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on Health Economics |
| By: | HOUGAARD, Jens L. (Institute of Food and Resource Economics, University of Copenhagen); MORENO-TERNERO, Juan (Department of Economics, Universidad Pablo de Olavide; Université catholique de Louvain, CORE, B-1348 Louvain-la-Neuve, Belgium); OSTERDAL, Lars P. (Department of Business and Economics, University of Southern Denmark) |
| Abstract: | We explore in this paper the implications of ethical and operational 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 rationale for popular theories in health economics (such as the unweighted aggregation of QALYs or HYEs, and generalizations of the two, aimed to capture concerns for distributive justice) without resorting to controversial assumptions over individual preferences. |
| Keywords: | population health, QALYs, HYEs, axioms |
| JEL: | D63 I10 |
| Date: | 2012–03–08 |
| URL: | http://d.repec.org/n?u=RePEc:cor:louvco:2012007&r=hea |
| By: | Mebratie, A.D.; Van de Poel, E.; Debebe, Z.Y.; Abebaw, D.; Alemu, G.; Bedi, A.S. |
| Abstract: | Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording an 18-fold increase in the number of health posts and a 7-fold increase in the number of health centers. However, annual per capita outpatient utilization has increased only marginally. The extent to which individuals forego necessary health care, especially why and who foregoes care are issues that have received little attention in the context of low-income countries. This paper uses five clinical vignettes covering a range of context-specific child and adult-related diseases to explore the health-seeking behavior of rural Ethiopian households. We find almost universal preference for modern care. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centers, private/NGO clinics as opposed to health posts. Similarly, delays in care-seeking behavior are apparent mainly for adult-related conditions. The differences in care seeking behavior between adult and child related conditions may be attributed to the recent spread of health posts which have focused on raising awareness of maternal and child health. Overall, the analysis suggests that the lack of health-care utilization is not driven by the inability to recognize health problems or due to a low perceived need for modern care but due to other factors. |
| Keywords: | Ethiopia;clinical vignettes;foregone care;health care seeking behavior |
| Date: | 2013–02–04 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:euriss:551&r=hea |
| By: | Vololona Rabeharisoa (Centre de Sociologie de l'Innovation, Mines ParisTech); Orla O'Donovan (Department of Applied Social Studies, University College Cork) |
| Abstract: | Analyses the role of European patients’ organizations in the process of Europeanization of healthcare policies by exploring the types of organizations constituted by European patients’ organizations and the form of activism they develop. |
| Keywords: | Europeanization; patient organizations; health activism; evidence-based activism; healthcare policy |
| JEL: | I18 |
| Date: | 2013–01 |
| URL: | http://d.repec.org/n?u=RePEc:emn:wpaper:030&r=hea |
| By: | Dean Baker |
| Abstract: | When Congress was debating the Medicare drug benefit in 2003, there were many who advocated that Medicare provide the benefit as part of the traditional hospital insurance program. This was expected to save money both due to lower administrative costs and also as result of Medicare’s ability to use its market power to directly negotiate lower prices with the pharmaceutical industry. The plan that was passed instead required beneficiaries to purchase insurance from private insurers who would be subsidized by the government. It has been widely noted that the drug benefit has cost considerably less than expected. In 2011, the benefit cost $67.4 billion, just 51.3 percent of the originally projected cost. While advocates of using private insurers have claimed that lower-than-projected costs vindicate their design for the benefit, in fact the main reason that costs have been less than projected is that drug costs in general have risen much less rapidly than had been projected. This issue brief looks at the main factor behind slower-than-projected costs and how the United States can lower spending by negotiating drug prices. |
| Keywords: | Medicare, medicare drug benefit, prescription drug, Dean Baker, hospital insurance, pharmaceutical industry, private insurers |
| JEL: | I I1 I14 I18 I3 I38 H |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:epo:papers:2013-05&r=hea |
| By: | Izabela Jelovac (Université de Lyon, Lyon, F-69007, France ; CNRS, GATE Lyon St Etienne,F-69130 Ecully, France) |
