nep-hea New Economics Papers
on Health Economics
Issue of 2014‒11‒07
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. A Study on the Implementation of Jampersal Policy in Indonesia By Endang L. Achadi; Anhari Achadi; Eko Pambudi; Puti Marzoeki
  2. Addressing the unemployment-mortality conundrum: Non-linearity is the answer By Giorgio Bonamore; Fabrizio Carmignani; Emilio Colombo
  3. Extending life for people with a terminal illness: a moral right or an expensive death? Exploring societal perspectives By McHugh, Neil; Baker, Rachel; Mason, Helen; Williamson, Laura; van Exel, Job; Deogaonkar, Rohan; Collins, Marissa; Donaldson, Cam
  4. Global issues, local solutions: rethinking wealth and health through the lens of social enteprise By Donaldson, Cam; Roy, Michael; Hill-O'Connor, Clementine; Biosca, Olga; Baker, Rachel; Kay, Alan; Gillespie, Morag; Godwin, Jon; Morgan, Antony; Skelton, Dawn A; Stewart, John; Anderson, Isobel; Docherty, Catherine; Fulford, Heather; Munoz, Sarah-Anne; Teasdale, Simon; Thomson, Hilary
  5. Health Risk Factors among the Older European Populations: Personal and Country Effects By Shoshana Neuman; Tzahi Neuman; Teresa García-Muñoz
  6. Health Spending and Public Pension: Evidence from Panel Data By Yonghong An; Kai Zhao; Rong Zhou
  7. Home care, hospitalizations, and doctor visits By Judite Gonçalves; France Weaver
  8. How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: A discrete choice experiment By KESSELS, Roselinde; VAN HERCK, Pieter; DANCET, Eline; ANNEMANS, Lieven; SERMEUS, Walter
  9. Illness and Health Satisfaction: The Role of Relative Comparisons By Lars Thiel
  10. Life Expectancy and Mother-Baby Interventions. Evidence from A Historical Trial By Sonia Bhalotra; Martin Karlsson; Therese Nilsson
  11. Long term care and capital accumulation: the impact of the State, the market and the family By Canta, Chiara; Pestieau, Pierre; Thibault, Emmanuel
  12. Modelling the Age Dynamics of Chronic Health Conditions: Life-Table-Consistent Transition Probabilities and their Application By Frank T. Denton; Byron G. Spencer
  13. Sustaining Universal Health Coverage in France: A Perpetual Challenge By Helene Barroy; Zeynep Or; Ankit Kumar; David Bernstein
  14. The Early Impact of the Affordable Care Act State-By-State By Amanda E. Kowalski
  15. The Impact of Being Poor During Crisis on Child Health and Cognitive Development in Indonesia By Rosy Wediawaty
  16. The Impact of Displacement on Child Health: Evidence from Colombia's DHS 2010 By Nina Wald
  17. The Reduction of Child Mortality in the Middle East and North Africa: A Success Story By Farrukh Iqbal; Youssouf Kiendrebeogo
  18. Transition to Modern Growth: the Role of Technological Progress and Adult Mortality By Davide Fiaschi; Tamara Fioroni
  19. Turkey on the Way of Universal Health Coverage Through the Health Transformation Program (2003-2013) By Meltem Aran; Claudia Rokx
  20. Universal Maternal Health Coverage? Assessing the Readiness of Public Health Facilities to Provide Maternal Health Care in Indonesia By World Bank; Indonesia National Institute of Research and Development
  21. Vietnam: Learning from Smart Reforms on the Road to Universal Health Coverage By Helene Barroy; Eva Jarawan; Sarah Bales

  1. By: Endang L. Achadi; Anhari Achadi; Eko Pambudi; Puti Marzoeki
    Abstract: Indonesia launched Jampersal in 2011, a nationwide program to accelerate the reduction of maternal and newborn deaths. The program was financed by central government revenues and provided free and comprehensive maternal and neonatal care with an emphasis on promoting institutional deliveries. Jampersal providers were public and enlisted private facilities at the primary and secondary levels. In 2013, the World Bank and the Center for Family Welfare, University of Indonesia conducted a qualitative and quantitative study to assess the implementation and impact of the program in Garut District and Depok Municipality in West Java Province. The study found that Jampersal utilization was highest among women who were least educated, poor, and resided in rural areas. Utilization was also high among women with delivery complications. The study showed Jampersal only had an impact where institutional delivery coverage was still low such as in Garut District. In this district, women were 2.4 times more likely to have institutional deliveries after Jampersal. The finding suggests implementation of Jampersal policy may have to be adjusted according to the utilization pattern for efficiency and effectiveness. The government discontinued Jampersal with the launching of the National Health Insurance Program (JKN) on January 1, 2014. The study?s findings indicate the merit in reevaluating the policy to terminate the program, given that Jampersal helped increase institutional deliveries while voluntary participation in JKN remains low.
