nep-hea New Economics Papers
on Health Economics
Issue of 2012‒10‒06
23 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Free Access to HAART and Pregnancy Response among HIV Patients: A Case Study from Cameroon By Miron Tequame
  2. Are Share Prices an Economic Barometer?: On the Relationship between Share Prices and Mental Health By Anita Ratcliffe; Karl Taylor
  3. Potential Effects of the Affordable Care Act on the Award of Life Care Expenses By Joshua Congdon-Hohman; Victor Matheson
  4. Early Life Health Interventions and Academic Achievement By Bharadwaj, Prashant; Loken, Katrine Vellesen; Neilson, Christopher
  5. The Declines in Infant Mortality and Fertility: Evidence from British Cities in Demographic Transition By Newell, Andrew T.; Gazeley, Ian
  6. A Dynamic Efficiency Rationale for Public Investment in the Health of the Young By Andersen, Torben M; Bhattacharya, Joydeep
  7. Should You Use Beta-MAX for Medicaid Research? Washington, DC: Mathematica Policy Research By Rosemary Borck; Rosalie Malsberger; Kristin Andrews
  8. Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable. Washington, DC: The Henry J. Kaiser Family Foundation By Marsha Gold; Julia Paradise
  9. Reporting Person-Level Separate CHIP Data to MSIS: A Guide for States Programmer's Supplement. Washington, DC: Mathematica Policy Research By Cheryl A. Camillo; Matthew Hodges; Stephen Kuncaitis; Paul M. Montebello; Ashley Zlatinov
  10. Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform By Aakvik, Arild; Holmås, Tor Helge; Kjerstad, Egil
  13. Physical limitations, depressive symptoms and cognitive problems: exploring the complex structure of un-health among older people in Italy By Marco Fuscaldo
  14. Handwashing behavior change at scale : evidence from a randomized evaluation in Vietnam By Chase, Claire; Do, Quy-Toan
  15. The power of beliefs: Evidence on the influence of trust on self-assessed health By Martin Ljunge
  16. Is Health Care a Necessity or a Luxury? New Evidence from a Panel of U.S. State-Level Data By Donald G. Freeman
  17. Income and Preventable Mortality: The Case of Youth Traffic Fatalities By Donald Freeman
  18. Taxes, Cigarette Consumption, and Smoking Intensity: Reply By Jérôme Adda; Francesca Cornaglia
  19. In brief: Mental illness and the NHS By Richard Layard
  20. Growth in Health Consumption and Its Implications for Financing OASDI: An International Perspective By Barry P. Bosworth; Gary Burtless
  21. The impact of private health insurers on the quality of Russian regional health systems By Galina Besstremyannaya; Jaak Simm
  22. Impacts of Patent Expiry and Regulatory Policies on Daily Cost of Pharmaceutical Treatments: OECD Countries, 2004-2010 By Berndt, Ernst R; Dubois, Pierre
  23. Maternal Stress and Child Outcomes: Evidence from Siblings By Anna Aizer; Laura Stroud; Stephen Buka

  1. By: Miron Tequame (Center for Research in the Economics of Development, University of Namur)
    Abstract: The HIV/AIDS epidemic has dramatically altered patterns of morbidity and mortality in Sub-Saharan Africa with potential consequences on fertility and population dynamics. We take advantage of a unique data-set collected in Cameroon among HIV positive patients and estimate the relationship between HAART treatment and (intended) pregnancy. HAART raises life expectancy, improves health outcomes and lowers the risk of transmission. These direct health benefits imply rational and behavioral responses in pregnancy as it allows individuals to accomplish their desired number of children. I con- duct a multivariate regression based on Before-After analysis to evaluate the effect of the 2007 policy of scaling-up HAART treatment in Cameroon on intended pregnancy. With respect to women not yet on treatment, HAART increased the propensity to pregnancy after one year with the coefficient increasing over time after 2007, when treatment was rendered free of charge. The results also show that pregnancy response is highest among people who have lower number of children pre-treatment and with CD4 counts above the average at treatment initiation. This means early treatment initiation, which results in better health outcomes, enhances pregnancy with respect to women who were too sick at treatment initiation. I discuss and test the different mechanisms that driving the behavioral response in YaoundŽ-Cameroon and exclude those that are less evident from the data.
