nep-hea New Economics Papers
on Health Economics
Issue of 2015‒05‒02
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The European Pharmaceutical Industry in a Global Economy: what drives EU exports of pharmaceuticals? By Ludivine Blanc
  2. Smoking in top-grossing US movies 2014 By Polansky, Jonathan R; Titus, Kori; Atayeva, Renata; Glantz, Stanton A PhD
  3. The political economy of rationing health care in England and the US: the ‘accidental logics’ of political settlements By Gwyn Bevan; Lawrence D. Brown
  4. Does increased medication use among seniors increase risk of hospitalization and emergency department visits? By Sara Allin; David Rudoler; Audrey Laporte
  5. Increasing access to HIV testing: Impacts on equity of coverage and uptake from a national campaign in South Africa By Brendan Maughan-Brown; Neil D. Lloyd; Jacob Bor; Atheendar S. Venkataramani
  6. Using equivalent income concept in blood pressure lowering drugs assessment By Van de Voorde, Carine; Schokkaert, Erik; Luchini, Stéphane; Fleurbaey, Marc; Thébaut, Clémence; Samson, Anne-Laure; Dormont, Brigitte
  7. Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries By Rivka Weiser; Marsha Gold
  8. Avoiding Blindness to Health Status in Health Achievement and Health Inequality Measurement By Paul Makdissi; Myra Yazbeck
  9. A Matter of Life and Death? Hospital Distance and Quality of Care - Evidence from Emergency Hospital Closures and Myocardial Infarctions By Daniel Avdic
  10. Why ‘Optimal’ Payment for Healthcare Providers Can Never Be Optimal Under Community Rating By Frech, Ted E; Zweifel, Peter
  11. The Process of Public Resources Allocation for Investment in Hospital Capacities By Alexandre Marinho
  12. Coming to Work While Sick: An Economic Theory of Presenteeism with an Application to German Data By Hirsch, Boris; Lechmann, Daniel S. J.; Schnabel, Claus
  13. Politico-Economic Determinants of Tort Reforms in Medical Malpractice By Ulrich Matter; Alois Stutzer
  14. The Effect of Air Pollution on Mortality in China: Evidence from the 2008 Beijing Olympic Games By Guojun He; Maoyong Fan; Maigeng Zhou
  15. Long-term effect on suicidal thoughts of graduating during a recession By Yamamura, Eiji
  16. Challenges of the Private Health Plans Regulation in Brazil By Carlos Octávio Ocké-Reis
  17. The Effect of Paid Parental Leave on Child Health in Australia By Broadway, Barbara; Kalb, Guyonne; Kuehnle, Daniel; Maeder, Miriam
  18. Is There a Link Between Employer-Provided Health Insurance and Job Mobility? Evidence from Recent Micro Data By Chute, Benjamin W.; Wunnava, Phanindra V.
  19. The Weaker Sex? Vulnerable Men, Resilient Women, and Variations in Sex Differences in Mortality since 1900 By Mark R. Cullen; Michael Baiocchi; Karen Eggleston; Pooja Loftus; Victor Fuchs

  1. By: Ludivine Blanc
    Abstract: The pharmaceutical industry is one of the most competitive sectors in the European Union. With its substantial investments in research and development, this industry represents a key asset for the European economy and a major source of growth and employment. However, despite the importance of the pharmaceutical sector for the European Union, few researchers have attempted to assess the determinants of the EU exports of pharmaceuticals. This paper aims at filling the aforementioned gap by examining what drives EU exports of pharmaceuticals. In order to tackle this question, this paper has derived hypotheses from the Gravity Model of Trade and the relevant academic literature on pharmaceuticals. Based on an econometric analysis, the research sheds light on the complex interaction of factors influencing the EU exports of pharmaceuticals. The paper finds that the protection of intellectual property in the receiving countries, their economic size, the importance of their health sector, and the quality of infrastructures constitute major drivers to the EU exports of pharmaceuticals. On the contrary, the research shows that transports costs as well as tariff barriers and non-tariff barriers tend to hinder the EU exports of pharmaceuticals.
