nep-hea New Economics Papers
on Health Economics
Issue of 2012‒07‒23
twenty-six papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Dispersion of Age Differences between Partners and the Asymptotic Dynamics of the HIV Epidemic By Hippolyte D'Albis; Emmanuelle Augeraud-Véron; Elodie Djemaï; Arnaud Ducrot
  2. What drives Health Care Expenditure in France since 1950? By Thomas Barnay; Olivier Damette
  3. Simultaneous causality between health status and employment status within the population aged 30-59 in France By Thomas Barnay; François Legendre
  4. Avoiding Blinding to Health Status: A New Class of Health Achievement and Inequality Indices By Paul Makdissi; Myra Yazbeck
  5. How Financial Incentives Induce Disability Insurance Recipients to Return to Work By Kostøl, Andreas Ravndal; Mogstad, Magne
  6. The Effects of Pharmacological Treatment of ADHD on Children's Health By Dalsgaard, Søren; Nielsen, Helena Skyt; Simonsen, Marianne
  7. Nudges at the Dentist By Altmann, Steffen; Traxler, Christian
  8. Do people have a preference for increasing or decreasing pain? An experimental comparison of psychological and economic measures in health related decision making By Eike Kroll; Judith Trarbach; Bodo Vogt
  9. State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India - Working Paper 298 By Victoria Fan, Anup Karan, and Anjay Mahal
  10. Value for Money in Malaria Programming: Issues and Opportunities - Working Paper 291 By Paul Wilson; Ya'ir Aizenman
  11. Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009 By Marion Devaux; Michael de Looper
  12. Competition between Managed Care Organizations and Indemnity Plans in Health Insurance Markets By Edmond Baranes; David Bardey
  13. The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data By Corinna Hentschker; Roman Mennicken
  14. The health effects of universal health care : evidence from Thailand By Wagstaff, Adam; Manachotphong, Wanwiphang
  15. Ownership and Hospital Productivity By Dormont, Brigitte; Milcent, Carine
  16. Health Inequality across Populations of Individuals By David SAHN
  17. Why Do State Disability Application Rates Vary Over Time? By Norma B. Coe; Kelly Haverstick; Alicia H. Munnell; Anthony Webb
  18. What Explains Variation in Disability Application Rates Across States? By Norma B. Coe; Kelly Haverstick; Alicia H. Munnell; Anthony Webb
  19. Is health wealth? Results of a panel data analysis By Dutta, Mousumi; Husain, Zakir; Chowdhary, Nidhi
  20. The effect of female and male health on economic growth: cross-country evidence within a production function framework By Hassan, Gazi; Cooray , Arusha
  21. Use of hospital services and socio-economic status in urban India: Does health insurance ensure equitable outcomes? By Dutta, Mousumi; Husain, Zakir
  22. Opportunities and challenges of health management information system in India: a case study of Uttarakhand By Husain, Zakir; Saikia, Nandita; Bora, R.S.
  23. VIH/Aids and alcohol: re-examination of the relation from african data By Kodila-Tedika, Oasis
  24. Factors influencing quality of life in patients with active tuberculosis in Pakistan By Masood, Sarwar Awan; Muhammad , Waqas; Muhammad , Amir Aslam
  25. Prevention of Mother-to-Child Transmission of HIV and Reproductive Behavior in Zambia By Nicholas Wilson
  26. Health and Work At Older Ages: Using Mortality To Assess Employment Capacity Across Countries By Kevin S. Milligan; David A. Wise

  1. By: Hippolyte D'Albis (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon Sorbonne); Emmanuelle Augeraud-Véron (MIA - Mathématiques, Image et Applications - Université de La Rochelle : EA3165); Elodie Djemaï (LEDa - Laboratoire d'Economie de Dauphine - Université Paris IX - Paris Dauphine, DIAL - Développement, institutions et analyses de long terme - IRD); Arnaud Ducrot (IMB - Institut de Mathématiques de Bordeaux - CNRS : UMR5251 - Université Sciences et Technologies - Bordeaux I - Université Victor Segalen - Bordeaux II)
    Abstract: In this article, the effect of a change in the distribution of age differences between sexual partners on the dynamics of the HIV epidemic is studied. In a gender and age structured compartmental model, it is shown that if the variance of the distribution is small enough, an increase in this variance strongly increases the basic reproduction number. Moreover, if the variance is large enough, the mean age difference barely affects the basic reproduction number. We therefore conclude that the local stability of the disease-free equilibrium relies more on the variance than on the mean.
