nep-hea New Economics Papers
on Health Economics
Issue of 2012‒07‒08
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Intermediary and structural determinants of early childhood health in Colombia: exploring the role of communities By Ana Maria Osorio; Catalina Bolancé; Nyovani Madise
  2. Genetic testing with primary prevention and moral hazard By Bardey, David; De Donder, Philippe
  3. The Effect of U.S. Health Insurance Expansiosn on Medical Innovation By Jeffrey Clemens
  4. Improving Health Outcomes and System in Hungary By Mehmet Eris
  5. Cost of Traffic Injuries in Latin America By Esteban Diez-Roux; Kavi Bahlla
  6. Retiree Health Benefits as Deferred Compensation: Evidence from the Health and Retirement Study By James Marton; Stephen A. Woodbury
  7. Health insurance as a productive factor By Dizioli, Allan; Pinheiro, Roberto B.
  8. Automation of e-health systems through mobile devices and semantic technology By Abdullai, Besim
  9. The effect of publishing hospital charges on healthcare costs: Evidence from Singapore By Parinduri, Rasyad
  10. Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act Dependent Coverage Mandate By Yaa Akosa Antwi; Asako S. Moriya; Kosali Simon

  1. By: Ana Maria Osorio (University of Barcelona, Department of Econometrics, Barcelona-Spain and Pontificia Universidad Javeriana, Department of Economics, Cali-Colombia); Catalina Bolancé (University of Barcelona, Department of Econometrics, Barcelona-Spain); Nyovani Madise (University of Southampton, Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, Southampton-United Kingdom)
    Abstract: This study examines how structural determinants influence intermediary factors of child health inequities and how they operate through the communities where children live. In particular, we explore individual, family and community level characteristics associated with a composite indicator that quantitatively measures intermediary determinants of early childhood health in Colombia. We use data from the 2010 Colombian Demographic and Health Survey (DHS). Adopting the conceptual framework of the Commission on Social Determinants of Health (CSDH), three dimensions related to child health are represented in the index: behavioural factors, psychosocial factors and health system. In order to generate the weight of the variables and take into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations are employed in the index construction. Weighted multilevel models are used to examine community effects. The results show that the effect of household’s SES is attenuated when community characteristics are included, indicating the importance that the level of community development may have in mediating individual and family characteristics. The findings indicate that there is a significant variance in intermediary determinants of child health between-community, especially for those determinants linked to the health system, even after controlling for individual, family and community characteristics. These results likely reflect that whilst the community context can exert a greater influence on intermediary factors linked directly to health, in the case of psychosocial factors and the parent’s behaviours, the family context can be more important. This underlines the importance of distinguishing between community and family intervention programmes.
    Keywords: Child health, intermediary determinants, structural determinants, communities, Colombia.
    Date: 2012–06
  2. By: Bardey, David (University of Rosario (Colombia) and Toulouse School of Economics); De Donder, Philippe (Toulouse School of Economics (GREMAQ-CNRS and IDEI))
    Abstract: We develop a model where a genetic test reveals whether an individual has a low or high probability of developing a disease. A costly prevention effort allows high-risk agents to decrease this probability. Agents are not obliged to take the test, but must disclose its results to insurers, and taking the test is associated to a discrimination risk. We study the individual decisions to take the test and to undertake the prevention e¤ort as a function of the effort cost and of its efficiency. If effort is observable by insurers, agents undertake the test only if the effort cost is neither too large nor too low. If the effort cost is not observable by insurers, moral hazard increases the value of the test if the e¤ort cost is low. We offer several policy recommendations, from the optimal breadth of the tests to policies to do away with the discrimination risk.
    JEL: D82 I18
    Date: 2012–05–11
  3. By: Jeffrey Clemens (Stanford Institute for Economic Policy Research)
    Abstract: I study the effect of health insurance expansions on medical innovation. Practitioner dominated innovation (Roberts, 1988) creates an important role for the incentives in “local” payment systems as drivers of medical technology development. I show that, over the 15 years following Medicare and Medicaid’s passage, U.S.-based patenting shifted towards medical equipment by nearly 1.5 percentage points (50 percent) more than foreign patenting. This did not reflect a more general, U.S.-specific trend towards health-sector innovation; no such increase occurred among pharmaceutical patents, the markets for which were unaffected. Subsequent decreases in cost-sharing for all health spending are also associated with increases in U.S.-based patenting relative to foreign patenting in the relevant areas. Back-of-the-envelope calculations suggest that the dynamic effect of U.S. insurance expansions may account for around 25 percent of global medical-equipment innovation and 15 percent of the rise in U.S. health spending in hospitals, physicians’ offices, and other clinical settings from 1960 to 2010.