| Abstract: | Some countries allow physicians to balance bill patients, that is, to bill a fee above the one that is negotiated with, and reimbursed by the health authorities. Balance billing is known for restricting access to physicians’ services while supplemental insurance against balance billing amounts is supposed to alleviate the access problem. This paper analyzes in a theoretical setting the consequences of balance billing on the fees setting and on the inequality of access among the users of physicians’ services. It also shows that supplemental insurance against the expenses associated with balance billing, rather than alleviating the access problem, increases it. |
| Keywords: | Physicians’ fees, balance billing, supplemental insurance |
| JEL: | I14 J33 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:gat:wpaper:1305&r=hea |
| By: | Stephan Klasen (Georg-August-University Göttingen); Sebastian Vollmer (Georg-August-University Göttingen) |
| Abstract: | In a recent paper in the Review of Economic Studies, Siwan Anderson and Debraj Ray (Anderson and Ray, 2010) develop and apply a new ‘flow’ measure of ‘missing women’ to estimate the extent of gender bias in mortality in developing countries. Contrary to the existing literature, they find that the problem of gender bias in mortality is as severe among adults as it is among children in India, that gender bias in mortality is larger in Sub‐Saharan Africa than in China and India, and that there was substantial evidence of gender bias in mortality in the US around 1900. These latter results are driven largely by the finding of substantial gender bias among adults. We show first that the data for Sub‐Saharan Africa used in the paper are generated by simulations in ways that deliver their findings on Africa (and the US in 1900) by construction. Second, we show that the analysis is entirely dependent on a highly implausible reference standard that is inappropriately applied to settings where the overall disease and mortality environment differ greatly; the attempt to control for the disease environment by the authors is not able to address these issues. When a more appropriate reference standard is used, most of the new findings of Anderson and Ray disappear. Instead, the findings from the existing literature relying on stock measures of missing women are confirmed. The one finding that remains and deserves further attention is some evidence of gender bias in mortality among young adults in Africa (though of much lower magnitude than suggested by Anderson and Ray). |
| Keywords: | Missing women; gender bias; mortality; disease; age; Sub‐Saharan Africa; China; India |
| JEL: | J16 D63 I10 |
| Date: | 2013–02–13 |
| URL: | http://d.repec.org/n?u=RePEc:got:gotcrc:133&r=hea |
| By: | Jaldell, Henrik (Dept. of Economics); Lebnak, P (Emergency Medical Institute Thailand, EMIT); Anurak, A (Emergency Medical Institute Thailand, EMIT); Krongkan, B (Emergency Medical Institute Thailand, EMIT); Khanisthar, P (Emergency Medical Institute Thailand, EMIT) |
| Abstract: | The monetary values for how much ambulance emergency services are calculated for two different time factors, response time, which is the time from when a call is received by the EMS call-taking centre until the response team arrives at the emergency scene, and operational time, which is the time from alarm to the accident scene and to the hospital. The study is performed in three steps. First, marginal effects of reduced fatalities and injuries for a minute change of the time factors are calculated using logistic regressions. Second, monetary values are chosen for fatalities and injuries; third, the marginal effects and the monetary values are put together to find a value per minute. The values are found to be 5.5 million Thai Baht per minute for fatality, 326,000 Baht per minute for severe injury, and 2,100 Baht per minute for slight injury. The total value of fatality, severe injury and slight injury for a one-minute improvement for each dispatch, summarized over one year, is 1.6 billion Thai Baht using response time. The resulting total values could be used on the benefit side in an economic cost-benefit analysis of investments, such as new technology, which could reduce the response and operational times. |
| Keywords: | Response time; cost-benefit; medicine; emergency; EMS |
| JEL: | D61 I31 R53 |
| Date: | 2013–02–21 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:kaunek:0008&r=hea |
| By: | Kjellsson, Gustav (Department of Economics, Lund University); Clarke, Philip (Centre for Health Policy, University of Melbourne); Gerdtham, Ulf-G (Department of Economics, Lund University) |
| Abstract: | Self-reported data on utilization of health care is a key input into a range of studies. However, the length of the recall period in self-reported health care questions varies between surveys and this variation may affect the results of the studies. While longer recall periods include more information, shorter recall periods generally imply smaller bias. This article examines the role of the recall period length for the quality of self-reported data by comparing registered hospitalization with self-reported hospitalizations of respondents that are exposed to a varying recall period length of one, three, six, or twelve month. Our findings have conflicting implications for survey design as the preferred length of recall period depends on the objective of analysis. If the objective is an aggregated measure of hospitalization, longer recall periods are preferred whereas shorter recall periods may be considered for a more micro-oriented level analysis since the association between individual characteristics (e.g. education) and recall error increases with the length of the recall period. |