    Keywords: pharmaceutical industry, exports, gravity model, intellectual property rights, non-tariff barriers, free trade agreements.
    JEL: F14 C23
    Date: 2015–04
  2. By: Polansky, Jonathan R; Titus, Kori; Atayeva, Renata; Glantz, Stanton A PhD
    Keywords: Education, Medicine and Health Sciences
    Date: 2015–04–13
  3. By: Gwyn Bevan; Lawrence D. Brown
    Abstract: This article considers how the 'accidental logics' of political settlements for the English National Health Service (NHS) and the Medicare and Medicaid programmes in the United States have resulted in different institutional arrangements and different implicit social contracts for rationing, which we define to be the denial of health care that is beneficial but is deemed to be too costly. This article argues that rationing is designed into the English NHS and designed out of US Medicare; and compares rationing for the elderly in the United States and in England for acute care, care at the end of life, and chronic care.
    JEL: N0
    Date: 2014–07–01
  4. By: Sara Allin; David Rudoler; Audrey Laporte
    Abstract: Objective: to examine the extent of the health risks of consuming multiple medications among the older population. Data sources/study setting: Secondary data from the period 2004-2006. The study setting was the province of Ontario, Canada, and the sample consisted of individuals aged 65 years or older who responded to a national health survey. Study design: We estimated a system of equations for inpatient and emergency department (ED) services to test the marginal effect of medication use on hospital services. We controlled for endogeneity in medication use with a two-stage residual inclusion approach appropriate for non-linear models. Principal findings: In- creased prescription drug use has the effect of increasing the likelihood of both being admitted into hospital and visiting a hospital ED. Each additional medication is associated with a 2% increase the likelihood of hospitalization and ED visit, after controlling for past utilization, health status, the endogeneity of medication use, and the unobserved factors that may affect the use of both services. Conclusions: Multiple medications appear to increase the risk of hospitalization among seniors covered by a universal prescription drug plan. These results raise questions about the appropriateness of medication use and the need for increased oversight of current prescribing practices.
    Keywords: pharmaceuticals, instrumental variable, seniors, Ontario
    Date: 2015–04
  5. By: Brendan Maughan-Brown (Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town); Neil D. Lloyd (Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town); Jacob Bor (Center for Global Health and Development, Boston University); Atheendar S. Venkataramani (Massachusetts General Hospital and Harvard Medical School)
    Abstract: Background: HIV counselling and testing (HCT) is a critical component of HIV prevention and treatment efforts. Between April 2010 and June 2011 South Africa ran an ambitious, multi-sector, campaign aiming to test 15 million people nationwide. We assessed the extent to which this campaign reached (1) those who previously had never tested for HIV and (2) high risk and socioeconomically vulnerable populations. Methods: We used data from the National Income Dynamics Study (NIDS, n=18,650), a nationally representative panel study in South Africa, to assess the uptake of first-time testing between 2010 and 2012 at the national level and by age, gender, racial, and province-level subgroups. Multivariate logistic regression analyses were used to compare the factors associated with HIV testing in 2010 and 2012, and to assess the characteristics of first-time testers. Results: The proportion of adults having ever received an HIV test increased from 43.7% (95% CI: 41.48; 45.96) in 2010 to 65.2% [63.28; 67.10] in 2012, as approximately 7.5 million individuals 15 years and older tested for the first time nationally. However, there was large variation in new testing rates across geographic areas and population subgroups. The association between ever testing and both income and self-reported health declined between 2010 and 2012, suggesting the campaign was successful in reaching poorer and healthier individuals. However, disparities in testing by education and gender remained strong between 2010 and 2012. Conclusion: The provision of HCT services in South Africa led to a steady rise in the proportion of individuals ever tested for HIV and has improved equity of HCT uptake. Future initiatives to increase HCT uptake, both within South Africa and in other countries, would gain from lessons learned from the South African effort. However, new interventions may be required to improve testing rates among the less educated and men, particularly poor men, and to achieve universal HCT access and uptake.
