nep-hea New Economics Papers
on Health Economics
Issue of 2014‒02‒08
fifteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Multi-payer health insurance systems in Central and Eastern Europe: lessons from the Czech Republic, Slovakia, and Russia By Galina Besstremyannaya; Jaak Simm
  2. Urban inequity in the performance of social health insurance system: evidence from Russian regions By Galina Besstremyannaya
  3. Network Meta-Analysis of (Individual Patient) Time to Event Data Alongside (Aggregate) Count Data By Pedro Saramago; Ling-Hsiang Chuang; Marta Soares
  4. A Note on Maintenance of Ethnic Origin Diet and Healthy Eating in Understanding Society By Platt, Lucinda; Ayse, K. Uskul
  5. Is Formal Employment Discouraged by the Provision of Free. Health Services to the Uninsured ? Evidence From a Natural Experiment in Mexico By Alejandro Del Valle
  6. Child health and use of health care services in France: Evidence on the role of family income By Bénédicte H. Apouey; Pierre-Yves Geoffard
  7. Does malaria control impact education? A study of the Global Fund in Africa By Maria Kuecken; Josselin Thuilliez; Marie-Anne Valfort
  8. Social Interactions and Malaria Preventive Behaviors in Sub-Saharan Africa By Bénédicte H. Apouey; Gabriel Picone
  9. Life Cycle Development of Obesity and Its Determinants in Six European Countries By Cavaco, Sandra; Eriksson, Tor; Skalli, Ali
  10. Combining Conditional Cash Transfers and Primary Health Care to Reduce Childhood Mortality in Brazil By Davide Rasella; Rômulo Paes-Sousa
  11. Economic Status, Air Quality, and Child Health: Evidence from Inversion Episodes By Jans, Jenny; Johansson, Per; Nilsson, Peter
  12. The effect of national pension income on the self-rated health of elderly people By Ai Nakano
  13. Improving Fairness and Efficiency in Matching with Distributional Constraints: An Alternative Solution for the Japanese Medical Residency Match By Goto, Masahiro; Iwasaki, Atsushi; Kawasaki, Yujiro; Yasuda, Yosuke; Yokoo, Makoto
  14. Physical Stature Decline and the Health Status of the Elderly Population in England By Alan Fernihough; McGovern, Mark E.
  15. Association between economic growth, coverage of maternal and child health interventions, and under-five mortality: a repeated cross-sectional analysis of 36 sub-Saharan African countries By Corsi, Daniel J; S V Subramanian

  1. By: Galina Besstremyannaya (CEFIR); Jaak Simm (Tallinn University of Technology)
    Abstract: Transition countries in Central and Eastern Europe and the former Soviet Union introduced social health insurance (SHI) to foster universal coverage, stable financing revenues, and consumer euity through a principle of solidarity. In particular, the Czech Republic, Slovakia, and Russia emphasized managed between health insurance companies. Howevr, insufficient financing of the health care systems and excessive regulation led to deficienciesof the multi-payer SHI model in the three countries. The paper examines common trends in the development of the SHI systems in the Czech Republic, Slovakia, and Russia, and conducts empirical estimations with data for Russian regions.
    Keywords: Social health insurance, infant mortality, maternal mortality, managed competition, transition economies
    JEL: I13 I18
    Date: 2014–01
  2. By: Galina Besstremyannaya (CEFIR)
    Abstract: The paper assesses the impact of urbanization on the quality related outcomes of social health insurance systems in 85 Russian regions in 2000-2006. The results of parametric and kernel regressions reveal that controlling for regional income is a significant determinant of infant and under-five mortality. Arguably, the influence of urbanization on health outcomes is due to latent processes (e.g. the development of infrastructure). The methods of provider reimbursement are related to infant and under-five mortality, which offers suggestive evidence for selective contracting. Yet, insurer competition might increase urban inequity.
