nep-hea New Economics Papers
on Health Economics
Issue of 2013‒11‒22
fifteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Impact of R&D Cooperation on Drug Variety Offered on the Market: Evidence from the Pharmaceutical Industry By Tannista Banerjee; Ralph Siebert
  2. Pharmaceutical regulation and innovative performance: a decision-theoretic model By Tannista Banerjee; Stephen Martin
  3. Care for money? Mortality improvements, increasing intergenerational transfers, and time devoted to the elderly By Tobias Vogt; Fanny A. Kluge
  4. Disease load at conception predicts survival in later epidemics in a historical French-Canadian cohort, suggesting functional epigenetic imprinting By Kai P. Willführ; Mikko Myrskylä
  5. Health and Education: Challenges and Financial Constraints By Lisa Grazzini; Alessandro Petretto
  6. Interregional Performance of the Public Health System of a High-Inequality Country By Gramani, Maria Cristina N.
  7. The Effect of Local Area Crime on Mental Health By Dustmann, Christian; Fasani, Francesco
  8. Individual Behavior as a Pathway between Early-Life Shocks and Adult Health: Evidence from Hunger Episodes in Post-War Germany By Kesternich, Iris; Siflinger, Bettina; Smith, James P.; Winter, Joachim K.
  9. Perspectives of Physicians and Nurse Practitioners on Primary Care Practice. By Karen Donelan; Catherine M. DesRoches; Robert S. Dittus; Peter Buerhaus
  10. Effectiveness of Home Visiting in Inproving Child Health and Reducing Child Maltreatment. By Sarah A. Avellar; lauren H. Supplee
  11. Examine Critical Access Hospital Payment Policies Within the Context of Integrated Systems. By JudyAnn Bigby
  12. Enrollment in Medicare Advantage Plans in Miami-Dade County: Evidence of Status Quo Bias? By Anna D. Sinaiko; Christopher C. Afendulis; Richard G. Frank
  13. Differing types of medical prevention appeal to different individuals. By Bouckaert, Nicolas; Schokkaert, Erik
  14. Managing Hospital Volumes: Germany and Experiences from OECD Countries By Ankit Kumar; Michael Schoenstein
  15. A randomized, controlled study of a rural sanitation behavior change program in Madhya Pradesh, India By Patil, Sumeet R.; Arnold, Benjamin F.; Salvatore, Alicia; Briceno, Bertha; Colford, Jr., John M.; Gertler, Paul J.

  1. By: Tannista Banerjee; Ralph Siebert
    Abstract: This study shows that R&D cooperation can be used as an instrument to coordinate drug development portfolios among participating firms, which has crucial implications on the number of drugs offered on the market. Our study puts special attention to the fact that R&D cooperation, formed at different stages throughout the drug development process, have different impacts on the technology and product markets. Using a comprehensive dataset on the pharmaceutical industry, our results show that R&D cooperation formed at the early stages increase the number of R&D projects and the number of drugs launched on the product market. Late stage R&D cooperation, however, have a positive impact on the drug development process and drug variety only in the short run. In the long run, late stage cooperation provoke that firms re-optimize their drug development portfolios which reduces the number of drugs offered on the market.
    Keywords: Drug development; Dynamics; Co-development; Pharmaceutical industry; Product variety; Product market competition; Research and Development cooperation
    JEL: L24 L25 L65 D22
    Date: 2013–11
  2. By: Tannista Banerjee; Stephen Martin
    Abstract: In this paper we develop a model of the impact of the drug approval process on the terms of a contract between a pharmaceutical company that requires the services of a contract research organization (CRO) to carry out testing of new drug molecules. Results show that if the equilibrium contract includes a variable payment (royalty), the CRO gives more effort to create a more accurate result, the more strict the FDA approval process. We also find that given the royalty shares in the contract if the FDA demands more accuracy in results as a condition of approval, then the CRO will generate more accurate results from late stage tests. However, greater FDA stringency in the approval process benefits pharmaceutical companies because the greater is FDA stringency, the less is the risk of a drug recall. We also find that in order to employ a CRO in the testing process, the pharmaceutical company's prior probability that the drug is of high quality must be very high.
