nep-hea New Economics Papers
on Health Economics
Issue of 2013‒06‒16
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Choice of contracts for quality in health care: Evidence from the British NHS By Eleonora Fichera; Hugh Gravelle; Mario Pezzino; Matt Sutton
  2. Long term care provision, hospital length of stay and discharge destination for hip fracture and stroke patients By James Gaughan; Hugh Gravelle; Rita Santos; Luigi Siciliani
  3. How Important Is Medicare Eligibility in the Timing of Retirement? By Norma B. Coe; Mashfiqur R. Khan; Matthew S. Rutledge
  4. Health Inequalities through the Lens of Health Capital Theory: Issues, Solutions, and Future Directions By Titus J. Galama; Hans van Kippersluis
  5. Early Marriage, Women Empowerment and Child Mortality: Married Too Young To Be a «Good Mother»? By Nathalie Guilbert
  6. Mixed Method Evaluation of a Passive mHealth Sexual Information Testing Service in Uganda By Julian Jamison; Dean Karlan; Pia Raffler
  7. Awareness as an Adaptation Strategy for Reducing Mortality from Heat Waves: Evidence from a Disaster Risk Management Program in India By Stephen C. Smith; Saudamini Das
  8. The Effect of Minimum Legal Drinking Age on the Incidence of First Pregnancy and Its Outcome By Inna Cintina
  9. Community-based health insurance and social capital: a review By Hermann Pythagore Pierre Donfouet; Pierre-Alexandre Mahieu
  10. Health capital depreciation effects on development: theory and measurement By Martine Audibert; Pascale Combes Motel; Alassane Drabo
  11. Lost in Translation. Rethinking the Inequality-Equivalence Criteria for Bounded Health Variables By Kjellsson, Gustav; Gerdtham, Ulf-G.
  12. From Comparative Effectiveness Research to Patient-Centered Outcomes Research: Policy History and Future Directions. By Laura P. D'Arcy; Eugene C. Rich
  13. The Effect of Medicare Advantage on Hospital Admissions and Mortality By Christopher C. Afendulis; Michael E. Chernew; Daniel P. Kessler
  14. Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD? By Janet Currie; Mark Stabile; Lauren E. Jones
  15. Economic Downturns and Substance Abuse Treatment: Evidence from Admissions Data By Johanna Catherine Maclean; Jonathan H. Cantor; Rosalie Liccardo Pacula
  16. How to Improve Patient Care? – An Analysis of Capitation, Fee-for-Service, and Mixed Payment Schemes for Physicians By Jeannette Brosig-Koch; Heike Hennig-Schmidt; Nadja Kairies; Daniel Wiesen
  17. How Effective are Pay-for-Performance Incentives for Physicians? – A Laboratory Experiment By Jeannette Brosig-Koch; Heike Hennig-Schmidt; Nadja Kairies; Daniel Wiesen
  18. How do Non-Monetary Performance Incentives for Physicians Affect the Quality of Medical Care? – A Laboratory Experiment By Nadja Kairies; Miriam Krieger
  19. The effects of old and new media on children's weight. By Agne Suziedelyte
  20. To love or to pay: Savings and health care in older age. By Loretti I. Dobrescu
  21. Mapping, Cost, and Reach to the Poor of Faith-Inspired Health Care Providers in Sub-Saharan Africa: Strengthening the Evidence for Faith-inspired Health Engagement in Africa, Volume 3 By Oliver, Jill; Wodon, Quentin
  22. Competition in the market for supplementary health insurance: The case of competing nonprofit sickness funds By Ellert, Alexander; Urmann, Oliver
  23. Impacts of parental health shocks on children's non-cognitive skills By Westermaier, Franz; Morefield, Brant; Mühlenweg, Andrea M.

