|
on Health Economics |
| By: | Jonathan Brown; Sarah Hudson Scholle; Melissa Azur |
| Keywords: | Behavioral Health, Quality Measurement, Psychotherapy |
| JEL: | I J |
| Date: | 2014–05–15 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:676febaa91f34fd6ba2cc137292a65c8&r=hea |
| By: | Marco R. Di Tommaso (University of Ferrara); Lauretta Rubini; Stuart Schweitzer |
| Abstract: | The analysis starts from the recognition of the difficulties that both Europe and the US are facing in dealing with the current economic crisis and of the emergence of a new middle class in China with increasing needs in terms of welfare. This paper suggests that the exportation of high--quality, health--related goods and services from the West to China could represent a possible way to support knowledge--intensive sectors in Europe and the US on one side, while allowing a growing part of the Chinese population to access advanced health goods and services on the other. In terms of industrial policy, this means to facilitate the destruction of barriers to entry in the China market (unfair competition, predominance of traditional Chinese medicine and producer--consumer information asymmetries) but also the creation or the enforcement of innovation networks that are a pre-requisite to maintain a high quality level in the production of Western Medicine products and services. |
| Keywords: | R&D collaboration; project failure; public research institutions |
| JEL: | O32 L14 |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:cme:wpaper:1407&r=hea |
| By: | David W. Brown; Amanda E. Kowalski; Ithai Z. Lurie |
| Abstract: | We examine the long-term impact of expansions to Medicaid and the State Children's Health Insurance Program that occurred in the 1980's and 1990's. With administrative data from the IRS, we calculate longitudinal health insurance eligibility from birth to age 18 for children in cohorts affected by these expansions, and we observe their longitudinal outcomes as adults. Using a simulated instrument that relies on variation in eligibility by cohort and state, we find that children whose eligibility increased paid more in cumulative taxes by age 28. These children collected less in EITC payments, and the women had higher cumulative wages by age 28. Incorporating additional data from the Medicaid Statistical Information System (MSIS), we find that the government spent $872 in 2011 dollars for each additional year of Medicaid eligibility induced by the expansions. Putting this together with the estimated increase in tax payments discounted at a 3% rate, assuming that tax impacts are persistent in percentage terms, the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60. This return on investment does not take into account other benefits that accrue directly to the children, including estimated decreases in mortality and increases in college attendance. Moreover, using the MSIS data, we find that each additional year of Medicaid eligibility from birth to age 18 results in approximately 0.58 additional years of Medicaid receipt. Therefore, if we scale our results by the ratio of beneficiaries to eligibles, then all of our results are almost twice as large. |
| JEL: | H2 I1 I38 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20835&r=hea |
| By: | Alessandro Fedele (Free University of Bolzano‐Bozen, Faculty of Economics and Management) |
| Abstract: | Some recent health economics papers suggest that increasing wage in the nursing labor market with the aim of reducing shortage may yield a negative effect on the average productivity and/or the average motivation of applicants attracted. Some feminist economics papers criticize this inefficiency wage result on the grounds that nurses' motivation is modeled in an overly simplistic way. The current paper aims to address this criticism by considering explicitly determinants of work motivation. Relying on introductory concepts from organizational psychology and management literatures, the inefficiency wage result is shown to disappear. A pay raise turns out to have no negative effect both on the average productivity and the average motivation of applicants attracted. |
| Keywords: | Nurses' wage, nursing shortage, nurses' productivity, nurses' motivation, inefficiency wage result, determinants of work motivation |
| JEL: | I11 J32 B54 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:bzn:wpaper:bemps24&r=hea |
| By: | Ian M. McCarthy; Michael Dardeny |
| Abstract: | We examine the response of Medicare Advantage contracts to published quality ratings. We identify the effect of star ratings on premiums using a regression discontinuity design that exploits plausibly random variation around rating thresholds. We find that 3, 3.5, and 4-star contracts in 2009 significantly increased their 2010 monthly premiums by $20 or more relative to contracts just below the respective threshold values. High quality contracts also disproportionately dropped $0 premium plans or expanded their offering of positive premium plans. Welfare results suggest that the estimated premium increases reduced consumer welfare by over $250 million among the affected beneficiaries. |
| Date: | 2014–08 |
| URL: | http://d.repec.org/n?u=RePEc:emo:wp2003:1501&r=hea |
| By: | Kai Zhao (University of Connecticut) |
