nep-hea New Economics Papers
on Health Economics
Issue of 2015‒09‒26
thirty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Insuring Health or Insuring Wealth? An Experimental Evaluation of Health Insurance in Rural Cambodia By Levine, David; Polimeni, Rachel; Ramage, Ian
  2. The Concentration of Hospital-Based Medical Spending: Evidence from Canada? By Aurélie Côté-Sergent; Damien Échevin; Pierre-Carl Michaud
  3. Non-economic Damages in Medical Malpractice Appeals: Does the Jurisdiction Make a Difference? By Sofia Amaral-Garcia
  4. Who is responsible for your health: is it you, your doctor or the new technologies? By Vincenzo Atella; Francesco D’Amico
  5. Survey response behaviour and the dynamics of self-reported health and disability: an experimental analysis By Jäckle, Annette; Pudney, Stephen
  6. Impacts of Leaving Paid Work on Health, Functions, and Lifestyle Behavior: Evidence from JSTAR panel data By HASHIMOTO Hideki
  7. Bad times, slimmer children By Cristina Belles-Obrero; Sergi Jiménez-Martín; Judit Vall-Castello
  8. Care more, earn less? The association between care leave for sick children and wage among Swedish parents By Boye, Katarina
  9. Pharmaceutical patents and generic entry competition: the role of marketing exclusivity By MIYAGIWA, Kaz; WAN, Yunyun
  10. The Effects of Two Influential Early Childhood Interventions on Health and Healthy Behaviors By Gabriella Conti; James J. Heckman; Rodrigo Pinto
  11. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – ARIA (Italy) Case Study Report By Francisco Lupiañez-Villanueva; Alexandra Theben
  12. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – Renewing Health Carinthia (Austria) Case Study Report By Ignacio Peinado; Elena Villalba; Francisco José Mansoa; Alberto Sánchez
  13. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – Veterans Health Administration (USA) Case Study Report By Francisco José Mansoa; Alberto Sánchez; Elena Villalba; Ignacio Peinado
  14. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – Integrated care programme for older in- and out-patients, University Hospital of Getafe (Spain) Case Study Report By Elena Villalba; Alberto Sánchez; Ignacio Peinado; Francisco José Mansoa
  15. Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) - Conceptual description of the Monitoring and Assessment Framework for the EIP on AHA By Fabienne Abadie; Christian Boehler
  16. The Affordable Care Act and the Growth of Involuntary Part-Time Employment By Even, William E.; Macpherson, David A.
  17. Economic Activity and the Spread of Viral Diseases: Evidence from High Frequency Data By Adda, Jérôme
  18. The Long Lasting Influenza: The Impact of Fetal Stress during the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden 1968-2012 By Bengtsson, Tommy; Helgertz, Jonas
  19. Fetal Malnutrition and Academic Success: Evidence from Muslim Immigrants in Denmark By Greve, Jane; Schultz-Nielsen, Marie Louise; Tekin, Erdal
  20. The Value of Socialized Medicine: The Impact of Universal Primary Healthcare Provision on Birth and Mortality Rates in Turkey By Cesur, Resul; Güneş, Pınar Mine; Tekin, Erdal; Ulker, Aydogan
  21. A "Healthy Immigrant Effect" or a "Sick Immigrant Effect"? Selection and Policies Matter By Constant, Amelie F.; García-Muñoz, Teresa; Neuman, Shoshana; Neuman, Tzahi
  22. Health, Medical Innovation and Disability Insurance: A Case Study of HIV Antiretroviral Therapy By Perry Singleton
  23. Health Information Technology in the United States, 2015: Transition to a Post-HITECH World (Executive Summary) By Edited by Catherine M. DesRoches; Michael W. Painter; Ashish K. Jha
  24. Health Information Technology in the United States, 2015: Transition to a Post-HITECH World By Edited by Catherine M. DesRoches; Michael W. Painter; Ashish K. Jha
  25. The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds By Mark Pauly; Adam Leive; Scott Harrington
  26. The Effect of Medicaid on Adult Hospitalizations: Evidence from Tennessee’s Medicaid Contraction By Ausmita Ghosh; Kosali Simon
  27. In- and Out-patient satisfaction assessment: the case of a greek General Hospital By Xesfingi, Sofia; Karamanis, Dimitrios
  28. Impact of gender aspect on self-perceived quality of life of elderly By Ghosh, Dona
