nep-hea New Economics Papers
on Health Economics
Issue of 2013‒05‒24
eight papers chosen by
Yong Yin
SUNY at Buffalo

  1. Heterogeneous hospital response to a per diem prospective payment system By Galina Besstremyannaya
  2. Do household surveys give a coherent view of disability benefit targeting? A multi-survey latent variable analysis for the older population in Great Britain By Hancock, Ruth; Morciano, Marcello; Pudney, Stephen; Zantomio, Francesca
  3. Socioeconomic Inequalities in Child Health in Ireland By Layte, Richard; Nolan, Anne
  4. Income-Related Inequity in the Use of GP Services: A Comparison of Ireland and Scotland By Layte, Richard; Nolan, Anne
  5. Maternal Health and the Baby Boom By Stefania Albanesi; Claudia Olivetti
  6. Maternal Health and Fertility: An International Perspective By Stefania Albanesi
  7. Using Performance Incentives to Improve Medical Care Productivity and Health Outcomes By Paul Gertler; Christel Vermeersch
  8. Adjusting Measures of Economic Output for Health: Is the Business Cycle Countercyclical? By Mark L. Egan; Casey B. Mulligan; Tomas J. Philipson

  1. By: Galina Besstremyannaya (CEFIR)
    Abstract: The paper provides the empirical support for heterogeneity in hospital response to changeover from the fee-for-service (FFS) system to a per diem prospective payment system (PPS). Using a recent administrative database for the universe of Japanese hospitals, I conduct estimations with dynamic panel data and show that hospitals with shorter (longer) average length of stay under FFS have longer (shorter) average length of stay under per diem PPS. The planned readmission rate increases under per diem PPS for FFS hospitals with longer average length of stay.
    JEL: I12 I18 C23
    Date: 2013–05
  2. By: Hancock, Ruth; Morciano, Marcello; Pudney, Stephen; Zantomio, Francesca
    Abstract: We compare three major UK surveys, BHPS, FRS and ELSA, in terms of the picture they give of the relationship between disability and receipt of the Attendance Allowance (AA) benefit. Using the different disability indicators available in each survey, we estimate a model in which probabilities of receiving AA depend on latent disability status. Despite major differences in design, once sample composition is standardised through statistical matching, the surveys deliver similar results for the model of disability incidence and AA receipt. Provided surveys offer a sufficiently wide range of disability indicators, the detail of disability measurement appears relatively unimportant.
    Date: 2013–05–07
  3. By: Layte, Richard; Nolan, Anne
    Abstract: There is extensive empirical evidence on the link between socio-economic status (SES) and child health outcomes. However, there is some international evidence that the SES gradient in child health is weaker for objective indicators of child health (e.g., anthropometric measures such as height) than for subjective indicators (e.g., parental assessments of general health status). In this paper, we use detailed cross-sectional micro-data on two cohorts of children in Ireland (aged 9 months and 9 years) to examine the SES gradient in various indicators of child health (length/height; weight/BMI; general health status; chronic illness incidence). Using two main indicators of SES, namely household income and mother's highest level of education, we find only limited support for the contention that the SES gradient in child health in Ireland is stronger for more subjective measures of child health.
    Keywords: Child Health/Socio-Economic Health Inequalities/Ireland
    JEL: C20 D12 I14
    Date: 2013–04
  4. By: Layte, Richard; Nolan, Anne
    Abstract: Equity of access to health care is a key component of national and international health policy. The Irish health-care system is unusual in requiring the majority of the population to pay the full cost of GP care at the point of use. In contrast, all Scottish residents are entitled to free GP care at the point of use. Using nationally representative micro-data on Irish and Scottish children, we find that the distribution of GP care in Ireland favours those on lower incomes (i.e., 'pro-poor'), but that there is no significant difference in the distribution of GP care across income groups in Scotland. Focusing just on children who pay for GP care in Ireland, we find some evidence for a significant 'pro-rich' distribution of GP visits.
    Keywords: GP Services/Children/Concentration Index/Inequity/Ireland/Scotland
    JEL: C20 D12 I10
    Date: 2013–04
  5. By: Stefania Albanesi (Federal Reserve Bank of New York and CEPR); Claudia Olivetti (Boston University and NBER)
