nep-hea New Economics Papers
on Health Economics
Issue of 2014‒05‒04
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Sustainable Health Care Financing in the Republic of Palau By Asian Development Bank (ADB); ; ;
  2. Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014 By Congressional Budget Office
  3. A Comparative Analysis of Pedestrian and Bicyclist Safety Around University Campuses By Grembek, Offer; Medury, Aditya; Orrick, Phyllis; Leung, Katherine; Ragland, David R.; Loukaitou-Sideris, Anastasia; Fink, Camille N.Y.; Resnick, Justin; Wong, Norman; Shafizadeh, Kevan; Khan, Ghazan
  4. Provider competition and over-utilization in health care By Jan Boone; Rudy Douven
  5. Adding Employer Contributions to Health Insurance to Social Security's Earnings and Tax Base By Karen E. Smith; Eric Toder
  6. Can formal home care reduce the burden of informal care for elderly dependents? Evidence from France. By Goltz, Andreas; Arnault, Louis
  7. Unemployment and Mortality: Evidence from the PSID By Timothy Halliday
  8. Parental unemployment and child health By Mörk, Eva; Sjögren, Anna; Svaleryd, Helena
  9. Out-Of-Pocket Payments In The Post-Semashko Health Care System By Sergey Shishkin; Elena Potapchik; Elena Selezneva
  10. Health, Height and the Household at the Turn of the 20th Century By Bailey, Roy E.; Hatton, Timothy J.; Inwood, Kris
  11. The Impact of Positive and Negative Income Changes on the Height and Weight of Young Children By Buser, Thomas; Oosterbeek, Hessel; Plug, Erik; Ponce, Juan; Rosero, José
  12. What do people actually learn from public health education campaigns? Incorrect inferences about male circumcision and female HIV infection risk in a cluster randomized trial in Malawi By Brendan Maughan-Brown; Susan Godlonton; Rebecca L. Thornton; Atheendar S Venkataramani
  13. Health Care Workers' Risk Perceptions of Personal and Work Activities and Willingness to Report for Work During an Influenza Pandemic By Georges Dionne; Denise Desjardins; Martin Lebeau; Stéphane Messier; André Dascal
  14. ObamaCare: Rocky Politics, Stable Coverage By David B. Kendall
  15. How Obamacare Will Re-Shape the Practice of Medicine By Scott Gottlieb
  16. The Past, Present and Future of U.S. Health Care Reform By Jonathan Gruber
  17. How to Improve Israel's Health-care System By Philip Hemmings
  18. Income Shocks and HIV in Africa By Burke, Marshall; Gong, Erick; Jones, Kelly M.
  19. Quantitative Evaluation of Prevention Strategies in Public Health By Schinaia, Giuseppe; Parisi, Valentino
  20. Time preference and perceptions about government spending and tax: Smokers’ dependence on government support By Yamamura, Eiji

  1. By: Asian Development Bank (ADB); (Pacific Department, ADB); ;
    Abstract: The government and the people of the Republic of Palau have been working with the Asian Development Bank (ADB) since 2005. Since Palau is one of ADB’s newest members, ADB conducted an extensive analysis of the constraints to development before agreeing on the country partnership strategy with the government in 2009. The strategy focuses on improving public sector effectiveness to meet the government’s fiscal strategy, supporting private sector development, reforming the water and sanitation sector, and addressing the impact of climate change. In support of this strategy, Palau has received two loans amounting $16.0 million and five technical assistance projects for a total of $3.3 million.
    Keywords: adb, asian development bank, asdb, asia, pacific, poverty asia, health, healthcare, health care system, healthcare financing, healthcare programs, health sector reforms, healthcare reform legislation
    Date: 2012–01
  2. By: Congressional Budget Office
    Abstract: CBO and the staff of the Joint Committee on Taxation have lowered their estimates of the net federal cost of the ACA’s insurance coverage provisions. As reflected in CBO’s April 2014 baseline, the agencies now project a cost of $36 billion for 2014, $5 billion less than the projection made in February; and close to $1.4 trillion for the 2015–2024 period, about $100 billion less than the February projection.