  29. Are Health Care Expenditures and Personal Disposable Income Characterised by Asymmetric Behaviour? Evidence from US State-Level Data By Mulatu F. Zerihun; Juncal Cunado; Rangan Gupta
  30. Effect of poverty on women health in khewra city pakistan By Asifa Batool

  1. By: Levine, David; Polimeni, Rachel; Ramage, Ian
    Keywords: Social and Behavioral Sciences, Insurance, Health, Impact, Randomized Trial, Cambodia
    Date: 2014–04–01
  2. By: Aurélie Côté-Sergent; Damien Échevin; Pierre-Carl Michaud
    Abstract: In this paper, we present evidence on the concentration of hospital-based medical spending in Canada. We use longitudinal administrative data from the province of Quebec to document how medical spending is concentrated cross-sectionally, over time and finally near the end-of-life when death occurs at the hospital. Average expenditures rise rapidly with age, starting around the age of 50, and are concentrated in a small fraction of high-cost users. For example, the top 1% of men and women in terms of hospital spending account for 55.5% and 54.8% of total spending respectively. Persistence among high-users is rather low. Fewer than 3% of those in the top quintile of hospital spending stay in the same quintile the following year, fewer than 5% have any spending the following year. Finally, hospital spending among those in their last year of life and who die at the hospital can account for 11.1% of total hospital spending in the population. Most of that end-of-life spending, more than 80%, occurs in the last month of life.
    Keywords: Medical spending, concentration, end-of-life,
    JEL: I10 I13 I18
    Date: 2015–09–16
  3. By: Sofia Amaral-Garcia
    Abstract: This article assesses predictors of payouts and non-economic damages in medical malpractice cases decided by the Spanish Supreme Court from 2006 until 2010. Medical malpractice cases can be judged in administrative or civil courts, and this distinction heavily relies on the type of hospital where the medical accident took place (in general terms, administrative courts judge cases involving public hospitals and civil courts judge cases involving private hospitals). I find that cases decided by the Administrative Section of the Supreme Court are not more likely to receive damages than cases decided by the Civil Section. The probability of receiving compensation is significantly higher among cases involving permanent major/grave injuries. With respect to non-economic compensation amounts, there are no significant differences between Administrative and Civil cases. This result is confirmed by matching estimation and simulation exercises. There is evidence of vertical inequality according to the level of harm: cases involving permanent grave injuries are those receiving the highest non-economic damages, followed by permanent major, death, permanent minor and temporary /emotional cases. Differences in compensation awards between Administrative and Civil courts has been one argument widely used against the current separation of jurisdictions in many civil law tradition countries. The results found in this paper do not support this claim.
    Keywords: medical malpractice, non-economic damages, scheduled damages, Supreme Court, Spain, administrative and civil jurisdictions, litigation
    JEL: K13 K32 K41
    Date: 2015
  4. By: Vincenzo Atella; Francesco D’Amico
    Abstract: The aim of the paper is to disentangle the roles that patients, physicians and technology can have on patient health outcomes. The analysis focuses on patients suffering from hypercholesterolemia. Using a large and detailed dataset of patients collected by the Italian College of General Practitioners (SIMG) over the period 2001–2006, we observe the existence of heterogeneity in the time needed to reach an optimal level of health stock. We firstly explore whether patients recovering faster exhibit lower hospitalization rates. Secondly, we study the determinants of the speed of recovery to a good health status. Results suggest that a 10 % increase in the speed of recovery reduces hospitalization rates by 1 % in the general sample and by 1.25 % in patients in primary prevention. Furthermore, we show that recovering to a good health status is a multifaceted phenomenon, with technology explaining from 54 to 68 % of the total effect.
