nep-hea New Economics Papers
on Health Economics
Issue of 2015‒01‒09
thirty-two papers chosen by
Yong Yin
SUNY at Buffalo

  1. Determinants of Access to Healthcare: A Survey in Istanbul By Muhammed Ziya Paköz; Mehmet Ali Yüzer
  2. Domestic Abuse and Child Health By Samantha Rawlings; Zahra Siddique
  3. A closed-form solution for the health capital model By Strulik, Holger
  4. Before-after differences in labor market outcomes for participants in medical rehabilitation in Germany By Sebastian Fischer; Inna Petrunyk; Christian Pfeifer; Anita Wiemer
  5. Are physician fees responsive to competition? By Choné, P.;; Coudin, É.;; Pla, A.;
  6. Life cycle responses to health insurance status By Pelgrin, F.;; St-Amour, P.;
  7. Does Experience Rating Improve Obstetric Practices? Evidence From Geographical Discontinuities* By Amaral-Garcia, S.;; Bertoli, P.;; Grembi, V.;
  8. Do Payment Disclosure Laws Affect Industry-Physician Relationships? By Chen, D.L.;; Levonyan, V.;; Reinhart, S.E.;; Taksler, G.;
  9. Fast-food consumption and child body mass index in China: Application of an endogenous switching regression model By Akpalu, Wisdom; Zhang, Xu
  10. Dynamic Optimization and Conformity in Health Behavior and Life Enjoyment over the Life Cycle By Hernán Bejarano; Hillard Kaplan; Stephen Rassenti
  11. Correlation Analysis of the quality of medical quality economic and financial management using correlation coefficients based on nonparametric data By Iacob, Constanta; Constantin, Camelia
  12. Source and Use of Insecticide Treated Net and Malaria Prevalence By Orkoh, Emmanuel; Annim, Samuel Kobina
  13. Early Health Shocks, Intrahousehold Resource Allocation, and Child Outcomes By Junjian Yi; James J. Heckman; Junsen Zhang; Gabriella Conti
  14. Fuel Poverty is it harmful for health? Evidence from French health survey data By Jusot, Florence; Lacroix, Elie
  15. Impact of Ethiopia’s Community Based Health Insurance on household economic welfare By Debebe, Z.Y.; Mebratie, A.D.; Sparrow, R.A.; Dekker, M.; Alemu, G.; Bedi, A.S.
  16. Epidemic trade By Lars Boerner; Battista Severgnini
  17. Basic versus Supplementary Health Insurance : The Role of Cost Effectiveness and Prevalence By Boone, J.
  18. Provider Competition and Over-Utilization in Health Care By Boone, J.; Douven, R.C.M.H.
  19. Care and cure : Compete or collaborate? Improving inter-organizational designs in healthcare. A case study in Dutch perinatal care By Pieters, A.J.H.M.
  20. Essays on subjective expectations and mortality trends By Niu, G.
  21. Health Status and the Allocation of Time: Cross-Country Evidence from Europe By Gimenez-Nadal, J. Ignacio; Molina, José Alberto
  22. Follow your Heart: Survival Chances and Costs after Heart Attacks - An Instrumental Variable Approach By Alice Sanwald; Thomas Schober
  23. To Charge or Not to Charge: Evidence from a Health Products Experiment in Uganda By Fischer, Greg; Karlan, Dean S.; McConnell, Margaret; Raffler, Pia
  24. The adverse effects of value-based purchasing in health care: dynamic quantile regression with endogeneity By Galina Besstremyannaya
  25. Who Benefits when the Government Pays More? Pass-Through in the Medicare Advantage Program By Mark Duggan; Amanda Starc; Boris Vabson
  26. Road Traffic Injuries : A Public Health Crisis in MENA By Said Dahdah; Dipan Bose
  27. Health information, treatment, and worker productivity : experimental evidence from malaria testing and treatment among Nigerian sugarcane cutters By Dillon, Andrew; Friedman, Jed; Serneels, Pieter
  28. Means-tested long term care and family transfers By CREMER, Helmuth; PESTIEAU, Pierre
  29. Impact of aging on curative health care workforce. Country Report Poland By Stanislawa Golinowska; Agnieszka Sowa; Ewa Kocot
  30. Fertility and early-life mortality: Evidence from smallpox vaccination in Sweden By Philipp Ager; Casper Worm Hansen; Peter Sandholt Jensen
  31. AUDIT FEE DETERMINANTS IN THE HOSPITAL SECTOR By Vanderbeke Dave; Christiaens Johan; Verbruggen Sandra
  32. Does performance disclosure influence physicians’ medical decisions? An experimental study* By Godager, Geir; Hennig-Schmidt, Heike; Iversen, Tor

  1. By: Muhammed Ziya Paköz; Mehmet Ali Yüzer
