nep-hea New Economics Papers
on Health Economics
Issue of 2014‒09‒29
ten papers chosen by
Yong Yin
SUNY at Buffalo

  1. A derivative-free approach for a simulation-based optimization problem in healthcare By Stefano Lucidi; Massimo Maurici; Luca Paulon; Francesco Rinaldi; Massimo Roma
  2. A household survey of the cost of illness due to air pollution in Beijing, China By Timothy Swanson; Chiara Ravetti; Yana Popp Jin; Mu Quan; Zhang Shiqiu
  3. Comparing the Relationship Between Stature and Later Life Health in Six Low and Middle Income Countries By McGovern, Mark E.
  4. Demand in New Zealand Hospitals: Expect the Unexpected? By Nan Jiang; Gail Pacheco
  5. Health, Work and Working Conditions: A Review of the European Economic Literature By Thomas Barnay
  6. Is temporary employment damaging to health? A longitudinal study on Italian workers By Elena Pirani; Silvana Salvini
  7. Life-care Awards in the Age of the Affordable Care Act By Joshua Congdon-Hohman; Victor Matheson
  8. Occupational hazards and social disability insurance By Michaud, Amanda M.; Wiczer, David
  9. The Determinants of Rising Inequality in Health Insurance and Wages By Rong Hai
  10. The Performance of Risk Adjustment Models in Colombian Competitive Health Insurance Market By Álvaro Riascos; Eduardo Alfonso; Mauricio Romero

