nep-hea New Economics Papers
on Health Economics
Issue of 2015‒08‒13
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Modelling and Forecasting Branded and Generic Pharmaceutical Life Cycles: Assessment of the Number of Dispensed Units By S. Buxton; Kostas Nikolopoulos; M. Khammash; P. Stern
  2. Changing the Schedule of Medical Benefits and the Effect on Primary Care Physician Billing: Quasi-Experimental Evidence from Alberta By Logan McLeod; Jeffrey A. Johnson
  3. Is the Rational Addiction model inherently impossible to estimate? By Audrey Laporte; Adrian Rohit Dass; Brian Ferguson
  4. Investigating Defensive Medicine: The Role of Access By Javier Cano-Urbina; Daniel Montanera
  5. Outcomes As Output: A New Approach to The Production Function for Medical Services By Eric Nauenberg
  6. The Role of Occupations in Differentiating Health Trajectories in Later Life By Michal Engelman; Heide Jackson
  7. Understanding the Health Effects of the Death of Spouses in Modern China: Evidence from the city of Qingdao By KAWATA Keisuke; WANG Meixin; YIN Ting
  8. Origin and Development of the Quasi-Market System in Japan: From healthcare to welfare, and to education (Japanese) By USHIRO Fusao
  9. Understanding the Effects of Education on Health: Evidence from China By Huang, Wei
  10. Associations Between Physical Activity and Metabolic Syndrome: Comparison Between Self-Report and Accelerometry By Jared M. Tucker; Gregory J. Welk; Nicholas K. Beyler; Youngwon Kim
  11. The Contribution of Female Health to Economic Development By David E. Bloom; Michael Kuhn; Klaus Prettner
  12. The Medicaid Program By Thomas Buchmueller; John C. Ham; Lara D. Shore-Sheppard
  13. Worms at Work: Long-run Impacts of a Child Health Investment By Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel
  14. The Demand for Reproductive Health Care By Gauthier Tshiswaka-Kashalala; Steven F. Koch
  15. Estimating the Value of Life, Injury, and Travel Time Saved Using a Stated Preference Framework By Naghmeh Niroomand; Glenn P. Jenkins
  16. A Selective Migration Review: from public policy to public health By Nikias Sarafoglou; William A. Sprigg
  17. Building Systems for Universal Health Coverage in South Korea By Sanggon Na; Soonman Kwon
  18. Modelling the distribution of health related quality of life of advanced melanoma patients in a longitudinal multi-centre clinical trial using M-quantile random effects regression By Borgini, Riccardo; Bianco, Paola Del; Salvati, Nicola; Schmid, Timo; Tzavidis, Nikos

  1. By: S. Buxton (Swansee University); Kostas Nikolopoulos (Bangor University); M. Khammash (University of Sussex); P. Stern (University of Exeter)
    Abstract: In this paper, modelling and forecasting pharmaceutical life cycles are investigated, specifically at the time of patent expiry when the generic form of the product could be introduced to the market, while the branded form is still available for prescription. Assessing the number of dispensed units of branded and generic forms of pharmaceuticals is increasingly important due to the irrelatively large market value in the United Kingdom and the limited number of new ÔblockbusterÕ branded drugs. As a result, pharmaceutical companies make every effort to extend the commercial life of their branded products and forecast their sales in the future, while public health institutes seek insights for effective governance as the use of a branded drug, when a generic form is available. In this paper, eleven methods are used to model and forecast drugs life cycles: Bass Diffusion, Repeat Purchase Diffusion Model, Exponential Smoothing, Holt Winters Exponential Smoothing, Moving Averages, ARIMA, Regression over t, Regression over t-1, Robust Regression, Na•ve and Na•ve with drift. The results suggest a difference depending on the forecasting horizon with the ARIMA model and Holt Winters Exponential Smoothing both producing accurate short term forecasts. However for 3-5 year forecasts the results suggest that a very simple forecasting model blended with an addition of a small trend provides the most accurate forecasts for both branded and generic pharmaceuticals
    Date: 2015–04
  2. By: Logan McLeod; Jeffrey A. Johnson
    Abstract: We exploit a quasi-experiment in the province of Alberta, Canada, to identify how changes in the schedule of medical benefits affected the provision of primary care services to patients with multiple co-morbidities. Specifically, Alberta introduced a new fee code to compensate physicians for completing a comprehensive annual care plan (CACP) for qualifying patients. During the period of study, primary care physicians could practice in two settings: (i) solo practice; or (ii) primary care networks (i.e., team based care). This paper asks how the policy change affected physician-billing patterns and whether delivery structure affected physician-billing. Data come from Alberta’s administrative physician claims data, covering the full population of Alberta and all services provided by primary care physicians, for one year before and two years after the policy change. We employ a difference-in-differences methodology and implement a set of robustness checks to control for confounding from other contemporaneous changes that may have occurred in Alberta as well as unobserved physician heterogeneity. Our results suggest the new fee code became the sixth most billed code in its first year (totaling $17.9 million), but was billed by only a small proportion of physicians (roughly 2% of physicians accounted for 20% of total billings). The fee code was disproportionately billed by physicians in team-based care (PCNs), and increased the billing of other complementary fee codes by 5%-10% (or roughly $80 million). The results suggest the unintended consequences of a well-intentioned policy can be costly.