    JEL: I10 I11 I13 I18 I38
    Date: 2014–04–14
  3. By: Grembek, Offer; Medury, Aditya; Orrick, Phyllis; Leung, Katherine; Ragland, David R.; Loukaitou-Sideris, Anastasia; Fink, Camille N.Y.; Resnick, Justin; Wong, Norman; Shafizadeh, Kevan; Khan, Ghazan
    Keywords: Engineering
    Date: 2014–04–01
  4. By: Jan Boone; Rudy Douven
    Abstract: This paper compares the welfare effects of three ways in which health care can be organized: no competition (NC), competition for the market (CfM) and competition on the market (CoM) where the payer offers the optimal contract to providers in each case. We show that CfM is optimal if the payer either has contractible information on provider quality or can enforce cost efficient protocols. If such contractible information is not available NC or CoM can be optimal depending on whether patients react to decentralized information on quality differences between providers and whether payer’s and patients’ preferences are aligned.
    JEL: D82 L5 I11
    Date: 2014–04
  5. By: Karen E. Smith; Eric Toder
    Abstract: The inclusion of employer-sponsored health insurance (ESI) in taxable income would increase income and payroll tax receipts, but would also increase Old Age, Survivors, and Disability Insurance (OASDI) benefits by adding ESI to the OASDI earnings base. This study uses the Urban Institute’s DYNASIM model to estimate the effects of including ESI premiums in taxable earnings on the level and distribution by age and income groups of income tax burdens, payroll tax burdens, and OASDI benefits. We find that the increased present value of OASDI benefits from including ESI in the wage base in 2014 offsets about 22 percent of increased income and payroll taxes, 57 percent of increased payroll taxes, and 72 percent of increased OASDI taxes. The overall distributions of taxes and benefits by income group follow the same pattern, with both taxes and benefits increasing as a share of income between the bottom and middle quintiles and then declining as a share of income for higher income taxpayers. But households in the bottom income quintiles receive a net benefit from including ESI in the tax base because their increase in OASDI benefits exceeds their increase in income and payroll taxes. Over a lifetime perspective, all earnings groups experience net tax increases, but workers in the middle of the earnings distribution experience the largest net tax increases as a share of lifetime earnings. Higher benefits offset a larger share of tax increases for lower than for higher income groups.
    Date: 2014–04
  6. By: Goltz, Andreas; Arnault, Louis
    Abstract: This paper focuses on the trade-off between formal and informal care for elderly dependents living at home in France. Using the French 2008 household Disability - Healthcare data and a newly built indicator of formal home-care prices in each French Council District, we wonder if fi nancial incentives to use more formal home care could relieve informal caregivers. We estimate a bivariate Tobit model to account for both the censor and the endogeneity of our formal home-care variable. Our results con firm that the volume of informal care provided would decrease if the elderly dependents were faced with lower formal home-care prices. Moreover, informal caregivers are shown to be much more sensitive to public subsidizes for skilled formal home care than for the low-skilled one. Subsidizing for skilled formal home care would make informal caregivers more effcient to perform lighter low-skilled tasks. Eventually, acting on formal home care prices could help French public administrators sustain the well-being of both care receivers and informal caregivers.
    Keywords: Long-term Care; Informal Care; Formal Care; Elderly;
    JEL: C34 I12 J14
    Date: 2014
  7. By: Timothy Halliday (Department of Economics, University of Hawaii at Manoa)
    Abstract: We use micro-data to investigate the relationship between unemployment and mortality in the United States using Logistic regression on a sample of over 16,000 individuals. We consider baselines from 1984 to 1993 and investigate mortality up to ten years from the baseline. We show that poor local labor market conditions are associated with higher mortality risk for working-aged men and, specifically, that a one percentage point increase in the unemployment rate increases their probability of dying within one year of baseline by 6%. There is little to no such relationship for people with weaker labor force attachments such as women or the elderly. Our results contribute to a growing body of work that suggests that poor economic conditions pose health risks and illustrate an important contrast with studies based on aggregate data.
