nep-hea New Economics Papers
on Health Economics
Issue of 2013‒12‒06
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  2. Distributional Cost-Effectiveness Analysis of Health Care Programmes By Miqdad Asaria; Susan Griffin; Richard Cookson; Sophie Whyte; Paul Tappenden
  3. Distributional cost-effectiveness analysis: a tutorial By Miqdad Asaria; Susan Griffin; Richard Cookson
  4. Adaptation to Health States: A Micro-Econometric Approach By Cubi-Molla, P.; Jofre-Bonet, M.; Serra-Sastre, V.
  5. Killing me softly: work and mortality among French seniors By Blake, Hélène; Garrouste, Clémentine
  6. Health, Pension Benefits and Longevity How They Affect Household Savings? By Oliveira Martins, Joaquim; El Mekkaoui de Freitas, Najat
  7. The Utility of Expressive Writing as Self-Help to Reduce Psychosocial Stress (Japanese) By OMORI Mika
  8. Financial incentives, health and retirement in Spain By Pilar García-Gómez; Sergi Jiménez-Martín; JudiVall Castelló
  9. The impact of health care reform on physician payments: evidence from Massachusetts By Abe Dunn; Adam Hale Shapiro
  10. Child health and use of health care services in France: Evidence on the role of family income By Bénédicte H. Apouey; Pierre-Yves Geoffard
  11. Adopting new medical technologies in Russian public hospitals: what causes inefficiency? By Liudmila Zasimova; Sergey Shishkin
  12. The Effect of Social Security, Health, Demography and Technology on Retirement By Ferreiray, Pedro Cavalcanti; Santos, Marcelo Rodrigues
  13. Public, Private or Both? Analysing Factors Influencing the Labour Supply of Medical Specialists By Cheng, Terence Chai; Kalb, Guyonne; Scott, Anthony
  14. Demand for primary healthcare in rural north India By Richard Andrew Iles
  15. Leveraging Medicaid in a Multi-Payer Medical Home Program: Spotlight on Rhode Island's Chronic Care Sustainability Initiative. By Julia Paradise; Marsha Gold; Winnie Wang
  16. Employing Health Information Technology in the Real World to Transform Delivery. By Marsha Gold
  17. Health and the Economy in the United States, from 1750 to the Present By Dora Costa
  18. The relationship between individual risk and cost-effectiveness in screening interventions By Sampson, Christopher; James, Marilyn; Whynes, David
  19. Tax Incentives and the Demand for Private Health Insurance By Olena Stavrunova; Oleg Yerokhin

  1. By: Pinar Karaca-Mandic; Roger Feldman; Peter Graven
    Abstract: Health insurance markets in the United States are characterized by imperfect information, complex products, and substantial search frictions. Insurance agents and brokers play a significant role in helping employers navigate these problems. However, little is known about the relation between the structure of the agent/broker market and access and affordability of insurance. This paper aims to fill this gap by investigating the influence of agents/brokers on health insurance decisions of small firms, which are particularly vulnerable to problems of financing health insurance. Using a unique membership database from the National Association of Health Underwriters together with a nationally representative survey of employers, we find that small firms in more competitive agent/broker markets are more likely to offer health insurance and at lower premiums. Moreover, premiums are less dispersed in more competitive agent/broker markets.
    Date: 2013–12
  2. By: Miqdad Asaria (Centre for Health Economics, University of York, UK); Susan Griffin (Centre for Health Economics, University of York, UK); Richard Cookson (Centre for Health Economics, University of York, UK); Sophie Whyte (School of Health and Related Research, University of Sheffield, UK); Paul Tappenden (School of Health and Related Research, University of Sheffield, UK)
    Abstract: This paper presents a case study application of a new methodological framework for undertaking distributional cost-effectiveness analysis (DCEA) to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The NHS Bowel Cancer Screening Programme (BCSP) introduced in 2006 is expected to improve population health on average but also to worsen population health inequalities associated with deprivation and ethnicity – a classic case of “intervention generated inequalityâ€. We demonstrate the DCEA framework by examining two redesign options for the BCSP: (1) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (2) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion.
    Date: 2013–11
  3. By: Miqdad Asaria (Centre for Health Economics, University of York, UK); Susan Griffin (Centre for Health Economics, University of York, UK); Richard Cookson (Centre for Health Economics, University of York, UK)
    Abstract: Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the NHS Bowel Cancer Screening Programme (BCSP). The two key stages in DCEA are (A) modelling social distributions of health associated with different interventions and (B) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgements that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modelling assumptions and social value judgements.
