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on Health Economics |
| By: | Norma B. Coe; Kalman Rupp |
| Abstract: | There is considerable policy concern about “DI lock” – that tying public health insurance coverage to cash disability benefit receipt contributes to the low exit rates due to work. This concern led Congress to institute continued health insurance eligibility after disability beneficiaries leave the cash-benefit rolls for work-related reasons. However, unlike the long literature on “job lock,” the importance of the DI lock hypothesis – either before or after these extensions – has remained unquantified. This paper tests whether “perceived DI lock” remains among disability beneficiaries, and whether state health insurance policies help alleviate the problem and encourage work among beneficiaries. The analysis includes both DI and SSI beneficiaries and tests if there are differential patterns between the two programs. We exploit state variation in the access and cost of health insurance caused by regulation of the non-group market, the existence of Medicaid buy-in programs, and Medicaid generosity, as well as detailed disability and health insurance program interactions. While we find little evidence overall of persistent DI-lock, heterogeneity is very important in this context. Our estimates suggest that increasing health insurance access does increase the likelihood of positive earnings among a subset of disability beneficiaries. We find evidence of SSI lock among beneficiaries with some Medicaid expenditures and find that both non-group health insurance regulation and generous Medicaid eligibility help alleviate the problem. We find evidence of remaining DI lock among individuals who do not have access to supplemental health insurance outside of Medicare. Medicaid buy-in programs alleviate the remaining DI lock. |
| Date: | 2013–04 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2013-10&r=hea |
| By: | Michel Dumont; Peter Willemé |
| Abstract: | While rising health care expenditures as a percentage of national income is a well-known and widely documented feature across the industrialized world, it has proved difficult to quantify the effects of the underlying cost drivers. The main difficulty is to find suitable proxies to measure medical technological innovation, which is believed to be a major determinant of steadily increasing health spending. This paper's main contribution is the use of data on approved medical devices and drugs to proxy for medical technological progress. The effects of these variables on total real per capita health spending are estimated using a panel model for 18 OECD countries covering the period 1981-2009. The results confirm the substantial cost-increasing effect of medical technology, which may account for at least 50% of the explained historical growth of spending. Excluding the approval variables causes a significant upward bias of the estimated income elasticity of health spending and negatively affects some model specification tests. Despite the overall net positive effect of technology, the effect of two subgroups of approvals on expenditure is significantly negative. These subgroups can be thought of as representing ‘incremental medical innovation', while the positive effects are related to radically innovative pharmaceutical products and devices. The results are consistent with those reported in other studies which suggest that some new products, despite their high price when they are introduced, can ultimately save money by reducing spending on other medical interventions. |
| Keywords: | Ageing, Health care expenditures, Income elasticity, Medical technology |
| JEL: | C23 H51 I10 |
| Date: | 2013–01–29 |
| URL: | http://d.repec.org/n?u=RePEc:fpb:wpaper:1302&r=hea |
| By: | Mark E. McGovern (Harvard School of Public Health); Till Bärnighausen (Harvard School of Public Health); Joshua A. Salomon (Harvard School of Public Health); David Canning (Harvard School of Public Health) |
| Abstract: | Selection bias in HIV prevalence estimates occurs if refusal to test is correlated with HIV status. Interviewer identity is plausibly correlated with consenting to test, but not with HIV status, allowing a Heckman-type correction that produces consistent HIV prevalence estimates. We innovate on existing approaches by showing that an interviewer random effects Bayesian estimator produces prevalence estimates that are unbiased as well as consistent. An additional advantage of this new estimator is that it allows the construction of bootstrapped standard errors. It is also easily implemented in standard statistical software. The model is used to produce new estimates and confidence intervals for HIV prevalence among men in Zambia and Ghana. |
| Keywords: | HIV, Heckman Selection Models, Missing Data, Bayesian Estimation |
| Date: | 2013–04 |
| URL: | http://d.repec.org/n?u=RePEc:gdm:wpaper:10113&r=hea |
| By: | Brekke, Kurt R. (Dept. of Economics, Norwegian School of Economics and Business Administration); Dalen, Dag Morten (Department of Economics, Norwegian Business School,); Holmås, Tor Helge (UNI Rokkan Centre) |