    Keywords: Recessions, Mortality, Health, Aggregation, Unemployment
    JEL: I0 I12 J1
    Date: 2014–04
  8. By: Mörk, Eva (Uppsala Center for Labor Studies); Sjögren, Anna (Uppsala Center for Labor Studies); Svaleryd, Helena (Uppsala Center for Labor Studies)
    Abstract: We analyze to what extent health outcomes of Swedish children are worse among children whose parents become unemployed. To this end we combine Swedish hospitalization data for 1992-2007 for children 3-18 years of age with register data on parental unemployment. We find that children with unemployed parents are 17 percent more likely to be hospitalized than other children, but that most of the difference is driven by selection. A child fixed-effects approach suggests a small effect of parental unemployment on child health.
    Keywords: Parental unemployment; child Health; human capital
    JEL: I12 J13
    Date: 2014–03–03
  9. By: Sergey Shishkin (National Research University Higher School of Economics); Elena Potapchik (National Research University Higher School of Economics); Elena Selezneva (National Research University Higher School of Economics)
    Abstract: This paper presents the analysis results of existing practices of out-of-pocket payments in the Russian post-Semashko health care system. It was carried out based on the data reflected in the ‘Russia Longitudinal Monitoring Survey’ from 1991-2012 and data of the ‘Georating’ survey carried out in all regions of the Russian Federation in 2010. The trends of legal and informal out-of-pocket payments for inpatient and outpatient care are revealed, and the social and economic factors which make patients pay a fee for medical services for fee are identified. The changes in out-of-pocket health expenditures in 2005-2010 are analyzed, and the assessment of total (public and private) health expenditures on different types of health care is made
    Keywords: Semashko health care system, health care, out-of-pocket payments, private payment, informal payment
    JEL: I10 I11
    Date: 2014
  10. By: Bailey, Roy E. (University of Essex); Hatton, Timothy J. (University of Essex); Inwood, Kris (University of Guelph)
    Abstract: We examine the health and height of men born in England and Wales in the 1890s who enlisted in the army at the time of the First World War. We take a sample of the army service records and use this information to find the recruits as children in the 1901 census. Econometric results indicate that adult height was negatively related to the number of children in the household as well as to the share of earners, the degree of crowding, and positively to socioeconomic class. Adding the characteristics of the local registration district has little effect on the household-level effects. But local conditions were important; in particular the industrial character of the district, local housing conditions and the female illiteracy rate. We interpret these as representing the negative effect on height of the local disease environment. The results suggest that changing conditions at both household and locality levels contributed to the increase in height and health in the following decades.
    Keywords: heights of recruits, household structure, health in Britain
    JEL: I12 J13 N33
    Date: 2014–04
  11. By: Buser, Thomas (University of Amsterdam); Oosterbeek, Hessel (University of Amsterdam); Plug, Erik (University of Amsterdam); Ponce, Juan (Flacso); Rosero, José (INEC Ecuador)
    Abstract: We estimate the impact of changes in unearned income on the height and weight of young children in a developing country. As source of variation we use changes in the eligibility criteria for receipt of an unconditional cash transfer in Ecuador. Two years after families lost the transfer, which they had received for seven years, their young children weigh less, and are shorter and more likely to be stunted than young children in families that kept the cash transfer. We find no effect on young children's height and weight two years after gaining the cash transfer. Information on household expenditures suggests that a reduction of food expenditures by households that lost the transfer is the main mechanism behind this finding.
