nep-hea New Economics Papers
on Health Economics
Issue of 2014‒03‒30
fourteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Medical care in early modern Venice By Alex Bamji
  2. Impact Evaluation of Health Insurance for Children: Evidence from a Developing Country By Nguyen Viet Cuong
  3. The Impact of Adult Child Emigration on the Mental Health of Older Parents By Mosca, Irene; Barrett, Alan
  4. Why Do Some Motorbike Riders Wear a Helmet and Others Don't? Evidence from Delhi, India By Grimm, Michael; Treibich, Carole
  5. Does Diabetes Prevention Pay for Itself? Evaluation of the M.O.B.I.L.I.S. By Jan Häußler; Friedrich Breyer
  6. Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative. By Deborah N. Peikes; Robert J. Reid; Timothy J. Day; Derekh D. F. Cornwell; Stacy B. Dale; Richard J. Baron; Randall S. Brown; Rachel J. Shapiro
  7. Medicare 101 and 201: Key Issues for State Programs for Medicare-Medicaid Enrollees. By Julie Klebonis; Michelle Herman Soper; Jim Verdier
  8. Who Benefits when the Government Pays More? Pass-Through in the Medicare Advantage Program By Mark Duggan; Amanda Starc; Boris Vabson
  9. Risk Adjustment of Health Plan Payments to Correct Inefficient Plan Choice from Adverse Selection By Jacob Glazer; Thomas G. McGuire; Julie Shi
  10. Option Value of Work, Health Status, and Retirement Decisions in Japan: Evidence from the Japanese Study on Aging and Retirement (JSTAR) By Satoshi Shimizutani; Takashi Oshio; Mayu Fujii
  11. Defining Hospital Markets – An Application to the German Hospital Sector By Corinna Hentschker; Andreas Schmid; Roman Mennicken
  12. Nursing Home Prices and Quality of Care - Evidence from Administrative Data By Arndt R. Reicher; Magdalena Stroka
  13. The Mental and Physical Burden of Caregiving - Evidence from Administrative Data By Magdalena Stroka
  14. Adjusting maternal mortality data for international comparisons : The case of vital registration systems By Susie Jentoft; Vibeke Oestreich Nielsen; Dag Roll-Hansen

  1. By: Alex Bamji
    Abstract: In early modern Venice, a wide range of people offered care, goods and services for the health of the city’s numerous inhabitants. This study utilises Venice’s civic death registers to assess when and why the sick and dying accessed medical care, and how this changed over the course of the early modern period. The detailed registers permit consideration of the profile of medical practitioners, key aspects of patient identity, the involvement of institutions in the provision of medical care, and the relationship between type of illness and the propensity of the sufferer to seek medical support. This study assesses the type, number, density and distribution of practitioners in the city. It demonstrates that recourse to medical care was largely determined by age, social status and type of illness. The lack of financial resources or family support did not preclude access to medical care, due to a web of institutions which offered care to a diverse clientele.
    Keywords: age; death; medical care; medical practitioners; Venice
    JEL: I3
    Date: 2014–03
  2. By: Nguyen Viet Cuong
    Abstract: Although there are numerous studies on impact evaluation of overall health insurance, little is known on the impact of health insurance on health care utilization and out-of-pocket health care spending of children, especially in developing countries. This paper measures the impact of child health insurance on health care utilization and spending of children from 6 to 14 years old in Vietnam using two recent nationally representative surveys. Unlike previous empirical studies which found a positive effect of health insurance on health care utilization in Vietnam, we did not find a statistically significant effect of school health insurance as well as free health insurance for children on outpatient health care contacts. However, the school health insurance and free health insurance help the insured children decrease out-of-pocket spending per outpatient contact by around 14 and 26 percent, respectively.
    Keywords: Child health insurance, impact evaluation, health care utilization, out-of-pocket spending, Vietnam.
    JEL: I10 G22 H43
    Date: 2014–02–25
  3. By: Mosca, Irene (Trinity College Dublin); Barrett, Alan (ESRI, Dublin)
    Abstract: A growing literature within economics has sought to examine the impacts of emigration on sending countries. Some of the studies have looked within families and have investigated how emigration affects those family members who are left behind. In this paper, we explore whether older parents of adult children who emigrate experience declines in mental health compared to parents whose children do not migrate. We use data from the first two waves of The Irish Longitudinal Study on Ageing. This is a nationally representative sample of 8,500 people aged 50 and above living in Ireland collected in 2009-11 (Wave 1) and 2012-13 (Wave 2). To deal with the endogeneity of migration, we apply fixed effects estimation models and control for a broad range of life-events occurring between the two waves. These include the emigration of a child but also events such as bereavement, onset of disease, retirement and unemployment. We find that depressive symptoms and feelings of loneliness increase among the parents of migrant children but that the effect is only present for mothers. Given the relationship between mental health and other health outcomes, the potential impacts for the older populations of migrant-sending regions and countries are significant.
