nep-hea New Economics Papers
on Health Economics
Issue of 2014‒10‒22
fourteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Can We Trust Online Physician Ratings? Evidence from Cardiac Surgeons in Florida By Susan Lu; Huaxia Rui
  2. Concentration in survival times and longevity: The log-scale-location family of failure time models By Chiara Gigliarano; Ugofilippo Basellini; Marco Bonetti
  3. Effects of an Integrated Care System on Children with Special Health Care Needs' Medicaid Expenditures By Marcu, Mircea; Knapp, Caprice; Madden, Vanessa; Brown, David; Wang, Hua; Sloyer, Phyllis
  4. Health Care in Sri Lanka : What Can the Private Health Sector Offer? By Ramesh Govindaraj; Kumari Navaratne; Eleonora Cavagnero; Shreelata Rao Seshadri
  5. Health Financing in Vanuatu : Challenges and Options By Ian Anderson
  6. Incentives and Children's Dietary Choices: A Field Experiment in Primary Schools By Michele Below; Jonathan James; Patrick Nolen
  7. Integrated Health Care Payment Methods: Typology, Evidence And Pre-Conditions Of Implementation By Igor M. Sheiman
  8. Life Expectancy and Mother-Baby Interventions By Sonia Bhalotra; Martin Karlsson; Therese Nilsson
  9. Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in location of birth, we exploit the exogenous variation in distance from a mother’s residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains. By N. Meltem Daysal; Mircea Trandafir; Reyn van Ewijk
  10. Robust Wagstaff Orderings of Distributions of Self-Reported Health Status By Paul Makdissi; Myra Yazbeck
  11. Simple Analytics of Disability Adjusted Life Years (DALYs) By Mariana Conte Grand
  12. The Changing Role of Government in Financing Health Care: An International Perspective By Mark Stabile
  13. Who benefits from government health spending and why? a global assessment By Wagstaff, Adam; Bilger, Marcel; Buisman, Leander R.; Bredenkamp, Caryn
  14. ‘Know Your Epidemic’: The Effects of Expected Health and Contextual Health Uncertainty on Risky Sex By Byela Tibesigwa, Martine Visser and Mintewab Bezabih

  1. By: Susan Lu (Purdue University, West Lafayette, Illinois 47907); Huaxia Rui (University of Rochester, Rochester, New York 14627)
    Abstract: Despite heated debate about the pros and cons of online physician ratings, very little systematic work examines the correlation between physicians’ online ratings and their actual medical performance. Using patients’ ratings of physicians at and the Florida Hospital Discharge data, we investigate whether online ratings reflect physicians’ medical performance by means of a two-stage model that takes into account patients’ ratings-based selection of cardiac surgeons. Estimation results show that five-star surgeons are associated with significantly lower mortality rates and are more likely to be selected by sicker patients compared with lower-rated surgeons. In contrast, not accounting for patients’ rating-based selection leads to the opposite outcome: patients treated by five-star surgeons had higher mortality rates than patients treated by surgeons rated below five stars. Further, we find that patients are not naïve: they know how to use different dimensions of online rating information when choosing a surgeon. Our findings suggest that we can trust online physician ratings, at least of cardiac surgeons.
    Keywords: word of mouth, physician ratings, patient selection, quality disclosure
    JEL: L15 I1
    Date: 2014–09
  2. By: Chiara Gigliarano; Ugofilippo Basellini; Marco Bonetti
    Abstract: Evidence suggests that the significantly higher life expectancy levels witnessed over the past centuries are associated with a lower concentration of survival times, both cross-country and over time. The purpose of this work is to study the relationships that exist among models for the evolution of survival distributions, longevity measures, and concentration. We first study relationships between concentration and cohort longevity through empirical comparisons. We then propose a family of survival models that can be used to capture such trends in longevity and concentration across survival distributions.
    Keywords: Survival analysis; Longevity; Gini index; Life tables.
