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on Health Economics |
| By: | Donado, Alejandro |
| Abstract: | Most empirical studies have estimated a positive union-nonunion “injury gap,” suggesting that unionized workers are more likely to have a nonfatal occupational injury than their nonunion counterparts. Using individual-level panel data for the first time, I study several explanations for this puzzling result. I find that controlling for time-invariant individual fixed effects already reduces the gap by around 40%. Some of the explanations that I study contribute in reducing this gap even further. I, however, do not find evidence of the gap becoming negative and the impact of unions on nonfatal injuries appears to be insignificant at best. |
| Keywords: | labor unions; occupational health and safety; working conditions; panel data |
| Date: | 2013–12–23 |
| URL: | http://d.repec.org/n?u=RePEc:awi:wpaper:0551&r=hea |
| By: | Eve Caroli (University Paris Dauphine); Mathilde Godard (CREST) |
| Abstract: | This paper estimates the causal effect of perceived job insecurity - i.e. the fear of involuntary job loss - on health in a sample of 22 European countries. We rely on an original instrumental variable approach based on the idea that workers perceive greater job security in countries where employment is strongly protected by the law, and relatively more so if employed in industries where employment protection legislation is more binding, i.e. in industries with a higher natural rate of dismissals. Using cross-country data from the 2010 European Working Conditions Survey, we show that when the potential endogeneity of job insecurity is not accounted for, the latter appears to deteriorate almost all health outcomes. After controlling for endogeneity, the health-damaging effect of job insecurity is confirmed for a subgroup of health outcomes, namely self-rated health, being sick in the past 12 months, suffering from skin problems, headaches or eyestrain and stomach ache. As for other health variables, the impact of job insecurity appears to be insignificant at conventional |
| Keywords: | Job insecurity, Health, Instrumental Variables |
| Date: | 2013–10 |
| URL: | http://d.repec.org/n?u=RePEc:crs:wpaper:2013-13&r=hea |
| By: | Christian Gourieroux (Crest, University of Toronto); Yang Lu (SCOR and Crest) |
| Abstract: | The increase of the expected lifetime, that is the longevity phenomenon, is accompanied by an increase of the number of seniors with a severe disability. Because of the significant costs of long term care facilities, it is important to analyze the time spent in long term care, as well as the probability of entering into this state during its lifetime, and how they evolve with longevity. Our paper considers such questions, when lifetime data are available, but long term care data are either unavailable, or too aggregated, or unreliable, as it is usually the case. We specify a joint structural model of long term care and mortality, and explain why parameters of such models are identifiable from only the lifetime data. The methodology is applied to the mortality data of French males, first with a deterministic trend and then with a dynamic factor process. Prediction formulas are then provided and illustrated using the same data. We show in particular that the expected cost of the long term care is increasing less fast than the residual life expectancy at age 50 |
| Keywords: | Longevity, Long term care (LTC), Semi-competing risks, Unobserved heterogeneity, Dynamic frailty, Affine process, Partial Observability, Identification, Markov chain Monte-Carlo |
| Date: | 2013–10 |
| URL: | http://d.repec.org/n?u=RePEc:crs:wpaper:2013-16&r=hea |
| By: | Tsuyoshi Takahara |
| Abstract: | We analyze the rationale for official authorization of patient dumping in the prospective-payment policy framework. We show that when the insurer designs the healthcare payment policy to let hospitals dump high-cost patients, there is a trade-off between the disutility of dumped patients (changes in hospitals' rent extracting due to low-severity patients) and the shift in the cost-reduction effort level for high-severity patients. We also clarify the welfare-improving conditions by allowing hospitals to dump high-severity patients. Finally, we show that if the efficiency of the cost-reduction effort varies by much and the healthcare payment cost is large, or if there exist many private hospitals, the insurer can improve social welfare in a wider environment. |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:dpr:wpaper:0891&r=hea |
| By: | Michèle, Belot; Jonathan, James; Patrick, Nolen |