    Keywords: emigration, depression, mental health
    JEL: I15 J61
    Date: 2014–03
  4. By: Grimm, Michael (University of Passau); Treibich, Carole (Paris School of Economics)
    Abstract: We focus on helmet use behavior among motorbike users in Delhi. We use a detailed data set collected for the purpose of the study. To guide our empirical analysis, we rely on a simple model in which drivers decide on self-protection and self-insurance. The empirical findings suggest that risk averse drivers are more likely to wear a helmet, there is no systematic effect on speed. Helmet use also increases with education. Drivers who show a higher awareness of road risks are both more likely to wear a helmet and to speed less. Controlling for risk awareness, we observe that drivers tend to compensate between speed and helmet use. The results can provide a basis for awareness-raising policies. Improvements to the road infrastructure bear the risk of leading to risk-compensating behavior.
    Keywords: road safety, helmet use, risky health behavior, self-protection, self-insurance, India, risk-taking behavior
    JEL: D10 I10 I15 K42 R41
    Date: 2014–03
  5. By: Jan Häußler (Department of Economics, University of Konstanz, Germany); Friedrich Breyer (Department of Economics, University of Konstanz, Germany)
    Abstract: In response to the growing burden of obesity, public primary prevention programs against obesity have been widely recommended. Several studies estimated the cost effectiveness of diabetes prevention trials for different countries. Nevertheless, it is still controversial if prevention conducted in more real-world settings and among people with increased risk but not yet exhibiting Increased Glucose Tolerance can be a cost-saving strategy to cope with the obesity epidemic. We examine this question in a simulation model based on the results of the M.O.B.I.L.I.S program, a German lifestyle intervention to reduce obesity, which is directed on the high-risk group of people who are already obese. The contribution of this paper is the use of 4-year follow-up data on the intervention group and a comparison with a control group formed by SOEP respondents as inputs in a Markov model of the long-term cost savings through this intervention due to the prevention of type-2 diabetes. We show that from the point of view of a health insurer, these programs can pay for themselves.
    Keywords: diabetes prevention, cost analysis, Markov modeling
    JEL: I12 H51
    Date: 2014–03–24
  6. By: Deborah N. Peikes; Robert J. Reid; Timothy J. Day; Derekh D. F. Cornwell; Stacy B. Dale; Richard J. Baron; Randall S. Brown; Rachel J. Shapiro
    Abstract: This article describes staffing patterns for nearly 500 primary care practices in the Centers for Medicare & Medicaid Services Comprehensive Primary Care initiative before the initiative began. The study found most of the practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. The authors note that this restricted staff composition is not surprising given the current fee-for-service payment environment. They conclude that without access to such staff–and payment for their services–practices are unlikely to deliver comprehensive, coordinated, and accessible care at a sustainable cost.
    Keywords: Medical Homes, Primary Care Practices, Staffing Patterns, Primary Care Initiative
    JEL: I
    Date: 2014–03–30
  7. By: Julie Klebonis; Michelle Herman Soper; Jim Verdier
    Keywords: Medicare, State Programs, Medicaid Enrollees, Health
    JEL: I
    Date: 2014–03–13
  8. By: Mark Duggan; Amanda Starc; Boris Vabson
    Abstract: Governments contract with private firms to provide a wide range of services. While a large body of previous work has estimated the effects of that contracting, surprisingly little has investigated how those effects vary with the generosity of the contract. In this paper we examine this issue in the Medicare Advantage (MA) program, through which the federal government contracts with private insurers to coordinate and finance health care for more than 15 million Medicare recipients. To do this, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250 thousand or more relative to MSAs just below this threshold. Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in MA plans. Our findings also reveal that only about one-fifth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures. Our results have implications for a key feature of the Affordable Care Act that will reduce reimbursement to MA plans by $156 billion from 2013 to 2022.
