nep-hea New Economics Papers
on Health Economics
Issue of 2015‒05‒16
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health Insurance Mandates in a Model with Consumer Bankruptcy By Gilad Sorek; David Benjamin
  2. What Factors Affect Doctors’ Hours Decisions: Comparing Structural Discrete Choice and Reduced-Form Approaches By Guyonne Kalb; Daniel Kuehnle; Anthony Scott; Terence Chai Cheng; Sung-Hee Jeon
  3. Prenatal Testosterone Exposure Predicts Mindfulness – Does This Mediate Its Effect on Happiness? By Levent Neyse; Patrick Ring; Steven Bosworth
  4. Peer Effects, Fast Food Consumption and Adolescent Weight Gain By Bernard Fortin; Myra Yazbeck
  5. The Political Economy of (in)formal Long Term Care Transfers By Philippe De Donder; Marie-Louise Leroux
  6. Reducing Avoidable Hospitalizations for Medicare-Medicaid Enrollees in Nursing Facilities: Issues and Options for States By Laura D. Kimmey; James M. Verdier
  7. When Should Governments Subsidize Health? The Case of Mass Deworming By Amrita Ahuja; Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel; Shawn Powers
  8. Do Individuals Make Sensible Health Insurance Decisions? Evidence from a Menu with Dominated Options By Saurabh Bhargava; George Loewenstein; Justin Sydnor
  9. Alcohol consumption and harmful drinking: Trends and social disparities across OECD countries By Marion Devaux; Franco Sassi
  10. Assessing the impacts of alcohol policies: A microsimulation approach By Michele Cecchini; Marion Devaux; Franco Sassi
  11. Health, responsibility and taxation with a fresh start By Aitor Calo-Blanco
  12. Does Defensive Medicine Reduce Health Care Spending? By Barkowski, Scott
  16. Capitalising on the benefits of participatory research partnerships to promote health and well-being in vulnerable communities By Ronel Ferreira
  17. The effectiveness of using developed nursing documentation on nursing documentation quality and professional nurses’ satisfaction in the surgery inpatient department, Maharaj Nakhon Si Thammarat Hospital, Thailand By Poranee Rattanasiri; Janwamol Phangyota; Yuwadee Wittayapun
  20. The population aging – a challenge for the sustainability of the Romanian social health insurance system By Eugenia Claudia Bratu; Dana Galieta Minc; Florentina Ligia Furtunescu
  21. A Meta-analysis of Nursing Interventions for Pain Relief in Cancer Patients By Atiya Sarakshetrin
  22. Who can predict their own Demise? Accuracy of Longevity Expectations by Education and Cognition By Teresa Bago d'Uva; Esen Erdogan Ciftci; Owen O'Donnell; Eddy van Doorslaer
  23. Adult Mortality and Modern Growth By Davide Fiaschi; Tamara Fioroni
  24. Universal health coverage in the Philippines : progress on financial protection goals By Bredenkamp,Caryn; Buisman,Leander Robert
  25. The Relationship between Forgone Health Care and High School Dropout: Evidence from US Adolescents By Migali, G,;; Zucchelli, E,;
  26. How Health Plan Enrollees Value Prices Relative to Supplemental Benefits and Service Quality By Bunnings, C,;; Schmitz, H,;; Tauchmann, H,;; Ziebarth, N.R,;
  27. The Pros and Cons of Sick Pay Schemes: A Method to Test for Contagious Presenteeism and Shirking Behavior By Pichler, S,;; Ziebarth, N.R,;

  1. By: Gilad Sorek; David Benjamin
    Abstract: We study insurance take-up choices by consumers who face medical-expense and income risks, knowing they can default on medical bills by filing bankruptcy. For a given bankruptcy system we explore total and distributional welfare effects of health insurance mandates, compared with pre-mandates market equilibrium. We consider different combinations of premium-subsides and out-of-insurance penalties, confining attention to budgetary neutral policies. We show that when insurance mandates are enforced through penalties only, the efficient take-up level may be incomplete. However, if mandates are supported also with premium subsidies full insurance coverage is efficient and can be also Pareto improving. Such policies are consistent with the incentives structure set in the ACA for insurance take-up.
    Keywords: Consumer Bankruptcy; Health Insurance Mandates; Welfare
    Date: 2015–05
  2. By: Guyonne Kalb (Melbourne Institute of Applied Economic and Social Research, University of Melbourne); Daniel Kuehnle (University of Erlangen-Nuremberg); Anthony Scott (Melbourne Institute of Applied Economic and Social Research, University of Melbourne); Terence Chai Cheng (School of Economics, The University of Adelaide); Sung-Hee Jeon (Statistics Canada)
    Abstract: Few papers examine the pecuniary and non-pecuniary determinants of doctors’ labour supply despite substantial predicted shortages in many OECD countries. We contribute to the literature by applying both a structural discrete choice and a reduced-form approach. Using detailed survey data for Australian physicians, we examine how these different modelling approaches affect estimated wage elasticities at the intensive margin. We show that all modelling approaches predict small negative wage elasticities for male and female General Practitioners (GPs) and specialists. Our detailed subgroup analysis does not reveal particularly strong responses to wage increases by any specific group. We show that the translog and Box-Cox utility functions outperform the quadratic utility function. Exploiting the advantages of the structural discrete choice model, we examine short-term effects at the intensive margin by calculating labour supply changes in response to 5 and 10% wage increases. The results show that such wage increases substantially reduce the full-time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs, but not of female specialists.