| Abstract: | We conduct a field experiment in 31 primary schools in England to test whether incentives to eat fruit and vegetables help children develop healthier habits. The intervention consists of rewarding children with stickers and little gifts for a period of four weeks for choosing a portion of fruit and vegetables at lunch. We compare the effects of two incentive schemes (competition and piece rate) on choices and consumption over the course of the intervention as well as once the incentives are removed and six months later. We find that the intervention had positive effects, but the effects vary substantially according to age and gender. However, we find little evidence of sustained long term effects, except for the children from poorer socio‐economic backgrounds. |
| Keywords: | Incentives, Health, Habits, Child nutrition, Field experiment, |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:edn:sirdps:471&r=hea |
| By: | Zukauskaite , Elena (CIRCLE, Lund University) |
| Abstract: | The focus of this paper is on how organizational change within medical research evolves and is influenced by different types of institutions at different geographical levels, as well as what characteristics of the key individuals are important in enacting institutional opportunities and overcoming hindrances. The paper reveals the complexity of institutions influencing change processes. First, the relations between institutions can be complementary, reinforcing or contradicting, suggesting that individuals initiating change should consider possible responses to institutions contradictory to the initial opportunities, as well as take advantage of reinforcing and complementary norms, rules and procedures. Second, although different types and levels of institutions have a joint impact on change processes, some institutions are more prominent than others in different phases of the process. Individuals can take advantage of institutional opportunities and overcome hindrances due to their personal qualities and position in the organization |
| Keywords: | Institutions; Individuals; Medical research; Sweden |
| JEL: | D23 D73 I29 O31 |
| Date: | 2013–12–20 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lucirc:2013_045&r=hea |
| By: | Barrett, Alan (ESRI, Dublin); O'Sullivan, Vincent (Trinity College Dublin) |
| Abstract: | The economic crisis of 2008/9 was felt more acutely in Ireland relative to elsewhere and culminated in the international bailout in 2010. Given the economic collapse, Ireland provides an ideal case-study of the link between wealth collapses and movements in variables such as health and well-being. Using nationally-representative samples of older people collected before and during the crisis, we show that mean net assets fell by 45 percent between 2006/7 and 2012/13. In spite of this massive fall in wealth, measures of health and well-being remained broadly unchanged. However, expectations about future living standards became less optimistic. The results tend to support the findings of other recent studies that recessions do not have widespread negative effects on health and well-being. |
| Keywords: | recession, wealth, health, wellbeing |
| JEL: | D31 J14 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7832&r=hea |
| By: | Bhalotra, Sonia R. (University of Essex); Venkataramani, Atheendar (Massachusetts General Hospital) |
| Abstract: | We exploit exogenous variation in the risk of waterborne disease created by implementation of a major water reform in Mexico in 1991 to investigate impacts of infant exposure on indicators of cognitive development and academic achievement in late childhood. We estimate that a one standard deviation reduction in childhood diarrhea mortality rates results in about a 0.1 standard deviation increase in test scores, but only for girls. We show that a reason for the gender differentiated impacts is that the water reform induces parents to make complementary investments in education that favor girls, consistent with their comparative advantage in skilled occupations. The results provide novel evidence of the potential for clean water provision to narrow test score gaps across countries and, within countries, across gender. |
| Keywords: | water, diarrhea, cognitive development, test scores, early life health interventions, brain-brawn, gender, Mexico, dynamic complementarity |
| JEL: | I38 J16 I12 I14 I15 I24 I25 H51 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7833&r=hea |
| By: | Daysal, N. Meltem (University of Southern Denmark); Trandafir, Mircea (University of Southern Denmark); van Ewijk, Reyn (University of Mainz) |
| Abstract: | We investigate the impact of obstetrician supervision, as opposed to midwife supervision, on the short-term health of low-risk newborns. We exploit a unique policy rule in the Netherlands that creates a large discontinuity in the probability of a low-risk birth being attended by an obstetrician at gestational week 37. Using a fuzzy regression discontinuity design, we consistently find no health benefits from obstetrician supervision, despite increased rates of neonatal intensive care unit admissions among births supervised by obstetricians. These results indicate potential cost savings from increased use of midwifery care for low-risk deliveries. |