    Keywords: HIV counselling and testing, HCT Services, National Income Dynamics Study, NIDS, South Africa
    Date: 2015
  6. By: Van de Voorde, Carine; Schokkaert, Erik; Luchini, Stéphane; Fleurbaey, Marc; Thébaut, Clémence; Samson, Anne-Laure; Dormont, Brigitte
    Keywords: Income; drugs;
    JEL: I12 I11
    Date: 2014–06
  7. By: Rivka Weiser; Marsha Gold
    Keywords: Medicare, Medicaid, Dually Eligible Beneficiaries
    JEL: I
    Date: 2015–04–22
  8. By: Paul Makdissi (Department of Economics, University of Ottawa); Myra Yazbeck (School of Economics, The University of Queensland)
    Abstract: This paper argues that health transfers from an individual at a lower rank in the health distribution to a person at a higher rank may decrease the concentration index if the former has a slightly higher income. The concentration index, being mainly focused on the socioeconomic dimension of health inequality, can produce such counter-intuitive results that overlooks the pure health inequality aversion of the planner. Building on Atkinson (1970), Yitzhaki (1983) and Wagstaff (2002), this paper presents a simple new class of health achievement and health inequality indices that overcomes the above mentioned problem.
    Keywords: Health inequality,Health Achievement
    JEL: D63 I10
    Date: 2015–04–23
  9. By: Daniel Avdic (CINCH – Health Economics Research Center)
    Abstract: The article analyzes to which extent residential proximity from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI). The critical time aspect in AMI treatment provides an ideal application for evaluating this proximity outcome hypothesis. Previous studies have encountered empirical difficulties relating to potential endogenous health-based spatial sorting of involved agents and data limitations on out-of-hospital mortality. Using policyinduced variation in hospital distance arising from plausibly exogenous emergency hospital closures in the highly regulated Swedish health care sector, and data on all AMI deaths in Sweden over two decades, estimation results show a clear, robust and gradually declining probability of surviving an AMI of about two percentage points (three percent) per additional ten kilometers distance from a hospital. Results further show that spatial sorting and sample selection from outof-hospital mortality are likely to significantly attenuate the distance effect unless accounted for.
    Keywords: myocardial infarction, geographical access, hospital closures, health policy, spatial sorting, self-selection, out-of-hospital mortality, causal effect
    JEL: C23 I14 I18 R41
    Date: 2015–01
  10. By: Frech, Ted E; Zweifel, Peter
    Abstract: This article extends the received literature on optimal provider payment by accounting for consumer heterogeneity in preferences for health insurance and health care. This heterogeneity breaks down the separation of the relationship between providers and the health insurer and the relationship between consumers and the insurer. Both experimental and market evidence for a high degree of heterogeneity are presented. Given heterogeneity, a uniform policy fails to effectively control moral hazard, while incentives for risk selection created by community rating cannot be neutralized through risk adjustment. Consumer heterogeneity spills over into relationships with providers, such that a uniform contract with providers cannot be optimal either. The decisive condition for ensuring optimality of provider payment is to replace community rating (which violates the principle of marginal cost pricing) by risk-rating of contributions combined with subsidization targeted at high risks with low incomes.