| Abstract: | This paper studies the effects of health shocks on the demand for health insurance and annuities, along with precautionary saving in a dynamic life-cycle model. I argue that when the health shock can simultaneously increase health expenses and reduce longevity, rational agents would neither fully insure their uncertain health expenses nor fully annuitize their wealth because the correlation between health expenses and longevity provides a self insurance channel for both uncertainties. That is, when the agent is hit by a health shock (which simultaneously increases health expenses and reduces longevity), she can use the resources originally saved for consumption in the reduced period of life to pay for the increased health expenses. Since the two uncertainties partially offset each other, the precautionary saving generated in the model should be smaller than in a standard model without the correlation between health expenses and longevity. In a quantitative life-cycle model calibrated using the Medical Expenditure Panel Survey dataset, I find that the health expenses are highly correlated with the survival probabilities, and this correlation significantly reduces the demand for actuarially-fair health insurance, while its impact on the demand for annuities and precautionary saving is relatively small. |
| Keywords: | Health Insurance, Annuities, Precautionary Saving |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:uct:uconnp:2014-37&r=hea |
| By: | Felipa, de Mello-Sampayo |
| Abstract: | Health fluctuations render the outcome of any treatment switch uncertain, so that decision makers might have to wait for more information before optimally switching treatments. This paper sets up a stochastic model that provides an optimal rule for the timing of treatment switch. The results of the model were then tested empirically with patient-based data on first-line and second-line antiretroviral treatment in India. The empirical results support the findings of the analytical model. |
| Keywords: | Uncertainty; Utility Function; Health; Antiretroviral Treatment; Treatment Switch |
| JEL: | C61 D81 I18 |
| Date: | 2014–12–29 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:60997&r=hea |
| By: | Apostolova-Mihaylova, Maria; Yelowitz, Aaron |
| Abstract: | Health insurance reform in Massachusetts lowered the financial cost of both pregnancy (by increased coverage of pregnancy-related medical events) and pregnancy prevention (by increasing access to reliable contraception and family planning). We examine fertility responses for women of childbearing age in Massachusetts and, on net, find no effect from increasing health insurance coverage. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34 – who have high latent fertility and for whom pregnancies are typically wanted – fertility increased by approximately 1 percent. For unmarried women in the same age range – for whom pregnancies are typically unwanted – fertility declined by 9 percent. Fertility rates changed very little for other groups, in part because of low latent fertility or minimal gains in insurance coverage. Pregnancy wantedness increased in the aggregate through a combination of increasing wanted births and decreasing unwanted births. |
| Keywords: | Health Insurance, Fertility, Moral Hazard, Pregnancy Wantedness |
| JEL: | I1 I13 I18 J1 J13 |
| Date: | 2015–01–11 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:61237&r=hea |
| By: | Banzon, Eduardo P.; Alcantara, Ma. Gerry Lyn; Diez, Maria Alyanna; Sayson, Lorra Angelia |
| Abstract: | To a large extent, planning and budgeting in government hospitals are still carried out in an unsystematic, nonstrategic manner that goes against the thrust of current reforms. Historic budgeting proves to be inadequate in responding to the real needs of hospitals, especially in terms of maintaining its capital assets. The lack of clear guidelines and protocols on prioritization and budget decisions render the process vulnerable to subjective influences. This paper provides information on the appropriate capital management and investments in maintaining and upgrading equipment and capital plant by analyzing the budgeting practices, maintenance and depreciation costs, and requirements of public hospitals. |
| Keywords: | government hospitals, DOH-managed hospitals, LGU-managed hospitals, depreciation costs, maintenance and other operating expenses, capital assets, straight line depreciation, capital investment fund, output-based payments |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2014-50&r=hea |
| By: | Banzon, Eduardo P.; Lucero, J.A.; Ho, B.L.; Puyat, M.E.; Quibod, E.J.; Factor, P.A. |
| Abstract: | Public-private partnerships (PPPs) are increasingly being utilized to meet development goals of many countries and there is much potential for PPPs to help address health inequities and advance universal health care (UHC). In support of these efforts, the paper defines PPPs and their role in the health system and proposes health PPP options that would support the pursuit of UHC. The objectives of this paper are to define what PPPs are and their application in the health sector. The paper presents representative case studies or models of PPP practices in health. Furthermore, it aims to provide a methodology for decisionmakers and stakeholders in developing health PPPs. |
| Keywords: | Philippines, health, public-private partnership (PPP), universal health coverage, public-private investment partnerships, public-private interactions, universal health care (UHC) |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2014-48&r=hea |
| By: | Baja, Emmanuel S.; Castillo-Carandang, Nina T.; Viray, Brent Andrew G.; Tagle, Pamela A. |
