nep-hea New Economics Papers
on Health Economics
Issue of 2013‒12‒15
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Urbanization and Mortality Decline By Sanghamitra Bandyopadhyay; Elliott Green
  2. The influence of cost-effectiveness and other factors on NICE decisions By Helen Dakin; Nancy Devlin; Yan Feng; Nigel Rice; Phill O’Neill; David Parkin
  3. The Relationship between Depression and Other Variables Including Income and Bank Deposits: A study using the Japanese Study of Aging and Retirement (JSTAR) (Japanese) By SEKIZAWA Yoichi; YOSHITAKE Naomi; GOTO Yasuo
  4. Revisiting the Educational Eects of Fetal Iodine De ciency By Bengtsson, Niklas; Petersen, Stefan; Sävje, Fredrik
  5. Public, Private or Both? Analysing Factors Influencing the Labour Supply of Medical Specialists By Terence Chai Cheng; Guyonne Kalb; Anthony Scott
  6. Physician Overtreatment and Undertreatment with Partial Delegation By Dmitry Lubensky; Eric Schmidbauer
  7. Negligence and Two-Sided Causation By Keith N. Hylton; Haizhen Lin; Hyo-Youn Chu
  8. Negligence, Causation and Incentive for Care By Keith N. Hylton; Haizhen Lin
  9. Health Insurance and the Supply of Entrepreneurs: New Evidence from the Affordable Care Act's Dependent Coverage Mandate By James Benjamin Bailey
  10. Willingness-to-pay for genetic testing for inherited retinal disease By Sandy Tubeuf; Thomas A. Willis; Barbara Potrata; Hilary Grant; Matthew J. Allsop; Mushtaq Ahmed; Jenny Hewison; Martin McKibbin
  11. Is This Time Different? The Slowdown in Healthcare Spending By Amitabh Chandra; Jonathan Holmes; Jonathan Skinner
  12. Going into the Affordable Care Act: Measuring the Size, Structure and Performance of the Individual and Small Group Markets for Health Insurance By Pinar Karaca-Mandic; Jean M. Abraham; Kosali Simon; Roger Feldman
  13. Calculating Disease-Based Medical Care Expenditure Indexes for Medicare Beneficiaries: A Comparison of Method and Data Choices By Anne E. Hall; Tina Highfill
  14. Medical Tourism in the Philippines: Market Profile, Benchmarking Exercise, and S.W.O.T. Analysis By Picazo, Oscar F.
  15. Does Health Accelerate Economic Growth in Pakistan? By Naeem Ur Rehman, Khattak; Jangraiz, Khan
  16. Rejoinder: Need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India By S V Subramanian; M.A. Subramanyam; DJ Corsi; G Davey Smith
  17. Divergent socioeconomic gradients in smoking by type of tobacco use in India By Corsi, Daniel J; S V Subramanian
  18. Review of The therapeutic effects of Camellia sinensis (green tea) on oral and periodontal health By Arab, H; Maroofian, A; Golestani, S; Shafaee, H; K. Sohrabi; Forouzanfar, A
  19. Descriptive spatial analysis of the cholera epidemic 2008-2009 in Harare, Zimbabwe: a secondary data analysis By Luque Fernandez, M. A.; Mason, P. R.; Gray, H.; Bauernfeind, A.; Fesselet, J. F.; Maes, P.
  20. Excess of maternal mortality in foreign nationalities in Spain, 1999-2006 By Luque Fernandez, M. A.; Bueno Cavanillas, A.; de Mateo, S.
  21. Cohort study of an outbreak of viral gastroenteritis in a nursing home for elderly, Majorca, Spain, February 2008 By Luque Fernandez, M. A.; Galmes Truyols, A.; Herrera Guibert, D.; Arbona Cerda, G.; Sancho Gaya, F.