  1. By: Eleonora Fichera (Manchester Centre for Health Economics, University of Manchester, UK); Hugh Gravelle (Centre for Health Economics, University of York, UK); Mario Pezzino (Economics, School of Social Sciences, University of Manchester, UK); Matt Sutton (Institute of Population Health, Manchester Centre for Health Economics, University of Manchester, UK)
    Abstract: We examine how public sector third-party purchasers and hospitals negotiate quality targets when a fixed proportion of hospital revenue is required to be linked to quality. We develop a bargaining model linking the number of quality targets to purchaser and hospital characteristics. Using data extracted from 153 contracts for acute hospital services in England in 2010/11, we find that the number of quality targets is determined by the purchaser's population health and its budget, the hospital type, whether the purchaser delegated negotiation to an agency, and the quality targets imposed by the supervising regional health authority.
    Keywords: Contracts; quality; financial incentives; pay for performance; hospitals; Nash bargaining
    JEL: I11 I18 L51 C35
    Date: 2013–06
  2. By: James Gaughan (Centre for Health Economics, University of York, UK); Hugh Gravelle (Centre for Health Economics, University of York, UK); Rita Santos (Centre for Health Economics, University of York, UK); Luigi Siciliani (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK)
    Abstract: Expenditure on long term care is expected to rise, driven by an ageing population. Coordination between health and long term care is increasingly a priority for policymakers. Elderly individuals living at home who suffer trauma, such as hip fracture or stroke, generally require immediate acute hospital care, followed by long term care and assistance which can be provided either in their home or in a residential or nursing home. However, little is known about the effects of one sector on the other. This study examines the association between formal long term care supply and the probability of being discharged to a long-term care institution (a nursing home or a care home) and length of stay in hospital for patients admitted for hip fracture or stroke.
    Date: 2013–06
  3. By: Norma B. Coe; Mashfiqur R. Khan; Matthew S. Rutledge
    Abstract: Eligibility for Medicare at age 65 is widely viewed as an important factor in retirement decisions. However, it has been difficult to quantify the influence of Medicare because eligibility for Medicare came at the same age as Social Security’s Full Retirement Age (FRA). The recent rise in the FRA, along with other changes, has decoupled the age-related incentives in the two programs, making it easier to estimate the effect of Medicare eligibility on the timing of retirement. This brief, based on a recent study, provides such estimates of the importance of Medicare on retirement decisions. The discussion proceeds as follows. The first section discusses the relationship between Medicare eligibility and the timing of retirement. The second section describes the metric used for assessing the timing of retirement and the effect of Medicare eligibility. The third section reports the findings. The fourth section concludes that Medicare eligibility is a significant factor in the retirement decision, but that changes in the availability of health insurance for retirees could alter its importance going forward.
    Date: 2013–05
  4. By: Titus J. Galama (University of Southern California, Dornsife College Center for Economic and Social Research, USA, and RAND Corporation, USA); Hans van Kippersluis (Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands)
    Abstract: We explore what health-capital theory has to offer in terms of informing and directing research into health inequality. We argue that economic theory can help in identifying mechanisms through which specific socioeconomic indicators and health interact. Our reading of the literature, and our own work, leads us to conclude that non-degenerate versions of the Grossman model (1972a;b) and its extensions can explain many salient stylized facts on health inequalities. Yet, further development is required in at least two directions. First, a childhood phase needs to be incorporated, in recognition of the importance of childhood endowments and investments in the determination of later-life socioeconomic and health outcomes. Second, a unified theory of joint investment in skill (or human) capital and in health capital could provide a basis for a theory of the relationship between education and health.
