nep-hea New Economics Papers
on Health Economics
Issue of 2015‒05‒22
thirty papers chosen by
Yong Yin
SUNY at Buffalo

  1. SafeTREC Seminar 5/1/15: Interventions for Alcohol Related Traffic Injuries and Deaths By Gruenewald, Paul J
  2. Do patients choose hospitals that improve their health? By Nils Gutacker; Luigi Siciliani; Giuseppe Moscelli; Hugh Gravelle
  3. The cost-effectiveness challenge: is it worth it? By Martin Knapp
  4. IRT modeling in the presence of zero-inflation with application to psychiatric disorder severity By Melanie M Wall; Jung Yeon Park; Irini Moustaki
  5. A Simple Recipe: Estimating the Effect of a Prenatal Nutrition Program on Child Health at Birth By Catherine Haeck; Pierre Lefebvre
  6. Maternal Health and Maternity Leave: Regression Discontinuity Evidence from Two Canadian Experiences on Lengthening and Benefits Enhancements with Health Administrative Data By Catherine Haeck; Pierre Lefebvre; Philip Merrigan
  7. Does Commuting Affect Health? By Künn-Nelen, Annemarie
  8. Obesity and Economic Performance of Young Workers in Italy By Bruno, Giovanni S. F.; Caroleo, Floro Ernesto; Dessy, Orietta
  9. Peer Effects on Obesity in a Sample of European Children By Gwozdz, Wencke; Sousa-Poza, Alfonso; Reisch, Lucia A.; Bammann, Karin; Eiben, Gabriele; Kourides, Yiannis; Kovács, Eva; Lauria, Fabio; Konstabel, Kenn; Santaliestra-Pasias, Alba M.; Vyncke, Krishna; Pigeot, Iris
  10. Prepregnancy Obesity and Birth Outcomes By Averett, Susan L.; Fletcher, Erin K.
  11. Prenatal Stress and Low Birth Weight: Evidence from the Super Bowl By Duncan, Brian; Mansour, Hani; Rees, Daniel I.
  12. What Factors Affect Doctors' Hours Decisions: Comparing Structural Discrete Choice and Reduced-Form Approaches By Kalb, Guyonne; Kuehnle, Daniel; Scott, Anthony; Cheng, Terence Chai; Jeon, Sung-Hee
  13. Drug Prices and Pressure Group Activities in the German Health Care Market: An Application of the Becker Model By Anne Maria Busch
  14. Drug Prices, Rents, and Votes in the German Health Care Market: An Application of the Peltzman Model By Anne Maria Busch
  15. Making Sense of Replication Studies: Guidance for Teen Pregnancy Prevention Researchers By Brian Goesling
  16. How are CHIPRA Quality Demonstration States Improving Perinatal Care? By Ellen Albritton; Dana Petersen
  17. Child Health and Access to Medical Care (Journal Article) By Lindsey Leininger; Helen Levy
  18. The Affordable Care Act and Employment Services for People with Mental Illness By Bonnie O'Day
  19. Interspecialty Communication Supported by Health Information Technology Associated with Lower Hospitalization Rates for Ambulatory Care-Sensitive Conditions By Ann S. O'Malley; James D. Reschovsky; Cynthia Saiontz-Martinez
  20. Improving the Rigor of Quasi-Experimental Impact Evaluations: Lessons for Teen Pregnancy Prevention Researchers By Brian Goesling; Joanne Lee
  21. Can helping the sick hurt the able? Incentives, information and disruption in a disability-related welfare reform By Nitika Bagaria; Barbara Petrongolo; John Van Reenen
  22. Personalities and Public Sector Performance: Evidence from a Health Experiment in Pakistan By Michael Callen; Saad Gulzar; Ali Hasanain; Yasir Khan; Arman Rezaee
  23. Neighborhood Sanitation and Infant Mortality By Michael Geruso; Dean Spears
  24. Private versus Social Incentives for Pharmaceutical Innovation By Paula González; Inés Macho-Stadler; David Pérez-Castrillo
  25. Relationship between health status and recycling rates: Evidence from Great Britain By Giovanis, Eleftherios; Ozdamar, Oznur
  26. SUCCESS OF VAGINAL BIRTH AFTER CESAREAN By Menekse Nazl Ulusoy; Neslihan Lok; Ilhan Gunbayi
  27. Health and welfare: results of a policy based on economic incentives but not only. By Cecilia Severi; Javier Lasida; Marisa Buglioli; Ima Leon; Noemí Kratovich
  28. Migration of health workers in the EU By Michaela Nováková
  29. Valuing malaria morbidity: Results from a global metaanalysis By Y Mehmet Kutluay; Roy Brouwer; Richard S. J. Tol
  30. Vertical Transmission of Overweight: Evidence from English Adoptees By Costa-Font, J.;; Jofre-Bonet, M.;; Le Grand, J.;

  1. By: Gruenewald, Paul J
    Abstract: Despite many decades of prevention efforts, alcohol related traffic injuries and deaths due to drinking and drunken driving remain major problems in communities throughout the US. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has recently sponsored an extensive study of the etiology of these problems across mid-size cities in California and is currently supporting an evaluation of community-based environmental preventive interventions intended to reduce these problems in 24 of these cities.  One of the primary concerns of these studies has been to identify the ecological causes and correlates of drinking and drunken driving in order to better tailor prevention efforts.  If we can identify the primary sources of drinking drivers in community settings, we can tailor prevention efforts to drinkers in those settings and develop effective behavioral ecological interventions.  The challenges are to develop a comprehensive representation of sources of drinking and drunken driving in community settings, and then use that information to guide prevention efforts. Progress on these efforts will be discussed. 
