nep-hea New Economics Papers
on Health Economics
Issue of 2015‒04‒19
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health: How Will the NHS Fare in a Cold Climate? By Alistair McGuire; John Van Reenen
  2. Discrimination Against The Obese And Very Thin Students in Brazilian Schools By Luis Claudio Kubota
  3. Labor Health Shortage and Future Prospects for the Medical Workforce in Morocco By Zouag, Nada; Driouchi, Ahmed; Achehboune, Amale
  4. The Role of Body Size in Economic Research Above and Beyond Beauty By Sonia Oreffice; Climent Quintana-Domeque
  5. Quality Healthcare and Health Insurance Retention: Evidence from a Randomized Experiment in the Kolkata Slums By Delavallade, Clara
  6. Public-private mix and performance of health care systems in CEE and CIS countries By Blazej Lyszczarz
  7. Health Care Systems’ Evolvement and the Changing Role of the State in Selected CEEC By Jacek Klich
  8. Public-private Partnerships in Biomedical Research and Health Innovation for Alzhemier's Disease and other Dementias By OECD
  9. Vog: Using Volcanic Eruptions to Estimate the Health Costs of Particulates and SO2 By De Paula, Áureo; Halliday, Timothy J.; Lynham, John
  10. Fiscal space for health in Sub-Saharan African countries: an efficiency approach By Novignon, Jacob; Nonvignon, Justice
  11. Do Education and Health Conditions Matter in a Large Cash Transfer? Evidence from a Honduran Experiment By Fiorella Benedetti; Pablo Ibarrarán; Patrick J. McEwan
  12. Market Socialism and Community Rating in the Affordable Care Act By Frech, Ted
  13. The impact of the recession on health care expenditure — How does the Czech Republic, Hungary, Poland and Slovakia compare to other OECD countries? By Baji, Petra; Péntek, Márta; Boncz, Imre; Brodszky, Valentin; Loblova, Olga; Brodszky, Nóra; Gulácsi, László
  14. Healthcare in the Light of the Concept of Welfare State Regimes - Comparative Analysis of EU MS By Dorota Kawiorska
  15. Nurses’ Motivation and Satisfaction at Work: an exploratory study at the Centro Hospitalar S. João By Fátima Gomes; Teresa Proença
  16. A Bayesian Analysis of Racial Differences in Treatment among Breast-cancer Patients By Nandram, B.; Bhadra, Dhiman; Liu, Yiwei
  17. Estimating nutrition-income elasticities in sub-Saharan African:Implication on health By Ogundari, Kolawole; Ito, Shoichi; Okoruwa, Victor
  18. A Theory of Education and Health By Titus J. Galama; Hans van Kippersluis
  19. The Effect of Paid Parental Leave on Child Health in Australia By Barbara Broadway; Guyonne Kalb
  20. Not Feeling Well… (True or Exhaggerated ?) Health (un)Satisfaction as a Leading Health Indicator By Maria Bachelet; Leonardo Becchetti; Fabiola Ricciardini
  21. Why Do Americans Spend So Much More on Health Care than Europeans? By Kevin x.d. Huang; Hui He

  1. By: Alistair McGuire; John Van Reenen
    Abstract: With the NHS a central issue of the 2015 general election, the parties are debating funding, the form of provision, quality and productivity. This paper looks at the NHS record under the coalition government and considers the plans each major party have put forward regarding the future of the health service.