    Keywords: Pharmaceutical regulation; Food and Drug Administration; R&D outsourcing; contract research
    JEL: L24 L65
    Date: 2013–11
  3. By: Tobias Vogt (Max Planck Institute for Demographic Research, Rostock, Germany); Fanny A. Kluge (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Background: After the reunification of Germany, mortality among older eastern Germans converged quickly with western German levels. Simultaneously, the pension benefits of eastern Germans rose tenfold. Objective: We make use of German reunification as a natural experiment to show that, first, increasing financial transfers from the elderly to their children led to increasing reverse transfers in the form of care; and, second, this rise in the number of hours spent on care led to a reduction in old-age mortality. Method: As a first step, we calculated intergenerational transfer profiles by age for eastern and western Germany to determine whether any changes in downward and in upward transfers in the form of time and money occurred since reunification. We use generalized linear regression to test whether rising pensions led to an increase in the number of hours spent on care, and whether this increase led to a reduction in old-age mortality. We use different macro level data sources to test our hypothesis, including mortality rates and time use surveys for East and West Germany and information on private intergenerational transfers from the National Transfer Accounts project for Germany. Results: We show that since German reunification, intergenerational downward transfers more than doubled in percentage terms in the east. This was predominantly caused by the sharp increase in pension benefits since the fall of the Berlin Wall. At the same time, mortality among pensioners dropped markedly, and converged to western German levels. We further show that the rise in pension income was strongly correlated with the increase in social support and the decline in mortality among older eastern Germans. Discussion: Our result suggest that there was an interfamilial monetary transfer from the elderly to the young in exchange for social support. This mutual beneficial exchange may have helped to improve the survival of older East Germans after the reunification.
    Keywords: Germany, mortality determinants
    JEL: J1 Z0
    Date: 2013–10
  4. By: Kai P. Willführ (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Background: Epigenetic inheritance is a potentially important determinant of health in several mammals. For humans, the existing evidence is weak. We investigate whether disease exposure triggers functional epigenetic inheritance among humans by analyzing siblings who were conceived under different disease loads, and comparing their mortality in later epidemics. Under functional epigenetic inheritance, we expect that those who were conceived under high pathogenic stress load will have relatively low mortality during a later epidemic. Methods: We use data from the Registre de la Population du Québec Ancien, which covers the historical population living in St. Lawrence Valley, Québec, Canada. Children born in 1705-1724 were grouped according to their exposure during conception to the measles 1714-15 epidemic. The 1714-15 epidemic was followed by two mortality crises in 1729-1734 which were caused by measles and smallpox. Using proportional hazard Cox regression models with multivariate adjustment and with fixed-effects approach that compare siblings, we analyze whether mortality in 1729-1734 is affected by exposure to the 1714-15 epidemic. Results: hildren who were conceived during the peak of the measles epidemic of 1714-15 exhibited significantly lower mortality during the 1729-1734 crisis than those who were born before the 1714-15 epidemic (mortality hazard ratio 0.106, p
    JEL: J1 Z0
    Date: 2013–10
  5. By: Lisa Grazzini (Università degli Studi di Firenze); Alessandro Petretto (Università degli Studi di Firenze)
    Abstract: Even if both the health and the educational sector are under the state supervision in basically all countries, there are wide differences in the mix of their public/private provision and financing across them. The debate on the proper mix between the private and the public involvement has also been re-enlightened by the recent financial crisis which has stressed many countries’ public finances. The aim of this paper is twofold. On the one hand, it aims at presenting the incentive mechanisms both for the public and the private sector behind different types of mix between private and public involvement according to the industrial organization design of the health and the educational sector. On the other hand, the paper aims at presenting some recent case studies on Public Private Partnerships in both the health and the educational sector in countries such as the U.K., the U.S.A., and the Netehrlands.
    Keywords: Health, Education, Public-Private Provision.