    Keywords: Engineering, traffic injuries, NIAAA, alcohol related traffic injuries
    Date: 2015–05–01
  2. By: Nils Gutacker (Centre for Health Economics, University of York, UK); Luigi Siciliani (Department of Economics and Related Studies, University of York, UK); Giuseppe Moscelli (Centre for Health Economics, University of York, UK); Hugh Gravelle (Centre for Health Economics, University of York, UK)
    Abstract: Many health care systems collect and disseminate information on provider quality in order to facilitate patient choice and induce competitive behaviour amongst providers. The Department of Health in England has recently mandated the collection of patient-reported health outcome measures (PROMs) for the purpose of performance assessment and consumer information. This is the first attempt to routinely measure the gain in health that patients experience as the result of care and thus offer a more comprehensive picture of hospital quality than existing ‘failure measures’ such as mortality or readmission rates. In this paper we test whether hospital demand responds to hospital quality measures based on health gains in addition to more conventional measures. We estimate hospital choice models for elective hip replacement surgery using rich administrative data for all publicly-funded patients in the English NHS in 2010-2012. Our focus is on two key aspects of hospital choice: 1) the extent to which patients are more likely to choose hospitals which are expected to achieve larger improvements in patients’ health and 2) whether patients’ response to quality differs with their morbidity, as measured by pre-operative health status, and other characteristics such as age or income deprivation. In order to address potential endogeneity bias we implement an empirical strategy based on lagged explanatory variables, hospital fixed effects and a control group design based on demand for emergency hip replacement. Our results suggest that hospitals can increase demand by 9% if they increase the average health gains that patients experience by one standard deviation. Hospital demand has a higher elasticity with respect to average health gains than emergency readmission or mortality rates. Elective patients are twice as willing as emergency hip replacement patients to travel further for an increase in quality
    Keywords: Patient choice, hospital demand, demand elasticity, quality of care, health outcomes
    Date: 2015–05
  3. By: Martin Knapp
    Abstract: Scarcity of resources means that difficult choices have to be made about to use them. Cost-effectiveness evidence provides a way to help decision-makers get ‘best value’ from their resources when choosing between two or more clinical or other interventions. Often it is found that one intervention has better outcomes than another, but also costs more. In these circumstances there is a need for the decision-maker to reach a view as to whether those better outcomes are ‘worth’ the higher costs, necessitating difficult trade-offs. Illustrations from the dementia field are given to illustrate how these trade-offs might be made. For strategic decisions it has often proved helpful to use a generic outcome measure such as the quality-adjusted life year (QALY). The fundamental aim of a healthcare system is not to save money, but to save and improve lives. Cost-effectiveness and similar analyses can help by showing how to get the most out of available resources.