    Keywords: hospital competition, market structure, 2015 General Election, government policy, NHS
    Date: 2015–04
  2. By: Luis Claudio Kubota
    Abstract: PeNSE 2012 is a survey conducted by the Brazilian Institute of Geography and Statistics (IBGE), in partnership with the Ministry of Health. PeNSE covers a broad range of subjects, especially risk behavior. This article has the aim of analyzing discrimination against obese and very thin students using PeNSE microdata. Data indicate that students that classify themselves as “very fat” or “very thin” are much more prone to risk behaviors like consumption of illicit drugs, alcohol, cigarettes and laxatives (or vomit inducing), when compared to “normal” pupils. They are also much more likely to suffer from frequent bullying (FB), especially that motivated by their body appearance, to be active bullies, to feel frequently lonely, to suffer from insomnia, family violence, aggressions and injuries. A great percentage was involved in fights and feel that their parents rarely or never understand their problems and preoccupations. Econometric model shows that non “normal” students have a greater chance of suffering FB than “normal” pupils. Male students have greater chance of being frequently discriminated when compared to the female ones. There is no statistical difference between public and private schools. Black, yellow and Indian students have greater chance of suffering FB than white pupils. Students whose mothers didn’t study have greater chance of suffering FB than those whose mothers have completed high school education. A Pesquisa Nacional de Saúde do Escolar (PeNSE) 2012, realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE), em parceria com o Ministério da Saúde (MS), abrange um amplo leque de assuntos, com destaque para comportamentos de risco. Este artigo tem o objetivo de analisar a discriminação contra estudantes obesos e muito magros, utilizando microdados da PeNSE. Os dados indicam que alunos que se autoclassificam “muito gordos” ou “muito magros” são muito mais propensos a comportamentos de risco, como o consumo de drogas ilícitas, álcool, cigarros e laxantes (ou indução ao vômito), quando comparados com alunos “normais”. Eles também são muito mais sujeitos a sofrer bullying frequente (BF) – especialmente aquele motivado por sua aparência corporal, a serem bullies ativos, a sentirem solidão, a sofrerem de insônia, violência familiar, agressões e lesões. Um elevado percentual está envolvido em brigas e avalia que seus pais raramente ou nunca entendem seus problemas e preocupações. O modelo econométrico implementado mostra que estudantes não “normais” têm mais chance de sofrer BF que os “normais”. Os alunos do sexo masculino têm maior chance de ser discriminados em relação às alunas. Não há diferença estatisticamente significativa entre escolas públicas e privadas. Alunos pretos, amarelos e indígenas têm maior chance de sofrer BF em relação aos brancos. Estudantes cujas mães não estudaram têm maior chance de sofrer BF em relação àqueles cujas mães têm ensino médio completo.
    Date: 2015–01
  3. By: Zouag, Nada; Driouchi, Ahmed; Achehboune, Amale
    Abstract: Abstract This paper looks at the current situation of health deficits and shortages in Morocco with a focus on the roles of medical education and prospects for the health workforce for the period 2010-2030. The attained results from both trend description and simulations of patterns show major shortages relative to the needs. The existence of these trends appeals for further cooperation in the areas of health care through emphasis on medical education and research. These outcomes appear to be promising for the pursuit of satisfying the needs of a growing population and demand for health care.
    Keywords: Keywords: Morocco-Health Workforce-Simulations
    JEL: I1 I14 I15
    Date: 2015–04–10
  4. By: Sonia Oreffice; Climent Quintana-Domeque
    Abstract: We analyze how attractiveness rated at the start of the interview in a nation- ally representative sample is related to weight, height, and body mass index (BMI), separately by gender and accounting for interviewers' characteristics or fixed effects. We also compute the non-anthropometric residual attractiveness, and present novel estimates of how non-anthropometric attractiveness and anthropometric attributes are related to labor and marital outcomes such as hourly wage and spousal educa- tion. We show that height, weight, and BMI all strongly contribute to male and female attractiveness when attractiveness is rated by opposite-sex interviewers, and that anthropometric characteristics are irrelevant to male interviewers when assessing male attractiveness. In addition, we estimate that non-anthropometric attractiveness and height matter for both men and women in the labor market, while BMI plays a stronger role than (residual) beauty in the marriage market.
    Keywords: Attractiveness, Body Mass Index, Height, Weight, Wage, Spousal Education.
    JEL: J01 J10
    Date: 2015
  5. By: Delavallade, Clara (SALDRU, School of Economics, University of Cape Town and IFPRI)
    Abstract: Health care in developing countries is often unreliable and of poor quality, reducing incentives to use quality health services. Using data from a field experiment in India, I show that providing initial quality care improves the demand for quality health care by raising intended health insurance renewal and subsequent use of quality services. Randomly offering insurance policyholders a free consultation with a qualified doctor has a twofold effect: receiving this additional benefit raises willingness to pay to renew health insurance by 56 percent, exposed individuals are 11 percentage points more likely to consult a qualified practitioner when ill after the consultation.