    JEL: O38 O31 H51 I11
    Date: 2012–06
  4. By: Mehmet Eris
    Abstract: Based on the latest available data up to 2009, the health status of the Hungarian population is among the poorest in the OECD, including countries with a similar level of income per capita. While this outcome has been driven by the socioeconomic status of the population and lifestyle risks, it also reflects the relatively limited effectiveness of the health care system, for which relatively low levels of resources have been available: total health spending amounted to 7.4% of GDP in 2009, lower than in other OECD countries with similar levels of income per capita. Although the health care system is generating significant health care outputs, such as doctor’s consultations and hospital discharges, problems with the quality of health services and the need to reallocate resources where they would contribute most to health outcomes suggest a need for reforms. Reforms are needed to address immediate challenges to stem the outflow of health care workers, reorganise care capacities, align incentives faced by providers and patients, and improve access to health care services. The medium–term challenge for the health care system is to increase available resources to significantly enhance health outcomes. As there are relatively weak mechanisms to regulate quality and prevent unnecessary care, further improving efficiency is also of key importance. This Working Paper relates to the 2012 OECD Economic Survey of Hungary (<P>Améliorer les résultats et le fonctionnement du système de santé en Hongrie<BR>Sur la base des données disponibles jusqu’en 2009, la situation de la population hongroise en matière de santé figure parmi les moins satisfaisantes de l’OCDE, même en tenant compte des pays où le revenu par habitant est similaire. Si ce résultat s’explique en partie par la situation socio-économique de la population et par les risques inhérents à son style de vie, il découle également du manque d’efficacité relatif du système de santé, dont les ressources sont assez faibles : en 2009, le total des dépenses de santé représentait 7.4 % du PIB, soit moins que dans les autres pays de l’OCDE présentant des niveaux similaires de revenu par habitant. En dépit d’un nombre important de prestations, dont témoignent, par exemple, les consultations médicales et les certificats de sortie des hôpitaux, les problèmes de qualité des services de santé et la nécessité d’une réaffectation des ressources vers des secteurs où elles pourraient contribuer au mieux à l’amélioration des résultats de santé suggèrent un besoin de réformes. Celles-ci sont nécessaires pour faire face aux défis immédiats : endiguer l’exode des professionnels de la santé, réorganiser les capacités de soins, harmoniser les incitations proposées aux prestataires et aux patients, et améliorer l’accès aux services de santé. À moyen terme, l’enjeu consiste à augmenter les ressources disponibles, de manière à renforcer sensiblement les résultats en matière de santé. Compte tenu de la faiblesse relative des mécanismes permettant de réglementer la qualité et d’éviter les prestations superflues, il est également crucial d’améliorer davantage l’efficience du système. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Hongrie, 2012 (
    Keywords: Hungary, spending efficiency, health care system, cost-effectiveness, access to health care, Hongrie, système de santé, accès aux soins de santé, efficacité des dépenses, efficacité-coût
    JEL: I11 I14 I18
    Date: 2012–05–23
  5. By: Esteban Diez-Roux; Kavi Bahlla
    Abstract: This presentation was given by Esteban Diez-Roux and Kavi Bahlla at the Ibero-American Road Safety Conference (CISEV) which took place in Bogota, Colombia in June, 2012. This presentation describes how the high rate of traffic accidents in Latin America places a burden on economies in the region. The authors present the methods and results of a study which assigns a monetary cost to these deaths and injuries as a percent of GDP. The presentation ends with conclusions and implications.
    Keywords: Health :: Health Care, Infrastructure & Transport :: Roads & Highways
    Date: 2012–06
  6. By: James Marton (Georgia State University); Stephen A. Woodbury (Michigan State University and W.E. Upjohn Institute)
    Abstract: Are early retiree health benefits (RHBs) a form of deferred compensation that binds workers to an employer? Most employers who offer RHBs offer them only to workers who have 10 or more years of tenure with the firm and have reached age 55. Accordingly, workers in firms offering RHBs have an incentive to stay with a firm in the years before they attain eligibility for RHBs, and a greater incentive than otherwise to retire thereafter. We test for the existence of such a pattern of incentives by examining the age-specific relationship between workers’ eligibility for RHBs and retirement. The findings suggest that workers in RHB-offering firms are less likely to retire at ages 50 and 51 than similar workers in firms that do not offer RHBs. Also, RHB-eligible workers aged 60 and 61 are more likely to retire than similar RHB-ineligible workers. Such a pattern is consistent with RHBs acting as part of a delayed-payment contract of the kind described by Lazear (1979, 1981).
