nep-hea New Economics Papers
on Health Economics
Issue of 2014‒11‒12
nine papers chosen by
Yong Yin
SUNY at Buffalo

  1. Bound estimator of HIV prevalence: Application to Malawi By Tomoki Fujii; Denis H.Y. Leung
  2. Education and Health Knowledge: Evidence from UK Compulsory Schooling Reforms By David W. Johnston; Grace Lordan; Michael A. Shields; Agne Suziedelyte
  3. Evidence and Prospects of Shortage and Mobility of Medical Doctors: A Literature Survey By Driouchi, Ahmed
  4. Fidelity Networks and Long-Run Trends in HIV/AIDS Gender Gaps By Pongou, Roland; Serrano, Roberto
  5. Health Effects of Containing Moral Hazard: Evidence from Disability Insurance Reform By Pilar Garcia-Gomez; Anne C. Gielen
  6. Healthcare Delivery and Stakeholder's Satisfaction under Social Health Insurance Schemes in India: An Evaluation of Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) By Sukumar Vellakkal; Shikha Juyal; Ali Mehdi
  7. Implementing HIV Prevention in the Context of Road Construction: A Case Study from Guangxi Zhuang Autonomous Region in the People’s Republic of China By Asian Development Bank (ADB); ; ;
  8. Maternal and Child Survival: Findings from five countries experience in addressing maternal and child health challenges By Rafael Cortez; Seemeen Saadat; Sadia Chowdhury; Intissar Sarker
  9. Maternal Employment, Childcare and Childhood Overweight during Infancy By Thérèse McDonnell; Orla Doyle

  1. By: Tomoki Fujii (School of Economics, Singapore Management University, Singapore, 178903); Denis H.Y. Leung (School of Economics, Singapore Management University, Singapore, 178903)
    Abstract: Objective: To find lower and upper bounds of HIV prevalence in Malawi under mild and intuitive assumptions to assess the importance of the refusal issue in the estimation of HIV prevalence. Methods: We derive bounds based on the following two key assumptions: (i) Among those who have never taken an HIV test before, those who refuse to take an HIV test (hereafter “refusers”) have at least as much risk to be HIV positive as those who participate in the HIV test, and (ii) among the refusers, those who have a prior testing experience are at least as likely to be HIV positive as those who have no prior experience. We compute the bounds using the Malawi Demographic and Health Survey and a longitudinal data set with a HIV testing component collected in the Malawi Diffusion and Ideational Change Project disaggregated by the sex, urban/rural areas, and three regions of Malawi. Findings: The bounds of HIV prevalence vary substantially across geographic and demographic groups. In particular, the bounds for males are tighter than those for females and the bounds for the Northern region are also tighter than those for other regions. There is no substantial difference in the width of bounds between the rural and urban populations. Conclusion: Bounds are useful for assessing the influence of refusal bias without the need for strong assumptions. Refusal issue is less of a concern if bounds are tight. However, when bounds are wide, refusal issue may be important.
    Keywords: Bias; Demographic and Health Surveys; Malawi; Missing data; Non-response; Refusals; Surveys
    Date: 2014–10
  2. By: David W. Johnston; Grace Lordan; Michael A. Shields; Agne Suziedelyte
    Abstract: We investigate if there is a causal link between education and health knowledge using data from the 1984/85 and 1991/92 waves of the UK Health and Lifestyle Survey (HALS). Uniquely, the survey asks respondents what they think are the main causes of ten common health conditions, and we compare these answers to those given by medical professionals to form an index of health knowledge. For causal identification we use increases in the UK minimum school leaving age in 1947 (from 14 to 15) and 1972 (from 15 to 16) to provide exogenous variation in education. These reforms predominantly induced adolescents who would have left school to stay for one additionally mandated year. Naïve ordinary least squares estimates suggest that education significantly increases health knowledge, with a one-year increase in schooling increasing the health knowledge index by 15% of a standard deviation. In contrast, estimates from instrumental-variable models show that increased schooling due to the education reforms did not significantly affect health knowledge: a one-year increase in schooling is estimated to decrease the health knowledge index by 0.1% of a standard deviation. This main result is robust to numerous specification tests and alternative formulations of the health knowledge index. Further research is required to determine whether there is also no causal link between higher levels of education - such as post-school qualifications - and health knowledge.
    Keywords: Education, health, knowledge, compulsory schooling, causality
    JEL: I20 I10 I12
    Date: 2014–09
  3. By: Driouchi, Ahmed
    Abstract: Abstract This paper focuses on the shortage in health workforce, its causes and its consequences. The implied mobility is also introduced. Series of issues are introduced to better capture the global prospects facing the health system. A literature review survey on the above dimensions is the main source of information used in this paper. The attained outcomes confirm the existing increasing current and future trends of shortage and mobility of the health workforce with emphasis on medical doctors. The expected consequences on developing countries are discussed in relation to the increasing demand for healthcare but also to the technological changes taking place at the level of the sector and in its environment.