    Keywords: Epidemiological models.
    Date: 2012–04
  2. By: Thomas Barnay (ERUDITE - Equipe de Recherche sur l'Utilisation des Données Individuelles Temporelles en Economie - Université Paris XII - Paris Est Créteil Val-de-Marne : EA437 - Université Paris Est Marne-la-Vallée); Olivier Damette (ERUDITE - Equipe de Recherche sur l'Utilisation des Données Individuelles Temporelles en Economie - Université Paris XII - Paris Est Créteil Val-de-Marne : EA437 - Université Paris Est Marne-la-Vallée)
    Abstract: Using the French annual database (1950-2009), we conducted a time-series analysis to explain the role of GDP per capita on HCE (Health Care Expenditure) per capita taking into account structural breaks and non-linearity in the long-term economic relationship between HCE and GDP, controlling for price effect, population ageing, innovation proxy and medical density. We show that the non-linearity of the long-run relationship between HCE and GDP comes from both the presence of a structural break and non-linearity explained by a transition variable (by constructing a smooth transition cointegrating regression). More precisely, lower GDP elasticity is explained by an exogenous shock linked to health system policies in the mid 1980's (break analysis) and endogenously driven changes in the health care system via medical density in France.
    Keywords: health expenditure; time series; GDP
    Date: 2012–05–01
  3. By: Thomas Barnay (ERUDITE - Equipe de Recherche sur l'Utilisation des Données Individuelles Temporelles en Economie - Université Paris XII - Paris Est Créteil Val-de-Marne : EA437 - Université Paris Est Marne-la-Vallée); François Legendre (ERUDITE - Equipe de Recherche sur l'Utilisation des Données Individuelles Temporelles en Economie - Université Paris XII - Paris Est Créteil Val-de-Marne : EA437 - Université Paris Est Marne-la-Vallée)
    Abstract: Economic literature clearly establishes the link between socio-economic status, good health and a high level of education. Health status also appears to be a determining factor in an individual's present and future preferences (Disney et al., 2006). The relationship between health status and employment status is the subject of numerous research studies and can be apprehended from the principle of double causality: healthy worker effect and reverse causality (Currie and Madrian, 1999). We focus on these both noncontradictory and potentially simultaneous working assumptions. The aim of this work is to simultaneously measure the effects of health-related selfselection on employment status and the reverse causality effect within the population aged 30-59 in France by using an original method of SBOP (Simultaneous Bi-Ordered Probit Model).
    Date: 2012–07–16
  4. By: Paul Makdissi (Department of Economics, University of Ottawa, 55 Laurier E., Ottawa,Ontario); Myra Yazbeck (CIRPÉE and Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montreal, CanadaTemplate-Type: ReDIF-Paper 1.0)
    Abstract: This paper argues that health transfers from an individual at a lower rank in the health distribution to a person at a higher rank may decrease the concentration index if the former has a slightly higher income. The concentration index, being mainly focused on the socio-economic dimension of health inequality, can produce such counter-intuitive results that overlook the pure health inequality aversion of the planner. Building on Atkinson (1970), Yitzhaki (1983) and Wagstaff (2002), this paper presents a simple new class of health achievement and health inequality indices that overcomes the above mentioned problem.
    Keywords: Health inequality, Health Achievement
    JEL: D63 I10
    Date: 2012
  5. By: Kostøl, Andreas Ravndal (Statistics Norway); Mogstad, Magne (University College London)
    Abstract: Disability Insurance (DI) programs have long been criticized by economists for apparent work disincentives. Some countries have recently modified their programs such that DI recipients are allowed to keep some of their benefits if they return to work, and other countries are considering similar return-to-work policies. However, there is little empirical evidence of the effectiveness of programs that incentivize the return to work by DI recipients. Using a local randomized experiment that arises from a sharp discontinuity in DI policy in Norway, we provide transparent and credible identification of how financial incentives induce DI recipients to return to work. We find that many DI recipients have considerable capacity to work that can be effectively induced by providing financial work incentives. We also show that providing work incentives to DI recipients may both increase their disposable income and reduce program costs. Our findings also suggest that targeted policies may be the most effective in encouraging DI recipients to return to work.