    Keywords: access to health care, access to health services, ambulance, Anesthesia, Antenatal Care, birth attendant, birth attendants, C-section, cancer, Center for Health, Cesarean ... See More + Section, Cesarean sections, child health, child health care, child mortality, child-bearing, childbearing, childbirth, clinics, communities, community activities, competencies, complications during pregnancy, Contraception, contraceptives, delivery care, delivery complications, DESCRIPTION, Development Planning, diseases, districts, doctor, doctors, drugs, educated women, elderly, emergency care, exposure to information, families, family members, Family Planning, family planning services, Family Welfare, financial management, first pregnancy, focus group discussions, general practitioners, government support, gynecology, health care, health care facilities, health centers, Health Facilities, Health Financing, Health Insurance, Health Organization, health professional, health providers, Health Research, health risks, health sector, Health Service, health service delivery, Health Service Provision, Health Services, health system, Home Affairs, home deliveries, home visits, Hospital, hospital beds, hospital management, hospital patients, hospital services, hospitals, Households, housing, Human Development, Human Resources, illiteracy, illiteracy rate, illness, immunization, income, indexes, insurance schemes, Intrauterine device, IUD, labor market, lack of knowledge, life expectancy, live births, local governments, low birth weight, marketing, mass media, maternal care, Maternal deaths, Maternal Health, Maternal Health Services, Maternal Mortality, Maternal Mortality Ratio, Maternity Care, medical staff, medical treatment, medicine, midwife, midwifery, Midwives, Military hospitals, military personnel, Millennium Development Goals, Ministry of Health, morbidity, Mortality, Mother, mothers, Multiple pregnancies, National Development, National Health Insurance, national level, neonatal care, neonatal conditions, neonatal health, newborn, newborn health, newborns, Nurses, Nutrition, obstetric complications, occupancy, occupancy rates, Occupation, patient, patient care, patients, Pharmacists, PHO, physicians, pills, policy decisions, Policy Formulation, political support, Postnatal Care, postpartum care, PPM, pregnancies, pregnancy, pregnancy complications, pregnant women, Primary Care, primary school, Probability, progress, Provider Payment, Public Health, public hospitals, qualitative approach, quality assurance, quality of care, reducing maternal mortality, referral services, referral system, rural area, rural areas, school years, secondary school, secondary schools, service delivery, service delivery points, service provider, service providers, Service Provision, service quality, service utilization, Skilled birth attendance, skilled birth attendants, Social Health Insurance, Socialization, Socioeconomic Status, Specialist, specialists, Spouse, surgery, Sustainable Development, traditional birth attendants, transportation, UNFPA, United Nations Population Fund, urban area, urban areas, vaginal delivery, villages, woman, women of child-bearing age, women of childbearing age, workers
    Date: 2014–09
  2. By: Giorgio Bonamore; Fabrizio Carmignani; Emilio Colombo
    Abstract: The effect of unemployment on mortality is the object of a lively literature. However, this literature is characterized by sharply conflicting results. We revisit this issue and suggest that the relationship might be non-linear. We use regional (NUTS 2) data from 23 European countries to estimate a multivariate regression of mortality. The estimating equation allows for a quadratic relationship between unemployment and mortality. We control for various other determinants of mortality at regional and national level and we include region-specific and time-specific fixed effects. The model is also extended to account for the dynamic adjustment of mortality and possible lagged effects of unemployment. We find that the relationship between mortality and unemployment is U shaped. In the benchmark regression, when the unemployment rate is low, at 3%, an increase by one percentage point decreases average mortality by 0.7%. As unemployment increases, the effect decays: when the unemployment rate is 8% (sample average) a further increase by one percentage point decreases average mortality by 0.4%. The effect changes sign, turning from negative to positive, when unemployment is around 17%. When the unemployment rate is 25%, a further increase by one percentage point raises average mortality by 0.4%. Results hold for different causes of death and across different specifications of the estimating equation. We argue that the non-linearity arises because the level of unemployment affects the psychological and behavioural response of individuals to worsening economic conditions.
    Keywords: unemployment, economic crisis, mortality, Europe
    JEL: I15 J64
    Date: 2014–10
  3. By: McHugh, Neil (Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK); Baker, Rachel (Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK); Mason, Helen (Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK); Williamson, Laura (Institute for Applied Health Research, Glasgow Caledonian University, UK); van Exel, Job (Institute of Health Policy & Management, Erasmus University, Rotterdam, Netherlands); Deogaonkar, Rohan (Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK); Collins, Marissa (Institute for Applied Health Research, Glasgow Caledonian University); Donaldson, Cam (Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK)
    Abstract: Health systems typically apply cost-utility frameworks in response to the moral dilemma of how best to allocate scarce health care resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to 'special cases' which enable the value attached to certain health benefits to be considered. Recent debate and research has focussed on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK. Q methodology was used to elicit societal perspectives from a purposively selected sample of data-rich respondents. Participants ranked 49 statements of opinion (developed for this study), onto a grid, according to level of agreement. These 'Q sorts' were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals' Q sorts). Analysis yielded an interpretable three factor solution. These rich, shared narratives can be broadly summarised as: i) 'a population perspective – value for money, no special cases', ii) 'an individual perspective – value of life, not cost', iii) 'a mixed perspective – value for money, individual values and the quality of life and death'. Ethical and policy implications emanate from the shared accounts as they reveal that the main philosophical positions that have long dominated debates on the just allocation of resources have a basis in public opinion. However, the existence of certain moral positions does not ethically imply, and pragmatically cannot mean, all are translated into policy. Our findings highlight normative tensions and the importance of critically engaging with these normative issues rather than adopting a procedural approach to public policy. Furthermore, it is necessary to understand the extent to which these perspectives are held in society and how they relate to specific questions of resource allocation, wider social value orientations and other characteristics.
