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on Health Economics |
| By: | F. Zagonari |
| Abstract: | This paper describes a dynamic system for the interrelationships between happiness and health that considers three main attitudes to life: α, β, and γ for Aristotelian, Epicurean, and Stoic, respectively. All variables that have been shown by empirical and theoretical studies to affect individual health and happiness are included (i.e., employment, occupation, education, ethical freedom, equity in achievements). Three main approaches are considered: behavioural and statistical ex-ante, and ex-post behavioural. I develop the model to rank the three attitudes in terms of health for a given happiness level, and consequently, provide insights into which attitude should be adopted by each individual, according to their characteristics: individuals in Protestant and non-Protestant Christian societies should adopt β and γ attitudes, respectively; educated individuals should adopt a γ attitude; and poor individuals should adopt an α attitude. Based on this analysis, I provide insights into which attitude actually is adopted by each society by comparing predicted health and achievement levels with the observed life expectancy at birth and per capita gross domestic product levels in 107 countries, thus providing an empirical test of the analytical model. This analysis revealed a prevalence of β attitudes in Protestant Developed Countries, with larger γ shares in less income-unequal countries; a prevalence of γ attitudes in non-Protestant Christian Developed Countries, with larger β shares in more income-unequal countries; a prevalence of α attitudes in Muslim Less Developed Countries, with larger γ shares in more educated countries; and a prevalence of β attitudes in more educated atheist and Jewish countries. |
| JEL: | I1 I3 Z1 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:bol:bodewp:wp949&r=hea |
| By: | Chia-Lin Chang; Wei-Chen Chen; Michael McAleer (University of Canterbury) |
| Abstract: | This paper examines the determinants of very low birth weight infant (or neonatal) mortality using the Taiwan National Health Insurance Research database from 1997 to 2009. After infants are discharged from hospital, it is not possible to track their mortality, so the Cox proportional hazard model is used to analyze the very low birth weight infant mortality rate. In order to clarify treatment responsibility and to avoid selective referral effects, we use the number of infants treated in the preceding five years to observe the effect of a physician’s and hospital’s medical experience on the mortality rate of hospitalized minimal birth weight infants. The empirical results show that, given disease control variables, a higher infant weight, higher quality hospitals, increased hospital medical experience, and higher investment in pediatrics can reduce the mortality rate significantly. However, an increased physician’s medical experience does not seem to influence significantly the very low birth weight infant mortality rate. |
| Keywords: | Very low birth weight, Neonatal mortality, Physician’s infant experience, Hospital infant experience, Statistical analysis, Cox proportional hazard model, Selective referral, Taiwan National Health Insurance Scheme |
| JEL: | C41 I10 I13 I18 |
| Date: | 2014–06–09 |
| URL: | http://d.repec.org/n?u=RePEc:cbt:econwp:14/15&r=hea |
| By: | Victoria Fan and William Savedoff |
| Abstract: | Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a “health financing transition” to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending e rising about 1 percent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country’s capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends. |
| Keywords: | public health, health finance |
| JEL: | I14 I15 |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:358&r=hea |
| By: | Florence Jusot (Université de Rouen, CREAM, Université Paris-Dauphine and PSL Research University,); Sabine Mage (PSL, Université Paris-Dauphine, LEDa, IRD UMR DIAL); Marta Menendez (PSL, Université Paris-Dauphine, LEDa, IRD UMR DIAL) |
| Abstract: | Whereas health equity issues are undoubtedly more relevant in developing countries, research on health inequalities and, more specifically, on inequality of opportunity in the health dimension, remains scarce in this context. This paper explores the degree of inequality of opportunity in health in a developing country, using the 2007 Indonesian Family Life Survey, a large-scale survey with extremely rich information about individual health outcomes (biomarkers and self-reports) and individual circumstances. We compute a continuous synthetic index of global health status based on a comprehensive set of health indicators and subsequently implement non-parametric and parametric methods in order to quantify the level of inequality of opportunity in the health dimension. Our results show large inequality of opportunities in health in Indonesia, compared