nep-hea New Economics Papers
on Health Economics
Issue of 2013‒03‒09
nine papers chosen by
Yong Yin
SUNY at Buffalo

  1. Performance Assessment in Primary Health Care: A Systematic Literature Review By Olena Kalinichenko; Carla A. F. Amado; Sérgio P. Santos
  2. Health insurance and diversity of treatment: a policy mix perspective By David Bardey; Bruno Jullien; Jean-Marie Lozachmeur
  3. Competition and Antibiotics Prescription By Fogelberg, Sara; Karlsson, Jonas
  4. Deductibles and the Demand for Prescription Drugs: Evidence from French Data By Marc Perronnin; Bidénam Kambia-Chopin
  5. Open Access to the Resource of Antibiotic Treatment Efficacy Subject to Bacterial Resistance By Bruno Nkuiya; Markus Herrmann
  6. Inequality and Risk Aversion in Health and Income: An Empirical Analysis Using Hypothetical Scenarios with Losses By Ignacio Abásolo; Aki Tsuchiya
  7. The application of discrete choice experiments in health economics: a systematic review of the literature By Alessandro Mengoni; Chiara Seghieri; Sabina Nuti
  8. A shirking theory of referrals By Damien S.Eldridge
  9. Impact evaluation of a large-scale rural sanitation project in Indonesia By Cameron, Lisa; Shah, Manisha; Olivia, Susan