    Keywords: Tax Subsidies, Health Insurance, Retirement, Employee Benefits, Deferred Compensation, Compensation Methods
    JEL: H25 I18 J26 J32 M52
    Date: 2012–03
  7. By: Dizioli, Allan; Pinheiro, Roberto B.
    Abstract: In this paper, we present a less-explored channel through which health insurance impacts productivity: by offering health insurance, employers reduce the expected time workers spend out of work in sick days. Using data from the Medical Expenditure Panel Survey (MEPS), we show that a worker with health coverage misses on average 52% fewer workdays than uninsured workers, after controlling for endogeneity. We develop a model that embodies this impact of health coverage in productivity. In our model, health insurance reduces the probability that a healthy worker gets sick, missing workdays, and it increases the probability that a sick worker recovers and returns to work. In our model, firms that offer health insurance are larger and pay higher wages in equilibrium, a pattern observed in the data. We calibrated the model using US data for 2004 and show the impact of increases in health costs, as well as of changes in tax benefits of health insurance expenses, on labor force health coverage and productivity. Finally, we show that a government mandate that forces firms to offer health insurance increases average wages and aggregate productivity while reducing aggregate profits, ultimately having a positive impact on welfare.
    Keywords: Health; Health Insurance; Labor Productivity; Labor Markets
    JEL: E62 E25 J32 J78 J63 E24 E20 I10
    Date: 2012–06–29
  8. By: Abdullai, Besim
    Abstract: In the time where the digital world is moving to mobile devices, new opportunities are emerging for the e-health systems. We live in the time when data are stored in different databases and different ways. This imposed the use of ontologies to resolve interoperability issues. Ontologies can be used for automation of e-health system data flow, enabling automated responses in real time to patient data entered into the medical record from Physicians and hospitals, and by offering caregivers evidence-based, best-practice information about how to act in emergency or nonemergency situations. Mobile e-health semantic systems help Physicians tracking better the health of their patients, avoid mistakes and act faster in emergency situations Semantic technology and database technology in combination with mobile devices together make a combined information system which will revolutionize the way how today’s health institutions treat their patients.
    Keywords: E-health; mobile computing; semantic technology; ontologies; system modelling
    JEL: I0 C88 L86 I1
    Date: 2012–06–01
  9. By: Parinduri, Rasyad
    Abstract: This paper examines the effect of publishing hospital charges on healthcare costs. We compare hospital charges before and after Singapore's Ministry of Health started publishing the statistics of hospital charges on its website in the late 2003. We do not find evidence of a decrease in healthcare costs. However, we find some evidence of an increase in cost dispersion, a decrease in patients' length of stay at hospitals, and an increase in hospital care cost per day.
    Keywords: hospital charges publication; healthcare costs; cost dispersion; Singapore
    JEL: I11 L10 D83
    Date: 2012
  10. By: Yaa Akosa Antwi; Asako S. Moriya; Kosali Simon
    Abstract: We study the impact of the recent Affordable Care Act (ACA) provision that required private health insurers to allow older child dependents to stay on parental policies until age 26 using data from the Survey of Income Program Participation (SIPP) spanning August 2008 to November 2011. By comparing outcomes for targeted young adults aged 19-25 to those who are slightly older and slightly younger, before and after the law, we find the ACA substantially reduced uninsurance among young adults. Young adults were 30 percent more likely to be on their parents’ employer policies on average after the staggered implementation commenced in September 2010, compared to before the enactment of the law. This increase in dependent coverage drew from both the uninsured and the otherwise insured. We also find evidence consistent with greater take-up among those with higher marginal benefits and lower marginal costs of obtaining dependent coverage, such as those whose parents already had family employer health insurance policies prior to the law. Dependent coverage increases are also greater for Whites relative to non-Whites, for single individuals relative to married individuals, and for non-students relative to students. We find no statistically significant difference in the impact of the provision on young adults who reside in states with and without some form of prior state dependent coverage mandate.
    JEL: I28
    Date: 2012–06

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