    Keywords: 2014-09
    Date: 2014–09
  4. By: Donaldson, Cam (Yunus Centre for Social Business & Health, Glasgow Caledonian University); Roy, Michael (Yunus Centre for Social Business & Health, Glasgow School for Business & Society, Glasgow Caledonian University); Hill-O'Connor, Clementine (Yunus Centre for Social Business & Health, Glasgow School for Business & Society, Glasgow Caledonian University); Biosca, Olga (Yunus Centre for Social Business & Health, Glasgow School for Business & Society, Glasgow Caledonian University); Baker, Rachel (Yunus Centre for Social Business & Health, Glasgow Caledonian University); Kay, Alan (Yunus Centre for Social Business & Health, Glasgow Caledonian University, Scottish Social Enterprise Academy); Gillespie, Morag (Scottish Poverty Information Unit, Glasgow Caledonian University); Godwin, Jon (Institute for Applied Health Research, Glasgow Caledonian University); Morgan, Antony (School of Health and Life Sciences, Glasgow Caledonian University); Skelton, Dawn A (Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University); Stewart, John (Glasgow School for Business & Society, Glasgow Caledonian University); Anderson, Isobel (School of Applied Social Science, University of Stirling); Docherty, Catherine (Institute for Design Innovation, Glasgow School of Art); Fulford, Heather (Centre for Entrepreneurship, Aberdeen Business School, Robert Gordon University); Munoz, Sarah-Anne (Centre for Rural Health, University of the Highlands and Islands); Teasdale, Simon (Third Sector Research Centre, University of Birmingham); Thomson, Hilary (Medical Research Council Social and Public Health Sciences Unit, University of Glasgow)
    Abstract: The Yunus Centre for Social Business & Health was opened by Nobel Peace Laureate, Professor Muhammad Yunus, in June 2010. In short, the Centre aims to build a research portfolio in the broad area of "social business as a public health intervention", thus working on the cutting edges of (and interfaces between) public health research, social science and research applied to the "Third Sector"‟. Staff and PhD students come from disciplines such as mainstream economics, health economics, sociology and social policy, anthropology, international finance, development and politics. A central part of the Centre's work involves researching the impact of Professor Yunus' ideas, particularly in the context of disadvantaged communities in advanced economies. In this respect, two main programmes of work are being pursued: - "microcredit, health and wellbeing"; and - "social enterprise3, health and wellbeing". In this paper, we discuss the Centre's planned research programme in the latter area, although many issues (e.g. of study design and measurement) cut across the two. What is described here is a programme that has been put together by a group of people from the social enterprise sector and from various disciplines (statistics, history, geography, public health, art and design, in addition to those mentioned above) and subject areas (active ageing, homelessness, entrepreneurship, Third Sector) within Universities, across Scotland. The importance of placing this proposed research in a health economics working paper series is that (a) it has been funded by the UK's Medical research Council and Economic & Social Research Council to the tune of £1.96m, and (b) although many of the arguments are well-rehearsed in other fields, it would be portrayed as offering a new branch of health economics. Given that the research programme has just commenced, it seemed worthwhile to submit the basics of the research proposed to the scrutiny of our health economics colleagues. The originality of this research programme is a product of the range of interests and fields of expertise represented in this collective, hopefully creating a new scientific and research interface, that of "social enterprise as a public health and wellbeing intervention". What this then offers each part of the collaboration is as follows: - for social enterprise, we offer a new way of thinking about how this sector views itself and measures success; - for public health science and practice, we propose a genuine "upstream" route to health creation amongst the most deprived communities; and - for economics and other social sciences, coalescing around a grand "cost-benefit analysis" of the impact of social enterprise on poverty, isolation, ill-health and well-being will offer new and enduring frameworks for evaluating future activities, not only of this nature but also, hopefully, more broadly in the Third and Public Sectors.