    JEL: N0
    Date: 2015–12
  4. By: Melanie M Wall; Jung Yeon Park; Irini Moustaki
    Abstract: IRT has been increasingly utilized in psychiatry for the purpose of describing the relationship among items in psychiatric disorder symptom batteries hypothesized to be indicators of an underlying latent continuous representing the severity of the psychiatric disorder. It is common to find zero-inflated data such that a large proportion of the sample has none of the symptoms. It has been argued that standard IRT models of psychiatric disorder symptoms may be problematic due to the unipolar nature of many clinical traits. In the current paper we propose to address this by using a mixture model to approximate the unknown latent trait distribution in the item response theory model while at the same time allowing for the presence of a nonpathological subgroup. The basic idea is that instead of assuming normality for the underlying trait, we will allow the latent trait to follow a mixture of normals including a degenerate component which is fixed to represent a non-pathological group for whom the psychiatric symptoms simply are not relevant and hence are expected to all be zero. We demonstrate how the zero-inflated mixture IRT method can be implemented in Mplus and present a simulation study comparing its performance to a standard IRT model assuming normality under different scenarios representative of psychiatric disorder symptom batteries. The model incorrectly assuming normality is shown to have biased discrimination and severity estimates. An application further illustrates the method using data from an alcohol use disorder criteria battery.
    Keywords: mixture IRT model; latent trait; symptom batteries
    JEL: J1
    Date: 2015
  5. By: Catherine Haeck (Department of Economics, University of Quebec in Montreal); Pierre Lefebvre (Department of Economics, University of Quebec in Montreal)
    Abstract: We study the impact of a Canadian prenatal nutrition program on child health at birth. The objective of the OLO program is to reduce the incidence of prematurity and low birth weight by providing a specific food basket and nutritional guidance to pregnant women in situations of poverty. Our identification strategy exploits exogeneous variations in access to the program caused by the progressive implementation of the program by local community service centers. The administrative birth records used in this study provide early health outcomes (birth weight and gestational age) for over 1.5 million newborns, along with a number of family characteristics. Our results suggest that the program had a positive impact on the birth weight of children and reduced the incidence of low birth weight, with larger impacts on children of mothers with a high school degree or less. While the cost of the program is equivalent to the US comparable WIC program, the food basket is simpler and the gains on birth weight are larger.
    Keywords: child health at birth, public program
    JEL: I12 I18 J13
    Date: 2014–10
  6. By: Catherine Haeck (Department of Economics, University of Quebec in Montreal); Pierre Lefebvre (Department of Economics, University of Quebec in Montreal); Philip Merrigan (Department of Economics, University of Quebec in Montreal)
    Abstract: Exploiting unique administrative longitudinal data sets on medical services provided to mothers before and after delivery, we estimate the causal effects of two large distinct parental leave reforms on maternal health outcomes, over the 5 years postpartum. The health outcomes are objective measures based on all types of medical services provided by physicians. For mothers publicly insured by the public prescription drug plan we can identify all drugs used, in particular those associated with depressive symptoms. The long time span of the longitudinal administrative data sets allows an assessment of short-run and long-run effects of maternity leave on mothers' health. The empirical approach uses a strict discontinuity design based on the day of regime change. The large samples of mothers, who gave birth three months before and three months after the two policy changes (in 2001 and 2006), are drawn randomly from the population of delivering women, all covered by the universal public health care program. We cannot find any strong evidence that the reforms had an effect on maternal health care costs, of a physical or of a mental nature, as measured by physicians' fee-for-service billing costs, prescription drug costs, or the number of hospitalizations.
    Keywords: maternal leave reform (2001 and 2006), longitudinal health administrative data, physical and mental health, costs and prescription drugs, universal public health and drugs insurance, parametric and non-parametric regression-discontinuity design
    JEL: I12 I18
    Date: 2014–10
  7. By: Künn-Nelen, Annemarie (ROA, Maastricht University)
    Abstract: This paper analyzes the relation between commuting time and health in the United Kingdom. I focus on four different types of health outcomes: subjective health measures, objective health measures, health behavior, and health care utilization. Fixed effect models are estimated with British Household Panel Survey data. I find that whereas objective health and health behavior are barely affected by commuting time, subjective health measures are clearly lower for people who commute longer. A longer commuting time is, moreover, related to more visits to the general practitioner. Effects turn out to be more pronounced for women and for commuters driving a car. For women, commuting time is also negatively related to regular exercise and positively to calling in sick.
    Keywords: health, commuting time, transportation mode
    JEL: I12 R41
    Date: 2015–04
  8. By: Bruno, Giovanni S. F. (Bocconi University); Caroleo, Floro Ernesto (University of Naples Parthenope); Dessy, Orietta (Università Cattolica del Sacro Cuore)
    Abstract: In this paper we explore recent ISFOL-PLUS 2006-2008-2010 data available for Italy about height and weight of young workers with the purpose of analysing the relationship between measures of obesity and measures of economic performance. Among the latter, we introduce job satisfaction, both overall and for nine specific aspects, which has not been previously considered in the literature on the effects of obesity. Interestingly enough, we find that BMI does not discriminate young workers with respect to their job earnings, but it does affect negatively young workers' job satisfaction with important gender effects.