    Keywords: technical progress; adjustment process; cholesterol; statins
    JEL: I12 O31 O33
    Date: 2014–09–16
  5. By: Jäckle, Annette; Pudney, Stephen
    Abstract: Disability research often uses survey questions asking whether respondents have a long-standing health problem, but longitudinal repetition of such questions produces implausibly high empirical transition rates into and out of ill-health. We exploit a repeated experiment in the Understanding Society Innovation Panel to identify reasons for these high transition rates, and to assess the common practice of using such questions to control who is asked further questions on difficulties with daily activities. Our results reveal ambiguity in the concept of a long-standing health problem and indicate significant biases in commonly used measures and multivariate analyses of health dynamics and disability.
    Date: 2015–09–22
  6. By: HASHIMOTO Hideki
    Abstract: Despite extensive research published in economic, psychological, and public health literature, a consensual view on the causal influence of leaving paid work on health, functions, lifestyle behavior, and social participation has not been reached. Recent review studies indicate that heterogeneous characteristics of the pre-retired should be accounted for to reveal the impact of leaving paid work. Related evidence is scarce in Japan where the effective retirement age is the highest among developed countries. We used panel data from the Japanese Study of Aging and Retirement (JSTAR) to fill this knowledge gap. Using propensity-matching difference-in-difference estimation stratified by age strata (under 65 vs. 65 and over), gender, and job characteristics, we find that transitioning from paid work status to retirement exerts limited impact on cognitive function, mobility, smoking behavior, body mass index, psychological distress, hypertension prevalence, fruit intake, and social participation to voluntary services. However, some segments of older people seem more vulnerable to specific impacts, e.g., men formerly engaged in white-collar jobs and secured jobs, or older women with unsecured jobs showed a negative impact on cognitive function, while men with stressful jobs show a reduced prevalence of hypertension after retirement. We argue that the heterogeneity of the population at retirement age should be considered to specify causal pathways and policy implications of health impacts after leaving paid work more effectively.
    Date: 2015–09
  7. By: Cristina Belles-Obrero; Sergi Jiménez-Martín; Judit Vall-Castello
    Abstract: In this paper we study the effect of business cycle conditions on infant underweight, overweight and obesity. We exploit 8 waves (1987-2012) of the Spanish National Health Survey for children aged 2-15 and use the regional unemployment rate of the trimester of the interview as a proxy for the business cycle phase at the local level. We find that an increase in the unemployment rate is associated with lower obesity incidence, especially for children under 6 years old and over 12 years old. Negative economic shocks also increase the prevalence of infant underweight, particularly for boys under 6 years old. Moreover, we show that one of the possible mechanism through which the cycle is impacting infant obesity is the nutritional composition of the children's diet, as well as, increases in the frequency of exercise. Although we show a deterioration in self-reported health for children under 6 years old, we provide some preliminary evidence that suggests that the impact of business cycle conditions on infant weight disorders have little objective health consequences in the short-run and do not persist in the medium-run.
    Date: 2015–09
  8. By: Boye, Katarina (Swedish Institute for Social Research, Stockholm University)
    Abstract: A number of studies have shown that women’s and men’s wages relate to parenthood in general and to parental leave in particular, but we know little about the possible wage impact of leave to care for sick children, which is a part of the Swedish parental leave system. On the one hand, care leave may influence human capital and real or perceived work capacity similarly to parental leave and send the employer the same signals about work commitment and responsibilities outside of work. On the other hand, important differences, including timing, frequency and predictability, between care leave and parental leave influence paid work. This study uses Swedish register data to analyse the association between care leave and wages among mothers and fathers who had their first child in 1994. The results show that care leave is associated with a lower wage, particularly among men, up to 13 years after the birth of the first child. One reason for the gender difference in the association between care leave and wage may be that men’s care leave has a stronger signalling effect compared with women’s care leave.
