate effects of specific chronic conditions on labour force participation.
    Keywords: Labour force participation; Health; Retirement; New Zealand; Longitudinal survey
    JEL: J26 J14 J21 I10
    Date: 2012–06
  8. By: Averett, Susan L (Lafayette College); Estelle, Sarah M. (Rhodes College)
    Abstract: Numerous social marketing campaigns exhort parents to talk to their children about sexual abstinence and pregnancy/STD prevention while child-development experts advise parents to initiate discussions about reproductive health and related values at an early age. The efficacy of these marketing campaigns and the precise impact of ongoing dialogue between parents and children are difficult to ascertain, however, if parents are more likely to broach related topics with adolescents with otherwise greater propensities for risky behavior. While extant research recognizes the importance of family environment and parenting activities, little has been done to separately control for the various aspects of parenting that might confound the influence of the marketing campaigns. We separately identify the effects of parenting style, a parent’s own risky behavior, and the parent’s communication about sex on her adolescent’s sexual behavior. OLS models indicate that female adolescents with less strict parents, whose mothers gave birth as teenagers, or whose mothers communicate more about sex are more likely to have sexual intercourse, practice unsafe sex, and engage in casual sex. After controlling for the endogeneity of parental talk, though, we find that an increase in parental talk neither increases nor decreases the probability an adolescent has had sex, unsafe sex, or casual sex. The only exception is a strongly significant result that more communication about sex from mothers who were themselves teen mothers actually increases the probability a daughter has had sex.
    Keywords: sexual intercourse, parental sex talk, unsafe sex, casual sex, teen mother
    JEL: J12
    Date: 2012–05
  9. By: Anderson, D. Mark (Montana State University); Cesur, Resul (University of Connecticut); Tekin, Erdal (Georgia State University)
    Abstract: While the contemporaneous association between mental health problems and criminal behavior has been explored in the literature, the long-term consequences of such problems, depression in particular, have received much less attention. In this paper, we examine the effect of depression during adolescence on the probability of engaging in a number of criminal behaviors using data from the National Longitudinal Study of Adolescent Health (Add Health). In our analysis, we control for a rich set of individual, family, and neighborhood level factors to account for conditions that may be correlated with both childhood depression and adult criminality. One novelty in our approach is the estimation of school and sibling fixed effects models to account for unobserved heterogeneity at the neighborhood and family levels. Furthermore, we exploit the longitudinal nature of our data to account for baseline differences in criminal behavior. The empirical estimates show that adolescents who suffer from depression face a substantially increased probability of engaging in property crime. We find little evidence that adolescent depression predicts the likelihood of engaging in violent crime or the selling of illicit drugs. Our estimates imply that the lower-bound economic cost of property crime associated with adolescent depression is about 219 million dollars per year.
    Keywords: crime, depression, Add Health
    JEL: I10 K42
    Date: 2012–05
  10. By: Oguzoglu, Umut (University of Manitoba)
    Abstract: Canadian disability policy has come a long way in the past century. However, in contrast with the evidence that disability is not permanent for most, current disability support programs still carry the old static view of permanent disability. By employing a dynamic panel data model of labour force participation, the findings of this paper suggest that labour force exposure is crucial for better return-to-work outcomes for persons with a disability. Without labour force exposure, the effect of a temporary disability is prolonged and participation efforts of the disabled community are slowed down.
    Keywords: disability, labour force participation, dynamic panel data models
    JEL: J14 J21 C23
    Date: 2012–05
  11. By: Anderson, D. Mark (Montana State University); Hansen, Benjamin (University of Oregon); Rees, Daniel I. (University of Colorado Denver)
    Abstract: While at least a dozen state legislatures are considering bills to allow the consumption of marijuana for medicinal purposes, the federal government has recently intensified its efforts to close medical marijuana dispensaries. Federal officials contend that the legalization of medical marijuana encourages teenagers to use marijuana and have targeted dispensaries operating within 1,000 feet of schools, parks and playgrounds. Using data from the national and state Youth Risk Behavior Surveys, the National Longitudinal Survey of Youth 1997 and the Treatment Episode Data Set, we estimate the relationship between medical marijuana laws and marijuana use. Our results are not consistent with the hypothesis that legalization leads to increased use of marijuana by teenagers.