    Keywords: HIV/AIDS, fertility, risky behavior
    Date: 2012–05
  2. By: Anita Ratcliffe (Department of Economics,); Karl Taylor (Department of Economics, The University of Sheffield)
    Abstract: This paper investigates the relationship between share prices and mental health, exploiting the availability of interview dates in the British Household Panel Survey to match the level and changes in the FTSE All Share price index to respondents over the period 1991-2008. We present evidence that the level, 6 month and yearly changes in the share price index are associated with better mental health while greater uncertainty, as measured by index volatility, is associated with poorer mental well-being. Finally, using several proxies of investor status, we find little evidence that this relationship is confined to holders of equity based assets, suggesting that the observed relationship does not arise via wealth effects. Instead, it appears as though share prices matter to mental health because they perform the role of economic barometer.
    Keywords: share prices; economic conditions; mental health
    JEL: J26 D12
    Date: 2012
  3. By: Joshua Congdon-Hohman (Department of Economics, College of the Holy Cross); Victor Matheson (Department of Economics, College of the Holy Cross)
    Abstract: Plaintiffs in personal injury lawsuits are entitled to compensation for future medical expenses. We argue that the “guaranteed issue” and “individual mandate” requirements of the recently passed Affordable Care Act (ACA) will allow victims to address their health needs through the purchase of a simple health insurance plan rather than direct compensation for an itemized list of health care needs. As such, damage awards for health expenditures should be capped at a maximum of $5,950 per year. Furthermore, the role of a life care planner should evolve into determining which life care expenses are covered under covered by the minimum insurance requirements mandated by the ACA and which entail additional expenditures beyond those covered by health insurance.
    Keywords: Health insurance, forensic economics, Affordable Care Act, tort reform
    JEL: I18 K41
    Date: 2012–09
  4. By: Bharadwaj, Prashant (University of California, San Diego); Loken, Katrine Vellesen (University of Bergen); Neilson, Christopher (Yale University)
    Abstract: This paper studies the effect of improved neonatal health care on mortality and long run academic achievement in school. We use the idea that medical treatments often follow rules of thumb for assigning care to patients, such as the classification of Very Low Birth Weight (VLBW), which assigns infants special care at a specific birth weight cutoff. Using detailed administrative data on schooling and birth records from Chile and Norway, we establish that children who receive extra medical care at birth have lower mortality rates and higher test scores and grades in school. These gains are in the order of 0.15-0.22 standard deviations.
    Keywords: child development, neonatal care, regression discontinuity
    JEL: I38 J13 J24
    Date: 2012–09
  5. By: Newell, Andrew T. (University of Sussex); Gazeley, Ian (University of Sussex)
    Abstract: At the beginning of the twentieth century Britain was roughly halfway through a 60-year demographic transition with declining infant mortality and birth rates. Cities exhibited great and strongly correlated diversity in these rates. We demonstrate cross-section correlations with, for instance, women's employment, population density, literacy and improved water supply and sanitation, that have been linked to the transition. When we analyse data from the late 1850s and the early 1900s, the changes in the two rates are not correlated across cities, but we find a robust and large impact from sanitation improvement to long-period infant mortality reduction. We also find the extension of basic literacy is related to increases in female labour market participation, which is in turn related to fertility reduction. Lastly we find that more rapid urban growth accelerates fertility decline, but, in late 19th century Britain it slowed the reduction of infant mortality.
    Keywords: fertility, infant mortality, education and sanitary reform, women's participation, education, 19th century and early 20th century Britain
    JEL: N33 J13 I15
    Date: 2012–09
  6. By: Andersen, Torben M; Bhattacharya, Joydeep
    Abstract: In this paper, we assume away standard distributional and static-efficiency arguments for public health, and instead, seek a dynamic efficiency rationale. We study a lifecycle model wherein young agents make health investments to reduce mortality risk. We identify a welfare rationale for public health under dynamic efficiency and exogenous mortalityeven when private and public investments are perfect substitutes. If health investment reduces mortality risk but individuals do not internalize its effect on the life-annuity interest rate, the Philipson-Becker effect emerges; when the young are net borrowers, it works together with dynamic efficiency to support a role for public health.