    Keywords: Cost-effectiveness analysis, economic evaluation, efficiency, equality, equity, fairness, health distribution, health inequality, inequality measures, opportunity cost, social value judgements, social welfare functions, trade-off
    Date: 2013–11
  4. By: Cubi-Molla, P.; Jofre-Bonet, M.; Serra-Sastre, V.
    Abstract: Health care funding decisions in the UK are based on valuations of the general public. However, it has been shown that there is a disparity between a hypothetical valuation of the impact of a specific condition on health and the effect of that health state by someone who experiences it. This paper examines the issue of adaptation to health states, which partially may explain the discrepancy between hypothetical and experienced health state valuations. We use the British Cohort Study (BCS70) which is a longitudinal dataset that tracks a sample of British individuals since their birth in 1970. We use four BCS70 waves containing information on self-assessed health (SAH), morbidity as well as a number of socio-economic characteristics. To estimate the issue of adaptation, we implement a dynamic ordered probit model that controls for (health) state dependence. The empirical specification controls for morbidity and also includes a variable for the duration of the illness. We find that, for most chronic conditions, duration has a positive impact on self-assessed health, while for some conditions-such as diabetes- this does not occur. We interpret our results as evidence in support of the hypothesis that adaptation to chronic diseases exists and may explain at least in part the differences between general public and patients’ health state valuations.
    Keywords: Self Assessed Health; Dynamic Ordered Probit; Adaptation to health states
    Date: 2013
  5. By: Blake, Hélène; Garrouste, Clémentine
    Abstract: This paper investigates the impact of the retirement age and working life on mortality over 64 years old. In 1993, the French government gradually increased incentives to work for seniors. This exogenous shock on labor supply is an instrument for retirement choices of French pensioners. We use this exogenous shock to measure how work impacts male mortality. We work on the Echantillon Interrégime des Retraités, an administrative panel data set which provides information on past contribution to the pension system and mortality at two points of time. We find that delaying the retirement age by one year increases the chances of dying within four years by 2.45 percentage points which is equivalent to a decrease of life expectancy at age 64 by around 2.6 months. However, this effect is far from homogeneous if we split our sample by income groups.
    Keywords: Retirement; mortality; pension reform;
    JEL: J12 J26 H55
    Date: 2013–08
  6. By: Oliveira Martins, Joaquim; El Mekkaoui de Freitas, Najat
    Abstract: This paper analyses the impact of health, pension systems and longevity on savings. It uses a simple life-cycle model embodying social transfers (health care and pension expenditures) and changes in longevity to determine the level of household savings. From this model, we derived an econometric specification, augmented with the effects of public budget balances. The model is estimated for a panel of 22 OECD countries for the period 1970-2009. Our principal result is that, from the point of view of incentive to save, health transfers have a similar impact as pension replacement rates. Therefore, welfare reforms that reduce replacement rates without reforming health system may not have all the expected impact on household savings. In line with life-cycle theory, we found that longevity increases saving ratios.
    Keywords: Ageing; consumption; health; longevity; pension systems; saving;
    JEL: D91 I13 J1 J11 J26
    Date: 2013–10
  7. By: OMORI Mika
    Abstract: Psychosocial stress has received attention from scholars and practitioners as a mental health issue within a variety of domains ranging from school to industrial settings. Extreme or chronic psychological distress results in not only psychological problems such as depression but also physical illnesses mediating health risk behaviors. Evidence-based preventive strategies must be developed to promote stress reduction programs. The present paper primarily sought to discuss new directions of self-help for psychological stress. In order to accomplish this, the paper first overviewed traditional psychotherapies and argues the potential problems. Next, expressive writing proposed by Pennebaker et al. (1986) as a self-help method was introduced. The effectiveness of expressive writing within the context of college transition was empirically tested by an experimental design with 24 female college freshmen. The participants were randomly assigned to one of three experimental groups: expressive writing, controlled writing, and non-writing control groups. Individuals assigned to either expressive writing or controlled writing groups were asked to engage in writing tasks for 20 minutes for three consecutive days. Changes in positive emotions increased after the completion of the writing sessions, however, those changes were not statistically significant. No statistically significant changes were observed for three outcome variables including depression, anxiety, and anger. Implications for future studies were discussed.
    Date: 2013–11
  8. By: Pilar García-Gómez; Sergi Jiménez-Martín; JudiVall Castelló
    Abstract: In this work we combine wage data from Social Security working histories and health information available in the Survey of Health and Retirement in Europe to explore the link between health, financial incentives and retirement in Spain. Our results show that individuals in worse health quintiles are, indeed, the more responsive to financial incentives as they prove to be less likely to retire when incentives to continue working increase.