    Keywords: Health Capital Models, Health Inequality
    JEL: I12 I14
    Date: 2013–06–03
  5. By: Nathalie Guilbert (PSL, Université Paris-Dauphine, IRD,LEDa, UMR DIAL)
    Abstract: (english) This paper uses data from recent Senegalese Demographic and Health Surveys to explore the link between female empowerment and child mortality via early marriage, defined as marriage before age 16. There exist three channels through which early marriage reduces a mother's ability to take good care of her children: the harmful physical consequences of early sex and pregnancy; a disrupted education; and reduced autonomy and bargaining power. Controlling for the first two of these allows us to isolate the empowerment effect of early marriage. We estimate that it increases the probability that the mother experience at least one son death by 4.43%, and raises the number of dead sons per mother by 0.074. Particular attention is paid to discuss and address endogeneity issues. We also further investigate the heterogeneity of impact by current age and marriage duration. Findings suggest that we effectively identify the empowerment channel. _________________________________ (français) Cet article utilise les données des Enquêtes Démographiques et de Santé collectées en 2005 et en 2010 au Sénégal pour explorer le lien entre autonomisation des femmes et mortalité infantile, via la pratique du mariage précoce. Le mariage précoce est défini comme tout mariage ayant lieu avant que la jeune fille ait atteint 16 ans. Cette pratique est encore très répandue au Sénégal où 34,4% des femmes mariées sont concernées. Il existe trois canaux via lesquels le mariage précoce réduit l’aptitude des femmes à prendre bien soin de leurs enfants. Le premier est lié aux conséquences physiques désastreuses des rapports sexuels et grossesses précoces. Le deuxième découle du manque d’éducation formelle et informelle reçue par ces jeunes femmes pour lesquelles toute opportunité d’aller à l’école est interrompue précocement par le mariage. Le troisième ressort de l’absence de pouvoir de négociation des femmes au sein de leur ménage et de leur absence d’autonomie. En contrôlant pour les deux premiers canaux, nous sommes en mesure d’isoler l’impact spécifique du canal d’autonomisation des femmes sur la mortalité infantile. On estime alors que cette absence de pouvoir de négociation des femmes, exacerbée dans le cas des mariages précoces, accroît la probabilité d’une femme de voir un de ses fils décédés avant l’âge de 5 ans de 4,43% et leur nombre de 0,074. L’impact sur la mortalité des filles est non significatif. Une attention particulière a été portée à discuter et résoudre les problèmes d’endogénéité auxquels nous faisons face dans cette étude. Nous avons aussi creusé l’hétérogénéité de l’impact en fonction de l’âge actuel de la femme et du nombre d’années passées dans l’union, ceci afin de confirmer que l’on identifie bien le canal d’autonomisation des femmes. En effet, avec le temps, la connaissance du ménage d’accueil et un âge plus élevé qui confère un certain statut social, il est probable que l’effet « pouvoir de négociation » du mariage précoce s’amenuise. C’est effectivement ce que l’on observe.
    Keywords: Early marriage, Senegal, Fertility, Child Mortality, Women Empowerment, Bargaining Power, Mariage précoce, Sénégal, fécondité, mortalité infantile, autonomisation des femmes, pouvoir de négociation.
    JEL: J12 J13 I14
    Date: 2013–05
  6. By: Julian Jamison (Consumer Financial Protection Bureau, D.C.); Dean Karlan (Economic Growth Center, Yale University); Pia Raffler (Department of Political Science, Yale University)
    Abstract: We evaluate the impact of a health information intervention implemented through mobile phones, using a clustered randomized control trial augmented by qualitative interviews. The intervention aimed to improve sexual health knowledge and shift individuals towards safer sexual behavior by providing reliable information about sexual health. The novel technology designed by Google and Grameen Technology Center provided automated searches of an advice database on topics requested by users via SMS. It was offered by MTN Uganda at no cost to users. Quantitative survey results allow us to reject the hypothesis that improving access to information would increase knowledge and shift behavior to less risky sexual activities. In fact, we find that the service led to an increase in promiscuity, and no shift in perception of norms. Qualitative focus groups discussions support the findings of the quantitative survey results. We conclude by discussing a potential mechanism explaining the counterintuitive findings.