    Keywords: marijuana, youth risky behavior, medical marijuana laws
    JEL: K4 I1 D8
    Date: 2012–05
  12. By: Carlo Ciccarelli; Gianni De Fraja
    Abstract: This paper studies the demand for tobacco products in post-unification Italy. We construct a very detailed panel dataset of yearly consumption in the 69 Italian provinces from 1871 to 1913, and use it to estimate the Becker and Murphy (1988) rational addiction model. We find support for the presence of rational addiction; we also find that, in the period considered, tobacco was a normal good in Italy: its consumption increase with income. Subsequently, we separate the analysis of the components of the aggregate tobacco consumption (fine-cut tobacco, snuff, cigars and cigarettes), and tentatively suggest that habit formation was a stronger factor on the persistence of consumption than physical addiction. The paper ends by showing that the introduction of the Bonsack machine did not coincide with changes in the structure of the demand for tobacco, suggesting cost driven technological change.
    Keywords: Smoking; Italian Kingdom; Rational Addiction; Panel Data
    JEL: D11 N33 I18
    Date: 2012–06
  13. By: Martha A. Starr; R. Forrest McCluer
    Abstract: In calculating damages in healthcare antitrust cases, the difference-in-difference (DID) approach provides a potentially valuable means of controlling for lawful factors that influence prices, such as case-mix and quality of care, as distinct from price differentials due to unlawful behavior. After first comparing DID to traditional methods of estimating damages, this paper uses DID to analyze data from a well-known case against Marshfield Clinic, a large multispecialty group practice that was found to have illegally allocated markets for physician services in Central Wisconsin. Using a specification similar to what was used in the case, we find that illegal behavior accounted for about two-fifths of the Clinic's extra increase in costs per patient during the damage period. The courts, however, were not persuaded that the analysis adequately controlled for legal factors. We discuss potential pitfalls in using DID to estimate damages suggested by the case, as well as possible ways around them.
    Keywords: healthcare antitrust, differences-in-differences, damage estimation JEL Classifications: I11, L4, K21, K41, C20
    Date: 2012–02
  14. By: Katharina Stepping (Colegio Carlo Alberto)
    Abstract: This paper analyzes the selection and allocation decisions of major and like-minded bilateral donors as regards development assistance for health for the period of 1990 till 2007. The central question is to what extent health indicators, reflecting the health objectives stated in the Millennium Development Goals, influence such decisions. The analysis reveals that health indicators are important determinants of the selection and allocation process for health assistance but to a different degree at the two stages; HIV prevalence is the proxy with the strongest impact. The results also show that the quality of the institutional environment and the bilateral relations affect the decisions of many donors. The national health expenditures, however, have no systematic effect and the allocation pattern of possible competitors is irrelevant for almost all donors. The evidence illustrates, furthermore, the great heterogeneity among major and like-minded donors as well as the differences between selection and allocation stage.
    Keywords: Foreign aid; Assistance; Health; Aid policy; MDGs
    JEL: F35 O15 O19
    Date: 2012
  15. By: Katharina Stepping (Colegio Carlo Alberto)
    Abstract: This paper analyzes the targeting of development assistance for health across countries in a multivariate regression framework, based on data from 22 bilateral donors to 160 recipients between 1990 and 2007. Donor characteristics, recipient characteristics and the donor-recipient-relationship are argued to be important determinants. The results show that health indicators influence the average allocation decision, but not to the same degree. HIV prevalence significantly increases aid receipts, while under-five mortality and maternal mortality are insignificant. The quality of the institutional environment in the recipient country, programmatic preferences of the donor and the relationship between donor and recipient also affect the average allocation pattern.