| Abstract: | This paper studies the diffusion of biopharmaceuticals across European countries, focusing on anti-TNF drugs, which are used to treat autoimmune diseases (e.g., rheumatism, psoriasis). We use detailed sales information on the three brands Remicade, Enbrel and Humira for nine European countries covering the period from the fi…rst launch in 2000 until becoming blockbusters in 2009. Descriptive statistics reveal largevariations across countries in per-capita consumption and price levels both overall and at brand level. We explore potential sources for the cross-country consumption differences by estimating several multivariate regression models. Our results show that large parts of the cross-country variation are explained by time-invariant country-speci…c factors (e.g., disease prevalence, demographics, health care system). We also fi…nd that differences in income (GDP per capita) and health spending (share of GDP) explain the cross-country variation in consumption, while relative price differences seem to have limited impact. |
| Keywords: | Di¤usion; pharmaceuticals; cross-country analysis. |
| JEL: | I11 L13 O33 |
| Date: | 2013–03–28 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:nhheco:2013_007&r=hea |
| By: | Brockwell, Erik (CERE, Centre for Environmental and Resource Economics) |
| Abstract: | The main objective of this article is to examine how taxes affect consumption of commodities that are detrimental to health and the environment: tobacco, alcoholic beverages, household energy and petroleum fuel (petrol) for transportation. Specifically, we examine if a tax increase leads to a significantly larger change in consumption than a producer price change, which is referred to as the signaling effect from taxation. This objective is achieved through an empirical analysis using the Linear Almost Ideal Demand System. The analysis uses aggregated cross sectional time series data and information on major legislation introductions in Sweden, Denmark and the United Kingdom from 1970 to 2009. We find the main result to be that the signaling effect is significant for “Alcoholic Beverages” and “Electricity” in Sweden, “Electricity” in Denmark and “Electricity and Gas” and “Electricity” the United Kingdom. This implies that tax policy is more effective in tackling consumption of commodities which produce negative public effects (negative externalities affecting the social good such as pollution) than those for negative private effects (negative externalities affecting the private good such as health). |
| Keywords: | environmental taxation; health-based taxation; public policy |
| JEL: | I18 Q58 |
| Date: | 2013–04–19 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:slucer:2013_003&r=hea |
| By: | Daniel Kuehnle (Department of Economics, Friedrich-Alexander-University Erlangen-Nuremberg) |
| Abstract: | Despite a recent growth in studies examining the association between family income and child health, very few studies investigate whether this is a causal relationship. This paper addresses this major methodological gap and examines the causal effect of family income on child health in the UK. Using rich observational data from a British cohort study, we exploit exogenous variation in local labour market characteristics to instrument for family income. We estimate the effect of family income on subjective child health and control for potential transmission channels through which income could affect child health. The results from our models provide novel evidence that income has a small but significant causal effect on subjective child health. Moreover, the analysis shows that parental health does not drive a spurious relationship between family income and child health as argued in recent contributions. We do not find significant effects of family income on chronic indicators of child health. The results are robust to different sets of instrumental variables, and to alternative measures of income. Despite a recent growth in studies examining the association between family income and child health, very few studies investigate whether this is a causal relationship. This paper addresses this major methodological gap and examines the causal effect of family income on child health in the UK. Using rich observational data from a British cohort study, we exploit exogenous variation in local labour market characteristics to instrument for family income. We estimate the effect of family income on subjective child health and control for potential transmission channels through which income could affect child health. The results from our models provide novel evidence that income has a small but significant causal effect on subjective child health. Moreover, the analysis shows that parental health does not drive a spurious relationship between family income and child health as argued in recent contributions. We do not find significant effects of family income on chronic indicators of child health. The results are robust to different sets of instrumental variables, and to alternative measures of income. |
| Keywords: | Child health, income gradient, instrumental variables, transmission channels, UK |
| JEL: | I1 |
| Date: | 2013–04 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2013n13&r=hea |
| By: | Jean-Marie Robine (INED); Emmanuelle Cambois (INED) |
| Abstract: | Each year since 2005, Eurostat has calculated life expectancy without activity limitations, known as"healthy life years". While life expectancy at age 65 increased by one year in the European Union between2005 and 2010, the years lived in poor perceived health decreased (by 0.5 years for men and 1.1 years for women)despite an increase in years with chronic morbidity (1.6 years for men, 1.3 years for women). Years withoutlimitation of activity remained unchanged. This paradoxcan be explained in part by more systematic detection and improved management of health problems, whoseprevalence may thus increase without necessarily producing an increase in reported activity limitations or innegative perceptions of health. |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:idg:posoce:499&r=hea |