    Abstract: Access to healthcare is formed according to the characteristics of the supply and demand. While siting hospitals, ?equity' in access to healthcare should be taken as a basis for all segments of society, and necessary measures should be taken to ensure that vulnerable groups benefit from health services adequately. This necessitates evaluating spatial and non-spatial dimensions of access to healthcare together. Spatial dimension emphasizes importance of the distance whereas non-spatial dimension includes factors such as level of income, educational attainment level, culture, ethnicity, age and sex. In this paper, results of the survey conducted on 756 households in Istanbul were put to evaluation within the framework of the dimensions of the access to healthcare; spatial patterns of the access to inpatient services in Istanbul were examined over the survey results. Dimensions of the access to healthcare put forward the level of access as well. Results of the survey show that different dimensions of the access to healthcare are effective with various degrees in hospital choices. However, as the level of income changes, so does the hospital preferences. Middle and low income groups have more limited budget for healthcare services and ownership of personal car is less frequent, so demand elasticity is lower compared to the high and high-middle income groups. Therefore, ?accessibility' and ?affordability' dimensions of the access come to the fore for middle and low income groups while ?acceptability' is cared more by the high and high-middle income groups. The paper also deals with the relationship between supply characteristics and travel time / travel distance accepted and realized for going to hospital in Istanbul. According to the international practices and literature, the maximum travel time for access to hospital is accepted generally as ?30 minutes', which turns out to be parallel with the survey results. However, the realized travel distance differentiates based on the type (public, private) and nature (regional-local) of the hospital. Distance covered for regional hospitals (training and research hospitals and university hospitals) and travel rate outside the district are higher than the distance covered for local hospitals. Similarly, distance covered for private hospitals is more than the distance made for public hospitals. The paper not only evaluates the spatial and non-spatial factors together, but also considers health supply in various aspects, reveals user behaviors which change depending on the type of the supply and the characteristics and the pattern of the city, and defines distance thresholds and border-crossing according to these features.
    Keywords: Access to healthcare; affordability; spatial accessibility; distance; Istanbul (and)
    JEL: I11 I14
    Date: 2014–11
  2. By: Samantha Rawlings (Department of Economics, University of Reading); Zahra Siddique (Department of Economics, University of Reading)
    Abstract: We examine the effects of different kinds of domestic abuse (physical violence, emotional abuse, sexual abuse and physical violence while the victim is pregnant) on health outcomes of children born to victims. We use data on approximately 0.6 million children born between 1975 and 2013 across thirty different developing countries to investigate this relationship. Comparing children of abused mothers with otherwise similar children whose mothers were not victims of abuse, we find these children are 0.4 percentage points more likely to die within thirty days, 0.9 percentage points more likely to die within a year and 1.5 percentage points more likely to die within the first five years of being born. They are also 1.8 percentage points more likely to be low birth weight and, conditional on survival, 1.1 percentage points more likely to be stunted. Our findings allow us to quantify the costs of domestic abuse beyond costs borne directly by victims (or mothers) and gain a better understanding of the child health production process in a developing country context.
    Keywords: child health, domestic violence
    JEL: I14 I15 J12 J13
    Date: 2014–10–15
  3. By: Strulik, Holger
    Abstract: This paper provides a closed-form solution for the health capital model of health demand. The results are exploited in order to prove analytically the comparative dynamics of the model. Results are derived for the so called pure investment model, the pure consumption model and a combination of both types of models. Given the plausible assumptions that (i) health declines with age and that (ii) the health capital stock at death is lower than the health capital stock needed for eternal life, it is shown that the optimal solution always implies eternal life. This outcome occurs independently from the initial stock of health, the impact of health on productivity, and the importance of health for utility and it is robust against the introduction of a finite age-dependent rate of health depreciation.