    Keywords: disability insurance, financial incentives, labor supply, regression discontinuity design
    JEL: H53 H55 I18 J21
    Date: 2012–07
  6. By: Dalsgaard, Søren (University of Southern Denmark); Nielsen, Helena Skyt (Aarhus University); Simonsen, Marianne (Aarhus University)
    Abstract: We are the first to investigate longer-term effects of pharmacological treatment of ADHD on children's health. We rely on a difference-in-differences strategy while exploiting Danish register-based panel data for children born in 1990-1999. We study effects of treatment initiated between ages five and ten and document that treated children benefit in terms of fewer hospital contacts in general, fewer emergency ward contacts, and fewer injuries. Estimated effects are large: early treatment is effective in reducing the probability of at least one hospital contact in a given year with around 30% compared to the mean. Effects are significantly smaller in later cohorts where more children are diagnosed and treated.
    Keywords: ADHD, evaluation, health
    JEL: I1
    Date: 2012–07
  7. By: Altmann, Steffen (IZA); Traxler, Christian (University of Marburg)
    Abstract: We implement a randomized field experiment to study the impact of reminders on dental health prevention. Patients who are due for a check-up receive no reminder, a neutral reminder postcard, or reminders including additional information on the benefits of prevention. Our results document a strong impact of reminders. Within one month after receiving a reminder, the fraction of patients who make a check-up appointment more than doubles. The effect declines slightly over time, but remains economically and statistically significant. Including additional information in the reminders does not increase response rates. In fact, the neutral reminder has the strongest impact for the overall population as well as for important subgroups of patients. Finally, we document that being exposed to reminders repeatedly does neither strengthen nor weaken their effectiveness.
    Keywords: field experiment, reminders, nudges, memory limitations, prevention, dental health, framing
    JEL: D03 I11 C93
    Date: 2012–07
  8. By: Eike Kroll (Faculty of Economics and Management, Otto-von-Guericke University Magdeburg); Judith Trarbach (Faculty of Economics and Management, Otto-von-Guericke University Magdeburg); Bodo Vogt (Faculty of Economics and Management, Otto-von-Guericke University Magdeburg)
    Abstract: This paper investigates preferences for different health profiles, especially sequences of increasing and decreasing pain. We test conflicting predictions in terms of preferences over two painful sequences. The QALY concept relevant for the determination of different levels of health-related quality of life implies indifference, whereas behavioral theories find preferences related to ordering, following the peak-end-rule. Using an experimental design with real consequences we generate decisions about painful sequences induced by the cold pressor test. The results are compared with hypothetical choice data elicited using standard methods. We find that hypothetical methods reveal decisions in line with the peak-end-rule. However when it comes to real consequences of their decisions, subjects are on average not willing to pay for that preference.
    Keywords: pain, peak-end-rule, willingness-to-pay
    JEL: D8 C9
    Date: 2012–06
  9. By: Victoria Fan, Anup Karan, and Anjay Mahal
    Abstract: In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
    Keywords: health insurance; health expenditure; tertiary care; poverty; India
    JEL: I18 I38 G22
    Date: 2012–06
  10. By: Paul Wilson; Ya'ir Aizenman
    Abstract: Although there have been studies of the cost-effectiveness of particular malaria interventions, there has been less analysis of broader aspects of value for money in malaria programming. In this paper, Paul Wilson and Ya’ir Aizenman examine opportunities for value for money in malaria control, extensively analyzing the effectiveness of interventions and current trends in spending. The authors conclude that on the whole resources for malaria control are well spent, but also note some areas where meaningful efficiencies might be possible, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants. In some ways, improving value requires increasing the quality of services--for example, while changing insecticides might increase the cost of spraying mpaigns in the short run, it could save much larger amounts in the long run by forestalling resistance. In addition to these recommendations, this paper offers a framework for analyzing value for money in malaria and considers a comprehensive set of factors, from spatial heterogeneity in malaria transmission to mosquito resistance to insecticides. If better results can be achieved at lower cost--and often they can be--donors and recipients alike should better utilize such opportunities. This paper offers not only recommendations to achieve better results in malaria, but also a platform for evaluation of global health interventions that will be useful in future analyses.