    Keywords: obesity, overweight, body mass index, job satisfaction, gross income
    JEL: J28 J81 I14
    Date: 2015–05
  9. By: Gwozdz, Wencke (Copenhagen Business School); Sousa-Poza, Alfonso (University of Hohenheim); Reisch, Lucia A. (Copenhagen Business School); Bammann, Karin (University of Bremen); Eiben, Gabriele (University of Gothenburg); Kourides, Yiannis (Research and Education Institute of Child Health, Cyprus); Kovács, Eva (University of Pecs); Lauria, Fabio (National Research Council, Italy); Konstabel, Kenn (University of Tartu); Santaliestra-Pasias, Alba M. (University of Zaragoza); Vyncke, Krishna (Ghent University); Pigeot, Iris (University of Bremen)
    Abstract: This study analyzes peer effects on childhood obesity using data from the first two waves of the IDEFICS study, which applies several anthropometric and other measures of fatness to approximately 14,000 children aged two to nine participating in both waves in 16 regions of eight European countries. Peers are defined as same-sex children in the same school and age group. The results show that peer effects do exist in this European sample but that they differ among both regions and different fatness measures. Peer effects are larger in Spain, Italy, and Cyprus – the more collectivist regions in our sample – while waist circumference generally gives rise to larger peer effects than BMI. We also provide evidence that parental misperceptions of their own children's weight goes hand in hand with fatter peer groups, supporting the notion that in making such assessments, parents compare their children's weight with that of friends and schoolmates.
    Keywords: peer effects, children, obesity, Europe
    JEL: I12 J13 J22
    Date: 2015–05
  10. By: Averett, Susan L. (Lafayette College); Fletcher, Erin K. (Harvard Kennedy School)
    Abstract: We investigate the association between prepregnancy obesity and birth outcomes using fixed effect models comparing siblings from the same mother. A total of 7,496 births to 3,990 mothers from the National Longitudinal Survey of Youth 1979 survey are examined. Outcomes include macrosomia, gestational length, incidence of low birthweight, preterm birth, large and small for gestational age (LGA, SGA), c-section, infant doctor visits, mother's and infant's days in hospital post-partum, whether the mother breastfed, and duration of breastfeeding. Association of income outcomes with maternal pre-pregnancy obesity was examined using Ordinary Least Squares (OLS) regression to compare across mothers and fixed effects to compare within families. In fixed effect models we find no statistically significant association between most outcomes and prepregnancy obesity with the exception of LGA, SGA, low birth weight and preterm birth. We find that prepregnancy obesity is associated with a with lower risk of low birthweight, SGA, and preterm birth but controlling for prepregnancy obesity, increases in GWG lead to increased risk of LGA. Contrary to previous studies, which have found that maternal obesity increases the risk of c-section, macrosomia and LGA, while decreasing the probability of breastfeeding, our sibling comparison models reveal no such association. In fact, our results suggest a protective effect of obesity in that women who are obese prepregnancy have longer gestation lengths, and are less likely to give birth to a preterm or low birthweight infant.
    Keywords: infant health, birth outcomes, BMI, maternal obesity, gestational weight gain
    JEL: I12 J13
    Date: 2015–05
  11. By: Duncan, Brian (University of Colorado Denver); Mansour, Hani (University of Colorado Denver); Rees, Daniel I. (University of Colorado Denver)
    Abstract: Studies have estimated the relationship between psychological stress and birth weight by exploiting natural disasters and terrorist attacks, both of which could affect fetal health through other channels. Using data from the National Vital Statistics System for the period 1969-2004, we estimate the effect of prenatal exposure to the Super Bowl on low birth weight. Although major sporting events elicit intense emotions, they do not threaten viewers with direct physical harm or limit access to prenatal care. We find that Super Bowl exposure is associated with a small, but precisely estimated, increase in the probability of low birth weight.