    Keywords: Social determinants of health, urbanization, social health insurance, infant mortality, provider payment, kernel regression, health care systems
    JEL: I10 I18 C14 C26
    Date: 2014–01
  3. By: Pedro Saramago (Centre for Health Economics, University of York, UK); Ling-Hsiang Chuang (Pharmerit International, Rotterdam, the Netherlands); Marta Soares (Centre for Health Economics, University of York, UK)
    Abstract: Objectives: Network meta-analysis (NMA) methods extend the standard pair-wise framework to allow simultaneous comparison of multiple interventions in a single statistical model. Despite published work on NMA mainly focussing on the synthesis of aggregate data (AD), methods have been developed that allow the use of individual patient-level data (IPD) specifically when outcomes are dichotomous or continuous. This paper focuses on the synthesis of IPD and AD time to event data, motivated by a real data example looking at the effectiveness of high compression treatments on the healing of venous leg ulcers. Methods: This paper introduces a novel NMA modelling approach that allows IPD (time to event with censoring) and AD (event count for a given follow-up time) to be synthesised jointly by assuming an underlying, common, distribution of time to healing. Alternative model assumptions were tested within the motivating example. Model fit and adequacy measures were used to compare and select models. Results: Due to the availability of IPD in our example we were able to use a Weibull distribution to describe time to healing; otherwise, we would have been limited to specifying a uniparametric distribution. Absolute effectiveness estimates were more sensitive than relative effectiveness estimates to a range of alternative specifications for the model. Conclusions: The synthesis of time to event data considering IPD provides modelling flexibility, and can be particularly important when absolute effectiveness estimates, and not just relative effect estimates, are of interest.
    Date: 2014–01
  4. By: Platt, Lucinda; Ayse, K. Uskul
    Abstract: In this note we take a first look at the extent to which ethnic minorities in the UK maintain or diverge from the diet associated with their country of origin; and whether those who maintain their ethnic origin diet eat more or less healthily. We find that immigrants are more likely to eat food of ethnic origins than minority group members born in the UK. Those of Indian, Pakistani and Bangladeshi ethnicity are more likely than other minority groups to eat food of ethnic origin whether immigrant or UK-born. UK born minorities who eat ethnic origin food less often also eat fruits and vegetables less often. Thus maintenance of an ethnic origin diet appears to be associated with healthier eating patterns.
    Date: 2014–01–24
  5. By: Alejandro Del Valle (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), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: This article analyzes whether the large scale provision of non-contributory health services encourages workers to move away from jobs that pay contributions to social security (formal employment). Using a difference-in-differences design, that exploits the variation generated by the municipal level roll-out of an intervention of this kind in Mexico, this paper finds that contemporaneous program exposure has no impact on the ratio of formal to total employed and that lagged exposure leads only to a small (0.78 percentage points) decrease. Two proxies of spillover effects further reveal that this estimate is robust and that the upper-bound of program effect is only moderately larger (1.5 percentage points).
    Keywords: Labor Markets ; Health Provision ; Informality ; Spillover Effects
    Date: 2013–06–24
  6. 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
  7. By: Maria Kuecken (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne); Marie-Anne Valfort (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: We examine the middle-run eff ects of the Global Fund's malaria control programs on the educational attainment of primary schoolchildren in Sub-Saharan Africa. Using a quasi-experimental approach, we exploit geographic variation in pre-campaign malaria prevalence (malaria ecology) and variation in exogenous exposure to the timing and expenditure of malaria control campaigns, based on individuals' years of birth and year surveyed. In a large majority of countries (14 of 22), we find that the program led to substantial increases in years of schooling and grade level as well as reductions in schooling delay. These countries are those for which pre-campaign educational resources are the highest. Moreover, although by and large positive, we nd that the marginal returns of the Global Fund disbursements in terms of educational outcomes are decreasing. Our findings, which are robust to both the instrumentation of ecology and use of alternative ecology measures, have important policy implications on the value for money of malaria control eff orts.
    Keywords: Malaria, Sub-Saharan Africa, Education, Quasi-experimental
    Date: 2014–01–06
  8. 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)); Gabriel Picone (Department of Economics - University of South Florida)
    Abstract: This paper examines the existence of social interactions in malaria preventive behaviors in Sub-Saharan Africa, i.e. whether an individual's social environment has an influence on the individual's preventive behaviors. We focus on the two population groups which are the most vulnerable to malaria (children under 5 and pregnant women) and on two preventive behaviors (sleeping under a bednet and taking intermittent preventive treatment during pregnancy). We define the social environment of the individual as people living in the same region. To detect social interactions, we calculate the size of the social multiplier by comparing the effects of an exogenous variable at the individual level and at the regional level. Our data come from 92 surveys for 29 Sub-Saharan countries between 1999 and 2012, and they cover approximately 660,000 children and 95,000 women. Our results indicate that social interactions are important in malaria preventive behaviors, since the social multipliers for women's education and household wealth are greater than one - which means that education and wealth generates larger effects on preventive behaviors in the long run than we would expect from the individual-level specifications, once we account for social interactions.
