nep-hea New Economics Papers
on Health Economics
Issue of 2014‒06‒14
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Child Mortality in sub-Saharan Africa: Why Public Health Spending Matters By Carl Grekou; Romain Perez
  2. Trends in Life Expectancy by Income and the Role of Specific Causes of Death By Hederos Eriksson, Karin; Jäntti, Markus; Lindahl, Lena; Torssander, Jenny
  3. Early retirement and post retirement health By Hallberg, Daniel; Johansson, Per; Josephson, Malin
  4. EU trade regulation for baby food: protecting health or trade? By Federica DeMaria; Sophie Drogue
  5. Calibration of Self-Report Tools for Physical Activity Research: The Physical Activity Questionnaire (PAQ) By Pedro F. Saint-Maurice; Gregory J. Welk; Nicholas K. Beyler; Roderick T. Bartee; Kate A. Heelan
  6. Impact of Premium Subsidies on the Take-up of Health Insurance: Evidence from the 2009 American Recovery and Reinvestment Act (ARRA) By Asako S. Moriya; Kosali Simon
  7. Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the Affordable Care Act Young Adult Mandate By Yaa Akosa Antwi; Asako S. Moriya; Kosali Simon
  8. Readmission and Hospital Quality under Prospective Payment System By Guccio, Calogero; Lisi, Domenico; Pignataro, Giacomo
  9. Trade Reform, Environment and Intermediation: Implication for Health Standard By Mandal, Biswajit
  10. Employment in Long-term Care. Report on Poland By Stanislawa Golinowska; Ewa Kocot; Agnieszka Sowa
  11. Evolution of outpatient healthcare expenditure due to ageing in 2030, a dynamic micro-simulation model for France By Grégoire De Lagasnerie; Charlotte Geay; Makram Larguem
  12. Do occupational demands explain the educational gradient in health? By Meyer S.C.; Künn-Nelen A.C.
  13. Health Insurance Tax Credits, the Earned Income Tax Credit, and Health Insurance Coverage of Single Mothers By Merve Cebi; Stephen A. Woodbury
  14. Health in All Policies as a Strategic Policy Response to NCDs By Vivian Lin; Catherine Jones; Shiyong Wang; Enis Barbd
  15. Effects of interventions to raise voluntary enrollment in a social health insurance scheme : a cluster randomized trial By Capuno, Joseph J.; Kraft, Aleli D.; Quimbo, Stella; Tan, Jr. Carlos R.; Wagstaff, Adam
  16. Progress toward the health MDGs : are the poor being left behind ? By Wagstaff, Adam; Bredenkamp, Caryn; Buisman, Leander R.
  17. Using panel econometric methods to estimate the effect of milk consumption on the mortality rate of prostate and ovarian cancer By Hagen, Tobias; Waldeck, Stefanie

  1. By: Carl Grekou; Romain Perez
    Abstract: Since 2000, child mortality has dramatically decreased in Africa. Based on an econometrical analysis over 45 sub-Saharan African countries, this paper analyses the determinants of such evolution, and shows that urbanization, sanitation improvement and GDP growth per capita played a critical role in this overall improvement over 2000-2011. The increase in public health expenditures proved to be also decisive, though the elasticity with mortality rate is much weaker. Reaching the Abuja target of 15% of public health expenditure in total public expenditures would have decreased the under-5 child mortality rate by 9% over 2001-2011. It could further reduce this rate by 14% over 2012-2021, and allow Africa to save 19.8 million of children lives. It would also help the region to achieve the Millennium Development Goal on child mortality (reduce by two thirds under-5 child mortality over 1990-2015) by 2022-23, while it would not be reached before 2027 otherwise, according to our estimates.
    Keywords: Millennium Development Goals, MDGs, Under-5 mortality rate, sub-Saharan Africa, Public expenditure on health.