    Date: 2014–09
  3. By: Marcu, Mircea (University of Florida); Knapp, Caprice (University of Florida); Madden, Vanessa (University of Florida); Brown, David (University of Alberta, Department of Economics); Wang, Hua (University of Florida); Sloyer, Phyllis (Florida Department of Health)
    Abstract: Objective: The Children’s Medical Services Network, a carved-out fee-for-service health care delivery system for Florida’s Children with Special Health Care Needs (CSHCN), chose to develop an Integrated Care System (ICS) for its enrollees. The goal of this study is to analyze the effects of the ICS managed care program on the Medicaid expenditures of CSHCN. Data Sources: Administrative data from 3,947 CSHCN enrolled in Florida’s Medicaid program between 2006 and 2008 for two treatment and control counties were included in the analyses. Methods: To account for the unique nature of health care expenditures data, five econometric models were constructed. These models were used to estimate differences in health care expenditures between CSHCN in the reform and control counties before and after the implementation of the ICS controlling for demographic and individual health status. Principal Findings: The ICS program decreased outpatient, inpatient, pharmacy, and total costs. These effects were statistically significant for one of the reform counties. Emergency room costs increased slightly, though not significantly. Among the econometric models, the Generalized Linear Models outperforms the Ordinary Least Squared regressions. Conclusions: This analysis provides evidence that Managed Care programs such as Florida’s ICS have the potential to reduce health care expenditures.
    Keywords: children; medicaid; managed care; health care cost; health econometrics
    JEL: C20 I10 I18
    Date: 2014–09–01
  4. By: Ramesh Govindaraj; Kumari Navaratne; Eleonora Cavagnero; Shreelata Rao Seshadri
    Abstract: This review represents an attempt to bridge the significant knowledge gaps on the private health sector in Sri Lanka, and foster a dialogue on opportunities for collaboration between the government and the private sector. It accomplishes this through a systematic collection and analysis of primary and secondary data on the provision, financing, and regulation of health care services. On health service delivery, the review finds that the private sector: includes a range of providers; focuses primarily on curative and outpatient services rather than preventive services; is heavily dependent on the public sector for its supply of human resources; and is concentrated in urban areas. The quality of health care services in Sri Lanka in both the private and public sectors, while better than in most developing countries, still lags behind those in more advanced countries. There is also little systematic dialogue and collaboration between the public and private sectors. On financing, the review finds that private health expenditure is more than half of total health expenditure, mostly in the form of out-of-pocket payments by households, with clear implications for Sri Lanka's progression toward universal health coverage. On stewardship and regulation, there is a clear and urgent need to bridge the existing gaps in the legal and regulatory framework, and in the enforcement of health regulations applicable to the private sector, as well as to create an enabling environment for more effective private sector participation in the health sector. The review demonstrates that the private health sector in Sri Lanka is a growing force, due both to greater investment from private players as well as greater demand from the population. The review highlights areas where a more effective engagement with the private sector could ensure that Sri Lanka is able to offer its citizens universal access to good quality health service while also stimulating economic growth.
    Keywords: access to health services, accountability, accounting, age structure, aging, ambulatory care, ancillary services, antenatal care, Availability of drugs, blood bank, blood ... See More + pressure, breastfeeding, burden of disease, catastrophic expenditure, Catastrophic Expenditures, child health, Childbirth, childhood vaccination, cleanliness, clinics, communicable diseases, cost of care, cost of health care, deaths, decision making, delivery of services, delivery system, dental surgery, diagnosis, diagnostic services, diagnostic tests, dispensaries, doctors, economic growth, embryo transfer, employment, epidemiological transition, ethical issues, family planning, financial information, general practitioners, Gross Domestic Product, gynecology, health authorities, HEALTH CARE, health care access, health care facility, health care financing, health care institutions, health care policy, health care provider, health care providers, Health Care Provision, health care services, health care system, health clinic, health coverage, health data, Health Database, health expenditure, health expenditures, Health Facilities, health financing, health indicators, health information, health institutions, Health Insurance, health insurance cover, health insurance coverage, health insurance policies, Health Policy, health promotion, health providers, health regulations, health research, health screening, Health Sector, health service, health service delivery, health service provision, health