    Keywords: 2014-08
    Date: 2014–08
  5. By: Shoshana Neuman (Bar-Ilan University); Tzahi Neuman; Teresa García-Muñoz
    Abstract: It is now common to use the individual's self-assessed-health-status (SAHS), which expresses her/his holistic 'internal' view, as a measure of health. The use of SAHS is supported by numerous studies that show that SAHS is a better predictor of mortality and morbidity than medical records. The 2011 wave of the rich Survey of Health Aging and Retirement Europe (SHARE) is used for the exploration of the full spectrum of factors behind the health-status in 16 European countries, using 23,800 observations. Special emphasis is given to the examination of behavioral risk factors (smoking, alcohol consumption and obesity) – both at the individual and country levels. The main findings are: (i) the estimation of self-assessed-health-status regressions provides clear evidence of the effects of the three behavioral risk factor on the individual’s subjective rating of her/his health status, beyond and above the obvious effects of health conditions and of socio-economic personal variables; (ii) the second, more innovative, finding is related to the effects of country-specific risk factors (country-level measures of smoking, obesity, and alcohol consumption) on the subjective-health of the residents, beyond and above those of the personal characteristics. Adapting the technique presented in Oswald and Wu (2010), country effects derived from the SAHS regression are examined for correlations with a set of objective country macro measures. They include: share of smokers on a daily/regular basis; alcohol consumption (per-capita liters per year); share of obese individuals in the country. It appears that country-level smoking and obesity affect negatively aggregate country SAHS, while alcohol consumption has no effect. It is therefore not only ‘who you are’ that affects the subjective rating of health, but also ‘in which country you live’. Overall, our findings indicate that what is true for the individual is also true for the country as a whole: both individual and country-level (obesity and smoking) risk factors affect subjective-health and the two levels of behavioral risks accumulate and reinforce the subjective-health assessment. This seems to be at odds with the ‘Easterlin Paradox’ that emphasizes within country individual effects and denies cross-country effects, and suggests the economic cost-effectiveness of preventive obesity and smoking treatment.
  6. By: Yonghong An (Texas A&M University); Kai Zhao (University of Connecticut); Rong Zhou (University of Connecticut)
    Abstract: This paper empirically investigates the determinants of aggregate health expenditure in a panel of OECD countries from 1980-2005. We differ from most existing studies by testing some new determinants motivated by recent theoretical advances in the literature. We find that a one percentage increase in public pension payments per elderly person leads to approximately a 1=3 percentage increase in aggregate health spending, and this effect is significant and robust across a variety of model specications. A back of the envelope calculation based on this estimate suggests that the expansion of the public pension program on average accounts for approximately over one fifth of the rise in aggregate health expenditure as a share of GDP in the set of OECD countries during 1980-2005. In addition, we find that the estimated effect of GDP per capita in our model ranges from 0.66 to 0.80, which is consistent with the results from some recent studies, and thus further reinforces the finding in the literature that health care is not a luxury good. Finally, our results show that the political factors do not significantly affect aggregate health expenditure, though they have been found to be important for understanding public health spending in existing studies.
    Keywords: Aggregate Health Expenditure, Public Pension, Labor Supply
    JEL: H51 I1
    Date: 2014–09
  7. By: Judite Gonçalves; France Weaver
    Abstract: This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effects. We instrument canton-level home care use with home care prices and education expenditures. While medically-related home care reduces length of stay below 60 days, non-medically-related home care increases stays beyond 10 days. Non-medically-related home care also reduces the number of GP visits. However, all these effects are small. Both types of home care tend to have stronger effects among the 65+ and those with informal care available in their household.
    Keywords: Home care; Hospitalizations; Doctor visits; Instrumental variables
    Date: 2014–09
  8. By: KESSELS, Roselinde; VAN HERCK, Pieter; DANCET, Eline; ANNEMANS, Lieven; SERMEUS, Walter
    Abstract: Background: Many developed countries are reforming healthcare payment systems in order to limit costs and improve clinical outcomes. Knowledge on how different groups of professional stakeholders trade off the merits and downsides of healthcare payment systems is limited. Methods: Using a discrete choice experiment we asked a sample of physicians, policy makers, healthcare executives and researchers from Canada, Europe, Oceania, and the United States to choose between profiles of hypothetical outcomes on eleven healthcare performance objectives which may arise from a healthcare payment system reform. We used a Bayesian D-optimal design with partial profiles, which enables studying a large number of attributes, i.e. the eleven performance objectives, in the experiment. Results: Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe. Finally, (c) such payment reform more closely aligns the overall fulfillment of objectives between stakeholders such as physicians versus healthcare executives. Conclusions: Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders choose in some health systems, but not in others. Future studies, including the use of random samples, should examine the contextual factors that explain such differences in values and buy-in.
    Keywords: Healthcare payment systems, Healthcare performance objectives, Physician incentive structures, Health policy reform, Discrete choice experiment
    JEL: C90 C99 E61 I11 I18 O57
    Date: 2014–10
  9. By: Lars Thiel
    Abstract: This paper investigates the role of relative comparisons in health status for individual health satisfaction. Previous research stresses the importance of interdependencies in subjective well-being and health arising from positional preferences and status e ects, social health norms, and comparison processes. Using representative longitudinal data from a German population survey, we estimate empirical health satisfaction models that take these interrelations into account. We find that positional preferences and social status effects in the context of health are rather unimportant for individual health satisfaction. Furthermore, higher levels of reference-group illness can temporarily alleviate the adverse impact of one's own illness on health satisfaction. This is also the first study to show the relevance of health-related upward and downward comparisons for health perception in the general population. The results suggest that upward comparisons are more important than downward comparisons and that becoming sicker than the reference group worsens health satisfaction.
