nep-hea New Economics Papers
on Health Economics
Issue of 2015‒03‒05
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. India : Maternal and Reproductive Health at a Glance By Sameh El-Saharty; Naoko Ohno; Intissar Sarker; Federica Secci; Vikram Rajan
  2. Does quality disclosure improve quality? Responses to the introduction of nursing home report cards in Germany By Herr, Annika; Nguyen, Thu-Van; Schmitz, Hendrik
  3. Drinking water salinity and infant mortality in coastal Bangladesh By Dasgupta, Susmita; Huq, Mainul; Wheeler, David
  4. Income-Related Children's Health Inequality and Health Achievement in China By Lu Chen; Ya Wu; Peter Coyte
  5. Cambodia's Main Challenges in Improving Health among the Poor By World Bank Group
  6. Assessment of Health Financing Options : Papua New Guinea By World Bank
  7. Violence Against Women and Girls : Health Sector Brief By Floriza Gennari; Jennifer McCleary-Sills; Diana Arango; Nidia Hidalgo
  8. Adolescent Sexual and Reproductive Health and Rights in Nicaragua : An Analysis Using a Sexual and Reproductive Health Framework and Human Rights By Amparo Gordillo-Tobar; Geraldine Beneitez; Juana Ortega; William Waters; Emig Bravo
  9. Self-employment and health care reform: evidence from Massachusetts By Tuzemen, Didem; Becker, Thealexa
  10. Individual Survival Curves Comparing Subjective and Observed Mortality Risk By Luc Bissonnette; Michael Hurd; Pierre-Carl Michaud
  11. An economic analysis of proposals to improve coverage of longevity risk By David Boisclair; Jean-Yves Duclos; Steeve Marchand; Pierre-Carl Michaud
  12. Gender Roles and Medical Progress By Stefania Albanesi; Claudia Olivetti
  13. The organization of working time and its effects in the health services sector : a comparative analysis of Brazil, South Africa and the Republic of Korea By Messenger, Jon C; Vidal, Patricia
  14. Circular migration of health-care professionals : what do employers in Europe think of it? By Frenzel, Helen; Weber, Tina
  15. Investigating the working conditions of Filipino and Indian-born nurses in the UK By Calenda, Davide
  16. Air Quality, Mortality, and Perinatal Health: Causal Evidence from Wildfires By Christopher Khawand
  17. The Effects of Loan Amounts on Health Care Utilization in Ghana By Ekow Asmah, Emmanuel; Orkoh, Emmanuel
  18. Using Budgeting for Results in HIV/AIDS Programs : Lessons from Peru By Andre Medici; Veronica Vargas; Fernando Lavadenz; Lais Miachon
  19. Long-Term Care Utility and Late in Life Saving By John Ameriks; Joseph S. Briggs; Andrew Caplin; Matthew D. Shapiro; Christopher Tonetti
  20. Prescription Drug Use under Medicare Part D: A Linear Model of Nonlinear Budget Sets By Jason Abaluck; Jonathan Gruber; Ashley Swanson
  21. Regulating Innovation with Uncertain Quality: Information, Risk, and Access in Medical Devices By Matthew Grennan; Robert Town
  22. Testing for Changes in the SES-Mortality Gradient When the Distribution of Education Changes Too By Thomas Goldring; Fabian Lange; Seth Richards-Shubik
  23. Risk Selection under Public Health Insurance with Opt-out By Sebastian Panthöfer

  1. By: Sameh El-Saharty; Naoko Ohno; Intissar Sarker; Federica Secci; Vikram Rajan
    Keywords: Health Monitoring and Evaluation Health, Nutrition and Population - Adolescent Health Gender - Gender and Health Health, Nutrition and Population - Population Policies Gender - Gender and Development Health Nutrition and Population
    Date: 2014–11
  2. By: Herr, Annika; Nguyen, Thu-Van; Schmitz, Hendrik
    Abstract: Since 2009, German nursing homes have been evaluated regularly with quality report cards published online. We argue that most of the information in the report cards does not reliably measure quality of care, but a subset of seven measures does. Using a sample of more than 3,000 nursing homes with information on two waves, we find a significant improvement in the nursing home quality from the first to the second evaluation. Both indicators comprising either the two outcome quality measures or the seven measures indicating "risk factors" in the report cards improve. This can be interpreted as evidence that quality disclosure positively affects the (reported) quality in nursing homes.
