nep-hea New Economics Papers
on Health Economics
Issue of 2012‒11‒03
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Internet's Dirty Secret: Assessing the Impact of Online Intermediaries on the Outbreak of Sexually Transmitted Diseases By Jason Chan; Anindya Ghose
  2. Modelling Primary Health Care Use: A Panel Zero Inflated Interval Regression Approach By Sarah Brown; Mark N. Harris; Jennifer Roberts; Karl Taylor
  3. Estimating Healthcare Demand for an Aging Population: A Flexible and Robust Bayesian Joint Model By Arnab Mukherji; Satrajit Roychowdhury; Pulak Ghosh; Sarah Brown
  4. Cost-containment policies in public pharmaceutical spending in the EU By Giuseppe Carone; Christoph Schwierz; Ana Xavier
  5. Did people "buy" what was "sold"? A qualitative evaluation a Contingent Valuation survey information set for gains in life expectancy By Rachel Baker; Anna Bartczak; Susan Chilton; Hugh Metcalf
  6. Women’s Empowerment and HIV Prevention in Rural Malawi By Gerritzen, Berit C.
  7. How bulimia nervosa relates to addictive behavior By Daniela Iorio; Michelle Sovinsky
  8. Healthcare Reform: The US Policy Debate By Zack Cooper
  9. Adverse Selection, Moral Hazard and the Demand for Medigap Insurance By Michael P. Keane; Olena Stavrunova
  10. Discrimination in a universal health system: Explaining socioeconomic waiting time gaps By Meliyanni Johar; Glenn Jones; Michael P. Keane; Elizabeth Savage; Olena Stavrunova
  11. A nonparametric Bayesian approach for counterfactual prediction with an application to the Japanese private nursing home market By Sugawara, Shinya
  12. The impact of husband's job loss on partners' mental health By Mendolia, Silvia
  13. Germs, Social Networks and Growth By Fogli, Alessandra; Veldkamp, Laura

  1. By: Jason Chan (Department of Information, Operations, and Management Sciences (IOMS), NYU Stern Business School); Anindya Ghose (Department of Information, Operations, and Management Sciences (IOMS), NYU Stern Business School)
    Abstract: We investigate how the expansion of Craigslist into different states over a 11 year period in the United States affected the incidence of HIV. Using a natural experiment setup, we identify the effects of Craigslist's entry on HIV trends by exploiting the variations across states and time. After controlling for extraneous factors, our results show that Craigslist's entry leads to a 19.8 percent increase in HIV cases, which maps out to an average of 158.7 cases for a state in a year. The analyses further suggest that non-market related casual sex serves as the underlying mechanism driving the increase in HIV cases, while paid transactions (e.g., escort services and prostitution) solicited on the site do not influence HIV trends. The increases in HIV cases as a result of Craigslist entry are estimated to impose treatment costs of over $118 million annually on the U.S. healthcare system. Study implications and limitations are discussed.
    Keywords: HIV, Entry, Online Platforms, Public Health
    JEL: C23 D83 I18 O33
    Date: 2012–06
  2. By: Sarah Brown (Department of Economics, The University of Sheffield); Mark N. Harris (Department of Econometrics and Quantitative Modelling, Curtin University, Australia); Jennifer Roberts (Department of Economics, The University of Sheffield); Karl Taylor (Department of Economics, The University of Sheffield)
    Abstract: We introduce the (panel) zero-inflated interval regression (ZIIR) model, to investigate GP visits using individual-level data from the British Household Panel Survey. The ZIIR is particularly suitable for this application as it jointly estimates the probability of visiting the GP and then, conditional on visiting, the frequency of visits (defined by given numerical intervals in the data). The results show that different socio-economic factors influence the probability of visiting the GP and the frequency of visits.
    Keywords: GP visits; panel data; zero-Inflated Interval Regression
    JEL: I10 C24 C25
    Date: 2012
  3. By: Arnab Mukherji (Centre for Public Policy, Indian Institute of Management Bangalore); Satrajit Roychowdhury (Expert Statistical Methodologist, Novartis Pharmaceutical Company); Pulak Ghosh (Department of QM & IS, Indian Institute of Management Bangalore); Sarah Brown (Department of Economics, The University of Sheffield)
    Abstract: In this paper, we analyse two frequently used measures of the demand for health care, namely hospital visits and out-of-pocket health care expenditure, which have been analysed separately in the existing literature. Given that these two measures of healthcare demand are highly likely to be closely correlated, we propose a framework to jointly model hospital visits and out-of-pocket medical expenditure. Furthermore, the joint framework allows for the presence of non-linear effects of covariates using splines to capture the effects of aging on healthcare demand. Sample heterogeneity is modelled robustly with the random effects following Dirichlet process priors with explicit cross-part correlation. The findings of our empirical analysis of the U.S. Health and Retirement Survey indicate that the demand for healthcare varies with age and gender and exhibits significant cross-part correlation that provides a rich understanding of how aging affects health care demand, which is of particular policy relevance in the context of an aging population.