  22. Pro-cyclical mortality : Evidence from Norway By Venke Furre Haaland; Kjetil Telle
  23. Health Care Expenditures and Longevity: Is there a Eubie Blake Effect? By Friedrich Breyer; Normann Lorenz; Thomas Niebel

  1. By: Sanghamitra Bandyopadhyay; Elliott Green
    Abstract: We investigate the relationship between mortality decline and urbanization, which has hitherto been proposed by demographers but has yet to be tested. Using pooled-OLS, fixed effects first differences and long differences we find evidence for a robust negative correlation between crude death rates and urbanization. The use of Granger causality tests and instrumental variables suggest that this relationship is causal. Our preliminary results suggest that mortality decline causes urbanization through the creation of new cities rather than promoting urban growth in already-extant cities.
    Keywords: Urbanization, Mortality Decline, Demography, Population Growth
    JEL: J11 N90 O18 R00
    Date: 2013–11
  2. By: Helen Dakin (Health Economics Research Centre, University of Oxford, UK); Nancy Devlin (Office of Health Economics, London, UK); Yan Feng (Office of Health Economics, London, UK); Nigel Rice (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK); Phill O’Neill (Office of Health Economics, London, UK); David Parkin (Department of Primary Care and Public Health Sciences, King’s College London, UK)
    Abstract: Background: The National Institute for Health and Care Excellence (NICE) emphasises that cost-effectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant. Observing NICE decisions and the evidence considered in each appraisal allows us to ‘reveal’ its implicit weights. Objectives: This study aims to investigate the influence of cost-effectiveness and other factors on NICE decisions and to investigate whether NICE’s decision-making has changed through time. Methods: We build on and extend the modelling approaches in Devlin and Parkin (2004) and Dakin et al (2006). We model NICE’s decisions as binary choices: i.e. recommendations for or against use of a healthcare technology in a specific patient group. Independent variables comprised: the clinical and economic evidence regarding that technology; the characteristics of the patients, disease or treatment; and contextual factors affecting the conduct of health technology appraisal. Data on all NICE decisions published by December 2011 were obtained from HTAinSite []. Results: Cost-effectiveness alone correctly predicted 82% of decisions; few other variables were significant and alternative model specifications led to very small variations in model performance. The odds of a positive NICE recommendation differed significantly between musculoskeletal disease, respiratory disease, cancer and other conditions. The accuracy with which the model predicted NICE recommendations was slightly improved by allowing for end of life criteria, uncertainty, publication date, clinical evidence, only treatment, paediatric population, patient group evidence, appraisal process, orphan status, innovation and use of probabilistic sensitivity analysis, although these variables were not statistically significant. Although there was a non-significant trend towards more recent decisions having a higher chance of a positive recommendation, there is currently no evidence that the threshold has changed over time. The model with highest prediction accuracy suggested that a technology costing £40,000 per quality-adjusted life-year (QALY) would have a 50% chance of NICE rejection (75% at £52,000/QALY; 25% at £27,000/QALY). Discussion: Past NICE decisions appear to have been based on a higher threshold than the £20,000- £30,000/QALY range that is explicitly stated. However, this finding may reflect consideration of other factors that drive a small number of NICE decisions or cannot be easily quantified.
    Keywords: Health technology assessment; implicit weights; cost-effectiveness, National Institute for Health and Care Excellence (NICE); logistic regression
    Date: 2013–11
  3. By: SEKIZAWA Yoichi; YOSHITAKE Naomi; GOTO Yasuo
    Abstract: This study investigated the association between depressive symptoms and variables related to socio-economic status (SES) in middle-aged and elderly Japanese, focusing on the differences between men and women. We used data from the Japanese Study of Aging and Retirement (JSTAR). Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Income and bank deposits were divided into four categories according to their amounts. After adjusting for age, number of illnesses, sex, marital status, education, employment status, house owning, existence of loan, and smoking status, the CES-D scores of the lowest income category are significantly higher than those of the other three categories for men. On the other hand, the association is not clear for women. Regarding bank deposits, there was no significant difference in the CES-D scores among the four categories of bank deposit amounts for men. However, CES-D scores of the lowest bank deposit category were significantly higher than the upper two categories for women.