    Keywords: public reporting,quality,long-term care,information
    JEL: L15 I11 I18
    Date: 2015
  3. By: Dasgupta, Susmita; Huq, Mainul; Wheeler, David
    Abstract: Bangladesh, with two-thirds of its land area less than five meters above sea level, is one of the most climate-vulnerable countries in the world. Low-lying coastal districts along the Bay of Bengal are particularly vulnerable to sea level rise, tidal flooding, storm surges, and climate-induced increases in soil and water salinity. This paper investigates the impact of drinking water salinity on infant mortality in coastal Bangladesh. It focuses on the salinity of drinking water consumed during pregnancy, which extensive medical research has linked to maternal hypertension, preeclampsia, and post-partum morbidity and mortality. The study combines spatially-formatted salinity measures for 2001-09 provided by Bangladesh with individual and household survey information from the Bangladesh Demographic and Health Surveys for 2004 and 2007. It uses probit and logit analyses to estimate mortality probability for infants less than two months old. Controlling for many other determinants of infant mortality, the analysis finds high significance for salinity exposure during the last month of pregnancy and no significance for exposure during the preceding months. The estimated impact of salinity on infant mortality is comparable in magnitude to the estimated effects of traditionally-cited variables such as maternal age and education, gender of the household head, household wealth, toilet facilities, drinking water sources, and cooking fuels.
    Keywords: Population Policies,Water Conservation,Town Water Supply and Sanitation,Water and Industry,Water Supply and Sanitation Governance and Institutions
    Date: 2015–02–01
  4. By: Lu Chen; Ya Wu; Peter Coyte
    Abstract: This study assessed income-related health inequality and health achievement in children in China, and additionally, examined province-level variations in health achievement. Longitudinal data on 19,801 children under 18 years of age were derived from the China Health and Nutrition Survey. Income-related health inequality and health achievement were measured by the Health Concentration and Health Achievement Indices, respectively. Panel data with a fixed effect multiple regression model was employed to examine province-level variations in health achievement. A growing trend was towards greater health inequality among Chinese children over the last two decades. Although health achievement was getting better over time, the pro-rich inequality component has lessened the associated gain in achievement. Health achievement was positively impacted by middle school enrollments, the urbanization rate, inflation-adjusted per capita gross domestic product, and per capita public health spending. This study has provided evidence that average health status of Chinese children has improved, but inequality has widened. Widening inequality slowed the growth in health achievement for children over time. There were wide variations in health achievement throughout China.
    Keywords: child health inequality, concentration index, health achievement
    JEL: D63 I14 J13
    Date: 2015–02
  5. By: World Bank Group
    Keywords: Health Monitoring and Evaluation Early Child and Children's Health Gender - Gender and Health Health Systems Development and Reform Disease Control and Prevention Health, Nutrition and Population
    Date: 2014–11
  6. By: World Bank
    Keywords: Public Sector Expenditure Policy Macroeconomics and Economic Growth - Subnational Economic Development Public Sector Development Health, Nutrition and Population Health, Nutrition and Population - Health Monitoring & Evaluation Health, Nutrition and Population - Health Economics & Finance Health, Nutrition and Population - Health Systems Development & Reform
    Date: 2014–08
  7. By: Floriza Gennari; Jennifer McCleary-Sills; Diana Arango; Nidia Hidalgo
    Keywords: Health, Nutrition and Population - Adolescent Health Gender - Gender and Health Health, Nutrition and Population - Population Policies Gender - Gender and Development Health, Nutrition and Population - Health Monitoring & Evaluation
    Date: 2014–12
  8. By: Amparo Gordillo-Tobar; Geraldine Beneitez; Juana Ortega; William Waters; Emig Bravo
    Keywords: Health Monitoring ; Evaluation Health, Nutrition and Population - Adolescent Health Education - Education For All Health, Nutrition and Population - Population Policies Gender - Gender and Development
    Date: 2014–11
  9. By: Tuzemen, Didem (Federal Reserve Bank of Kansas City); Becker, Thealexa (Federal Reserve Bank of Kansas City)
    Abstract: We study the e ect of the Massachusetts health care reform on the uninsured rate and the self-employment rate in the state. The reform required all individuals to obtain health insurance, required most employers to o er health insurance to their employees, formed a private marketplace that o ered subsidized health insurance options and ex- panded public insurance. We examine data from the Current Population Survey (CPS)for 1994-2012 and its Annual Social and Economic (ASEC) Supplement for 1996-2013. We show that the reform led to a dramatic reduction in the state's uninsured rate due to increased enrollment in both public and private health insurance. Estimation results from di erence-in-di erences models and the synthetic control method indicate that the aggregate self-employment rate was higher in the state after the implementation of the reform. We conclude that easier access to health insurance encouraged self-employment in Massachusetts. There are many similarities between the Massachusetts health care reform and the national health care reform, the Patient Protection and Affordable Care Act (PPACA). Based on Massachusetts' experience, the PPACA will lower the national uninsured rate and may lead to a higher self-employment rate in the nation.