    Keywords: public health; moral hazard; overlapping generations; mortality risk
    JEL: E21 H3 I18
    Date: 2012–09–24
  7. By: Rosemary Borck; Rosalie Malsberger; Kristin Andrews
    Keywords: Medicaid, Beta-MAX, Health
    JEL: I
    Date: 2012–08–31
  8. By: Marsha Gold; Julia Paradise
    Keywords: MCO, enrollees, health, care, children
    JEL: I
    Date: 2012–09–30
  9. By: Cheryl A. Camillo; Matthew Hodges; Stephen Kuncaitis; Paul M. Montebello; Ashley Zlatinov
    Keywords: Children’s Health Insurance Program, CHIP, CHIP data, technical assistance; TA
    JEL: I
    Date: 2012–09–13
  10. By: Aakvik, Arild (Department of Economics, University of Bergen); Holmås, Tor Helge (UniRokkansenteret); Kjerstad, Egil (UniRokkansenteret)
    Abstract: A health policy reform aiming to reduce hospital waiting times and sickness absences, the Faster Return to Work (FRW) scheme, is evaluated by creating treatment and control groups to facilitate causal interpretations of the empirical results. We use a unique dataset on individuals where we match hospital data with social security data and socio-economic characteristics. The main idea behind the reform is that long waiting times for hospital treatment lead to unnecessarily long periods of sick leave. We find that the waiting period for treatment or consultation for FRW patients is 12–15 days shorter than for people on sick leave on the regular waiting list. This reduction is only partially transformed into a reduction in the total length of sick leave. On average, the reduction is approximately eight days. There is a significant difference between surgical and non-surgical patients.
    Keywords: waiting times; length of sick leave; policy reform and econometric evaluation
    JEL: C21 H51 I12
    Date: 2012–08–15
  11. By: Rieck, Karsten Marshall Elseth (Department of Economics, University of Bergen)
    Abstract: In several European countries, a paternity quota has been introduced as part of paid parental leave to provide incentives for fathers to increase their child care responsibilities and household involvement.In this paper, we explore the introduction of the first paternity quota in Norway in 1993. Through a regression discontinuity (RD) framework, we examine the sickness absence of parents who had children just before and after the reform—due to the parents’ own illness and to care for close family members. Our findings suggest that the amount of sick leave taken by fathers has increased in the short and long term and that the amount of sick leave taken by mothers has decreased, although the estimates are not statistically significant. The results are supported by standard RD and robustness tests. We also address the relevance of a composition bias resulting from the unobservable latent sick leave of non-employed individuals. This sensitivity check shows that their latent absence may affect the estimated treatment effect.
    Keywords: sickness absence; paternity leave; child care
    JEL: I38 J13 J22
    Date: 2012–06–24
  12. By: Rieck, Karsten Marshall Elseth (Department of Economics, University of Bergen); Vaage, Kjell (Department of Economics, University of Bergen)
    Abstract: We investigate whether a worker’s sickness absence is affected by her colleagues’ absences from the workplace. The analysis is based on unique matched employer-employee data for Norwegian schoolteachers for the period 2001 to 2006 with information on different types of absences and multiple teacher and school characteristics. Using different approaches where methodological problems such as the reflection problem and intra-group correlation are mitigated, we look for evidence of social interaction effects. Our results show that the significance of the social interaction effects critically depends on our ability to control for unobserved school characteristics.
    Keywords: Social interaction; peer effects; sickness absence
    JEL: C23 C31 H55 I38 J22
    Date: 2012–08–24
  13. By: Marco Fuscaldo
    Abstract: Although health has always been a multidimensional concept, the research on older peoplefs health has been mostly focused on specific dimension or disease, studied one at a time. The present work aims at understanding the complex associations among different indicators of older peoplefs un]health in Italy. In order to reach this purpose, the work uses the Italian panel of the Survey on Health, Ageing and Retirement in Europe (SHARE) and explores the associations among a wide range of indicators of health problems by applying a series of Confirmative Factor Analysis. Differences between men and women and between a numbers of age groups of old people are systematically scrutinized. Finally, a SEM is carried out in order to map the inter]relations of the retained un]health dimensions across time. The preferred representation of the data is a nested model that identified one global factor, which related to all manifest indicators, and four residual factors that measured the specific experiences of physical impairment, cognitive problems, affective suffering and motivational difficulties. The findings confirm the invariance of the proposed nested latent structure across time and improve our understanding about how health dimensions are connected over time.