    JEL: D61 I11 I15 I18 O14 O19
    Date: 2012–04
  11. By: Marion Devaux; Michael de Looper
    Abstract: This Working Paper examines income-related inequalities in health care service utilisation in OECD countries. It extends a previous analysis (Van Doorslaer and Masseria, 2004) to 2008-2009 for 13 countries, and adds new results for 6 countries, for doctor and dentist visits, and cancer screening. Quintile distributions and concentration indices were used to assess inequalities. For doctor visits, horizontal equity was assessed, i.e. the extent to which adults in equal need of physician care appear to have equal rates of utilisation. The paper considers the evolution of inequalities over time by comparing results with the previous study, as data permit. Health system financing arrangements are examined to see how these might affect inequalities in health service use.<BR>Ce document de travail examine les inégalités liées aux revenus dans l’utilisation des services de santé dans les pays de l’OCDE. Il met à jour une étude précédente (Van Doorslaer and Masseria, 2004) pour 13 pays, et inclut 6 nouveaux pays, utilisant des données de 2008-2009, portant sur les consultations de médecins et dentistes, et le dépistage du cancer. Les inégalités sont mesurées à l’aide de distributions par quintile et d’indices de concentration. Cette étude s’intéresse à l’équité horizontale pour les consultations de médecins, i.e. dans quelle mesure des adultes ayant un besoin égal de soins médicaux ont apparemment des taux identiques d’utilisation de soins. Elle examine l’évolution des inégalités en comparant les résultats avec l’étude précédente lorsque les données le permettent. Le cadre d’analyse s’intéresse aux caractéristiques de financement des systèmes de santé et à leurs possibles influences sur les inégalités d’utilisation des services de santé.
    Keywords: health care, private health insurance, inequality
    JEL: I14 I18
    Date: 2012–07–10
  12. By: Edmond Baranes; David Bardey
    Abstract: This paper examines a model of competition between two types of health insurers: Managed Care Organizations (MCOs) and “Conventional Insurers”. MCOs vertically integrate health care providers and pay them at a competitive price, while conventional insurers work as indemnity plans and pay the health care providers that are freely chosen by their policyholders at a wholesale price. This first difference is called input price effect. Moreover, we assume that policyholders put a positive value on providers. diversity supplied by their health insurance plan and that this value increases with their probability of disease. Due to the restricted choice of health care providers in MCOs, a risk segmentation occurs: policyholders who choose conventional insurers are characterized by a higher risk. Surprisingly, our results point out that the effects of this input price and risk segmentation can be countervailing and do not necessarily work in the same direction. More precisely, we show that vertical integration in health insurance markets can create an anti-raise rivals’ cost effect. Consequently, our results reveal that the penetration of vertical integration may decrease conventional insurers’ premiums, which is a sufficient condition to be Pareto-improving. After more than three decades of vertical integration waves, our model may also explain why we observe an interior equilibrium in which conventional insurers have survived.
    Date: 2012–07–03
  13. By: Corinna Hentschker; Roman Mennicken
    Abstract: This paper examines the effects of hospital case volume on quality of care on the example of intact abdominal aortic aneurysm (AAA) and hip fracture (HIP). We conduct the analysis on patient level with multiple logistic regression analysis. Quality is measured with a binary variable which indicates whether the patient has died in hospital. The results show that patients who are treated in hospitals with a higher case volume have on average a significantly lower probability of death.