| Keywords: | Survey Methods; Health survey; Hospitalization; Recall error; Recall periods |
| JEL: | C42 C83 I10 |
| Date: | 2013–01–28 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2013_001&r=hea |
| By: | Rosemary Borck; Ashley Zlatinov; Susan Williams |
| Abstract: | This chartbook uses Medicaid Analytic eXtract (MAX) 2008 data to describe the service utilization of Medicaid enrollees in managed care plans. The chartbook extends the analysis of the previous MAX chartbooks, which focused on the service utilization of Medicaid enrollees covered on a fee-for-service basis. This chartbook also supplements recent MAX issue briefs that focused on the quality and completeness of encounter data. This chartbook provides valuable information for the Centers for Medicare & Medicaid Services and researchers on the availability of and uses for encounter data in MAX data. |
| Keywords: | MAX 2008, Medicaid Analytic eXtract, Encounter Data, Chartbook |
| JEL: | I |
| Date: | 2013–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7655&r=hea |
| By: | Rosemary Borck; Ashley Zlatinov; Susan Williams |
| Keywords: | MAX 2008, Medicaid Analytic eXtract, Encounter Data, Chartbook |
| JEL: | I |
| Date: | 2013–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7656&r=hea |
| By: | John L. Czajka; Shinu Verghese |
| Abstract: | This report presents findings from a validation study of Social Security numbers (SSNs) in Medicaid Statistical Information System (MSIS) records for the fourth quarter of federal fiscal year 2009. The study produced results for the nation and the states on how often SSNs were reported in MSIS records and how often the reported SSNs passed a validation test at the U.S. Census Bureau, based on data obtained from the Social Security Administration. |
| Keywords: | SSN, Social Security Numbers, Medicaid Records, Reporting and Validity |
| JEL: | I |
| Date: | 2013–01–15 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7659&r=hea |
| By: | Thomas Fraker |
| Keywords: | The Youth Transition Demonstration; YTD; transition to adulthood for youth with disabilities; disability benefits , Supplemental Security Income (SSI); , Social Security Disability Insurance (DI), Social Security Administration (SSA) |
| JEL: | I J |
| Date: | 2013–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7660&r=hea |
| By: | Allison Hedley Dodd; Philip M. Gleason |
| Keywords: | Medicaid Analytic eXtract (MAX) , Medicaid enrollment , The National Health and Nutrition Examination Survey (NHANES), data to evaluate the association of Medicaid costs and obesity |
| JEL: | I |
| Date: | 2013–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7661&r=hea |
| By: | Jonathan D. Brown; Lawrence S. Wissow; Benjamin L. Cook; Shaina Longway; Emily Caffery; Chris Pefaure |
| Keywords: | Mental Health, Pediatric Primary Care, Medical Assistants, Communications, Health |
| JEL: | I |
| Date: | 2013–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7664&r=hea |
| By: | Alisa B. Busch; Frank Yoon; Colleen L. Barry; Vanessa Azzone; Sharon-Lise T. Normand; Howard H. Goldman; Haiden A. Huskamp |
| Abstract: | This article counters concerns that benefit expansion under parity would increase spending. The study finds that mental health parity provisions in the Federal Employees Health Benefits program reduced total out-of-pocket spending for patients with more-severe behavioral health conditions, while the level of services they received remained largely unchanged. The study also found, however, that individuals with less-severe but acute mental health conditions received fewer services, suggesting that health plans manage benefits selectively. |
| Keywords: | Bipolar Disorder, Adjustment Disorder, Mental Health, Parity |
| JEL: | I |
| Date: | 2013–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7668&r=hea |
| By: | Grace A. Ferry; Henry T. Ireys; Leslie Foster; Kelly J. Devers; Lauren Smith |
| Keywords: | CHIPRA, Quality Measurement, Maine, Massachusetts, North Carolina, Pennsylvania, Health |
| JEL: | I |
| Date: | 2013–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7669&r=hea |
| By: | Grace A. Ferry; Henry T. Ireys; Leslie Foster; Kelly J. Devers; Lauren Smith |
| Keywords: | CHIPRA, Maine, Massachusetts, North Carolina, Pennsylvania, Quality Measurement, Health |
| JEL: | I |
| Date: | 2013–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7670&r=hea |