    Date: 2013–11
  9. By: Abe Dunn; Adam Hale Shapiro
    Abstract: This study assesses the impact of major health insurance reform in Massachusetts on the prices of services paid to physicians in the privately insured market. We estimate that the reform caused physician payments to increase at least 10.8 percentage points. This impact occurred while the legislation was materializing but before the final compromised version of the reform was enacted in April 2006. This finding is consistent with prices being set in a forward-looking manner, in anticipation of the reform. Overall, one-sixth of physician service price growth in Massachusetts between 2003 and 2010 was directly attributable to the insurance reform.
    Keywords: Health care reform
    Date: 2013
  10. By: Bénédicte H. Apouey (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - École des Hautes Études en Sciences Sociales [EHESS] - École des Ponts ParisTech (ENPC) - École normale supérieure [ENS] - Paris - Institut national de la recherche agronomique (INRA)); Pierre-Yves Geoffard (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - École des Hautes Études en Sciences Sociales [EHESS] - École des Ponts ParisTech (ENPC) - École normale supérieure [ENS] - Paris - Institut national de la recherche agronomique (INRA))
    Abstract: Our paper investigates the relationship between family income and child health in France. We first examine whether there is a significant correlation between family income and child general health, and the evolution of this relationship across childhood years. We then study the role of specific health problems, the use of health care services, and supplemental health insurance coverage, in the income gradient in general health. We also quantify the role of income in child anthropometric measurements. Whenever possible, we compare our results for France with those obtained for other developed countries.
    Keywords: Socioeconomic factors ; Child ; Anthropometry ; Healthcare disparities
    Date: 2013–11–25
  11. By: Liudmila Zasimova (National Research University Higher School of Economics, Laboratory for Economic Research in Public Sector, deputy head); Sergey Shishkin (National Research University Higher School of Economics, Institute of Health Economics, research supervisor)
    Abstract: The adoption of new medical technologies in Russian public hospitals is an important part of healthcare modernization and thus is a subject for public finance and regulation. Here we examine the decision-making process on adoption of new technologies in Russian hospitals, and the institutional environment in which they are made. We find that public hospitals operate within a strategic-institutional model of decision making and tend to adopt technologies that bring indirect benefits to their heads/physicians. Unlike Western clinics, the interests of Russian hospital heads and physicians are driven by the possibilities to obtain income from a part of hospital activities: the provision of chargeable medical services to the population, as well as receiving informal payments from patients. The specifically Russian feature of the decision-making process is that hospitals are strongly dependent on health authorities’ decisions about new equipment acquisition. The inefficiency problems arise from the contradiction between hospitals’ and authorities’ financial motivation for acquiring new technologies: hospitals tend to adopt technologies that bring benefits to their heads/physicians and minimize maintenance and servicing costs, while authorities’ main concern is initial cost of technology. The main reason for inefficiency of medical technology adoption arises from centralization of procurement of medical equipment for hospitals that creates the preconditions for rent-seeking behaviour of persons making such decisions
    Keywords: medical technology, adoption, public hospital, Russia, causes of inefficiency
    JEL: I10
    Date: 2013
  12. By: Ferreiray, Pedro Cavalcanti; Santos, Marcelo Rodrigues
    Date: 2012–10
  13. By: Cheng, Terence Chai (Melbourne Institute of Applied Economic and Social Research); Kalb, Guyonne (Melbourne Institute of Applied Economic and Social Research); Scott, Anthony (Melbourne Institute of Applied Economic and Social Research)
    Abstract: This paper investigates the factors influencing the allocation of time between public and private sectors by medical specialists. A discrete choice structural labour supply model is estimated, where specialists choose from a set of job packages that are characterised by the number of working hours in the public and private sectors. The results show that medical specialists respond to changes in earnings by reallocating working hours to the sector with relatively higher earnings, while leaving total working hours unchanged. The magnitudes of the own-sector and cross-sector earnings elasticities fall in the range of 0.21-0.54, and are larger for male than for female specialists. The labour supply response varies by doctors' age and medical specialty. Family circumstances such as the presence of young dependent children influence the hours worked by female specialists but not male specialists. We illustrate the relevance of our findings by simulating the impact of recent trends in earnings growth in the public and private sectors.
    Keywords: labour supply, elasticities, medical specialists, public-private mix
    JEL: I10 I11 J22 J24
    Date: 2013–11
  14. By: Richard Andrew Iles
    Abstract: Indiaâs dynamic primary healthcare market is dominated, in rural north India, by the private sector that operates alongside a weak government system. The Indian healthcare market, in theory, offers several systems of medicine, a variance in the level of provider qualifications and incorporates both the formal and informal provider markets. However, in practice in rural north India, consumers have limited effective choice. A major constraint on our understanding of the rural north Indian primary healthcare market is the lack of data and analysis of consumersâ preferences for unqualified doctors. This study estimates consumer demand for private unqualified and qualified âdoctorsâ and government doctors in three districts of Indiaâs largest stateâUttar Pradeshâfor the treatment of mild to severe fever. Results demonstrate that unqualified âdoctorâ services are normal goods and that government doctor utilization may be improved by increasing user fees to enable reduced patient travel distances.