    Keywords: Social and Behavioral Sciences, Community Rating, Health Insurance, Optimal Payment
    Date: 2015–04–27
  11. By: Alexandre Marinho
    Abstract: This work develops a simple and comprehensive framework to improve the allocation of public resources to public and private hospitals from the standpoint of public hospital profitability in the presence of income inequalities. The paper illustrates the direct impacts that publicly-funded investments in capacity, the adoption of a public market share, the institution of punishments for insufficient supply and the provision of a stochastic reservation quality have on a public hospital’s surplus. The presented framework fits well the enormous Brazilian health system and can be useful in other circumstances and countries where public and private hospitals coexist. O presente trabalho explicita um modelo simples e abrangente, para explorar possibilidades de aprimoramento na alocação de recursos públicos para investimentos em hospitais. Estuda-se a coexistência de hospitais públicos e privados, que devem atender diferentes estratos populacionais segmentados por renda em um mesmo setor saúde, o que possibilita a ocorrência de excessos de demanda. Nesse arcabouço, são explicitados os impactos que a adoção de diferentes políticas de racionalização da oferta podem ter sobre o desempenho econômico dos hospitais públicos. O modelo é aplicável ao sistema de saúde brasileiro e a outros casos e situações semelhantes.
    Date: 2015–01
  12. By: Hirsch, Boris (University of Erlangen-Nuremberg); Lechmann, Daniel S. J. (University of Erlangen-Nuremberg); Schnabel, Claus (University of Erlangen-Nuremberg)
    Abstract: Presenteeism, i.e. attending work while sick, is widespread and associated with significant costs. Still, economic analyses of this phenomenon are rare. In a theoretical model, we show that presenteeism arises due to differences between workers in (health-related) disutility from workplace attendance. As these differences are unobservable by employers, they set wages that incentivise sick workers to attend work. Using a large representative German data set, we test several hypotheses derived from our model. In line with our predictions, we find that bad health status and stressful working conditions are positively related to presenteeism. Better dismissal protection, captured by higher tenure, is associated with slightly fewer presenteeism days, whereas the role of productivity and skills is inconclusive.
    Keywords: presenteeism, absenteeism, sick leave, Germany
    JEL: I19 J22
    Date: 2015–04
  13. By: Ulrich Matter; Alois Stutzer (University of Basel)
    Abstract: The U.S. tort system has experienced various reforms during the last three decades. While there is a broad literature on the consequences of these reforms, very little is known about their determinants. In this study, we investigate the politico-economic forces that were driving the reform process across U.S. states. We focus on five types of medical malpractice tort reform and apply semi-parametric proportional hazards models to assess the factors that are related to reform enactments. We find, first, that a higher fraction of Republicans in a state legislature as well as a Republican governor are the major drivers of medical malpractice tort reforms. Second, we find that a higher fraction of women in a state legislature is associated with reforms being deferred. This finding is corroborated by micro-evidence on female legislators’ voting behavior on medical malpractice tort reforms, and it is consistent with the notion that women are disproportionally aggrieved by such reforms.
    Keywords: Tort reform, tort law, medical malpractice, rent-seeking, legislatures, women in politics
    JEL: D72 K13
    Date: 2015
  14. By: Guojun He (Department of Economics, Hong Kong University of Science and Technology; Institute for Emerging Market Studies, Hong Kong University of Science and Technology); Maoyong Fan (Department of Economics, Ball State University); Maigeng Zhou (National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention)
    Abstract: By exploiting exogenous variation in air quality during the 2008 Beijing Olympic Games, we estimate the effect of air pollution on mortality in China. We find that a 10-μg/m^3 (roughly 10%) decrease in PM_10 concentrations reduces monthly standardized all-cause mortality by 6.63%. The mortality reduction during the Olympics is mainly driven by fewer cardiocerebrovascular and respiratory deaths. Extrapolating our results to all urban areas in China, we estimate that the economic benefits from averted pre-mature deaths would range from 380 billion to 6 trillion Yuan annually if PM_10 concentrations were reduced to the WHO guideline level of 20 μg/m^3.
    Keywords: air pollution, mortality, particulate matter, 2008 Beijing Olympic Games
    JEL: Q53 I15 I18
    Date: 2015–01
  15. By: Yamamura, Eiji
    Abstract: Based on survey data from Japan, empirical results show that stock prices in the graduation year of university students are negatively associated with the probability that those individuals will consider suicide many years after graduation.
    Keywords: Graduation year; Recession; Stock price; Suicide; Subjective perception.
