nep-hea New Economics Papers
on Health Economics
Issue of 2013‒06‒30
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Inequality and mortality: new evidence from U.S. county panel data By Mary C. Daly; Daniel J. Wilson
  2. Is Formal Employment Discouraged by the Provision of Free. Health Services to the Uninsured ? Evidence From a Natural Experiment in Mexico By Alejandro Del Valle
  3. Gender differences in preferences for health-related absences from work By Avdic, Daniel; Johansson, Per
  4. Do Mixed Reimbursement Schemes Affect Hospital Productivity? An Analysis of the Case of Denmark. By Hansen, Xenia Brun; Bech, Mickael; Jacobsen, Mads Leth; Lauridsen, Jørgen T
  5. Is the quality of hospital care price sensitive? Regression kink estimates from a volume dependent price setting scheme By Kristensen, Søren Rud; Fe, Eduardo; Bech, Mickael; Mainz, Jan
  6. Who to pay for performance? The choice of organisational level for hospital performance incentives By Kristensen, Soren Rud; Bech, Mickael; Lauridsen, Jørgen T
  7. Patient heterogeneity and income under mixed remuneration - empirical explorations of general practice partnerships By Olsen, Kim Rose; Kristensen, Troels
  8. Successes and Failures in the Fight against Child Mortality in Sub-Saharan Africa: Lessons from Senegal By Gilles Pison; Laetitia Douillot; Géraldine Duthé; Malick Kante; Cheikh Sokhna; Jean-François Trape
  9. Getting Stuck in the Blues: Persistence of Mental Health Problems in Australia By Roy, John; Schurer, Stefanie
  10. Anthropometric Mobility During Childhood By Millimet, Daniel L.; Tchernis, Rusty
  11. Partial Identification of the Long-Run Causal Effect of Food Security on Child Health By Millimet, Daniel L.; Roy, Manan
  12. Did liberalising English and Welsh bar hours cause traffic accidents? By Colin Green; John Heywood; Maria Navarro Paniagua
  13. Life Quantity, Life Quality and Longevity : an Intertemporal Social Evaluation framework By Jean-Yves Duclos; Bouba Housseini
  14. Programs to Reduce Teen Pregnancy, Sexually Transmitted Infections, and Associated Sexual Risk Behaviors: A Systematic Review. By Brian Goesling; Silvie Colman; Christopher Trenholm; Mary Terzian; Kristin Moore
  15. Using Performance Measures to Promote Evidence-Based Care: A Bayesian Approach. By Timothy F. Christian; Thomas W. Croghan; Myles Maxfield
  16. How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? By Stacey McMorrow; Anna Christensen; Brenda Natzke; Kelly Devers; Rebecca Peters
  17. Proven Strategies for Missouri Health Care Covergage: Program Outreach and Enrollment. By Sean Orzol
  18. Genetic testing with primary prevention and moral hazard. By Bardey, David; De Donder, Philippe
  19. The Demand for Private Health Insurance: Do Waiting Lists Matter?” – Revisited By Meliyanni Johar; Glenn Jones; Michael P. Keane; Elizabeth Savage; Olena Stavrunova
  20. 我国医疗保健的城乡分割问题研究 By Ma, Chao; Gu, Hai; Li, Jiajia

  1. By: Mary C. Daly; Daniel J. Wilson
    Abstract: A large body of past research, looking across countries, states, and metropolitan areas, has found positive and statistically significant associations between income inequality and mortality. By contrast, in recent years more robust statistical methods using larger and richer data sources have generally pointed to little or no relationship between inequality and mortality. This paper aims both to document how methodological shortcomings tend to positively bias this statistical association and to advance this literature by estimating the inequality-mortality relationship. We use a comprehensive and rich new data set that combines U.S. county-level data for 1990 and 2000 on age-race-gender-specific mortality rates, a rich set of observable covariates, and previously unused Census data on local income inequality (Gini index and three income percentile ratios). Using panel data estimation techniques, we find evidence of a statistically significant negative relationship between mortality and inequality. This finding that increased inequality is associated with declines in mortality at the county level suggests a change in course for the literature. In particular, the emphasis to date on the potential psychosocial and resource allocation costs associated with higher inequality is likely missing important offsetting positives that may dominate.