    Keywords: information technology for development, mhealth, ICT4D, sexual health
    JEL: D13 O12 O31 O33
    Date: 2013–05
  7. By: Stephen C. Smith (Department of Economics/Institute for International Economic Policy, George Washington University); Saudamini Das (Department of Economics, Swami Shradhanand College, University of Delhi)
    Abstract: Heat waves, defined as an interval of abnormally hot and humid weather, have been a prominent killer in recent years. With heat waves worsening with climate change, adaptation is essential; one strategy has been to issue heat wave warnings and undertake awareness campaigns to bring about behavioral changes to reduce heat stroke. Since 2002, the Indian state of Odisha has been undertaking a grassroots awareness campaign on "dos and don'ts" during heat wave conditions through the Disaster Risk Management (DRM) program. Selection criteria for DRM districts were earthquake, flood, and cyclone incidence; but subsequently heat wave awareness also received intensive attention in these districts. We present quasi-experimental evidence on the impact of the program, taking DRM districts and periods as treatment units and the rest as controls, analyzing the impact on the death toll from heat stroke for the 1998 to 2010 period, using difference-in-difference (DID) regressions with a district level panel data set and a set of control variables. We find indications of program effectiveness with initial DID specifications, but results are not strongly robust. We then take into account a statewide heat wave advertising program, to which the poor have limited exposure but which may also provide spillover benefits, using a triple differencing approach; results suggest the heat wave awareness programs may have complementary impacts. We examine research strategies for much-needed improvement in the precision of impact evaluation results for innovative programs of this type.
    Keywords: Adaptation to climate change, Awareness campaigns, Heat waves, Disaster Risk Management Program, India, Odisha, Difference-in-difference
    JEL: Q54 O13 I18
    Date: 2012–05
  8. By: Inna Cintina (University of Hawaii at Manoa Economic Research Organization)
    Abstract: The minimum legal drinking age (MLDA) requirements can affect teen fertility rates through changes in alcohol-induced risky sexual behavior. The direction of the effect can vary depending on changes in alcohol consumption context and intensity. Using micro-level data, I find that a decrease in the MLDA increases the probability of unwanted first pregnancy among 15-20 year-old blacks and poor whites. The effect on non-poor whites is not statistically significant. I find some evidence that the individual eligibility status at the time of first pregnancy rather than the state MLDA might affect fertility among non-poor whites.
    Keywords: Minimum Legal Drinking Age (MLDA), Pregnancy, Fertility, Sexual Behavior, Alcohol Consumption, Discrete Hazard
    JEL: J13 J18
    Date: 2013–06
  9. By: Hermann Pythagore Pierre Donfouet (CREM - Centre de Recherche en Economie et Management - CNRS : UMR6211 - Université de Rennes 1 - Université de Caen Basse-Normandie); Pierre-Alexandre Mahieu (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272)
    Abstract: Community-Based Health Insurance (CBHI) is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. CBHI is currently being provided in some rural areas in developing countries and there is ongoing research about its impact on the well-being of the poor in these areas. However, the success of CBHI revolves around the existence of social capital in the community. This has led researchers to explore the impact of CBHI on the well-being of the poor in rural areas, especially as it relates to social capital. The overall objective of this paper is to review recent developments that address the link between CBHI and social capital. Policy implications are also discussed.
