nep-hea New Economics Papers
on Health Economics
Issue of 2012‒09‒16
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health and Wealth of a Nation: Employer-Based Health Insurance and the Affordable Care Act. Kalamazoo, MI: W.E. Upjohn Institute for Employment Research By Nan L. Maxwell
  2. Public Procurement and Non-contractible Quality: Evidence from Elderly Care By Bergman, Mats A.; Lundberg, Sofia; Spagnolo, Giancarlo
  3. Mandatory Quality Disclosure and Quality Supply: Evidence from German Hospitals By Filistrucchi, L.; Ozbugday, F.C.
  4. Health, Fairness and Taxation By Valletta Giacomo
  5. Care regimes on the move: Comparing home care for dependent older people in Belgium, England, Germany and Italy. By Degavre, Florence
  6. Heterogeneity in expected longevities By Josep Pijoan-Mas; Jose-Victor Rios-Rull
  7. Coordinating Healthcare and Pension Policies : An Exploratory Study By Azad Singh Bali; Mukul G. Asher
  8. Financing Health Care Expenditure in the OECD Countries: Evidence from a Heterogeneous, Cross-Sectionally Dependent Panel By de Mello-Sampayo, Felipa; de Sousa-Vale, Sofia
  9. Early-Life Health and Adult Circumstance in Developing Countries By Janet Currie; Tom Vogl
  10. Consumer Inertia and Firm Pricing in the Medicare Part D Prescription Drug Insurance Exchange By Keith M. Marzilli Ericson
  11. Recessions, Older Workers, and Longevity: How Long Are Recessions Good For Your Health? By Courtney C. Coile; Phillip B. Levine; Robin McKnight

  1. By: Nan L. Maxwell
    Keywords: ACA, Affordable Care Act, Health Insurance, Employment
    JEL: I J
    Date: 2012–12–30
  2. By: Bergman, Mats A. (Södertörns högskola Institutionen för samhällsvetenskaper); Lundberg, Sofia (Department of Economics, Umeå University); Spagnolo, Giancarlo (Stockholm School of Economics)
    Abstract: Many quality dimensions are hard to contract upon and are at risk of degradation when the service is procured rather than produced in-house. On the other hand, procurement may foster performance-improving innovation. We assemble a large data set on elderly care services in Sweden for the 1990-2009 period, including survival rates, our measure of non-contractible quality, and indicators of subjectively perceived quality of service. We estimate the effects of municipalities’ decision to procure rather than produce in-house on non-contractible quality using a difference-in-difference approach and controlling for a number of other potential determinants. The results indicate that procurement significantly increases non-contractible quality as measured by survival rate, reduces the cost per resident but does not affect subjectively perceived quality.
    Keywords: incomplete contracts; privatization; procurement; quality; elderly care; mortality; outsourcing; nursing home; performance measurement
    JEL: H57 I18 L33
    Date: 2012–09–06
  3. By: Filistrucchi, L.; Ozbugday, F.C. (Tilburg University, Center for Economic Research)
    Abstract: Abstract: Using a newly constructed dataset on German hospitals, which includes 24 process and outcome indicators of clinical quality, we test whether quality has increased in various clinical areas since the introduction of mandatory quality reports and the online publication of part of the collected quality measures. Our results suggest that process indicators of clinical quality have increased significantly in 2008 compared to 2006. In addition, the hospitals underperforming in 2006 appear to have increased their clinical quality relatively more than the other hospitals. When instead quality is measured by outcome indicators, average clinical quality is estimated to have increased for underperforming hospitals and decreased for the best performing hospitals in 2006, so that on average across all hospitals the changes in outcome indicators are insignificant for just more than half of the outcome quality measures. We further show that the best performing hospitals in 2006 in terms of outcome quality measures experienced an increase in their share of patients in 2008, thus providing indirect evidence that patients react to disclosed quality. Interestingly, the best performing hospitals in 2006 in terms of process quality measures did not experience a significant change in their share of patients in 2008, thus suggesting that patients react more to output than to process measures of quality. Finally, for the subset of hospitals who offer services in obstetrics, we find that higher competitive pressure, measured as the number of competitors in a given radius, is associated with a higher increase in quality following quality disclosure. We argue that the latter effect is unlikely to be due to selection of patients by hospitals.
    Keywords: health care;hospitals;quality disclosure;quality competition;Germany.
    JEL: I11 I18 L15 C23
    Date: 2012
  4. By: Valletta Giacomo (METEOR)
    Abstract: We consider a model where agents differ in their preferences about consumption labor and health,in their (health-dependent) earning ability, and in their health disposition. We study the jointtaxation of income and health expenditure, under incentive-compatibility constraints, on the basisof efficiency and fairness principles. The fairness principles we consider propose, on one side,to reduce inequalities deriving from factors that do not depend on individuals'' responsibility. Onthe other side, redistribution should be precluded at least when all agents in the economy haveequal physical characteristics. We construct, on the basis of such principles, a particular socialwelfare function. Then we give the explicit formula for the comparison of tax policies: we provethat a tax reform should always benefit agents with the worst earning ability and the worst healthdisposition first. Finally, at the bottom of the income distribution the optimal tax scheme shouldexhibit non-uniform tax rates over health expenditure and non-positive average marginal tax ratesover income.