    Keywords: Care leave; parental leave; wages; gender equality; family; labour market
    JEL: J13 J16
    Date: 2015–09–14
  9. By: MIYAGIWA, Kaz; WAN, Yunyun
    Abstract: Extensive tests required by FDA severely curtail effective patent length for innovation drugs, raising concern that incentives to develop new drugs are insufficient in the U.S. The Hatch-Waxman Act addresses this issue with a five-year patent extension. At the same time, Hatch-Waxman promotes generic entry by reducing the entry cost for generics and by granting 180-day marketing exclusivity to a first challenger of the patent. While these two objectives seem at odds with other, we show that if the entry cost reduction is substantial, granting the marketing exclusivity also contributes to restoration of incentives to innovate. However, market exclusivity most likely decreases social welfare.
    Keywords: innovation, generic entry competition, patent, pharmaceuticals
    JEL: I18 K23 L13
    Date: 2015–08–21
  10. By: Gabriella Conti (University College London); James J. Heckman (The University of Chicago); Rodrigo Pinto (The University of Chicago)
    Abstract: This paper examines the long-term impacts on health and healthy behaviors of two of the oldest and most widely cited U.S. early childhood interventions evaluated by the method of randomization with long-term follow-up: the Perry Preschool Project (PPP) and the Carolina Abecedarian Project (ABC). There are pronounced gender effects strongly favoring boys, although there are also effects for girls. Dynamic mediation analyses show a significant role played by improved childhood traits, above and beyond the effects of experimentally enhanced adult socioeconomic status. These results show the potential of early life interventions for promoting health.
    Keywords: Health, early childhood intervention, social experiments, randomized trial, Abecedarian Project, Perry Preschool Project
    JEL: C12 C93 I12 I13 J13 J24
    Date: 2015–07
  11. By: Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence)
    Abstract: The ARIA case emerged from an idea of some pulmonology specialists, who have been dedicated for some time to the care and follow up of patients with acute and chronic respiratory failure caused by neuromuscular, neurological and reb cage diseases. These specialists are members of the Italian Association of Muscular Dystrophy Patients (UILDM) and belong to the Arcispedale Santa Maria Nuova (Santa Maria Nuova General Hospital) and to the San Sebastiano Hospital, within the Local Health Unit of Reggio Emilia. The basic idea underpinning the ARIA case is that telecare can play an important and powerful role in the care of patients with chronic diseases. In particular, it can contribute to the delivery of services that benefit patients in terms of independent living and quality of life through improved collaboration amongst caregivers and health workers, while simultaneously helping to cut the cost of the regional healthcare system.
    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: 2015–06
  12. By: Ignacio Peinado (Hospital Universitario de Getafe); Elena Villalba (Hospital Universitario de Getafe); Francisco José Mansoa (Hospital Universitario de Getafe); Alberto Sánchez (Hospital Universitario de Getafe)
    Abstract: Renewing Health is a European project (February 2010-December 2013), partly funded by the European Union under the ICT Policy Support Programme, part of the Competitiveness and Innovation framework Programme (CIP), with a total budget of €14 million and European co-financing of €7 million. The project aimed to implement health-related ICT services through large-scale real-life test beds for the validation and subsequent evaluation of innovative eHealth services, using a patient-centred approach and a rigorous common assessment methodology. This case study focuses on the Austrian Partner of the project: the Carinthia region and, more precisely, KABEG (Krankenanstalten Betriebsgesellschaft), the hospital management company in the region. In RENEWING HEALTH, KABEG integrated a set of telemonitoring solutions into their existing systems for two target groups - patients suffering from Diabetes Mellitus Type II and patients suffering from COPD – in order to carry out two pilots to test the effects of the resulting system.