to European countries. Concerning transmission mechanisms, parental (particularly maternal) vital status appears as the main channel. Compared to what has been observed in more developed countries, the effect of parental education on health is relatively smaller, and mainly indirect (passing through descendants’ socioeconomic, marital and migration statuses), while the existence of long-term differences in health related to religion, language spoken and particularly province of location suggest a relatively higher relevance of community belonging variables for health equity in the context of a developing country as Indonesia. _________________________________ Les pays en développement sont particulièrement concernés par la question des inégalités de santé et notamment celle de l’inégalité des chances. Néanmoins, très peu de travaux sont proposés dans le cadre des économies en développement. Cet article étudie l’ampleur des inégalités des chances en matière de santé en Indonésie à partir de données recueillies par l’enquête IFLS (Indonesian Family Life Survey) de 2007 qui propose une information individuelle détaillée sur l’état de santé (bio-marqueurs et auto-évaluation) mais aussi sur l’environnement socio- économique. Un indicateur synthétique continu de l’état de santé global calculé à partir d’un ensemble complet d’informations sur la santé est dans un premier temps proposé. Des méthodes paramétriques et non paramétriques sont ensuite mobilisées pour mesurer le niveau de l’inégalité des chances dans le domaine de la santé. Les résultats mettent en évidence une importante inégalité des chances relative à l’état de santé en Indonésie par rapport au niveau d’inégalité observée dans les pays européens. Le principal vecteur de transmission de l’inégalité est le statut de santé des parents (statut vital) et en particulier celui de la mère. L’impact du niveau d’éducation des parents est indirect (agissant sur l’environnement socio-économique, le statut marital et la migration des descendants) et est beaucoup plus faible que celui généralement observé dans des économies plus développées. Les disparités à long terme de l’état de santé liées à la religion, à la langue pratiquée et plus encore à la région d’habitation suggèrent que les variables d’appartenance communautaire sont prépondérantes pour analyser la question de l’équité en santé dans un pays en développement comme l’Indonésie. |
| Keywords: | Equality of opportunity; health, Indonesia, stochastic dominance, continuous health index, Egalité des chances ; santé ; Indonésie ; dominance stochastique ; indicateur continu de santé |
| JEL: | D63 I14 O15 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:dia:wpaper:dt201406&r=hea |
| By: | Delavallade, Clara |
| Abstract: | This paper examines an innovative approach to access to and demand for quality health care from the poor. Using data from a field experiment in India, I examine the impact of high-quality care experiences in the form of a free medical consultation with a qualified nongovernmental organization doctor, randomly offered by a health insurance provider to a subset of its enrollees. |
| Keywords: | health care, Poverty, Insurance, health insurance, trust, insurance retention, micro health insurance, insurance demand, |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:1352&r=hea |
| By: | Elena Gross (University of Bayreuth); Isabel Günther (ETH Zurich) |
| Abstract: | 70 percent of the rural population in sub-Saharan Africa does not use adequate sanitation facilities. In rural Benin, as much as 95 percent of the population has no access to improved sanitation. This paper explores why households remain without latrines analyzing a representative sample of 2000 rural households. Our results show that wealth and latrine prices play the most decisive role for sanitation demand and ownership. At current income levels, sanitation coverage will only increase to 50 percent if costs for construction are reduced from currently $200 USD to $50 USD per latrine. Our analysis also suggests that previous sanitation promotion campaigns, which were based on prestige and modern lifestyle as motives for latrine construction, have had no success in increasing sanitation coverage. Moreover, improved public health, which is the objective of public policies promoting sanitation, is also difficult to achieve at low sanitation coverage rates. Fear at night, especially of animals, and personal harassment, are stated as the most important motivational factors for latrine ownership and the intention to build one. We therefore suggest that new low cost technologies should be introduced on rural markets and that social marketing strategies should be adjusted accordingly. |
| Keywords: | Sanitation; Sanitation Demand; Willingness to pay; Motivational factors |
| JEL: | D12 O12 O31 O55 |
| Date: | 2014–06–18 |
| URL: | http://d.repec.org/n?u=RePEc:got:gotcrc:159&r=hea |