| Keywords: | medical technology, birth, midwife, mortality |
| JEL: | I11 I12 I18 J13 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7834&r=hea |
| By: | Échevin, Damien (University of Sherbrooke); Fortin, Bernard (Université Laval) |
| Abstract: | We provide an analysis of the effect of physician payment methods on their hospital patients' length of stay and risk of readmission. To do so, we exploit a major reform implemented in Quebec (Canada) in 1999. The Quebec Government introduced an optional mixed compensation (MC) scheme for specialist physicians working in hospital. This scheme combines a fixed per diem with a reduced fee for services provided, as an alternative to the traditional fee-for- service system. We develop a model of a physician's decision to choose the MC scheme. We show that a physician who adopts this system will have incentives to increase his time per clinical service provided. We demonstrate that as long as this effect does not improve his patients' health by more than a critical level, they will stay more days in hospital over the period. At the empirical level, we estimate a model of transition between spells in and out of hospital analog to a difference-in-differences approach. We find that the hospital length of stay of patients treated in departments that opted for the MC system increased on average by 5.3% (0.35 days). However, the risk of readmission to the same department with the same diagnosis does not appear to be overall affected by the reform. |
| Keywords: | physician payment mechanisms, mixed compensation, hospital length of stay, risk of re-hospitalisation, duration model, natural experiment |
| JEL: | J33 I10 I12 I18 C41 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7835&r=hea |
| By: | Farré, Lídia (IAE Barcelona (CSIC)) |
| Abstract: | This paper provides new empirical evidence on the contribution of selective migration to the health advantage of immigrants upon arrival to the new destination (i.e. the Healthy Immigrant Effect). It analyses a very interesting episode in international migration, namely the exodus of Ecuadorians in the aftermath of the economic collapse in the late 1990s. Between 1999 and 2005, more than 600,000 Ecuadorians left the country and most of them headed towards Spain. Using administrative data from the Vital Statistics, it compares the health distribution (in terms of birth outcomes) of immigrant children born in Spain to that of non-immigrants in Ecuador and immigrants from other nationalities, and not only to that of natives at destination. These comparisons suggest that positive selection is partly responsible for the health advantage of recent immigrants. |
| Keywords: | immigration, selection, health, birth outcomes |
| JEL: | J61 I14 C14 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7840&r=hea |
| By: | Lawrence S. Wissow; Jonathan Brown; Kate E. Fothergill; Anne Gadomski; Karen Hacker; Peter Salmon; Rachel Zelkowitz |
| Abstract: | A systematic review examined universal mental health screening in pediatric primary care, and found little research has addressed patients' engagement in the process or how clinicians can best use screening results. |
| Keywords: | Mental Health, Patient Engagement, Pediatrics, Primary Care, Screening |
| JEL: | I |
| Date: | 2013–11–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7983&r=hea |
| By: | James M. Verdier |
| Keywords: | Dual Eligible, Health |
| JEL: | I |
| Date: | 2013–12–03 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7985&r=hea |
| By: | David K. Baugh; Shinu Verghese |
| Keywords: | MAX, Medicaid, Eligibility, Enrollment, Migration, Moving |
| JEL: | I |
| Date: | 2013–12–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7990&r=hea |
| By: | Catherine M. DesRoches; Jennifer Gaudet; Jennifer Perloff; Karen Donelan; Lisa I. Iezzoni; Peter Buerhaus |
| Keywords: | Advanced Practice Nurse, Medicare, Patient Characteristics |
| JEL: | I |
| Date: | 2013–11–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7992&r=hea |
| By: | Alexander Dokumentov; Rob J Hyndman |
| Abstract: | We propose three new practical methods of smoothing mortality rates (the procedure known in demography as graduation) over two dimensions: age and time. The first method uses bivariate thin plate splines. The second uses a similar procedure but with lasso-type regularization. The third method also uses bivariate lasso-type regularization, but allows for both period and cohort effects. Thus the mortality rates are modelled as the sum of four components: a smooth bivariate function of age and time, smooth one-dimensional cohort effects, smooth one-dimensional period effects and random errors. Cross validation is used to compare these new methods of graduation with existing approaches. |
| Keywords: | Mortality rates, nonparametric smoothing, graduation, cohort effects, period effects. |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:msh:ebswps:2013-26&r=hea |