    Keywords: Labour supply, discrete choice model, wage elasticity, health workforce, MABEL
    JEL: I11 J22 J44 J21
    Date: 2015–04
  3. By: Levent Neyse; Patrick Ring; Steven Bosworth
    Abstract: This study investigates the connection between mindfulness and prenatal testosterone exposure and explores whether this is related to the relationship between mindfulness and human well-being as captured by three separate measures. In a sample of 90 German student participants, we find that subjects’ digit ratio – a reliable indicator for exposure to prenatal testosterone – predicts their Mindful Attention Awareness Scale (MAAS) scores. Respondents with moderate levels of testosterone exposure have the highest MAAS scores. We additionally elicit participants’ self-reported general life satisfaction and current happiness levels as well as their estimates about others’ general life satisfaction. We find that MAAS strongly predicts absolute and relative life satisfaction and also current happiness levels, but digit ratios do not mediate the relationship between human well-being and mindfulness
    Keywords: Mindfulness; Digit ratio (2D:4D); Prenatal Testosterone; Life Satisfaction; Happiness
    JEL: L8 O5
    Date: 2015–04
  4. By: Bernard Fortin; Myra Yazbeck
    Abstract: This paper aims at opening the black box of peer effects in adolescent weight gain. Using Add Health data on secondary schools in the U.S., we investigate whether these effects partly flow through the eating habits channel. Adolescents are assumed to interact through a friendship social network. We propose a two-equation model. The first equation provides a social interaction model of fast food consumption. To estimate this equation we use a quasi maximum likelihood approach that allows us to control for common environment at the network level and to solve the simultaneity (reflection) problem. Our second equation is a panel dynamic weight production function relating an individual’s Body Mass Index z-score (zBMI) to his fast food consumption and his lagged zBMI, and allowing for irregular intervals in the data. Results show that there are positive but small peer effects in fast food consumption among adolescents belonging to a same friendship school network. Based on our preferred specification, the estimated social multiplier is 1.15. Our results also suggest that,in the long run, an extra day of weekly fast food restaurant visits increases zBMI by 4.45% when ignoring peer effects and by 5.11%, when they are taken into account.
    Keywords: Obesity, overweight, peer effects, social interactions, fast food, spatial models
    JEL: C31 I10 I12
    Date: 2015
  5. By: Philippe De Donder; Marie-Louise Leroux
    Abstract: We develop a model where families consist of one parent and one child, with children diering in income and all agents having the same probability of becoming dependent when old. Young and old individuals vote over the size of a social long term care transfer program, which children complement with informal (time) or formal (money) help to their dependent parent. Dependent parents have an intrinsic preference over informal to monetary help. We rst show that low (resp., high) income children provide informal (resp. formal) help, whose amount is decreasing (resp. increasing) with the child's income. The middle income class may give no family help at all, and its elderly members would be the main beneciaries of the introduction of social LTC transfers. We then provide several reasons for the stylized fact that there are little social LTC transfers in most countries. First, social transfers are dominated by informal help when the intrinsic preference of dependent parents for informal help is large enough. Second, when the probability of becoming dependent is lower than one third, the children of autonomous parents are numerous enough to oppose democratically the introduction of social LTC transfers. Third, even when none of the rst two conditions is satised, the majority voting equilibrium may entail no social transfers, especially if the probability of becoming dependent when old is not far above one third. This equilibrium may be local (meaning that it would be defeated by the introduction of a suciently large social program). This local majority equilibrium may be empirically relevant whenever new programs have to be introduced at a low scale before being eventually ramped up.
    Keywords: Majority voting, Local Condorcet winner, Crowding out, Intrinsic preference for informal help, Tax reform
    JEL: H55 I13 D91
    Date: 2015
  6. By: Laura D. Kimmey; James M. Verdier
    Abstract: States that contract with health plans to provide comprehensive Medicare and Medicaid services for dually eligible enrollees in nursing facilities can work with these plans to reduce avoidable hospitalizations.
    Keywords: Hospitalizations, Medicare, Medicaid, Enrollees, Nursing Facilities, State Health
    JEL: I
    Date: 2015–04–30
  7. By: Amrita Ahuja; Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel; Shawn Powers
    Abstract: We discuss how evidence and theory can be combined to provide insight on the appropriate subsidy level for health products, focusing on the specific case of deworming. Although intestinal worm infections can be treated using safe, low-cost drugs, some have challenged the view that mass school-based deworming should be a policy priority. We review well-identified research which both uses experimental or quasi-experimental methods to demonstrate causal relationships and adequately accounts for epidemiological externalities from deworming treatment, including studies of deworming campaigns in the Southern United States, Kenya, and Uganda. The existing evidence shows consistent positive impacts on school participation in the short run and on academic test scores, employment, and income in the long run, while suggesting that most parents will not pay for deworming treatment that is not fully subsidized. There is also evidence for a fiscal externality through higher future tax revenue, which may exceed the cost of the program. Our analysis suggests that the economic benefits of school-based deworming programs are likely to exceed their costs in places where worm infestations are endemic. This would likely be the case even if the benefits were only a fraction of estimates in the existing literature.