    Keywords: Foreign aid; Assistance; Health; Aid policy; MDGs
    JEL: F35 O15 O19
    Date: 2012
  16. By: Calzada, Joan; Iranzo Sancho, Susana
    Abstract: The literature on local services has focused on the effects of privatization and, if anything, has compared the effects of private and mixed public-private systems versus public provision. However, alternative forms of provision such as cooperatives, which can be very prevalent in many developing countries, have been completely ignored. In this paper, we investigate the effects of communal water provison (Comités Vecinales and Juntas Administrativas de Servicios de Saneamiento) on child health in Peru. Using detailed survey data at the household- and child-level for the years 2006-2010, we exploit the cross-section variability to assess the differential impact of this form of provision. Despite controlling for a wide range of household and local characteristics, the municipalities served by communal organizations are more likely to have poorer health indicators, what would result in a downward bias on the absolute magnitude of the effect of cooperatives. We rely on an instrumental variable strategy to deal with this potential endogeneity problem, and use the personnel resources and the administrative urban/rural classi fication of the municipalities as instruments for the provision type. The results show a negative and signi cant effect of comunal water provision on diarrhea among under- five year old children. Keywords: water utilities, cooperatives, child health, regulation, Peru. JEL Classi fication Numbers: L33; L50; L95
    Keywords: Aigua -- Abastament, Infants -- Salut i higiene, Perú, Cooperatives, Aigües residuals, 338 - Situació econòmica. Política econòmica. Gestió, control i planificació de l'economia. Producció. Serveis. Turisme. Preus,
    Date: 2012
  17. By: Christine Le CLAINCHE; Jerome WITTWER
    Abstract: Risky behaviours are found to substantially increase medical and social costs and mortality. In this paper, we document the extent to which a sample of European students (from Denmark, France, Italy and Sweden) consider that individuals should assume the financial burden of paying the costs of risky behaviour. Using an empirical social choice methodology, we test in a positive manner the acceptability of different ways of financing costs due to ill-health more or less associated with risky behaviour in accordance with a normative framework relating to responsibility-sensitive fairness. We particularly check the sensitivity of our sample to responsibility in a health context with questions that make it possible to clearly distinguish between risky behaviour under an individual’s control and circumstances beyond the individual’s control. The health conditions chosen in this study are not life-threatening, but the specific disease varies in different parts of the survey. We find that the majority of students approve of responsibility-sensitive fairness but that the specific health context, the type of risky behaviours involved, and the framing all matter as determinants of the choices made by the individuals of our sample in the financing of health care. We also find that students’ nationality has a small influence.
    Date: 2012–06
  18. By: Colantuoni, Francesca; Rojas, Christian
    Abstract: The scientific evidence on the effect of sugar consumption on obesity has propelled policy makers in several states across the U.S. to propose the imposition of a tax on soft drinks. In this paper, we look at the effect of a 5.5% sales tax on soft drinks imposed by the state of Maine in 1991. We investigate this question by using sales data collected by scanner devices in Maine, Massachusetts, New York and Connecticut. This sample comprises stores that account for 82% of all grocery sales nationwide and includes brand-level sales data for the 1988-1992 period. We employ a difference-in-difference matching estimator (DIDM) that, in our setting, permits the comparison among treatment and control groups based on brand identity. Results suggest that Maine’s tax had a statistically insignificant impact on the overall consumption of soft drinks. This finding is robust to several alternative specifications.
    Keywords: Consumer/Household Economics, Demand and Price Analysis,
    Date: 2012
  19. By: Zeng, Di; You, Wen; Mills, Bradford; Alwang, Jeffrey; Royster, Michael; Studer, Kenneth; Anson-Dwamena, Rexford
    Abstract: Health disparities are abundantly recorded in literature, but is much less understood within a rural-urban context. In this paper, four major diseases in Virginia are studied: cancer, stroke, cardiovascular disease (heart disease) and chronic obstructive pulmonary disease (COPD). Separate count data regressions are estimated at regional level to provide a primary understanding of those factors. A simultaneous equations model with rural-urban specification are then estimated via seemingly unrelated regression (SUR) techniques to take account of possible causalities among these diseases as well as error correlations, which is followed by Blinder-Oaxaca decomposition of the disparity proportions explained by observed characteristics and unobserved mechanisms. The results suggest that regional-level factors are significantly correlated with health disparities between rural and urban areas. The unknown mechanisms behind these linkages are different between rural and urban areas, and explain an even larger proportion of these disparities.
