nep-hea New Economics Papers
on Health Economics
Issue of 2012‒12‒15
twelve papers chosen by
Yong Yin
SUNY at Buffalo

  1. Analyzing intersectoral convergence to improve child undernutrition in India: Development and application of a framework to examine policies in agriculture, health, and nutrition By Ved, Rajani; Menon, Purnima
  2. Free to Choose? Reform and Demand Response in the English National Health Service By Martin Gaynor; Carol Propper; Stephan Seiler
  3. Health Care Reforms and the Value of Future Public Liabilities By Kristopher J. Hult; Tomas J. Philipson
  4. Impact of Health Aid on Infant Mortality Rate By Yousuf, Ahmed Sadek
  5. Inequalities in Child Mortality in India: A District-Level Analysis By Prabir C. Bhattacharya; Cornilius Chikwama
  6. Long-term care: need, use and expenditure in the EU-27 By Barbara Lipszyc; Etienne Sail; Ana Xavier
  7. Longevity, pollution and growth By Natacha Raffin; Thomas Seegmuller
  8. Population Dynamics and Economic Growth: Should We Adopt Different Frameworks for Poor and Rich Countries? By Elise S. Brezis
  9. Putting Teenagers on the Pill: The Consequences of Subsidized Contraception By Grönqvist., Hans
  10. Social protection and cash transfers to strengthen familes affected by HIV and AIDS By Adato, Michelle; Bassett, Lucy
  11. The Gorbachev Anti-Alcohol Campaign and Russia's Mortality Crisis By Jay Bhattacharya; Christina Gathmann; Grant Miller
  12. Well-being of elderly people living in nursing homes: The benefits of making friends By François-Charles Wolff

  1. By: Ved, Rajani; Menon, Purnima
    Abstract: India’s record of undernutrition presents a stubborn challenge. Given the multiple determinants of child undernutrition, effective action to tackle this problem in India and globally requires a range of inputs across various sectors. Delivering nutrition-specific and nutrition-sensitive interventions to entire populations requires that these various sectors come together at critical points and in meaningful ways to ensure delivery of key nutrition-related actions for communities and households. However, currently in India, a major challenge is bringing sectors together to deliver for a common goal. Although the lack of convergence is well documented, there lingers a substantial gap in articulating what needs to be assessed to ensure that convergence is indeed happening, or not happening. In an effort to close this gap, in this paper we describe a possible framework to enable convergence across sectors for action on nutrition. Our framework notes that issues related to convergence must be resolved in relation to three major steps in the policy process: policy formulation, implementation, and monitoring and evaluation. We articulate here questions related to convergence that must be asked at each of these stages of the policy process. We also conduct a desk review to analyze health and nutrition policies in India for evidence of attention to these aspects of convergence.
    Keywords: Nutrition, Convergence, Policy, child malnutrition, undernourishment, Monitoring and evaluation, policy formulation, implementation, Health,
    Date: 2012
  2. By: Martin Gaynor; Carol Propper; Stephan Seiler
    Abstract: The impacts of choice in public services are controversial. We exploit a reform in the English National Health Service to assess the impact of relaxing constraints on patient choice. We estimate a demand model to evaluate whether increased choice increased demand elasticity faced by hospitals with regard to clinical quality and waiting time for an important surgical procedure. We find substantial impacts of the removal of restrictions. Patients became more responsive to clinical quality. Sicker patients and better informed patients were more affected. We leverage our model to calculate potential benefits. We find increased demand responsiveness led to a significant reduction in mortality and an increase in patient welfare. The elasticity of demand faced by hospitals increased post-reform, giving hospitals potentially large incentives to improve their quality of care and find suggestive evidence that hospitals responded strongly to the enhanced incentives due to increased demand elasticity. The results suggests greater choice can enhance quality.