| Abstract: | The PhilHealth Customer Assistance, Relations and Empowerment Staff (CARES) project was launched in 2012 to help members and their families navigate the complex Filipino health care system. The study assesses the design and quality of implementation of the PhilHealth CARES project in selected hospitals in PhilHealth`s National Capital Region (NCR). The specific objectives were: 1) understand the overall goals and objectives of the project and how these are being understood by the project managers, implementers, and staff in selected areas in NCR; 2) evaluate to what extent project objectives are being met; 3) identify the project strengths, weaknesses, opportunities, and threats as perceived by CARES managers, implementers, and staff; and 4) craft appropriate policy and programmatic responses to improve project implementation. Focus group discussions and desk review (i.e., documents and records review) were the main methods for the study. Observations and mystery client visits to four PhilHealth-accredited hospitals in NCR (private and public, Level 2 and 3) were also done. The study found there were a few critical gaps (weak technical support, discrepancies among offices in policy implementation/interpretation, problematic claiming procedures, etc.) in the execution and operation of the project which needed to be addressed so as to fully maximize the benefits of the project and ensure its sustainability not just as a project but as a program in the future. |
| Keywords: | service delivery, Philippines, social health insurance, patient navigation |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2014-41&r=hea |
| By: | Swenson, David A. |
| Abstract: | This analysis measures the regional economic value of The University of Iowa Hospitals and Clinics (hereafter, UIHC). The assessment looks at UIHC operational expenditures using a properly specified regional input-output model that accurately reflects its major spending categories and its primary territory of economic influence. This analysis does not contain an estimate of the regional economic boost attributable to patients or the families of patients traveling to the Iowa City metropolitan area for services or other visits. An estimate of those values would require a scientifically valid survey of visitors and patients that details average duration of stay and the amount of spending accruing regionally. This study analyzes only the economic activity associated with the operation of the UIHC as a public health care institution. |
| Keywords: | input-output; economic impact; University of Iowa Hospitals and Clinics |
| Date: | 2015–01–05 |
| URL: | http://d.repec.org/n?u=RePEc:isu:genres:38339&r=hea |
| By: | Max Groneck; Frederic Krehl |
| Abstract: | Informal care of children for their frail elderly parents may induce parents to compensate their children for their help. To test this hypothesis, we use the Exit Interview from the Health and Retirement Study. Our results show that caregiving has a significant positive impact on the incidence and the amount of received bequests both at the extensive and intensive margin of help. Three pieces of evidence suggest exchange motives rather than altruism to be the main source for this outcome. First, financially more well off children are more likely to receive an inheritance. Second, we find that a positive impact of help on bequest requires a written will as a contract between the parent and the helping child. Third, our results are even more pronounced when employing a fixed effects model to control for family altruism. |
| Keywords: | Intergenerational Transfers, Strategic Bequest Motive, Informal Long-term care, Altruism |
| JEL: | D13 D19 J14 |
| Date: | 2014–12–22 |
| URL: | http://d.repec.org/n?u=RePEc:kls:series:0079&r=hea |
| By: | Bärbel Held (Steinbeis-Hochschule Berlin, Germany) |
| Abstract: | The health care system in Germany is undergoing a phase of transformation. The resulting challenges and fields of action for the hospitals were described as one outcome of a scenario analysis conducted by the author. These include, for example, setting up new organisation structures, professionalising management competence or also developing a comprehensive quality management system. In the following analysis, the hospitals are to be described and compared to one another in terms of their initial conditions regarding these fields of action. The question at the focus is which different prerequisites and options the clinics have subject to their organisational structure. |
| Keywords: | analysis, comparison, health care, hospitals, soft budget constraint syndrome (SBC) |
| JEL: | I11 I12 I13 P36 |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:pes:wpaper:2014:no23&r=hea |
| By: | Catherine M. DesRoches; Peter Buerhaus; Robert S. Dittus; Karen Donelan |
| Abstract: | Efforts to solve the primary care workforce shortage that ignore the significant dissatisfaction of PCPs with their own careers are unlikely to be successful. Simply adding training slots and increasing reimbursement rates will do little to solve the problem if PCPs continue to view their own careers as ones they cannot recommend to others. |
| Keywords: | Primary Care Workforce Shortages and Career Recommendations from Practicing Clinicians |
| JEL: | I |
| Date: | 2014–12–23 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:58ddfa3f2d5a4d2b9f469bf4708f5ff4&r=hea |
| By: | Katerina Sherstyuka (University of Hawaii at Manoa); Dolgorsuren Dorjb (University of Hawaii at Manoa); Gerard Russo (University of Hawaii at Manoa) |