    JEL: E60 I12 I39 Z10
    Date: 2015–04–15
  16. By: Carlos Octávio Ocké-Reis
    Abstract: The idea of regulating private health plans so as to favor major players and the “managed care” is incompatible with the guidelines of the National Health System [Sistema Único de Saúde (SUS)] and for this reason we defend instead a regulatory action aiming to strengthen the public sphere. In particular, we discuss how this alternative could improve the regulatory capacity of the National Supplementary Health Agency [Agência Nacional de Saúde Suplementar (ANS)] to face the economic crisis in the health plan marketplace, dispelling the mistaken notion that the market, once strengthened, will cooperate with the SUS rather than contaminate it. A idéia que defende uma regulação dos planos de saúde em favor dos grandes players e do “managed care” é incompatível com as diretrizes do Sistema Único de Saúde (SUS), por isso, defendemos a adoção de um tipo de ação regulatória em direção ao fortalecimento da esfera pública. Em particular, apontamos como essa alternativa poderia capacitar a Agência Nacional de Saúde Suplementar (ANS) no enfrentamento da crise econômica do mercado de planos, desfazendo a ficção de que o mercado, uma vez fortalecido, vai cooperar com o SUS, ao invés de contaminá-lo.
    Date: 2015–01
  17. By: Broadway, Barbara (Melbourne Institute of Applied Economic and Social Research); Kalb, Guyonne (Melbourne Institute of Applied Economic and Social Research); Kuehnle, Daniel (University of Erlangen-Nuremberg); Maeder, Miriam (University of Erlangen-Nuremberg)
    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 socio-economic 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
  18. By: Chute, Benjamin W. (Middlebury College); Wunnava, Phanindra V. (Middlebury College)
    Abstract: This study investigates the prevalence and severity of job immobility induced by the provision of employer-sponsored health insurance – a phenomenon known as 'job-lock'. Using data from the National Longitudinal Survey of Youth from 1994 to 2010, job-lock is identified by measuring the impact of employer-sponsored health insurance on voluntary job turnover frequency. Estimates from a logistic regression with random effects indicate that job-lock reduces voluntary job turnover by 20% per year. These results that are consistent with past research and are also supported by two alternative identification strategies employed in this paper. Our results indicate a persistence of the job-lock effect, despite two major policy interventions designed to mitigate it (COBRA and HIPAA) and signal a fundamental misunderstanding of its causes. Both policies made health insurance more portable between employers, but this paper presents evidence from a quasi-natural experiment to suggest that the problem is a lack of viable alternative private sources of health insurance. In this model, we find evidence that access to health insurance through one's spouse or partner dramatically increases voluntary job turnover. This finding has significant bearing on predicted impacts of the Patient Protection and Affordable Care Act (2010) and the individual health insurance exchanges catalyzed by it; these new markets will create risk pools that may 'unlock' a job-locked individual by providing them a viable alternative to employer-sponsored health insurance.
    Keywords: job-lock, COBRA (1985), HIPAA (1996), Affordable Care Act (2010), random effects, difference-in-difference, voluntary job switch
    JEL: I13 J16 J32 J51
    Date: 2015–04
  19. By: Mark R. Cullen; Michael Baiocchi; Karen Eggleston; Pooja Loftus; Victor Fuchs
    Abstract: Sex differences in mortality (SDIM) vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. We document “stylized facts” about SDIM with which any theory will have to contend. We draw on a wide swath of mortality data, including probability of survival to age 70 by county in the United States, the Human Mortality Database data for 18 high-income countries since 1900, and mortality data within and across developing countries over time periods for which reasonably reliable data are available. We show that, in each of the periods of economic development after the onset of demographic and epidemiologic transition, cross-sectional variation in SDIM exhibits a consistent pattern of female resilience to mortality under adversity. Moreover, as societies develop, M/F survival first declines and then increases, a “SDIM transition” embedded within the demographic and epidemiologic transitions.
    JEL: I14 I15 J10 J16
    Date: 2015–04

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