    Keywords: longevity,health,health care demand
    JEL: D91 J17 J26 I12
    Date: 2014
  4. By: Sebastian Fischer (Leuphana University Lueneburg, Germany); Inna Petrunyk (Leuphana University Lueneburg, Germany); Christian Pfeifer (Leuphana University Lueneburg, Germany); Anita Wiemer (Leuphana University Lueneburg, Germany)
    Abstract: The authors address the issue of effectiveness of medical rehabilitation in terms of labor market outcomes by analyzing a large representative administrative panel data set for Germany. The research design focuses on socio-demographic group differences in before-after differences in days with unemployment benefits, days in employment, and labor income of participants in medical rehabilitation. The mean before-after differences indicate that medical rehabilitation is rather ineffective with respect to labor market outcomes, because the number of days with unemployment benefits is larger and the number of working days and labor income are smaller after the rehabilitation than before. The differences in the before-after differences are however large between socio-demographic groups. For example, older participants perform significantly worse and better educated participants have significant better labor market outcomes after the rehabilitation than before, whereas gender differences are small.
    Keywords: medical rehabilitation, effectiveness, labor market performance
    JEL: I1 J2
    Date: 2014–12
  5. By: Choné, P.;; Coudin, É.;; Pla, A.;
    Abstract: We assess the extent to which specialist doctors respond to local competition when setting prices (including extra-billings) in a fee-for-service system. We use an exhaustive panel data set to estimate physician reaction functions, exploiting exogenous changes in medical density and labor supply to identify the effects of local market structure and competitors' prices. We find that fees are strategic complements and decrease with physician density. Our results are consistent with a static competition model where patient choice is based on distance, price and observable physician characteristics and doctors have standard consumption-leisure preferences. Finally, we examine how the presence of physicians subject to full price regulation affects strategic interactions.
    Keywords: fee-for-service; local competition; price competition; physicians' labor supply; extra billings;
    JEL: I11 J22 L11
    Date: 2014–08
  6. By: Pelgrin, F.;; St-Amour, P.;
    Abstract: Health insurance status can change over the life cycle for exogenous reasons (e.g. Medicare for the elders, PPACA for younger agents, termination of coverage at retirement in employer-provided plans). Durability of the health capital, endogenous mortality and morbidity, as well as backward induction suggests that these changes should affect the dynamic life cycle beyond the period at which theyoccur. The purpose of this paper is to study these lifetime effects on the optimal allocation (consumption, leisure, health expenditures), status (health, wealth and survival rates), and welfare. We analyse the impact of young (resp. old) insurance status conditional on old (resp. young) coverage through the structural estimation of a dynamic model with endogenous death and sickness risks. Our resultsshow that young insurees are healthier, wealthier, consume more health care yet are less exposed to OOP risks, and substitute less (more) leisure before (after) retirement. Old insurees show similar patterns, except for lower precautionary wealth balances. Compulsory health insurance is unambiguously optimal for elders, and for young agents, except early in the life cycle. We draw other implicationsfor public policy such as Medicare and PPACA.
    Keywords: household finance;endogenous morbidity and mortality risks; demand for health; medicare and patient protection and aordable care act; simulated moments estimation;
    JEL: D91 G11 I13
    Date: 2014–08
  7. By: Amaral-Garcia, S.;; Bertoli, P.;; Grembi, V.;
    Abstract: We provide an assessment of the introduction of experience rating for medical malpractice insurance using 2002-2009 inpatient discharge records data on deliveries from the Italian Region of Piedmont. Considering experience rating as an increase in medical malpractice pressure, we show that such increase decreased the incidence of cesarean sections between 7 and 11.6% with no consequences on a broadly defined measure of complications. Our identification strategy exploits the territorial peculiarities of Piedmont: its 33 hospitals are distributed across 16 Courts' districts, 10 of which use schedules of non economic damages to set compensations for personal injuries and 6 do not. We use this ex-ante policy conditions to distinguish treated from control and implement first a difference in difference analysis, the robustness of which we test through a basic difference in discontinuities specification. We show that our results are robust to the different methodologies, and they can be explained in terms of a reduction in the discretion over obstetric decisions ratherthan a change in the risk profile of the patients.
