nep-hea New Economics Papers
on Health Economics
Issue of 2014‒10‒03
thirteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Adjusting Measures of Economic Output for Health: Is the Business Cycle Countercyclical? By Mark Egan; Casey Mulligan; Tomas Philipson
  2. Croatia Health System Quality and Efficiency Improvement : Fiduciary System Assessment By World Bank
  3. Croatia Program-for-Results : Improving Quality and Efficiency of Health Services By World Bank
  4. Did Men Benefit More from Medical Progress in Recent Decades? Cause-of-Death Contributions to the Decreasing Sex-Gap in Life Expectancy in the United States By Magdalena Muszyñska; Roland Rau Roland
  5. Diverse disability By Berthoud, Richard
  6. Going Beyond the Mean in Healthcare Cost Regressions: a Comparison of Methods for Estimating the Full Conditional Distribution By Jones, A.;; Lomas, J.;; Rice, N.;
  7. Pricing and competition in Specialist Medical Services: An Overview for South Africa By Ankit Kumar; Grégoire de Lagasnerie; Frederica Maiorano; Alessia Forti
  8. Reducing Health Care Disparities: Where Are We Now? By Marsha Gold
  9. The Effect of Non-Work Related Health Events on Career Outcomes: An Evaluation in the French Labor Market By Emmanuel Duguet; Christine Le Clainche
  10. The Effects of Hospital Consolidation on Labor Market Outcomes By Christina DePasquale
  11. The impact of spousal bereavement on self-assessed health status: evidence from the Taiwanese elderly population By Fu-Min Tseng; Dennis Petrie; Roberto Leon-Gonzalez
  12. The reduction of child mortality in the Middle East and North Africa : a success story By Iqbal, Farrukh; Kiendrebeogo, Youssouf
  13. To Vaccinate or to Procrastinate? That is the Prevention Question By Robert Nuscheler; Kerstin Roeder

  1. By: Mark Egan (University of Chicago); Casey Mulligan (University of Chicago); Tomas Philipson (University of Chicago Harris School)
    Abstract: Many national accounts of economic output and prosperity, such as gross domestic product (GDP) or net domestic product (NDP), offer an incomplete picture by ignoring, for example, the value of leisure, home production, and the value of health. Discussed shortcomings have focused on how unobserved dimensions affect GDP levels but not their cyclicality, which affects the measurement of the business cycle. This paper proposes new measures of the business cycle that incorporate monetized changes in health of the population. In particular, we incorporate in GDP the dollar value of mortality, treating it as depreciation in human capital analogous to how NDP measures treat depreciation of physical capital. We examine the macroeconomic fluctuations in the United States and globally during the past 50 years, taking into account how depreciation in health affects the cycle. Because mortality tends to be pro-cyclical, fluctuations in standard GDP measures are offset by monetized changes in health; booms are not as valuable as traditionally measured because of increased mortality, and recessions are not as bad because of reduced mortality. Consequently, we find that U.S. business cycle fluctuations appear milder than commonly measured and may even be reversed for the majority of “recessions†after accounting for the cyclicality of health. We find that adjusting for mortality reduces the measured U.S. business cycle volatility during the past 50 years by about 37% in the United States and 46% internationally. We discuss future research directions for more fully incorporating the cyclicality of unobserved health capital into standard output measurement.
    Keywords: national accounts, health economics, macroeconomics
    JEL: E01 I10
    Date: 2013
  2. By: World Bank
    Keywords: Health Monitoring and Evaluation Public Sector Expenditure Policy International Economics and Trade - Government Procurement Health Systems Development and Reform Private Sector Development - E-Business Public Sector Development Health, Nutrition and Population
    Date: 2014–01
  3. By: World Bank
    Keywords: Health Monitoring and Evaluation Health, Nutrition and Population - Population Policies Health Economics and Finance Health Systems Development and Reform Disease Control and Prevention
    Date: 2014–01
  4. By: Magdalena Muszyñska (Institute of Statistics and Demography, Warsaw School of Economics); Roland Rau Roland (Demographic Research, University of Rostock)
    Abstract: BACKGROUND The narrowing of the sex gap in life-expectancy since the mid-1970s in the United States has been explained by women’s growing involvement in previously male-dominated risky behaviours, and in particular tobacco consumption. We argue that the narrowing sex-gap could additionally have resulted from greater benefits to men than women from new medical technologies due to differential access and the fact that many medical solutions result from studies based entirely on men. METHODS We decompose the sex gap in the mean duration of life between ages 0 and 75 into four large cause of death groups according to the index of amenable mortality. FINDINGS In the studied years, with the exception of 1985-1995, the sex gap decreased due to causes amenable to public policy interventions. An important contributor to this change was increased smoking among women. The observed narrowing of the sex gap due to medically amenable causes is limited to age 0. When a new group of causes amenable to medical interventions was formed by including half of the contribution of IHD, it had a positive contribution to the narrowing sex gap, and in particular at ages 1-75 years. CONCLUSIONS We demonstrate that when the group of medically amenable causes of death includes half of the contribution of IHD, the narrowing-sex gap in life-expectancy results from the two sexes benefiting to a different degree from medical developments due to differential access or from the fact that treatments are better fitted to male physiological needs than those of women.