    Keywords: cash transfers, health outcomes, developing country, poverty reduction
    JEL: I14 H51 C31
    Date: 2014–04
  12. By: Brendan Maughan-Brown (SALDRU, School of Economics, University of Cape Town); Susan Godlonton (Ford School of Public Policy, University of Michigan); Rebecca L. Thornton (Department of Economics, University of Michigan); Atheendar S Venkataramani (Department of Medicine, Massachusetts General Hospital, Harvard University)
    Abstract: Objective: To examine whether individuals who learn that voluntary medical male circumcision (VMMC) partially reduces female-to-male HIV transmission erroneously infer a reduction in male-to-female HIV transmission risk. Design: Cluster randomised controlled trial. Methods: In 2008, information that VMMC reduces female-to-male HIV transmission risk was randomly disseminated to men in rural Malawi, with follow-up in 2009 (n=917). Data was collected on perceived male and female HIV-transmission risks. We assessed whether beliefs about male circumcision and female HIV-risk varied by receipt of VMMC information and by whether or not individuals believed that VMMC partially protects men from HIV-infection. Results: Men informed about VMMC were more likely to believe that sex with a circumcised male would confer lower transmission risk for women vis-à-vis sex with an uncircumcised male (38% versus 50%, p0.01). Multivariate regression analyses showed that incorrect inferences were most likely to be made by those who believed that circumcised men were partially protected from contracting HIV. Consistent with this, instrumental variable analyses indicated that those individuals who received information about VMMC, and consequently believed it, were 82 percentage points more likely to believe that male circumcision also protects women (p0.01). The inferred reduction in direct HIV infection risk for women due to male circumcision was approximately 50%. Conclusions: Our results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection. It is also important to assess whether incorrect inferences lead to updated self-perceived HIV-risk and the adoption of riskier sexual behaviours.
    Keywords: Male circumcision, female HIV risk, risk compensation, Southern Africa, HIV/AIDS, prevention, information campaigns
    Date: 2013
  13. By: Georges Dionne; Denise Desjardins; Martin Lebeau; Stéphane Messier; André Dascal
    Abstract: The ability and willingness of health care workers to report for work during a pandemic are essential to pandemic response. The main contribution of this article is to examine the relationship between risk perception of personal and work activities and willingness to report for work during an influenza pandemic. Data were collected through a quantitative Web-based survey sent to health care workers on the island of Montreal. Respondents were asked about their perception of various risks to obtain index measures of risk perception. A multinomial logit model was applied for the probability estimations, and a factor analysis was conducted to compute risk perception indexes (scores). Risk perception associated with personal and work activities is a significant predictor of intended presence at work during an influenza pandemic. The average predicted probability of being at work during the worst scenario of an influenza pandemic is 46% for all workers in the sample, 36% for those overestimating risk in personal and work activities (95% CI: 35%-37%), 53% for those underestimating risk in work activities (95% CI: 52%-54%), and 49% for those underestimating risk of personal activities (95% CI: 48%-50%). When given an opportunity to change their intentions, 45% of those who initially did not intend to report for work in the worst scenario would do so if the pandemic resulted in a severe manpower shortage. These results have not been previously reported in the literature. Many organizational variables are also significant.
    Keywords: Influenza pandemic, pandemic preparedness, risk perception, reporting for work, health policy, personal and work activities
    JEL: D80 D81 D83 I11 I12
    Date: 2014
  14. By: David B. Kendall
    Abstract: The Affordable Care Act (ACA) and Medicare Part D had the same rocky start. Both were criticized as unworkable and unsustainable. Yet both have similar structures. They offer individuals a choice of competing health plans, provide subsidies to make coverage affordable, and impose penalties for late enrollment. Medicare Part D's success in creating stable coverage of prescriptions drugs for Medicare beneficiaries shows how the ACA may stabilize health insurance coverage for working-age Americans. The comparison with Part D also reveals two potential sources of instability for the ACA: a narrow subsidy structure and benefit mandates. The biggest source of instability for the ACA and all other forms of health care coverage is rising health care costs. That threat, which can lead to higher taxes or benefit cuts, could stimulate bipartisan action. There are a series of opportunities that start small and work up to major action: the repeal of Medicare’s Sustainable Growth Rate, sequestration replacement, state gain-sharing, and tax reform. A focus by policy makers on rising costs as a common enemy can help move the health care debate beyond the rocky politics over the ACA.