    Keywords: Community-based health insurance ; social capital ; rural areas
    Date: 2012
  10. By: Martine Audibert (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Pascale Combes Motel (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I); Alassane Drabo (CERDI - Centre d'études et de recherches sur le developpement international - CNRS : UMR6587 - Université d'Auvergne - Clermont-Ferrand I)
    Abstract: Relationships between health and economic prosperity or economic growth are difficult to assess. The direction of the causality is often questioned and the subject of a vigorous debate. For some authors, diseases or poor health had contributed to poor growth performances especially in low-income countries. For other authors, the effect of health on growth is relatively small, even if one considers that human capital accumulation needs also health investments. It is argued in this paper that commonly used health indicators in macroeconomic studies (e. g. life expectancy, infant mortality or prevalence rates for specific diseases such as malaria or HIV/AIDS) imperfectly represent the global health status of population. Health is rather a complex notion and includes several dimensions which concern fatal (deaths) and non-fatal issues (prevalence and severity of cases) of illness. The reported effects of health on economic growth vary accordingly with health indicators and countries included in existing analyses. The purpose of the paper is to assess the effect of health on growth. The augmented Solow model is modified so as to account for human capital depreciation. It is argued that the latter is measured by the so-called disability-adjusted life year (DALY) that was proposed by the World Bank and the WHO in 1993. Income regressions are run on 129 countries over the 2000-2004's period, where the potential endogeneity of the health indicator is dealt for. The negative effect of poor health on development is not rejected thus reinforcing the importance of achieving MDGs.
    Keywords: Global Burden of Disease;DALYs;augmented Solow model;cross-country analysis
    Date: 2013–06–11
  11. By: Kjellsson, Gustav (Department of Economics, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University)
    Abstract: What distributional change of a population's health preserves the level of inequality? In the income inequality literature, the answer lies somewhere between a uniform and a proportional change of the distribution. The polar positions represent the absolute and relative Inequality Equivalence Criteria (IEC), respectively. For a bounded health variable, health may be defined in terms of both attainments and shortfalls. As a distributional change cannot simultaneously be proportional to attainments and to shortfalls, relative inequality measures may rank populations differently for the two perspectives. In contrast to the literature that stresses the importance of measuring inequality in attainments and shortfalls consistently using an absolute IEC, this paper formalizes a new compromise concept for a bounded variable by explicitly considering the two relative IECs, defined with respect to attainments and shortfalls, to represent the polar cases of defensible positions. We further use a surplus-sharing approach to provide new insights on commonly used inequality indices by evaluating the underpinning IECs in terms of how infinitesimal surpluses of health must be successively distributed to preserve the level of inequality. The IECs underpinning the intensively discussed indices suggested by Adam Wagstaff and Guido Erreygers both satisfy our new compromise concept, but the weights assigned to the polar cases vary with the mean health. In contrast, we derive a one-parameter IEC that assigns constant weights independent of the health distribution. That is, the size of the surplus shares distributed according to the two relative sharing rules is constant and equal to a parameter value.
    Keywords: health inequality; bounded variable; inequality equivalence criteria
    JEL: D63 I14
    Date: 2013–05–29
  12. By: Laura P. D'Arcy; Eugene C. Rich
    Keywords: Comparative Effectiveness Research, Health Care Costs, Patient-Centered Outcomes research, Health
    JEL: I
    Date: 2012–07–30
  13. By: Christopher C. Afendulis; Michael E. Chernew; Daniel P. Kessler
    Abstract: Medicare currently allows beneficiaries to choose between a government-run health plan and a privately- administered program known as Medicare Advantage (MA). Because enrollment in MA is optional, conventional observational estimates of the program's impact are potentially subject to selection bias. To address this, we use a discontinuity in the rules governing MA payments to health plans that gives greater payments to plans operating in counties in Metropolitan Statistical Areas with populations of 250,000 or more. The sharp difference in payment rates at this population cutoff creates a greater incentive for plans to increase the generosity of benefits and therefore enroll more beneficiaries in MA in counties just above versus just below the cutoff. We find that the expansion of MA on this margin reduces beneficiaries' rates of hospitalization and mortality.
    JEL: I1 I18
    Date: 2013–06
  14. By: Janet Currie; Mark Stabile; Lauren E. Jones
    Abstract: We examine the effects of a policy change in the province of Quebec, Canada which greatly expanded insurance coverage for prescription medications. We show that the change was associated with a sharp increase in the use of Ritalin, a medication commonly prescribed for ADHD, relative to the rest of Canada. We ask whether this increase in medication use was associated with improvements in emotional functioning and short- and long-run academic outcomes among children with ADHD. We find evidence of increases in emotional problems among girls, and reductions in educational attainment among boys. Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication use can have negative consequences given the average way these drugs are used in the community.