    Keywords: Health satisfaction, physical illness, social status, social norms, social comparisons
    JEL: D03 I10
    Date: 2014
  10. By: Sonia Bhalotra; Martin Karlsson; Therese Nilsson
    Abstract: This paper investigates the potential of maternal and infant health programs to improve the life expectancy of women and children. We study a program trialed 1931-33 in seven Swedish medical districts, assembling individual data from parish records and aggregate data from annual reports of medical districts. We estimate short run program effects on maternal and infant mortality. In addition, we track individuals exposed to the program together with unexposed individuals from neighbouring birth-cohorts so as to establish whether they survive to age 40, an age by which maternal mortality of the offspring is determined, and age 75, an age by which 35% of the sample cohorts had died. We find significant impacts of exposure to the infant program on infant survival and on the probability of surviving to ages 5, 40 and 75. The estimates suggest that the impact on life expectancy is largely driven by infant survival. The program narrowed health inequalities. Its impact was systematically larger among children born out of wedlock, who also exhibit higher baseline rates of infant mortality. There is no evidence of endogenous fertility responses or of selection into the program on a range of relevant observables. The evidence is consistent with parents reinforcing treatment by the public health intervention. We are unable to identify any impacts of program components delivered to mothers.
    Keywords: Maternal care; infant care; early life interventions; barker hypothesis; program evaluation; Sweden
    JEL: I15 I18 H41
    Date: 2014–09
  11. By: Canta, Chiara; Pestieau, Pierre; Thibault, Emmanuel
    Abstract: The rising level of long-term care (LTC) expenditures and their financing sources are likely to impact savings and capital accumulation and henceforth the pattern of growth. This paper studies how the joint interaction of the family, the market and the State influences capital accumulation in a society in which the assistance the children give to dependent parents is triggered by a family norm. We find that, with a family norm in place, the dynamics of capital accumulation differ from the ones of a standard Diamond (1965) model with dependence. For instance, if the family help is sizeably more productive than the other LTC financing sources, a pay-as-you-go social insurance might be a complement to private insurance and foster capital accumulation.
    Date: 2014–09–24
  12. By: Frank T. Denton; Byron G. Spencer
    Abstract: Background: Surveys of chronic health conditions provide information about prevalence but not about the incidence and the process of change within the population. Objective: We show how the “age dynamics” of chronic conditions ‐‐ the probabilities of contracting the conditions at different ages, of moving from one chronic conditions state to another, and of dying ‐‐ can be inferred from prevalence data for those conditions that can be viewed as irreversible. Methods: Transition probability matrices are constructed for five‐year age groups, representing the age dynamics of health conditions for a stationary population. We illustrate the application of the matrices by simulating the age/health path of an initially healthy cohort. Results and conclusion: Surveys of chronic conditions provide valuable information about prevalence rates; we show that such surveys can be made even more valuable by allowing the calculation of the transition probabilities that define the chronic conditions age dynamic process. We report the results of simulations based on transition probabilities that we have derived, and note the general applicability of the methods.
    Keywords: chronic health conditions, transition probabilities, age dynamics
    Date: 2014–10
  13. By: Helene Barroy; Zeynep Or; Ankit Kumar; David Bernstein
    Abstract: While universal health coverage (UHC) offers a powerful goal for a nation, all countries-irrespective of income are struggling with achieving or sustaining UHC. France is a high-income country where HC is in effect universal. Health-related costs are covered by a mix of mandatory social health insurance (SHI) and private complementary schemes, while benefit packages are comprehensive, uniform, and of good quality. France provides some of the highest financial protection among countries in the Organization for Economic Co-operation and Development (OECD). Still, under pressure to sustain UHC without compromising equity of access, the system has been fine-tuned continually since inception. Much can be learned from France's experience in its reforms toward better fiscal sustainability, equity, and efficiency. The main purpose of the study is to assess major challenges that France has faced for sustaining UHC, and to share its experiences and lessons in addressing system bottlenecks to benefit less developed countries as they embark on the path to UHC.