    JEL: D12 I11 I18 L13 L30
    Date: 2012–11
  3. By: Kristopher J. Hult; Tomas J. Philipson
    Abstract: Many developed countries are grappling with the large public liabilities attributable to health care subsidy programs. However, there has been no explicit analysis by economists of how various reforms affect future spending growth and, consequently, how they affect future public program liabilities. We analyze how approval and reimbursement reforms affect public liabilities through their impact on the returns to medical innovation, which many argue is a central factor driving spending growth. We separate how reforms impact innovative returns through changes to expected cash flows, their risk-adjustment, and their timing and defaults implied by the approval process. We argue that the innovation effects of common reforms imply that cutbacks in government programs may raise government liabilities and expansions may lower them. We quantitatively calibrate the implications of these arguments for the US Medicare program and find that further means-testing the program may substantially raise innovative returns and thereby put upward pressure on Medicare liabilities.
    JEL: I1 I11 I18
    Date: 2012–11
  4. By: Yousuf, Ahmed Sadek
    Abstract: This paper examines the relationship between health aid and infant mortality, using data from in total 135 countries, between 1975 and 2010. According to the findings, aid comes to have a statistically significant and positive effect on infant mortality rate, as doubling of aid leads to an approximately 1.3% reduction in infant mortality rates. Thus for an average aid recipient country, doubling per capita aid leads to a reduction of about 790 deaths per million live births in a particular year. This effect, in comparison to the set goals of the Millennium Development Goals, is small and may not be enough to ensure that the MDG targets are met by 2015.
    Keywords: Health Aid; Infant Mortality Rate; System GMM
    JEL: F35 C23 C33 I10
    Date: 2012–10–12
  5. By: Prabir C. Bhattacharya; Cornilius Chikwama
    Abstract: This paper measures the degree of inequality in child mortality rates across districts in India, using data from the 1981, 1991 and 2001 Indian population censuses. The results show that child mortality is more concentrated in less developed districts in all three census years. Further, between 1981 and 2001, the inequality in child mortality seems to have increased to the advantage of the more developed districts (i.e., there was an increasing concentration of child mortality in less developed districts). However, the inequality in female child mortality rates seems to have declined between 1991 and 2001, even as it increased – albeit at a slower rate than before – for male child mortality rates. In the decomposition analysis, it is found that while a more equitable distribution of medical facilities and safe drinking water across districts did contribute towards reducing inequality in child mortality between 1981 and 1991, different levels of structural change among districts were responsible for a very large part of the inequality in child mortality to the advantage of the more developed districts in all three census years. Other variables which played important roles in increasing inequality included a measure of infrastructure development, female literacy, and a social group status variable. The paper concludes with some brief comments on the policy implications of the findings.
    Date: 2012
  6. By: Barbara Lipszyc; Etienne Sail; Ana Xavier
    Abstract: Public provision of long-term care (LTC) will pose an increasing challenge to the sustainability of public finances in the EU, due to an ageing population. In this view, the paper aims to provide indications on the timing and potential fiscal impact associated to changes in the demographic structure. The ageing of the population is expected to put pressure on governments to provide long-term care services as (very) old people often develop multi-morbidity conditions, which require not only long-term medical care but assistance with a number of daily tasks. This paper presents the projections of public expenditure on LTC in the long run (2060) under alternative assumptions. All scenarios project a non-negligible increase in public expenditure. All other things being equal, the expected increase in the demand for formal LTC support will vary across EU-27 Member States according to their current patterns of LTC provision: the balance between formal and informal care, the emphasis they put on institutional care, home care or provision of cash benefits, the supply constraints both in the formal and informal care sectors, the current average cost and coverage rate for each type of care and their distribution across age groups. The paper also discusses policy implications of the projection results.
    JEL: H51 I18 J14 J18
    Date: 2012–11
  7. By: Natacha Raffin; Thomas Seegmuller
    Abstract: We analyze the interplay between longevity, pollution and growth. We develop an OLG model where longevity, pollution and growth are endogenous. The authorities may provide two types of public services, public health and environmental maintenance, that participate to increase agents’ life expectancy and to sustain growth in the long term. We show that global dynamics might be featured by a high growth rate equilibrium, associated with longer life expectancy and a environmental poverty trap. We examine changes in public policies: increasing public intervention on health or environmental maintenance display opposite effects on global dynamics, i.e. on the size of the trap and on the level of the stable balanced growth path. On the contrary, each type of public policy induces a negative leverage on the long run rate of growth.