    Keywords: Keywords: Shortage-Labor supply-Backward Bending Labor Supply-Migration-Brain drain
    JEL: I1 J1 J2
    Date: 2014–10–16
  4. By: Pongou, Roland; Serrano, Roberto
    Abstract: More than half of the HIV/AIDS-infected population today are women. We study a dynamic model of (in)fidelity, which explains the HIV/AIDS gender gap by the configuration of sexual networks. Each individual desires sexual relationships with opposite sex individuals. Two Markov matching processes are defined, each corresponding to a different culture of gender relations. The first process leads to egalitarian pairwise stable networks in the long run, and HIV/AIDS is equally prevalent among men and women. The second process leads to anti-egalitarian pairwise stable networks reflecting male domination, and women bear a greater burden. The results are consistent with empirical observations.
    Keywords: Fidelity networks, contagion index, HIV/AIDS, gender gap
    JEL: A1 A10 A13 C7 C73 C78 I1 I12 J1 J16 O1
    Date: 2013–01–13
  5. By: Pilar Garcia-Gomez; Anne C. Gielen (Erasmus University Rotterdam, the Netherlands)
    Abstract: We exploit an age discontinuity in a Dutch disability insurance (DI) reform to identify the health impact of stricter eligibility criteria and reduced generosity. Women subject to the more stringent rule experience greater rates of hospitalization and mortality. A €1,000 reduction in annual benefits leads to a rise of 4.2 percentage points in the probability of being hospitalized and a 2.6 percentage point higher probability of death more than 10 years after the reform. There are no effects on the hospitalization of men subject to stricter rules but their mortality rate is reduced by 1.2 percentage points. The negative health effect on females is restricted to women with low pre-disability earnings. We hypothesize that the gender difference in the effect is due to the reform tightening eligibility particularly with respect to mental health conditions, which are more prevalent among female DI claimants. A simple back-of-the-envelope calculation shows that every dollar reduction in DI is almost completely offset by additional health care costs. This implies that policy makers considering a DI reform should carefully balance the welfare gains from reduced moral hazard against losses not only from less coverage of income risks but also from deteriorated health.
    Keywords: disability insurance, moral hazard, health, mortality, regression discontinuity
    JEL: I14 H53 I38
    Date: 2014–08–07
  6. By: Sukumar Vellakkal (Indian Council for Research on International Economic Rela); Shikha Juyal (Indian Council for Research on International Economic Rela); Ali Mehdi
    Abstract: This study attempted to evaluate the working of the Central Government HealthScheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) byassessing patient satisfaction as well as the issues and concerns of empanelled privatehealthcare providers.The study is based on a primary survey of 1,204 CGHS and 640 ECHS principalbeneficiaries, 100 empanelled private healthcare providers and 100 officials of theschemes across 12 Indian cities.We have found that patients are reasonably well satisfied with the healthcare servicesof both empanelled private healthcare providers and the dispensaries-polyclinics butare relatively more satisfied with the former than the latter. We also found thatbeneficiaries are willing to pay more for better quality services. Though the schemesprovide comprehensive healthcare services, the beneficiaries incur some out-ofpockethealth expenditure while seeking healthcare. Furthermore, beneficiaries are notin favour of the recent proposal to replace the schemes with health insurance forseveral reasons. The empanelled private healthcare providers are dissatisfied with theterms and conditions of empanelment, especially the low tariffs for their services ascompared to prevailing market rates and the delays in reimbursements from theschemes.We suggest that appropriate efforts be undertaken to enhance the quality of healthcareservice provided in the dispensaries-polyclinics of the CGHS and ECHS as well as toaddress the issues and concerns of empanelled private healthcare providers to ensurebetter healthcare delivery and for a long-term, sustainable public-private partnership
    Keywords: CGHS, ECHS, patient satisfaction, willingness to pay, empanelled private, healthcare providers
    JEL: H30 H51 H53 I19
  7. By: Asian Development Bank (ADB); (East Asia Department, ADB); ;
    Abstract: This case study documents HIV prevention work on the Longbai Expressway in Guangxi in the People’s Republic of China. It describes how to build HIV prevention into existing processes in road construction projects. It also highlights opportunities and constraints for HIV prevention work in the transport context. Finally it brings examples to show that the basic model can be adapted and replicated.
    Keywords: HIV/AIDS, HIV prevention, road construction, transport, road construction workers, PRC, Guangxi, ADB
    Date: 2014–04
  8. By: Rafael Cortez; Seemeen Saadat; Sadia Chowdhury; Intissar Sarker
    Abstract: Considerable progress has been made towards the achievement of the Millennium Development Goals (MDGs) since 1990. Although advances in improving MDG 4 and MDG 5a (reducing child and maternal mortality, respectively) have been made, progress is some countries have been insufficient. While some countries have made substantial gains, others have not. This paper is part of a larger study that aims to address this gap in knowledge. The paper discusses the findings from qualitative case studies of five countries that are either on track to meet MDGs 4 and 5a by 2015 or have made significant progress to this end (Bolivia, China, Egypt, Malawi and Nepal). Although they have different socio-economic characteristics, all have made significant advancements due to a strong commitment to improving maternal and child health. To do this, strong political commitment, through policies backed by financial and programmatic support, was critical. In addition, focusing on the most vulnerable populations helped increase access to and use of services. Empowering women and families through education, employment, and poverty reduction programs have led to better health outcomes. These countries still face challenges, however, in terms of the evolving health system, and changes at the economic, social and political levels. Future qualitative and quantitative analyses on the returns of health investments, the political context and institutional arrangements at the country level could help deepen the understanding of the ways in which various countries, with their unique conditions, can improve MCH.