| By: | Taryn Dinkelman |
| Abstract: | Drought is Africa’s primary natural disaster and a pervasive source of income risk for poor households. This paper documents the long-run health effects of early life exposure to drought and investigates an important source of heterogeneity in these effects. Combining birth cohort variation in South African Census data with cross-sectional and temporal drought variation, I estimate long-run health impacts of drought exposure among Africans confined to homelands during apartheid. Drought exposure in early childhood significantly raises later life male disability rates by 4% and reduces cohort size. Among a subset of homelands – the TBVC areas – disability effects are double and negative cohort effects are significantly larger. I show that differences in spatial mobility restrictions that influence the extent of migrant networks across TBVC and non-TBVC areas contribute to this heterogeneity. Placebo checks show no differential disability impacts of drought exposure across TBVC and non-TBVC areas after the repeal of migration restrictions. The results show that although drought has significant long-run effects on health human capital, migrant networks in poor economies provide one channel through which families mitigate these negative impacts of local environmental shock. |
| JEL: | I15 J61 N37 O15 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19756&r=hea |
| By: | Yiyan Liu; Ginger Zhe Jin |
| Abstract: | We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. |
| JEL: | H2 I1 L1 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19760&r=hea |
| By: | Jeffrey Clemens |
| Abstract: | I study the channels through which health insurance influences medical innovation. Following Medicare and Medicaid's passage, I find that U.S.-based medical-equipment patenting rose by 40 to 50 percent relative to both other U.S. patenting and foreign medical-equipment patenting. Within the United States, increases in medical-equipment patenting were most dramatic in states where the Great Society insurance expansions were largest and in which there were large baseline numbers of physicians per resident. Consistent with historical case studies, Medical innovation's determinants extend beyond the potential revenues associated with global market size; a physician driven process of innovation-while-doing appears to play a central role. An extrapolation of the evidence suggests that the last half century's U.S. insurance expansions have driven 25 percent of recent global medical-equipment innovation. In a standard decomposition of health spending growth, this insurance-induced innovation accounts for 15 percent of the long run rise in U.S. health spending in hospitals, physicians' offices, and other clinical settings. |
| JEL: | H51 H57 I1 I13 O3 O31 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19761&r=hea |
| By: | Trevor S. Gallen; Casey B. Mulligan |
| Abstract: | The Affordable Care Act’s taxes, subsidies, and regulations significantly alter terms of trade in both goods and factor markets. We use a multi-sector (intra-national) trade model to predict and quantify consequences of the Affordable Care Act for the incidence of health insurance coverage and patterns of labor usage. If and when the new exchange plans are competitive with employer-sponsored insurance (ESI), our model suggests that more than 20 million people will leave ESI as a consequence of the law. Behavioral changes that are captured in the model could add about 3 million participants to the new exchange plans: beyond those that would participate solely as the result of employer decisions to stop offering coverage and beyond those who would have been uninsured. Industries and regions will grow, decline, and change coverage on the basis of their relative demand for skilled labor. |
| JEL: | H3 I13 I18 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19770&r=hea |
| By: | Casey B. Mulligan; Trevor S. Gallen |
| Abstract: | Our paper documents the large labor market wedges created by taxes, subsidies, and regulations included in the Affordable Care Act. The law changes terms of trade in both goods and factor markets for firms offering health insurance coverage. We use a multi-sector (intra-national) trade model to predict and quantify consequences of the Affordable Care Act for the patterns of output, labor usage, and employee compensation. We find that the law will significantly redistribute from high-wage workers to low-wage workers and to non-workers, reduce total factor productivity about one percent, reduce per-capita labor hours about three percent (especially among low-skill workers), reduce output per capita about two percent, and reduce employment less for sectors that ultimately pay employer penalties. |
| JEL: | H3 I13 J2 J3 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19771&r=hea |
| By: | OECD |