| 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)); Jacques Silber (Department of Economics - Bar-Ilan University, CEPS/INSTEAD - Centre d'Etudes de Populations, de Pauvreté et de Politiques Socio-Economiques / International Networks for Studies in Technology, Environment, Alternatives, Development - Centre d'Etudes de Populations, de Pauvreté et de Politiques Socio-Economiques / International Networks for Studies in Technology, Environment, Alternatives, Development) |
| Abstract: | Traditional indices of bi-dimensional inequality and polarization were developed for cardinal variables and cannot be used to quantify dispersion in ordinal measures of socioeconomic status and health. This paper develops two approaches to the measurement of inequality and bi-polarization using only ordinal information. An empirical illustration is given for 24 European Union countries in 2004-2006 and 2011. Results suggest that inequalities and bi-polarization in income and health are especially large in Estonia and Portugal, and that inequalities have significantly increased in recent years in Austria, Belgium, Finland, Germany, and the Netherlands, whereas bi-polarization significantly decreased in France, Portugal, and the UK. |
| Keywords: | Inequality ; Bi-polarization ; Ordinal variables ; Self-assessed health |
| Date: | 2013–08–05 |
| URL: | http://d.repec.org/n?u=RePEc:hal:pseose:halshs-00850014&r=hea |
| By: | Laurent Gobillon (CEPR - Center for Economic Policy Research - CEPR, 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, INED - Institut National d'Etudes Démographiques Paris - INED); Carine Milcent (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, CEPREMAP - Centre pour la recherche économique et ses applications - Centre pour la recherche économique et ses applications) |
| Abstract: | Using a French exhaustive dataset, this article studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities. |
| Keywords: | Spatial health disparities ; Economic geography ; Stratified duration model |
| Date: | 2013–09 |
| URL: | http://d.repec.org/n?u=RePEc:hal:pseose:halshs-00879787&r=hea |
| By: | Danielle Carusi Machado (Universidade Federal Fluminense e Pesquisadora do CEDE-UFF - Universidade Federal Fluminense e Pesquisadora do CEDE-UFF); Carine Milcent (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); Jack Huguenin (IEMS - Institut d'économie et de management de la santé - Université de Lausanne) |
| Abstract: | We estimate a system of three behavioral equations for Brazilian children and teenagers (school absenteeism, health status and child labor). We relieved the assumption of independence of the disturbance terms of each equation. Moreover, if causality mechanisms between these three components (school absenteeism, health status and child labor) can occur either way, it can also be the result of a simultaneous decision-making process. Thus, to take into account both endogenous causality aspects and simultaneity, we estimate using the FIML method, which provides some improvement to the quality of the estimation, allowing us to simultaneously estimate all relevant parameters, including covariance parameters, and also to the subsequent interpretation of the results. |
| Keywords: | Children; Education; Health; Work; Limited information model; Full information model |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:hal:pseose:halshs-00943045&r=hea |
| By: | David Dranove; Craig Garthwaite; Manuel Hermosilla |
| Abstract: | Prior research has shown that exogenous shocks to the demand for medical products spur additional product development. These studies do not distinguish between breakthrough products and those that largely duplicate the performance of existing products. In this paper, we use a novel data set to explore the impact of the introduction of Medicare Part D on the development of new biotechnology products. We find that the law spurred development of products targeting illnesses that affect the elderly, but most of this effect is concentrated among products aimed at diseases that already have multiple existing treatments. Moreover, we find no increase in products targeting orphan disease or those receiving either fast track or priority review status from the FDA. This suggests that marginal changes in demand may have little effect on the development of products with large welfare benefits. |
| JEL: | H0 I1 I18 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20212&r=hea |
| By: | Jeremy D. Goldhaber-Fiebert; David M. Studdert; Monica S. Farid; Jay Bhattacharya |