    Keywords: Mortality - United States ; Health
    Date: 2013
  2. By: Alejandro Del Valle (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - École des Hautes Études en Sciences Sociales [EHESS] - Ecole des Ponts ParisTech - Ecole normale supérieure de Paris - ENS Paris - Institut national de la recherche agronomique (INRA), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: This article analyzes whether the large scale provision of non-contributory health services encourages workers to move away from jobs that pay contributions to social security (formal employment). Using a difference-in-differences design, that exploits the variation generated by the municipal level roll-out of an intervention of this kind in Mexico, this paper finds that contemporaneous program exposure has no impact on the ratio of formal to total employed and that lagged exposure leads only to a small (0.78 percentage points) decrease. Two proxies of spillover effects further reveal that this estimate is robust and that the upper-bound of program effect is only moderately larger (1.5 percentage points).
    Keywords: Labor Markets ; Health Provision ; Informality ; Spillover Effects
    Date: 2013–06–24
  3. By: Avdic, Daniel (IFAU - Institute for Evaluation of Labour Market and Education Policy); Johansson, Per (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: Women are on average more absent from work for health reasons than men. At the same time, they live longer. This conflicting pattern suggests that part of the gender difference in health-related absenteeism arises from differences between the genders unrelated to actual health. An overlooked explanation could be that men an women's preferences for absenteeism differ, for example because of gender differences in risk preferences. These differences may originate from the utility-maximizing of households in which women's traditional dual roles influence household decisions to invest primarily in women's health. Using detailed administrative data on sick leave, hospital visits and objective health measures we first investigate the existence of gender-specific preferences for abstenteeism and subsequently test for the household investment hypothesis. We find evidence for the existence of gender differences in preferences for absence from work, and that a non-trivial part of these preference differences can be attributed to household investments in women's health.
    Keywords: Sickness absence; gender norms; health investments
    JEL: D13 J22
    Date: 2013–05–28
  4. By: Hansen, Xenia Brun (COHERE, Department of Business and Economics); Bech, Mickael (COHERE, Department of Business and Economics); Jacobsen, Mads Leth (Department of Political Sciences, Universitry of Århus); Lauridsen, Jørgen T (COHERE, Department of Business and Economics)
    Abstract: The majority of public hospitals in Scandinavia are reimbursed through a mixture of two prospective reimbursement schemes, block grants (a fixed amount independent of the number of patients treated) and activity-based financing (ABF). This article contributes theoretically to the existing literature with a deeper understanding of such mixed reimbursement systems as well as empirically by identifying key design factors that determines the incentives embedded in such a mixed model. Furthermore, we describe how incentives vary in different designs of the mixed reimbursement scheme and assess whether different incentives affects the performance of hospitals regarding activity and productivity differently. Information on Danish reimbursement schemes has been collected from documents provided by the regional governments and through interviews with regional administrations. The data cover the period from 2007-2010. A theoretical framework identified the key factors in an ABF/block grant model to be the proportion of the national Diagnosis-Related Group (DRG) tariff above and below a predefined production target (i.e. the baseline); baseline calculations; the presence of kinks/ceilings; and productivity requirements. A comparative case study across the five regions in Denmark demonstrated presence of inter-regional variation in the design of reimbursement schemes. This variation creates different incentives regarding activity and productivity. Using gender-age standardized rates across year and region we show that there have not been any significant changes in the number of hospital discharges for any of the regions from 2007 to 2010 within any of the treatment groups.