    Keywords: aging; Bayesian methods; healthcare demand; joint model; splines
    JEL: C11 C14 I10
    Date: 2012
  4. By: Giuseppe Carone; Christoph Schwierz; Ana Xavier
    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. Drawing on various initiatives at the EU level related to the pharmaceutical sector, the paper also explores policy options for the EU.
    JEL: I11 I18
    Date: 2012–09
  5. By: Rachel Baker (Yunus Centre for Social Business and Health, Glasgow Caledonian University); Anna Bartczak (Warsaw Ecological Economics Center, Faculty of Economic Sciences, University of Warsaw); Susan Chilton (Newcastle University Business School); Hugh Metcalf (Newcastle University Business School)
    Abstract: A number of stated preferences studies have quantified the value of gains in life expectancy from pollution control and use a Value of a Life Year (VOLY) approach to calculate the value placed on avoiding premature mortality following exposure to such pollution. However, life expectancy gains are a complex concept and no attempt has been made, to date, to investigate peoples’ understanding of what it is they are being asked to value. This paper uses a structured debriefing exercise to qualitatively investigate an approach which explicitly emphasises how this gain is delivered. We find that, for the majority of respondents, the approach is effective in communicating the ongoing nature of the gain and reduces the use of the (incorrect) heuristic that it is an ‘add-on’ at the end of life, in poor health. Further refinements are required, however, to communicate the cumulative nature of these risk reductions and the lack of impact on quality of life.
    Keywords: air pollution reduction, contingent valuation, gain in life expectancy, information set and provision, qualitative debriefing survey, quality of life, Value of a Life Year (VOLY)
    JEL: I15 I18 Q51 Q53 Q56
    Date: 2012
  6. By: Gerritzen, Berit C.
    Abstract: Condom use and communication among sexual partners are important strategies for HIV prevention. Using a panel data set of more than 1,200 married women in rural Malawi from 1998-2008, this paper shows that adequate HIV prevention strategies, i.e. condom use within marriage and HIV-related spousal communication, are more widely used as women's bargaining power increases. I focus on different dimensions of women’s empowerment, namely personal and interpersonal empowerment. Among the proxies used for women's empowerment, own income, knowledge of other local languages and awareness of exit options from marriage are found to play a particularly important role in promoting adequate preventive behaviors. The main findings continue to hold after individual-specific fixed effects and time dummies are included in order to account for unobserved hetereogeneity and time trends.
    Keywords: HIV/AIDS, Sub-Saharan Africa, gender, development, spousal communication, condom use within marriage
    JEL: I14 O15 J16
    Date: 2012–10
  7. By: Daniela Iorio; Michelle Sovinsky
    Abstract: Using longitudinal data that tracks bulimic behavior among young girls (National Heart, Lung, and Blood Institute Growth and Health Study), we examine (1) whether bulimic behavior is consistent with addiction criteria as stated in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV (APA, 1994); and 2) whether the persistence in bulimia nervosa (BN) reflects tolerance formed from an addiction or if it can be attributed to slow learning about the deleterious health effects of BN. Making the case for treating BN as an addiction has important policy implications. First, it suggests that the timing of educational policy and treatment is crucial: preventive educational programs aimed at instructing girls about the deleterious health effects of BN, as well as treatment interventions, will be most effective if provided in the early stages. Second, it would put those exhibiting BN on more equal footing (from a treatment reimbursement perspective) with individuals with drug or alcohol addictions.
    Keywords: Eating disorders, bulimia nervosa, addiction
    JEL: I1
    Date: 2012–10
  8. By: Zack Cooper
    Abstract: The ability of the next US president to rein in spending on healthcare and improve the productivity of the healthcare system is largely going to determine the country's fiscal future. That is one of the conclusions of the latest in a series of US Election Analyses , published by the Centre for Economic Performance.