    Keywords: low birth weight, Super Bowl, prenatal stress, tobacco use
    JEL: I12 J13
    Date: 2015–05
  12. By: Kalb, Guyonne (Melbourne Institute of Applied Economic and Social Research); Kuehnle, Daniel (University of Erlangen-Nuremberg); Scott, Anthony (Melbourne Institute of Applied Economic and Social Research); Cheng, Terence Chai (University of Adelaide); Jeon, Sung-Hee (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: 2015–05
  13. By: Anne Maria Busch (Leuphana University Lueneburg, Germany)
    Abstract: This article analyzes the shifts of power relation and influence between pharmaceutical industry (producers), pharmacies, and social health insurers (SHI) in Germany based on drug prices. Since the health care reform of 2004, these interest groups have negotiated fees and discounts among each other without any intervention from the government. These negotiations and resulting amendments to the original law express the shift of power of the involved groups, which can be explained with the Becker (1983) model. As a result, a trend becomes apparent, which shows a slight increase in political pressure on the part of SHI and a big decrease of political pressure on the part of pharmacies and producers. This reflects the cost control trend in combination with the empowerment incentives for SHI. The last years have shown increased competition between the interest groups, resulting in more balanced power relations. Nevertheless, the most powerful group is still the producer group and the influence of SHI is still very low.
    Keywords: interest groups, political pressure, health care market, regulation
    JEL: D78 I39 D72 I18
    Date: 2015–05
  14. By: Anne Maria Busch (Leuphana University Lueneburg, Germany)
    Abstract: Using the health care reform of 2004 as an experience, the reaction of consumers (insured persons) and producers (pharmaceutical industry) based on electoral behavior and relating to drug prices and copayments imposed on drugs is analyzed. The changes in prices and medications after this reform make it to a natural choice. For the analysis, the interest group model by Peltzman (1976) is applied to the German health care market. The vote-maximizing government has to find the optimal combination of rent and price of regulation. As a result, the vote-maximizing outcome is determined by a price level which reflects the interests of consumers as well as the pharmaceutical industry. The analysis of the reaction of consumers related to the co-payment rules of 2004 leads to the hypothesis that the regulator, and finally the pharmaceutical industry, sets drug prices in a way that they are ranging from 5 to 50 Euro. Prices between 50 and 100 Euro are possible as well, reflecting a balance of power facing the pharmaceutical industry. Producers who had accepted the 1989 reference price had an incentive to increase their price while lowering their sales volume.
    Keywords: German health care market, interest groups, political pressure, lobbyism
    JEL: D72 D78 I39
    Date: 2015–05
  15. By: Brian Goesling
    Abstract: This research brief provides practical guidance for making sense of this growing body of research. It is intended primarily for researchers, policymakers, and practitioners working in the field of teen pregnancy prevention research, to help them navigate and make best use of findings from the growing number of replication studies.
    Keywords: Teen Pregnancy Prevention, Replication Studies, Family Support
    JEL: I
    Date: 2015–05–12
  16. By: Ellen Albritton; Dana Petersen
    Abstract: In this Highlight, we discuss how Florida and Illinois are leveraging CHIPRA quality demonstration funds to improve the quality of perinatal care, defined as health care provided during pregnancy up until a week after birth.
    Keywords: CHIPRA quality demonstration, perinatal care, prenatal care, pediatric, Florida, Illinois
    JEL: I
    Date: 2015–05–12
  17. By: Lindsey Leininger; Helen Levy
    Abstract: In this overview article, the authors adopt an economic framework to review studies designed to show a potential causal effect between policies to increase health care access and better health for children.
    Keywords: child health, access to health care
    JEL: I
    Date: 2015–03–21
  18. By: Bonnie O'Day
    Abstract: Mental illness, like any health problem, can disrupt the ability to work. Many people with mental illness can only work part time, intermittently, or for low wages. For people with access to mental health care, disruptions to the ability to work are often short term, allowing them to return to their jobs and former productivity levels quickly. But people who cannot afford treatment, whose treatment is not quickly or fully effective, or whose illness often recurs may lose their jobs, leading to long-term disability and unemployment.
    Keywords: ACA, Affordable Care Act, Employment Services, Mental Illness
    JEL: I J
    Date: 2015–05–13
  19. By: Ann S. O'Malley; James D. Reschovsky; Cynthia Saiontz-Martinez
    Abstract: Greater primary care and specialist communication is associated with reduced hospitalizations for ambulatory care-sensitive conditions. This effect was magnified in the presence of higher provider-reported HIT use, suggesting that coordination of care with support from HIT is important in the treatment of ambulatory care-sensitive conditions.
    Keywords: Health Care Systems, Information Systems, Prevention & Control, Primary Health Care, Quality of Health Care
    JEL: I
    Date: 2015–05–14
  20. By: Brian Goesling; Joanne Lee
    Abstract: This research brief highlights three ways to reduce the risk of selection bias and thereby improve the rigor of quasi-experimental impact evaluations, focusing specifically on evaluations of teen pregnancy prevention programs.