    Keywords: experience rating; medical liability insurance; difference-in-differences; difference-in-discontinuities; c-sections; schedules of damages compensation;
    JEL: K13 K32 I13
    Date: 2014–08
  8. By: Chen, D.L.;; Levonyan, V.;; Reinhart, S.E.;; Taksler, G.;
    Abstract: The effect of disclosure laws on what is being disclosed is typically unknown since data on disclosed activity rarely exist in the absence of disclosure laws. We exploit data from legal settlements disclosing $316 million in payments to 316,622 physicians across the U.S. from 2009-2011. Multiple regression analysis of differences-indifferences and LASSO double-selection models were used. States were classified as having strong, weak, or no disclosure based on data reported only to state authorities or being publicly available. One state, Massachusetts, began releasing payment data on the web during our sample period, allowing separate analysis of physician payments while the cost of disclosing data remained fixed for pharmaceutical companies. Strong disclosure law reduced payments among doctors accepting less than $100 and increased payments among doctors accepting greater than $100. Weak disclosure states were indistinguishable from no disclosure states. The behavioral response to mandatory disclosure is likely due to the public visibility of disclosed data.
    Keywords: physician payment; legal/regulatory issues; ethical issues;
    Date: 2014–08
  9. By: Akpalu, Wisdom; Zhang, Xu
    Abstract: The rapid economic growth experienced within the past two decades in China highly correlates with childhood overweightness. The epidemic has become an issue of grave concern. A principal factor considered to be responsible for the epidemic in the literatu
    Keywords: child body mass index, fast-food consumption, endogenous switching regression model
    Date: 2014
  10. By: Hernán Bejarano (Economic Science Institute, Chapman University, Orange, CA); Hillard Kaplan (Economic Science Institute, Chapman University, Orange, CA and University of New Mexico, Albuquerque, NM); Stephen Rassenti (Economic Science Institute, Chapman University, Orange, CA)
    Abstract: This article examines individual and social influences on investments in health and enjoyment from immediate consumption. We report the results of a lab experiment that mimics the problem of health investment over a lifetime, building on Grossman’s (1972a, 1972b) theoretical framework. Subjects earn money through the experiment in proportion to the sum of the life enjoyment they have consumed. However, income in each period is a function of previous health investments, so there is a dynamic optimum for maximizing earnings through the appropriate expenditures on life enjoyment and health in each period. In order to model social effects in the experiment, we randomly assigned individuals to chat/observation groups, composed of four subjects each. Two treatments were employed: In the Independent treatment, an individual’s rewards from investments in life enjoyment depend only on his choice and in the Interdependent treatment, rewards not only depend on an individual’s choices but also on their similarity to the choices of the others in their group. Seven predictions were tested and each was supported by the data. We found: 1) Subjects engaged in helpful chat in both treatments; 2) there was significant heterogeneity among both subjects and groups in chat frequencies; and 3) chat was most common early in the experiment. The interdependent treatment 4) increased strategic chat frequency, 5) decreased within-group variance, 6) increased between-group variance, and 7) increased the likelihood of behavior far from the optimum with respect to the dynamic problem. Individual incentives explain a large part, but not all, of the variance in prosocial behavior in the form of strategic advice. Incentives for conformity appear to promote prosocial behavior, but also increase variance among groups in equilibrium outcomes, leading to convergence on suboptimal strategies for some groups
    Keywords: experimental economics, behavioral economics, health economics, dynamic programming
    Date: 2014
  11. By: Iacob, Constanta; Constantin, Camelia
    Abstract: Starting from the idea that the use of multi-criteria analysis of performance within the hospital system allows a more accurate validation of employment, compared to the current methodology and seeking correlations between scores practiced economic efficiency and technical competence for all hospitals analyzed we see that there is a correlation between these values which suggests that hospital management's performance is a delusion because subordanarea different and multiple units of the health system vis-à-vis how separate assessment of skills and management capabilities make it virtually impossible able to generate management solutions. The aim of our research is to demonstrate that in any normal system, and therefore in the health, environmental factors acting in a correlate between them.
    Keywords: analysis, correlation, scores, hospitals coefficients
    JEL: C14 C15 I15 M41
    Date: 2014–11–28
  12. By: Orkoh, Emmanuel; Annim, Samuel Kobina
    Abstract: This study argues that different practices of sources from which households obtain their Insecticide Treated Nets (ITNs) determine the effect of ITN use on malaria prevalence. The study categorises the sources into those that include some sort of education about how to use the nets and those that do not and examines the effect of these sources on the relationship between ITN use and malaria prevalence in Ghana. A recursive bivariate probit estimation technique that addresses endogeneity between ITN use and malaria prevalence was used to analyse data on 2,908 under-five children from the 2011 Multiple Indicator Cluster Survey (MICS). The descriptive results revealed that the proportion of ITN usage among children in households who acquired their ITNs from government, NGOs and Community Based Agents (CBAs) was higher than the proportion of usage among those who acquired their ITNs from private health centers, market, shops and street vendors that do not include education. The estimation shows that controlling for other socio-demographic factors, sleeping under ITN reduces the likelihood of experiencing malaria by 22 percent. Owners of ITNs will not use them to bring the expected reduction in malaria prevalence, unless the source includes education.