    Keywords: physician payment, physician behaviour, difference-in-differences
    JEL: I10 I13 I18
    Date: 2015–07
  3. By: Audrey Laporte; Adrian Rohit Dass; Brian Ferguson
    Keywords: Rational Addiction model, dynamic time series, dynamic panel
    JEL: I12 C22 C23
    Date: 2015–07
  4. By: Javier Cano-Urbina; Daniel Montanera
    Abstract: Defensive medicine is the treatment decisions by physicians made primarily to limit malpractice liability risk, rather than for the medical benefit of patients. Despite widespread reports of defensive medicine in surveys of physicians, empirical investigations have produced conflicting evidence. This paper develops a model of the interactions in the health care market that shows that rises in medical malpractice pressure have non-monotonic effects on health care spending. The key element in the model is the endogenous determination of access to health care, which reacts to changes in medical malpractice pressure. This implication is tested using the Vital Statistics Natality Birth Data and data on tort reforms by state-month-year, and it is found that, in general, the non-monotonic relationship predicted by the model is supported.
    Keywords: defensive medicine, obstetrics, healthcare spending
    JEL: I18 H75 K13
    Date: 2015–08
  5. By: Eric Nauenberg
    Keywords: productivity; potential Pareto improvement
    Date: 2015–08
  6. By: Michal Engelman; Heide Jackson
    Abstract: This study characterizes heterogeneous trajectories of health among older Americans and investigates how employment histories differentiate them. Using the 1998-2010 waves of the Health and Retirement Study, we examine the impact of longest-held occupations on patterns of limitations in activities of daily living. We use latent class growth analysis to identify distinct health trajectory classes and linear growth curve analysis to model the pattern of limitation accumulation for individuals. All analyses are stratified by sex and race, to account for differential labor markets and health experiences of these demographic groups. A limitation of this analysis is its reliance on broad occupational categories rather than specific measures of working conditions. In future work, we plan to incorporate data on specific occupations and merge them with detailed information on occupational characteristics available in the O*NET database (an online repository that has updated the Dictionary of Occupational Titles used in previous research on aging and retirement and occupational epidemiology: The paper found that: - White respondents (both male and female) are substantially more likely to be in the healthiest class compared to black respondents. - Certain occupations are protective against membership in poor health classes, but the list of protective occupational categories differs substantially by sex and race. - The impact of occupations on health trajectories was diminished when we controlled for educational attainment and smoking, suggesting the important role of education in sorting individuals into occupations that differ in physical and cognitive demands that likely influence health. The policy implications of the findings are: - Life expectancy alone does not capture all the health information that would be relevant for assessing the capacity of American workers to stay on the job beyond traditional retirement ages. Legislators should consider differences in health and in the trajectories of functional decline across demographic groups defined by sex, race, and occupational exposures when debating further increases in the Social Security retirement age.