    Keywords: Life expectancy; Pollution; Health; Growth
    JEL: I15 O44 Q56
    Date: 2012
  8. By: Elise S. Brezis (Bar-Ilan University)
    Abstract: From the canonical model of Becker onward, models of population dynamics have been based on assumptions which fit the family structure of developed countries. The aim of this paper is to develop a framework that fits the family structure of poor countries. The building blocks of the model incorporate elements essential to the determination of population dynamics in poor countries, i.e., child labor, intergenerational flows from children to parents, and the effects of child labor on children’s health. The main result of this paper is that the correlation between economic growth and fertility rates runs in inverse directions for poor and rich countries.
    Keywords: child labor; health deterioration; intergenerational transfers; fertility rates.
    JEL: J13 O11 O16 O40
    Date: 2012–01
  9. By: Grönqvist., Hans (Swedish Institute for Social Research, Stockholm University)
    Abstract: This paper investigates the consequences of a series of Swedish policy changes in which several regions in the 90s introduced heavily subsidized oral contraception for teenagers. The results reveal that access to the subsidy significantly increased the use of the pill as well as reduced the abortion and teenage birth rate. The decline in teenage births was especially strong among financially constrained youths. The estimates are precise enough to rule out even moderate effects on the birth weight of the children to the exposed mothers. Despite the documented improvements in women’s outcomes, the analysis reveals that the monetary costs of the subsidy substantially exceed its measurable social benefits.
    Keywords: Family planning; Abortions; Teenage childbearing
    JEL: J13
    Date: 2012–12–04
  10. By: Adato, Michelle; Bassett, Lucy
    Abstract: As HIV and AIDS simultaneously undermine livelihoods and household and community safety nets, families are especially vulnerable to poverty, food insecurity, and threats to their children’s nutrition, health, and education, with irreversible consequences. With more than 33.3 million people affected by HIV globally, a new focus on the risks for families and the long-term well-being of children has accelerated international, regional, and national commitments to social protection programs in heavily AIDS-affected countries.
    Keywords: Social protection, food security, HIV/AIDS, Cash transfers, Safety nets, conditional cash transfer, Education, health, food consumption, Nutrition, Economic aspects,
    Date: 2012
  11. By: Jay Bhattacharya; Christina Gathmann; Grant Miller
    Abstract: Political and economic transition is often blamed for Russia’s 40% surge in deaths between 1990 and 1994. Highlighting that increases in mortality occurred primarily among alcohol-related causes and among working-age men (the heaviest drinkers), this paper investigates an alternative explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. Using archival sources to build a new oblast-year data set spanning 1978-2000, we find a variety of evidence suggesting that the campaign’s end explains a large share of the mortality crisis – implying that Russia’s transition to capitalism and democracy was not as lethal as commonly suggested.
    JEL: I12 I18 N34
    Date: 2012–12
  12. By: François-Charles Wolff (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272, INED - Institut National d'Etudes Démographiques Paris - INED)
    Abstract: Using French data collected in 2007 from a sample of about 2,000 elderly people living in nursing homes, this paper investigates the role that individual characteristics play in satisfaction with life and depression. Following psychological studies that have highlighted the benefits of social interactions on individual well-being, I focus in particular on the role played by making friends in the nursing home. Results from random effect ordered Probit models show that both satisfaction with living conditions and feeling of depression are much more influenced by making friends in the institution than by visits from family and relatives or other individual background characteristics. These findings may be interpreted as evidence of a relational return to friendship within nursing homes.
    Keywords: friends; institutionalized elderly; living conditions; nursing home; relational goods
    Date: 2012–09–30

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