    JEL: I0
    Date: 2013–06
  15. By: Johanna Catherine Maclean; Jonathan H. Cantor; Rosalie Liccardo Pacula
    Abstract: This study investigates the effect of economic downturns on substance abuse treatment admissions using data from the Treatment Episodes Data Set between 1992 and 2010. Given the differences between alcohol and illicit drugs, we separately examine these two classes of substances. Changes in admissions may be driven by both demand and supply side determinants of substance abuse treatment, and we include supply side proxies in our regressions to isolate the role of demand. We find that admissions for both alcohol and illicit drugs decrease in downturns. Unconditional quantile regressions reveal that the relationship varies across the admissions distribution: results are driven by states with low admissions. Our findings shed new light on the relationship between economic downturns and substance abuse, and have implications for public health policy and prioritization of government spending.
    JEL: I1 I12 J2
    Date: 2013–06
  16. By: Jeannette Brosig-Koch; Heike Hennig-Schmidt; Nadja Kairies; Daniel Wiesen
    Abstract: In recent health care reforms, several countries have replaced pure payment schemes for physicians (fee-for-service, capitation) by so-called mixed payment schemes. Until now it is still an unresolved issue whether patients are really better off after these reforms. In this study we compare the effects resulting from pure and mixed incentives for physicians under controlled laboratory conditions. Subjects in the role of physicians choose the quantity of medical services for different patient types. Real patients gain a monetary benefit from subjects’ decisions. Our results reveal that overprovision observed in fee-for-service schemes and underprovision observed in capitation schemes can, in fact, be reduced by mixed incentives. Interestingly, even the presentation of pure incentives as mixed incentives already significantly affects physicians’ behavior. Moreover, the mixed payment schemes generally provide a higher benefit-remuneration ratio than the respective pure payment schemes. Our findings provide some valuable insights for designing health care reforms.
    Keywords: Physician incentive schemes; fee-for-service; capitation; mixed payment; laboratory experiment; presentation effect; benefit-remuneration analysis
    JEL: C91 I11
    Date: 2013–05
  17. By: Jeannette Brosig-Koch; Heike Hennig-Schmidt; Nadja Kairies; Daniel Wiesen
    Abstract: Recent reforms in health care have introduced a variety of pay-for-performance programs using financial incentives for physicians to improve the quality of care. Their effectiveness is, however, ambiguous as it is often difficult to disentangle the effect of financial incentives from the ones of various other simultaneous changes in the system. In this study we investigate the effects of introducing financial pay-for-performance incentives with the help of controlled laboratory experiments. In particular, we use fee-for-service and capitation as baseline payment schemes and test how additional pay-for-performance incentives affect the medical treatment of different patient types. Our results reveal that, on average, patients significantly benefit from introducing pay-forperformance, independently of whether it is combined with capitation or fee-for-service incentives. The magnitude of this effect is significantly infl uenced by the patient type, though. These results hold for medical and non-medical students. A cost-benefit analysis further demonstrates that, overall, the increase in patient benefits cannot overcompensate the additional costs associated with pay-for-performance. Moreover, our analysis of individual data reveals different types of responses to pay-for-performance incentives. We find some indication that pay-forperformance might crowd out the intrinsic motivation to care for patients. These insights help to understand the effects caused by introducing pay-for-performance schemes.