    Keywords: ability to pay, access to health care, access to health services, accessibility of care, acute care, alcohol consumption, alcoholism, allocative efficiency, ambulatory ... See More + care, ambulatory sector, basic health services, breast cancer, burden of disease, Cancer patients, capital income, cardiovascular diseases, care techniques, catastrophic health spending, cervical cancer, choice of provider, chronic diseases, chronically ill patients, clinical guidelines, clinical quality, clinician, clinicians, clinics, competencies, cost control, cost of health care, cost of services, cost sharing, cost-effectiveness, cost-efficiency, deaths, decision making, delivery system, dental care, Dental health, Dental health care, diabetes, diagnosis, Diagnostic services, direct costs, doctors, drug consumption, drugs, emergency care, enrollees, entitlement, expenditure control, Fee for Service, fee-for-service, financial consequences, financial impact, financial incentives, financial protection, financial resources, financing health care, Flat Rate, free choice, gambling, general practice, general practitioners, global budgets, growth of health expenditure, HEALTH CARE, health care costs, Health care delivery, health care facilities, Health Care Financing, health care needs, health care networks, health care policies, health care policy, health care professionals, health care providers, health care provision, health care resources, health care services, Health Care Spending, health care system, health care utilization, health centers, HEALTH COVERAGE, Health Economics, health expenditure, Health Expenditure by Source, health expenditure growth, HEALTH EXPENDITURES, Health Financing, HEALTH INEQUALITIES, Health Insurance, health insurance coverage, health insurance funds, health insurance markets, health insurance system, health management, health needs, Health Organization, health outcomes, health policy, health professionals, health promotion, health sector, health service, health service providers, health services, Health Specialist, HEALTH SPENDING, health status, HEALTH SYSTEM, healthcare, high blood pressure, hospital beds, Hospital care, hospital expenditure, hospital management, hospital section, HOSPITAL SECTOR, hospitalisation, hospitalization, Hospitals, Household Income, Human Development, immigrants, income, income countries, Income Distribution, income groups, Indexes, induced demand, information system, insurance contracts, insurance coverage, insurance premiums, insurers, life expectancies, life expectancy, low income, medical activities, medical care, medical devices, medical fees, medical information, medical personnel, medical staff, medication, mental illness, Ministries of Health, monitoring mechanisms, morbidity, mortality, National Health, National Health Insurance, National Health Insurance Fund, nurses, nursing, nursing homes, Nutrition, Outpatient care, patient, patient outcomes, patients, pharmaceutical companies, pharmaceutical industry, physician, physicians, physiotherapists, physiotherapy, pocket payments, poliomyelitis, pregnant women, prescription drug, prescriptions, preventive care, prices of health care, PRIMARY CARE, private clinics, private hospitals, private insurance, private sector, private sectors, Probability, psychiatrists, Public Health, public hospital, public hospital staff, public hospitals, public insurance, Public Policy, public sector, public spending, quality of care, Refugees, rehabilitation, reimbursement rates, screening, SERVICE DELIVERY, sickness funds, smoking, Social Health Insurance, social insurance, social insurance system, social security, Social Security Financing, surgery, treatments, tuberculosis, unemployment, use of health services, vaccination, visits, Workers, working conditions
    Date: 2014–06
  14. By: Amanda E. Kowalski (Cowles Foudation, Yale University)
    Abstract: I examine the impact of state policy decisions on the early impact of the ACA using data through the first half of 2014. I focus on the individual health insurance market, which includes plans purchased through exchanges as well as plans purchased directly from insurers. In this market, at least 13.2 million people were covered in the second quarter of 2014, representing an increase of at least 4.2 million beyond pre-ACA state-level trends. I use data on coverage, premiums, and costs and a model developed by Hackmann, Kolstad, and Kowalski (2013) to calculate changes in selection and markups, which allow me to estimate the welfare impact of the ACA on participants in the individual health insurance market in each state. I then focus on comparisons across groups of states. The estimates from my model imply that market participants in the five "direct enforcement" states that ceded all enforcement of the ACA to the federal government are experiencing welfare losses of approximately $245 per participant on an annualized basis, relative to participants in all other states. They also imply that the impact of setting up a state exchange depends meaningfully on how well it functions. Market participants in the six states that had severe exchange glitches are experiencing welfare losses of approximately $750 per participant on an annualized basis, relative to participants in other states with their own exchanges. Although the national impact of the ACA is likely to change over the course of 2014 as coverage, costs, and premiums evolve, I expect that the differential impacts that we observe across states will persist through the rest of 2014.
    Keywords: Health reform, Adverse selection, Markups, Direct enforcement, Exchange, Community rating, Guaranteed issue
    JEL: H75 I11
    Date: 2014–10
  15. By: Rosy Wediawaty (Directorate of State Finance and Monetary Analysis (BAPPENAS))
    Abstract: Shocks, such as economic crisis, that occur in the critical periods of children development are believed to have lasting effects. Using data from Indonesia Family Life Survey (IFLS), this study investigates the timing issue and whether Asian Financial 1997/1998 crisis has impacts on child health and cognitive development in Indonesia. By running pooled cross-section model, this study finds that generally crisis has not had negative impacts on child health and cognitive development for those who were poor. Yet, in urban areas, crisis struck harder and negatively affected the cognitive score of specific age groups. This study also finds that the critical periods of children development might be in the first two years of early life. Expenditure levels and mothers’ education are strong predictors for child health and cognitive development.
    Keywords: Crisis, Child Health, Cognitive Development, Indonesia
    JEL: I15 O15 O53
    Date: 2014–10
  16. By: Nina Wald
    Abstract: This paper investigates the causal impact of displacement on health outcomes for Colombian children of different age cohorts. It uses the Colombian Demographic and Health Survey 2010, which provides both a number of health outcomes and information about displacement of households. Two different empirical strategies are employed to identify the impact of displacement on child health, namely a linear regression model and propensity score matching. In order to capture different dimensions of health, four health outcomes are used as dependent variables: (i) height-for-age z-scores; (ii) subjective health status; (iii) affiliation to a health insurance; and (iv) having a health problem last month. Overall, a negative relationship between displacement and child health is documented. In line with findings from African and Asian countries, displacement increases the likelihood for malnutrition for young children and primary school children. Moreover, being displaced leads to a lower subjective health status for children from all age cohorts. Yet, displaced children are not affected by health problems significantly more often than non-displaced children. Last, but not least, displaced children from all age cohorts are significantly less likely to have health insurance.