| Abstract: | Reforms introduced by the Affordable Care and Patient Protection Act (ACA) build new sources of coverage around employment-based health insurance. But what if firms find it cheaper to have their employees obtain insurance from these sources, even after accounting for penalties (for non-provision of insurance) and employee bonuses (to ensure the shift is cost neutral for them)? State and local governments (SLGs) have strong incentives to consider the economics of such “divestment”; many have large unfunded benefits liabilities. We investigated whether SLGs would save under two scenarios: (1) shifting all employees and under-65-retirees to alternative sources of coverage; (2) shifting only employees whose household incomes indicate they would be eligible for federally subsidized coverage and all under-65-retirees. Full divestment would cost SLGs more than they currently pay, due primarily to penalty costs. Selective divestment could save SLGs nearly $119 billion over 10 years at the expense of the federal government. |
| JEL: | H51 H7 I1 J45 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20222&r=hea |
| By: | Mark Pauly; Scott Harrington; Adam Leive |
| Abstract: | This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purchasers of self only coverage in California and in 23 states with minimal prior state premium regulation before the ACA now using federally managed exchanges. Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent, with similar changes in California and the federal exchange states; we attribute the increase primarily to higher premiums in exchanges associated with insurer expectations of a higher risk population being enrolled. The increase in total expected price is similar for age-gender population subgroups except for a larger than average increases for older women. A welfare calculation of the change in risk premium associated with moving from coverage that prevailed before reform to bronze or silver coverage finds small changes. |
| JEL: | I11 I13 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20223&r=hea |
| By: | Liran Einav; Amy Finkelstein; Heidi Williams |
| Abstract: | We present a simple framework to illustrate the welfare consequences of a “top up” health insurance policy that allows patients to pay the incremental price for more expensive treatment options. We contrast it with common alternative policies that require essentially no incremental payments for more expensive treatments (as in the United States), or require patients to pay the full costs of more expensive treatments (as in the United Kingdom). We provide an empirical illustration of this welfare analysis in the context of treatment choices among breast cancer patients, where lumpectomy with radiation therapy is a more expensive treatment than mastectomy, with similar average health benefits. We use variation in distance to the nearest radiation facility to estimate the relative demand for lumpectomy and mastectomy. Extrapolating the resultant demand curve (grossly) out of sample, our estimates suggest that the “top-up” policy, which achieves the efficient treatment decision, increases total welfare by $700-2,500 per patient relative to the current US “full coverage” policy, and by $700-1,800 per patient relative to the UK “no top up” policy. While we caution against putting much weight on our specific estimates, the analysis illustrates the potential welfare gains from more efficient reimbursement policies for medical treatments. We also briefly discuss additional tradeoffs that arise from the top-up and UK-style policies, which both lead to additional (ex-ante) risk exposure. |
| JEL: | H44 I13 I18 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20226&r=hea |
| By: | Mussa, Richard |
| Abstract: | This paper proposes three measures of average exit time from catastrophic health payments; the first measure is non-normative in that the weights placed on catastrophic payments incurred by poor and nonpoor households are the same. It ignores the fact that the opportunity cost of health spending is different between poor and nonpoor households. The other two measures allow for distribution sensitivity but differ in their conceptualization of inequality; one is based on socioeconomic inequalities in catastrophic health payments, and the other uses pure inequalities in catastrophic health payments. The proposed measures are then applied to Malawian data from the Third Integrated Household Survey. The empirical results show that when the threshold of pre-payment income is increased from 5% to 15%, the average exit time decreases from 2.1 years to 0.2 years; and as the catastrophic threshold rises from 10% to 40% of ability to pay, the average exit time falls from 3.6 years to 0.1 years. It is found that when socioeconomic inequality is adopted, the changes in the exit times are quite small, however, using pure inequality leads to large reductions in the exit time. |
| Keywords: | Catastrophic payments; average exit time; Malawi |
| JEL: | I13 I15 |
| Date: | 2014–06–12 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:56618&r=hea |
| By: | Ahsan, Henna; Idrees, Dr Muhammad |