    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: 2015–04
  13. By: Francisco José Mansoa (Hospital Universitario de Getafe); Alberto Sánchez (Hospital Universitario de Getafe); Elena Villalba (Hospital Universitario de Getafe); Ignacio Peinado (Hospital Universitario de Getafe)
    Abstract: The Veterans Health Administration (VHA) is an agency of the United States Department of Veterans’ Affairs (this Department that has the 3rd largest budget among departments of the US administration). The medical assistance program implemented by the VHA is the largest integrated care system in the US (consisting of 150 medical centres and nearly 1,700 facilities comprising community-based outpatient clinics, community living centres, Veterans’ Centres and domiciliary assistance). It provides comprehensive care to almost 9 million veterans every year. The VHA is centrally administered and fully integrated; its services are funded and provided by the federal government. Therefore the VHA works both as a provider and payer, a rather unusual feature in the US health care structure. In fact, VHA is the only truly national health care system in the US, with hospitals or other facilities in every state and major metropolitan area of the country, as well as in Puerto Rico, the Virgin Islands, Guam, American Samoa and the Philippines. The VHA network is divided into 23 Veterans Integrated Service Networks, or VISNs, i.e. regional systems of care working together to better meet local health care needs and provide greater access to care.
    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: 2015–04
  14. By: Elena Villalba (Hospital Universitario de Getafe); Alberto Sánchez (Hospital Universitario de Getafe); Ignacio Peinado (Hospital Universitario de Getafe); Francisco José Mansoa (Hospital Universitario de Getafe)
    Abstract: For more than 20 years the Geriatrics Service of the University Hospital of Getafe (Hospital Universitario de Getafe – HUG) has been offering integrated care programmes for older in- and out-patients. These services provide continuous, progressive and coordinated attention to patients at high risk of functional decline, institutionalisation, and hospitalisation, at home or in residential care settings. The objective is to offer the most appropriate care according to the changing needs of the patients. The programme is twofold: for people admitted to the hospital, the care teams responsible for the different phases of the treatment are coordinated through periodic meetings (both physical and remote, the latter to coordinate care with other hospitals) and coordinate with the team in primary care before discharge; for patients who are at home or in residential care facilities, the programme includes follow-up of the patient directly, or in close collaboration with primary care and social care agents when needed.
    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: 2015–04
  15. By: Fabienne Abadie (European Commission – JRC - IPTS); Christian Boehler (European Commission – JRC - IPTS)
    Abstract: After having identified a short list of candidate indicators for assessing the impact of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) in the first and second reports on outcome indicators for MAFEIP, the next step in this project was to develop a quantitative approach that could be suited to establishing a link between candidate indicators and the EIP on AHA objectives. This report therefore conceptualises a model for estimating the impact of the Partnership's activities on its targets for health and sustainability of health and care system using the outcome indicators that were previously identified. In accordance with the EIP on AHA headline target of increasing the average healthy life expectancy of European citizens by two years by 2020, we took the methods to calculate Healthy Life Years (HLY) as a starting point, but adapted them to better accommodate the needs of MAFEIP. The rationale for this adaptation was to ensure the resulting model can adequately estimate the health impacts achieved by EIP on AHA commitments, and also to utilise data on indicators that are most frequently reported across EIP on AHA participants. The resulting model is based on a Markov process with three generic health states ('baseline health', 'deteriorated health' and 'death'), which can draw upon data from primary and secondary outcome indicators across populations, interventions, commitments and geographic domains. We discuss how the model's flexibility that allows it to be applied to different contexts could be enhanced further through the optional inclusion of additional health states or extensions for incorporating additional secondary indicators. We also discuss how to use the model for estimating the impact of activities delivered within the EIP on AHA on the sustainability of health and care systems in terms of the incremental impact of the interventions on health and care expenditure. We propose that the model should be implemented as a web-based monitoring tool to enable stakeholders within commitments to independently assess the impact of their respective interventions on health and sustainability of health and care systems, with the support and guidance of IPTS.