    Keywords: USA, Presidential election, politics, government policy, healthcare, public debt
    Date: 2012–10
  9. By: Michael P. Keane (Nuffield College, University of Oxford); Olena Stavrunova (University of Technology, Sydney, Australia)
    Abstract: The size of adverse selection and moral hazard eects in health insurance markets has important policy implications. For example, if adverse selection eects are small while moral hazard eects are large, conventional remedies for ineciencies created by adverse selection (e.g., mandatory insurance enrolment) may lead to substantial increases in health care spending. Unfortunately, there is no consensus on the magnitudes of adverse selection vs. moral hazard. This paper sheds new light on this important topic by studying the US Medigap (supplemental) health insurance market. While both adverse selection and moral hazard eects of Medigap have been studied separately, this is the rst paper to estimate both in an unied econometric framework. We develop an econometric model of insurance demand and health care expenditure, where adverse selection is measured by sensitivity of insurance demand to expected expenditure. The model allows for correlation between unobserved determinants of expenditure and insurance demand, and for heterogeneity in the size of moral hazard eects. Inference relies on an MCMC algorithm with data augmentation. Our results suggest there is adverse selection into Medigap, but the eect is small. A one standard deviation increase in expenditure risk raises the probability of insurance purchase by 0.037. In contrast, our estimate of the moral hazard eect is much larger. On average, Medigap coverage increases health care expenditure by 32%.
    Keywords: Health insurance, adverse selection, moral hazard, health care expenditure
    JEL: D82 C34 C35
    Date: 2012–10–23
  10. By: Meliyanni Johar (Economics Discipline Group, University of Technology, Sydney); Glenn Jones (Economics Discipline Group, University of Technology, Sydney); Michael P. Keane (Nuffield College, University of Oxford); Elizabeth Savage (Economics Discipline Group, University of Technology, Sydney); Olena Stavrunova (Economics Discipline Group, University of Technology, Sydney)
    Abstract: One of the core goals of a universal health care system is to eliminate discrimi- nation on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should re ect patients' clinical need with priority given to more urgent cases. Using data from Australia, we nd evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benet from variation in supply endowments. These results challenge the universal health system's core principle of equitable treatment.
    Keywords: Public hospital, waiting time, discrimination, decomposition analysis
    JEL: I11 J7 H51 C14 C21
    Date: 2012–10–23
  11. By: Sugawara, Shinya
    Abstract: This paper proposes a new inferential framework for structural econometric models using a nonparametric Bayesian approach. Although estimation methods based on moment conditions can employ a flexible estimation without distributional assumptions, they have difficulty conducting a prediction analysis. I propose a nonparametric Bayesian methodology for an estimation and prediction analysis. My methodology is applied to an empirical analysis of the Japanese private nursing home market. This market has a sticky economic circumstance, and my prediction simulates an intervention that removes this circumstance. The prediction result implies that the outdated circumstance in this market is harmful for consumers today.
    Keywords: Nonparametric Bayes; Nonlinear simultaneous equation model; Prediction; Industrial organization; Nursing home; Long-term care in Japan
    JEL: J14 L11 C11
    Date: 2012–10–23
  12. By: Mendolia, Silvia
    Abstract: The objective of this paper is to examine the impact of job loss on family mental well-being. The negative income shock can affect the mental health status of the individual who directly experiences such displacement, as well as the psychological well-being of his partner; also, job loss may have a significantly detrimental effect on life satisfaction, self-esteem and on the individual’s perceived role in society. This analysis is based on a sample of married and cohabitating couples from the first 14 waves of the British Household Panel Survey. In order to correct for the possible endogeneity of job loss, data from employment histories is utilised and redundancies (different from dismissals) in declining industries are used as an indicator of exogenous job loss. Results show evidence that couples in which the husband experiences a job loss are more likely to experience poor mental health.
    Keywords: Job loss Mental health Income shock Psychological well-being
    JEL: I00 J12
    Date: 2011–05–04
  13. By: Fogli, Alessandra; Veldkamp, Laura
    Abstract: Does the pattern of social connections between individuals matter for macroeconomic outcomes? If so, how does this effect operate and how big is it? Using network analysis tools, we explore how different social structures affect technology diffusion and thereby a country’s rate of technological progress. The network model also explains why societies with a high prevalence of contagious disease might evolve toward growth-inhibiting social institutions and how small initial differences can produce large divergence in incomes. Empirical work uses differences in the prevalence of diseases spread by human contact and the prevalence of other diseases as an instrument to identify an effect of social structure on technology diffusion.
    Keywords: development; disease; economic networks; growth; pathogens; social networks; technology diffusion
    JEL: E02 I1 O1 O33
    Date: 2012–10

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