    Keywords: Disparities, Rural-Urban, Count Data, SUR, Virginia, Health Economics and Policy,
    Date: 2012
  20. By: Allanson, Paul; Petrie, Dennis
    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,
    Date: 2012
  21. By: Tseng, Fu-Min; Petrie, Dennis
    Abstract: This paper uses an exogenous increase in income for a specific sub-group in Taiwan to explore the extent to which higher income leads to higher levels of health and wellbeing. In 1995, the Taiwanese government implemented the Senior Farmer Welfare Benefit Interim Regulation (SFWBIR) which was a pure cash injection, approximately US$110 (£70) per month in 1996, to senior farmers. A Difference-in-differences (DiD) approach is used on survey data from the Taiwanese Health and Living Status of Elderly in 1989 and 1996 to evaluate the short term effect of the SFWBIR on self-assessed health, depression, and life satisfaction. Senior manufacturing workers are employed as a comparison group for the senior farmers in the natural experiment because their demographic backgrounds are similar. This paper provides evidence that the increase in income from the SFWBIR significantly improved the mental health of senior farmers by reducing the scale of depression (CES-D) by 1.718, however, it had no significant short term impact on self-assessed health or life satisfaction.
    Keywords: social welfare benefit, life satisfaction, mental health, natural experiment, difference-in-differences,
    Date: 2012
  22. By: Dan Shane;; Pravin Trivedi;
    Abstract: This paper employs an econometric model to parse dierences in health care utilization attributable to private health insurance and differences due to self-selection into insurance status, with specifc interest in selection on unobservable traits such as insurance preference or attitude toward health risks. The model has two components, one component to model insurance outcome, the other to model demand for care measured as the annual number of doctor visits and prescriptions filled. Recognizing the endogeneity of health insurance, the model allows for correlated unobserved heterogeneity by assuming a latent factor structure. Values for these latent factors are drawn through simulation and the model is estimated using maximum simulated likelihood methods. For the observable characteristics that predict need for health services we find evidence of adverse selection. However, we also find evidence of advantageous selection on the unobservable characteristics common to insurance choice and utilization. In other words, unobserved heterogeneity that increases the chances of being uninsured isassociated with higher utilization. Given this selection decomposition, there is no inherent conflict in describing the influence of both adverse and advantageous selection in utilization comparisons. After controlling for selection, the insurance incentive effect (ex-post moral hazard) is positive and signifcant. For the average individual, switching from no coverage to full coverage would result in 2 additional visits to the doctor per year (+160%) and 8 additional prescriptions lled (+207%).
    Keywords: Health care; Health insurance; Adverse selection; Treatment eects model, Medical subsidy program
    JEL: I11 D82 C31 H51
    Date: 2012–06
  23. By: Masayoshi Hayashi (Graduate School of Economics, The University of Tokyo)
    Abstract: There are more than 1,700 municipalities serving as insurers in Japan’s system of National Health Insurance (NHI). The NHI has several institutional routes to buffer local premiums from abrupt changes in regional health demands that destabilize the NHI benefit expenditures. After briefly introducing the system of public health care in Japan, this study elaborates on the methods for quantifying the degree of stabilization of local public health care expenditures by critically evaluating the methods that have been utilized in the related literature and proposes a modified method appropriate for this study. It then quantifies the channels and degrees of stabilization using municipal NHI data in the 2000s.
