nep-hea New Economics Papers
on Health Economics
Issue of 2013‒01‒26
eight papers chosen by
Yong Yin
SUNY at Buffalo

  1. Intersectoral Health Action in Tanzania – Determinants and Policy Implications By Simon, Michael; Tsegai, Daniel W.; Flessa, Steffen
  2. Why the geographic variation in health care spending can't tell us much about the efficiency or quality of our health care system By Louise Sheiner
  3. Urban Mortality Transitions: The Role of Slums By Günther Fink; Isabel Günther; Kenneth Hill
  4. Health Information Technology and Patient Outcomes: The Role of Organizational and Informational Complementarities By Jeffery S. McCullough; Stephen Parente; Robert Town
  5. The impact of air pollution on Hospital admissions: evidence from Italy By Raffaele Lagravinese; Lee Habin; Francesco Moscone; Eliza Tosetti
  6. Climate Change and the Willingness to Pay to Reduce Ecological and Health Risks from Wastewater Flooding in Urban Centers and the Environment By Marcella Veronesi; Fabienne Chawla; Max Maurer; Judit Lienert
  7. The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review By Acharya, Arnab; Vellakkal, Sukumar; Taylor Fiona; Masset Edoardo; Satija, Ambika; Burke, Margaret; Ebrahim, Shah
  8. House Prices, Home Equity and Health By Fichera, E.;; Gathergood, J.;