    Keywords: Massachusetts health care reform; Patient Protection and Affordable Care Act; self-employment; health insurance; difference-in-differences model; synthetic control method
    JEL: C10 C15 E24 I13 I18 I38 L26
    Date: 2014–11–25
  10. By: Luc Bissonnette; Michael Hurd; Pierre-Carl Michaud
    Abstract: In this paper, we compare individual survival curves constructed from objective (actual mortality) and elicited subjective information (probability of survival to a given target age). We develop a methodology to estimate jointly subjective and objective individualsurvival curves accounting for rounding on subjective reports of perceived mortality risk. We make use of the long follow-up period in the Health and Retirement Study and the high quality of mortality data to estimate individual survival curves which feature both observed and unobserved heterogeneity. This allows us to compare objective and subjective estimates of remaining life expectancy for various groups, evaluate subjective expectations of joint survival and widowhood by household, and compare objective and subjective mortality with standard life-cycle models of consumption.
    Keywords: Subjective probabilities, old age mortality, joint survival of couples,
    JEL: C81 D84 I10
    Date: 2015–02–25
  11. By: David Boisclair; Jean-Yves Duclos; Steeve Marchand; Pierre-Carl Michaud
    Abstract: We use simulation methods to analyze the impacts of certain proposed reforms to improve the coverage of longevity risk. This risk, which may in principle be adequately covered by classic defined-benefit pension plans, has been of particular interest in Quebec for some years now, notably due to the decline in the participation to such plans. Recent proposals which aim to increase the coverage of longevity risk mostly deal with expansion of the “2nd pillar" of the retirement income system, currently comprised of the Quebec Pension Plan. We therefore consider a key proposal of the D’Amours committee (the longevity pension), in addition to two other proposals: that of Mintz and Wilson, which aims to increase the generosity of the current regime, and that of Wolfson, which introduces a concept of contribution and benefit rates differentiated by income. Using data from Statistics Canada surveys, we analyze the internal rate of return (IRR) of these proposals for various types of individuals taking into consideration inequality in life expectancy, temporal variability of income, and interactions with taxation and the different retirement income support programs. We contrast the results with those obtained when opting instead for additional contributions into existing voluntary savings vehicles combined with a basic annuity purchased at retirement.
    Keywords: longevity risk, retirement savings, inequality, life expectancy,
    JEL: I14 J18 J26 J32
    Date: 2015–02–25
  12. By: Stefania Albanesi (Federal Reserve Bank of New York); Claudia Olivetti (Boston University and NBER)
    Abstract: Maternal mortality was the second largest cause of death for women in childbearing years up until the mid-1930s in the United States. For each death, twenty times as many mothers were estimated to suffer pregnancy related conditions, often leading to severe and prolonged disablement. Poor maternal health made it particularly hard for mothers to engage in market work. Between 1930 and 1960 there was a remarkable reduction in maternal mortality and morbidity. We argue that these medical advances, by enabling women to reconcile work and motherhood, were essential for the joint rise in married women's labor force participation and fertility over this period. We also show that the diffusion of infant formula played an important auxiliary role.
    Keywords: maternal mortality, female labor force participation, fertility, baby boom, human capital
    JEL: I15 J13 J22 N30
    Date: 2015–02
  13. By: Messenger, Jon C; Vidal, Patricia
    Abstract: This study of the organization of working time and its effects in the health services sector was managed by Jon Messenger, ILO Inclusive Labour Markets, Labour Relations and Working Conditions Branch (INWORK), in collaboration with Christiane Wiskow, ILO Sectoral Activities Department (SECTOR). Research assistance for the preparation of this report synthesizing the findings of the country case studies conducted in Brazil, the Republic of Korea, and South Africa was provided by Patricia Vidal, including a desk review and qualitative analysis of the effects of working time arrangements on workers' well-being and individual and organizational performance.