    Keywords: EIP, Active and Healthy Ageing, EIP on AHA, indicators, monitoring, framework
    JEL: I11 I18 O33 O38
    Date: 2015–05
  16. By: Even, William E. (Miami University); Macpherson, David A. (Trinity University)
    Abstract: This study tests whether the employer mandate under the Affordable Care Act (ACA) increased involuntary part-time (IPT) employment. Using data from the Current Population Survey between 1994 and 2014, we find that IPT employment in 2014 was higher than predicted based on economic conditions and the composition of jobs and workers in the labor market. More importantly, using difference-in-difference methods, we find that the increase in the probability of IPT employment since 2010 was greatest in the industries and occupations where workers were most likely to be affected by the mandate. We also show that there has been virtually no change in the probability of IPT employment where the number of workers affected by the mandate was small. We estimate that approximately 1 million additional workers between the ages of 19 and 64 are in IPT employment as a result of the ACA employer mandate.
    Keywords: Affordable Care Act, involuntary part-time employment, employer mandate, health insurance
    JEL: J22 J23 J32 J33 H25
    Date: 2015–09
  17. By: Adda, Jérôme (Bocconi University)
    Abstract: Viruses are a major threat to human health, and - given that they spread through social interactions - represent a costly externality. This paper addresses three main issues: i) what are the unintended consequences of economic activity on the spread of infections? ii) how efficient are measures that limit interpersonal contacts? iii) how do we allocate our scarce resources to limit their spread? To answer these questions, we use novel high frequency data from France on the incidence of a number of viral diseases across space, for different age groups, over a period of a quarter of a century. We use quasi-experimental variation to evaluate the importance of policies reducing inter-personal contacts such as school closures or the closure of public transportation networks. While these policies significantly reduce disease prevalence, we find that they are not cost-effective. We find that expansions of transportation networks have significant health costs in increasing the spread of viruses and that propagation rates are pro-cyclically sensitive to economic conditions and increase with inter-regional trade.
    Keywords: health, epidemics, spatial diffusion, transportation networks, public policy
    JEL: I12 I15 I18 H51 C23
    Date: 2015–09
  18. By: Bengtsson, Tommy (Lund University); Helgertz, Jonas (Lund University)
    Abstract: The observation in the 1940s, that children to mothers having rubella in the first part of the pregnancy experienced elevated health risks in later life led to a growing interest into whether fetal exposure to other – less severe – diseases could cause health problems as well. Epidemiological studies of the fetal origins of later life health that followed found that, while this indeed was the case, the effect was rather modest. A frequent weakness with many of these studies is furthermore that they only demonstrate associations, not causal relationships. Recent studies by economists and demographers, using quasi-experimental design to overcome this weakness, show that fetal conditions not only affect health in later life but also education and socioeconomic attainment. There is, however, a lack of consistency in the results. While some are showing strong effects, others show weak or no effects at all. Whether this is due to omitted variables, such as the socioeconomic status of parents or data quality problems is unclear. Thus, the question remains: does fetal stress caused by less severe diseases such as influenza, have long lasting impact on health and socioeconomic attainment? In this study we use a quasi-experimental design to test whether exposure to the 1918 influenza pandemic during the fetal stage influenced later life attainment using detailed data on the entire population living in Sweden anytime between 1968 and 2012. In addition, we use rich contextual data on morbidity and mortality, as well as on the socioeconomic status of parents, for the period 1914 to 1922 in order to address issues of selection. We find that the children of mothers exposed during pregnancy to influenza suffered from worse adult health and, for males, also increased mortality at old ages, particularly in cancer. Their income attainment was, however, only weakly – and positively - affected by fetal influenza exposure. We therefore conclude that observed health disadvantage is likely to have been a direct effect of fetal exposure to the 1918 influenza pandemic, remaining latent until later in life.