    Date: 2013–12
  4. By: Bengtsson, Niklas (Department of Economics); Petersen, Stefan (Department of Public Health Sciences); Sävje, Fredrik (Department of Economics)
    Abstract: Recent research has reported positive effects on schooling due to in utero protection from iodine deficiency resulting from iodized oil capsule distribution in Tanzania. We revisit the Tanzanian experience by investigating how these effects differ over time and across surveys; across different treatment specifications; and across additional educational outcome measures. Contrary to previous studies, we find that the estimated effects tend to be small and not robust across specifications or samples. Using all available data and a medically motivated iodine depletion function, we find no evidence of a positive long-run effect of iodine deficiency protection on educational attainment.
    Keywords: Iodine de ciency; Education; Prenatal exposure; Multiple outcomes; Replication; Field; Robles and Torero
    JEL: I12 I21 J16 O15
    Date: 2013–10–25
  5. By: Terence Chai Cheng (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Guyonne Kalb (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Anthony Scott (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    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
  6. By: Dmitry Lubensky (Department of Business Economics and Public Policy, Indiana University Kelley School of Business); Eric Schmidbauer (Department of Business Economics and Public Policy, Indiana University Kelley School of Business)
    Abstract: The physician induced demand literature finds that doctors tend to overtreat patients for financial gain. We analyze this phenomenon when patients are rationally skeptical of doctor's motives and can reject a proposed treatment. We find the classic physician induced demand approach understates patient's welfare loss: treatment on average is excessive but also less medically appropriate, and the latter effect may dominate. Inappropriate treatment arises from the doctor's strategic misdiagnosis to forestall rejection, but this problem can be attenuated by insurance which better aligns incentives and improves communication. We resolve an open question in the partial delegation literature by showing that a generalization of the Krishna and Morgan (2001) equilibrium is the most informative equilibrium that survives the intuitive criterion in a setting that nests both our and their model.
    Keywords: physician induced demand, over-utilization, non-compliance, partial delegation, cheap talk
    JEL: L0 D82 I10
    Date: 2013–11
  7. By: Keith N. Hylton (Boston University Law School); Haizhen Lin (Department of Business Economics and Public Policy, Indiana University Kelley School of Business); Hyo-Youn Chu (Kyung Hee University)
    Abstract: We extend the economic analysis of negligence and intervening causation to "two-sided causation" scenarios. In the two-sided causation scenario the effectiveness of the injurer's care depends on some intervention, and the risk of harm generated by the injurer's failure to take care depends on some other intervention. We find that the distortion from socially optimal care is more severe in the two-sided causation scenario than in the one-sided causation scenario, and generally in the direction of excessive care. The practical lesson is that the likelihood that injurers will have optimal care incentives under the negligence test in the presence of intervening causal factors is low.
    Keywords: negligence, causation, proximate cause, intervening causal factor, optimal care
    JEL: D81 K00 K13 K41
    Date: 2013–08
  8. By: Keith N. Hylton (Boston University Law School); Haizhen Lin (Department of Business Economics and Public Policy, Indiana University Kelley School of Business)
    Abstract: We present a new model of negligence and causation and examine the influence of the negligence test, in the presence of intervening causation, on the level of care. In this model, the injurer’s decision to take care reduces the likelihood of an accident only in the event that some nondeterministic intervention occurs. The effects of the negligence test depend on the information available to the court, and the manner in which the test is implemented. The key effect of the negligence test, in the presence of intervening causation, is to induce actors to take into account the distribution of the intervention probability as well as its expected value. In the most plausible scenario – where courts have limited information – the test generally leads to socially excessive care.