    Keywords: arrangement of working time, health service, medical personnel, hours of work, work life balance, comparative study, Brazil, Korea R, South Africa, aménagement du temps de travail, service de santé, personnel médical, durée du travail, conciliation travail-vie personnelle, étude comparative, Brésil, Corée R, Afrique du Sud, ordenamiento del tiempo de trabajo, servicio de salud, personal médico, horas de trabajo, conciliación vida familiar y laboral, estudio comparativo, Brasil, Corea R, Sudáfrica
    Date: 2015
  14. By: Frenzel, Helen; Weber, Tina
    Abstract: The paper captures the findings of a study on employer views regarding the importance and feasibility of the implementation of circular migration policies. It is based on desk review and interviews with employers’ organisations, individual employers, public employment services and ministries and agencies responsible for coordinating international migration of health-care personnel. Interviews focused on the experience in a selected number of countries (Finland, Germany, Ireland and the United Kingdom), which are among the destination countries for health-care professionals from the Philippines and India.
    Keywords: nurse, medical personnel, labour migration, return migration, international migration, migrant worker, management attitude, health service, EU countries, infirmière, personnel médical, migrations de main-d'oeuvre, migration de retour, migration internationale, travailleur migrant, attitude patronale, service de santé, pays de l'UE, enfermera, personal médico, migraciones laborales, retorno de los migrantes, migración internacional, trabajador migrante, actitud de la dirección, servicio de salud, países de la UE
    Date: 2014
  15. By: Calenda, Davide
    Keywords: nurse, migrant worker, Filipino, Indian, labour migration, international migration, working conditions, health service, UK, infirmière, travailleur migrant, Philippin, Indien, migrations de main-d'oeuvre, migration internationale, conditions de travail, service de santé, Royaume-Uni, enfermera, trabajador migrante, filipino, indio, migraciones laborales, migración internacional, condiciones de trabajo, servicio de salud, Reino Unido
    Date: 2014
  16. By: Christopher Khawand
    Abstract: I demonstrate how scientific models of pollution processes can be leveraged in quasi-experimental econometric designs to credibly estimate the impacts of environmental quality on health or other outcomes while also improving precision and external validity over previous approaches. I simulate the geographic distribution of fine particulate matter (PM2.5) caused by wildfires for the entire continental United States during 2004-2010 using a set of scientific models of wildfire emissions and air pollution transport commonly used wildfire and air quality applications. Regressing observed concentrations of PM2.5 at pollution monitoring stations on simulated PM2.5 from wildfires, I find that wildfires can explain at least 15 percent of ambient ground-level PM2.5 and even larger fractions of toxic mercury and lead particulates. I then regress county-level health outcomes on station-measured PM2.5 using simualted wildfire PM2.5 as an instrumental variable. I find that a 10 microgram per cubic meter (approximately 2.3 standard deviation) increase in monthly PM2.5 concentration is associated with one additional premature death per 100,000 individuals. This effect is driven primarily by deaths from cardiovascular and respiratory diseases for individuals over age 65. With a control function approach, I find evidence that dose response is approximately linear below the U.S. ambient air quality standard for PM2.5. In addition, I find that in-utero exposure to PM2.5 is associated with higher rates of prematurity, lower birth weights, and changes in the sex ratio, which I interpret as evidence of fetal attrition. Finally, I show that the estimated health effects of PM2.5 are sensitive to the inclusion of controls for other pollutants. I present suggestive evidence that this sensitivity reflects a heterogeneous response to metallic particulates, which are known to be particularly detrimental to health. These findings contribute to a growing body of evidence on the health dangers of fine particulate matter.
    JEL: Q53 Q54 I18
    Date: 2015–02–28
  17. By: Ekow Asmah, Emmanuel; Orkoh, Emmanuel
    Abstract: Utilization of health care services - both preventive and curative, is among the myriad of important determinants of health and remains an issue of significant policy concern and focus in developing countries. Despite the importance of health care utilization, there is evidence to confirm that many people in Ghana go without health care from which they could benefit greatly. This disturbing, yet preventable, state of affairs causes’ untold suffering and, given its wide scale, presents a major obstacle to the development process. A range of socioeconomic, demographic, and public health related factors work together to influence household health utilization but the extent to which access to formal and informal credit plays in the Ghanaian context has not been addressed in the empirical literature. Using recently released Ghana Household Living Standard Survey round six (GLSS, 6) in 2012/2013, this study examines the extent to which an individual’s relative control over household resources, gauged by loan amounts influence health care utilization. The results, based on logistic and multinomial regression model estimation, demonstrate that a one percent increase in the amount of credit accessed from a financial institution is associated with 0.611 probability that an individual will consult a health practitioner when ill. Other variables that significantly predict the tendency that a respondent will consult a health practitioner when suffering any infirmity include income of the household, insurance status of the individual, place of residence and household size. We also find that Individuals in different socio-economic strata (region, rural/urban) face different risks with health care utilization. Policies aimed at making credit available to individuals and households can make an important contribution to health care utilization in Ghana. Moving forward, health programs and interventions should be embedded in financial services and they need to be tailored to particular socio-economic groups.