| By: | James M. Verdier; Ashley Zlatinov |
| Keywords: | Medicaid , prescription drugs , prescription drug expenditures, MAX |
| JEL: | I |
| Date: | 2013–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7722&r=hea |
| By: | Jeffrey T. Kullgren; Catherine G. McLaughlin; Nandita Mitra and; Katrina Armstrong |
| Keywords: | Nonfinancial Barriers, Access to Care, Adult health care, health |
| JEL: | I |
| Date: | 2012–02–28 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7725&r=hea |
| By: | Suzanne Felt-Lisk; Grace Ferry; Rebecca Roper; Melanie Au; James Walker; J.B. Jones; Virginia Lerch |
| Keywords: | THQIT, Transforming Healthcare Quality, IT Grans, Health IT |
| JEL: | I |
| Date: | 2012–12–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7726&r=hea |
| By: | James M. Verdier |
| Keywords: | Medicare Part D, Prescription Drug Coverage, Capitated Financial Alignment, Health |
| JEL: | I |
| Date: | 2013–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7728&r=hea |
| By: | Emmanuelle Lavaine; Matthew J. Neidell |
| Abstract: | This paper examines the effect of energy production on newborn health using a recent strike that affected oil refineries in France as a natural experiment. First, we show that the temporary reduction in refining lead to a significant reduction in sulfur dioxide (SO2) concentrations. Second, this shock significantly increased birth weight and gestational age of newborns, particularly for those exposed to the strike during the third trimester of pregnancy. Back-of-the-envelope calculations suggest that a 1 unit decline in SO2 leads to a 196 million euro increase in lifetime earnings per birth cohort. This externality from oil refineries should be an important part of policy discussions surrounding the production of energy. |
| JEL: | I12 Q4 |
| Date: | 2013–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:18974&r=hea |
| By: | Volker, D. (Tilburg University); Vlasveld, M.C.; Anema, J.R.; Beekman, A.T.F.; Hakkaart-van Roijen, L.; Brouwers, E.P.M. (Tilburg University); Lomwel, A.G.C. van (Tilburg University); Feltz-Cornelis, C.M. van der (Tilburg University) |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:ner:tilbur:urn:nbn:nl:ui:12-5905225&r=hea |
| By: | Kurt R. Brekke (Department of Economics and Centre and Health Economics Bergen, Norwegian School of Economics); Luigi Siciliani (Department of Economics and Centre for Health Economics, University of York, Heslington); Odd Rune Straume (Department of Economics, University of Minho) |
| Abstract: | Using a spatial competition framework with three ex ante identical hospitals, we study the effects of a hospital merger on quality, price and welfare. The merging hospitals always reduce quality, but the non-merging hospital responds by reducing quality if prices are fixed and increasing quality if not. The merging hospitals increase prices if demand responsiveness to quality is sufficiently low, whereas the non-merging hospital always increases its price. If prices are endogenous, a merger leads to higher average prices and quality in the market. A merger is harmful for total patient utility but can improve social welfare under price competition. |
| Keywords: | Hospital mergers; Spatial Competition; Antitrust |
| JEL: | I11 I18 L13 L44 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:nip:nipewp:04/2013&r=hea |
| By: | Manoj K. Pandey |
| Abstract: | Evidence on the association between traditional poverty measures and health is widely available in the literature. However, the traditional ex-post poverty measures neglect many aspects of household welfare by overlooking the risk that a household faces in view of fewer resources available to it. Household’s vulnerability to expected poverty is an alternative measure which allows quantification of welfare loss due to poverty as well as due to other sources of uncertainty. Using two waves of independent cross-sectional data collected by National Sample Survey Organization (NSSO) in the years 1995–96 and 2004, the paper aims to estimate household’s vulnerability to poverty for Indian households with elderly and examine whether health shocks from the elderly members translated into the risk of household’s poverty in the near future. The econometric results accounting for possible endogenous relationship between health and vulnerability suggest that households with higher concentration of aged members with poor health and disability are more vulnerable to poverty. Thus, economic policies, for general population as well as for aged, should be integrated well with the health policies. Sufficient healthcare facilities and affordable health insurance is needed to be provided to the households with aged — in particular for those living in rural and other poverty prone areas and communities. This is a necessary step to eradicate poverty from poor households and to prevent non-poor households from falling into poverty in the near future. |
| Keywords: | Health shocks, Poverty, Vulnerability to poverty, elderly |
| JEL: | J14 I18 C35 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2013-01&r=hea |
| By: | Jon H. Fiva,; Torbjørn Hægeland; Marte Rønning; Astri Syse (Statistics Norway) |
| Abstract: | The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and ii) the use of such treatment improved these patients' survival. |
| Keywords: | Education; Health; Inequality |
| JEL: | I10 I20 |
| Date: | 2013–02 |
| URL: | http://d.repec.org/n?u=RePEc:ssb:dispap:735&r=hea |