    Keywords: Quasi-Experimental Impact Evaluations, Teen Pregnancy Prevention, Family Support
    JEL: I
    Date: 2015–05–12
  21. By: Nitika Bagaria; Barbara Petrongolo; John Van Reenen
    Abstract: Disability rolls have escalated in developed nations over the last 40 years. The UK, however, stands out because the numbers on these benefits stopped rising when a welfare reform was introduced that integrated disability benefits with unemployment insurance (UI). This policy reform improved job information and sharpened bureaucratic incentives to find jobs for the disabled (relative to those on UI). We exploit the fact that policy was rolled-out quasi-randomly across geographical areas. In the long-run the policy improved the outflows from disability benefits by 6% and had an (insignificant) 1% increase in unemployment outflows. This is consistent with a model where information helps both groups, but bureaucrats were given incentives to shift effort towards helping the disabled find jobs and away from helping the unemployed. Interestingly, in the short-run the policy had a negative impact for both groups, suggesting important disruption effects. We estimate that it takes about six years for the estimated benefits of the reform to exceed its costs, which is beyond the time horizon of most policy-makers.
    JEL: H53 I13 I38 J14 J18 J64
    Date: 2015–05
  22. By: Michael Callen; Saad Gulzar; Ali Hasanain; Yasir Khan; Arman Rezaee
    Abstract: This paper provides evidence that the personality traits of policy actors matter for policy outcomes in the context of two large-scale experiments in Punjab, Pakistan. Three results support the relevance of personalities for policy outcomes. First, doctors with higher Big Five and Perry Public Sector Motivation scores attend work more and falsify inspection reports less. Second, health inspectors who score higher on these personality measures exhibit a larger treatment response to increased monitoring. Last, senior health officials with higher Big Five scores are more likely to respond to a report of an underperforming facility by compelling better subsequent staff attendance.
    JEL: C93 D02 D73 H11 O31
    Date: 2015–05
  23. By: Michael Geruso; Dean Spears
    Abstract: In the developing world, there has been significant policy interest in recent years in ending open defecation—that is, defecation in fields, behind homes, and near roads. This attention is in part motivated by a belief that the private demand for latrines and toilets is below the social optimum. We investigate the infant mortality externalities of poor sanitation by exploiting differences in the demand for latrines between Muslim and Hindu households in India: Indian Muslims, despite being poorer, are 25 percentage points more likely than Indian Hindus to use latrines or toilets. Instrumenting for local sanitation with the religious composition of neighborhoods, we show large infant mortality externalities of neighbors defecating in the open. Estimates of these neighbor effects are similar regardless of the household's own latrine use and own religion. Our findings are informative of the external harm generated by the roughly 1 billion people today who defecate in the open.
    JEL: H23 H41 I1 I12 I15 O1 O15
    Date: 2015–05
  24. By: Paula González (Department of Economics, Universidad Pablo de Olavide.); Inés Macho-Stadler (Department of Economics, Universitat Autònoma de Barcelona and Barcelona GSE.); David Pérez-Castrillo (Department of Economics, Universitat Autònoma de Barcelona and Barcelona GSE.)
    Abstract: There is a great deal of debate in society regarding the tendency of pharmaceutical companies to direct their R&D toward marketing products that are "follow-on" drugs of already existing drugs, rather than the development of breakthrough drugs. This paper provides a theoretical framework to study firm incentives for pharmaceutical innovation that disentangle the quest for breakthrough drugs from the firm effort to develop follow-on drugs. We construct a model with a population of patients treated with one of two --horizontally and vertically differentiated-- drugs. One of the drugs is the pioneer; the other is the result of an innovative process by a firm that seeks to achieve an improvement over the existing drug. Our results offer theoretical support for the conventional wisdom that pharmaceutical firms devote too many resources to conducting R&D activities that lead to incremental innovations.
    Keywords: pharmaceuticals, R&D activities, me-too drugs, breakthrough drugs, incremental innovation, radical innovation.