    Keywords: Loan amount, Health care utilization, Multinomial logit
    JEL: I12
    Date: 2015–02–25
  18. By: Andre Medici; Veronica Vargas; Fernando Lavadenz; Lais Miachon
    Keywords: Health Monitoring and Evaluation Health, Nutrition and Population - HIV AIDS Gender - Gender and Health Disease Control and Prevention Health, Nutrition and Population - Population Policies Health Nutrition and Population
    Date: 2014–10
  19. By: John Ameriks; Joseph S. Briggs; Andrew Caplin; Matthew D. Shapiro; Christopher Tonetti
    Abstract: Older wealthholders spend down assets slowly. To study this pattern, the paper introduces health dependent utility into a model in which different preferences for bequests, expenditures when in need of long-term care (LTC), and ordinary consumption combine with health and longevity uncertainty to determine saving behavior. To help separately identify motives, it develops Strategic Survey Questions (SSQs) that elicit stated preferences. The model is estimated using new SSQ and wealth data from the Vanguard Research Initiative. Estimates of the health-state utility function imply that motives associated with LTC are significantly more important than bequest motives in determining late in life saving.
    JEL: D91 E21 H31 I10 J14
    Date: 2015–02
  20. By: Jason Abaluck; Jonathan Gruber; Ashley Swanson
    Abstract: Medicare Part D enrollees face a complicated decision problem: they must dynamically choose prescription drug consumption in each period given difficult- to-find prices and a non-linear budget set. We use Medicare Part D claims data from 2006-2009 to estimate a flexible model of consumption that accounts for non-linear budget sets, dynamic incentives due to myopia and uncertainty, and price salience. By using variation away from kink points, we are able to estimate structural models with a linear regression of consumption on coverage range prices. We then compare performance under several candidate models of expectations and coverage phase weighting. The estimates suggest small marginal price elasticities and substantial myopia; we also find evidence that salient plan characteristics impact consumption beyond their effect on out-of-pocket prices. A hyperbolic discounting model which allows for salient plan characteristics fits the data well, and outperforms both rational models and alternative behavioral models.
    JEL: D12 G22 I13
    Date: 2015–02
  21. By: Matthew Grennan; Robert Town
    Abstract: This paper examines optimal regulatory testing requirements when new product quality is uncertain but market participants may learn over time. We develop a model capturing the regulator's tradeoff between consumer risk exposure and access to innovation. Using new data and exogenous variation between EU and US medical device regulatory rules, we document patterns consistent with our model and estimate its parameters. We find: without information from regulatory testing, risk shuts down the market; US policy is close to the one that maximizes a measure of welfare derived from our theoretical model and our empirical estimates; EU surplus could increase 20 percent with more pre-market testing; and “post-market surveillance” could increase surplus 24 percent.
    JEL: I11 L11 L51
    Date: 2015–02
  22. By: Thomas Goldring; Fabian Lange; Seth Richards-Shubik
    Abstract: We develop a flexible test for changes in the SES-mortality gradient over time that directly accounts for changes in the distribution of education, the most commonly used marker of SES. We implement the test for the period between 1984 and 2006 using microdata from the Census, CPS, and NHIS linked to death records. Using our flexible test, we find that the evidence for a change in the education-mortality gradient is not as strong and universal as previous research has suggested. Our results indicate that the gradient increased for females during this time period, but we cannot rule out that the gradient among males has not changed. Informally, the results suggest that the changes for females are mainly driven by the bottom of the education distribution.
    JEL: I14 J11
    Date: 2015–02
  23. By: Sebastian Panthöfer
    Abstract: This paper studies risk selection between public and private health insurance when some individuals can purchase private insurance by opting out of otherwise mandatory public insurance. Using a theoretical model, I show that public insurance is adversely selected when insurers and insureds are symmetrically informed about health-related risks, and that selection can be of any type (advantageous or adverse) when insureds have private information about health risks. Drawing on data from the German Socio-Economic Panel, I find that: (1) public insurance is adversely selected under the German public health insurance with opt-out scheme, (2) individuals adversely select public insurance based on self-assessed health and advantageously select public insurance based on risk aversion, and (3) there is evidence of asymmetric information.
    Keywords: Public and private health insurance, Risk selection, Asymmetric information
    JEL: D82 H51 I13 I18
    Date: 2015–02

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