services, health service­delivery, Health Specialist, health status, health system, Health unit, health units, Healthcare, Healthcare Services, Homeopathy, Hospital Beds, hospital care, Hospitals, household budgets, household expenditure, Household Income, Human Development, human resources, human tissues, hygiene, illness, immunization, Income, income countries, independent medical practitioners, inequalities in health care, information system, inpatient care, Insurance, insurance companies, insurance firms, insurance premium, Insurance Premiums, interest rate, iron, laboratory services, laboratory technicians, Laboratory testing, legal framework, life expectancy, life insurance, marketing, medical benefits, medical bills, medical equipment, medical goods, Medical Insurance, medical records, medical services, medical staff, Medical Supplies, medication, medicines, mental health, Ministry of Finance, morbidity, mortality, nonprofit sector, notifiable diseases, nurses, Nursing, Nursing care, Nursing Homes, Nutrition, outcome indicators, outpatient care, outpatient services, PATIENT, Patient Satisfaction, Patients, Pediatrics, Pharmacists, physician, pocket payments, pocket payments by households, Policy Research, postnatal care, preventive care, preventive health services, Primary care, primary health care, Private Financing, private health insurance, Private Health Services, Private Hospital Sector, Private Hospitals, private insurance, private pharmacies, Private Providers, private sector, private sector actors, private sector financing, private sectors, private spending, provision of health care, provision of health services, provision of services, public expenditure, Public Health, Public Health Care, public health care system, public health objectives, public health programs, public health services, public health system, public hospital, public hospitals, public sector, public sectors, public services, quality of care, quality of health, quality of health care, quality of services, quality standards, regulatory framework, rural hospitals, school health, screening, service providers, Share of Health Expenditure, smoking, smoking cessation, Surgery, teaching hospitals, Total Expenditure, transparency, treatments, universal access, vaccination, visits, waste
    Date: 2014–06
  5. By: Ian Anderson
    Abstract: Population growth, an unfinished agenda of communicable diseases and maternal health and nutrition, and the rapid rise of Non-communicable diseases are putting increasing strain on not just the Ministry of Health budget, but also the broader financial position of the government as a whole. These pressures are ultimately financially unsustainable, given current and projected future economic conditions. But many of the health burdens and costs can be avoided, or at least delayed, with good primary and secondary prevention. There are practical options for making health financing in Vanuatu more effective, efficient, equitable, affordable, and accountable. Improving efficiency of public expenditure is a key to achieving this.
    Keywords: Acquired Immunodeficiency Syndrome, addiction, aged, ageing populations, allocative efficiency, babies, basic needs, birth attendants, blindness, both sexes, breast feeding ... See More + burden of disease, cancer, Cardiovascular disease, causes of death, child health, child health services, child mortality, cities, citizens, clinics, communicable diseases, community health, Community Health Services, complications, contraceptive prevalence, deaths, debt, decision making, Demographic factors, demographic trends, developing countries, development assistance, development goals, development objectives, deworming, diabetes, diets, disabilities, disability, disasters, Disparities in Health, dispensaries, doctors, drugs, Early marriage, economic conditions, economic growth, employment, employment opportunities, epidemic, epidemiological transition, essential medicines, expenditures, family planning, fertility, fertility rate, Financial Management, financial position, financial pressures, gender disparity, girls' education, Global Health, Glucose, government finances, Gross domestic product, gross national income, health burden, health care, health centers, health centres, health costs, health effects, HEALTH EXPENDITURE, health facilities, HEALTH FINANCING, health information, health information system, health insurance, Health Organization, HEALTH OUTCOMES, health problems, health risks, health sector, health service, health service delivery, health services, Health Specialist, health system, health workforce, healthy lifestyles, high rate of population growth, HIV, Hospital, hospital buildings, Hospital Services, hospitalization, hospitals, Human Development, Human Immunodeficiency Virus, Human resources, hunger, hypertension, ill health, illness, Immunization, Immunodeficiency, income, inequities, Infant, Infant mortality, infant mortality rate, infant mortality rates, infants, Injuries, Integrated Management of Childhood Illnesses, intervention, large numbers of people, leading cause of death, LEADING CAUSES, Life expectancy, live births, Malaria, married women, maternal health, maternal mortality, maternal mortality rate, measles, medical supplies, medical treatment, medicines, mental health, midwives, migration, Millennium Development Goal, Millennium Development Goals, Ministry of