    Keywords: nnegligence, causation, proximate cause, factual causation, ex post negligence, optimal care
    JEL: D81 K00 K13 K41
    Date: 2013–07
  9. By: James Benjamin Bailey
    Abstract: Is the difficulty of purchasing health insurance as an individual or small business a major barrier to entrepreneurship in the United States? I answer this question by taking advantage of the natural experiment provided by the Affordable Care Actâs dependent coverage mandate, which allowed many 19-25 year olds to acquire health insurance independently of their employment. This mandate provides a means to estimate the number of potential entrepreneurs discouraged by the current system of employer-based health insurance. A difference-in-difference strategy finds that the dependent coverage mandate led to a 13-24% increase in self-employment among the treated group. The effect is found to be larger for women and for unincorporated businesses. An instrumental variables strategy finds that those actually receiving health insurance coverage as dependents were much more likely to start businesses.
    JEL: L26 J20 I13 I18
    Date: 2013–12–06
  10. By: Sandy Tubeuf (Leeds Institute of Health Sciences, University of Leeds); Thomas A. Willis (Leeds Institute of Health Sciences, University of Leeds); Barbara Potrata (Leeds Institute of Health Sciences, University of Leeds); Hilary Grant (Leeds Institute of Health Sciences, University of Leeds); Matthew J. Allsop (Leeds Institute of Health Sciences, University of Leeds); Mushtaq Ahmed (Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds); Jenny Hewison (Leeds Institute of Health Sciences, University of Leeds); Martin McKibbin (Ophthalmology Department, St James’s University Hospital, Leeds)
    Abstract: Background: Diagnostic tests are often evaluated according to how the results will change clinical management. Patients may value information even if the management does not change. Objective: To investigate the willingness of adults with inherited retinal disease to undergo and pay for diagnostic genetic testing in three hypothetical scenarios and to explore the factors that influence decision making. Methods: Fifty patients were purposively sampled from an initial cohort of 200 participants and presented with three scenarios whereby genetic testing provided increasing information: (i) confirming the diagnosis and inheritance pattern alone, (ii) providing additional information on future visual function, and (iii) identifying in addition a new treatment which could stabilise their condition. Willingness-to-pay (WTP) was elicited using an iterative bidding game. Regression analysis was used to investigate the probability of agreeing to and paying for testing. Qualitative data were also reviewed to provide a comprehensive understanding of WTP and decision making. Results: The majority of participants agreed to undergo genetic testing in each of the three scenarios. Scenario 2 was the least acceptable with 78% of participants agreeing to genetic testing. The probability of agreeing genetic testing decreased with age. Between 72%-96% of participants reported a WTP for genetic testing. Average WTP was £539, £1,516 and £6,895 for scenarios 1, 2 and 3 respectively. WTP appeared to rise with age and income. Qualitative data provided additional detail about the rationale behind participants’ decisions. Conclusions: The study suggests that patients with inherited retinal disease were willing to undergo and to pay for diagnostic genetic testing, suggesting that they valued the information it may provide. However, several patients preferred not to receive prognostic information and were less willing to pay for genetic testing that yielded such detail.
    Keywords: genetic testing; willingness-to-pay; qualitative interviews; inherited retinal disease
    Date: 2013
  11. By: Amitabh Chandra; Jonathan Holmes; Jonathan Skinner
    Abstract: Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population. A more difficult question is: Will this slowdown continue? Here we are more pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in the technology pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000) is projected to grow rapidly. Accountable care organizations (ACOs) and emboldened insurance companies may yet stifle health care cost growth, but our best estimate over the next two decades is that health care costs will grow at GDP plus 1.2 percent; lower than previous estimates but still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums.