    Date: 2015–07
  7. By: KAWATA Keisuke; WANG Meixin; YIN Ting
    Abstract: This paper provides new empirical results to understand the impacts of the death of spouses on the surviving partner's health status. We use the survey data for elderly persons in the city of Qingdao in China, which include information for individual health status and other basic characteristics. Based on the probit estimation and the propensity-score approaches, we estimate the impacts of the death of spouses on health status. These estimation results consistently show the heterogeneous health effects between males and females; we can observe statistically significant negative effects on females' health status, while any statistically significant effects for males were unable to be found. One of the possible interpretations of these results is the unique policy in the Mao era (1949-1976).
    Date: 2015–07
  8. By: USHIRO Fusao
    Abstract: Healthcare and welfare systems can be classified into three broad types: a public model in which services are provided and financed by the government through taxes; a social insurance model in which services are provided by multiple players including private-sector entities with the cost of services financed primarily by insurance premiums; and a free-choice model in which private-sector insurance firms and private-sector service providers fulfill the roles. Under the social insurance model, users are subsidized by public funds collected in the form of mandatory social insurance premiums and can choose from multiple service providers. Therefore, this model is often accompanied by a quasi-market where multiple service providers compete for users (it should be noted, however, that a quasi-market mechanism can also be combined with the tax-financed public model).In Japan, a welfare system close to the public model was established immediately after World War II to provide publicly-funded services through private-sector providers. This system remained the pillar of Japan's welfare system for decades. However, in the course of the fundamental structural reform of the social and welfare system from the 1990s onward, Japan adopted the quasi-market system to introduce competition in various service areas including nursery schools (although they do not fit the exact definition of "quasi-market"), long-term care services for the elderly, and welfare services for the disabled. The Comprehensive Support System for Children and Child-rearing, which was enacted in April 2015, in effect introduced an integrated quasi-market for nursery schools and kindergartens.In fact, however, Japan's prewar healthcare insurance system established under the National Health Insurance Act of 1922 had a de facto quasi-market mechanism.This paper looks at how the quasi-market was adopted and took root as a prototype for Japan's public healthcare services from the historical perspective, and examines the factors and developments that led to the extensive adoption of the quasi-market mechanism in other areas of social and welfare services in the 1990s and thereafter.Furthermore, this paper seeks to clarify the unique characteristics of the quasi-market system that have not been understood consciously so far, and reviews various cases of the quasi-market system that has now become fairly prevalent in Japan by comparing them in a cross-cutting manner, thereby pointing to the need for systematic work to propose measures to improve the institutional design of the current quasi-market system and address problems arising therefrom.
    Date: 2015–05
  9. By: Huang, Wei (Harvard University)
    Abstract: Using a national representative sample in China from three largest on-going surveys, this study examines the effects of education on health among working-age population and explores the potential mechanisms. Using the exogenous variation in temporal and geographical impacts of Compulsory Schooling Laws (CSLs), it finds an additional year of schooling decreases 2-percentage points in reporting fair or poor health, 1-percentage points for underweight and 1.5-percentage points for smoking, and increases cognition by about 0.16 standard deviation. Further analysis also suggests that nutrition, income, cognition and peer effects are important channels in the education-health nexus, and all of these factors explain almost half of the education's impact. These suggest that CSLs have improved national health significantly in China and the findings help to explain the mixed findings in the literature.
    Keywords: education, health, China
    JEL: I12 I21 I28
    Date: 2015–07
  10. By: Jared M. Tucker; Gregory J. Welk; Nicholas K. Beyler; Youngwon Kim
    Abstract: Individuals who do not meet the PA guidelines exhibited greater odds of having metabolic syndrome. This relationship tended to be stronger for objective PA measures than for self-report.
    Keywords: NHANES, Objective, Risk Factors, Guidelines, Prevention Research, research, relationship testing, cross-sectional, biometric, morbidity, national, fitness/physical activity, behavior change, adults, all education levels, all income levels, all U.S. locations, all races/ethnicities
    Date: 2015–08–03
  11. By: David E. Bloom; Michael Kuhn; Klaus Prettner
    Abstract: We analyze the economic consequences for less developed countries of investing in female health. In so doing we introduce a novel micro-founded dynamic general equilibrium framework in which parents trade off the number of children against investments in their education and in which we allow for health-related gender differences in productivity. We show that better female health speeds up the demographic transition and thereby the take-off toward sustained economic growth. By contrast, male health improvements delay the transition and the take-off because ceteris paribus they raise fertility. According to our results, investing in female health is therefore an important lever for development policies. However, and without having to assume anti-female bias, we also show that households prefer male health improvements over female health improvements because they imply a larger static utility gain. This highlights the existence of a dynamic trade-off between the short-run interests of households and long-run development goals. Our numerical analysis shows that even small changes in female health can have a strong impact on the transition process to a higher income level in the long run. Our results are robust with regard to a number of extensions, most notably endogenous investment in health care.