    JEL: H2 H51 I1 I12 I15 I2 I20 I25 I3 O1
    Date: 2015–05
  8. By: Saurabh Bhargava; George Loewenstein; Justin Sydnor
    Abstract: The recent expansion of health-plan choice has been touted as increasing competition and enabling people to choose plans that fit their needs. This study provides new evidence challenging these proposed benefits of expanded health-insurance choice. We examine health-insurance decisions of employees at a large U.S. firm where a new plan menu included a large share of financially dominated options. This menu offers a unique litmus test for evaluating choice quality since standard risk preferences and beliefs about one’s health cannot rationalize enrollment into the dominated plans. We find that a majority of employees – and in particular, older workers, women, and low earners – chose dominated options, resulting in substantial excess spending. Most employees would have fared better had they instead been enrolled in the single actuarially-best plan. In follow-up hypothetical-choice experiments, we observe similar choices despite far simpler menus. We find these choices reflect a severe deficit in health insurance literacy and naïve considerations of health risk and price, rather than a sensible comparison of plan value. Our results challenge the standard practice of inferring risk attitudes and assessing welfare from insurance choices, and raise doubts whether recent health reforms will deliver their promised benefits.
    JEL: D82 D89 I11 I13
    Date: 2015–05
  9. By: Marion Devaux; Franco Sassi
    Abstract: Harmful alcohol consumption is one of the leading causes of ill health and premature mortality worldwide. This paper illustrates trends and social disparities in alcohol consumption and harmful drinking in 20 OECD countries. Analyses are based on individual-level data from national health and lifestyle surveys. Alcohol consumption, on average, remained relatively stable in OECD countries over the past 20 years, but with significant variations between countries. However, a closer look at trends and patterns of consumption in specific population groups reveals a more complex picture. Young people are increasingly taking up harmful drinking. Women with high education and high socio-economic status are more likely to engage in harmful drinking than their less educated and less well-off counterparts, while the opposite is observed in men. Levels and patterns of alcohol consumption have an impact on labour market. Heavy alcohol consumption is associated with less employment opportunities, high wage penalties, and lower productivity, whereas light and moderate consumption are associated with positive labour market outcomes. By shedding light on some of the dimensions of alcohol consumption in OECD countries, this paper aims at contributing to the design of appropriate health policies to prevent alcohol-related harms. The findings presented in the paper provide a basis for a quantitative assessment of the impacts of alternative policy options, and may contribute to a better targeting of such policies.<BR>La consommation à risque d’alcool est l’une des principales causes de maladie et de mortalité prématurée dans le monde. Ce document de travail s’intéresse aux tendances et aux disparités sociales face à la consommation d’alcool et à la consommation à risque dans 20 pays de l’OCDE. Les analyses reposent sur des données individuelles d’enquêtes nationales de santé. La consommation d’alcool est restée en moyenne relativement stable dans les pays de l’OCDE lors des 20 dernières années, malgré de grandes variations entre pays. Une analyse approfondie des tendances et des modes de consommation dans certains groupes de population révèle cependant un schéma plus complexe. Les jeunes adultes adoptent de plus en plus des modes de consommation à risque. Les femmes les plus éduquées ou avec un statut socioéconomique élevé ont davantage une consommation à risque que celles moins éduquées ou avec un statut socioéconomique plus faible, alors que la relation inverse est observée chez les hommes. Les niveaux et les modes de consommation d’alcool ont un impact sur le marché du travail. Une consommation à risque est associée à de plus faibles opportunités d’emploi, des pénalités de salaires plus importantes, et une plus faible productivité, alors qu’une consommation légère et modérée est associée à des résultats positifs. Ce papier apporte un éclairage sur certaines dimensions de la consommation d’alcool dans les pays de l’OCDE, et aide ainsi à la définition de politiques de santé en matière de prévention des risques de la consommation d’alcool. Les résultats présentés dans ce document sont utiles à une évaluation quantitative de l’impact des politiques de prévention, et peuvent contribuer à un meilleur ciblage de ces politiques.