    Keywords: Affordable Care Act, health insurance, exchanges, Medicare Part D.
    JEL: H4 H2 I00
    Date: 2013–10
  15. By: Scott Gottlieb
    Abstract: Critics and supporters alike have framed the Affordable Care Act as an effort primarily aimed at expanding access to healthcare insurance. As the refrain goes, the legislation placed much less emphasis on pursuing ways to make healthcare delivery more affordable. This analysis belies significant measures that the legislation pursues, in the name of cost control, which will fundamentally transform the delivery of medical care. These provisions are based on a primary belief that there is a lot of waste in the delivery of medical care. Moreover, the President and his advisers believed that this waste owes largely to the inefficient and sometimes-inappropriate decisions made by providers. The legislation sets out, through a collection of policy measures, to restructure the organization and delivery of medical care. Among other things, it consolidates providers around hospitals where they will become salaried employees that are easier to regulate and supposedly less likely to overprescribe services. History shows, such measures do not produce the promised savings. Moreover, this re-organization comes at a significant cost, not only in terms of the quality of medical care, but its affordability. Provider productivity will inevitably decline. Continuity of care will suffer. Entrepreneurship in medical practice will be squelched. Obamacare will dramatically change the practice of medicine. This will perhaps be its most enduring legacy, and its most significant human cost.
    Keywords: Health care reform, Affordable Care Act, Obamacare
    JEL: I1 H1
    Date: 2013–10
  16. By: Jonathan Gruber
    Abstract: The beginning of the most important elements of the Patient Protection and Affordable Care Act of 2010 (ACA) is an opportune time to review the history of health care reform in the United States, the issues involved in the development of the ACA and its prospects. Efforts for reform trace back to President Teddy Roosevelt and have moved forward since then. The ACA is the culmination of years of debate and discussion at the federal level, but the Massachusetts Health Care Reform Plan adopted in 2006, Romneycare, was the most tangible forerunner and experiment confirming the design, possibilities and success of the ACA. Obamacare is Romneycare. Based on the success of Romneycare, Obamacare will be successful. This paper develops the fundamental challenges of reform and the approaches taken by the ACA to solve those potential problems, especially improving access to health care, improving affordability and avoiding increased federal budget deficits. It also outlines steps developed in the ACA to achieve significant future cost control in health care without sacrificing the trend productivity gains in health care observed in the past and that can further improve access and affordability. This paper is based on a presentation at the Networks Financial Institute’s forum on health care reform, \The Big Bang for the Affordable care Act
    Keywords: Affordable Care Act, Health Care Insurance, Obamacare
    JEL: H20 H11 I13
    Date: 2013–10
  17. By: Philip Hemmings
    Abstract: Israelis enjoy higher life expectancy and have a much younger demographic profile than most OECD countries. However, the demand for health care is expanding rapidly due to population growth and ageing. Also, the country’s wide socio-economic divides are reflected in differences in health outcomes. To date the health-care system, centred on four health funds, is widely acknowledged as providing a basket of universal services, with good quality primary and secondary care, while also accommodating demand for private health care. However, there are challenges and tensions in the system. Currently the authorities are having to rapidly expand the number of places in medical schools and nurse training because large cohorts of health-care professionals are heading for retirement. More broadly, there are concerns that the core notion of a universal basket of services is being eroded by co-payments and the increasing demand for the additional services and options provided by private insurance. Although the quality of care is generally good, in hospital care there is room to improve data and concern that overcrowding may become chronic. This Working Paper relates to the 2013 OECD Economic Review of Israel ( israel.htm). Comment améliorer le système de santé d'Israël Israël se singularise par une espérance de vie plus élevée et une structure démographique nettement plus jeune que la plupart des