    JEL: H51 I12 I18 O15
    Date: 2014
  2. By: Hederos Eriksson, Karin (Swedish Institute for Social Research, Stockholm University); Jäntti, Markus (Swedish Institute for Social Research, Stockholm University); Lindahl, Lena (Swedish Institute for Social Research, Stockholm University); Torssander, Jenny (Swedish Institute for Social Research, Stockholm University)
    Abstract: -
    Keywords: Life expectancy; income distribution; socio-economic gradient;
    Date: 2014–06–02
  3. By: Hallberg, Daniel (Uppsala Center for Labor Studies); Johansson, Per (Uppsala Center for Labor Studies); Josephson, Malin (the Swedish Social Insurance Inspectorate (ISF))
    Abstract: This paper studies empirically the consequences of retirement on health. We make use of a targeted retirement offer to army employees 55 years of age or older. Before the offer was implemented in the Swedish defense, the normal retirement age was 60 years of age. Estimating the effect of the offer on individuals’ health within the age range 56-70, we find support for a reduction in both mortality and in inpatient care as a consequence of the early retirement offer. Increasing the mandatory retirement age may thus not only have positive government income effects but also negative effects on increasing government health care expenditures
    Keywords: Health; mortality; inpatient care; retirement; health care; pensions; occupational pensions
    JEL: I18 J22 J26
    Date: 2014–06–04
  4. By: Federica DeMaria (Dipartimento di Economia e Statistica, Università degli Studi della Calabria); Sophie Drogue (Marchés, Organisations, Institutions et Stratégies d'Acteurs, INRA)
    Abstract: This article explores the effect of European Union (EU)’s food safety regulations on the trade of baby food products. A large number of medical studies have shown that pesticides and contaminants contribute to various health problems including cancer, lung disease or reproductive, endocrinal and immune system disorders. They also agree that children are more vulnerable to the dangers of pesticides and contaminants because as soon as they start eating solid foods, they eat a limited number of food items most of which are fruits and vegetables. In order to protect the health of the most vulnerable part of the population, the EU’s regulations establish that no more than 0.01 mg/kg of any single pesticide residue is permitted in baby food products. In this respect, the EU differs from most of its trading partners, the majority of which do not differentiate food safety regulations according to the consumer population age. The purposes of this paper is to compare the EU regulations on Maximum Residual Level of pesticides to those of its major trading partners through a severity index and quantify the impact of the specific European regulations on the trade of baby food products. Results show that the specific EU regulations may be considered as a tool protecting vulnerable population.
    Abstract: Cet article explore l'effet des réglementations de l'Union européenne (UE) sur la sécurité des aliments sur le commerce d'aliments pour bébé. Un grand nombre d'études médicales ont montré que les pesticides et les contaminants contribuent à divers problèmes de santé comme cancers, maladies pulmonaires ou des désordres du système immunitaire, endocrine ou reproducteur. Ces études s'accordent aussi sur le fait que les enfants sont plus vulnérables aux dangers des pesticides et contaminants car dès qu'ils commencent à manger des aliments solides, ils mangent un nombre limité de produits dont la plupart sont des fruits et légumes. Pour protéger la santé de la partie la plus vulnérable de sa population, l'UE a mis en place une réglementation qui établit que la limite maximale de résidus (LMR) pour n'importe quel pesticide ne doit pas excéder 0.01 mg/kg dans les aliments pour bébé. A ce niveau, la réglementation européenne est très différente de celle de la plupart de ses partenaires commerciaux qui ne différencient pas les réglementations en fonction de l'âge. L'objectif de cet article est de comparer la réglementation de l'UE sur les LMR de pesticides par rapport à celle de ses partenaires commerciaux grâce à un indicateur de sévérité et de quantifier l'impact de de cette réglementation européenne spécifique sur le commerce des produits pour bébé. Les résultats montrent que la réglementation de l'UE représente une barrière à l'entrée sur ses marchés, mais qu'elle a aussi un effet positif sur le volume du commerce.
    Keywords: food safety, pesticides, baby food products, market access, gravity modeling, sécurité des aliments, pesticidesécurité sanitaire, alimentation du nourrisson, modèlealimentation infantileaccès au marché
    Date: 2013
  5. By: Pedro F. Saint-Maurice; Gregory J. Welk; Nicholas K. Beyler; Roderick T. Bartee; Kate A. Heelan
    Keywords: Youth, Accelerometry, Measurement, Public Health
    JEL: C
    Date: 2014–05–16
  6. By: Asako S. Moriya; Kosali Simon
    Abstract: We study the impact of the 65-percent federal health insurance premium subsidy, which aimed to help unemployed workers retain coverage and was in effect from February 2009 to May 2010 through the American Recovery and Reinvestment Act (ARRA). In doing so, we also estimate the price elasticity of demand for health insurance using very recent public policy variation. Our research contributes to the evaluation of the ARRA subsidy’s coverage impact and to a better understanding of consumer responses to subsidized coverage options through the Affordable Care Act. We find that the ARRA subsidy is associated with a 15.2-percent increase in the continuation of employer coverage. This translates into a price elasticity estimate of -0.24, which is towards the middle range of elasticities in existing studies. We also find evidence that part of the increase in the continuation of employer coverage was offset by a decrease in non-group insurance.