    JEL: I10 I12 I14
    Date: 2015–05
  10. By: Michele Cecchini; Marion Devaux; Franco Sassi
    Abstract: Alcohol policies have significant potential to curb alcohol-related harms, improve health, increase productivity, reduce crime and violence, and cut government expenditure. The WHO Global Strategy to reduce the harmful use of alcohol provides a menu of policy options based on international consensus, which the OECD has used as a starting point in identifying a set of policies to be assessed in an economic analysis based on a computer simulation approach. This working paper provides a comprehensive illustration of the modelling approach, input data and underlying assumptions that have been used to carry out the analyses. The policies assessed in three country settings – Canada, the Czech Republic and Germany – include price policies, regulation and enforcement policies, education programmes and health care interventions. The results of the OECD analyses show that brief interventions in primary care, typically targeting high-risk drinkers, and tax increases, which affect all drinkers, have the potential to generate large health gains. The impacts of regulation and enforcement policies as well as other health care interventions are more dependent on the setting and mode of implementation, while school-based programmes show less promise. Alcohol policies have the potential to prevent alcohol-related disabilities and injuries in hundreds of thousands of working-age people in the countries examined, with major potential gains in their productivity. Most alcohol policies are estimated to cut health care expenditures to the extent that their implementation costs would be more than offset. Health care interventions and enforcement of drinking-and-driving restrictions are more expensive policies, but they still have very favourable cost-effectiveness profiles.<BR>Les politiques de l’alcool peuvent jouer un rôle majeur dans la réduction des méfaits de l’alcool, l’amélioration de la santé, l’accroissement de la productivité, la réduction des délits et de la violence, et la diminution des dépenses publiques. La Stratégie mondiale de l’OMS visant à réduire l’usage nocif de l’alcool propose une liste d’options découlant d’un consensus international, que l’OCDE a utilisée comme point de départ pour mettre en lumière un ensemble d’actions à évaluer dans le cadre d’une analyse économique s’appuyant sur un modèle de micro-simulation. Ce document de travail offre une description complète du modèle, des données et des hypothèses sous-jacentes utilisées pour mener les analyses. Les actions évaluées dans trois pays – le Canada, la République tchèque et l’Allemagne – incluent des politiques de prix, des mesures de réglementation et d’application de la législation, des programmes d’éducation et des interventions sanitaires. Les résultats de l’analyse de l’OCDE montrent que l’on peut obtenir d’importants résultats en termes de santé grâce à des interventions brèves dans le cadre de soins primaires, qui ciblent généralement des consommateurs à haut risque, et à des hausses des taxes qui pénalisent tous les consommateurs. L’impact des mesures de réglementation et d’application de la législation, ainsi que d’autres interventions sanitaires, dépendent davantage du contexte et du mode d’application, tandis que les programmes en milieu scolaire semblent quant à eux moins prometteurs. Dans les pays étudiés, les politiques de l’alcool peuvent permettre à des centaines de milliers de personnes en âge de travailler d’éviter les incapacités et les blessures liées à l’alcool, ce qui améliorerait beaucoup leur productivité. On estime que la plupart des politiques de l’alcool pourraient contribuer à réduire les dépenses de santé dans la mesure où leurs coûts de mise en oeuvre seraient plus que compensés. Les interventions sanitaires et l’application de restrictions concernant l’alcool au volant constituent des mesures plus onéreuses, mais présentent quand même des rapports coût-efficacité très positifs.
    JEL: D61 D63 H51 I12 I18
    Date: 2015–05
  11. By: Aitor Calo-Blanco (Dpto. de Análisis Económico y Admon. de Empresas. University of A Coruña)
    Abstract: In a model where individuals differ in both their health care needs and their lifestyle preferences, we study the fair provision of health care with fresh starts. Grounded on basic ethical principles, we axiomatically derive social preferences that allow us to make welfare assessments when agents who regret their initial decisions may be granted a fresh start. Such preferences give top priority to that individual with the highest well-being difference between her actual choice and an ideal situation that entails neither regret nor health disabilities. Next, we characterise a schedule of taxes and health treatments that satisfies this social ordering. Limited by incentive-compatibility and health care needs heterogeneity, this schedule advocates balancing additional health treatments and reductions in non-medical consumption.
    Keywords: Health, Lifestyle Preferences, Fairness, Fresh Start, Taxation.
    JEL: D63 D71 H20 I10
    Date: 2015–05
  12. By: Barkowski, Scott
    Abstract: The medical community often argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous empirical work, however, has ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that health care spending does not rise in response to higher levels of risk. An increase in adverse actions equal to 16 (the mean, absolute value of year-to-year changes within a state) is found to be associated with statistically significant average annual spending decreases in hospital care and prescription drugs of as much as 0.25% (nearly $29 million) and 0.29% (almost $9.3 million). Malpractice payments were generally estimated to have smaller, statistically insignificant effects.