    Keywords: Insecticide Treated Net, Malaria prevalence, children under-five, endogeneity, recursive bivariate probit
    JEL: I12
    Date: 2014–06–30
  13. By: Junjian Yi (The University of Chicago); James J. Heckman (The University of Chicago); Junsen Zhang (Chinese University of Hong Kong); Gabriella Conti (University College London)
    Abstract: An open question in the literature is whether families compensate or reinforce the impact of child health shocks. Discussions usually focus on one dimension of child investment. This paper examines multiple dimensions using household survey data on Chinese child twins whose average age is 11. We find that, compared with a twin sibling who did not suffer from negative early health shocks at ages 0-3, the other twin sibling who did suffer negative health shocks received RMB 305 more in terms of health investments, but received RMB 182 less in terms of educational investments in the 12 months prior to the survey. In terms of financial transfers over all dimensions of investment, the family acts as a net equalizer in response to early health shocks for children. We estimate a human capital production function and establish that, for this sample, early health shocks negatively affect child human capital, including health, education, and socioemotional skills. Compensating investments in health as measured by BMI reduce the adverse effects of health shocks by 50%, but exacerbate the adverse impact of shocks on educational attainment by 30%.
    Keywords: early health shocks, intrahousehold resource allocation, human capital formation
    JEL: C23 D13 I12 J13
    Date: 2014–12
  14. By: Jusot, Florence; Lacroix, Elie
    Keywords: France; Health; Fuel poverty;
    JEL: I18
    Date: 2014–12
  15. By: Debebe, Z.Y.; Mebratie, A.D.; Sparrow, R.A.; Dekker, M.; Alemu, G.; Bedi, A.S.
    Abstract: In 2011, the Government of Ethiopia launched a pilot Community-Based Health Insurance (CBHI) scheme. This paper uses three rounds of household survey data, collected before and after the introduction of the CBHI pilot, to assess the impact of the scheme on household consumption, income, indebtedness and livestock holdings. We find that enrolment leads to a 5 percentage point – or 13 percent – decline in the probability of borrowing and is associated with an increase in household income. There is no evidence that enrolling in the scheme affects consumption or livestock holdings. Our results show that the scheme reduces reliance on potentially harmful coping responses such as borrowing. This paper adds to the relatively small body of work which rigorously evaluates the impact of CBHI schemes on economic welfare.
    Date: 2014–08–08
  16. By: Lars Boerner; Battista Severgnini
    Abstract: This paper uses the spread of disease as a proxy to measure economic interactions. Based on a case study of the Black Death (1346-51) in the Mediterranean region and Europe, we find geographic, institutional, and cultural determinants of trade. To achieve this we create and empirically test a trade model between cities. Our findings allow us to create a new methodology to measure economic interaction and shed light on open questions in economics, especially pertaining to trade, economic history, and growth
    Keywords: trade; Black Death; gravity model; Poisson pseudo maximum likelihood; spatial regression discontinuity
    JEL: N0
    Date: 2014
  17. By: Boone, J. (Tilburg University, Center For Economic Research)
    Abstract: In a model where patients face budget constraints that make some treatments unaffordable, we ask which treatments should be covered by universal basic insurance and which by private voluntary insurance. We argue that both cost effectiveness and prevalence are important if the government wants to maximize the health gain that it gets from its health budget. In particular, basic insurance should cover treatments that are used by people who at the margin buy treatments that are highly cost effective. This is not the same as covering treatments that are themselves highly cost effective.