    Keywords: health
    JEL: I14 J14
    Date: 2012–09
  14. By: Chase, Claire; Do, Quy-Toan
    Abstract: Handwashing with soap, which has been shown to reduce diarrhea in young children by as much as 48 percent, is frequently mentioned as one of the most effective and inexpensive ways to save children's lives. Yet rates of handwashing remain very low throughout the world. Handwashing with soap campaigns are de rigueur in developing countries, but little is known about their effectiveness. Few have been rigorously evaluated, and none on a large-scale. This paper evaluates a large-scale handwashing campaign in three provinces of Vietnam in 2010. Exposure to the campaign resulted in a slight increase in the availability of handwashing materials in the household, and caregivers in the treatment group were more likely to report washing hands at some of the times emphasized by the campaign. However, observed handwashing with soap at these times is low, and there isn't any difference between the treatment and control groups. As a result, no impact on health or productivity is found. These results suggest that even under seemingly optimal conditions, where knowledge and access to soap and water are not main constraints, behavior change campaigns that take place on a large scale face tradeoffs in terms of intensity and effectiveness.
    Keywords: Health Monitoring&Evaluation,Hygiene Promotion and Social Marketing,Food&Beverage Industry,Disease Control&Prevention,Population Policies
    Date: 2012–09–01
  15. By: Martin Ljunge (University of Copenhagen and SITE)
    Abstract: This paper estimates the influence of trust on self-assessed health. Second generation immigrants in a broad set of European countries with ancestry from across the world are studied. There is a significant positive effect of trust on selfassessed health. Health has both intrinsic and instrumental value. The finding provides evidence for one mechanism through which trust creates desirable outcomes. Individuals with high trust feel healthier. As health may promote a more productive life, it may be one channel through which trust increases national income. The results suggest policy put more emphasis on promoting social trust.
    Keywords: trust; self-assessed health; subjective health; intergenerational transmission; cultural transmission
    JEL: I12 D13 D83 Z13
    Date: 2012–08–28
  16. By: Donald G. Freeman (Department of Economics and International Business, Sam Houston State University)
    Abstract: This paper estimates the income elasticity of health care expenditures using annual data on health spending by state in the U.S. from 1966-2009. Panel stationarity tests incorporating structural breaks in the levels and trends in Health Care Expenditures and Disposable Personal Income yield inconsistent results, with stationarity rejected for HCE but not for DPI. Regression results using levels estimation robust to orders of integration differed considerably depending on time period, and the cross-state variation in elasticity estimates was quite large. Results of the first difference models provide more consistent estimates across time periods, whether expressed as averages of individual state estimates or as pooled time series. Income elasticities for the full sample fall in the range 0.21-0.22, below that of recent research.
    Date: 2012–08
  17. By: Donald Freeman (Department of Economics and International Business, Sam Houston State University)
    Abstract: The income-health gradient is a well-established finding in public health. This paper explores the gradient between income and different types of mortality: mortality that can be ameliorated via specific public policy measures, namely traffic fatalities, and mortality that is due to more “natural” causes, such as infectious disease. Using U.S. state-level data, growth in traffic mortality for 15-19 year-olds is shown to be more sensitive to initial levels of median income than growth in non-injury mortality. In addition, some but not all traffic safety legislation aimed at this age group is shown to be associated with lower mortality. Results are established via cross-section estimates, panel-data type models, and tests of one-step-ahead prediction
    Date: 2012–01
  18. By: Jérôme Adda; Francesca Cornaglia
    Abstract: This paper shows that smoking intensity, i.e. the amount of nicotine extracted per cigarette smoked, responds to changes in excise taxes and tobacco prices. We exploit data covering the period 1988 to 2006 across many US states. Moreover, we provide new evidence on the importance of cotinine measures in explaining long-run smoking behaviour and we investigate the sensitivity of smoking cessation to changes in excise taxes and their interaction with smoking intensity.
    Keywords: Tobacco, public health, compensatory behavior, excise taxes
    JEL: D12 H25 I12
    Date: 2012–09
  19. By: Richard Layard
    Abstract: Richard Layard and colleagues reveal the shocking scale of mental illness in Britain - and how little the NHS does about it.