    JEL: I1 L1
    Date: 2015–05
  25. By: Giovanis, Eleftherios; Ozdamar, Oznur
    Abstract: This study explores the relationship between self-reported health status and recycling rates in Great Britain. The estimates are based on the data from the British Household Panel Survey (BHPS). The effects of recycling rates on individuals’ health status with a scale from 1- excellent- to 5-very poor- are estimated and their monetary values are calculated. In addition, the non-movers sample is considered in order to reduce endogeneity. Three approaches are followed. The first approach refers to the panel Probit-OLS, while the second approach is the ordered Probit model with random effects. The third approach refers to a dynamic panel regression estimated with the system Generalized Methods of Moments (GMM). The average marginal willingness-to-pay (MWTP) for a one per cent increase in recycling rates ranges between is £470-£800 per year. Moreover, other determinants play significant role on health status such as education, marital status, age, job status, age and weather conditions among others. The originality of this paper is that the relationship between self-reported health status and recycling rates using micro-level panel data is explored. Moreover, the reression analysis controls for various demographic, regional and meteorological factors. Finally, this is the first study presenting three different panel estimates to deal with the potential endogeneity of the pollution measure which is derived from recycling. Using fixed effects the regional time invariant characteristics are controlled, while the dynamic model allows controlling for time varying unobservables.
    Keywords: Environmental valuation; Panel data; Recycling; Self-reported health status
    JEL: I31 Q51 Q53 Q54
    Date: 2014
  26. By: Menekse Nazl Ulusoy (Selcuk University, Ak); Neslihan Lok (Akdeniz University Nursing Faculty, Psychiatric Nursing Department); Ilhan Gunbayi (Akdeniz University)
    Abstract: Purpose:This study is conducted to determine the factors that facilitate and hinder vaginal birth after cesarean by specifying emotions, opinions and experiences about delivery of women that gave vaginal birth after cesarean and using birth stories which those women told in the Facebook group “Vaginal Birth After Cesarean” to support each other.Material and Method:The study is a quantitative one. Since it aims to study and present vaginal birth after cesarean in detail in a point of view that depends on the experiences of the participants, it is planned in a phenomenological pattern. The data is gathered from the documents that are based on the birth stories of the participants and analysed using document analysis method. In the research, birth stories of 16 women who had been members of the “Vaginal Birth After Cesarean” group in Facebook which is one of the social media environments, given a successful vaginal birth, shared their birth stories in the group, and accepted to participate in the research were used as documents. Findings:In the study, the stories that the participants experienced in the duration between the stage in which the participants decided to give vaginal birth and the time in which they actually gave vaginal birth are presented by their own expressions. The data gathered from the stories that participants shared is analysed using content analysis method, coded and themes are created. The data acquired from the emotions, ideas and experiences of the women who have given vaginal birth after cesarean about vaginal birth is analysed under four main titles (themes) which are “the time at which decision to give vaginal birth after cesarean is given”, “preparation stage before the birth (hindering and facilitating factors)”, birth stage (hindering and facilitating factors and medical intervention)”, and “definition of the experience of the vaginal birth after cesarean”.Result:The study shows that the most important step of succeeding in giving vaginal birth after cesarean is the decision stage.Thus, the time of previous birth is important in this process. It has been seen that searching for doctors for giving vaginal birth, getting examined, and the support of the ones who have given vaginal birth after caesarean are important for the continuum of the decision stage. It has been seen that during the delivery, supportive approach of the obstetrician, moving, waiting for the baby to born, pushing and affirmations are the most important ones among the facilitating factors.