| By: | Adam Dunn; Leslie Foster |
| Keywords: | Health-e-App Public Access , Children's Health Care Coverage , California , Health |
| JEL: | I |
| Date: | 2013–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7672&r=hea |
| By: | Rutger P. Daems PhD (Planet Strategy Group, Brussels, Belgium); Edith L. Maes DBA (Maastricht School of Management, PO Box 1203, 6201 BE Maastricht, The Netherlands) |
| Abstract: | BACKGROUND Consistent with good corporate citizenship and the role of multinational pharmaceutical corporations in producing social goods, there is a need to clarify the concept of global burden of disease (GBD) and create performance metrics that measure a firm’s contribution to ‘saving lives’ through its current portfolio as well as identify future opportunities for enhanced product/service offering. OBJECTIVE The purpose is to develop besides a conceptual framework an analytic decision-making tool to assess and enhance a firm’s contribution to reducing the burden of disease, and to propose pathways on how this can be accomplished by optimizing the social and business returns on investment thereby maximizing the outcome for all stakeholders (i.e. patient, government, payer and firm). METHODOLOGY Product development and financial parameters are connected in an analytic decision model in combination with disease burden metrics. Through event study methodology, we subsequently explore solutions to a number of market, technology, and system issues leading to a disparity between socially and privately appropriable benefits. This is examined through a series of case studies. The GBD-based theoretical framework provides a general overview and at the same time an assessment of the social return on investment (SRI) as well as the contribution made by any specific compound or project that together constitute the company’s portfolio – now and in the future. The social outcome (SRI) is commonly expressed as Disability Adjusted Life Years (DALYs) averted and the preferred indicator of how successful the burden of disease has been reduced. Simultaneously, the business return on investment (BRI) is computed, capturing the R&D costs and risks in a modular fashion, allowing executives to calculate the profitability index for each product or project. CONCLUSION This paper contributes to the burgeoning literature on medical innovation and the ambition to broaden access to medicines. The relationship between a firm’s product outcomes and its corporate social responsibility is examined in the context of a globalizing world still dominated by different national economies and healthcare needs. To better accommodate these needs a holistic framework is required that captures the demands of those living in high, middle and low-income countries. We believe the suggested framework is able to accomplish this goal and essentially provides a more holistic product portfolio management tool that links the social and business returns of pharmaceutical innovation into a coherent analytic and decision framework, while also providing a dynamic view on how the results obtained along each of the core axes can be improved or optimized. |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:msm:wpaper:2013/07&r=hea |
| By: | Jonathan T. Kolstad |
| Abstract: | If profit maximization is the objective of a firm, new information about quality should affect firm behavior only through its effects on market demand. I consider an alternate model in which suppliers are motivated by a desire to perform well in addition to profit. The introduction of quality “report cards” for cardiac surgery in Pennsylvania provides an empirical setting to isolate the relative role of extrinsic and intrinsic incentives in determining surgeon response. Information on performance that was new to surgeons and unrelated to patient demand led to an intrinsic response four times larger than surgeon response to profit incentives. |
| JEL: | I10 I11 I18 L15 |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18804&r=hea |
| By: | John Cawley; Stephanie von Hinke Kessler Scholder |
| Abstract: | We provide new evidence on the extent to which the demand for cigarettes is derived from the demand for weight control (i.e. weight loss or avoidance of weight gain). We utilize nationally representative data that provide the most direct evidence to date on this question: individuals are directly asked whether they smoke to control their weight. We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight. This practice is significantly more common among youths who describe themselves as too fat than those who describe themselves as about the right weight. The derived demand for cigarettes has important implications for tax policy. Under reasonable assumptions, the demand for cigarettes is less price elastic among those who smoke for weight control. Thus, taxes on cigarettes will result in less behavior change (but more revenue collection and less deadweight loss) among those for whom the demand for cigarettes is a derived demand. Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls. |