    Abstract: U.S. fertility rose from a low of 2.27 children for women born in 1908 to a peak of 3.21 children for women born in 1932. It dropped to a new low of 1.74 children for women born in 1949, before stabilizing for subsequent cohorts. We propose a novel explanation for this boom-bust pattern, linking it to the huge improvements in maternal health that started in the mid 1930s. Our hypothesis is that the improvements in maternal health contributed to the mid-twentieth century baby boom and generated a rise in women's human capital, ultimately leading to a decline in desired fertility for subsequent cohorts. To examine this link empirically, we exploit the large cross-state variation in the magnitude of the decline in pregnancy-related mortality and the differential exposure by cohort. We find that the decline in maternal mortality is associated with a rise in fertility for women born between 1921 and 1940, with a rise in college and high school graduation rates for women born in 1933-1950 relative to previous cohorts, and with a decline in fertility for women born in 1941-1950 relative to those born in 1921-1940. The analysis provides new insights on the determinants of fertility in the U.S. and other countries that experienced similar improvements in maternal health.
    Keywords: Maternal mortality, Fertility choice, Baby boom, human capital
    JEL: J11 J13 N12 N3
    Date: 2013–05
  6. By: Stefania Albanesi (Federal Reserve Bank of New York and CEPR)
    Abstract: This paper examines the impact of the decline in maternal mortality on fertility and women's human capital. Fertility theory suggests that a permanent decline in maternal mortality initially increases fertility and generates a permanent rise in women's human capital, relative to men. The resulting rise in the opportunity cost of children leads to a subsequent decline in desired fertility, generating a boom-bust response. We assess these predictions using newly digitized data on maternal mortality for 25 advanced and emerging economies for the time period 1900-2000. The empirical estimates suggest that the decline in maternal mortality contributed significantly to the baby booms and subsequent baby busts experi- enced by these economies in the twentieth century, and that the female-male differential in education attainment grew more in those countries that experience a sizable maternal mortality decline.
    Keywords: Maternal mortality decline, fertility choice, baby boom, women's, human capital
    JEL: J11 J13 J16 N3
    Date: 2013–05
  7. By: Paul Gertler; Christel Vermeersch
    Abstract: We nested a large-scale field experiment into the national rollout of the introduction of performance pay for medical care providers in Rwanda to study the effect of incentives for health care providers. In order to identify the effect of incentives separately from higher compensation, we held constant compensation across treatment and comparison groups – a portion of the treatment group’s compensation was based on performance whereas the compensation of the comparison group was fixed. The incentives led to a 20% increase in productivity, and significant improvements in child health. We also find evidence of a strong complementarity between performance incentives and baseline provider skill.
    JEL: I11 J33 O12
    Date: 2013–05
  8. By: Mark L. Egan; Casey B. Mulligan; Tomas J. Philipson
    Abstract: Many national accounts of economic output and prosperity, such as gross domestic product (GDP) or net domestic product (NDP), offer an incomplete picture by ignoring, for example, the value of leisure, home production, and the value of health. Discussed shortcomings have focused on how unobserved dimensions affect GDP levels but not their cyclicality, which affects the measurement of the business cycle. This paper proposes new measures of the business cycle that incorporate monetized changes in health of the population. In particular, we incorporate in GDP the dollar value of mortality, treating it as depreciation in human capital analogous to how NDP measures treat depreciation of physical capital. We examine the macroeconomic fluctuations in the United States and globally during the past 50 years, taking into account how depreciation in health affects the cycle. Because mortality tends to be pro-cyclical, fluctuations in standard GDP measures are offset by monetized changes in health; booms are not as valuable as traditionally measured because of increased mortality, and recessions are not as bad because of reduced mortality. Consequently, we find that U.S. business cycle fluctuations appear milder than commonly measured and may even be reversed for the majority of “recessions” after accounting for the cyclicality of health. We find that adjusting for mortality reduces the measured U.S. business cycle volatility during the past 50 years by about 37% in the United States and 46% internationally. We discuss future research directions for more fully incorporating the cyclicality of unobserved health capital into standard output measurement.
    JEL: E01 I1
    Date: 2013–05

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