    Keywords: universal basic health insurance; voluntary supplementary insurance; public vs private insurance; access to care,; cost effectiveness
    JEL: I3 D82 H51
    Date: 2014
  18. By: Boone, J. (Tilburg University, Center For Economic Research); Douven, R.C.M.H. (Tilburg University, Center For Economic Research)
    Abstract: This paper compares the welfare effects of three ways in which health care can be organized: no competition (NC), competition for the market (CfM) and competition on the market (CoM) where the payer offers the optimal contract to providers in each case. We argue that each of these can be optimal depending on the contracting environment of a speciality. In particular, CfM is optimal in a clinical situation where the payer either has contractible information on provider quality or can enforce cost efficient protocols. If such contractible information is not available NC or CoM can be optimal depending on whether patients react to decentralized information on quality differences between providers and whether payer’s and patients’ preferences are aligned.
    Keywords: competition; health care; selective contracting; over-utilization; mechanism design
    JEL: D82 L5 I11
    Date: 2014
  19. By: Pieters, A.J.H.M. (Tilburg University, School of Economics and Management)
    Abstract: This research aims to contribute to the development of theory regarding inter-organizational designs for these care-cure conditions through a combination of case study research and simulation. The case setting chosen is that of perinatal care in the Netherlands. The research consists of three phases and combines both qualitative and quantitative methods (mixed methods approach). The first phase focuses on what goes wrong in Dutch perinatal care (what-question). The second phase focuses on understanding why it is going wrong (why-question). The third phase focuses on gaining insight into how Dutch perinatal care can be improved, on what inter-organizational design would work best for Dutch perinatal care (how-question). As such, this research combines three layers of a healthcare system: firstly, the structure of the system, the inter-organizational design, secondly, the inter-organizational dynamics, such as collaboration and trust between organizations and professionals, and thirdly, the flow of patients between organizations.
    Date: 2013
  20. By: Niu, G. (Tilburg University, School of Economics and Management)
    Abstract: This thesis consists of four chapters on two topics. The first topic, covered in chapter 2, 3, and 4, is about subjective expectations. Economists have long understood that expectations are important determinants of economic decisions. However, expectations are rarely observed. One way to overcome the problem is to elicit beliefs of individuals, or so-called subjective expectations, directly from survey questions. The three chapters study directly measured expectations on two important assets: housing and stock. Home ownership is very high in many countries and housing is typically the largest asset in most households' portfolios. Stock is often the major component of households' financial wealth. Chapter 2 investigates how house price expectations are related to macro and micro characteristics. Chapter 3 focuses on stock price expectations. Both chapters are based on panel data analysis of individual expectations at the micro level. Chapter 4 is also about house price expectations, but is from a macroeconomic perspective and relies on time series analysis of aggregate data. The second topic, discussed in Chapter 5, is about mortality trends. This chapter introduces a mortality forecasting model, which links mortality trends to trends in economic growth, and studies mortality dynamics for six developed countries.
    Date: 2014
  21. By: Gimenez-Nadal, J. Ignacio (University of Zaragoza); Molina, José Alberto (University of Zaragoza)
    Abstract: This paper analyzes the relationship between reported health status and time allocation decisions in six European countries. Using the Multinational Time Use Study, we find that a better perception of own health is associated with less time devoted to sleep, personal care, and non-market work, for both men and women, and with less time in leisure for men, while it is associated with more time in market work for both men and women. We also find that the relationship with activities is very similar across countries, and that market work has a relationship of substitution with sleep, personal care, non-market work, and leisure, with mixed evidence for the rest of the uses of time. These findings are consistent with prior results regarding health, market work, and leisure in the US. However, in contrast to the large positive correlation between health and home production in the US, we find a large negative correlation between these activities in the six European countries analyzed. This study represents a first step in understanding cross-country differences in the relationship between health status and time devoted to a range of activities, in contrast with other analyses that have mainly focused only on market work. A better understanding of these cross-country differences may help to identify the effects of public policies on individual uses of time.
    Keywords: health, time allocation, Multinational Time Use Study
    JEL: D13 J16 J22
    Date: 2014–11
  22. By: Alice Sanwald; Thomas Schober
    Abstract: We analyze mortality and follow-up costs of heart attack patients using administrative data from Austria from 2002-2011. As treatment intensity in a hospital largely depends on whether it has a catheterization laboratory, we focus on the effects of patients' initial admission to these specialized hospitals. To account for the nonrandom selection of patients into hospitals, we exploit individuals' place of residence as a source of exogenous variation in an instrumental variable framework. We find that the initial admission to specialized hospitals increases patients' survival chances substantially. The effect on 3-year mortality is -9.5 percentage points. A separation of the sample into subgroups shows the strongest effects in relative terms for patients below the age of 65. We do not find significant effects on longterm inpatient costs and find only marginal increases in outpatient costs.