  1. By: Stefano Lucidi (Department of Computer, Control and Management Engineering, Universita' degli Studi di Roma "La Sapienza"); Massimo Maurici (Dipartimento di Biomedicina e Prevenzione Laboratorio di Simulazione e Ottimizzazione dei servizi del SSN Universita' di Roma "Tor Vergata"); Luca Paulon (Dipartimento di Biomedicina e Prevenzione Laboratorio di Simulazione e Ottimizzazione dei servizi del SSN Universita' di Roma "Tor Vergata"); Francesco Rinaldi (Dipartimento di Matematica, Universita' di Padova); Massimo Roma (Department of Computer, Control and Management Engineering, Universita' degli Studi di Roma "La Sapienza")
    Abstract: In this work a simulation-based optimization model is considered in the framework of the management of hospital services. Given specific parameters which describe the hospital setting, the simulation model aims at reproducing the hospital processes and evaluating their efficiency. The use of a simulation-based optimization approach is necessary since the model can not be expressed as closedÐform function. In order to obtain the optimal setting, we combine a derivative-free optimization method with a discrete event simulation model. The resulting framework has been tested on a real healthcare problem. More specifically, we study how to optimize the performance of an obstetric ward of a big Italian hospital, from both an economical and clinical point of view, taking into account some relevant constraints. The resulting optimization problem is a Mixed Integer Nonlinear Programming problem due to the presence of some variables constrained to be integer.
    Keywords: Healthcare problems ; Simulation-based optimization ; Derivative-free methods
    Date: 2014
  2. By: Timothy Swanson; Chiara Ravetti; Yana Popp Jin; Mu Quan; Zhang Shiqiu (Centre for International Environmental Studies, IHEID, The Graduate Institute of International and Development Studies, Geneva)
    Abstract: This paper examines with a case study of Beijing, China, the health benefits that could be reaped from urban air quality improvements. The study implements a household survey to collect information about the yearly medical expenditures and lost days of work, to estimates the total costs of illness (COI) borne by a typical individual due to airborne diseases. The results of this survey provide a lower bound for the health costs borne by the urban population of Beijing due to air pollution. We find that the average individual COI in our sample is more than 3000 yuan per year, corresponding to almost one month of the average wage (slightly more than 500 US$ per year). This is quite sizeable, considering that it represents just the minimum benchmark for the damages caused by pollution to health. This result indicates that Beijing could benefit quite substantially from reducing air pollution in terms of health costs: if it could completely eliminate pollution, the savings in terms of COI would range in an order of magnitude of 21 million yuan per year only from hospitalized cases.
    Keywords: Cost of Illness, Air pollution, Household survey, Insurance
    JEL: Q53 I13 C83
    Date: 2014–09–12
  3. By: McGovern, Mark E.
    Abstract: This paper examines the relationship between stature and later life health in 6 emerging economies, each of which are expected to experience significant increases in the mean age of their populations over the coming decades. Using data from the WHO Study on Global Ageing and Adult Health (SAGE) and pilot data from the Longitudinal Ageing Study in India (LASI), I show that various measures of health are associated with height, a commonly used proxy for childhood environment. In the pooled sample, a 10cm increase in height is associated with between a 2 and 3 percentage point increase in the probability of being in very good or good self-reported health, a 3 percentage point increase in the probability of reporting no difficulties with activities of daily living or instrumental activities of daily living, and between a fifth and a quarter of a standard deviation increase in grip strength and lung function. Adopting a methodology previously used in the research on inequality, I also summarise the height-grip strength gradient for each country using the concentration index, and provide a decomposition analysis.
    Date: 2014–01
  4. By: Nan Jiang (Department of Economics, Faculty of Business and Law, Auckland University of Technology); Gail Pacheco (Department of Economics, Faculty of Business and Law, Auckland University of Technology)
    Abstract: The New Zealand health care sector stands out relative to other OECD countries, with relatively low per-capita health expenditure and a public dominant health system. Efficient allocation of resources is therefore paramount. This paper creates a predictive model for patient volume using the national database of hospital admissions. Contrasting predicted with actual demand, we construct indicators of volatility in unexpected demand (at the hospital and disease chapter level) and assess their role with regard to patient outcomes. There is consistent evidence that when actual exceeds predicted, patients stay in hospital longer, and are more likely to have an acute readmission.
    Keywords: hospital demand, emergency readmission, length of hospital stay
    Date: 2014–04
  5. By: Thomas Barnay
    Date: 2014
  6. By: Elena Pirani (Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti", Università di Firenze); Silvana Salvini (Dipartimento di Statistica, Informatica, Applicazioni "G. Parenti", Università di Firenze)
    Abstract: Working conditions have dramatically changed over recent decades in all the countries of European Union: permanent full-time employment characterized by job security and a stable salary is replaced more and more by temporary work, apprenticeship contracts, casual jobs and part-time work. The consequences of these changes on the general well-being of workers and their health represent an increasingly important path of inquiry. We add to the debate by answering the question: are Italian workers on temporary contracts more likely to suffer from poor health than those with permanent jobs? Our analysis is based on a sample of men and women aged 16-64 coming from the Italian longitudinal survey 2007-2010 of the European Union Statistics on Income and Living Conditions. We use the method of inverse-probability-of-treatment weights to estimate the causal effect of temporary work on self-rated health, controlling for selection effects. Our major findings can be summarized as follows: firstly, we show that the negative association between precarious employment and health is not simply due to a selection of healthier individuals in the group of people who find permanent jobs (selection effect), but it results from a causal effect in the work-to-health direction. Secondly, we find that the temporariness of the working status becomes particularly negative for the individual’s health when it is prolonged over time. Thirdly, whereas temporary employment does not entail adverse consequences for men, the link between precarious work and health is strongly harmful for Italian women.
    Keywords: Self-rated health; temporary contracts; Italy; causal inference; gender inequalities
    Date: 2014–09
  7. By: Joshua Congdon-Hohman (Department of Economics, College of the Holy Cross); Victor Matheson (Department of Economics, College of the Holy Cross)
    Abstract: Prior to January 1, 2014, it would have been reasonable to assume that persons injured in an act of negligence would be forced to pay for their future medical care costs out-of-pocket rather than being able to rely on health insurance. The passage of the Affordable Care Act (ACA) has the potential to radically change how victims pay for future medical expenses, and now nearly every tort award that provides money to the plaintiff for the full payment of medical costs without consideration of the availability of health insurance will serve to overcompensate victims for their expected medical costs. New statutory or judicial rulings regarding subrogation and the collateral source rule appear to be required in order to simultaneously achieve the twin goals of making a tortfeasor pay for their damages while also making the victim whole.
    Keywords: Affordable Care Act, forensic economics, tort awards, lawsuits, health insurance
    JEL: I13 I18 K41
    Date: 2014–09
  8. By: Michaud, Amanda M. (Indiana University); Wiczer, David (Federal Reserve Bank of St. Louis)
    Keywords: Disability Insurance; Occupational Choice; Optimal Policy
    JEL: E62 I13
    Date: 2014–08–26
  9. By: Rong Hai (Becker Friedman Institute)
    Abstract: What has caused the rising gap in health insurance coverage by education in the U.S. over the last thirty years? How does the employment-based health insurance market interact with the labor market? What are the effects of social insurance such as Medicaid? By developing and structurally estimating an equilibrium model, I find that the interaction between labor market technological changes and the cost growth of medical services explains 60% to 70% of the gap. Using counterfactual experiments, I also evaluate the impact of further Medicaid eligibility expansion and employer mandates introduced in the Affordable Care Act on labor and health insurance markets.
    Date: 2013
  10. By: Álvaro Riascos; Eduardo Alfonso; Mauricio Romero
    Abstract: We introduce new risk groups to a standard capitation formula and evaluate risk selection incentives of insurers. The study uses a unique data set of almost 24 million affiliates to Government’s mandatory health insurance system. This data set is very rich in the sense of reporting all claims during year 2010, basic demographic variables, initial diagnostic, health services, pharmaceuticals used, etc. It compromises more than 300 million claims. We construct two diagnostic related groups: an adaptation of the 3M algorithm, and a ad hoc diagnostic related group constructed by the authors. Using standard linear capitations formulas we evaluate incentives for cream skimming using several measures. In general, results show a notable improvement in the explanatory power of health expenditures by introducing the ad hoc diagnostic related groups to the standard Colombian risk adjustment formula. With the new risk groups the R2 of the model is 13.53% as opposed to 1.45% of the current formula. Furthermore, for users in the highest expenditure quintile, expected expenditure is 71% of actual expenditure, as opposed to 27% under the current formula. This suggest there is much space for improving the current Colombian capitation formula using information that is currently available.
    Keywords: Risk adjustment, Diagnostic Related Groups, Risk Selection.
    JEL: I11 I13 I18
    Date: 2014–08–15

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