| Abstract: | This report examines examples of new and emerging governance models that aim to support the responsible development of diagnostics and treatments based on the latest advances in biomedicine. In particular, it presents programmes and initiatives that aim to manage uncertainty in the development and approval of new medical products and thereby to improve the understanding of the risk/benefit balance. It also identifies some of the main challenges for policy makers, regulators and other communities involved in the translation of biomedical innovation and health technologies from the laboratory bench to point of care. |
| Date: | 2013–12–05 |
| URL: | http://d.repec.org/n?u=RePEc:oec:stiaac:11-en&r=hea |
| By: | Emiko Higami (Graduate School of Economics, Osaka University); Kenichi Tomobe (Graduate School of Economics, Osaka University); Makoto Hanashima (Institute of areal Studies, Foundation) |
| Abstract: | The average infant mortality rate (IMR) was 155.4 in rural areas in Japan, and IMR in Osaka city was 231.6 during 1906 to 1910. The outstanding level of IMR in Osaka city might have been influenced by somewhat negative urban factors, which we can call the gurban penalty.h Dr. Hiroshi Maruyama discovered the ƒ¿-index in 1938. The ƒ¿-index represents infant mortality number divided by neonatal mortality number. After all, Maruyama set one month after birth as a boundary to divide endogenous and exogenous. The ƒ¿-index shows a qualitative measure of infant mortality. Post neonatal mortality was increased due to acquired diseases such as diarrhea, pneumonia and beriberi. This shows that the effect of the urban penalty was raising the ƒ¿-index. The ƒ¿-index of the industrial zones shows that bad maternal conditions affected endogenous factors. Most mothers suffered from a deficiency of breast-feeding capability. The first reason was anemia. The second reason was mothersf ignorance about breast-feeding. The third reason was motherfs illnesses. They had to rely on bottle-feeding without any knowledge to handle artificial milk. Those babies often died from diarrhea or pneumonia. |
| Keywords: | Infant Mortality Rate (IMR), Breast-feeding, ƒ¿-index, diarrhea, visiting nurses |
| JEL: | J13 N35 R23 |
| Date: | 2013–11 |
| URL: | http://d.repec.org/n?u=RePEc:osk:wpaper:1330&r=hea |
| By: | Cordero Ferrera, Jose Manuel; Alonso Morán, Edurne; Nuño Solís, Roberto; Orueta, Juan F.; Souto Arce, Regina |
| Abstract: | This paper uses a fully nonparametric approach to estimate efficiency measures for primary care units incorporating the effect of (exogenous) environmental factors. This methodology allows us to account for different types of variables (continuous and discrete) describing the main characteristics of patients served by those providers. In addition, we use an extension of this nonparametric approach to deal with the presence of undesirable outputs in data, represented by the rates of hospitalization for ambulatory care sensitive condition (ACSC) and of hospital readmissions. The empirical results show that all the exogenous variables considered have a significant and negative effect on efficiency estimates |
| Keywords: | OR in health services, Efficiency, Data Envelopment Analysis, Environmental factors, Nonparametric analysis |
| JEL: | C14 I12 |
| Date: | 2013–11–24 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:51926&r=hea |
| By: | Christian Bünnings |
| Abstract: | This paper investigates whether new health information aff ects smoking behavior. Interpreting three distinct categories of health events as different information, the paper also tests whether behavioral change depends on the type of information received. Based on retrospectively reported data on smoking behavior from the Swiss Household Panel, a linear probability model is applied to estimate the effects of three different health events on the decision to quit smoking. The empirical results yield robust evidence that smokers respond differently to health events that are due to different causes. Suffering from physical health problems increases the inclination to stop smoking, the opposite holds true for mental disorders, while accidents do not affect health behavior at all. Analyses of effect heterogeneity further reveal that the same type of information affects various subgroups of the population differently. |
| Keywords: | Health events; behavioral change; smoking cessation; retrospective data |
| JEL: | C23 I10 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:rwi:repape:0459&r=hea |
| By: | Kevin x.d. Huang (Vanderbilt University); Hui He (Shanghai University of Finance and Economics); Sheng-ti Hung (University of Hawai''i at Manoa) |