    Keywords: Wellbeing, mental health, NHS, government policy
    Date: 2012–09
  20. By: Barry P. Bosworth; Gary Burtless
    Abstract: The rising cost of U.S. health care has reduced the share of compensation that is taxable by Social Security. Between 1960 and 2010, non-taxable employer premiums for worker health plans increased from 1 percent of employee compensation to 7 percent. We use international data to examine the determinants of trends in health care spending and the reasons that the U.S. experience has differed from that of other high-income countries. In 2010, the share of U.S. gross domestic product devoted to health care was 7.2 percentage points higher than the share in other rich countries. We document the growth of this gap in the past five decades. Much of it developed between 1980 and the mid-1990s, though we also find another episode of outsized growth in the early 2000s. We identify six countries, including most of Scandinavia, which have seen a slowdown in health spending growth. These were also countries that had higher-than expected health spending, given their average incomes, in the 1960s and 1970s. The slowdown in health expenditure growth may simply reflect a reversion of their spending toward the OECD mean. We find no mean reversion in U.S. health spending growth. Our review of other literature suggests that the current excess in U.S. health costs is mainly traceable to higher prices for health care goods and services. Compared with other OECD countries, the United States has been slow to develop institutions or global budget constraints that restrain the pace of growth in health costs.
    Date: 2012–09
  21. By: Galina Besstremyannaya (Center for Economic and Financial Research at New Economic School); Jaak Simm (Tokyo Institute of Technology, Graduate School of Information Science and Engineering)
    Abstract: The 1991 law ‘On health insurance for the citizens of the Russian Federation’ established that social health insurance is to be offered by multiple private insurance companies. The paper is the first econometric analysis measuring the effect of private health insurers on quality related outcomes of social health insurance (SHI) systems in Russian regions. The baseline model introduces regional SHI system as a binary variable with unity value corresponding to the presence of private health insurers as the only agents at the SHI market. The extended model captures endogeneity by employing an instrumental variable approach. The non-parametric model uses kernel regressions. The results of parametric and kernel regressions reveal that the presence of private insurers is a significant determinant of infant and under-five mortality. The positive impact of private insurers is explained by regional institutional reforms. The methods of provider reimbursement are related to infant and under-five mortality, which offers suggestive evidence for enabling insurer competition through selective contracting with health care providers.
    Keywords: social health insurance, infant mortality, under-five mortality, kernel regression, health care systems, health care quality, provider payment
    JEL: I10 I18 G22 R22
    Date: 2012–09
  22. By: Berndt, Ernst R; Dubois, Pierre
    Abstract: Cross-country variability in regulatory frameworks, industrial policy, physician/pharmacy autonomy, brand/generic distinctions, and in the practice of medicine contributes to ambiguous interpretations of pharmaceutical cost comparisons. Here we report cross-country comparisons that: (i) focus on 11 therapeutic classes experiencing patent expiration and loss of exclusivity 2004-2010 in eight industrialized countries; (ii) convert revenues and unit sales to cost per day of treatment and number patient days treated using the World Health Organizations’ Defined Daily Dosage metrics; (iii) compare patterns in costs per day of treatment with price index measures based on average price per day of treatment for each molecule computed over all molecule versions; (iv) utilizing econometric methods, model and quantify various factors affecting variations in daily treatment price indexes such as national regulatory and reimbursement policy changes, physician/pharmacy autonomy, and other factors; and (v) simulate changes in expenditures by country and therapeutic class had counterfactual policies been implemented.
    Keywords: cross-country comparisons; generic drugs; pharmaceutical costs
    JEL: D4 I11 I18 L11 L65 O34
    Date: 2012–09
  23. By: Anna Aizer; Laura Stroud; Stephen Buka
    Abstract: We study how maternal stress affects offspring outcomes. We find that in-utero exposure to elevated levels of the stress hormone cortisol negatively affects offspring cognition, health and educational attainment. These findings are based on comparisons between siblings which limits variation to short-lived shocks and controls for unobserved differences between mothers that could bias estimates. Our results are consistent with recent experimental results in the neurobiological literature linking exogenous exposure to stress hormones in-utero with declines in offspring cognitive, behavioral and motor development. Moreover, we find that not only are mothers with low levels of human capital characterized by higher and more variable cortisol levels, but that the negative impact of elevated cortisol is greater for them. These results suggest that prenatal stress may play a role in the intergenerational persistence of poverty.
    JEL: I12 I14 I24 J24
    Date: 2012–09

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