    JEL: I11 D12 C42
    Date: 2013–12–03
  15. By: Julia Paradise; Marsha Gold; Winnie Wang
    Keywords: Medical Home, Rhode Island, Chronic Care Sustainability Initiative, Medicaid
    JEL: I
    Date: 2013–11–30
  16. By: Marsha Gold
    Keywords: HIT, Health Information Technology, Transform Delivery
    JEL: I
    Date: 2013–11–30
  17. By: Dora Costa
    Abstract: This review discusses theories of the health transition and examines how the health transition occurred in the United States, including changes in the distribution of health by socioeconomic status. I bring new data to bear on an extensive array of health indicators -- mortality, height, BMI, birth weight, and chronic conditions. I investigate the role in the health transition played by rising incomes and by scientific advances and their application and I will argue that the preponderance of the evidence shows that scientific advances have played an outsize role in the United States. I will examine how these scientific advances, which during the health transition took the form of expensive sanitation projects, were implemented. Fear of infection provided the political support for the financing of these projects, even when the poor were the primary beneficiaries. Because more recent scientific advances have taken the form of therapies targeted to chronic disease and because the importance of behavioral factors has grown, political support for expenditures aimed at the poor is likely to be lower. I will argue that while improvements in health raise productivity, these improvements are not necessarily a precondition for modern economic growth. The nature of the economy in which these improvements occur also matters. The gains to early life health are largest when the economy has moved from “brawn” to “brains” because this is when the wage returns to education are high, leading the healthy to obtain more education. Although the causal effect of education on health is still unclear, those who obtain more education may be better able to take advantage of new medical knowledge and therapies as they age. Analyses and theories of health therefore need to treat health as a dynamic variable. The review also suggests that future health can continue to improve provided that innovation continues. How to finance this innovation remains an issue, but in a rich society the value of even marginal improvements in health is higher than the value of the dramatic mortality declines of the health transition.
    JEL: I1 N30
    Date: 2013–11
  18. By: Sampson, Christopher; James, Marilyn; Whynes, David
    Abstract: Advancements in our understanding of the causes and correlates of disease mean that we are now able to estimate an individual's level of risk. This, and the ever-increasing need for healthcare interventions to be cost-effective, has led to calls for the introduction of risk-based screening. Risk-based screening would involve the use of information about an individual's risk factors to decide whether or not they should be eligible for screening, or the frequency with which they should be invited to attend screening. Evidence is emerging that targeted screening, towards those at higher risk, can increase the cost-effectiveness of a screening programme. The relationship between individual risk and the cost-effectiveness of screening an individual is implicitly recognised in current population screening programmes in the UK. However, the nature of this relationship, and its implications for cost-effectiveness analysis, has not been presented in the academic literature. In this study we propose that an individual's risk of developing a disease has a consistent and quantifiable relationship with the cost-effectiveness of screening them. We suggest a simple modification to standard methods of cost-effectiveness analysis that enables the incorporation of individual risk. Using numerical examples we demonstrate the nature of the relationship between risk and cost-effectiveness and suggest means of optimising a screening intervention. This can be done either by defining a minimum level of risk for eligibility or by defining the optimal recall period for screening. We suggest that methods of decision modelling could enable such an analysis to be carried out, and that information on individual risk could be used to optimise the cost-effectiveness of population screening programmes.
    Keywords: risk-based screening; prevention; decision modelling; economic evaluation; personalised medicine
    JEL: I10
    Date: 2013–11–29
  19. By: Olena Stavrunova (Economics Discipline Group, University of Technology, Sydney); Oleg Yerokhin (University of Wollongong)
    Abstract: This paper studies the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. It uses the administrative income tax returns data to show that mandate has several distinct effects on taxpayers' behavior. First, despite the large size of the tax penalty for not having PHI cover relative to the cost of the cheapest eligible insurance policy, the compliance with mandate is relatively low: the proportion of population with PHI cover increases by 6.5 percentage points (15.6%) at the income threshold at which the tax penalty starts to apply. This effect is most pronounced for young age taxpayers, while the middle aged people seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions the effect of the policy is extrapolated to other income levels to show that overall this policy hasn't had a significant impact on the demand for private health insurance in Australia.
    Date: 2013–11–01

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