    Keywords: Mixed reimbursement system; prospective payment system; activity-based financing; incentives; activity; productivity
    JEL: H51 H72 I18
    Date: 2013–04–01
  5. By: Kristensen, Søren Rud (Centre of Health Economics); Fe, Eduardo (Health Economics Research Unit); Bech, Mickael (COHERE, Department of Business and Economics); Mainz, Jan (COHERE)
    Abstract: This paper estimates the price sensitivity of the quality of acute stroke care using a regression kink design. When Danish hospitals reach a production target, marginal taris for treating acute stroke patients falls by 50%{100%. This reimbursement scheme allow us to identify local average treatment ef- fects of reimbursement taris on the quality of hospital care. A rich data set of the process quality of stroke care allows us to detect minor changes in the quality of care that are important for the long term outcomes but do not lead to dead or readmission captured by commonly employed outcome indicators. Hospitals that were exposed to reductions in the marginal tari of less than 100% did not appear to respond in quality to reductions in taris. Hospital for which the marginal tari for acute stroke patients dropped to 0 responded to tari reductions by slightly decreasing the level of quality for acute stroke care patients. The estimated size of the eect is minor but robust to various tests of sensitivity, indicating that the estimated eect is not spurious.
    Keywords: Quality of health care; Price regulation; Activity based reimbursement; Supply side incentives
    JEL: H42 I18 L51
    Date: 2013–06–24
  6. By: Kristensen, Soren Rud (Centre of Health Economics); Bech, Mickael (COHERE, Department of Budiness and Economics); Lauridsen, Jørgen T (COHERE, Department of Business and Economics)
    Abstract: When implementing a pay for performance (P4P) scheme, designers must decide to whom the nancial incentive for performance should be directed. This paper compares department level hospital reported performance on the Danish Case Management Scheme at hospitals that did and did not redistribute performance payments to the department level. Across a range of models we nd that hospital reported performance at departments that operate under a direct nancial incentive is about 5 percentage points higher than performance at departments at hospital where performance payments are not directly redistributed to the department level. This result is in line with the theoretical expectations but due to the non-experimental design of the study, our results only have a causal interpretation under certain assumptions discussed in the paper
    Keywords: Pay for performance; P4P; Hospital incentives; Incentive design; Team production
    JEL: L23 M52 O18
    Date: 2013–06–15
  7. By: Olsen, Kim Rose (COHERE, Department of Business and Economics); Kristensen, Troels (COHERE, Department of Business and Economics)
    Abstract: Background: Based upon the assumption that GPs utility as a function of income and leisure it has been suggested that GPs serving complex patients will face lower utility in mixed remuneration systems. The income effect in this model is ambiguous but is has been shown, with Danish data, that solo practices have lower income the higher the complexity of their patients. No analysis of partnership practices has been undertaken. Aim: To assess the income effect of patient complexity for partnership practices and discuss potential differences between solo – and partnership practices. Methods: A reduced form income equation based on the incomeleisure utility function is applied using OLS regressions on a dataset of partnership practices. Bootstrapping technics is used to estimate confidence intervals around the income effect of patient complexity and subgroup analysis is undertaken to assess differences between small and large partnerships. Results: As solopractices, partnerships have negative income effect of patient complexity meaning that the remuneration system is fully rewarding the resource use connected to serving complex patients. However the confidence interval on partnerships is ambiguous ( 4,614;2,559) and analysis of subsamples show that the income effect is negative for small partnerships (less than 4 GPs) and positive for larger partnerships (4 or more GPs). Analysis of list size and visits per patient indicates that larger partnerships are able to supply more fee for services to complex patients indicating either supply inducement from large partnerships or time rationing on small partnerships (and solo practices). Conclusion: The behavioural pattern in partnerships differs from that in solo practices and it cannot be assumed that their behaviour can be derived from the same utility function. It seems that we do not yet have a full understanding of the theoretical foundation of partnership behaviour under mixed remuneration.