    JEL: O1
    Date: 2015–07
  12. By: Thomas Buchmueller; John C. Ham; Lara D. Shore-Sheppard
    Abstract: In both its costs and the number of its enrollees, Medicaid is the largest means-tested transfer program in the United States. It is also a fundamental part of the health care system, providing health insurance to low-income families, indigent seniors, disabled adults and, in some states, low-income adults more broadly. This paper reviews the history and structure of the Medicaid program and the large body of economic research that it has spawned in the nearly half century since it was established. We begin by summarizing the program’s history, goals and current rules. We then present program statistics, mainly related to enrollment and expenditures. Finally we turn to the research on the impact of Medicaid on a broad range of outcomes, discussing theoretical and methodological issues important for understanding these effects and reviewing the empirical literature, describing what has been learned thus far, investigating areas where studies seem to reach different conclusions and pointing to areas where we believe additional research would be fruitful.
    JEL: I11 I13 I18 I3
    Date: 2015–07
  13. By: Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel
    Abstract: This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased education among women and labor supply among men, with accompanying shifts in labor market specialization. Ten years after deworming treatment, women who were eligible as girls are 25% more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and entrepreneurship. Men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in entrepreneurship, are more likely to hold manufacturing jobs, and miss one fewer meal per week. We estimate an annualized financial internal rate of return of at least 32.2%.
    JEL: I00 I10 I20 J24 O15
    Date: 2015–07
  14. By: Gauthier Tshiswaka-Kashalala (Department of Economics, University of Pretoria); Steven F. Koch (Department of Economics, University of Pretoria)
    Abstract: This research formalizes the interactions between the various determinants of a woman's reproductive health behavior during her reproductive years, and, using nonparametric control functions, examines those determinants. The theoretical model is developed from Grossman's (2000) model of health as a form of human capital, focusing on the cyclicality and volatility of fecundity, as well as the potential costs (such as lost wages and direct costs of purchase) and benefits (such as the ability to invest in her education and/or career) of being able to control or at least mitigate it. The empirical model, which controls for the endogeneity between sexual activity and contracepting decsions supports our theoretical model of reproductive health-seeking behavior.
    Keywords: Health Production, Contraception Efficiency, Nonparametric Analysis
    Date: 2015–08
  15. By: Naghmeh Niroomand (Eastern Mediterranean University, North Cyprus); Glenn P. Jenkins (Queen’s University, Canada and Eastern Mediterranean University, North Cyprus)
    Abstract: The incidence of death and injury from automobile accidents in North Cyprus is 3.6 times greater than the average for the EU. With the prospect of North Cyprus entering the EU, many investments will need to be undertaken in order to reduce these figures and reach EU norms. A key task will be to select the investments that are justified on the basis of a cost–benefit or cost–effectiveness analysis and not to waste resources through poor project selection. The objective of this study is to provide local estimates of the value of a statistical life and injury along with the value of time savings. These are among the key parameters needed for the evaluation of the benefits of such projects. In this study we conducted a stated choice experiment to identify the preferences and trade-offs of automobile drivers in North Cyprus for improved travel times, travel costs and safety. The choice of route was examined using mixed logit models to obtain the marginal utilities associated with each attribute of the routes that consumers choose. These estimates were used to assess the individuals’ willingness to pay (WTP) to avoid fatalities and injuries and to save travel time. We then used the results to obtain community-wide estimates of the value of a statistical life (VSL) saved, the value of injury (VI) prevented, and the value per hour of travel time saved.