    Keywords: sex-gap in mortality, causes of death, medically amenable mortality, policy amenable mortality, sex differences in life expectancy, United States
    JEL: J19 I14
    Date: 2014
  5. By: Berthoud, Richard
    Abstract: Policy has long been based on the assumption that disabled people are either capable, or incapable, of work. This paper extends earlier analyses which show that the probability of employment is a variable, not an absolute. The disability employment penalty varies by number, type, severity and duration of impairments. Many impaired people’s job prospects are scarcely affected, and they are probably not “disabled†at all. Others have very low chances of employment, and fit the concept of “incapacityâ€. In between is a group who face serious barriers, without work being ruled out altogether. This “50:50†group may be the primary focus of policy interest.
    Date: 2014–04–28
  6. By: Jones, A.;; Lomas, J.;; Rice, N.;
    Abstract: Understanding the data generating process behind healthcare costs remains a key empirical issue. Although much research to date has focused on the prediction of the conditional mean cost, this can potentially miss important features of the full conditional distribution such as tail probabilities. We conduct a quasi-Monte Carlo experiment using English NHS inpatient data to compare 14 approaches to modelling the distribution of healthcare costs: nine of which are parametric, and have commonly been used to fit healthcare costs, and five others designed specifically to construct a counterfactual distribution. Our results indicate that no one method is clearly dominant and that there is a trade-off between bias and precision of tail probability forecasts. We find that distributional methods demonstrate significant potential, particularly with larger sample sizes where the variability of predictions is reduced. Parametric distributions such as log-normal, generalised gamma and generalised beta of the second kind are found to estimate tail probabilities with high precision, but with varying bias depending upon the cost threshold being considered.
    Keywords: healthcare costs; heavy tails; counterfactual distributions; quasi-Monte Carlo
    JEL: C1 C5
    Date: 2014–08
  7. By: Ankit Kumar; Grégoire de Lagasnerie; Frederica Maiorano; Alessia Forti
    Abstract: Major disparities in the cost of health care have made the pricing of specialist and hospital services a contentious issue in South Africa, particularly in the private sector. To help inform policy debate, this paper profiles selected experiences on the pricing of health services, competition policy and models of buying specialist health care services from the private sector across the OECD. Firstly, South Africa is compared to OECD countries to identify countries where voluntary private health insurance – the major source of financing for private hospitals – plays a similar role. Second, this paper provides an overview of price setting across OECD health care systems. It then covers the economic rationale and the institutional arrangements which OECD countries have established to set prices, before moving to an overview of competition policy considerations surrounding these arrangements. Finally, the paper highlights a few models of buying services from the private sector for public patients, with a particular focus on Mexico and Turkey. It is argued that South Africa should separate the task of establishing a schedule of medical services from negotiations over overall payments to medical professionals. La tarification des services spécialisés et hospitaliers est devenue en Afrique du Sud, en particulier dans le secteur privé, une question controversée suite à d'importantes disparités dans le coût des soins de santé. Pour éclairer le débat politique, ce document décrit différents exemples de tarification des services de santé, de politique de concurrence et des modèles d'achat de services de soins spécialisés au secteur privé dans la zone OCDE. Dans un premier temps, l’étude compare l'Afrique du Sud à d'autres pays de l'OCDE pour identifier les pays où l'assurance-maladie volontaire privée - la principale source de financement pour les hôpitaux privés en Afrique du Sud - joue un rôle similaire. Il donne ensuite un aperçu de la fixation des prix dans les systèmes de santé de l'OCDE. Puis, il aborde la logique économique et les dispositifs institutionnels mis en place par les pays de l’OCDE pour fixer les prix, avant de présenter une vue d'ensemble de la réflexion concernant la politique de la concurrence autour de ces arrangements. Enfin, le document expose quelques modèles d'achat de services au secteur privé pour les patients du secteur public, en développant plus particulièrement les exemples du Mexique et de la Turquie. Il apparaît que l'Afrique du Sud devrait séparer d’un côté l’élaboration d’une liste de services médicaux et de l’autre les négociations faites sur l'ensemble des paiements des professionnels de santé.