Education, Ministry of Finance, Ministry of Health, modern family, modern family planning, morbidity, Mortality, national budget, national level, natural disaster, Natural disasters, nature of health, neonatal care, newborn, newborn care, newborns, number of women, nurse, nurses, Nutrition, obesity, obstetric care, Official development assistance, old age, patient, patients, physical activity, Physicians, policy decisions, policy makers, Population growth, population growth rate, population pressures, Poverty Reduction, pregnancy, pregnant women, premature death, primary health care, primary school, Program Manager, progress, public expenditure, Public Financial Management, Public health, Public health expenditure, public policy, Purchasing power, Purchasing power parity, reducing maternal mortality, remittances, reproductive age, Reproductive health, Resource allocation, respect, risk factors, rural areas, sanitation, sanitation facilities, scarce resources, school attendance, school children, screening, services for children, sexually transmitted infections, skilled attendance, skilled attendance at delivery, skilled birth attendance, skilled birth attendants, smokers, Social health insurance, spillover, strategic priorities, Tuberculosis, Under-five mortality, UNFPA, universal access, urban areas, urbanization, vaccine coverage, Village Health Workers, vulnerability, vulnerable groups, woman, workers, World Health Organization, young women
    Date: 2014–06
  6. By: Michele Below; Jonathan James; Patrick Nolen
    Abstract: We conduct a field experiment in 31 primary schools in England to test the effectiveness of different temporary incentive schemes, a standard individual based incentive scheme and a competitive scheme, on increasing the choice and consumption of healthy items at lunchtime. The individual scheme has a weak positive effect that masks significantly differential effects by age whereas all students respond positively to the competitive scheme.For our sample of interest, the competivie scheme increases choice of healthy items by 33% and consumption of healthy items by 48%, twice and three times as much as ain the individual incentive scheme, respectively. The positive effects generally carry over to the week immediately following the treatment but we find little evidence of any effects six months later. Our results show that incentives can work, at least temporarily, to increase healthy eating but that there are large differences in effectiveness between schemes. Furthermore it is important to analyse things at the individual level as average effects appear to be masking significant heterogeneous effects that are predicted by the health literature.
    Date: 2014–09–05
  7. By: Igor M. Sheiman (National Research University Higher School of Economics)
    Abstract: Many countries have recently started the search for new payments methods with the specific objective to encourage integration in health care delivery – teamwork of providers, their coordination and continuity of care. This paper suggests the typology of three major integrated payment methods – pay-for-performance, episode based bundled payment and global payment. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of their effects on integration and other dimensions of medical service delivery performance. It is argued that relative to other integrated methods global payment is the most promising method, since it provides incentives for comprehensive organizational changes. The major pre-conditions for global payment implementation are risk bearing in integrated networks, shared savings schemes, performance transparency system, infrastructure for coordination and collaboration. It is also argued that global payment is hard to implement – mostly due to a high probability of excessive financial risks placed on providers in integrated networks. The activities to mitigate these risks are discussed based on the approaches piloted in Russia
    Keywords: medical service integration, integrated payment methods, pay-for-performance, episode based bundled payment, global payment, fundholding.
    JEL: Z
    Date: 2014
  8. By: Sonia Bhalotra; Martin Karlsson; Therese Nilsson
    Date: 2014–04
  9. By: N. Meltem Daysal (JUniversity of Southern Denmark); Mircea Trandafir (University of Southern Denmark); Reyn van Ewijk (Johannes Gutenberg-Universitaet Mainz, Germany)
    Keywords: medical technology, birth, home birth, mortality
    Date: 2014–09–18
  10. By: Paul Makdissi (Department of Economics, University of Ottawa); Myra Yazbeck (School of Economics, The University of Queensland)
    Abstract: When assessing socioeconomic health inequalities researchers often draw upon measures of income inequality that were developed for ratio scale variables. As a result, the use of categorical data (such as self-reported health status) produces rankings that may be arbitrary and contingent to the scaling adopted. In this paper, we develop a method that overcomes this problem by providing conditions for which these rankings are invariant to the scaling function chosen by the researcher. In doing so, we draw on the insight provided by Alkire and Foster (2004) and extend their method to the dimension of socioeconomic inequality exploiting the properties of Wagstaff’s class of indices. We then provide an empirical illustration using the National Institute of Health Survey 2012.