| JEL: | D01 H2 H3 I1 |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18805&r=hea |
| By: | Silvie Colman; Thomas S. Dee; Theodore J. Joyce |
| Abstract: | Parental involvement (PI) laws require that physicians notify or obtain consent from a parent(s) of a minor seeking an abortion before performing the procedure. Several studies suggest that PI laws curb risky sexual behavior because teens realize that they would be compelled to discuss a subsequent pregnancy with a parent. We show that prior evidence based on gonorrhea rates overlooked the frequent under-reporting of gonorrhea by race and ethnicity, and present new evidence on the effects of PI laws using more current data on the prevalence of gonorrhea and data that are novel to this literature (i.e., chlamydia rates and data disaggregated by year of age). We improve the credibility of our estimates over those in the existing literature using an event-study design in addition to standard difference-in-difference-in-differences (DDD) models. Our findings consistently suggest no association between PI laws and rates of sexually transmitted infections or measures of sexual behavior. |
| JEL: | I18 |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18810&r=hea |
| By: | Roberto Astolfi; Luca Lorenzoni; Jillian Oderkirk |
| Abstract: | Concerns about health expenditure growth and its long-term sustainability have stimulated the development of health expenditure forecasting models in many OECD countries. This comparative analysis reviewed 25 models that were developed by, or used for, policy analysis by OECD member countries and other international organisations... |
| JEL: | H51 I12 J11 |
| Date: | 2012–10–31 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:59-en&r=hea |
| By: | David Morgan; Roberto Astolfi |
| Abstract: | Health spending slowed markedly or fell in many OECD countries recently after years of continuous growth, according to OECD Health Data 2012. As a result of the global economic crisis which began in 2008, a zero rate of growth in health expenditure was recorded on average in 2010, and preliminary estimates for 2011 suggest that low or negative growth in health spending continued in many of the countries for which data are available.<BR>Il ressort de l’édition 2012 de la Base de données de l’OCDE sur la santé qu’après des années de progression constante, récemment les dépenses de santé se sont nettement ralenties, voire ont reculé, dans de nombreux pays de l'OCDE. Suite à la crise économique mondiale qui a commencé en 2008, un taux de progression nul des dépenses de santé a été enregistré en moyenne en 2010, et les premières estimations pour 2011 semblent indiquer une progression faible et même négative dans nombre des pays pour lesquels on dispose de données. |
| JEL: | H51 I12 I18 |
| Date: | 2013–01–29 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:60-en&r=hea |
| By: | David Madden (University College Dublin) |
| Abstract: | Using the nationally representative Slan dataset of 2007 we analyse the relationship between self-reported and measured BMI. We find that self-reported BMI significantly underestimates obesity rates and suggest that the traditional threshold of 30 should be adjusted downwards. We outline a number of approaches to choose the optimal threshold and results suggest that the new obesity threshold for self-reported BMI could be as low as 26. |
| Keywords: | body mass index, receiver operating characteristic, sensitivity, specificity |
| Date: | 2013–02–14 |
| URL: | http://d.repec.org/n?u=RePEc:ucn:wpaper:201301&r=hea |
| By: | de Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnes; Condo, Jeanine |
| Abstract: | Paying for performance provides financial rewards to medical care providers for improvements in performance measured by specific utilization and quality of care indicators. In 2006, Rwanda began a paying for performance scheme to improve health services delivery, including HIV/AIDS services. This study examines the scheme's impact on individual and couples HIV testing and counseling and using data from a prospective quasi-experimental design. The study finds a positive impact of paying for performance with an increase of 6.1 percentage points in the probability of individuals having ever been tested. This positive impact is stronger for married individuals: 10.2 percentage points. The results also indicate larger impacts of paying for performance on the likelihood that the respondent reports both partners have ever been tested, especially among discordant couples (14.7 percentage point increase) in which only one of the partners is HIV positive. |
| Keywords: | Health Monitoring&Evaluation,Disease Control&Prevention,Population Policies,Health Systems Development&Reform,HIV AIDS |
| Date: | 2013–02–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6364&r=hea |