    Keywords: Child Health, Displacement, Armed Conflict, Colombia, Propensity Score Matching
    JEL: C21 D19 I13 O54
    Date: 2014
  17. By: Farrukh Iqbal; Youssouf Kiendrebeogo
    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.
  18. By: Davide Fiaschi; Tamara Fioroni
    Abstract: This paper presents a model inspired by the Unified Growth Theory, where reductions in adult mortality together with improvements in technological progress are the deep causes of the transition from a Traditional (Malthusian) Regime to a Pre-Modern Regime, characterized by the accumulation of fixed capital only, and finally, to a Modern Regime, characterized by the joint accumulation of both fixed and human capital. A calibrated version of the model is able to reproduce the dynamics of the UK economy in the period 1541-1914, matching both the periods of transition and the pattern of main macroeconomic variables. UK growth before the mid-nineteen th century ap- pears to be mainly due to technological progress, while thereafter, the decline in adult mortality and factors accumulation played the major role. Finally, fertility decline during the nineteenth century has only a marginal impact on growth because it is more than balanced by the increase in adult survival.
    Keywords: Unified Growth Theory, Human Capital, Adult mortality, Nonlinear Dynamics, Endogenous Fertility, Industrial Revolution.
    JEL: O10 O40 I20
    Date: 2014–09–01
  19. By: Meltem Aran; Claudia Rokx
    Abstract: Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey?s health system has few, if any, parallels in scope and speed. Before the reforms, Turkey?s aggregate health indicators lagged behind those of OECD member states and other middle-income countries. The health financing system was fragmented, with four separate insurance schemes and a ?Green Card? program for the poor, each with distinct benefits packages and access rules. Both the Ministry of Labor and Social Security and Ministry of Health (MoH) were providers and financiers of the health system, and four different ministries were directly involved in public health care delivery. Turkey?s reform efforts have impacted virtually all aspects of the country?s health system and have resulted in the rapid expansion of the proportion of the population covered and of the services to which they are entitled. At the same time, financial protection has improved. For example, (i) insurance coverage increased from 64 to 98 percent between 2002 and 2012; (ii) the share of pregnant women having four antenatal care visits increased from 54 to 82 percent between 2003 and 2010; and (iii) citizen satisfaction with health services increased from 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic improvements there is still space for Turkey to continue to improve its citizens? health outcomes, and challenges lie ahead for improving services beyond primary care. The main criticism to reform has so far come from health sector workers; the future sustainability of reform will rely not only on continued fiscal support to the health sector but also the maintenance of service provider satisfaction.
    Keywords: access to health care, access to health care services, access to health services, administrative control, allocative efficiency, antenatal care, Capita Health Expenditure ... See More + child mortality, Childbirth, citizen, citizens, communicable diseases, deaths, Debt, delivery system, demand for health, demand for health services, doctors, Economic growth, economic resources, emergency vehicles, Employment, expenditures, financial protection, financing of health care, focus group discussions, fragmented financing system, General practitioners, Health Affairs, health care, Health Care Costs, health care delivery, health care expenditures, health care facilities, health care providers, health care sector, health care services, health care system, health centers, HEALTH COVERAGE, Health Data, health delivery, health delivery system, Health Expenditure, Health expenditure growth, Health Expenditure per capita, health expenditures, Health facilities, health finance, health financing, health financing system, health indicators, health infrastructure, health insurance, health insurance scheme, Health Insurance System, Health Organization, health outcomes, Health Planning, Health Policy, health posts, health professionals, Health Project, health reform, health reforms, health risks, health sector, health sector reform, health sector workers, health services, health spending, Health status, health status indicators, health supply, health system, Health System Efficiency, Health Systems, Health Systems in Transition, health workers, health workforce, Health-Care, Health-Care System, Health-Financing, Healthcare Spending, hospital autonomy, hospital beds, Hospital management, Hospital Sector, hospitals, HR, human development, human resources, illness, Immunization, income, income countries, income households, individual health, induced demand, infant, infant mortality, infant mortality rate, inservice training, insurance, insurance coverage, insurance schemes, integration, labor market, level of health spending, life =expectancy, life expectancy, life expectancy at birth, live births, local authorities, maternal health, maternal health services, medical centers, Medical Policy, medical school, medical specialties, medicines, Midwives, Ministry of Health, morbidity, mortality, National Health, National Health Insurance, National Health Policy, Newborn Health, nurses, Nutrition, old system, outpatient services, paradigm shift, paramedics, parliamentary seats, party platform, patient, patient care, Patient Cost, patient satisfaction, patients, pharmaceutical expenditures, pharmacists, pharmacy, physician, physicians, pocket payments, policy change, policy decisions, policy goals, policy makers, Policy Research, political power, political turmoil, popular support, Pregnancy, pregnant women, prescription drugs, preventive health services, primary care, primary health care, primary health care facilities, private insurance, private pharmacies, private sector, private sectors, professional associations, progress, provision of health care, Public Expenditure, public health, public health care, public health expenditures, public health system, Public Hospital, Public Hospitals, public providers, public sector, public service, public support, purchaser-provider split, purchasing power, purchasing power parity, quality assurance, quality of care, quality of services, rural areas, scientific evidence, series of meetings, service delivery, service provider, service provision, service quality, service utilization, Social Insurance, Social Policy, Social Security, social security schemes, socioeconomic development, socioeconomic status, State Planning, supply of health care, Sustainable Development, Trade Unions, Under-five mortality, urban centers, workers