    JEL: H50 I1 I11 I13 I28
    Date: 2013–12
  12. By: Pinar Karaca-Mandic; Jean M. Abraham; Kosali Simon; Roger Feldman
    Abstract: The Affordable Care Act (ACA) will dramatically alter health insurance markets and the sources through which individuals obtain coverage. As the ACA is implemented, it is essential to monitor the intended and the unintended consequences of these regulations. To evaluate the changes in health insurance markets linked to the ACA, it is critical to consistently measure the size and structure of health insurance markets, as well as the performance of participating health insurers, prior to and post-ACA. In this paper we discuss challenges of describing the size, structure, and performance of the individual and small group markets. Next, we discuss improvements in data availability starting in 2010 to address some of these concerns. Finally, using data from the National Association of Insurance Commissioners (NAIC), we evaluate insurance market structure and performance during 2010-2012, focusing on enrollment, the number of participating insurers, premiums, claims spending, MLR, and administrative expenses.
    JEL: I1 I13 I28
    Date: 2013–12
  13. By: Anne E. Hall; Tina Highfill
    Abstract: Disease-based medical care expenditure indexes are currently of interest to measurement economists. In this paper, using two data sources and two different methods for calculating disease-based expenditure indexes for the Medicare population, we establish some results that will help guide policymakers in choosing indexes for this population. First, we find that the two methods we examine (primary diagnosis and a regression-based method) produce the same results for the aggregate index and have a moderate level of agreement in which diseases contribute the most to growth in per capita health-care spending. Since the primary diagnosis method is preferable because of its transparency, this result implies that we may use the regression-based method when the data is not suitable for the primary diagnosis method without a great loss of accuracy. Second, we find that the two data sources, the Medicare Current Beneficiary Survey and the Medical Expenditure Panel Survey, produce very similar results in the aggregate but there is some evidence that they treat chronic illnesses differently. As the MCBS has a larger sample and more comprehensive coverage of Medicare beneficiaries than the MEPS, it seems that a regression-based expenditure index based on the MCBS is overall preferable for fee-for-service Medicare beneficiaries.
    JEL: I1
    Date: 2013–12
  14. By: Picazo, Oscar F.
    Abstract: This report reviews the medical tourism industry in the Philippines. It discusses the global market for medical tourism, analyzes the demand and supply aspects of the local industry, and identifies its drivers of growth. It performs an industry benchmarking exercise by looking at benchmarks associated with strategy setting, organization and management, service quality, care, travel and accommodation, and financing. It also conducts an analysis of the strengths, weaknesses, opportunities, and threats of the industry.
    Keywords: Philippines, medical tourism, industry benchmarks, market profile, demand for medical tourists, supply of services and facilities for medical tourism
    Date: 2013
  15. By: Naeem Ur Rehman, Khattak; Jangraiz, Khan
    Abstract: This paper has been designed to investigate whether health accelerate economic growth in Pakistan. The study is using Growth Accounting Method, Ordinary Least Squares and Johansen Cointegration Test as analytical techniques. The Growth Accounting Method shows that Total Factor Productivity, Capital and health contributed 46.61%, 43.15% and 2.61% to growth rate of GDP per capita during 1971-2008. The Ordinary Least Squares results showed health, labour and Research and Development as the significant determinants of economic growth in Pakistan. The results further indicate that real GDP per capita, R&D, education and health institutions affect heath in Pakistan. The Cointegration test results confirmed the existence of long run relation ship between health and economic growth. Therefore, the study concludes that health accelerates economic growth in Pakistan and this relationship also exists in long run. The study suggests increase in public expenditure on health and R&D. It is also suggests further research on the determinants of Total Factor Productivity
    Keywords: Health, Economic Growth, Growth Accounting, Ordinary Least Squares, Pakistan
    JEL: O15
    Date: 2012
  16. By: S V Subramanian; M.A. Subramanyam; DJ Corsi; G Davey Smith
  17. By: Corsi, Daniel J; S V Subramanian
    Abstract: We describe the relationship between socioeconomic status and current bidi/cigarette smoking among Indian men aged 15 years and older. The prevalence of bidi smoking was 13.7% (95% confidence interval [CI]: 13.3-14.1) and cigarette smoking was 6.3% (95% CI: 6.1-6.6). Bidi smoking was concentrated among the socioeconomically disadvantaged while cigarette smoking was common among men with higher status occupations and greater levels of education and household wealth. This suggests India has not transitioned to the later stages of the tobacco epidemic and underscores the need for prevention and control strategies adapted to current patterns of consumption across socioeconomic groups in India.