    Keywords: Volume; hospital quality; mortality
    JEL: I12 I18
    Date: 2012–06
  14. By: Wagstaff, Adam; Manachotphong, Wanwiphang
    Abstract: This paper exploits the staggered rollout of Thailand’s universal health coverage scheme to estimate its impacts on whether individuals report themselves as being too ill to work. The statistical power comes from the fact that there is an average of 62,000 respondents in the labor force survey at each survey date and no less than 68 survey dates, most of which are just one month apart. The analysis finds that universal coverage reduced the likelihood of people reporting themselves to be too sick to work: the authors estimate the effect to be -0.004 one year after universal coverage and -0.007 three years after. The estimated effects are much larger among those age 65 and over. Universal coverage had a much larger effect on health (about four times larger) than the Village Fund scheme, which provided free credit to rural households through a subsidized microcredit scheme and which was rolled out around the same time as universal coverage.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Population Policies,Health Law
    Date: 2012–07–01
  15. By: Dormont, Brigitte; Milcent, Carine
    Abstract: There is ongoing debate about the effect of ownership on hospital performance as regards efficiency and care quality. This paper proposes an analysis of the differences in productivity and efficiency between French public and private hospitals. In France, public and private hospitals do not only differ in their objectives. They are also subject to different rules as regards investments and human resources management. In addition, they were financed according to different payment schemes until 2004: a global budget system was used for public hospitals, while private hospitals were paid on a fee-for-service basis. Since 2004, a prospective payment system (PPS) with fixed payment per stay in a given DRG is gradually introduced for both private and public hospitals. Payments generally differ for the same DRG, depending on whether the stay occurred in a private or public hospital. A convergence of payments between the nonprofit and for profit sectors was planned by 2018 by the previous government, but this project has been abandoned by the newly elected government. Pursuing such a convergence comes down to suppose that there are differences in efficiency between private and public hospitals, which would be reduced by the introduction of competition between these two sectors. The purpose of this paper is to compare the productivity of public and private hospitals in France. We try to assess the respective impacts, on productivity differences, of differences in efficiency, patient characteristics and production composition. We have chosen to estimate a production function. For that purpose, we have defined a variable measuring the volume of care services provided by each hospital, synthetizing the hospital multiproduct activity into one homogenous output. Our data comes from two administrative sources which record exhaustive information about French hospitals. Matching these two database provides us an original source of information, at the hospital-year level, about both the production composition (number of stays in each DRG), and production factors (number of beds, facilities, number of doctors, nurses, of administrative and support staff, etc.). We observe 1,604 hospitals over the period 1998-2003, of which 642 hospitals are public, 126 are private not-for-profit and 836 are private-for-profit. This database is relative to acute care and covers more than 95 % of French hospitals. We use a stochastic production frontier approach combined with hospitals fixed effects. We find that the lower productivity of public hospitals is not explained by inefficiency (distance to the frontier), but oversized establishments, patient characteristics and production characteristics (small proportion of surgical stays). Once patient and production characteristics are taken into account, large and medium sized public hospitals appear to be more efficient than private hospitals. As a result, payment convergence would provide incentives for public hospitals to change the composition of their supply for care.
    Date: 2012–07
  16. By: David SAHN (Centre d'Etudes et de Recherches sur le Développement International)
    Abstract: Health Inequality across Populations of Individuals
    Date: 2012
  17. By: Norma B. Coe; Kelly Haverstick; Alicia H. Munnell; Anthony Webb
    Abstract: Social Security Disability Insurance (SSDI) applicatons and benefit receipts vary greatly by state, which has led to concerns about potential inconsistencies in the way that states apply disability standards. An earlier brief concluded that more than 70 percent of the variation across states in SSDI application rates is explained by state health, demographic, and employment characteristics; state policies and politics explain very little. Another concern has been the growth in the SSDI program over time. This brief uses the same data as the earlier analysis to answer a related ques-tion: How much of the trends in SSDI application rates within states can be explained by the different factors? The discussion proceeds as follows. The first section provides background on the variation in SSDI application rates within states over time. The second recaps the model and the variables. The third section reports the results for a state and year fixed-effects model that identifies the changes within states that affect the SSDI application rates over time. To better understand the results, it also estimates equations for two types of SSDI applicants – those who apply to SSDI alone and lower-income individuals who apply concurrently to SSDI and Supplemental Security Income (SSI). The key finding is that when states limit the ability of insurance companies to price coverage based on an individual’s characteristics (“community rating”) and to deny coverage (“guaranteed issue”), SSDI application rates decline. This provocative result merits further exploration because it implies that health care reform, such as the Affordable Care Act, could have spill-over effects to the SSDI program.