  1. By: Simon, Michael; Tsegai, Daniel W.; Flessa, Steffen
    Abstract: The tremendous human resource and economic burden of HIV/AIDS, malaria and diarrhoeal diseases is well acknowledged in many developing countries. Most of these diseases have multifaceted causes such as malnutrition, the consumption of contaminated water or poor education. Thus, cross-sectoral action is needed to lower the burden of disease in the long run. However, little has been done to investigate the causal relationship between investments in ‘health related’ sectors and the reduction of disease prevalence. This paper aims at analysing the marginal health returns to cross-sectoral government spending for the case of Tanzania. For this, the normative assumption is to maximise the amount of Disability Adjusted Life Years (DALYs) averted per dollar invested. A Simultaneous Equation Model (SEM) is developed to estimate the required elasticities. The results of the quantitative analysis show that the highest returns on DALYs are obtained by improved nutrition and access to safe water sources, followed by sanitation. Looking at the impact of indirect factors, the health effect of investments in mother education exceeds the effect of additional short- and long-term public spending on water.
    Keywords: Health Promotion, Public Health Policy, Intersectoral Health Action, Disability Adjusted Life Years, Health Determinants, Cost-effectiveness, Tanzania, Community/Rural/Urban Development, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,
    Date: 2012–12
  2. By: Louise Sheiner
    Abstract: This paper examines the geographic variation in Medicare and non-Medicare health spending and finds little support for the view that most of the variation is attributable to differences in practice styles. Instead, I find that socioeconomic factors that affect the need for medical care, as well as interactions between the Medicare system, Medicaid, and private health spending, can account for most of the variation in Medicare spending. Furthermore, I find that the health spending of the non-Medicare population is not well correlated with Medicare spending, suggesting that Medicare spending is not a good proxy for average health spending by state. Finally, there is a negative correlation between the level and growth of Medicare spending: Low-spending states are not low-growth states and are thus unlikely to provide the key to curbing excess cost growth in Medicare. ; The paper also explores the econometric differences between controlling for health attributes at the state level vs the individual level. I show that a state-level approach is better at controlling for health attributes and argue that this econometric difference likely explains most of the difference between my results and those of the Dartmouth group. ; More broadly, the paper shows that the geographic variation in health spending does not provide a useful measure of the inefficiencies of our health system. States where Medicare spending is high are very different in multiple dimensions from states where Medicare spending is low, and thus it is difficult to isolate the effects of differences in health spending intensity from the effects of the differences in the underlying state characteristics. I show, for example, that the relationships between health spending, physician composition and quality are likely the result of omitted factors rather than the result of causal relationships.
    Date: 2013
  3. By: Günther Fink (Harvard School of Public Health); Isabel Günther (ETH Zurich); Kenneth Hill (Harvard School of Public Health)
    Abstract: High urban mortality delayed transitions to low mortality in 19th century Europe, but an urban mortality advantage emerged as European transitions progressed into the 20th century. Recent analysis has suggested that high mortality in the rapidly growing urban slums of developing countries might once again delay transitions to low mortality in the 21st century. In this paper we use data from Demographic and Health Surveys across 37 countries to investigate this hypothesis. We document the changes in child mortality over the last twenty years, with a special focus on urban slums and on differences between small and large cities. We show that slum areas fare worse than other urban areas across all child mortality categories and all city categories, but that generally children growing up in urban slums fare at least as well as children in rural areas. Moreover, the improvements in child mortality appear to have affected slum residents at least as much as other urban and rural residents, indicating a neutral role of slum settlements in the mortality transition of developing countries.
    Keywords: child mortality, urban slums, mortality transition
    Date: 2013–01
  4. By: Jeffery S. McCullough; Stephen Parente; Robert Town
    Abstract: Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the roles of technological and organizational complements in affecting IT's value and explore underlying mechanisms through which IT facilitates the coordination of labor inputs. We link detailed hospital discharge data on all Medicare fee-for-service admissions from 2002-2007 to detailed hospital-level IT adoption information. We employ a difference-in-differences strategy to identify the parameters of interest. For all IT sensitive conditions we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. This implies that the benefits from IT adoption are skewed to large institutions with a severe case mix. We decompose the impact of health IT into care coordination, clinical information management, and other components. The benefits from health IT are primarily experienced by patients whose diagnoses require cross-specialty care coordination and extensive clinical information management.
    JEL: D24 I12
    Date: 2013–01
  5. By: Raffaele Lagravinese; Lee Habin; Francesco Moscone; Eliza Tosetti
    Abstract: In this paper we examine the relationship between air pollution and hospital admissions for chronic obstructive pulmonary disease in Italy, at province level, over the period 2004- 2009. To this end, we use information on annual mean concentrations of carbon monoxide, nitrogen dioxide, particulate matter, and ozone measured at monitoring station level to build province-level indicators. In our model for hospital admissions, we allow pollution measures to be subject to measurement error and possibly correlated with the error term. By adopting an instrumental variables approach, we find that higher levels of particulate matter and carbon monoxide are associated with higher hospitalisation for children, while ozone has an influence on hospital admissions of the elderly. Other factors that appear to have an important role are the rainfall and the level of education.
    Keywords: airborne pollutants; hospital admission; instrumental variables.
    JEL: I12 I18 Q53
    Date: 2013–01
  6. By: Marcella Veronesi (Department of Economics (University of Verona)); Fabienne Chawla (Eawag: Swiss Federal Institute of Aquatic Science and Technology); Max Maurer (Eawag: Swiss Federal Institute of Aquatic Science and Technology); Judit Lienert (Eawag: Swiss Federal Institute of Aquatic Science and Technology)
    Abstract: Climate change scenarios predict an increase of extreme rain events, which will increase the risk of wastewater flooding and of missing legal water quality targets. This study elicits the willingness to pay to reduce ecological and health risks from combined sewer overflows in rivers and lakes, and wastewater flooding of residential and commercial zones under the uncertainty of climate change. We implement a discrete choice experiment on a large representative sample of the Swiss population. Swiss households strongly value the protection of water bodies, and mostly, the avoidance of high ecological risks and health risks for children related to combined sewer overflows in rivers and lakes. Our findings also show that climate change perception has a significant effect on the willingness to pay to reduce these risks. These results are important to support policy makers’ decisions on how to deal with emerging risks of climate change in the water sector and where to set priorities.
    Keywords: choice experiment; climate change; ecological risk; health risk; wastewater
    JEL: D61 D81 I10 Q25 Q51 Q54 Q57
    Date: 2013–01
  7. By: Acharya, Arnab; Vellakkal, Sukumar; Taylor Fiona; Masset Edoardo; Satija, Ambika; Burke, Margaret; Ebrahim, Shah
    Abstract: This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Health Law,Insurance&Risk Mitigation
    Date: 2013–01–01
  8. By: Fichera, E.;; Gathergood, J.;
    Abstract: Home equity has a strong impact on individual health. In UK household panel data home equity lowers the likelihood of home owners exhibiting a broad range of medical conditions. This is due to increased use of private health care, reduced hours of work and increased exercise. Home equity, unlike income, does not increase risky health behaviours such as smoking and drinking.Home equity is highly pro-cyclical. The positive health effects of home equity gains on home owner health over the business cycle offset the negative effects of labour market conditions and work intensity as shown in US data by Ruhm (2000).
    Keywords: Health, wealth
    JEL: I10
    Date: 2013–01

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