    JEL: H44 H51 H52 H75
    Date: 2013
  6. By: Gramani, Maria Cristina N.
    Date: 2013–10
  7. By: Dustmann, Christian (University College London); Fasani, Francesco (Queen Mary, University of London)
    Abstract: This paper analyses the effect of local crime rates on the mental well-being of residents. Our identification strategy addresses the problem of sorting, and endogenous moving behaviour. We find that crime causes considerable mental distress of residents, and that these effects are mainly driven by property crime. However, individuals react also to violent crime, in particular in areas individuals may be exposed to when following their daily routines, such as travel to work. Local crime creates more distress for females, and is mainly related to depression and anxiety. The impact on mental well-being is large: We find that the increase in mental distress following a one standard deviation increase in local crime is about 2-4 times as large as that caused by a one standard deviation decrease in local employment, and about one seventh of the effect experienced by in the direct aftermath of the London Bombings of Jul 7th, 2005.
    Keywords: neighbourhood effects, mental wellbeing, fear of crime
    JEL: I18 K42 R23
    Date: 2013–11
  8. By: Kesternich, Iris (University of Munich); Siflinger, Bettina (University of Mannheim); Smith, James P. (RAND); Winter, Joachim K. (University of Munich)
    Abstract: We investigate long-run effects of episodes of hunger experienced as a child on health status and behavioral outcomes in later life. We combine self-reported data on hunger experiences from SHARELIFE, a retrospective survey conducted as part of SHARE in Europe in 2009, with administrative data on food supply (caloric rations) in post-war Germany. The data suggest that individual behavior is a pathway between early life shocks and adult health: We find that those who experienced hunger spend a larger fraction of income on food. Taken together, our results confirm that in addition to the well-documented biological channel from early life circumstances to adult health, there is also a behavioral pathway.
    Keywords: war, health, income
    JEL: I10
    Date: 2013–11
  9. By: Karen Donelan; Catherine M. DesRoches; Robert S. Dittus; Peter Buerhaus
    Abstract: A study finds that, although primary care physicians and nurse practitioners mostly agree that nurse practitioners should be able to practice to the full extent of their education and training, they strongly disagree about proposed changes to the scope of nurse practitioners' responsibilities. The survey—led by investigators from Massachusetts General Hospital, the Institute for Medicine and Public Health at Vanderbilt University Medical Center, and Mathematica—revealed points of disagreement on appropriate leadership roles for nurse practitioners, reimbursement levels, and overall quality of services.
    Keywords: Physicians, Nurse Practitioners, Primary Care Practice, Health Care System
    JEL: I
    Date: 2013–05–16
  10. By: Sarah A. Avellar; lauren H. Supplee
    Keywords: Home Visiting, Child Health, Child Development, Child Maltreatment
    JEL: I
    Date: 2013–11–30
  11. By: JudyAnn Bigby
    Keywords: Critical Access, Hospital Payment Policies, Integrated Systems, Health
    JEL: I
    Date: 2013–11–04
  12. By: Anna D. Sinaiko; Christopher C. Afendulis; Richard G. Frank
    Abstract: Evidence from behavioral economics reveals that decision-making in health care settings can be affected by circumstances and choice architecture. This paper conducts an analysis of choice of private Medicare plans (Medicare Advantage plans) in Miami-Dade County. We provide a detailed description of the choice of MA plans available in Miami over much of the program’s history and the composition of Medicare beneficiaries in Miami over the 2000s. Our analysis suggests that first becoming eligible for Medicare is the key transition point for MA, and that there is significant status quo bias in the MA market. This consumer behavior has important implications for policy that regulates the MA market.
    JEL: I13
    Date: 2013–11
  13. By: Bouckaert, Nicolas; Schokkaert, Erik
    Abstract: We analyse participation in medical prevention with an expected utility model that is sufficiently rich to capture diverging features of different prevention procedures. We distinguish primary and secondary prevention (with one or two rounds) for both fatal or non-fatal diseases. Moreover, we introduce a flexible relationship between the specific disease for which the prevention procedure is set up and the general background health of the individual. We show how these various possibilities change the comparative statics of the prevention decision and we test the differential predictions with data from SHARE (Survey of Health, Ageing and Retirement in Europe) about participation in mammography, dental caries screening and .u vaccination.