| Abstract: | We develop a general equilibrium macroeconomic model with endogenous health accumulation, and we use the model's equilibrium condition to estimate the elasticity of substitution between medical care and leisure time in maintaining health, based on a cross-country panel dataset. Our econometric estimates imply that increasing health-enhancing leisure time may substantially reduce the nation's medical expenditure and help resolve its pressing fiscal uncertainty. Our study highlights the importance of several current nationwide campaigns aimed at improving national health status, from not only health but macroeconomic perspectives. Our study also provides a guidance to a growing macro-health literature in modeling health production. |
| Keywords: | general equilibrium, macro-health, health care, leisure time, elasticity of substitution, fiscal uncertainty |
| JEL: | E2 I1 |
| Date: | 2013–12–23 |
| URL: | http://d.repec.org/n?u=RePEc:van:wpaper:vuecon-sub-13-00020&r=hea |
| By: | Birg, Laura |
| Abstract: | This paper studies externalities of nationally determined cost-sharing systems, in particular coinsurance rates (patients pay a percentage of the price), under pharmaceutical parallel trade in a two-country model with a vertical distributor relationship. Parallel trade generates a price-decreasing competition effect in the destination country and a price-increasing double marginalization effect in the source country. An increase of the coinsurance rates in the destination country of the parallel import mitigates the double marginalization effect in the source country. An increase of the coinsurance rate in the source country reinforces the competition effect in the destination country. This may be a case for policy coordination in the European Union. -- |
| Keywords: | externalities,spillovers,parallel trade,cost-sharing,coinsurance rates |
| JEL: | F12 I11 I18 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cegedp:178&r=hea |
| By: | Birg, Laura |
| Abstract: | This paper analyzes the consequences of parallel trade on health care systems in a two-country model with a vertical distributor relationship. In particular, two cost-sharing systems - coinsurance and indemnity insurance - are compared with respect to changes in copayments and public health expenditure. Under both cost-sharing systems, parallel trade generates a price-decreasing competition effect in the destination country and a price-increasing double marginalization effect in the source country. In the destination country, copayments for patients decrease to a larger extent under indemnity insurance, whereas reductions of public health expenditure occur only under coinsurance. In the source country, copayments increase less under coinsurance, whereas health expenditure is reduced more under indemnity insurance. This illustrates that a harmonization of health care systems would not make sense. -- |
| Keywords: | cost-sharing,parallel trade,coinsurance rates,indemnity insurance |
| JEL: | F12 I11 I18 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cegedp:179&r=hea |
| By: | Birg, Laura |
| Abstract: | This paper studies the effect of pharmaceutical regulation at the wholesale level, if markets are integrated by parallel trade, i.e. trade outside the manufacturer´s authorized distribution channel. In particular, maximum wholesale margins, a restriction of pricing by the intermediary, and mandatory rebates, a restriction of the pricing by the manufacturer, are analyzed with respect to their effect on drug prices, quantities, and public pharmaceutical expenditure. Maximum wholesale margins enhance the manufacturer´s ability to reduce competition from parallel trade in the destination country by increasing wholesale prices. In a symmetric equilibrium, maximum wholesale margins of both countries partly offset each other. Mandatory rebates may be a policy alternative, as they exhibit a reinforcing effect with respect to drug prices. -- |
| Keywords: | parallel trade,regulation,maximum markups,spillovers,mandatory rebates |
| JEL: | F12 I11 I18 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cegedp:180&r=hea |
| By: | Bünnings, Christian; Tauchmann, Harald |
| Abstract: | The coexistence of social health insurance and private health insurance in Germany is subject to intense public debate. As only few have the opportunity to choose between the two systems, they are often regarded as privileged by the health insurance system. Applying a hazard model in discrete time, this paper examines the role of incentives set by the regulatory framework as well as the influence of individual personality characteristics on the decision to opt out of the statutory system. To address potential endogeneity of one of the key explanatory variables an instrumental variable approach is also applied. The estimation results yield robust evidence on the choice of health insurance type that is consistent with rational decision making, with both incentives set by regulation and personality traits as relevant determinants. -- |
| Keywords: | statutory and private health insurance,incentives,personality traits |
| JEL: | C13 C23 I13 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:iwqwdp:102013&r=hea |