nep-hea New Economics Papers
on Health Economics
Issue of 2012‒10‒27
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Management Evaluation of Public Hospital -Measurement from Factor Analysis- By Takako Nakajima; Kiheiji Nishida; Masashi Manabe
  2. Spatial Disparities in Hospital Performance By Gobillon, Laurent; Milcent, Carine
  3. Self-Rated Health Status of the Japanese and Europeans in Later Life: Evidence from JSTAR and SHARE By Fujii, Mayu; Oshio, Takashi; Shimizutani, Satoshi
  4. Armed conflict, household victimization, and child health in Côte d'Ivoire By Camelia Minoiu; Olga N. Shemyakina
  5. Generosity norms and intrinsic motivation in health care provision: evidence from the laboratory and the field By J. Michelle Brock; Andreas Lange; Kenneth L. Leonard
  6. Can governments do it better? Merger mania and hospital outcomes in the English NHS By Propper, C; Laudicella, M; Gaynor, M
  7. Cost-effectiveness of HIV testing in non-traditional settings – the HINTS study By Pizzo, E
  8. Hospital readmission rates: signal of failure or success? By Laudicella, M; Smith, PC
  9. Are you what you eat? Experimental evidence on risk preferences and health habits By Miraldo, M; Galizzi, MM
  10. Regional density of private dentists: Empirical evidence from Austria By Gächter, Martin; Schwazer, Peter; Theurl, Engelbert; Winner, Hannes
  11. Suit the action to the word, the word to the action: Hypothetical choices and real decisions in Medicare Part D By Kesternich, Iris; Heiss, Florian; McFadden, Daniel; Winter, Joachim
  12. A new axiomatic approach to the evaluation of population health By Jens L. Hougaard; Juan D. Moreno-Ternero; Lars P. Osterdal
  13. Cost-containment policies in public pharmaceutical spending in the EU By Carone, Giuseppe; Schwierz, Christoph; Xavier, Ana
  14. Reform of Ill-health Retirement Benefits for Police in England and Wales: The roles of National Policy and Local Finance By Rowena Crawford; Richard Disney
  15. Behavioral Hazard in Health Insurance By Katherine Baicker; Sendhil Mullainathan; Joshua Schwartzstein
  16. Is Psychological Well-being Linked to the Consumption of Fruit and Vegetables? By David G. Blanchflower; Andrew J. Oswald; Sarah Stewart-Brown

  1. By: Takako Nakajima (Ph.D. Candidate, Osaka School of International Public Policy (OSIPP)); Kiheiji Nishida (Specially Appointed Researcher, Department of Medical Economics and Management, Graduate School of Medicine, Osaka University); Masashi Manabe (Associate Professor, Graduate School of simulation Studies, University of Hyogo)
    Abstract: Japanese public hospitals are recently facing at difficult situation in their management, and some are in bankruptcies. In order to dismiss this situation, drastic management reforms are required. In this paper, we extracted 8 indexes for its management evaluation of financial managements, medical services and its cost efficiency by factor analysis. Applied these indexes for local public hospitals, we found that they could not keep enough number of doctors to maintain enough income opportunity they need, which greatly damaged their financial statuses. We have also discussed the stability of the indexes by comparing with the outcomes of DEA (Date Envelopment Analysis), mainly applied for evaluation of public hospitals efficiency. In results, we found that the information scores for management evaluation by our index and DEA have a possibility of independent. Itfs also indicates that it can be made misunderstandings if we discuss the management evaluation of public hospitalsf only by using each of the indexes extracted by factor analysis or DEAfs efficiency score.
    Keywords: Public Hospitals, Management evaluation, Factor analysis, Medical economics
    JEL: C1 H41 I1 L3
    Date: 2012–10
  2. By: Gobillon, Laurent (INED, France); Milcent, Carine (Paris School of Economics)
    Abstract: Using a French exhaustive dataset, this paper studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
    Keywords: spatial health disparities, economic geography, stratified duration model
    JEL: I11 C41
    Date: 2012–10
  3. By: Fujii, Mayu; Oshio, Takashi; Shimizutani, Satoshi
    Abstract: Using panel data from two surveys in Japan and Europe, we examine the comparability of the self-rated health of the middle-aged and elderly across Japan and the European countries and the survey periods. We find that a person’s own health is evaluated on different standards (thresholds) across the different countries and survey waves. When evaluated on common thresholds, the Japanese elderly are found to be healthier than their counterparts in the European countries. At the individual level, reporting biases leading to discrepancies between the changes in individuals’ SRH and their actual health over the survey waves are associated with age, education, and country of residence
    Keywords: self-rated health status, response bias, JSTAR, SHARE
    JEL: C42 I12
    Date: 2012–10
  4. By: Camelia Minoiu (International Monetary Fund); Olga N. Shemyakina (Georgia Institute of Technology)
    Abstract: We examine the effect of the 2002-2007 civil conflict in Côte d'Ivoire on children's health status using household surveys collected before, during, and after the conflict, and information on the exact location and date of conflict events. Our identification strategy relies on exploiting both temporal and spatial variation across birth cohorts to measure children's exposure to the conflict. We find that children from regions more affected by the conflict suffered significant health setbacks compared with children from less affected regions. We further examine possible war impact mechanisms using rich data on households' experience of war from the post-conflict survey. Our results suggest that conflict-induced economic losses, health impairment, displacement, and other forms of victimization are important channels through which conflict negatively impacts child health.