    JEL: I1 I11 I18
    Date: 2014–06–12
  8. By: Marsha Gold
    Abstract: This issue brief for the Robert Wood Johnson Foundation gives an overview of how the field of health care disparities has evolved in recent years to identify emerging perspectives, progress and current activity, and outstanding needs. The paper focuses specifically on health care disparities, while recognizing that these are obviously also intertwined with broader efforts to reduce health disparities.
    Keywords: Health Care Disparities, Health
    JEL: I
    Date: 2014–03–30
  9. By: Emmanuel Duguet; Christine Le Clainche
    Date: 2014
  10. By: Christina DePasquale
    Abstract: In this paper, I estimate the labor market outcomes of two types of hospital consolidation: mergers and system-joinings. The effects of hospital consolidation on prices have received much attention from researchers over the past 25 years. These studies, however, largely ignore the possible effects of system-joinings. I use a difference-in- differences approach and propensity-score weighting to correct for selection bias in order to estimate labor market outcomes of hospital consolidation for the years 1983-2009. I find large employment decreases following a hospital merger, but much smaller decreases following a system-joining. I find that the merger effects on employment levels persist even five years after a merger, but the effect of system-joining completely disappears after year three. I also find zero wage effect from either type of consolidation. I conclude that this result is consistent with the employment decreases being driven by eciency gains rather than an increase in monopsony power.
    Date: 2014–09
  11. By: Fu-Min Tseng (Queen Margaret University Edinburgh); Dennis Petrie (University of Melbourne); Roberto Leon-Gonzalez (National Graduate Institute for Policy Studies)
    Abstract: Bereavement is a grieved and inevitable event in our life. For an aging society, the incidence of spousal bereavement and parental bereavement is higher than the other kinds of bereavement events. This study employs the difference-in-differences (DiD) strategy and the Taiwanese panel Survey of Health and Living Status of the Elderly (SHLSE) to evaluate the impact of losing a spouse on well-being measured by self-assessed health status, depression, and life satisfaction. The results show that spousal bereavement causes substantial depression and loss in life satisfaction. The spousal bereavement impact increases depression by 1.46 CES-D points and reduces life satisfaction by 0.71 points. The decay effect of time is not observed in this study. We also examine the demographic differences of the spousal bereavement impact and find that the gap in life satisfaction between the bereaved who received more than 9 years education and the bereaved who received 9 years or less is 1.43 points, which implies that spousal bereavement causes less impact on more educated people in terms of life satisfaction. The increase in depression for the bereaved in a larger household is smaller than that for those in a small household by 2.75 CES-D points but it is weakly significant. The self-reported health outcomes are the intermediate outcomes between spousal bereavement and societal costs such as healthcare utilisation and death. The association between self-reported health status and mortality and health utilization has been well documented by literature. Thus, our results also provide the policy insight that giving proper interventions on the onset of bereavement may cause less societal costs afterwards.
    Date: 2014–09
  12. By: Iqbal, Farrukh; Kiendrebeogo, Youssouf
    Abstract: Although child mortality rates have declined all across the developing world over the past 40 years, they have declined the most in the Middle East and North Africa region. This paper documents this remarkable experience and shows that it is broad based in the sense that all countries in the Middle East and North Africa experienced significant declines in child mortality over this period and each country did better than most of its comparators. In looking for the sources of the region’s performance edge, the paper confirms the importance of such determinants of child mortality as income growth, education stock, public spending on health, urbanization, and food sufficiency. In addition, the paper establishes that the initial level of mortality has a substantial influence on the pace of subsequent child mortality decline. Of these factors, food sufficiency status is found to contribute to the region’s performance edge over all developing regions, while the other factors are found to matter to varying degrees in selected pairwise regional comparisons.
    Keywords: Population Policies,Regional Economic Development,Early Child and Children's Health,Health Monitoring&Evaluation,Adolescent Health
    Date: 2014–09–01
  13. By: Robert Nuscheler; Kerstin Roeder
    Abstract: Invoking Yaari's dual theory we develop a model of individual vaccination decisions that incorporates quasi-hyperbolic discounting (present-biasedness), risk aversion, and information. We test the resulting hypotheses for the flu season 2010/2011 using a representative German data set. It turns out that quasi-hyperbolic discounting men vaccinate with a significantly lower probability than exponential discounters; they tend to procrastinate. There is no such delay in the prevention behavior of women who tend to vaccinate despite their distorted time preference. Risk aversion is positively related to the probability to vaccinate for men, while the association is negative for women. Well informed individuals have a much higher propensity to vaccinate than poorly informed individuals. Our results suggest that public health policy should not only concentrate on providing information about the flu and the flu shot but also increase the awareness that distorted time preferences may have a bearing on individual prevention decisions.
    Keywords: flu shot, prevention, quasi-hyperbolic discounting, risk aversion, information, public health
    JEL: D03 D81 H42 I11 I18
    Date: 2014–09

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