  18. By: Arab, H; Maroofian, A; Golestani, S; Shafaee, H; K. Sohrabi; Forouzanfar, A
  19. By: Luque Fernandez, M. A.; Mason, P. R.; Gray, H.; Bauernfeind, A.; Fesselet, J. F.; Maes, P.
    Abstract: This ecological study describes the cholera epidemic in Harare during 2008-2009 and identifies patterns that may explain transmission. Rates ratios of cholera cases by suburb were calculated by a univariate regression Poisson model and then, through an Empirical Bayes modelling, smoothed rate ratios were estimated and represented geographically. Mbare and southwest suburbs of Harare presented higher rate ratios. Suburbs attack rates ranged from 1.2 (95% Cl = 0.7-1.6) cases per 1000 people in Tynwald to 90.3 (95% Cl = 82.8-98.2) in Hopley. The identification of this spatial pattern in the spread, characterised by low risk in low density residential housing, and a higher risk in high density south west suburbs and Mbare, could be used to advocate for improving water and sanitation conditions and specific preparedness measures in the most affected areas.
    Keywords: Adolescent; Adult; Child; Child, Preschool; Cholera/*epidemiology/transmission; Disease Outbreaks/*statistics & numerical data; Female; Geographic Information Systems; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Poisson Distribution; Population Surveillance; Regression Analysis; Risk Factors; Sanitation/*standards; Space-Time Clustering; Young Adult; Zimbabwe/epidemiology
  20. By: Luque Fernandez, M. A.; Bueno Cavanillas, A.; de Mateo, S.
    Abstract: OBJECTIVE: This study aimed to compare maternal mortality by province, autonomous region and mother's country of birth in Spain during 1999-2006. STUDY DESIGN: A cross-sectional ecological study with all live births and maternal mortality cases occurring during 1999-2006 in Spain was done. Data were drawn from the National Statistics Institute (INE) and we used the Movement of Natural Persons (MNP) and death statistics broken down by cause of death. Maternal mortality rates by province, autonomous region and mother's country of birth were calculated. To compare maternal mortality by province, standardised mortality ratios were calculated using an indirect standardisation. The risk of maternal death by autonomous region, age and mother's country of birth was calculated by a Poisson regression. RESULTS: Sub-Saharan nationalities present the highest maternal mortality rates. Adjusted by age and autonomous region, foreign nationalities had 67% higher risk of maternal mortality (RR=1.67; 95%CI=1.22-2.33). Adjusted by mother's country of birth and age, two autonomous regions had a significant mortality excess: Andalusia (RR=1.84; 95%CI=1.32-2.57) and Asturias (RR=2.78 95%CI=1.24-6.24). CONCLUSION: This study shows inequalities in maternal mortality by province, autonomous region and mother's country of birth in Spain. It would be desirable to implement a maternal mortality active surveillance system and the use of confidential qualitative surveys for analysis of socio-economic and healthcare circumstances surrounding deaths. These measures would be invaluable for in-depth understanding and characterisation of a preventable phenomenon such as maternal death.