    Keywords: Physician incentive schemes; pay-for-performance; fee-for-service; capitation; laboratory experiment
    JEL: C91 I11
    Date: 2013–05
  18. By: Nadja Kairies; Miriam Krieger
    Abstract: In recent years, several countries have introduced non-monetary performance incentives for health care providers to improve the quality of medical care. Evidence on the effect of non-monetary feedback incentives, predominantly in the form of public quality reporting, on the quality of medical care is, however, ambiguous. This is often because empirical research to date has not succeeded in distinguishing between the effects of monetary and non-monetary incentives, which are usually implemented simultaneously. We use a controlled laboratory experiment to isolate the impact of nonmonetary performance incentives: subjects take on the role of physicians and make treatment decisions for patients, receiving feedback on the quality of their treatment. The subjects’ decisions result in payments to real patients. By giving either private or public feedback we are able to disentangle the motivational eff ects of self-esteem and social reputation. Our results reveal that public feedback incentives have a significant and positive effect on the quality of care that is provided. Private feedback, on the other hand, has no impact on treatment quality. These results hold for medical students and for other students.
    Keywords: Laboratory experiment; quality reporting; feedback; treatment quality; performance incentives
    JEL: I11 C91 L15 I18
    Date: 2013–05
  19. By: Agne Suziedelyte (The University of New South Wales)
    Abstract: The aim of this paper is to determine if there is a causal relationship between children's time spent on media related activities and their weight. Since the beginning of 1980s, childhood obesity rates in the U.S. and other developed countries have been increasing. It has been suggested in the literature that changes in children's media use is an important explanation for the observed increase in children's weight. I investigate whether or not this hypothesis is supported by data. Additionally, I compare the eects of television, or old media, with the eects of computers and video games, or new media. The Child Development Supplement to the Panel Study of Income Dynamics is used for the analysis. To address the endogeneity of children's media use, I use the child xed eects and correlated random effects models. I find no evidence that media use contributes to weight gain among children. On average, a one hour per week increase in a child's video game or computer time is estimated to decrease his/ her body mass index slightly and to not affect signicantly the probability of being overweight or obese. The estimated effects of television time on weight are not significantly different from zero. These findings, especially the results related to children's computer or video game time, are robust to a number of sensitivity checks. Additionally, there is heterogeneity in the effects of media time by child and family characteristics.
    Keywords: obesity; body weight; media use; time use; children
    JEL: D13 I12 J13
    Date: 2012–09
  20. By: Loretti I. Dobrescu (University of New South Wales)
    Abstract: This paper develops a dynamic structural life-cycle model to study how heterogeneous health and medical spending shocks a¤ect the savings behavior of the elderly. Individuals are allowed to respond to health shocks in two ways: they can directly pay for their health care expenses (self-insure) or they can rely on health insurance contracts. There are two possible insurance options, one through formal contracts and another through informal care provided by family. Formal contracts may be a¤ected by asymmetric information problems, whereas informal insurance depends on social ties (cohesion) and on bequeathable wealth. I estimate the model on SHARE data using simulated method of moments for four levels of wealth in a sample of single retired Europeans. Counterfactual experiments show that health, medical spending and health insurance are indeed the main drivers of the slow wealth decumulation in old age. I also fi?nd that social cohesion rises with age, declines with wealth and is higher in Mediterranean countries than in Central European and Scandinavian countries. Finally, high social cohesion appears typically associated with increased life expectancy.
    Keywords: savings, health, health insurance, social cohesion, life expectancy
    JEL: D1 D31 E27 H31 H51 I1
    Date: 2012–12
  21. By: Oliver, Jill; Wodon, Quentin
    Abstract: This role of faith-inspired health care providers in sub-saharan Africa and public-private partnerships is comprised of a three volume series on strengthening the evidence for faith inspired engagement in health in sub-Saharan Africa. An increasing level of interest in the role of faith in development has generated much debate and dialogue at the international and national levels over the last decade. Despite difficulties in communication and differences in cultures within such debates, there has been a continued reaffirmation of the potential benefits that faith-inspired communities can bring towards efforts to achieve the millennium development goals (MDGs), especially in the areas of health. This series focuses on assessing the role and market share of faith-inspired providers and on assessing the extent to which they are involved in and benefit from public-private partnerships. The purpose of this series is three HNP discussion papers is to round up various analytical perspectives and emerging research on faith engagement in health in Africa from a range of researchers and practitioners from the north as well as the south. The series is structured into three volumes: a first volume on the role and market share of faith-inspired providers and public-private partnerships, a second on satisfaction and the comparative nature of faith-inspired health provision, and the third on mapping of faith inspired provision and the extent to which faith-inspired providers reach to the poor.