    Keywords: defensive medicine; medical malpractice; health care spending; medical licensing
    JEL: H75 I11 I18 K23 K32
    Date: 2015–02–01
  13. By: Neslihan Lok (Akdeniz University, Nursing Faculty, Psychiatric Nursing Department); Sefa Lok (Selcuk University, School of Physical Education and Sports, Coaching Education Department)
    Abstract: Introduction: Mild cognitive impairment is the pathological case in which the individual is between dementia and healthy. Therefore, especially in the protection, it is necessary to maintain and protect the cognitive functions. The physical activities exercised by the old people are crucial in increasing the cognitive functions or in maintenance of the present condition.Aim: In this research, the aim is to analyse the effects of the physical activities on the cognitive functions of the old people with mild cognitive impairment.Methods: The research was organized within the order of pretest-posttest design as experimental type using control groups. For the experiment, 25 old people with mild cognitive impairment who were convenient for physical activities were selected with regard to the doctors’ advice. For the control group, a group of old people with mild cognitive impairment was listed. For the old people in the experimental group, a physical activity programme was applied including 30 minutes walk and 30 minutes regular exercise three days in a week which had continued for four weeks. Nothing was applied on the control group. Sociodemographic form and Standardized Mini Mental Test were applied on the old people both before and after the activity. The data has been analysed using Mann Whitney U test and percentage distributions.Results: The average age of the experimental group is 71.3±3.6and the control group is 70.2±42. The average mini mental test point of the old people in the experimental group before the activity (20.6±2.4) increased considerably after the activity (24.3±3.6) and the difference is significant statistically (p<0.05). When the mini mental test points of the experimental and control group was compared after the activity, it was found out that the experimental group has higher points compared to the experimental group and the difference is significant (p<0.05).Conclusions: Regular and a three-day week physical activity program improved the cognitive functions of the old people with mild cognitive impairment.
    Keywords: Elderly, Mild cognitive impairment, Physical activity, Cognitive functions
    JEL: I19
  14. By: Neslihan Lok (Akdeniz University, Nursing Faculty, Psychiatric Nursing Department); Arzu Kocak Uyaroglu (Selcuk University, Faculty of Health Science); Ilhan Gunbayi (Akdeniz University)
    Abstract: Introduction: Specific cultural practices as a vital phenomenon, which is comprised as collectively and repeatedly in society, reveal the effect of social attitudes and behaviors on health and illness. Aim: The objective of this study is to determine views related with specific cultural practices of chronic mental illness individuals’ families and experiences about these practices. Methods: the study was conducted in a psychiatry hospital in the province of Konya, in Turkey and planned as a qualitative study and in phenomenological pattern. 12 patient relatives were interviewed within the scope of the study. Results: Data, obtained with sub- structural interview, was examined under the heading as definitions related with illness, help- seeking, cultural practices and metaphors. Paranoid schizophrenia, major depression, bipolar disorder and substance abuse are the diagnosis of patients. The majority of interviewed family members is women and graduated primary school. Plurality of patients’ relatives considers that the reason of psychiatric illness is fate, written by God, rather than an individual or a case. Religious help- seeking is often the first practice associated with mental illness. Conclusions: It is considered continuously in society that psychiatric disorders are taboo. The first applied place for psychiatric disorders is fake clergy due to the viewpoint that these patients seem as creatures that can think and have ability as people and also are obliged to obey religious rules according to religious belief in Islam. Praying, other rituals like praying in Islam (okutmak- üfletmek ), drinking water and taking a bath with water that made holly by praying are the most preferred cultural practices. However, the majority of patients’ relatives applied to the hospitals for medical treatment because they have not any benefits from these Hodjas. Interestingly, Hodja forwards the patients and relatives to the hospitals because of lack of doing anything.
    Keywords: Family, Cronic Mental Illness, Phenomenological study
    JEL: I29
  15. By: Ahmad Abu Jrai (Al-Hussein Bin Talal University)
    Abstract: This study seeks to compare the utilization of health services and expenditures between two groups and to assess the effect of socioeconomic factors (income, age, gender education and family size) on utilization of medical care services among AHU university. The first one is the staff of Al-Hussein Bin Talal University ( under cost sharing plans) and the second one is the staff of Ministry of Education ( Under free care). Data on health care services utilization were collected for the periods (2009-2014). Utilization of health services for both groups was measured by several variable including, inpatient care, routine checkups, specialty care, dental care, laboratory tests, X-ray, prescription drugs, and hospital length of stay. In this investigation there were several sources for error. The main error is that some individuals in both samples may be covered through other health insurance plans such as public health insurance, military health insurance, and other private health insurance arrangements. Preliminary analysis of the current research show that employees' visits under the free care plans provided by the Ministry of Education were around 30% higher than the employees' visits covered by the cost sharing plans.