    Keywords: fetal origins hypothesis, 1918 influenza pandemic, quasi-experiment, income, hospitalization, mortality, causes of death, register data, total population, Sweden
    JEL: I14 N14
    Date: 2015–09
  19. By: Greve, Jane (KORA - Danish Institute for Local and Regional Government Research); Schultz-Nielsen, Marie Louise (Rockwool Foundation Research Unit); Tekin, Erdal (American University)
    Abstract: This paper examines the impact of potential fetal malnutrition on the academic proficiency of Muslim students in Denmark. We account for the endogeneity of fetal malnutrition by using the exposure to the month of Ramadan during time in utero as a natural experiment, under the assumption that some Muslim women might have fasted during Ramadan when they were pregnant. In some of our specifications, we use a sample of students from predominantly non-Muslim countries as an additional control group to address potential seasonality in cognitive outcomes in a difference-indifferences framework. Our outcome measures are the standardized test scores from the national exams on the subjects of Danish, English, Math, and Science administered by the Danish Ministry of Education. Our results indicate that fetal exposure to Ramadan has a negative impact on the achievement scores of Muslim students, especially females. Our analysis further reveals that most of these effects are concentrated on the children with low socioeconomic status (SES) background. These results indicate that fetal insults such as exposure to malnutrition may not only hamper the cognitive development of children subject to such conditions, but it may also complicate the efforts of policy-makers in improving the human capital, health, and labor market outcomes of low-SES individuals. Our findings highlight the importance of interventions designed to help economically disadvantaged women during pregnancy.
    Keywords: Denmark, fetal, fetal origins, education, Muslim, immigrant, malnutrition, food, intrauterine
    JEL: I12 I14 I24 J15
    Date: 2015–09
  20. By: Cesur, Resul (University of Connecticut); Güneş, Pınar Mine (University of Alberta); Tekin, Erdal (American University); Ulker, Aydogan (Deakin University)
    Abstract: This paper examines the impact of universal, free, and easily accessible primary healthcare on population health as measured by age-specific birth and mortality rates, focusing on a nationwide socialized medicine program implemented in Turkey. The Family Medicine Program (FMP), launched in 2005, assigns each Turkish citizen to a specific state-employed family physician, who offers a wide range of primary healthcare services that are free-of-charge. Furthermore, these services are provided at family health centers, which operate on a walk-in basis and are located within the neighborhoods in close proximity to the patients. To identify the causal impact of the FMP, we exploit the variation in its introduction across provinces and over time. Our estimates indicate that the FMP caused large declines in mortality rates across all age groups with more pronounced impacts among infants and the elderly, and a moderate reduction in the birth rates, primarily among teenagers. Furthermore, the results are suggestive that the program has also contributed towards equalization in the mortality disparities across provinces. Our findings highlight the importance of a nationwide supply-side intervention on improving public health.
    Keywords: healthcare, reform, socialized, medicine, health, Turkey, infant, mortality, birth, teenager, physician
    JEL: I0 I1 I11 I13 I14 I18 J13 J14
    Date: 2015–09
  21. By: Constant, Amelie F. (George Washington University, Temple University); García-Muñoz, Teresa (Universidad de Granada); Neuman, Shoshana (Bar-Ilan University); Neuman, Tzahi (Hebrew University, Jerusalem)
    Abstract: An extensive body of research related to immigrants in a variety of countries has documented a "healthy immigrant effect" (HIE). When immigrants arrive in the host country they are healthier than comparable native populations, but their health status may deteriorate with additional years in the country. HIE is explained through the positive self-selection of the health of immigrants and the positive selection, screening and discrimination applied by the host countries. In this paper we study the health assimilation of immigrants within the context of selection and migration policies. Using SHARE data we are able to compare Israel and Europe that have fundamentally different migration policies. Israel has virtually unrestricted open gates for Jewish people around the world, who in turn have ideological rather than economic considerations to move. European countries have selective policies with regards to the health, education and wealth of migrants, who self-select themselves. Our hypothesis is that the HIE, evidenced in many countries will not be found in Israel. Instead, immigrants to Israel may arrive with lower health than that of natives and improve their health with residence in the country, due to the universal health coverage and generous socio-economic support of the government. Our results provide evidence that a) immigrants to Israel have compromised health and suffer from many health ailments upon arrival, making them less healthy than comparable natives. Their health does not improve for up to twenty years of living in Israel, after which they become similar to natives; b) immigrants to Europe have better health than natives upon arrival and up to eleven years since arrival in the host country, after which they are not significantly different than natives. Our results are important for policy.