    Date: 2012–01
  18. By: Norma B. Coe; Kelly Haverstick; Alicia H. Munnell; Anthony Webb
    Abstract: Social Security Disability Insurance (SSDI) applica­tions and benefit receipts vary greatly by state, which has led to concerns about potential inconsistencies in the way that states apply disability standards. This possibility has prompted numerous Congressional hearings and reports, and led the Social Security Advisory Board to express concern about the Social Security Administration’s ability to disentangle the potential causes. This brief, using a longer time period and more comprehensive list of variables than other studies, explores the extent to which health, demographic, and employment characteristics – as well as state policies or politics – explain the variation across states. The discussion proceeds as follows. The first sec­tion describes an individual’s SSDI application deci­sion and factors that may influence state-level applica­tion rates. The second section presents variables used to determine the underlying causes of the state-level variation in application rates. The third section sum­marizes the results. The conclusion is that the health, demographic, and employment characteristics of each state explain the largest variations in SSDI application rates. Politics have little effect. Interestingly, states that require employers to provide temporary disability insurance have lower SSDI application rates.
    Date: 2012–01
  19. By: Dutta, Mousumi; Husain, Zakir; Chowdhary, Nidhi
    Abstract: The objective of this paper is to determine whether health (measured by life expectancy at birth) contributes to economic growth and the functional form in which it influences per capita income. This links our study to the debate between Neo-classical and endogenous growth theorists on whether investment in human capital can sustain growth indefinitely. Data on 216 countries for the period 1980-2009 has been obtained from World Development Indicators dataset. This enables us to focus on a period characterized by globalization and demographic changes manifested in the form of population graying. Our findings confirm the importance of investment in human capital. But, in contrast to conclusions of endogenous growth models, we find evidence that benefit from increasing longevity tapers off. We conclude by pointing out that it is necessary to extend this study further by incorporating other dimensions of health that are not captured by life expectancy.
    Keywords: Life expectancy at birth; endogenous growth models; Neo-classical growth models; panel data; human capital
    JEL: C33 O40 I10
    Date: 2012–07–09
  20. By: Hassan, Gazi; Cooray , Arusha
    Abstract: It is widely believed by development economists that the role of human capital is one of the most fundamental determinants of economic growth. Sustained growth depends on the level of human capital whose stocks increase due to better education, higher levels of health, new learning and training procedure. The intuition that good health raises the level of human capital and has a positive effect on productivity and economic growth has been modelled by enodogenous growth theorists. But empirically ascertaining the causal relationship between health and growth is more difficult due to the possible existence of endogeneity between these two variables. We use a production function based approach and model the role of health as a regular factor of production. Additionally, we depart from all the previous literature by estimating the gender disaggregated effect of human health on economic growth. We adopt a constant return to scale production function that fits the data in the microeconometric literature on return to human capital. Using this particular production function, we disaggregate the measures of human capital by including male and female life expectancy and school enrolments. Allowing for the dynamics of TFP to be embedded in the production function we empirically test it in growth form using various estimators appropriate for our data. Our main finding is that male life expectancy has a positive effect on the growth of income while female life expectancy has a negative effect, controlling for unobserved time and country effects in a panel of 83 countries from 1960 - 2009. We use lag differences of life expectancy and school enrolments and lagged growth rates of other inputs as instruments for controlling the endogenity of health in the growth regressions. We check for the robustness of the results with use of ‘deletion diagnostics’ to identify influential observations and outliers. The results continue to show that male life expectancy has a positive effect on income growth while that of female has a negative effect.
    Keywords: Health and economic development; economic growth; endogeneity; panel data; TFP; convergence; economics of gender
    JEL: O47 I12 J16
    Date: 2012–02–01
  21. By: Dutta, Mousumi; Husain, Zakir
    Abstract: In recent years universal health coverage has become an important issue in developing countries. Successful introduction of such a social security system requires knowledge of the relationship between socio-economic status and usage of health care services. This paper examines this relationship, and analyzes the impact of introducing health insurance into the model, using data for India, a major developing country with poor health outcomes. In contrast to similar works undertaken for developed countries, results of the instrumental variable model estimated reveals that the positive relation between usage of in-patient services and socio-economic status persists even in the presence of health insurance. This implies that insurance is unable to eliminate the inequities in accessing health care services stemming from disparities in socio-economic status. In fact, the presence of a double moral hazard and adverse selection leads to further attenuation of inequity in the health care market. The study is based on unit level data from the “Morbidity and Health Care Survey” undertaken by the National Sample Survey Organization (2005-06).