    Keywords: cost sharing insurance, health insurance, Jordan, heath services
  16. By: Ronel Ferreira (University of Pretoria)
    Abstract: In this paper I illustrate how participatory intervention research can be utilized to promote health and well-being in vulnerable communities. More specifically, I posit that the key to vulnerable communities taking ownership and addressing the challenges they face lies in strong research partnerships, where university researchers and community stakeholders (e.g. teachers and community volunteers) collaborate. As co-researchers, community stakeholders are required to gradually take the lead in participatory intervention projects, and subsequently function in an independent sustainable manner. My theory is based on two broad research projects, employing similar methodology yet involving different stakeholders as participants. The first project commenced in 2003 (on-going), initially involving teachers as participants. This longitudinal project’s (STAR – Supporting Teachers, Assets and Resilience) focus falls on the way in which teachers can promote resilience among vulnerable children or families, by implementing a strength-based philosophy when planning and introducing supportive initiatives in school-communities. Based on the positive outcome of the STAR study (which eventually involved 74 teachers from 12 schools), a follow-up study has been conducted since 2012, involving 38 community volunteers as participants, or rather co-researchers. The follow-up SHEBA (Supporting Home environments in Beating Adversity) project utilizes a similar research design, and focuses on the way in which community volunteers can rely on a strength-based philosophy to support vulnerable clients. Data have been generated and documented over the past more than a decade for the two projects by means of participatory reflection and action based activities and discussions, focus groups, individual interviews, observations, field notes, research diaries and visual techniques. Two primary investigators have taken the lead, involving several academic peers and postgraduate students as co-researchers, working alongside the participating teachers and volunteers. Even though these projects have resulted in rich findings in various related knowledge fields, this presentation specifically concerns the fundamental role of sound research partnerships in promoting sustainable health and well-being among people facing risk and adversity. Research partnerships and collaboration are foregrounded as protective factor within the broader resilience theory framework. In addition to my focus on methodology as basis for the argument, I also link my discussion to strength-based philosophies, as foundation of positive psychology theory. Within the global context of high incidences of vulnerability and increased demands for support on various levels, the possibility of people on ground level taking the lead in providing such support will not only add to existing theory, but also imply practical application value.
    Keywords: Participatory intervention research, Research partnerships, Research collaboration, Vulnerable communities, Resilience, Positive psychology, Strength-based, philosophy
    JEL: I30 C18
  17. By: Poranee Rattanasiri (Maharaj Nakhon Si Thammarat Hospital); Janwamol Phangyota (Maharaj Nakhon Si Thammarat Hospital); Yuwadee Wittayapun (School of Allied Health Sciences and Public Health)
    Abstract: The quality of nursing documentation is an important issue for nurses to achieve patient outcome goals. The nursing documentation has constantly developed to increase accurate and legally prudent documentation.The purposes of this quasi-experimental research were: (1) to study the effectiveness of using developed nursing documentation on nursing documentation quality and (2) to study the satisfaction of professional nurses in using them. The first sample comprised 348 nursing documentation samples in the surgery inpatient department, including 174 documentation samples before and 174 documentation samples after using developed nursing documentation. The simple random sample was used to select sample. The second sample comprised 101 professional nurses working in the surgery inpatient department. The instruments used in this study included I) the developed nursing documentation, including (1) a form for nursing care plan and (2) a form for nursing progress notes (3) the nursing documentation audit form II) the nursing documentation manual and III) a questionnaire of professional nurses’ satisfaction in using the developed documentation. All instruments were approved for content validity by 3 experts. The Cronbach’s alpha coefficient of professional nurses’ satisfaction was 0.97. The implementation was applied for 3 months in 3 surgery inpatient wards. Data were analyzed using mean, standard deviation and independent t-test.The study showed that: 1) the mean quality of the nursing documentations after using developed nursing documentations was significantly higher than that before the experiment (p<.05).The professional nurses’ satisfaction regarding using the developed nursing documentation was at a high level (mean =3.41, sd =.51).The result suggested that the developed nursing documentation and the nursing documentation manual should be extended in nursing care practices to increase the quality of nursing documentation. That would reflect effective nursing care for patients.
    Keywords: nursing documentation, nursing documentation audit, professional nurses
    JEL: I19 I19 I19
    Abstract: Occupational accidents are one of the most crucial problems in working life. A good many people lose their lives because of these accidents around the world. Thousands of people from different sectors die because of the accidents, which are one of the leading problems in Turkey. In this context, it is very obvious that legislative regulations are not enough in terms of preventing occupational accidents and making people aware about these kinds of accidents and training them about their sectors are also crucial.Despite the differences between the work risks of craft who are going to work in different sectors, they are expected to have a certain level of perception about hindering occupational accidents. The aim of this study is to determine the level of occupational health and security perceptions of the students at Technical Vocational School. A questionnaire was used in this study in order to identify their perceptions.Security education, security communication, security awareness and fatalism scale were used in order to detect the security perceptions of the students. The results of this study are expected to guide and shed light on the regulations for creating a healthy and safe working environment and to develop the awareness about occupational health and security of the students.
    Keywords: Occupational health and safety, perception of security, occupational accidents
    JEL: I00 I29
  19. By: Çi BERK ÖZCAN (Selcuk University); H ESME (Konya Training and Research Hospital)
    Abstract: OBJECTIVES: There is no doubt the diagnosis of a life threatening disease such as cancer is devastating and has an enormous effect on one’s quality of life.It is argued that cancer is not just a single event with a certain end but a permanent condition characterized by ongoing ambiguity, potentially delayed or late effects of the disease or treatment, and concurrent psychological issues.Thus historically there was a belief that a patient should not be told about his or her cancer diagnosis.At present this has changed.In recent years there has been considerable attention on how to break ‘bad news’ from a patient’s perspective.Given that lung cancer is one of the common cancers world-wide, the implications of focusing on quality of life as well as survival require to be understood.METHODS: The European Organization of Life Questionnaire(EORTC QLQ-C30), a core cancer specific questionnaire containing 30 item patients’ functioning, global quality of life, disease and The EORTC Lung Cancer Questionnaire(EORTCQLQ-LC13), a site specific questionnaire consisting of 13 items on lung cancer symptoms and its treatment related side-effects.Comparison was made in quality of life scores between who knew their cancer diagnosis and those who did not. CONCLUSIONS: In all, 70 lung cancer patients were interviewed.Of these, 28 patients(%40) knew and 42(%60) did not knew their cancer diagnosis.The intention here is to show that knowing or not knowing one’s cancer diagnosis does not make any significant difference to the patients’ responses to a quality of life questionnaire.With regards to patients’ symptom scores, again there were no significant differences between the two groups, indicating that the knowledge of their cancer diagnosis did not lead to an overestimation of symptoms by patients who knew they had developed lung cancer.RESULTS: We,there argue that assessment of quality of life in lung ancer patients should be integrated into clinical practice and evaluated prospectively.