    Keywords: Social interactions ; Social multiplier ; Malaria preventive behavior
    Date: 2014–02
  9. By: Cavaco, Sandra; Eriksson, Tor; Skalli, Ali
    Abstract: This paper empirically examines the role and relative importance of parents’ and individuals’ own socioeconomic status and how their impacts on the probability of overweight and obesity evolve over the life cycle. The impact of individuals’ health behaviours on their obesity status later in life is also studied. We use data from Denmark, Finland, France, Greece, the Netherlands and the U.K. in which about 6,000 individuals aged 50 to 65 are surveyed and where individuals’ height and weight at different ages (25, 25, 45 and current age) are available. We perform “repeated cross-sections” analyses as well as dynamic probit analyses of the individuals’ obesity histories. Key findings are: (i) parents’ socioeconomic status predicts obesity in early adulthood whereas the individual’s own socioeconomic status as adult is more important in explaining obesity at later stages of the life cycle, (ii) changes in obesity status are associated with changes in health behaviours, (iii) obesity in late adulthood is strongly and positively correlated with overweight and obesity in younger ages, and (iv) cross-country differences in obesity and overweight largely remain after controlling for parental and childhood factors and individuals’ health behaviours.
    Keywords: Obesity, socioeconomic status, life cycle, cross-country differences
    JEL: I12
    Date: 2014–01
  10. By: Davide Rasella (Instituto de Saúde Coletiva, Federal University of Bahia); Rômulo Paes-Sousa (World Centre for Sustainable Development, RIO+ Centre)
    Abstract: Strategies adopted to reduce child mortality in developing countries are usually focused on interventions addressing biological causes, without considering its key underlying determinants. Conditional cash transfers (CCTs) are poverty reduction interventions that transfer money to poor households with the requirement that parents comply with specific conditions focused on improving health and education for their children.
    Keywords: Combining Conditional Cash Transfers and Primary Health Care to Reduce Childhood Mortality in Brazil
    Date: 2013–12
  11. By: Jans, Jenny (Uppsala University); Johansson, Per (IFAU); Nilsson, Peter (IIES, Stockholm University)
    Abstract: On normal days, the temperature decreases with altitude, allowing air pollutants to rise and disperse. During inversion episodes, a warmer air layer at higher altitude traps pollutants close to the ground. We show how readily available NASA satellite data on vertical temperature profiles can be used to measure inversion episodes on a global scale with high spatial and temporal resolution. Then, we link inversion episode data to ground level pollution monitors and to daily in- and outpatient records for the universe of children in Sweden during a six-year period to provide instrumental variable estimates of the effects of air quality on children's health. The IV estimates show that the respiratory illness health care visit rate increases by 8 percent for each 10 μm/m³ increase in PM10; an estimate four times higher than conventional estimates. Importantly, by linking the health care data to detailed records of parental background characteristics, we show that children from low-income households suffer significantly more from air pollution than children from high income households. Finally, we provide evidence on the importance of several mechanisms that could contribute to the difference in the impact of air pollution across children in rich and poor households.
    Keywords: instrumental variable, environmental policy, inversions, health, air pollution, nonparametric regression, socio-economic gradient in health
    JEL: Q53 I1 I3 J24
    Date: 2014–01
  12. By: Ai Nakano (Graduate School of Economics, Kobe Universityy)
    Date: 2014–01
  13. By: Goto, Masahiro; Iwasaki, Atsushi; Kawasaki, Yujiro; Yasuda, Yosuke; Yokoo, Makoto
    Abstract: Regional imbalance of doctors is a serious issue in many countries. In an attempt to average the geographical distribution of doctors, the Japanese government introduced ``regional caps'' recently, restricting the total number of medical residents matched within each region. Motivated by this policy change, Kamada and Kojima (2013) proposed a mechanism called the flexible deferred acceptance mechanism (FDA) that makes every doctor weakly better off than the current system. In this paper, we further study this problem and develop an alternative mechanism that we call the priority-list based deferred acceptance mechanism (PLDA). Both mechanisms enable hospitals in the same region to fill their capacities flexibly until the regional cap is filled. FDA lets hospitals take turns to (tentatively) choose the best remaining doctor, while PLDA lets each region directly decide which doctor is (tentatively) matched with which hospital based on its priority list. We show that PLDA performs better than FDA in terms of efficiency and fairness through theoretical and computational analyses.