    Keywords: access to and demand for quality healthcare, micro health insurance retention, willingness to pay, trust, poverty, India
    JEL: I13 I15 O15
    Date: 2015
  6. By: Blazej Lyszczarz (Nicolaus Copernicus University in Toruñ)
    Abstract: The role of the public and private sector in health care systems remains one of the crucial problems of these systems' operation. The purpose of this research is to identify the relationships between the performance of health systems in CEE and CIS (Central and Eastern Europe and Commonwealth of Independent State) countries and the mix of public-private sector in the health care of these countries. The study uses a zero unitarization method to construct three measures of health system performance in the following areas: (1) resources; (2) services; and (3) health status. The values of these measures are correlated with the share of public financing that represents the public-private mix in the health systems. The data used is from World Health Organization’s Health for All Database for 23 CEE and CIS countries and comprises the year 2010. The results show that the performance of health systems in the countries investigated is positively associated with a higher proportion of public financing. The strongest relationship links public financing with performance in the area of services production. For policy makers, these results imply that health systems in post-communist transition economies could be susceptible to a decreasing role of the state and that growing reliance on the market mechanism in health care can deteriorate the operation of these systems.
    Keywords: health care system; public-private mix; transition economies, health status
    JEL: I11 H51 P36
    Date: 2015–04
  7. By: Jacek Klich (Pañstwowa Wy¿sza Szko³a Zawodowa im. rtm. W. Pileckiego w Oœwiêcimiu)
    Abstract: Despite common heritage, Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovakia (hereinafter Central and Eastern European Countries – CEEC) opted for different models while reforming their health care systems. A common (and important) component of these reforms was privatization and introduction of various market mechanisms in health care systems. The objective of the paper is to identify main challenges resulting from the health care reforms in CEEC. Review of the literature (using EBSCO and ScienceDirect databases) on the results of the health care reforms in CEEC will be followed by an analysis of the changes in health care financing in CEEC between 1995-2012 with a special emphasis on the role of the state in this process. WHO statistics (data) on national health care expenditures divided further into: total health expenditure, general government expenditure, private expenditure, and out of pocket expenditure (with various configurations) will be used. It is argued that health care reforms led (among others) to shifting the financial risk to patients and the state is slowly (and continually) withdrawing from financing health care in CEEC. This diminishing share of state financing of health care is not compensated by tax deductions and/or other forms of allowances. Also the issue of restricted access to health care is indicated here as a by-product of the health care reforms undertaken in CEEC.
    Keywords: health care reforms; Central and Eastern Europe; financing health care; privatization of health care services
    JEL: O57 L38 L30
    Date: 2015–04
  8. By: OECD
    Abstract: The Organisation for Economic Co-operation and Development (OECD), through its Working Party on Biotechnology, undertook a project on “Healthy Ageing and Biomedical Innovation for Dementia and Alzheimer’s disease”. The project was conducted under Output Result 2.1 of the WPB Programme of Work and Budget 2013-14 and aimed to identify good practices to strengthen effective co-operation at a global level for the governance of biomedical technologies and health innovation in Alzheimer’s disease and other dementias. This report is in line with recommendations of the G8 Summit Declaration to strengthen collaboration for innovation and cross-sector partnerships focused on social impact investment, new care and prevention models, and academia/ industry partnerships. It had been informed by a literature review and information on public-private partnership case studies provided by members of the Working Party on Biotechnology.