    JEL: I13 J64
    Date: 2014–06
  7. By: Yaa Akosa Antwi; Asako S. Moriya; Kosali Simon
    Abstract: The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent’s private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion for the use of inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent. Visits related to mental illness increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.
    JEL: I13
    Date: 2014–06
  8. By: Guccio, Calogero; Lisi, Domenico; Pignataro, Giacomo
    Abstract: Nowadays different healthcare policies in OECD countries seem to consider hospital readmissions somehow “quality dependent”. Nonetheless, the theoretical literature on the incentives provided by payment systems tend to disregard this aspect, which indeed might be relevant in driving providers’ behaviour. In this paper we study the incentives for hospitals to provide quality and cost-reducing effort under different payment regimes, either a global budgeting or a prospective payment system, considering explicitly the role played by financial incentives directly linked to readmissions. As far as the specific results about quality are concerned, we find that prospective payment systems do not necessarily perform better than retrospective systems if the reimbursement to hospitals is not adjusted to take into account specific outcome-based indicators of quality, such as readmissions. More specifically, if patients readmitted are fully paid to hospitals, moving from a retrospective to a prospective payment systems might even induce a reduction on quality and, in turn, an increase in readmission probability. However, if the prospective payment system is adjusted for internalizing this counter-incentive, by a different payment for patients readmitted, it could be able to foster a higher treatment quality through the competition channel.
    Keywords: Patient readmission, Quality, Cost-reducing effort, Prospective payment system
    JEL: I11 I12 I18
    Date: 2014
  9. By: Mandal, Biswajit
    Abstract: Health standard of a region or economy significantly depends on environmental quality. And informal sector has a striking role for overall environmental quality as sometimes producers prefer not to produce in the formal sector as formal production calls for stringent environmental and other governmental regulations. Under such circumstances the informal counterpart of the economy becomes heaven for those producers who do not want to abide by the rules. Extralegality of informal production, by definition, indicates the emergence of intermediation activity. In light of these concerns here I build a standard general equilibrium structure to capture these phenomena and to focus on the effects of trade reform. It has been shown in this paper that tariff reform may lead to greater usage of abatement technology under certain factor intensity assumption. However, interestingly, this can not unambiguously ensure a better environmental quality in broader sense.
    Keywords: Environment, International Trade; Intermediation; General Equilibrium
    JEL: D5 D73 F1 O1 O13
    Date: 2014
  10. By: Stanislawa Golinowska; Ewa Kocot; Agnieszka Sowa
    Abstract: The report discusses the formal long-term care workforce in Poland. It presents past and future trends in the development of LTC employment. Authors collected scattered statistical information, estimated lacking data and projected future growth in the number of employed in care services. Performed analysis includes employment in the health and social sector and across various types of care. Projections of the demand for care and supply of the LTC workforce were based on the demographic prognosis of the population size and changes in the age structure taking into account different scenarios for demographic development. Results show the growing gap between demand and supply in the LTC employment. The policy towards aging in Poland will must take up the challenge of growing care needs, family changes and lower opportunities for provision of informal care.
    Keywords: Long-term Care, Employment in Long-term Care, Employment Projections, Labour Resources in Long-term Care, Medical and Care Professions
    JEL: H51 H53 H75 I18
    Date: 2014–06
  11. By: Grégoire De Lagasnerie (Sciences Po LIEPP); Charlotte Geay (INSEE); Makram Larguem (Université Panthéon-Assas - Paris II)
    Abstract: Population ageing will be a major challenge in Europe in the coming decades. This phenomenon will raise the question of the sustainability of public spending with increasing healthcare provision costs. This paper presents a dynamic micro-­‐simulation model for outpatient healthcare expenditure in France, which projects healthcare costs in the long run. Like all the dynamic micro-­‐simulation models, the model projects the population structure over time. The projections are run using a transition process between three states: two non-­‐absorbing (good-­‐health or ill-­‐health) and one absorbing state (death). The outpatient healthcare expenditure is estimated on data between 2002 and 2008 through a two-­‐part model. While healthcare spending of 25 years old and more represent 3.9% of GDP in 2008, they would reach 4.6% in the baseline scenario in 2032 (+0.7 percentage point of GDP or +17.5%). A difference in the share of expenditure in GDP appears between scenarios with different evolutions of health status during the projection period. Outpatient healthcare spending represents 4.6% of GDP in the central scenario in 2032, against 4.4 % in the most optimistic scenario and 4.7% in a pessimistic scenario.