    Keywords: public economics ;
    Date: 2012
  5. By: Degavre, Florence
    Date: 2012
  6. By: Josep Pijoan-Mas; Jose-Victor Rios-Rull
    Abstract: We develop a new methodology to compute differences in the expected longevity of individuals who are in different socioeconomic groups at age 50. We deal with two main problems associated with the standard use of life expectancy: that people’s socioeconomic characteristics evolve over time and that there is a time trend that reduces mortality over time. Using HRS data for individuals from different cohorts, we estimate a hazard model for survival with time-varying stochastic endogenous covariates that yields the desired expected durations. We uncover an enormous amount of heterogeneity in expected longevities between individuals in different socioeconomic groups, albeit less than implied by a naive (static) use of socioeconomic characteristics. Our analysis allows us to decompose the longevity differentials into differences in health at age 50, differences in mortality conditional on health, and differences in the evolution of health with age. Remarkably, it is the latter that is the most important for most socioeconomic characteristics. For instance, education and wealth are health protecting but have little impact on two-year mortality rates conditional on health. Finally, we document an increasing time trend of all these differentials in the period 1992–2008, and a likely increase in the socioeconomic gradient in mortality rates in the near future. The mortality differences that we find have huge welfare implications that dwarf the differences in consumption accruing to people in different socioeconomic groups.
    Keywords: Life expectancy
    Date: 2012
  7. By: Azad Singh Bali (Asian Development Bank Institute (ADBI)); Mukul G. Asher
    Abstract: Rapid ageing of the population globally represents an unprecedented historical trend. As pension and healthcare costs are positively correlated with rising incomes, ageing, urbanization, and a shift from communicable to life-style diseases, managing these costs is a major challenge. There are many linkages between healthcare and pension arrangements—in terms of costs, exposure to risks, and as they jointly impact on crucial policy decisions. This paper discusses the rationale for coordination between various programs to better manage the cost of ageing. The current difficult macroeconomic environment, including fiscal stringency conditions, strengthens the case for such coordination.
    Keywords: Pension, health care, coordination of healthcare and pension programs
    JEL: J1 J4
    Date: 2012–08
  8. By: de Mello-Sampayo, Felipa; de Sousa-Vale, Sofia
    Abstract: This paper analyses the relationship between health expenditure and the way it is financed using a panel of 30 OECD countries observed since the 1990s. In particular, the nonstationarity and cointegration properties between health care spending and its sources of funding, income and non-income variables are studied. This is performed in a panel data context controlling for both cross-section dependence and unobserved heterogeneity. The findings suggest that when health care expenditure is mainly nanced by government it becomes highly inelastic, with an income elasticity much smaller than expected, controlling for dependency rates for old and young age structure and technological progress.
    Keywords: Health Expenditure; Drivers of Health Expenditure; Panel Unit Root Tests; Panel Cointegration; Cross Section Dependence model
    JEL: H51 C33 I10
    Date: 2012–03–01
  9. By: Janet Currie; Tom Vogl
    Abstract: A growing literature documents the links between long-term outcomes and health in the fetal period, infancy, and early childhood. Much of this literature focuses on rich countries, but researchers are increasingly taking advantage of new sources of data and identification to study the long reach of childhood health in developing countries. Health in early life may be a more significant determinant of adult outcomes in these countries because health insults are more frequent, the capacity to remediate is more limited, and multiple shocks may interact. However, the underlying relationships may also be more difficult to measure, given significant mortality selection. We survey recent evidence on the adult correlates of early-life health and the long-term effects of shocks due to disease, famine, malnutrition, pollution, and war.
    JEL: I12 I15 J24 O15
    Date: 2012–09
  10. By: Keith M. Marzilli Ericson
    Abstract: I use the Medicare Part D prescription drug insurance market to examine the dynamics of firm interaction with consumers on an insurance exchange. Enrollment data show that consumers face switching frictions leading to inertia in plan choice, and a regression discontinuity design indicates initial defaults have persistent effects. In the absence of commitment to future prices, theory predicts firms respond to inertia by raising prices on existing enrollees, while introducing cheaper alternative plans. The complete set of enrollment and price data from 2006 through 2010 confirms this prediction: older plans have approximately 10% higher premiums than comparable new plans.
    JEL: H51 I1 I11 I18 I28 L11 L38 L51
    Date: 2012–09
  11. By: Courtney C. Coile; Phillip B. Levine; Robin McKnight
    Abstract: This paper examines the impact of exposure to higher unemployment rates in the pre-retirement years on subsequent mortality. Although past research has found that recessions reduce contemporaneous mortality, these short-term effects may reverse over time, particularly for older workers. If workers experience an economic downturn in their late 50s, they may face several years of reduced employment and earnings before “retiring” when they reach Social Security eligibility at age 62. They also may experience lost health insurance, and therefore higher financial barriers to health care, through age 65, when Medicare becomes available. All of these experiences could contribute to weaker long-term health outcomes. To examine these hypotheses, we use Vital Statistics mortality data between 1969 and 2008 to generate age-specific cohort survival probabilities at older ages. We then link these survival probabilities to labor market conditions at earlier ages. We also use data from the 1980-2010 March Current Population Surveys and the 1991-2010 Behavioral Risk Factor Surveillance System surveys to explore potential mechanisms for this health effect. Our results indicate that experiencing a recession in one’s late 50s leads to a reduction in longevity. We also find that this exposure leads to several years of reduced employment, health insurance coverage, and health care utilization which may contribute to the lower long-term likelihood of survival.
    JEL: I18 J26
    Date: 2012–09

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