    Date: 2015–04–09
  9. By: De Paula, Áureo; Halliday, Timothy J.; Lynham, John
    Abstract: Kilauea volcano is the largest stationary source of SO2 pollution in the United States of America. Moreover, the SO2 that the volcano emits eventually forms particulate matter, another major pollutant. We use this exogenous source of pollution variation to estimate the impact of particulate matter and SO2 on emergency room admissions and costs in the state of Hawai‘i. Importantly, our data on costs is more accurate than the measures used in much of the literature. We find strong evidence that particulate pollution increases pulmonary-related hospitalization. Specifically, a one standard deviation increase in particulate pollution leads to a 2-3% increase in expenditures on emergency room visits for pulmonary-related outcomes. However, we do not find strong effects for pure SO2 pollution or for cardiovascular outcomes. We also find no effect of volcanic pollution on fractures, our placebo outcome. Finally, the effects of particulate pollution on pulmonary-related admissions are most concentrated among the very young. Our estimates suggest that, since the large increase in emissions that began in 2008, the volcano has increased healthcare costs in Hawai‘i by approximately $6,277,204.
    Keywords: Health; Particulates; Pollution; SO2; Volcano
    JEL: H51 I12 Q51 Q53
    Date: 2015–04
  10. By: Novignon, Jacob; Nonvignon, Justice
    Abstract: The study argues that potential savings from efficiency could be effective alternative to increasing health system financing in SSA. Health system efficiency estimates were derived from the Data Envelopment Analysis and Stochastic Frontier Analysis and used to compute potential gains from efficiency. Data was sourced from the World Bank's world development indicators for 45 SSA countries in 2011. The results reveal that average potential saving in health expenditure from improved efficiency was 0.10% and 0.75% of GDP per capita in the DEA and SFA models, respectively. The results also showed that a 1% increase in efficiency of health expenditure reduced infant mortality rate by 0.91% compared to 0.40% reduction in infant mortality if health expenditure increased by 1%. The results imply that in the face of significant economic challenges and burden on government budget, improving health expenditure efficiency to create some fiscal space will be an important step.
    Keywords: Fiscal space for health, health expenditure, DEA, SFA
    JEL: H5 H51 I1
    Date: 2015–02–02
  11. By: Fiorella Benedetti; Pablo Ibarrarán; Patrick J. McEwan
    Abstract: The paper analyzes a new Honduran conditional cash transfer experiment (Bono 10,000) in which 150 poor villages (of 300) were treated. The transfers were much larger in size than an earlier experiment (Galiani & McEwan, 2013), but yielded smaller full-sample effects on school enrollment, child labor participation, and measures of health service use. One explanation is that Bono 10,000 did not apply conditions to children: only one child in eligible households was subject to the education condition, and young children and mothers were only subject to health conditions in the absence of older children. Consistent with this, we find a large effect on enrollment (and a nearly off-setting one on child labor) among only children, and smaller and insignificant effects on children in larger households. We only find significant effects on health service use among children and mothers in the absence of older children (despite a much smaller household transfer). The heterogeneity does not appear to be driven by correlated variables such as household size, child age, or poverty.
    Keywords: Labor, Youth & Children, Conditional cash transfers, Women, Health Care, Conditional cash transfers, Impact evaluation, Conditionalities, Honduras
    Date: 2015–02
  12. By: Frech, Ted
    Keywords: Social and Behavioral Sciences
    Date: 2015–04–13
  13. By: Baji, Petra; Péntek, Márta; Boncz, Imre; Brodszky, Valentin; Loblova, Olga; Brodszky, Nóra; Gulácsi, László
    Abstract: In the past few years, several papers have been published in the international literature on the impact of the economic crisis on health and health care. However, there is limited knowledge on this topic regarding the Central and Eastern European (CEE) countries. The main aims of this study are to examine the effect of the financial crisis on health care spending in four CEE countries (the Czech Republic, Hungary, Poland and Slovakia) in comparison with the OECD countries. In this paper we also revised the literature for economic crisis related impact on health and health care system in these countries. OECD data released in 2012 were used to examine the differences in growth rates before and after the financial crisis. We examined the ratio of the average yearly growth rates of health expenditure expressed in USD (PPP) between 2008–2010 and 2000–2008. The classification of the OECD countries regarding “development” and “relative growth” resulted in four clusters. A large diversity of “relative growth” was observed across the countries in austerity conditions, however the changes significantly correlate with the average drop of GDP from 2008 to 2010. To conclude, it is difficult to capture visible evidence regarding the impact of the recession on the health and health care systems in the CEE countries due to the absence of the necessary data. For the same reason, governments in this region might have a limited capability to minimize the possible negative effects of the recession on health and health care systems.