autres pays de l’OCDE. Néanmoins, la demande de soins de santé augmente rapidement en raison de l’accroissement et du vieillissement de la population. Par ailleurs, les larges fractures socioéconomiques qui caractérisent le pays se traduisent par des disparités sur le plan de la santé. Pour l’heure, le système de santé, qui s’articule autour de quatre organismes d’assurance maladie, offre un ensemble de services universels, recouvrant des soins primaires et secondaires dont la qualité est largement reconnue, tout en satisfaisant la demande de soins de santé privés. Néanmoins, ce système est en proie à des difficultés et des tensions. Aujourd’hui, les autorités doivent rapidement accroître le nombre de places offertes dans les facultés de médecine et les formations aux soins infirmiers, car des cohortes nombreuses de professionnels de la santé se préparent à prendre leur retraite. De manière plus générale, certains craignent que le principe fondamental d’universalité des soins correspondant à un ensemble de services ne soit en train d’être remis en cause par le système de participation aux frais médicaux, et par la demande croissante de services et options supplémentaires offerts par des assurances privés. Bien que les soins soient globalement de bonne qualité, il serait possible d’améliorer les données concernant les soins dispensés dans les hôpitaux et certains craignent que leur surpeuplement ne devienne chronique. Ce Document de travail se rapporte à l’Étude économique de l’OCDE d’Israël 2013 ( 2013.htm).
    Keywords: health care, Israel, life expectancy, nurses, doctors, primary care, physicians, preventative care, hospitals, hôpitaux, infirmières, soins préventifs, médecins, Israël, soins de santé, soins primaires, espérance de vie
    JEL: H75 I11 I13 I14 I18
    Date: 2014–04–14
  18. By: Burke, Marshall; Gong, Erick; Jones, Kelly M.
    Abstract: We examine how variation in local economic conditions has shaped the AIDS epidemic in Africa. Using data from over 200,000 individuals across 19 countries, we match biomarker data on individuals' HIV status to information on local rainfall shocks, a large source of variation in income for rural households. We estimate that infection rates in HIV-endemic rural areas increase by 11% for every recent drought, an effect that is statistically and economically significant. Income shocks explain up to 20% of the variation in HIV prevalence across African countries, suggesting policy approaches for HIV prevention that are distinct from existing efforts.
    Keywords: income shocks; HIV/AIDS; Africa
    JEL: I15 O12 O55
    Date: 2013
  19. By: Schinaia, Giuseppe; Parisi, Valentino
    Abstract: Various schemes of prevention measures in public health are developed and analyzed on the basis of a general mathematical model. Features related to cost issues, including primary and secondary prevention interventions, differential survival experiences and communicable diseases are in turn used to show the potentialities of the theoretical framework. A numerical application is presented with reference to Italian cancer data.
    Keywords: Mathematical Modelling; Health Prevention Measures; Cost Analysis
    JEL: C63 H89 I18
    Date: 2014–04–24
  20. By: Yamamura, Eiji
    Abstract: Previous studies show that smokers are likely to be more impatient and prefer immediate benefits compared with non-smokers. Thus, smokers are regarded as myopic people and therefore have a high time discount rate. Such a tendency is thought to be related not only to short-term benefits (as opposed to long-term benefits), but also free-riding behavior. Using individual data, this paper examines which types of government spending smokers with such characteristics prefer. The important findings are: (1) smokers consider the amount of government spending on social security and unemployment measures to be low and (2) smokers perceive their tax burden to be high. These findings imply that smokers tend to place greater importance on public expenditure that they will personally benefit from, but they are less willing to bear its cost. It is inferred from the estimation results that those who are myopic do not consider long-term benefits, which can result in a number of personal problems in the future, and they anticipate government expenditure will help them with such problems. That is, to enjoy the benefit of free riding, seemingly myopic people are more likely to prefer expenditure on social security and unemployment measures.
    Keywords: smoker; government spending; perceived tax burden; free rider.
    JEL: D31 H51 H55
    Date: 2014–03–25

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