    Keywords: distributional constraints, medical residency matching, school admission, stability, fairness, nonwastefulness, efficiency, strategy-proofness, matching with contracts
    JEL: C71 C78 D61
    Date: 2014–02
  14. By: Alan Fernihough; McGovern, Mark E.
    Abstract: Few research papers in economics have examined the extent, causes or consequences of physical stature decline in aging populations. Using repeated observations on objectively measured data from the English Longitudinal Study of Ageing (ELSA), we document that reduction in height is an important phenomenon among respondents aged 50 and over. On average, physical stature decline occurs at an annual rate of between 0.08% and 0.10% for males, and 0.12% and 0.14% for females—which approximately translates into a 2cm to 4cm reduction in height over the life course. Since height is commonly used as a measure of long-run health, our results demonstrate that failing to take age-related height loss into account substantially overstates the health advantage of younger birth cohorts relative to their older counterparts. We also show that there is an absence of consistent predictors of physical stature decline at the individual level. However, we demonstrate how deteriorating health and reductions in height occur simultaneously. We document that declines in muscle mass and bone density are likely to be the mechanism through which these effects are operating. If this physical stature decline is determined by deteriorating health in adulthood, the coefficient on measured height when used as an input in a typical empirical health production function will be affected by reverse causality. While our analysis details the inherent difficulties associated with measuring height in older populations, we do not find that significant bias arises in typical empirical health production functions from the use of height which has not been adjusted for physical stature decline. Therefore, our results validate the use of height among the population aged over 50.
    Date: 2014–01
  15. By: Corsi, Daniel J; S V Subramanian
    Abstract: Infant and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population. In this report, using data from 99 Demographic and Health Surveys (DHS) conducted in 36 sub-Saharan African countries, we investigate factors that have contributed to the declines in under-five mortality rates (U5MR) in sub-Saharan Africa. Specifically, we focus on the extent to which changes in country-level economic growth and changes in the coverage of key maternal, neonatal, and child health (MNCH) interventions have contributed to reductions in under-five mortality. For this analysis we constructed two distinct data structures: (1) an ecological time series (with countries repeatedly observed) and (2) a multilevel repeated cross-section (which in addition took account of the variability between children within a country at any time). We employed a country-level fixed effects regression to model changes in U5MR across survey periods as a function of changes in economic growth and coverage of MNCH interventions for ecological time series data. The multilevel repeated cross-sectional data was used to examine the probability of a child being reported to have died at age 0-59 months, corresponding with different levels of economic growth and coverage, while accounting for within-country between-child factors that could influence both child mortality and the country-level economic development and coverage indicators. Our results show that changes in country-level per capita GDP (pcGDP) are not consistently associated with a reduction in U5MR across different model specifications. In ecological time series models, a unit increase in pcGDP is associated with a reduction in U5MR of 11.6 deaths per 1000 live births (95% CI: -29.1, 5.9), while a composite index of MNCH interventions is associated with a reduction in U5MR of 31.9 deaths per 1000 live births (95% CI: -48.6, -15.3). The results of the multilevel repeated cross-section data structure suggest that MNCH coverage indicators are important. For example, pcGDP is associated for a decreased likelihood of child mortality with an odds ratio of 0.96 (95% CI: 0.92 -1.00) and an increase of 1 standard deviation in the composite coverage index (CCI) is also associated with a decrease in child mortality [odds ratio 0.92 (95% CI: 0.88 - 0.96)]. A measure of improvements in sanitary facilities is associated with an odds ratio of 0.57 (95% CI: 0.50-0.65) for child mortality. Together, these results indicate that MNCH interventions are important in reducing U5MR, while the effects of economic growth in sub-Saharan Africa remain weak and inconsistent. Sub-Saharan Africa continues to have the highest U5MR globally, and progress toward reducing mortality rates has been slow. Our findings indicate that improved coverage of proven life-saving interventions and access to clean water and sanitation will likely contribute to further reductions in U5MR in sub-Saharan Africa in the future.
    Date: 2014–02

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