    Keywords: Hospitalization; Health insurance; Strategic independence; Simultaneous equation system; SES-health gradient; India
    JEL: I11 C34
    Date: 2012–07–12
  22. By: Husain, Zakir; Saikia, Nandita; Bora, R.S.
    Abstract: The introduction of the National Rural Health Mission has increased the demand for micro-level data on population and health for use in monitoring, planning and programme implementation. This calls for the introduction of a Health Management Information System (HMIS). The launching of a national portal-based HMIS by Government of India in 2008 was a bold and innovative step. However, there are several challenges that must be overcome to develop HMIS as an effective tool for planning and monitoring. In particular, without training and motivating grass-root functionaries to report HMIS data in an accurate, timely manner and monitor its quality, HMIS data cannot be used for health sector planning. The study analyzed HMIS portal data in details in order to evaluate the quality of HMIS in Uttarakhand, a high focus state with a poor HMIS. It also documents challenges to improve HMIS based on a field survey at selected health facilities in the state.
    Keywords: Health Management Information System; Health policy; National Rural Health Mission; India
    JEL: C81 I10
    Date: 2012–07–11
  23. By: Kodila-Tedika, Oasis
    Abstract: This article re-examines the relationship alcohol and VIH/Aids, while resorting to another methodological approach that utilized by Fisher et al., (2007) and Kalichman et al. (2007). We confirm a direct relation of alcohol to the AIDS.
    Keywords: Africa; Alcohol; Determinant; HIV/Aids prevalence
    JEL: I12 O15 I10
    Date: 2012–06–01
  24. By: Masood, Sarwar Awan; Muhammad , Waqas; Muhammad , Amir Aslam
    Abstract: Evidently Tuberculosis remains a major threat to public health globally. Latterly academia with exertion dedication has tried to extract the health related quality of life of the people with active tuberculosis. Meager studies in Pakistan have tried to explore the factors that influences patient’s health related quality of life besides the disease. The intentions of this study were to scrutinize the factors that influences patient’s quality of life with active tuberculosis in Pakistan. By using SF-36, 120 patients of tuberculosis were interviewed at TB hospital Sargodha. Results reveals that female patients are enjoying better quality of life as compared to male and rural patient’s quality of life scores are better than urban patients. Multiple regression results show that disease severity, use of drugs and death threat are the factors that negatively affect the patients HRQOL.
    Keywords: HRQOL; TB; Pakistan
    JEL: I12 I1
    Date: 2012
  25. By: Nicholas Wilson
    Abstract: Prevention of mother-to-child transmission of HIV (PMTCT) is the single most effective HIV prevention intervention in practice today. Nonetheless, little reliable empirical evidence exists on the behavioral effects of PMTCT. This paper documents the rapid expansion of access to PMTCT in Zambia during the period 2000-2007 and provides some of the first evidence on the change in reproductive behavior associated with PMTCT scale-up. The results of a primarily descriptive analysis suggest that PMTCT may have generated increases in knowledge about PMTCT and MTCT, large reductions in child mortality and pregnancy rates, and smaller changes in breastfeeding rates. However, additional research is required to address the potential endogeneity of PMTCT availability.
    JEL: I10 J13
    Date: 2012–07
  26. By: Kevin S. Milligan; David A. Wise
    Abstract: While longevity increased substantially over the last 50 years and health at older ages has improved, labor force participation at older ages has declined. We use mortality rates as a marker for the “health capacity” to work at older ages in 12 OECD countries. Mortality rates can be compared across countries and over time within the same country. For a given level of mortality, we find employment rates of older men vary substantially through time and across countries. At each mortality rate in 2007, if men in France worked as much as men in the United States, they would work 4.6 years more over ages 55 to 69 than they actually did. Comparing the work and mortality of American men in 2007 to the base year of 1977, the same calculation yields 3.7 years more work. These findings suggest a large increase in the health capacity to work, as measured by mortality. The relationship between cross-country mortality and changes in work over time at older ages is weak, suggesting the take-up of this extra capacity to work has varied. However, the dispersion in employment given mortality is strongly influenced by the retirement incentives inherent in public pension programs.
    JEL: J14 J26
    Date: 2012–07

This nep-hea issue is ©2012 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.