    Keywords: diagnos, lung cancer, quality of life, truth telling
    JEL: I10
  20. By: Eugenia Claudia Bratu (University of Medicine and Pharmacy ”Carol Davila” Bucharest, Romania. Faculty of Medicine, Preclinical Department III – Complementary Sciences, Discipline of Public Health and Management); Dana Galieta Minc (University of Medicine and Pharmacy ”Carol Davila” Bucharest, Romania. Faculty of Medicine, Preclinical Department III – Complementary Sciences, Discipline of Public Health and Management); Florentina Ligia Furtunescu (University of Medicine and Pharmacy ”Carol Davila” Bucharest, Romania. Faculty of Medicine, Preclinical Department III – Complementary Sciences, Discipline of Public Health and Management)
    Abstract: Global population ageing in Romania is a challenge for ensuring the sustainability, and for maintaining the bioethical principle of distributive justice for the social health insurance system. This study aims to examine and to highlight the theoretical influence and the practical impact of the current demographic evolution on the Romanian health system financial sustainability. Along with the presentation of a demographic forecasting for the demographic quota of working age and after the age of 65 years by 2025, using the age specific fertility and mortality model for Romania 2014, the potential consequences regarding the sustainability and ethics of this demographic development are compared and analyzed, taking into acount the source of financing for the Romanian health system. Also, an analysis of the health status of the population over 65 years is performed, using health status and health interventions indicators.In 2013, Romanian population coverage with health insurance was 83.8%. Only 47% of the health insured persons have financially contributed to the system, 76% of the contributors being employees. Thus, given that 66% of the Unique National Health Insurance Fund's income are based on the contribution of employers and employees, the decreasing by more than 1 million people from working age quota and the rising with approximately 50 000 persons of the population over 65 years, can cause major disruptions in the functionality of the social health insurance system. Meantime, the health status of the over 65 population is characterized by indicators that are worsening.There are two possibilities of future evolution, cost restraints situation, in which the sustainability of the health insurance system is preserved, or negative situation of inability to cover the costs associated with the disease burden of an older population. The health system sustainability can be ensured, only if the onset for the first disability (in the length of life) may be delayed as much as possible towards the time of death, for the entire population. That means to upgrade and to enhance public health as a major policy for sustainability of the healthcare system.
    Keywords: population aging, health system sustainability, distributive justice
    JEL: I14 I18
  21. By: Atiya Sarakshetrin (Boromarajonani College of Nursing, Suratthani)
    Abstract: Incidence and prevalence of cancer and cancer-related pain indicate that a majority of patients experience pain at one time or another during the course of treatment. Therefore, proper management of patients with pain is essential for controlling cost and alleviating patient suffering. There are a wide range of nursing interventions to relieve pain in cancer patients.The purpose of this meta-analysis was to study nursing interventions for decreasing pain with cancer patients. The quasi-experimental research studies in Thailand during 1997 – 2008 were selected. Of 13 studies, 9 studies in the inclusion criteria were selected. The studies were analyzed for general, methodology, and type of nursing interventions. By using the method of Glass, McGraw, and Smith (1981), effect size was calculated for each study. According to Snyder (1992), the nursing interventions for pain relief in cancer patients were categorized into 3 types: cognitive intervention, sensory intervention, and mix intervention. The results of study revealed that all types of nursing interventions on pain relief in cancer patients had large effect size. In Thailand, 22.22%, 33.33% and 44.44% of nursing studies on pain relief in cancer patients are classified as cognitive intervention, sensory intervention, and mix intervention. Recommendations for further studies include improving guidelines for nursing intervention and the development of nursing intervention databases on patients with cancer pain.
    Keywords: Pain Relief , Cancer Patients
    JEL: I10
  22. By: Teresa Bago d'Uva (Erasmus University Rotterdam, the Netherlands); Esen Erdogan Ciftci (Novartis, Turkey); Owen O'Donnell (Erasmus University Rotterdam, the Netherlands, University of Macedonia, Greece); Eddy van Doorslaer (Erasmus University Rotterdam, the Netherlands)
    Abstract: Biased longevity expectations will lead to suboptimal decisions regarding saving, retirement, annuitization and health, with consequences for wellbeing in old age. Systematic differences in the accuracy of longevity expectations may partly explain heterogeneity in economic behaviour by education and cognitive functioning. Analysis of eight waves of the US Health and Retirement Study reveals that individuals with lower levels of education and cognitive functioning report survival probabilities that are less accurate in predicting their in-sample mortality. There is little evidence that the gradients in the veracity of expectations are due to the less educated and cognitively able responding less to changes in objective mortality risks. However, high school dropouts and the least cognitively able report survival probabilities that are less stable and display greater un explained variability. These disadvantaged groups appear to be less confident in their longevity beliefs, which is justified given that their expectations are less accurate.
