nep-hea New Economics Papers
on Health Economics
Issue of 2015‒08‒07
seven papers chosen by
Yong Yin
SUNY at Buffalo

  1. Forecasting Leading Death Causes in Australia using Extended CreditRisk$+$ By Pavel V. Shevchenko; Jonas Hirz; Uwe Schmock
  2. Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – DREAMING (Spain) Case Study Report By Ramon Sabes-Figuera
  3. The financial support for long-term elderly care and household savings behaviour By Asako Ohinata; Matteo Picchio
  4. If You Don’t Snooze You Lose Health and Gain Weight Evidence from a Regression Discontinuity Design By Osea Giuntella; Fabrizio Mazzonna
  5. Information Technology and Patient Health: Analyzing Outcomes, Populations, and Mechanisms By Seth Freedman; Haizhen Lin; Jeffrey Prince
  6. Nudges in Exercise Commitment Contracts: A Randomized Trial By Jay Bhattacharya; Alan M. Garber; Jeremy D. Goldhaber-Fiebert
  7. Evaluating the Economic and Health Impacts of Investing in Laboratories in East Africa: Development and Application of a Conceptual Framework By Simone Peart Boyce; Andrés A. Berruti; Helen Connolly; Miriam Schneidman

  1. By: Pavel V. Shevchenko; Jonas Hirz; Uwe Schmock
    Abstract: Recently we developed a new framework in Hirz et al (2015) to model stochastic mortality using extended CreditRisk$^+$ methodology which is very different from traditional time series methods used for mortality modelling previously. In this framework, deaths are driven by common latent stochastic risk factors which may be interpreted as death causes like neoplasms, circulatory diseases or idiosyncratic components. These common factors introduce dependence between policyholders in annuity portfolios or between death events in population. This framework can be used to construct life tables based on mortality rate forecast. Moreover this framework allows stress testing and, therefore, offers insight into how certain health scenarios influence annuity payments of an insurer. Such scenarios may include improvement in health treatments or better medication. In this paper, using publicly available data for Australia, we estimate the model using Markov chain Monte Carlo method to identify leading death causes across all age groups including long term forecast for 2031 and 2051. On top of general reduced mortality, the proportion of deaths for certain certain causes has changed massively over the period 1987 to 2011. Our model forecasts suggest that if these trends persist, then the future gives a whole new picture of mortality for people aged above 40 years. Neoplasms will become the overall number-one death cause. Moreover, deaths due to mental and behavioural disorders are very likely to surge whilst deaths due to circulatory diseases will tend to decrease. This potential increase in deaths due to mental and behavioural disorders for older ages will have a massive impact on social systems as, typically, such patients need long-term geriatric care.
    Date: 2015–07
  2. By: Ramon Sabes-Figuera (European Commission – JRC - IPTS)
    Abstract: DREAMING (ElDeRly-friEndly Alarm handling and MonitorING) was a large-scale pilot project that took place in 6 sites over a period of around 4 years, starting in 2008. It aimed to demonstrate new services that could help elderly people live independently in their home environment as long for as their physical and mental conditions allow. The technologies deployed were a combination of health and environmental monitoring systems. The data collected was processed by a decision support system and handled by a call centre. None of the 6 DREAMING sites developed further or integrated the services into the package of health and social care benefits offered to the population covered. Nevertheless, the innovation Unit of Barbastro Health Care Area (Spain) relied on the lessons and experiences from DREAMING and previous projects to design and test the implementation of telemonitoring services with a stronger integrated care approach.
    Keywords: SIMPHS, eHealth, Remote Monitoring, ageing, integrated care, independent living, case studies, facilitators, governance, impact, drivers, barriers, integration, organisation
    JEL: I11 I18 O33 O38
    Date: 2015–07
  3. By: Asako Ohinata; Matteo Picchio
    Abstract: We analyse how the financial support for long-term elderly care affects the level of household savings. Using a difference-in-differences estimator, we investigate the 2002 Scottish reform, which introduced free formal personal care for all the elderly aged 65 and above residing in Scotland. Our semiparametric estimation technique allows the policy effects to be flexibly estimated across age groups. We find that the Scottish policy reduced the average household saving by about £7,200. Moreover, the estimated effects are heterogeneous across age groups of the head of household: these effects are particularly strong among those aged between 40 and 60. The largest effect is observed at age 49 with the reduction in the average household saving by £12,764.
    Keywords: Long-term elderly care; ageing; means tested financial support; saving; wealth; difference-in-differences.
    JEL: C21 D14 I18 J14
    Date: 2015–07
  4. By: Osea Giuntella (University of Oxford); Fabrizio Mazzonna (Università della Svizzera Italiana (USI))
    Abstract: Sleep deprivation is increasingly recognized as a public health challenge. While several studies provided evidence of important associations between sleep deprivation and health outcomes, it is less clear whether sleep deprivation is a cause or a marker of poor health. This paper studies the causal effects of sleep on health status and obesity exploiting the relationship between sunset light and circadian rhythms and using time-zone boundaries as an exogenous source of variation in sleep duration and quality. Using data from the American Time Use Survey, we show that individuals living in counties on the eastern side of a time zone boundary go to bed later and sleep less than individuals on the opposite side of the time zone boundary. These findings are driven by individuals whose biological schedules and time use are constrained by social schedules (i.e., work schedules, school starting times). Exploit- ing these discontinuities, we find evidence that sleep deprivation increases the likelihood of reporting poor health status and the incidence of obesity. Our results suggest that the increase in obesity is explained by both changes in eating behavior and a decrease in physical activity.