    Keywords: General practice; remuneration systems; partnerships
    JEL: I10 I18
    Date: 2013–06–15
  8. By: Gilles Pison (Ined); Laetitia Douillot (Ined); Géraldine Duthé (Ined); Malick Kante (Ined); Cheikh Sokhna (Ined); Jean-François Trape (Ined)
    Abstract: Child mortality has declined in Sub-Saharan Africa over the last 60 years but the decrease has not been regular: it has accelerated over some periods, as during the last decade, and slowed down in others. This is not solely attributable to HIV/AIDS. This paper examines in detail the trends observed in Senegal, an example of a country with low HIV prevalence but where trends in mortality have resembled those of the whole region. Both national and local level data are used, in particular the data on mortality and causes of deaths produced by the demographic surveillance systems (DSS) in the three rural areas of Bandafassi, Mlomp and Niakhar. Although Senegal experienced an appreciable fall in under-five mortality from the end of World War II, the country experienced a fifteen year stagnation in child mortality in the late 1980s and 1990s. This halt was due to a slowdown in vaccination efforts and a resurgence of malaria mortality linked to the spread of chloroquine resistance. The decrease in malaria and other infectious diseases thanks to renewed vaccination efforts and investment in anti-malaria programmes appears to be the main factor responsible for the return to a very rapid decline in under-five mortality observed during the 2000s.
    Date: 2013
  9. By: Roy, John (Victoria University of Wellington); Schurer, Stefanie (RMIT University)
    Abstract: Do episodes of mental health problems cause future mental health problems, and if yes, how strong are these dynamics? We quantify the degree of persistence in mental health problems using nationally-representative, longitudinal data from Australia and system GMM-IV and correlated random effects approaches are applied to separate true from spurious state dependence. Our results suggest only a moderate degree of persistence in mental health problems when assuming that persistence is constant across the mental health distribution once individual-specific heterogeneity is accounted for. However, individuals who fell once below a threshold that indicates an episode of depression are up to five times more likely to experience such a low score again a year later, indicating a strong element of state dependence in depression. Low income is a strong risk factor in state dependence for both men and women, which has important policy implications.
    Keywords: dynamic panel data models, depression and anxiety, mental health, GMM-IV, HILDA
    JEL: I14 C23
    Date: 2013–06
  10. By: Millimet, Daniel L. (Southern Methodist University); Tchernis, Rusty (Georgia State University)
    Abstract: While childhood obesity has become a significant public health concern over the last few decades, knowledge concerning the origins of or persistence in childhood anthropometric measures is incomplete. Here, we utilize several nonparametric measures of mobility to assess the evolution of weight, height, and body mass index during early childhood. We find that mobility is quite high prior to primary school and then declines noticeably. However, there are important sources of heterogeneity, including race, gender, and age, that should prove insightful to researchers and policymakers.
    Keywords: childhood obesity, persistence, mobility
    JEL: C23 I12 I18
    Date: 2013–06
  11. By: Millimet, Daniel L. (Southern Methodist University); Roy, Manan (IMPAQ International, LLC)
    Abstract: Food security and obesity represent two of the most significant public health issues. However, little is known about how these issues are intertwined. Here, we assess the causal relationship between food security during early childhood and relatively long-run measures of child health. Identifying this causal relationship is complicated due to endogenous selection and misclassification errors. To overcome these difficulties, we utilize a nonparametric bounds approach along with data from the ECLS-K and ECLS-B. The analysis reveals a positive association between food insecurity and future child obesity in the absence of misclassification. However, under relatively innocuous assumptions concerning the selection process, we often obtain bounds that indicate a negative causal effect of food insecurity on future child obesity. All results are extremely sensitive to misclassification.