    Date: 2014–09–30
  11. By: Mariana Conte Grand
    Abstract: Disability adjusted life years lost (DALYs) are one of the most usual health outcome metrics in environmental and health assessments and cost-effectiveness or cost/benefit analysis of interventions in those two areas. The methodology for DALYs´ calculation has been evolving under the Global Burden of Disease Project. The objective of this paper is to show in a simple way what lies behind DALYs´ method. The dependence of DALYs´ metric from parameter values and estimates is illustrated using as a base the Fox-Rushby and Hanson (2001) example for depression.
    Date: 2014–09
  12. By: Mark Stabile (University of Toronto)
    Abstract: This paper explores the changing role of government involvement in health care financing policy outside the United States. It provides a review of the economics literature in this area to understand the implications of recent policy changes on efficiency, costs and quality. Our review reveals that there has been some convergence in policies adopted across countries to improve financing incentives and encourage efficient use of health services. In the case of risk pooling, all countries with competing pools experience similar difficulties with selection and are adopting more sophisticated forms of risk adjustment. In the case of hospital competition, the key drivers of success appear to be what is competed on and measurable rather than whether the system is public or private. In the case of both the success of performance-related pay for providers and issues resulting from wait times, evidence differs both within and across jurisdictions. However, the evidence does suggest that some governments have effectively reduced wait times when they have chosen explicitly to focus on achieving this goal. Many countries are exploring new ways of generating revenues for health care to enable them to cope with significant cost growth. However, there is little evidence to suggest that collection mechanisms alone are effective in managing the cost or quality of care.
    Date: 2014–05
  13. By: Wagstaff, Adam; Bilger, Marcel; Buisman, Leander R.; Bredenkamp, Caryn
    Abstract: This paper uses a common household survey instrument and a common set of imputation assumptions to estimate the pro-poorness of government health expenditure across 69 countries at all levels of income. On average, government health expenditure emerges as significantly pro-rich, but there is heterogeneity across countries: in the majority, government health expenditure is neither pro-rich nor pro-poor, while in a small minority it is pro-rich, and in an even smaller minority it is pro-poor. Government health expenditure on contracted private facilities emerges as significantly pro-rich for all types of care, and in almost all Asian countries government health expenditure overall is significantly pro-rich. The pro-poorness of government health expenditure at the country level is significantly and positively correlated with gross domestic product per capita and government health expenditure per capita, significantly and negatively correlated with the share of government facility revenues coming from user fees, and significantly and positively correlated with six measures of the quality of a country's governance; it is not, however, correlated with the size of the private sector nor with the degree to which the private sector delivers care disproportionately to the better-off. Because poorly-governed countries are underrepresented in the sample, government health expenditure is likely to be even more pro-rich in the world as a whole than it is in the countries in this study.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Information Security&Privacy,E-Business,Economic Theory&Research
    Date: 2014–09–01
  14. By: Byela Tibesigwa, Martine Visser and Mintewab Bezabih
    Abstract: This study measures the link between expected health and contextual health uncertainty on sexual behaviours associated with the risk of HIV infection. We extend similar studies on the subject by focusing on contextual factors as a way of explaining individual sexual behaviour in low and high HIV infection areas across sub-Saharan Africa. Overall, we find expected health and contextual health uncertainty to have significant effects on sexual risk taking. These results point to the fact that context is equally important than the widely held view that individual level characteristics (e.g. lack of HIV/AIDS knowledge) contributes to risky sexual practices. These findings give support to UNAIDS ‘know your local epidemic’, as health and uncertainty appear to be background factors shaping sexual behaviours associated with the risk of HIV infection. Thus it becomes paramount to look at the context within which sexual behaviours can be altered.
    Keywords: Contextual factors, Risk Taking, HIV/AIDS, Sexual behaviour, Expected health, Health Uncertainty
    JEL: D1 D8 I10 I15
    Date: 2014

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