    JEL: I15
    Date: 2015
  14. By: Dorota Kawiorska (Cracow University of Economics)
    Abstract: This paper addresses issues related to health care in the context of the debate about the typology of welfare state regimes and comparative studies conducted by reference to the debate. Particular attention has been paid to the phenomenon of decommodification as one of the key dimensions that define welfare regimes identified in the literature associated with this debate. The study presents a health decommodification index, on the basis of which an attempt has been made to assess the decommodification potential of health care, taking into account the situation in the 28 EU Member States in 2012. The identification of a widely understood accessibility of publicly funded health care as a basic measure for assessing the decommodifying features of health programs is an important result of the empirical analysis. The study has also confirmed the views expressed in the literature about the existence of practical obstacles standing in the way of developing a universal typology of welfare states.
    Keywords: welfare state regimes, health care, decommodification
    JEL: A11 H51 I18 P16
    Date: 2015–04
  15. By: Fátima Gomes (Hospital de S. João); Teresa Proença (CEF.UP, Faculdade de Economia, Universidade do Porto)
    Abstract: This study aims to assess nurses’ motivation and satisfaction and measure the impact of socio-demographical and socio-professional variables, namely professional contract. A questionnaire was delivered to a sample consisting of 560 nursing professionals of the second major Hospital in Portugal, Hospital São João (HSJ): 277 nurses on public contract, 173 on open ended contract and 110 on fixed term contract. Results show that the relationship with the patients is the most important factor for nurses’ satisfaction, followed by satisfaction with the job content. Remuneration is the factor in which nurses show the least satisfaction. Nurses with a fixed contract, the most insecure of all, are the ones with greater motivation and satisfaction, contrary to what is expected according to content motivational theories. However, they also have greater expectation that their performance can improve their contract, what may explain the previous results. This paper also suggests that work and the type of contract has an impact on personal life and vice-versa, namely on the intent of leaving the job, on the marital status and the number of children.
    Keywords: motivation, satisfaction, nursing, professional contract
    JEL: J28
    Date: 2015–04
  16. By: Nandram, B.; Bhadra, Dhiman; Liu, Yiwei
    Abstract: It is a well known fact that race and ethnicity specificc variations exist in the treatment and survival of cancer patients. Studies based on breast cancer patients admitted to community hospitals in U.S depicted that there is significant difference in patterns of care between black and white breast cancer patients with blacks receiving lower quality and quantity of care. In this study, we look at this problem from a different perspective, treating the hospitals as small areas, and employing Bayesian techniques for parameter estimation. Two separate models are constructed to estimate the odds ratio of receiving liver scan (a pattern of care) for blacks and whites. The first model uses hospital-specific information while the second one uses pooled hospital data by borrowing strength from neighbouring hospitals. We have used the non-central hyper-geometric distribution as the basis for constructing the likelihood while estimation has been carried out using the griddy Metropolis-Hastings sampler. We apply our methodology on a National Cancer Institute (NCI) database. Although our results corroborate some of the observations from previous studies, it proposes a computationally attractive alternative to the established procedures in formulating and analyzing this problem.
  17. By: Ogundari, Kolawole; Ito, Shoichi; Okoruwa, Victor
    Abstract: The study estimates calories, proteins and fats-income elasticities in sub Saharan Africa (SSA). Annual time series data for 43 countries covering 1975-2009 that yields a balanced panel was employed for the analysis. The nutrient-income elasticities are estimated based on the aggregate Engel Curve framework using Feasible Generalized Least Square (FGLS) technique that is robust to autocorrelation and non-parametric plot. The empirical results show that a 10% increase in income will lead to about a 0.90%, 0.87%, and 0.73% rise in fats, proteins and calories supply, respectively in the region. This shows that the estimated nutrient-income elasticities are of small size. Other results show that the relationship between calorie and protein-income was found to be non-linear at higher income and diminished, as revealed by the estimated aggregate Engel Curve and non-parametric plot.