| Abstract: | Most individuals who have health insurance in the U.S. obtain it through their employer. In some states the government mandates employers to provide insurance to certain types of workers. We use experimental laboratory to study how employer mandates affect labor market efficiency and the level and structure of employment in the presence of wage rigidities such as minimum wage laws. We find that a binding minimum wage reduces labor market efficiency and decreases, and may fully eliminate, voluntary provision of health insurance by firms to low wage workers. Mandating health insurance for all workers guarantees insurance coverage for those employed, but reduces firms’ demand for workers and thus leads to unemployment. |
| Keywords: | Labor market, health insurance, minimum wages |
| JEL: | C92 I18 J20 J3 |
| Date: | 2014–10 |
| URL: | http://d.repec.org/n?u=RePEc:hai:wpaper:201427&r=hea |
| By: | Anna Hill JudyAnn Bigby |
| Keywords: | Preventive Services, Affordable Care Act, Databases |
| JEL: | I |
| Date: | 2014–11–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:0e16a88fe9df48c4bed29a48c508b90d&r=hea |
| By: | Jan Marcus; Thomas Siedler |
| Abstract: | Excessive alcohol consumption among young people is a major public health concern. On March 1, 2010, the German state of Baden-Württemberg banned the sale of alcoholic beverages between 10pm and 5am at off-premise outlets (e.g., gas stations, kiosks, supermarkets). We use rich monthly administrative data from a 70 percent random sample of all hospitalizations during the years 2007-2011 in Germany in order to evaluate the short-term impact of this policy on alcohol-related hospitalizations. Applying difference-in-differences methods, we find that the policy change reduces alcohol-related hospitalizations among adolescents and young adults by about seven percent. There is also evidence of a decrease in the number of hospitalizations due to violent assault as a result of the ban. |
| Keywords: | Binge drinking, drinking hours, alcohol control policies, difference-in-differences, hospital diagnosis statistics, alcohol |
| JEL: | I12 I18 D04 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp1443&r=hea |
| By: | McGovern, Mark E.; Canning, David |
| Abstract: | Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimate the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determine the relationship between vaccination coverage and under five mortality at the survey cluster level. Our data include over one million children in 68,490 clusters in 62 countries. We consider the childhood measles, Bacille Calmette-Guérin (BCG), Diphtheria-Pertussis-Tetanus (DPT), Polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjust for selection bias caused by the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimate that children in clusters with complete vaccination coverage have relative risk of mortality 0.73 (95% Confidence Interval: 0.68, 0.77) that of children in a cluster with no vaccination. While widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing their coverage rates in order to reduce child mortality. |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:227741&r=hea |
| By: | Marcus Dillender (W.E. Upjohn Institute for Employment Research); Karen Mulligan |
| Abstract: | A majority of married couples in the United States take advantage of the fact that employers often provide health insurance coverage to spouses. When the older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of the younger spouse. We find spousal eligibility for Medicare results in the younger spouse having worse insurance coverage and reduced access to health care services. |
| Keywords: | Health Insurance, Medicare, Individual Market, Marriage, Employer Benefits, ACA |
| JEL: | I13 J3 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:upj:weupjo:15-216&r=hea |
| By: | Talampas, Rolando G. |
| Abstract: | The study assesses the experience of three Asian countries: China, Thailand, and Vietnam in the pursuit of universal health coverage (UHC) of their social health insurance schemes. It seeks to analyze a set of domains including membership fees, services, benefits, equity, among others, relative to the economic and political conditions of these countries as "push and pull" factors in achieving UHC. This paper mainly utilizes empirical studies, assessment reports, international discussions and proceedings, and individual country plans of integrating, widening, and deepening health insurance coverage with the end goal of identifying comparative areas where the Philippines might be able to benchmark itself in its UHC quest. The study adopts the UHC cube of the World Health Organization as the framework for the review. It finally submits applicable recommendations that the Philippines may consider in advancing its plans toward universal health coverage. |
| Keywords: | health insurance, health, social health insurance, universal health coverage |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2014-46&r=hea |
| By: | Racelis, Rachel H. |
| Abstract: | The expenditures for employer-provided health care in private establishments and for student health services in private schools are two components estimated in the Philippine National Health Accounts (PNHA). The basic methodology for producing the annual estimates of the two components have remained the same since the first PNHA was produced in 1994 and estimation procedures had continued to use through the years the parameters (average costs) generated from the 1993-1994 establishments and private schools surveys. The surveys on health expenditures of private establishments and private schools were conducted again in 2013-2014 as part of this study. Results from the new surveys are used to generate the updated parameters for PNHA estimation. Additionally, results from the survey provide detail on curative care provision and preventive health care activities of establishments and private schools. |