    JEL: H22 I13 L1
    Date: 2014–03
  9. By: Jacob Glazer; Thomas G. McGuire; Julie Shi
    Abstract: This paper develops and implements a statistical methodology to account for the equilibrium effects (aka adverse selection) in design of risk adjustment formula in health insurance markets. Our setting is modeled on the situation in Medicare and the new state Exchanges where individuals sort themselves between a discrete set of plan types (here, two). Our “Silver” and “Gold” plans have fixed characteristics, as in the well-known research on selection and efficiency by Einav and Finkelstein (EF). We build on the EF model in several respects, including by showing that risk adjustment can be used to achieve the premiums that will lead to efficient sorting. The target risk adjustment weights can be found by use of constrained regressions, where the constraints in the estimation are conditions on premiums that should be satisfied in equilibrium. We illustrate implementation of the method with data from seven years of the Medical Expenditure Panel Survey.
    JEL: I13 I18
    Date: 2014–03
  10. By: Satoshi Shimizutani; Takashi Oshio; Mayu Fujii
    Abstract: This study examined the factors that affect the retirement decisions of the middle-aged and elderly in Japan, focusing especially on their earnings, public pension benefits, and health status. Using two-year panel data from the JSTAR and applying the OV model proposed by Stock and Wise (1990a, 1990b), we found that the probability of retirement has a negative and significant correlation with the OV of work, and that correlation does not depend on the health status. Our counter-factual simulation based on the OV model showed that, if the probability of being enrolled in the disability program were zero, the average years of work when individuals are in their 50s and 60s would increase. However, it should be emphasized that, in Japan—where being enrolled in the disability program is unlikely to make one a candidate for the retirement path—the result of this simulation does not indicate that satisfying the eligibility criteria for disability pension receipts will more stringently increase the labor supplied by the middle-aged and elderly.
    JEL: H55 I14 J26
    Date: 2014–03
  11. By: Corinna Hentschker; Andreas Schmid; Roman Mennicken
    Abstract: The correct definition of the product market and of the geographic market is a prerequisite for assessing market structures in antitrust cases. For hospital markets, both dimensions are controversially discussed in the literature. Using data for the German hospital market we aim at elaborating the need for differentiating the product market and at investigating the effects of different thresholds for the delineation of the geographic market based on patient flows. Thereby we contribute to the scarce empirical evidence on the structure of the German hospital market. We find that the German hospital sector is highly concentrated, confirming the results of a singular prior study. Furthermore, using a very general product market definition such as “acute in-patient care” averages out severe discrepancies that become visible when concentration is considered on the level of individual diagnoses. In contrast, varying thresholds for the definition of the geographic market has only impact on the level of concentration, while the correlation remains high. Our results underline the need for more empirical research concerning the definition of the product market for hospital services.
    Keywords: Hospital market; concentration; product market; geographic market; Germany
    JEL: L11 I11
    Date: 2014–02
  12. By: Arndt R. Reicher; Magdalena Stroka
    Abstract: There is widespread concern about the quality of care in nursing homes. Based on administrative data of a large health insurance fund, we investigate whether nursing home prices affect relevant quality of care indicators at the resident level. Our results indicate a significantly negative price effect on inappropriate and psychotropic medication. In contrast, we find no evidence for fewer painful physical sufferings for residents of nursing homes with higher prices.
    Keywords: Quality of care; nursing homes; inappropriate medication; psychotropic drugs; panel data analysis
    JEL: I10
    Date: 2014–02
  13. By: Magdalena Stroka
    Abstract: This study evaluates the mental and physical strain experienced by informal caregivers. Econometric problems due to individuals selecting themselves into informal care provision are tackled by using informative and detailed data from the largest sickness fund in Germany and applying propensity score matching techniques. The findings suggest that carers take more psychoactive drugs as well as analgesics and gastrointestinal agents. Thus, informal caregiving appears to be a burdensome task with implications for both mental and physical health.
    Keywords: Informal care; burden; drugs; propensity score matching
    JEL: I10
    Date: 2014–02
  14. By: Susie Jentoft; Vibeke Oestreich Nielsen; Dag Roll-Hansen (Statistics Norway)
    Abstract: Register data on maternal deaths is adjusted in international reports to account for underreporting; however, there has been controversy around these adjustments. The objective of this article is to review the adjustment factors applied to maternal mortality register data. A literature review provided 72 studies on underreporting showing differences in the definition of maternal mortality. This has not previously been taken into account when calculating average adjustment factors. Our analysis showed that including psychiatric disease and maternal deaths occurring 42 days post-partum had significant effects on the adjustment factor. When using the strict WHO definition of maternal mortality, a median adjustment factor of 1.5 was calculated which is identical to the one used by the WHO. Guidelines on inclusion criteria for maternal deaths need to be clarified in order for figures to be internationally comparable.
    Keywords: Maternal mortality ratio (MMR); Misclassification; Underreporting; Incompleteness; World Health Organisation (WHO)
    JEL: I18
    Date: 2014–03

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