    Keywords: child health, conflict, height-for-age, sub-Saharan Africa
    JEL: I12 J13 O12
    Date: 2012
  5. By: J. Michelle Brock (EBRD); Andreas Lange (University of Hamburg); Kenneth L. Leonard (University of Maryland)
    Abstract: We examine the correlation between the generosity of clinicians – as measured in a laboratory experiment – and the quality of care in their normal practices under three different intrinsic incentive schemes. Specifically, we observe clinicians in their normal work environment, when a peer observes them and six weeks after an encouragement visit from a peer. Clinicians who give at least half of their endowment to a stranger in the laboratory (generous) provide 10 per cent better quality care than those who do not. In addition, the average clinician provides about 4 per cent better quality when observed by a peer and 10 per cent higher quality care after the encouragement visit. Importantly, we find that generous clinicians react to peer scrutiny and encouragement in the same way as non-generous clinicians. Many clinicians are intrinsically motivated to provide higher quality care. However, most clinicians respond to increased intrinsic incentives in the form of scrutiny and encouragement from peers.
    Keywords: intrinsic incentives, health care quality, altruism, professionalism, Tanzania, experimental economics, Hawthorne effect, Encouragement effect, Study effect
    JEL: I15 O19 C91 C93 J2
    Date: 2012–08
  6. By: Propper, C; Laudicella, M; Gaynor, M
    Date: 2012–01
  7. By: Pizzo, E
    Date: 2012–07
  8. By: Laudicella, M; Smith, PC
    Date: 2012–02
  9. By: Miraldo, M; Galizzi, MM
    Date: 2012–06
  10. By: Gächter, Martin (Oesterreichische Nationalbank); Schwazer, Peter (Department of Economics and Statistics, University of Innsbruck); Theurl, Engelbert (Department of Economics and Statistics, University of Innsbruck); Winner, Hannes (University of Salzburg)
    Abstract: Objectives: We investigated the determinants of disparities in the regional density of private dentists in Austria. Specifically, we focused on the relationship between the density of private dentists and their public counterparts, thereby controlling for other possible covariates of dentist density. Methods: Dentist density was measured at the district level. We used panel data of dentist density from 121 Austrian districts over the years 2001 to 2008. We applied a Hausman-Taylor framework to cope with possible endogeneity and to control for cross-district effects in the dentist density. Results: A significant negative relationship was found between the density of private and public dentists, indicating a substitution effect between the two dentist groups. A significant positive spatial relationship also existed for private and public dentists in the neighboring regions. Dental capacities in public and private hospitals and dental laboratories run by the public health insurance system did not have a significant effect on private dentist density. Conclusions: Although a strong negative relationship existed between private and public dentists within the districts, one should not draw the conclusion that private dentists in Austria are close substitutes for public dentists. Such a conclusion would require further empirical analysis on the utilization patterns of dental services and their relationships with financing mechanisms.
    Keywords: Competition in health care markets; dentist location and density; models with panel data
    JEL: I11 I18 I23
    Date: 2012–10–19
  11. By: Kesternich, Iris; Heiss, Florian; McFadden, Daniel; Winter, Joachim
    Abstract: In recent years, consumer choice has become an important element of public policy. One reason is that consumers differ in their tastes and needs, which they can express most easily through their own choices. Elements that strengthen consumer choice feature prominently in the design of public insurance markets, for instance in the United States in the recent introduction of prescription drug coverage for older individuals via Medicare Part D. For policy makers who design such a market, an important practical question in the design phase of such a new program is how to deduce enrollment and plan selection preferences prior to its introduction. In this paper, we investigate whether hypothetical choice experiments can serve as a tool in this process. We combine data from hypothetical and real plan choices, elicited around the time of the introduction of Medicare Part D. We first analyze how well the hypothetical choice data predict willingness to pay and market shares at the aggregate level. We then analyze predictions at the individual level, in particular how insurance demand varies with observable characteristics. We also explore whether the extent of adverse selection can be predicted using hypothetical choice data alone.