    Keywords: food insecurity, health outcomes, nonclassical measurement error, nonparametric bounds
    JEL: C14 C21 I12 I32
    Date: 2013–06
  12. By: Colin Green; John Heywood; Maria Navarro Paniagua
    Abstract: Legal bar closing times in England and Wales have historically been early and uniform. Recent legislation liberalised closing times with the object of reducing social problems thought associated with drinking to "beat the clock." Indeed, we show that one consequence of this liberalization was a decrease in traffic accidents. This decrease is concentrated heavily among younger drivers. Moreover, we provide evidence that the effect was most pronounced in the hours of the week directly affected by the liberalization; late nights and early mornings on weekends. This evidence survives a series of robustness checks and suggests at least one socially positive consequence of expanding bar hours.
    Date: 2013
  13. By: Jean-Yves Duclos; Bouba Housseini
    Abstract: The evaluation of development processes and of public policies often involves comparisons of social states in which populations differ in size and longevity. This requires social evaluation principles to be sensitive to both the number and the length of lives. This paper explores the use of axiomatic and welfarist principles to assess social welfare in that framework. It attempts to overcome some of the limits of existing methods in the literature, in particular by avoiding a temporal repugnant conclusion, by neither penalizing nor favoring life fragmentation, and by satisfying critical-level temporal consistency. It does this by characterizing a critical-level lifetime utility function that values life periodically. To address some of the controversies on discounting utilities across time, two alternative versions of the function are developed, one with discounting and one without.
    Keywords: Intertemporal social evaluation, population ethics, critical-level utilitarianism, lifetime utility, social discounting
    JEL: C02 D31 D63 I31 J17
    Date: 2013
  14. By: Brian Goesling; Silvie Colman; Christopher Trenholm; Mary Terzian; Kristin Moore
    Keywords: adolescent, evidence-based programs, HIV, sexually transmitted infections, systematic review, teen pregnancy
    JEL: I
    Date: 2013–04–30
  15. By: Timothy F. Christian; Thomas W. Croghan; Myles Maxfield
    Keywords: Performance Measures, Evidence-Based Care, Bayesian Approach, Health Care Effectiveness
    JEL: I
    Date: 2013–06–30
  16. By: Stacey McMorrow; Anna Christensen; Brenda Natzke; Kelly Devers; Rebecca Peters
    Keywords: CHIPRA, Medical Homeness, Children's Health, Quality Grant Program
    JEL: I
    Date: 2013–05–30
  17. By: Sean Orzol
    Keywords: Missouri, Health Care Costs, Enrollement, Health
    JEL: I
    Date: 2013–06–30
  18. By: Bardey, David; De Donder, Philippe
    JEL: D82 I18
    Date: 2013–09
  19. By: Meliyanni Johar (University of Technology Sydney); Glenn Jones (University of Technology Sydney); Michael P. Keane (Nuffield College and Department of Economics, University of Oxford); Elizabeth Savage (University of Technology Sydney); Olena Stavrunova (University of Technology Sydney)
    Abstract: Besley, Hall and Preston (JPubEc, 1999) investigate how waiting for medical treatment in public hospitals influences the decision to buy private health insurance, which covers faster private treatment. They find sizable positive impacts which have subsequently been influential on waiting lists management policies. This paper re-examines this result, in particular the sensitivity to the use of waiting lists as a proxy for waiting times. It is found that waiting lists do not predict private health insurance demand, and that the impact of waiting time in motivating the purchase of insurance has been overstated.
    Keywords: health insurance, waiting time, waiting lists
    Date: 2013–06–13
  20. By: Ma, Chao; Gu, Hai; Li, Jiajia
    Abstract: Based on the definition of health care disparities in international health economic academia, the paper adopts the method of counterfactual analysis, using cross-section data of CHNS2009, to make a precise calculation of the inequity section of the urban-rural differences in health care, which refers to urban-rural disparities. According to research, 88.1%of urban-rural differences are inequity, mere 11.9% are supposed to legitimatable. In addition, the larger amounts of expenditures on healthcare, the more conspicuous urban-rural disparities become.
    Keywords: health care; inequity;urban-rural disparities;counterfactual
    JEL: I14 I18 I38
    Date: 2012–07

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