    Date: 2014–05
  12. By: Meyer S.C.; Künn-Nelen A.C. (GSBE)
    Abstract: The aim of this paper is to investigate to what extent occupation-specific demands explain the relationship between education and health. We concentrate on ergonomic, environmental, psychical, social and time demands. Merging the German Microcensus 2009 data with a dataset including detailed occupational demands German Employment Survey 2006, we have a unique dataset to analyze the mediating role of occupational demands in the relationship between education and health status on the one hand and education and health behavior BMI and smoking on the other. We base our analyses on the entire working population and therefore also include those who no longer work, taking occupational demands related to their last job. First, we find that occupational demands are significantly related to subjective health and health behaviors. This holds even stronger for those who are no longer employed. Second, we find that whereas occupational demands do not explain educational differences in subjective health status, they do partially mediate the education gradient in the considered health behaviors. Educational differences in smoking status can partly be explained by ergonomic, environmental, psychical and social demands. The educational gradient in BMI is partly attributable to social occupational demands.
    JEL: I1 I2 J2
    Date: 2014
  13. By: Merve Cebi (University of Massachusetts Dartmouth); Stephen A. Woodbury (W.E. Upjohn Institute for Employment Research)
    Keywords: Employment, compensation, health insurance, poverty, inequality, tax policy
    JEL: J3 H2 I3
  14. By: Vivian Lin; Catherine Jones; Shiyong Wang; Enis Barbd
    Abstract: The aim of Health in All Policies (HiAP) is to bring diverse sectors together to find shared solutions; it focuses on identifying 'win-win' or 'cobenefits' such that policy measures contribute not only to improved health outcomes but also to outcomes desired by other sectors, such as education, environment, welfare, agriculture, and transportation. HiAP can be applied to NCD prevention and control from three different entry points: risk factors or conditions, population groups (including life course), and sectors. (HiAP) is a relatively new concept and policy practice that attempts to incorporate consideration into the policy decision-making process of how public policies and programs affect community health and well-being. It represents a way of working across sectors that aim to find solutions for complex, interrelated, and persistent problems. With the global epidemic in non-communicable diseases (NCDs), HiAP offers a potential approach and a pathway to secure coordinated action on social determinants of health that relate to NCDs and result in health inequalities. Promising examples can be seen globally for action on both specific NCD risk factors as well as in a more systemic approach to policy decision making.
    Keywords: abstinence, Adolescence, Aging, agricultural policies, air pollution, Alcohol consumption, Alcoholic, basic needs, behavior change, breastfeeding, Bulletin, Burden of ... See More + Disease, capacity building, child health, citizen, civic participation, climate change, communicable Disease, communicable diseases, community development, community education, community health, community participation, Counseling, crime, death rates, decision making, developing countries, development policies, diet, disabilities, disability, disease burden, dissemination, dropout, early childhood, Early detection, economic policies, economic policy, effective action, effective governance, elderly, Employment, environmental pollution, epidemic, Epidemiological Analysis, epidemiology, families, family health, family income, family members, family planning, Fetal Alcohol Syndrome, fiscal policies, food production, food safety, Generic Drugs, government agencies, government policies, green space, health care, health care delivery, health care services, health care system, health centers, health consequences, health for all, health impact, Health impact assessments, health impacts, health inequities, Health information, Health insurance, health interventions, health outcomes, health policies, Health Policy, health problems, health programs, health promotion, health sector, health service, health services, Health Specialist, health status, health system, health systems, Health Targets, Health Workforce, healthy cities, Healthy Environment, Healthy Lifestyles, high blood pressure, HIV, HIV prevention, Hospital, hospitalization, hospitals, Human Development, Human resources, illness, important policy, infant, infant mortality, infant mortality rates, infrastructure investment, Institutional capacity, integration, international cooperation, intersectoral cooperation, intervention, labor force, laws, life expectancy, living conditions, local authorities, local communities, Local Governments, Long-term Care, management systems, mandates, marketing, Mass media, medical services, mental health, ministries of health, Ministry of Education, Ministry of Health, mortality, mother, multiple