    Keywords: Medicare; health insurance demand; hypothetical choice experiments
    JEL: I11 C25 D12 H51 I18
    Date: 2012–10
  12. By: Jens L. Hougaard (Department of Food and Resource Economics, University of Copenhagen); Juan D. Moreno-Ternero (Department of Economics, Universidad Pablo de Olavide; CORE, Université catholique de Louvain); Lars P. Osterdal (Department of Business and Economics, University of Southern Denmark)
    Abstract: In this paper we explore the implications of normative principles for the evaluation of population health. We formalize those principles as axioms for social preferences over distributions of health for a given population. We single out several focal population health evaluation functions, which represent social preferences, as a result of combinations of those axioms. Our results provide new rationale for popular theories in health economics, such as the unweighted aggregation of quality-adjusted life years (QALYs) or healthy years equivalents (HYEs) and generalizations of the two, aimed to capture concerns for distributive justice, without resorting to controversial assumptions on individual preferences.
    Keywords: population health, social preferences, QALYs, HYEs, axioms
    JEL: D63 I10
    Date: 2012–10
  13. By: Carone, Giuseppe; Schwierz, Christoph; Xavier, Ana
    Abstract: This paper presents and evaluates pharmaceutical policies in the EU aimed at the rational use of medicines and at keeping pharmaceutical spending under control. Policy makers are growing more aware that by regulating pharmaceutical markets correctly, considerable savings can be achieved without compromising the quality of care. Specifically, the paper makes the case that, by following numerous best-practices in pharmaceutical sector regulations, the value for money of pharmaceutical consumption could be substantially increased. Appropriate regulations can be relevant for pricing, reimbursement, market entry and expenditure control, as well as specific policies targeted at the distribution chain, physicians and patients.
    Keywords: rational use of medicines, generic substitution, public pharmaceutical expenditure, pharmaceutical policies, cost-containment, value for money, pharmaceutical sector regulations
    JEL: H51 I18 I00 I1 I10
    Date: 2012–09–14
  14. By: Rowena Crawford; Richard Disney
    Abstract: We examine the ill-health retirement of police officers in the forces of England and Wales between 2002-03 and 2009-10. Differences in ill-health retirement rates across forces are statistically related to area-specific stresses of policing and force-specific differences in human resources policies. Reforms to police pension plans – in particular a shift in the incidence of financing ill-health retirement from central government to local police authorities – occurred in the mid-2000s. We show these measures impacted on the level of ill-health retirement, especially on forces with above-average rates of retirement. We find that residual differences in post-2006 ill-health retirement rates across forces are related to their differential capacities to raise revenue from local property taxes.
    JEL: H75 J26 J45
    Date: 2012–10
  15. By: Katherine Baicker; Sendhil Mullainathan; Joshua Schwartzstein
    Abstract: This paper develops a model of health insurance that incorporates behavioral biases. In the traditional model, people who are insured overuse low value medical care because of moral hazard. There is ample evidence, though, of a different inefficiency: people underuse high value medical care because they make mistakes. Such “behavioral hazard” changes the fundamental tradeoff between insurance and incentives. With only moral hazard, raising copays increases the efficiency of demand by ameliorating overuse. With the addition of behavioral hazard, raising copays may reduce efficiency by exaggerating underuse. This means that estimating the demand response is no longer enough for setting optimal copays; the health response needs to be considered as well. This provides a theoretical foundation for value-based insurance design: for some high value treatments, for example, copays should be zero (or even negative). Empirically, this reinterpretation of demand proves important, since high value care is often as elastic as low value care. For example, calibration using data from a field experiment suggests that omitting behavioral hazard leads to welfare estimates that can be both wrong in sign and off by an order of magnitude. Optimally designed insurance can thus increase health care efficiency as well as provide financial protection, suggesting the potential for market failure when private insurers are not fully incentivized to counteract behavioral biases.
    JEL: D01 D03 D8
    Date: 2012–10
  16. By: David G. Blanchflower; Andrew J. Oswald; Sarah Stewart-Brown
    Abstract: Humans run on a fuel called food. Yet economists and other social scientists rarely study what people eat. We provide simple evidence consistent with the existence of a link between the consumption of fruit and vegetables and high well-being. In cross-sectional data, happiness and mental health rise in an approximately dose-response way with the number of daily portions of fruit and vegetables. The pattern is remarkably robust to adjustment for a large number of other demographic, social and economic variables. Well-being peaks at approximately 7 portions per day. We document this relationship in three data sets, covering approximately 80,000 randomly selected British individuals, and for seven measures of well-being (life satisfaction, WEMWBS mental well-being, GHQ mental disorders, self-reported health, happiness, nervousness, and feeling low). Reverse causality and problems of confounding remain possible. We discuss the strengths and weaknesses of our analysis, how government policy-makers might wish to react to it, and what kinds of further research -- especially randomized trials -- would be valuable.
    JEL: I1
    Date: 2012–10

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