| Keywords: | Philippines, health, Philippine National Health Accounts, employer-provided health care, private schools health services, health accounts approach |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2014-44&r=hea |
| By: | Moscone, Francesco; Tosetti, Elisa; Vittadini, Giorgio |
| Abstract: | In this paper, we investigate the impact of precarious employment on mental health using a unique dataset that matches information on mental health with labour characteristics for a set of employees in Italy. We examine the causal effect of temporary contracts, their duration and the number of contract changes during the year on psychotropic medication prescription. To this end, we estimate a dynamic probit model, and deal with the potential endogeneity of regressors by adopting a control function approach, recently advanced by Wooldridge (2014). Our results show that the probability of psychotropic medication prescription is higher for workers under temporary job contracts. More days of work under temporary contract as well as more changes in temporary contracts significantly increase the probability of being depressed. We also find that moving from permanent to temporary contracts increases depression; symmetrically, although with a smaller effect in absolute value, moving from temporary to permanent contracts tends to reduce it. An exploratory data analysis corroborates the hypothesis that depression developed after a movement to precarious employment may permanently affect future job trajectories. One lesson to learn from our empirical work is that policies aimed at enhancing the flexibility of the labour market to boost firms' competitiveness, if increasing the precariousness of employment, may also produce sides effects on the wellbeing and mental health of employees, ultimately having consequences on firms' productivity and health care costs. |
| Keywords: | Precarious employment, mental health, prescriptions. |
| JEL: | I1 I11 J0 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:61405&r=hea |
| By: | Jasmin Kantarevic; Boris Kralj |
| Abstract: | We develop a simple principal–agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behaviour. These features include: (1) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contract and a blended capitation contract; (2) the capitation rate is higher and the cost-reimbursement rate is lower in the blended capitation contract; (3) physicians sort selectively into the contracts based on their initial productivity; (4) all else equal, physicians in the blended capitation model provide fewer services than physicians in the enhanced fee-for-service model. |
| Keywords: | physician remuneration, moral hazard, adverse selection, Ontario |
| JEL: | I10 I12 I18 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:cch:wpaper:150001&r=hea |
| By: | Godard, Mathilde; Garrouste, Clémentine |
| Abstract: | This paper investigates whether leaving school in a bad economy deteriorates health in the longrun. We focus on individuals in England and Wales who left full-time education in their last year of compulsory schooling immediately after the 1973 oil crisis. Our identification strategy builds on two sources. First, it relies on the comparison of very similar individuals – born the same year – whose school-leaving behaviour in different economic conditions was exogeneously induced by compulsory schooling laws. More specifically, within a same birth cohort, pupils born at the end of the calendar year (September to December) were forced to leave school almost a year later than pupils born earlier in the year (January to August). Second, we exploit the sharp increase in unemployment rates generated by the 1973 oil crisis. Between 1974 and 1976, each school cohort indeed faced worse economic conditions at labour-market entry than the previous one. Unlike school-leavers who did postpone their entry on the labour market during the 1980s and 1990s recessions, we provide evidence that pupils’ decisions to leave school at compulsory age between 1974 and 1976 were not endogeneous to the contemporaneous economic conditions at labour market entry. We use a repeated cross section of individuals over 1983-2001 from the General Household Survey (GHS) and take a life-course perspective, from 7 to 26 years after school-leaving. Our results show that men who left school in a bad economy have a higher probability of smoking over the whole period (1983-2001) and of having ever smoked. Women who left school in a bad economy are more likely to report poorer health over the whole period under study. They also have a higher probability to restrict their activity due to illness or injury and to consult the General Practitioner. We do not find any significant effects of poor economic conditions at labour-market entry on subsequent labour-market, marriage and fertility outcomes. |
| Keywords: | General Household Survey; Labour market; School-leavers; Economic crisis; Education; England; Wales; |
| JEL: | J17 N34 I29 |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:dau:papers:123456789/14542&r=hea |