| Abstract: | The present study aims to explore the impact of health on productivity, measured through earnings at both individual level and district level of Pakistan. For individual analysis health is measured by various nutrition intakes (calories, protein and vitamin A) and for district analysis health is measured by nutrition intake as well as through regional health facilities (number of beds per earners and basic health units per earners) by obtaining the data from Household Integrated Economic Survey 2010-2011 and from various Provisional Development of Statistics. The study concludes that health is foremost element to enhance the productivity level. The unequal distribution of nutrition intake and health facilities causes the earnings inequality, to narrow down this earning inequality there is a need for fair distribution of nutrition intake and health facilities. |
| Keywords: | Health, Earnings, Nutrition |
| JEL: | I00 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:56769&r=hea |
| By: | Michael Gerfin; Boris Kaiser; Christian Schmid |
| Abstract: | Deductibles in health insurance generate nonlinear budget sets and dynamic incentives. This paper uses detailed individual claims data from a large Swiss insurance company to estimate the response in health care demand to the discrete price increase that is generated by resetting the deductible at the start of each calendar year. We use a regression discontinuity type framework based on daily data to estimate the change in health care demand right before and right after the turn of the year. We find that for individuals with high deductibles health care demand drops by 27%, which translates into an elasticity of -.21. The decrease is most pronounced for inpatient care and prescription drugs. By contrast, for individuals with low deductibles there is no significant change in health care demand (except for prescription drugs). A remaining open question is whether the observed behavioral responses can be attributed to intertemporal substitution or whether they constitute a classic moral hazard effect. |
| Keywords: | Health care demand; nonlinear pricing; dynamic incentives; health insurance |
| JEL: | C31 D12 I13 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:ube:dpvwib:dp1403&r=hea |
| By: | Wagstaff, Adam; Nguyen, Ha Thi Hong; Dao, Huyen; Balesd, Sarah |
| Abstract: | Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. This paper reports the results of a cluster randomized control trial in which 3,000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam’s government-run scheme and the benefits of health insurance; a voucher entitling eligible household members to 25 percent off their annual premium; and both. The four groups were balanced at baseline. In the control group, 6.3 percent (82/1296) of individuals were enrolled in the endline, compared with 6.3 percent (79/1257), 7.2 percent (96/1327), and 7.0 percent (87/1245) in the information, subsidy, and combined intervention groups; the adjusted odds ratios were 0.94, 1.12, and 1.15, respectively. Only among those reporting poor health were any significant intervention effects found, and only for the combined intervention: an enrollment rate of 16.3 percent (33/202) compared with 8.3 percent (18/218) in the control group, and an adjusted odds ratio of 2.50. The results suggest limited opportunities to raise voluntary health insurance enrollment through information campaigns and subsidies, and that these interventions exacerbate adverse selection. |
| Keywords: | Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Health Law,Housing&Human Habitats |
| Date: | 2014–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6910&r=hea |
| By: | Eibich, P.; |
| Abstract: | This paper estimates the causal effect of retirement on health, health behavior, and healthcare utilization. Using Regression Discontinuity Design to exploit financial incentives in the German pension system for identification, I investigate a wide range of health behaviors (e.g. alcohol and tobacco consumption, physical activity, diet and sleep) as potential mechanisms. The results show a long-run improvement in health upon retirement. Relief from work-related stress, increased sleep duration and more frequent physical exercise seem to be key mechanisms through which retirement affects health. Moreover, the improvement in health caused by retirement leads to a reduction in healthcare utilization. |
| Keywords: | retirement; health; regression dicontinuity design; health behavior; healthcare; |
| JEL: | I12 J14 J26 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:14/10&r=hea |
| By: | Schreyögg, Georg; Ostermann, Simone M. |
| Abstract: | [Introduction ...] The paper is organized as follows: First, we develop a frame of reference based on a brief overview of the concepts of risk and uncertainty and organizational responses. The second part presents our empirical investigation. We briefly report on the results of our exploratory study and then describe first findings of our main study. In part three we will discuss our findings in the light of modern organizational theory. Part four highlights the limitations of our study and discusses implications for further analysis and theoretical conclusions. -- |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:fubsbe:201414&r=hea |