    Keywords: Expectations; Mortality; Health; Cognition; Education
    JEL: D83 D84 I12 J14
    Date: 2015–05–07
  23. By: Davide Fiaschi (Dipartimento di Economia e Management (DEM), Università di Pisa); Tamara Fioroni (Department of Economics (University of Verona))
    Abstract: In this paper we analyze the relationship between (adult) mortality and the long-run development of countries from an empirical and theoretical perspective. A quantitative exploration of the model shows that improvements in adult survival rates alone bring an economy towards a Malthusian regime in the long run, while a transition from a Malthusian to a modern regime requires substantial advances in technological progress. Limited gains in technological progress associated with a strong decline in adult mortality can produce a sort of “false” take-off, i.e. an economy passed from a Malthusian to a pre-modern regime can be pushed back by the increasing demographic pressures.
    Keywords: Unified Growth Theory, Human Capital, Adult mortality, Non-linear Dynamics, Endogenous Fertility, Industrial Revolution
    JEL: O10 O40 I20
    Date: 2015–05
  24. By: Bredenkamp,Caryn; Buisman,Leander Robert
    Abstract: Providing protection against the financial risk of high out-of-pocket health spending is one of the main goals of the Philippines? health strategy. Yet, as this paper shows using eight household surveys, health spending increased by 150 percent (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has trebled since 2000, from 2.5 to 7.7 percent. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate. In light of these findings, recent policies to enhance financial risk protection?such as the expansion of government-subsidized health insurance for the poor, a deepening of the benefit package, and provider payment reform aimed at cost-containment?are to be applauded. Between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, possible quick wins could include issuing health insurance cards for the poor to increase awareness of coverage and introducing a fixed copayment for non-poor members. Over the medium term, complementary investments in supply-side readiness are essential. Finally, an in-depth analysis of the pharmaceutical sector would help to shed light on why medicines continue to place such a large financial burden on households.
    Keywords: Rural Poverty Reduction,Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Health Law
    Date: 2015–05–06
  25. By: Migali, G,;; Zucchelli, E,;
    Abstract: High school dropout is an important policy issue and its determinants are a longstanding interest of economics. However, very little is known on the roles of noncognitive traits in influencing school dropoutdecisions. We employ voluntary forgone health care as a proxy for the underlying noncognitive traits that may induce adolescents to drop out and estimate its effects on early school attrition. We exploit data from the US National Longitudinal Study of Adolescent to Adult Health (Add Health) and employ a series of flexible specifications with school fixed effects and cohort effects. Our models account for well-established determinants of dropout, including individual and parental characteristics, together with personality traits. Forgone health care consistently appears to be a statistically significant and substantial predictor of dropout among adolescents. We suggest that forgone health care could be used as a signalling device for policy makers targeting potential high school dropouts.
    Keywords: forgone health care; high school dropout; Add Health
    JEL: I1 I2 I18
    Date: 2015–01
  26. By: Bunnings, C,;; Schmitz, H,;; Tauchmann, H,;; Ziebarth, N.R,;
    Abstract: This paper empirically assesses the relative role of health plan prices, service quality and optional benefits in the decision to choose a health plan. We link representative German SOEP panel data from 2007 to 2010 to (i) health plan service quality indicators, (ii) measures of voluntary benefit provision on top of federally mandated benefits, and (iii) health plan prices for almost all German health plans. Mixed logit models incorporatea total of 1,700 health plan choices with more than 50 choice sets for each individual. The findings suggest that, compared to prices, health plan service quality and supplemental benefits play a minor role in making a health plan choice.
    Keywords: service quality; non-essential benefits; prices; health plan switching; German sickness funds; SOEP
    JEL: D12 H51 I11 I13 I18
    Date: 2015–02
  27. By: Pichler, S,;; Ziebarth, N.R,;
    Abstract: This paper proposes a test for the existence and the degree of contagious presenteeism and negative externalities in sickness insurance schemes. First, we theoretically decompose moral hazard into shirking and contagious presenteeism behavior. Then we derive testable conditions for reduced shirking, increased presenteeism, and the level of overall moral hazard when benefits are cut. We implement the test empirically exploiting German sick pay reforms and administrative industry-level data on certified sick leave by diagnoses. The labor supply adjustment for contagious diseases is significantly smaller than for non-contagious diseases, providing evidence for contagious presenteeism and negative externalities which arise in form of infections.
    Keywords: Sickness Insurance; Sick Pay; Presenteeism; Contagious Diseases; Infections; Negative Externalities; Shirking
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2015–02

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