    Date: 2013–05
  14. By: Ankit Kumar; Michael Schoenstein
    Abstract: To help inform a conference organised by the Germany Ministry of Health (BMG) and the OECD on ‘Managing Hospital Volumes’ on the 11th April 2013, the OECD Secretariat produced this paper giving an international perspective on Germany’s situation and the current policy debate. It provides a number of observations about the structure and financing of hospitals in Germany. It begins by arguing that Germany has a more open-ended approach to the financing of hospital services and weaker controls over the hospital budget than in many other OECD countries. In large part this reflects that DRGs in Germany are almost strictly used for pricing, whereas other countries use DRGs as one of many tools they have to influence hospital budgets. This is compounded by a situation where State governments do not have an incentive to rationalise hospital capacity where this may be desirable. Finally, the paper argues that the vast array of quality information available in Germany ought to be used to better direct financing. Afin d’apporter des informations à l’appui de la conférence organisée le 11 avril 2013 par le ministère allemand de la Santé (BMG) et l’OCDE sur le thème de la « Gestion des volumes d’activité des hôpitaux », le Secrétariat de l’OCDE a élaboré ce document, qui permet d’aborder la situation de l’Allemagne et le débat en cours selon une perspective internationale. Ce texte livre un certain nombre d’observations concernant la structure et le financement des hôpitaux allemands. Il montre dans un premier temps que l’Allemagne a du financement des services hospitaliers une approche plus ouverte que de nombreux autres pays de l’OCDE, et que le budget des hôpitaux y est plus faiblement contrôlé. Cela tient en grande partie au fait que la tarification des services hospitaliers repose en Allemagne presque exclusivement sur les groupes homogènes de malades (GHM), alors que d’autres pays s’en servent plutôt – avec un grand nombre d’autres outils – pour contrôler le budget des hôpitaux. Cette situation est renforcée par le fait que les autorités des Länder ne sont pas incitées à rationaliser la capacité du secteur hospitalier, alors que cela pourrait être souhaitable. Enfin, le document fait valoir que les nombreuses informations disponibles en Allemagne sur la qualité des soins devraient contribuer à une meilleure affectation des financements.
    JEL: I11 I12 I13 I18
    Date: 2013–10–11
  15. By: Patil, Sumeet R.; Arnold, Benjamin F.; Salvatore, Alicia; Briceno, Bertha; Colford, Jr., John M.; Gertler, Paul J.
    Abstract: Poor sanitation and open defecation are thought to be a major cause of diarrhea and intestinal parasite infections among young children. In 1999, India launched the Total Sanitation Campaign with the goal of achieving universal toilet coverage in rural India by 2012. This paper reports on a cluster-randomized, controlled trial that was conducted in 80 rural villages in Madhya Pradesh to measure the effect of the program on toilet access, sanitation behavior, and child health outcomes. The study analyzed a random sample of 3,039 households and 5,206 children under five years of age. Field staff collected baseline measures of sanitation conditions, behavior, and child health, and re-visited households 21 months later. The analysis finds that implementation of the program activities was slower than the original timeline (only 35 percent of villages were triggered more than six months before the follow-up survey). Nevertheless, the Total Sanitation Campaign successfully increased toilet coverage by 19 percent in intervention villages compared with control villages (41 percent v. 22 percent), while reported open defecation decreased by 10 percent among adults (74 percent v. 84 percent). The intervention also led to some improvements in water quality and protozoan infection, but consistent improvements were not observed across multiple child health outcomes (diarrhea, helminth infections, child growth). However, the exposure period was likely to have been too short to result in any benefit of the sanitation interventions on child health. Given the large improvements in toilet construction documented, an additional follow-up survey with a longer period of exposure would yield valuable information on the effects of improved sanitation conditions on health outcomes.
    Keywords: Health Monitoring&Evaluation,Housing&Human Habitats,Hygiene Promotion and Social Marketing,Urban Water Supply and Sanitation,Town Water Supply and Sanitation
    Date: 2013–11–01

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