    Date: 2012–04
  24. By: Kannan, Srinivasan; Sarma, Sankara P
    Abstract: Introduction. The study aims to gather information on level of work load among the women public health workers and factors associated with this in five districts of Kerala (Thiruvananthapuram, Alappuzha, Ernakulam, Malappuram and Wayanad). In the recent past, the occupational hazards of the nurses become a topic of interest. An increasing number of nurses are suffering back injuries on the job from lifting and moving patients. An Australia study found work and age related factors increase difficulties lead to perceived workload(Fragar and Depczynski 2011). Philibin study in Ireland on public health nurses’ role in changing society emphasized the need for defining and redesigning their role for better community service. Methodology:Primary data collection among the public health nurses (including staff nurses from CHCs) was done among 1238 respondents. In addition, Time and work study in selected work places (PHCs and SCs) and Qualitative studies also been done from the field area. The respondents include, Junior Public Health Nurses (JPHN), Junior Health Inspector (JHI), Staff nurses, Lady Health Inspectors (JHI) and Lady Health Supervisors (LHS). Findings: The workload had three important components, role overload, role stagnation and role distance. The prevalence of role overload among the public health nurses was 75.26%(95% CI*: 72.78, 77.59). While the prevalence of role stagnation was 55.62%(95% CI*: 52.84,58.37) and the prevalence of self role distance was 12.04% (95% CI*: 10.34,13.97). The role stagnation decreases with age (Chisquare test for trend p=0.004). The Role over load is higher among women and the role stagnation and self role distance are higher among men. There is an increasing workload for those who disagree that the training helped in upgrading skills and knowledge. Conclusion: The workload of the public health nurses is related to their, salary, doing additional duties such as managing funds, attending meetings, maintaining records and so on. All these affect their routine health delivery such as immunisation, special clinics, Mother and Child care, Adolescent care, communicable and non-communicable disease control and sanitation.
    Keywords: Nursing; Workload; Public Health Nurses; Kerala
    JEL: R53 D73 I18 J2
    Date: 2012–06
  25. By: Antón, José-Ignacio; Muñoz de Bustillo, Rafael; Fernández-Macías, Enrique; Rivera, Jesús
    Abstract: The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens’ satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996-2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain, we find that, in general, decentralization has not improved citizens’ satisfaction with different features of the health services. In fact, the only significant -though small- effects found were of the opposite sign, i.e., a reduction in satisfaction as a result of decentralization, regarding the following aspects of medical care: assistance in the primary care centers, waiting time before consultation, ease of getting appointments, confidence transmitted by doctors and the number of persons per hospital room.
    Keywords: health care; decentralization; Spain; citizens’ satisfaction
    JEL: H51 H11 H75
    Date: 2012–06–13
  26. By: Jayanta Sarkar (QUT); Dipanwita Sarkar (QUT)
    Abstract: The paper develops a theory of intergenerational persistence of child labour. Using an overlapping generations model with heterogeneous agents, we highlight the interaction between human capital inequality, health and child labour. The intergenerational evolution of human capital distribution is shown to generate multiple equilibria, leading to child-labour traps and polarisation of human capital. The results suggest that public provision of education can lead to perfect equality in the long run, but a ceteris paribus ban on child labour is likely to exacerbate both health and schooling outcomes for the poor.
    Keywords: Child labour, Health, Human capital, Inequality, Multiple equilibria, Polarisation
    JEL: I1 J2 O1
    Date: 2012–06–07
  27. By: Jenni Pääkkönen; Timo Seppälä
    Abstract: This paper evaluates the determinants of quality - cost relationship in primary health care. We first summarize information from various indicators of care by principal component analysis (PCA), effectively producing quality of care indicators: accessibility, coverage and allocative efficiency. We then regress the costs of care against these indicators to evaluate their relationship. Our results suggest that PCA may be used to produce quality of care indicators. Furthermore, the relationship between the costs and quality of care is complex. Better accessibility is reflected in higher costs, whereas the efficient allocation of resources will bring some cost savings.
    Keywords: Quality of care, principal component analysis
    JEL: H40 H51
    Date: 2012–05–28

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