partners, National Development, National Development Plan, National Health Policy, national level, national levels, National Plan, national policies, national policy, National Research Council, national strategies, natural resources, NCD, Noncommunicable Diseases, Nutrition, obesity, physical activity, policy analysis, policy development, policy goals, policy guidance, policy level, policy makers, policy process, POLICY RESPONSE, political climate, political leadership, political support, pollution, poor health, population data, population groups, prevalence, Prevention Strategies, Primary care, primary health care, progress, public administration, public health, public health concern, public health interventions, public health policy, public health services, public health strategies, public hearings, public policies, public policy, public service, public transportation, quality of health, radio, recreational activities, research · Policy, restaurants, risk factors, rooms, rural areas, safe drinking water, school attendance, scientific evidence, screening, service delivery, Set of Recommendations, Smoke-free environments, smokers, smoking, Social Affairs, social development, social factors, social inequality, Social Justice, social marketing, social movements, social norms, social participation, Social Policy, social sector, social services, socioeconomic status, Sodium, tobacco products, transportation, TV, urban areas, Urban development, urbanization, violence, vision, vulnerability, vulnerable groups, walking, waste, Workforce, working conditions, World Conference, World Health Organization
    Date: 2014–02
  15. By: Capuno, Joseph J.; Kraft, Aleli D.; Quimbo, Stella; Tan, Jr. Carlos R.; Wagstaff, Adam
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Housing&Human Habitats,Health Law
    Date: 2014–05–01
  16. By: Wagstaff, Adam; Bredenkamp, Caryn; Buisman, Leander R.
    Abstract: This paper looks at differential progress on the health Millennium Development Goals between the poor and better-off within countries. The findings are based on original analysis of 235 Demographic and Health Surveys and Multiple Indicator Cluster Surveys, spanning 64 developing countries over the period 1990-2011. Five health status indicators and seven intervention indicators are tracked for all the health Millennium Development Goals. In most countries, the poorest 40 percent have made faster progress than the richest 60 percent. On average, relative inequality in the Millennium Development Goal indicators has been falling. However, the opposite is true in a sizable minority of countries, especially on child health status indicators (40-50 percent in the cases of child malnutrition and mortality), and on some intervention indicators (almost 40 percent in the case of immunizations). Absolute inequality has been rising in a larger fraction of countries and in around one-quarter of countries, the poorest 40 percent have been slipping backward in absolute terms. Despite reductions in most countries, relative inequalities in the Millennium Development Goal health indicators are still appreciable, with the poor facing higher risks of malnutrition and death in childhood and lower odds of receiving key health interventions.
    Keywords: Health Monitoring&Evaluation,Population Policies,Disease Control&Prevention,Achieving Shared Growth,Health Systems Development&Reform
    Date: 2014–05–01
  17. By: Hagen, Tobias; Waldeck, Stefanie
    Abstract: Recently prostate and ovarian cancer has been related to milk consumption. However, existing observational studies based on country level data do not attempt to identify causal effects since they are only based on simple cross-sectional analyses. This paper takes a step toward estimating of causal effects of milk consumption on cancer by applying panel econometric models and by using the within-country variation of the mortality rates and food consumption instead of the between-country variation in a panel of up to 50 countries for 1990 to 2008. Possible methodological problems arising from omitted variables (confounding factors), heterogeneity, and outliers are carefully discussed and a wide range of recent panel econometric estimators are applied. The results indicate fairly well that milk consumption increases both the mortality rate of prostate cancer as well as the mortality rate of ovarian cancer. The estimated effects are also important in quantitative terms, i.e., a reduction in the consumption of milk products can reduce the number of people dying of prostate and ovarian cancer appreciably. Furthermore, the consumption of other animal food products as well as sugar seems to be harmful. For the mortality rate of ovarian cancer we find that total calories intake increases the mortality rate too. --
    Keywords: Panel Econometrics,GMM,Dynamic Panel Data Methods,Fixed-Effects,Quantile Regression,Prostate Cancer,Ovarian Cancer,Cross-Country Analysis,Causal Effect,Quantile Regression,Bayesian Model Averaging,Extreme Bounds Analysis
    JEL: C33 Q18 I19
    Date: 2014

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