    Keywords: Willingness to pay; choice experiment; value of risk reduction; value of a statistical life; road safety; car drivers
    JEL: D12 D61 Q50 J17 R41 D12
    Date: 2015–08
  16. By: Nikias Sarafoglou; William A. Sprigg
    Abstract: The contribution of Steinbeck in the late-1930’s concerning motives and decisionmaking for environmental migrations did much to influence research in social science. The Tiebout’s hypothesis and theoretical model of migration, published in 1956, permitted evaluation of urban public policy implications. The impact of these two pioneers in migration theory set the stage for new models and new methods in migration research having advantage of much more data from many more environmental, economic and social sectors applied to many more accumulating, often tragic, examples. This paper looks at the state of the science as these two influential authors left it and how the public health part of the 1930’s Dust Bowl migration to California contributes to our understanding of this complex human, decision-making system. Finally, Garfield's scientometric propagation of scientific thinking was utilized for migration theories.
    JEL: A12 B16 H10 I18 J61 O18 Q5 R38
    Date: 2015–07
  17. By: Sanggon Na; Soonman Kwon
    Abstract: This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). Health insurance agencies have improved the accountability and transparency of the health insurance system, thanks to the ICT-based centralized claim review and assessment. Lessons and challenges from Korea’s experiences and achievements on the road to UHC could provide valuable policy implications to low- and middle-income countries.
    Keywords: health care providers, health information system, health insurance coverage, access to health care, employment, risks, fee- for-service, health planning, health insurance ... See More + system, physician, stroke, financing, informal sector, pharmacists, information system, health reforms, income, quality of health care, fee for service, health care utilization, fee-for-service, doctors, fee-for- service system, health care reform, health economics, hospital sector, primary care, pocket payment, monitoring, cost sharing, health insurance, health care, financial protection, health insurance expenditure, social insurance contributions, health care facilities, incentives, national health insurance, health, health care reforms, provision of services, pocket payments, contribution rates, information systems, public health, life expectancy, quality of health, knowledge, health sector, insurance funds, health information systems, choice, demand for health care, cost effectiveness, multiple insurers, private hospitals, health institutions, costs, pharmaceutical spending, cost control, patients, patient, public long- term care insurance, aging, social insurance, health insurance scheme, marketing, medical care, insurers, health care quality, social security, risk sharing, health care coverage, social development, insurance coverage, public insurance, mortality, financial incentive, health care system, health promotion, administrative costs, health information, health spending, reimbursement rates, social marketing, unemployment, equity, health specialist, workers, social health insurance, fee schedule, surgery, public long-term care, health care provision, incentives for providers, health-care, fee schedules, care, contribution rate, health policy, medical services, social policy, demand, health outcomes, health-care providers, insurance contributions, public providers, income countries, health care financing, decision making, measurement, nutrition, beds, health coverage, social welfare, insurance system, fee-for-service payment, internet, national health, health system, insurance, delivery of health care, physicians, health care delivery, cancer patient, clinics, evaluation, risk, inpatient care, health providers, fee-for- service, demand for health, health insurance contributions, integration, health expenditure, ability to pay, hospital admission, health care expenditure, health insurance funds, sustainable health care, population, hospital beds, health insurance program, public long- term care, strategy, fees, medicines, medicaid, hospitals, implementation, pregnancy, capita health expenditure, provider payment, medical fees, financial incentives, health reform, access to drugs
    Date: 2015–03
  18. By: Borgini, Riccardo; Bianco, Paola Del; Salvati, Nicola; Schmid, Timo; Tzavidis, Nikos
    Abstract: Health-related quality of life assessment is important in the clinical evaluation of patients with metastatic disease that may offer useful information in understanding the clinical effectiveness of a treatment. To assess if a set of explicative variables impacts on the health-related quality of life, regression models are routinely adopted. However, the interest of researchers may be focussed on modelling other parts (e.g. quantiles) of this conditional distribution. In this paper we present an approach based on M-quantile regression to achieve this goal. We applied the proposed methodology to a prospective, randomized, multi-centre clinical trial. In order to take into account the hierarchical nature of the data we extended the M-quantile regression model to a three-level random effects specification and estimated it by maximum likelihood.
    Keywords: hierarchical data,in uence function,robust estimation,quantile regression,multilevel modelling
    Date: 2015

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