    Keywords: Acute myocardial infarction, mortality, costs, instrumental variables
    JEL: I11 I12
    Date: 2014–10
  23. By: Fischer, Greg; Karlan, Dean S.; McConnell, Margaret; Raffler, Pia
    Abstract: Pricing policy for any experience good faces a key tradeoff. On one hand, a price reduction increases immediate demand and hence more people learn about the product. On the other hand, lower prices may serve as price anchors and, through a comparison effect, decrease subsequent demand. This tension is particularly important for the distribution of health products in low-income countries, where free or heavily subsidized distribution is a common but controversial practice. Based on a model combining the learning aspect of experience goods with reference-dependent preferences, we setup a field experiment in Northern Uganda in which three health products differing in their scope for learning were initially offered either for free or for sale at market prices. In line with prior studies, when the product has potential for positive learning, we do not find an effect of free distribution on future demand. However, for products without scope for positive learning, we find evidence of price anchors: future demand is lower after a free distribution than after a distribution at market prices.
    Keywords: health; learning; pricing; subsidies
    JEL: D11 D12 D83 I11 I18 O12
    Date: 2014–06
  24. By: Galina Besstremyannaya (Stanford University)
    Abstract: The paper demonstrates differential effects of performance-based reimbursement, when price-setting within inpatient prospective payment system is related to benchmark values of quality measures or length-of-stay. We develop fixed effect quantile regression dynamic panel data models with endogeneity and apply them to nationwide administrative databases for recent implementations of performance-based reimbursement in the U.S. (Hospital Compare data for 4048 hospitals in 2008-2014) and Japan (Ministry of Health, Labor and Welfare's data for 1849 hospitals in 2005-2014). The results indicate persuasive evidence supporting the adverse effects of value-based purchasing for best-performing hospitals. Patient experience of care measures significantly decrease in the top percentiles of the U.S. hospitals. Similarly, average length of stay significantly increases for most diagnosis-related groups at Japanese hospitals in percentiles with the lowest length of stay. A natural experiment aimed at best-practice rate setting diminishes the undesired effects of the reform.
    Keywords: dynamic quantile regressions, prospective payment, diagnosis-related groups
    JEL: C22 C23 D21 D22 I18
    Date: 2014–11
  25. By: Mark Duggan (Stanford University); Amanda Starc (University of Pennsylvania); Boris Vabson (University of Pennsylvania)
    Abstract: Governments contract with private firms to provide a wide range of services. While a large body of previous work has estimated the effects of that contracting, surprisingly little has investigated how those effects vary with the generosity of the contract. In this paper we examine this issue in the Medicare Advantage (MA) program, through which the federal government contracts with private insurers to coordinate and finance health care for 16 million Medicare recipients. To do this, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250 thousand or more relative to MSAs below this threshold. Our results demonstrate that the additional reimbursement leads more private firms to enter this market and to an increase in the share of Medicare recipients enrolled in MA plans. Our findings also reveal that about one-sixth of the additional reimbursement is passed through to consumers in the form of better coverage. A somewhat larger share accrues to private insurers in the form of higher profits and we find suggestive evidence of a large impact on advertising expenditures. Our results have implications for a key feature of the Affordable Care Act that will reduce reimbursement to MA plans by $156 billion from 2013 to 2022.
    Date: 2014–10
  26. By: Said Dahdah; Dipan Bose
    Keywords: Transport Economics Policy and Planning Road Safety Transport - Airports and Air Services Roads and Highways Conflict and Development - Post Conflict Reconstruction
    Date: 2013–12
  27. By: Dillon, Andrew; Friedman, Jed; Serneels, Pieter
    Abstract: Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and choice of job tasks among workers by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention -- the offer of a workplace-based malaria testing and treatment program increases worker earnings by approximately 10 percent over the weeks following the offer. The study further investigates theeffect of health information by contrasting program effects by workers'revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return tasks within the plantation as a result of changes in the perceived cost of effort. A model of the worker labor decision that allows health expectations partly to determine the supply of effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to suboptimal labor allocation decisions. The results underline the importance of medical treatment, but also of access to improved information about one's health status, as the absence of either may lead workers to deliver lower effort in lower return jobs.