    Keywords: Nutrition, health, income elasticity, cross-country, and SSA
    JEL: E0 E00 I1 I10
    Date: 2014–07–16
  18. By: Titus J. Galama (University of Southern California, and RAND Corporation, United States); Hans van Kippersluis (Erasmus School of Economics, Erasmus University Rotterdam, the Netherlands)
    Abstract: This paper presents a unified theory of human capital with both health capital and, what we term, skill capital endogenously determined within the model. By considering joint investment in health capital and in skill capital, the model highlights similarities and differences in these two important components of human capital. Health is distinct from skill: health is important to longevity, provides direct utility, provides time that can be devoted to work or other uses, is valued later in life, and eventually declines, no matter how much one invests in it (a dismal fact of life). Lifetime earnings are strongly multiplicative in skill and health, so that investment in skill capital raises the return to investment in health capital, and vice versa. The theory provides a conceptual framework for empirical and theoretical studies aimed at understanding the complex relati onship between education and health, and generates several new testable predictions.
    Keywords: health investment; lifecycle model; human capital; health capital
    JEL: D91 I10 I12 J00 J24
    Date: 2015–03–05
  19. By: Barbara Broadway (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Guyonne Kalb (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: Providing mothers with access to paid parental leave may be an important public policy to improve child and maternal health. Using extensive information from the Australian Longitudinal Study of Children (LSAC), we contribute to the literature by estimating the effect of paid parental leave entitlements on child health up to age seven. Exploiting detailed information on children’s health, family background, mothers’ pre-birth work histories and mothers’ health behaviours during pregnancy within a propensity score matching framework, we show that paid parental leave entitlements reduce the probability of a child having multiple ongoing health conditions, but do not significantly affect any single condition. We find that the effect on multiple conditions is strongest for children from lower socioeconomic backgrounds. Our study implies that the provision of paid parental leave, even for short periods (as usually available in Australia), will benefit children’s health.
    Keywords: Child health, parental leave, Australia, LSAC
    JEL: I1
    Date: 2015–04
  20. By: Maria Bachelet (Università di Roma "Tor Vergata"); Leonardo Becchetti (DEDI and CEIS, Università di Roma "Tor Vergata"); Fabiola Ricciardini (ISTAT)
    Abstract: A desirable property of subjective wellbeing indicators is their capacity to predict future objective outcomes. In our paper we provide novel cross-country original evidence documenting that lagged health (un)satisfaction is a leading health indicator, that is, a significant predictor of future changes in health conditions on a large sample of Europeans aged above 50. We find that, after controlling for attrition bias, lagged (un)satisfaction with health is significantly and positively correlated with changes in the number of chronic diseases, net of the concurring impact of levels and changes in socio-demographic factors and health styles, country and regional health system effects and declared symptoms. Our findings are robust in age, gender, education and income class splits and are significant when separately estimated in the 13 countries of our sample. We further test the ordinal predictive properties of the health (un)satisfaction indicator in magnitude and statistical significance. Illness specific estimates document that the impact of lagged health (un)satisfaction is significant on ulcer, hypertension, arthritis and cholesterol (and weakly so on cataracts, hip or femoral fracture and lung diseases), while having a robust and significant effect on the probability of contracting cancer.
    Keywords: health outcomes, health satisfaction
    JEL: I12 I31
    Date: 2015–04–02
  21. By: Kevin x.d. Huang (Vanderbilt University); Hui He (Shanghai University of Finance and Economics and International Monetary Fund)
    Abstract: Empirical evidence suggests that both leisure time and medical care are important for maintaining health. We develop a general equilibrium macroeconomic model in which taxation is a key determinant of the composition of these two inputs in the endogenous accumulation of health capital. In our model, higher taxes lead to using relatively more leisure time and less medical care in maintaining health. We find that difference in taxation between the US and Europe can account for a large fraction of their difference in health expenditure-GDP ratio and almost all of their difference in time input for health production.
    Keywords: Taxation; Relative health care price; Time allocation; Health care expenditure; Macroeconomics
    JEL: E2 H2
    Date: 2015–04–08

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