    Keywords: *Emigrants and Immigrants; Cause of Death; Cross-Sectional Studies; Female; Humans; Maternal Health Services; Maternal Mortality/*ethnology; Pregnancy; Registries; Risk; Risk Factors; Socioeconomic Factors; Spain/ethnology
  21. By: Luque Fernandez, M. A.; Galmes Truyols, A.; Herrera Guibert, D.; Arbona Cerda, G.; Sancho Gaya, F.
    Abstract: An outbreak of acute gastroenteritis occurred in a nursing home for elderly in Majorca between 4 and 23 February 2008. To know its aetiology and mechanism of transmission a retrospective cohort study was conducted with a fixed cohort including 146 people (96 residents and 50 employees). The data were collected from clinical histories and through a survey by questionnaire. In total 71 cases were identified (53 residents, 18 employees), corresponding to an overall attack rate (AR) of 48.6%. The consumption of tap water, adjusted by age, sex and consumption of meals provided at the nursing home, presented a relative risk (RR) of 4.03 (95%CI, 1.4-11.4). The microbiological analyses confirmed the presence of norovirus and/or rotavirus in five of the seven stool samples submitted. The slow appearance of cases at the beginning of the outbreak is characteristic of a person to person transmission, while the sudden peak in the middle of the month suggests a common source such as the tap water. We therefore concluded that the outbreak likely originated from two sources: an infected employee of the nursing home and the tap water. The high number of dependent residents most probably facilitated the spread of the outbreak.
    Keywords: *Population Surveillance; Aged; Aged, 80 and over; Caliciviridae Infections/*epidemiology; Cohort Studies; Disease Outbreaks/*statistics & numerical data; Female; Gastroenteritis/*epidemiology; Humans; Incidence; Male; Nursing Homes/*statistics & numerical data; Risk Assessment/*methods; Risk Factors; Rotavirus Infections/*epidemiology; Spain/epidemiology
  22. By: Venke Furre Haaland; Kjetil Telle (Statistics Norway)
    Abstract: Using variation across geographical regions, a number of studies from the U.S. and other developed countries have found more deaths in economic upturns and less deaths in economic downturns. We use data from regions in Norway for 1977-2008 and find the same procyclical patterns. Using individual-level register data for the same population, we then look at differences in pro-cyclicality across subsamples that are expected to be affected differently by the business cycle. Mortality is most pro-cyclical for young men (18-24), but there are also some indications of more pro-cyclical mortality for subgroups, such as the disabled, who are already dependent on the health-care system. Furthermore, the data allow us to look at pro-cyclicality in measures of morbidity, and we find procyclicality in disability, obesity and traffic accidents in densely populated areas. Finally, we investigate pro-cyclical mortality across socioeconomic groups and find that mortality is more procyclical for the well educated than the less educated, but it is less pro-cyclical for those with high earnings and more wealth than those with low earnings and less wealth. Overall, the observed associations between mortality and macroeconomic conditions seem to stem from a myriad of diverging mechanisms.
    Keywords: Mortality; Morbidity; Health; Recession; Unemployment; business cycle
    JEL: I10 E32 J6
    Date: 2013–11
  23. By: Friedrich Breyer; Normann Lorenz; Thomas Niebel
    Abstract: It is still an open question whether increasing life expectancy as such is causing higher health care expenditures (HCE). According to the “red-herring”-hypothesis, the positive correlation between age and HCE is exclusively due to the fact that mortality rises with age and a large share of HCE is caused by proximity to death. As a consequence, rising longevity – through falling mortality rates – may even reduce HCE. However, a weakness of previous empirical studies is that they use cross-sectional evidence to make inferences on a development over time. In this paper we try to isolate the impact of rising longevity on the trend of HCE over time by using data for a pseudo-panel of German sickness fund members over the period 1997-2009. Using dynamic panel data models, we find that age, mortality rate and five-year survival rates have a positive impact on per-capita HCE. Our explanation for the last finding is that physicians treat patients more aggressively if they think the result will pay off for a longer time span, which we call “Eubie Blake effect”. A simulation on the basis of an official population forecast for Germany is used to isolate the effect of demographic ageing on real per-capita HCE over the next decades.
    Keywords: health care expenditures, ageing, longevity, 5-year survival rate
    JEL: H51 J11 I19
    Date: 2012

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