    Keywords: Health Monitoring&Evaluation,Disease Control&Prevention,Labor Markets,Labor Policies,Work&Working Conditions
    Date: 2014–11–01
  28. By: CREMER, Helmuth (Toulouse School of Economics); PESTIEAU, Pierre (CREPP, Universté de Liège; Université catholique de Louvain, CORE, B-1348 Louvain-la-Neuve, Belgium)
    Abstract: One of the pervasive problems with means-tested public long term care (LTC) programs is their inability to prevent individuals who could afford private long term services from taking advantage of public care. They often manage to elude the means-test net through “strategic impoverishment”. We show in a simple model how this problem comes about, how it affects welfare and how it can be mitigated.
    Keywords: long term care, means-testing, strategic impoverishment, opting out, public insurance, altruism
    JEL: H2 H5
    Date: 2014–06–11
  29. By: Stanislawa Golinowska; Agnieszka Sowa; Ewa Kocot
    Abstract: The report discusses employment in the health care system in Poland based on analysis and projections of the demand and supply of medical workforce. The impact of the financial situation and policy on relativelly low employment level of medical personel was accounted for in the analysis while projections were driven by demographic changes in the following two decades. Results of different demographic variants of projections used in Neujobs project and additional scenarios show that while ageing is an important factor that may stimulate demand for provision of medical personnel, changes might be mitigated by further increase in efficiency of care. At the same time the supply of care will be affected by ageing too. The results indicate that more detailed monitoring of employment in the future will be needed in order to assure adequacy of provision of medical professionals, especially of nurses (critical gap), some medical specialists, physiotherapists and medical technical personnel.This report was prepared within a research project entitled NEUJOBS, which has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 266833.
    Keywords: Health Care, Employment in Health Care, Employment Projections, Labor Resources in Health, Medical Professions
    JEL: H51 H75 I18
    Date: 2014
  30. By: Philipp Ager (University of Southern Denmark); Casper Worm Hansen (Aarhus University); Peter Sandholt Jensen (University of Southern Denmark)
    Abstract: We examine how the introduction of smallpox vaccination affected early-life mortality and fertility in Sweden during the first half of the 19th century. We demonstrate that parishes in counties with higher levels of smallpox mortality prior to the introduction of vaccination experienced a greater decline in infant mortality afterwards. Exploiting this finding in an instrumental-variable approach reveals that this decline had a negative effect on the birth rate, while the number of surviving children and population growth remained unaffected. These results suggest that the decline in early-life mortality cannot account for the onset of the fertility decline in Sweden.
    Keywords: Fertility transition, infant mortality, smallpox vaccine
    JEL: J10 J13 I15
    Date: 2014–07
  31. By: Vanderbeke Dave; Christiaens Johan; Verbruggen Sandra (-)
    Abstract: Although the number of non-profit audit fee studies recently has risen, evidence in the hospital sector is rather scarce. Apart from NHS studies, hospitals are a fairly new topic and several specific fee determinants are yet to be tested. For instance, hospitals can have a private or a public status and they have a distinct number of clinical services. These and other dependent variables known from earlier research are added to a fee model and investigated. As hypothesized the hospital status does affect the fee as well as the auditor’s experience. Public status positively influences the fee. Considering the auditor’s experience, higher skill levels appear to have a negative impact on the fee. More experience cannot be converted into cash.
    Keywords: Audit fee, health care, pricing model
    Date: 2014–11
  32. By: Godager, Geir (Department of Health Management and Health Economics); Hennig-Schmidt, Heike (Department of Health Management and Health Economics); Iversen, Tor (Department of Health Management and Health Economics)
    Abstract: Quality improvements in markets for medical care are key objectives in any Health reform. An important question is whether disclosing physicians’ performance can contribute to achieving these goals. Due to the asymmetric information inherent in medical markets, one may argue that changes in the information structure are likely to influence the environment in which health care providers operate. In a Laboratory experiment with medical students that mimics a physician decision-making environment we analyze the effect of disclosing performance information to peers. We find that making performance transparent has a positive impact in that significantly higher total patient benefits are generated than under a regime where physician performance is private information. Also, significantly more patients receive benefit-maximizing treatment. We discuss policy implications of our findings
    Keywords: Physician payment system; laboratory experiment; incentives; transparency; fee-for-service; information and product quality
    JEL: C91 H40 I11 J33 L15
    Date: 2014–11–27

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