    Keywords: Health, Obesity, Sleep Deprivation, Time Use, Regression Discontinuity
    JEL: I12 J22 C31
    Date: 2015–07
  5. By: Seth Freedman; Haizhen Lin; Jeffrey Prince
    Abstract: We study the effect of hospital adoption of electronic medical records (EMRs) on health outcomes, particularly patient safety indicators (PSIs). We find evidence of a positive impact of EMRs on PSIs via decision support rather than care coordination. Consistent with this mechanism, we find an EMR with decision support is more effective at reducing PSIs for less complicated cases, using several different metrics for complication. These findings indicate the negligible impacts for EMRs found by previous studies focusing on the Medicare population and/or mortality do not apply in all settings.
    JEL: I10 O33
    Date: 2015–07
  6. By: Jay Bhattacharya; Alan M. Garber; Jeremy D. Goldhaber-Fiebert
    Abstract: We consider the welfare consequences of nudges and other behavioral economic devices to encourage exercise habit formation. We analyze a randomized trial of nudged exercise commitment contracts in the context of a time-inconsistent intertemporal utility maximization model of the demand for exercise. The trial follows more than 4,000 people seeking to make exercise commitments. Each person was randomly nudged towards making longer (20 weeks) or shorter (8 weeks) exercise commitment contracts. Our empirical analysis shows that people who are interested in exercise commitment contracts choose longer contracts when nudged to do so, and are then more likely to meet their pre-stated exercise goals. People are also more likely to enroll in a subsequent commitment contract after the original expires if they receive a nudge for a longer duration initial contract. Our theoretical analysis of the welfare implications of these effects shows conditions under which nudges can reduce utility even when they succeed in the goal of promoting habitual exercise.
    JEL: D6 I1 I12
    Date: 2015–07
  7. By: Simone Peart Boyce; Andrés A. Berruti; Helen Connolly; Miriam Schneidman
    Abstract: Laboratories provide essential services to the health sector on the monitoring and treatment of disease. Routine implementation of new diagnostic techniques may be costly; therefore, understanding their clinical utility, impact, and cost-effectiveness are necessary to guide decisions as to whether and how such techniques should be implemented. In this study, the authors design a conceptual framework for examining the following: (1) optimal mix of laboratory services at different levels of the health system; (2) combination of resources required within laboratories to promote efficiency; and (3) potential for outsourcing to promote cost containment. The framework considers both the health and economic rationale for laboratory investments. The authors then use the conceptual framework to inform a decision analytics model that maps out the health and economic impact of laboratory investments, and to illustrate the model by investigating the best placement of a new technology (GeneXpert) for detecting multi-drug-resistant tuberculosis (MDR-TB). The illustrative application of the model shows that investment in a new diagnostic technology for MDR-TB is cost-effective regardless of placement in a district-level (satellite) or national-level (reference) laboratory. Placement of the GeneXpert system at the satellite laboratory results in patients tested for MDR-TB or TB at lower costs than the reference laboratory. Furthermore, if testing occurs at the satellite laboratory, more primary and secondary cases are treated and cured than if testing was conducted at the reference laboratory, leading to better outcomes. Overall, testing at the satellite laboratory results in more deaths averted and more disability life-adjusted years (DALYs) saved. Both facilities have average costs per DALY well below the World Health Organization (WHO) - suggested threshold for the per capita gross domestic product (GDP). However, the satellite laboratory saves more DALYs at a lower additional cost per DALY.
    Keywords: pharmacy, clinical chemistry, harmonization, risks, human capacity, treatment, diagnosis, supervision, equipment, laboratory testing, epidemiological data, lung diseases ... See More + syndromes, information system, human immunodeficiency virus, antimalarial drugs, prevention, disease burden, disease prevalence, morbidity, sexually transmitted diseases, community health, information, monitoring, disease transmission, health care, biochemistry, death, prevalence, effects, clinical outcomes, health, transmission, disease prevention and control, hiv # positive, disease reporting, laboratory services, drug resistance, tb control, information systems, public health, life expectancy, satellite, leprosy, data, pathogens, diseases, infectious diseases, patients, patient, life, dna, intervention, hiv/aids care, serology, productivity, opportunistic infections, health management, hiv infection, medical care, standardization, duration of treatment, tuberculosis control, diagnostic methods, material, tuberculosis, symptoms, screening, hiv/aids, epidemics, inventory, disease prevention, mortality, capabilities, malaria diagnosis, medical treatment, dangerous diseases, disease outbreaks, immune deficiency, technology, blood samples, diagnoses, reliability, hematology, medical research, workers, hiv antibodies, time frame, hiv, tb, results, surveillance, immunodeficiency, health policy, medicine, health outcomes, networks, fax, decision making, measurement, nutrition, medical officer, malaria, adolescents, quality control, health surveillance, burden of disease, therapy, diagnostics, internet, result, communicable diseases, pathology, virus, tropical medicine, physical health, disease control, disease, clinics, network, human resources, retention, infection, disability, infections, all, sites, early detection, communication, new technology, strategy, epidemiology, disease characteristics, clinical biochemistry, medicines, technologies, aids, outsourcing, health services, implementation, lung disease, uses, disease detection, storage
    Date: 2015–05

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