  1. By: Olena Kalinichenko (University of Algarve - Faculty of Economics and CEFAGE-UE); Carla A. F. Amado (University of Algarve - Faculty of Economics and CEFAGE-UE); Sérgio P. Santos (University of Algarve - Faculty of Economics and CEFAGE-UE)
    Abstract: The aim of this research is to carry out a systematic literature review of the studies devoted to the performance assessment of primary health care providers. Focusing on the peculiarities of performance evaluation in the public sector, we analyse the selected empirical papers in terms of the efficacy of the developed measurement schemes. We also examine and classify performance measurement categories, dimensions, and techniques in order to provide a holistic picture of the main developments in the referred domain and to identify directions for future research.
    Keywords: Primary health care; Performance assessment; Equity; Efficiency; Effectiveness.
    JEL: C67 D61 I14
    Date: 2013
  2. By: David Bardey; Bruno Jullien; Jean-Marie Lozachmeur
    Abstract: We determine the optimal health policy mix when the average utility of patients in- creases with the supply of drugs available in a therapeutic class. Health risk coverage rely on two instruments, copayment and reference pricing, that affect the supported risk composed by health expenses and diversity of treatment. For a fixed supply of drugs, the reference pricing policy aims at minimizing expenses in which case, the equilibrium price of drugs is independent of the copayment rate. However, with endogenous supply of drugs, diversity of treatment may susbtitute for insurance so that the reference pricing may depart from maximal cost-containement to promote entry. We then analyse the determinents of the optimal policy. While an increase in risk aversion or in the side effect loss increases diversity and decreases the copayment rate, an increase in entry cost both decreases diversity and the copayment rate.
    Date: 2013–02–03
  3. By: Fogelberg, Sara (Research Institute of Industrial Economics (IFN)); Karlsson, Jonas (The Institute for Social Research)
    Abstract: The introduction of antibiotics as a medical treatment after World War II helped to dramatically increase life expectancy in the industrialized world. As a consequence of over-prescription the last decades have however seen a sharp increase in prevalence of multi-resistant bacteria, disarming once powerful anti-pathogens. This paper investigates the effect of increased competition between healthcare providers on prescription of antibiotics. We make use of a competition-inducing reform implemented in different counties in Sweden at different points in time during 2007 to 2010. Our dataset contains monthly data on all prescribed antibiotics in Sweden which makes us able to estimate the effects on all antibiotics prescribed, as well as different subcategories of antibiotics. The results indicate that increased competition had a positive and significant effect on antibiotics prescription.
    Keywords: Healthcare; Competition; Competition reform; Antibiotics
    JEL: C23 H30 I11 I18
    Date: 2013–01–08
  4. By: Marc Perronnin (IRDES Institute for research and information in health economics); Bidénam Kambia-Chopin (MSSS Ministère de la Santé et des services sociaux, Québec(Canada))
    Abstract: On January 1st 2008, a 0.5€ deductible levied on every prescription drug package purchased was introduced in France. This study aims at shedding light on the effect of this policy on prescription drug purchasing behavior among the targeted individuals. Declared behavior from a cross-sectional study based on participants in the French Health, Health Care and Insurance Survey of 2008. The determinants of having changed one’s prescription drugs consumption following the introduction of deductibles were explored based on the socio-behavioral model of Andersen and an economic model of drug demand. The empirical analysis used a logistic regression. All other factors being equal, individuals’ probability of having modified their drug consumption behaviour following the introduction of deductibles decreases with income level and health status (self-assessed health and suffering from a chronic disease). Deductibles on prescription drugs represent a significant financial burden for low-income individuals and those in poor health, with the potential effect of limiting their access to drugs.
    Keywords: User fees, Out-of-pocket payment, Prescription drugs, Financial access, France.
    JEL: D81
    Date: 2013–02
  5. By: Bruno Nkuiya; Markus Herrmann
    Abstract: In this paper, we are interested in how a pharmaceutical industry manages existing antibiotic drugs in the context of bacterial resistance. We consider a model based on an epidemiological framework where antibiotic recovery rates, and thus intrinsic qualities, may differ. Antibiotic efficacy is modeled as a common pool of a non-renewable resource to which antibiotic producers have open access. The paper derives antibiotic demands within a vertical differentiation model and characterizes the dynamics of infected individuals, antibiotic efficacy and treatment rates under the open-access and the socially optimal allocation. We show that the high-quality antibiotic drug loses its comparative advantage over time under both allocations, such that the low-quality drug should be used longer. This occurs at a later point of time in the social optimum and allows for a better control of infection in the longer run. In contrast with the ambiguous outcome reported in the literature, the socially optimal steady-state level of antibiotic efficacy is lower than that of the open-access allocation. We also extend our analysis to a strategic, duopolistic context.
    Keywords: Antibiotic management, Non-renewable resource, Open access, Social optimum, Public health
    JEL: L13 Q21 I18
    Date: 2013
  6. By: Ignacio Abásolo (Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Facultad de Ciencias Económicas y Empresariales. Universidad de La Laguna, Spain); Aki Tsuchiya (Department of Economics, The University of Sheffield)
    Abstract: Four kinds of distributional preferences are explored: inequality aversion in health, inequality aversion in income, risk aversion in health, and risk aversion in income. Face to face interviews of a representative sample of the general public are undertaken using hypothetical scenarios involving losses in either health or income. Whilst in health risk aversion is stronger than inequality aversion, in the income context we cannot reject that attitudes to inequality aversion and risk aversion are the same. When we compare across contexts we find that inequality aversion and risk aversion are both stronger in income than they each are in health.
    Keywords: inequality; risk aversion; health; income
    JEL: I14 D63 D71
    Date: 2013
  7. By: Alessandro Mengoni; Chiara Seghieri (Istituto di Management - Scuola Superiore Sant’Anna, Pisa); Sabina Nuti (Istituto di Management - Scuola Superiore Sant’Anna, Pisa)
    Abstract: Objectives. In recent years, there has been a growing interest in the development and application of discrete choice experiments (DCEs) within health economics. Even though the literature include several reviews of the methodology associated with conducting DCEs and analysing the resultant choice data, a detailed classification of the areas covered by DCEs is lacking. The aim of this paper is to provide, after a brief description of the most important phases of a DCE, a comprehensive categorization of the various areas in which DCEs in health care have been performed. Methods. A systematic literature review was conducted to identify published studies using stated preferences DCEs within a health context between January 1990 and May 2011. Results. 256 DCEs were included in the review. Compared to the 1990-2000 period, the number of DCEs has increased quickly, with experiments carried out in 30 different countries. A growing number of studies primarily investigated patients’ preferences during the years, collecting a greater number of responses in comparison to the baseline period. A significant proportion of publications estimated the benefits of health care services, like specialistic surgical and medical services, generic medical services, services for chronics and elderly people, maternity and childbirth services and diagnostic facilities. Nevertheless, DCEs has also been used to value health outcomes, examine preferences for pharmaceutical products, investigate labour-market choices as well as healthcare systems characteristics and health policies. Conclusions. This paper adds to the body of literature reviewing the growing stock of published DCEs in health economics, providing a new detailed taxonomy of the various areas in which such experiments have been applied. Together with the methodological refinements, future research should continue to explore new contexts of analysis.
    Keywords: choice experiments, review, areas of application, health economics
    JEL: I10
    Date: 2013–01–01
  8. By: Damien S.Eldridge (School Economics, La Trobe University)
    Abstract: The health care industry in some countries displays a gated structure. Rather than approaching a specialist directly, a patient will first seek a referral from a general practitioner. We provide one possible explanation for such an industry structure. If the outcome of treatment depends on the effort exerted by the treating specialist, then a market failure might occur. By aggregating many patients, general practitioners can sometimes create an artificial long- run relationship between a patient and a specialist that otherwise would have a short-run relationship. Such an artificial long-run relationship reduces the incidence of shirking on the part of the specialist.
    Keywords: Gatekeepers, Reputation, Moral Hazard, Referral
    JEL: C73 D82 I11
    Date: 2013
  9. By: Cameron, Lisa; Shah, Manisha; Olivia, Susan
    Abstract: Lack of sanitation and poor hygiene behavior cause a tremendous disease burden among the poor. This paper evaluates the impact of the Total Sanitation and Sanitation Marketing project in Indonesia, where about 11 percent of children have diarrhea in any two-week period and more than 33,000 children die each year from diarrhea. The evaluation utilizes a randomized controlled trial but is unusual in that the program was evaluated when implemented at scale across the province of rural East Java in a way that was designed to strengthen the enabling environment and so be sustainable. One hundred and sixty communities across eight rural districts participated, and approximately 2,100 households were interviewed before and after the intervention. The authors found that the project increased toilet construction by approximately 3 percentage points (a 31 percent increase in the rate of toilet construction). The changes were primarily among non-poor households that did not have access to sanitation at baseline. Open defecation among these households decreased by 6 percentage points (or 17 percent). Diarrhea prevalence was 30 percent lower in treatment communities than in control communities at endline (3.3 versus 4.6 percent). The analysis cannot rule out that the differences in drinking water and handwashing behavior drove the decline in diarrhea. Reductions in parasitic infestations and improvements in height and weight were found for the non-poor sample with no sanitation at baseline.
    Keywords: Health Monitoring&Evaluation,Hygiene Promotion and Social Marketing,Housing&Human Habitats,Disease Control&Prevention,Early Child and Children's Health
    Date: 2013–02–01

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