    Keywords: Abortion, access to education, access to reproductive health services, adolescent reproductive health, adolescents, aged, basic education, behavior change, behaviour ... See More + hange, birth attendants, birth rates, care for children, censuses, child health, child health services, child mortality, CHILD SURVIVAL, childbearing, childbirth, childhood diseases, clinics, Communicable Diseases, community development, Community Health, contraception, contraceptive choices, contraceptive prevalence, contraceptive use, decision making, delivery care, delivery of family planning, demand for services, dependency ratio, diphtheria, economic growth, Educated women, education for girls, educational attainment, Empowering women, equal opportunities, equal opportunity, essential health services, ethnic groups, families, Family Planning, family planning program, family planning services, female circumcision, female education, female literacy, Gender inequality, gender parity, Gender Parity Index, Global Health, Gross national income, health care, health care services, health centers, health education, health facilities, health for all, health infrastructure, health insurance, health interventions, Health Management, health outcomes, Health Policy, health sector, health system, health systems, Health Workers, Healthy Mother, hepatitis B, HIV, home visits, hospitals, Human Development, human rights, Hygiene, Illness, illnesses, Immunization, immunizations, indigenous populations, inequities, Infant, Infant Health, infant mortality, infertility, influenza, Information System, information systems, International Conference on Population, Investments in education, iron, Labor force, labor market, laws, leading causes, live births, local governments, low-income countries, malaria, mandates, Maternal death, maternal deaths, maternal health, maternal mortality, maternal mortality data, Maternal mortality ratio, measles, measles immunization, medical staff, midwives, Migration, Millennium Development Goals, Ministries of health, Ministry of Health, mobile clinics, morbidity, mortality, mortality rate, Mother, Mother to Child, Mother to Child Transmission, multilateral organizations, National Health Policy, National Plan, National Population, National Population Policy, neo-natal mortality, neonatal mortality, Newborn, newborn care, Newborn Health, Nutrition, nutritional status, nutritional status of women, Plan of Action, polio, poliomyelitis, political climate, Population and Development, population concerns, population density, Population growth, population issues, Post-Abortion, Post-Abortion Care, postnatal care, pregnancy, pregnant women, prenatal care, primary health care, primary schooling, progress, promoting gender equality, public health, public health services, quality of care, reducing maternal mortality, regional strategies, reproductive health, reproductive health care, Reproductive Health Policy, Reproductive Health Program, research institutions, right to health care, rural areas, rural populations, rural women, Safe Motherhood, school children, School Health, screening, secondary enrolment, Service Delivery, service providers, service provision, services for adolescents, services to women, sex, sexually transmitted infections, Skilled Birth Attendance, skilled birth attendants, smaller families, social change, social development, social norms, social sector, social services, socioeconomic factors, tertiary level, tetanus, traditional practices, transportation, Unemployment, UNFPA, United Nations Population Fund, universal primary education, unplanned pregnancies, urban populations, user fees, vaccination, violence, vulnerable populations, whooping cough, woman, women of childbearing age, Workers, working-age population, World Health Organization
    Date: 2014–05
  9. By: Thérèse McDonnell (University College Dublin); Orla Doyle (University College Dublin)
    Abstract: This paper examines the relationship between maternal employment, childcare during infancy and the overweight status of pre-school children. Using data from the Infant Cohort of the Growing-Up in Ireland Survey, propensity score matching addresses the issue of potential selection bias, quantile regression allows the impact of both maternal employment and childcare to be examined throughout the weight distribution and multiple imputation is used to address the problem of missing data due to item non-response. The results suggest that both full-time and part-time maternal employment when a child is 9 months old increase the likelihood of being overweight at 3 years old, but only for children of mothers with higher levels of education. Informal childcare at 9 months also has harmful effects on child weight, but again only for children of more educated mothers. Quantile regression finds that the children most impacted by maternal employment are those at the upper percentiles of the weight distribution. When selection on observables is used to assess bias arising from selection on unobservables, maternal employment estimates are determined to be a lower bound, while informal childcare results could be attributed to selection bias. Overall findings are consistent with research from North America and the United Kingdom, and are in contrast to recent findings from the rest of Europe, suggesting the possible role of institutional factors.
    Keywords: Child overweight, obesity, maternal employment, childcare
    Date: 2014–10–20

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