    Keywords: ability to pay, AIDS prevention, AIDS Relief, antenatal care, block grants, chronic disease, cities, civil society organizations, clinics, communities, COMMUNITY HEALTH, cost of care, COST OF HEALTH CARE, delivery of health services, description, Developing Countries, development policy, disadvantaged patients, diseases, districts, educational services, Emergency Plan, epidemic, exercises, Global health, Global Poverty, HEALTH CARE, health care centers, health care facilities, HEALTH CARE PROVIDERS, health care provision, health care services, health centers, Health Delivery, HEALTH FACILITIES, Health Financing, health funding, health infrastructure, health initiatives, health needs, Health Organization, Health Policy, health posts, health providers, health provision, Health Sector, Health Sector Reform, health service, health service providers, health service provision, health services, health system, health systems, HIV, HIV/AIDS, homes, hospital, hospital beds, hospital care, hospitals, household surveys, households, Human Development, Human Resources, impact on health, incidence analysis, income, indigenous populations, information system, information systems, integration, international policy, international response, intervention, interventions, level of poverty, limited resources, Living Standards, local communities, Malaria, mandates, measurement techniques, midwives, Millennium Development Goals, Ministry of Health, modernization, national health, national health systems, national population, national strategies, non-governmental organizations, Nongovernmental Organizations, nurses, Nutrition, pandemic, patients, pharmacists, Policy Framework, policy level, policy makers, population groups, practitioners, prevention activities, prevention strategies, primary care, primary health care, private sector, probability, Progress, providers of health care, provision of health care, Provision of Health Services, provision of services, Public Health, public health services, PUBLIC HEALTH SPENDING, public health strategies, public life, public providers, public sector, public spending, QUALITY CARE, quality of care, quality services, religious groups, religious institutions, religious leaders, respect, risk groups, rural areas, rural health care, service delivery, settlement, significant policy, Social Services, towns, traditional healers, Tuberculosis, Universal Access, urban areas, urban centers, urbanization, voluntary sector, vulnerable groups, vulnerable populations, Waste, World Council of Churches, World Health Organization
    Date: 2012–11–01
  22. By: Ellert, Alexander; Urmann, Oliver
    Abstract: This paper examines the competition of nonprofit sickness funds in the market for supplementary health insurance. We investigate product quality strategies when quality is costly and the sickness funds are competing for customers. As long as the sickness funds choose the qualities for simultaneously, any equilibrium will be nondifferentiated. Only if total demand is increasing in quality, both sickness funds provide the maximum quality. For decreasing total demand the existence of an equilibrium depends on the consumers' sensitivity. If there is no equilibrium in the simultaneous competition, sequential quality competition leads to a differentiated equilibrium with a first mover advantage. --
    Keywords: supplementary health insurance,vertical differentiation,output maximization
    JEL: I11 L22 L30
    Date: 2012
  23. By: Westermaier, Franz; Morefield, Brant; Mühlenweg, Andrea M.
    Abstract: We examine how parental health shocks affect children's non-cognitive skills. Based on a German mother-and-child data base, we draw on significant changes in selfreported parental health as an exogenous source of health variation to identify effects on outcomes for children at ages of three and six years. At the age of six, we observe that maternal health shocks in the previous three years have significant negative effects on children's behavioral outcomes. The most serious of these maternal health shocks decrease the observed non-cognitive skills up to half a standard deviation. Paternal health does not robustly affect non-cognitive outcomes. --
    Keywords: Human capital,health,non-cognitive skills
    JEL: I00 J24 I10
    Date: 2013

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