    Date: 2014–09
  20. By: World Bank; Indonesia National Institute of Research and Development
    Keywords: Health Monitoring and Evaluation Health, Nutrition and Population - Adolescent Health Health Systems Development and Reform Disease Control and Prevention Health, Nutrition and Population - Population Policies
    Date: 2014–07
  21. By: Helene Barroy; Eva Jarawan; Sarah Bales
    Abstract: Universal Health Coverage is a powerful framework for a nation aiming to protect their population against health risks. However, countries face multiple challenges in implementing, achieving and sustaining UHC strategies. Sharing and learning from diverse country experiences may enable to foster global and country progress toward that goal. The study seeks to contribute to the global effort of sharing potentially useful lessons to address policy concerns on the design and implementation of UHC strategies in LMICs. Vietnam is one of the LMICs that have taken relatively quick and effective actions to expand health coverage and improve financial protection in the last two decades. The country study, first, takes stock of UHC progress in Vietnam, examining both the breadth and the depth of health coverage and assessing financial protection and equity outputs (chapter one). Chapter two includes an in-depth analysis of some of the major success strategies and policy actions that the country took to expand health coverage and financial protection for all, including for the poor. Chapter three focuses on some of the UHC-related challenges that the country faces in pursuing expansion and sustaining UHC. Vietnam?s experience suggests that, moving toward greater UHC outputs, the system must be constantly adjusted, and that UHC strategies must be adaptive, those used in the past to cover the formal sector and the poor may turn out inadequate to reach the uninsured in the informal sector.
    Keywords: ability to pay, access to health care, access to health services, access to services, Administrative costs, aging, antenatal care, artificial limbs, basic health care ... See More + blood pressure, blood tests, Budget Law, cancer, capitation, capitation payment, capitation system, Catastrophic Health Expenditure, catastrophic health spending, central budget, child health, child health services, citizens, clean water, Clinical laboratory, Clinical practice, communicable diseases, contribution rate, contribution rates, cost control, cost sharing, cost-effectiveness, costs of care, curative health care, debt, delivery system, demand for services, Dental care, developing countries, development plans, diabetes, Dialysis, disabilities, disadvantaged groups, disease control, drug list, drugs, early detection, economic growth, Emergency services, employment, entitlement, epidemics, expenditures, families, Family Planning, Fee for Service, fee schedule, financial incentives, financial protection, financial resources, Financial Risk, food safety, global effort, health care, health care costs, health care coverage, Health Care Financing, Health Care Provider, health care services, health care system, Health Care Systems, health centers, HEALTH COVERAGE, health expenditure, Health Expenditures, health facilities, health financing, health financing system, Health Insurance, health insurance funds, Health Insurance Program, health insurance scheme, Health Organization, health outcomes, Health Policy, health professionals, health promotion, Health Purchaser, health reforms, health risks, Health sector, health service, health service delivery, health services, Health Specialist, health spending share, Health Strategy, health system, health system performance, health system reform, Health Systems, health workers, health workforce, Healthcare, Healthcare System, hearing aids, hepatitis B, HIV/AIDS, hospital autonomy, hospital services, hospitals, household expenditure, human resources, hypertension, Immunization, incidence analysis, income, income countries, income elasticity, income groups, induced demand, infant, infant mortality, infectious disease control, infectious diseases, Informal Payments, informal sector, injuries, inpatient admission, inpatient hospital, inpatient hospital services, insurance package, insurance premiums, insurance schemes, Integration, laws, leprosy, live births, living standards, long-term care, medical care, medical care costs, medical costs, medical doctors, medical education, medical equipment, medical examination, Medical Goods, medical services, medical technologies, medical training, medicines, mental illness, Ministry of Health, morbidity, mortality, national development, national Health, national Health Insurance, national policies, nurses, nursing, Nutrition, Outpatient services, patient, patient demand, patients, pediatrics, pharmacists, physician, physicians, Policy Process, Policy Research, population groups, preventive care, preventive health care, primary care, private sector, private services, Private Spending, progress, Prostitution, Provider Payment, Public Expenditure, Public Health, public health programs, Public Health Spending, Public Hospital, public hospitals, Public Policy, public sector, public spending, purchaser-provider split, quality of care, quality of health, quality of health care, Referrals, rehabilitation, reproductive health, Resource Allocation, risk adjustment, screening, smoking, Social Affairs, Social Health Insurance, social insurance, social mobilization, Social Security, social security benefits, social welfare, Sustainable Development, tuberculosis, under-five mortality, universal health insurance coverage, use of health services, vaccination, visits, workers, World Health Organization
    Date: 2014–08

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