    Keywords: Women; Vaginal Birth After Cesarean; Experience; Phenomenological study
  27. By: Cecilia Severi (Departament of preventive and social medicine. Faculty of Medicine. University of the Republic. Uruguay); Javier Lasida (Catholic University); Marisa Buglioli (Departament of preventive and social medicine. Faculty of Medicine. University of the Republic. Uruguay); Ima Leon (Departament of preventive and social medicine. Faculty of Medicine. University of the Republic. Uruguay); Noemí Kratovich (Departament of preventive and social medicine. Faculty of Medicine. University of the Republic. Uruguay)
    Abstract: The Health reform in Uruguay included a payment for assistance goals in 2007. In 1996, it began a quality improvement experience called Accreditation in Good feeding Practices (AGFP), which in 2009 was included as a heath goal. This policy strategy includes the best practices maternities and primary health care centers a health service should implement to improve little children diet and growth. Objective: To study associated factors to the success and the positive impact of health goals through the analysis of ABPA as a goal.Metodology. Secondary analysis of survey data applied by UNICEF over a representative sample of the population adjusted by age, type of health provider and region. It were processed excusive breast feeding rates at 6 month over 1996, 1999, 2003, 2007 and 2011 data bases. It was calculated the evolution by accreditation, type of provider and geographic region. A binary probit model was applied to measure the ABPA impact on providers. The variable to explain was exclusive breast feeding and the independent variables were accreditation on GFP, country region, kind of health provider (private/public), birth weight, baby’s age, mother’s age and mother’s work situation. Afterwards a qualitative analysis was made by interviewing actors who play different roles in the governance system: Ministry of health, health services providers, representatives in the National Board of Health (workers, Institutions, patients). Results. Exclusive breast feeding increased in providers which applied ABPA all over the period (37% to 67%). Probit regression showed that ABPA was the variable which increases most the probability of exclusive breast feeding (17%, SD 2% and p<0.05). Breast feeding rate in 2007 differs 10 points with that of 2011 (57 Y 67% respectively). The qualitative analysis showed that the success was due to governance based in three factors: training, institutional strengthening and gradual accountability. Conclusion: The AGFP strategy has been demonstrated to be an effective tool to improve exclusive breast feeding at 6 months old. The inclusion as a health goal had capitalized and enhanced a previous experience. Results showed that a governance strategy which contains: training, institutional strengthening and incentives achieve the expected health impacts over the population
    Keywords: health reform, economic incentives, best feeding practices
  28. By: Michaela Nováková (University of Economics in Bratislava)
    Abstract: Migration of health workers for better opportunities either within the country or abroad creates global concern because of the burden of health systems in developing countries. Migration of health workers caused serious global health problem, which is reflected in all aspects of society - structural, political, social and economic. Migration trends of health workers have been studied since 1960. Nevertheless, there is still an imbalance between rich and poor countries. In many cases, the country loses not only an investment in the education of health professionals, but also benefit the workers in health care. Many health systems in developing countries for years suffered from underinvestment, which also translates to low salaries of health workers and poor working conditions. Employers in the recipient countries have in turn lack of experienced people in specific areas and employment opportunities may obtain brains from other countries.
    Keywords: Health workers, migration, brain drain, mobility
    JEL: I18
  29. By: Y Mehmet Kutluay (Department of Environmental Economics, Institute for Environmental Studies, Vrije Universiteit, Amsterdam, The Netherlands; Tinbergen Institute, Amsterdam, The Netherlands); Roy Brouwer (Department of Environmental Economics, Institute for Environmental Studies, Vrije Universiteit, Amsterdam, The Netherlands); Richard S. J. Tol (Department of Economics, University of Sussex, UK; Institute for Environmental Studies, Vrije Universiteit, Amsterdam, The Netherlands; Department of Spatial Economics, Vrije Universiteit, Amsterdam, The Netherlands; Tinbergen Institute, Amsterdam, The Netherlands; CESifo, Munich, Germany)
    Abstract: The risk of malaria transmission worldwide is expected to increase with climate change. In order to estimate the welfare implications, we analyse the factors that explain willingness to pay to avoid malaria morbidity using a meta-analysis. We compare multiple regression models via a cross-validation exercise to assess best fit, the first in the meta-analysis literature to do so. Weighted random effects gives best fit. Confirming previous studies, we find that revealed preferences are significantly lower than stated preferences; and that there is no significant difference in the willingness to pay for policies that prevent (pre-morbidity) or treat malaria (post-morbidity). We add two new results to the morbidity literature. 1) Age has a non-linear impact on mean willingness to pay and 2) willingness to pay decreases if malaria policies target communities instead of individual households.
    Keywords: Malaria, Meta-analysis, Willingness-to-pay, Morbidity, Stated Preferences
    JEL: I10
    Date: 2015–05
  30. By: Costa-Font, J.;; Jofre-Bonet, M.;; Le Grand, J.;
    Abstract: We examine the vertical transmission of overweight drawing upon a sample of English children, both adopted and non-adopted, and their families. Our results suggest strong evidence of an intergenerational association of overweight among adoptees, indicating transmission through cultural factors. We find that, when both adoptive parents are overweight, the likelihood of an adopted child being overweight is between 10% and 20% higher than when they are not. We also find that the cultural transmission of overweight is not aggravated by having afull-time working mother, so do not confirm the existence of a female labour market participation penalty on child overweight among adoptees. Overall, our findings, despite subject to data limitations, are robust to a battery of robustness checks, specification and sample selection corrections.
    Keywords: vertical transmission; cultural transmission; overweight; children; natural parents; Body Mass Index; sample selection;
    JEL: I18 D13 Z1
    Date: 2015–05

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