    Keywords: self-reported health status, immigration, Europe, Israel, older population, multilevel regression, SHARE
    JEL: C22 J11 J12 J14 O12 O15 O52
    Date: 2015–09
  22. By: Perry Singleton (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244)
    Abstract: The growth of the US Social Security Disability Insurance (SSDI) program has raised questions about whether the program targets the disabled population effectively. To address these questions, this study examines the direct effect of health on SSDI outcomes. The effect is identified by a new antiretroviral therapy introduced in late 1995 and early 1996 to treat the human immunodeficiency virus. Administrative data on SSDI applications come from the Disability Research File. According to the analysis, the new therapy had an immediate and persistent effect on program entry. By 1997, the therapy decreased HIV-related applications by 35.2 percent and new awards by 36.7 percent. The therapy did not substantially increase program exits for work and, instead, decreased program exits through death. By 1999, the therapy increased HIV-related expenditures by $43.6 million, reflecting a decrease in mortality among existing beneficiaries who continued to receive benefits.
    Keywords: Health, HIV, Social Security, Disability Insurance
    JEL: H51
    Date: 2015–09
  23. By: Edited by Catherine M. DesRoches; Michael W. Painter; Ashish K. Jha
    Abstract: This report reviews the progress made on HIT adoption, examine remaining barriers, and discuss options for ensuring that the nation continues to advance toward a truly interoperable health care system.
    Keywords: HIT, HITECH, Health Information Technology
    JEL: I
    Date: 2015–09–18
  24. By: Edited by Catherine M. DesRoches; Michael W. Painter; Ashish K. Jha
    Abstract: Report reviews the progress made on HIT adoption, examine remaining barriers, and discuss options for ensuring that the nation continues to advance toward a truly interoperable health care system.
    Keywords: HIT, HITECH, Health Information Technology
    JEL: I
    Date: 2015–09–18
  25. By: Mark Pauly; Adam Leive; Scott Harrington
    Abstract: This paper estimates the change in net (of subsidy) financial burden (“the price of responsibility”) and in welfare that would be experienced by a large nationally representative sample of the “non-poor” uninsured if they were to purchase Silver or Bronze plans on the ACA exchanges. The sample is the set of full-year uninsured persons represented in the Current Population Survey for the pre-ACA period with incomes above 138 percent of the federal poverty level. The estimated change in financial burden compares out-of-pocket payments by income stratum in the pre-ACA period with the sum of premiums (net of subsidy) and expected cost sharing (net of subsidy) for benchmark Silver and Bronze plans, under various assumptions about the extent of increased spending associated with obtaining coverage. In addition to changes in the financial burden, our welfare estimates incorporate the value of additional care consumed and the change in risk premiums for changes in exposure to out-of-pocket payments associated with coverage, under various assumptions about risk aversion. We find that the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare; indicating a positive “price of responsibility” for complying with the individual mandate. The percentage of the sample with estimated welfare increases is close to matching observed take-up rates by the previously uninsured in the exchanges.
    JEL: I11 I13 I18
    Date: 2015–09
  26. By: Ausmita Ghosh; Kosali Simon
    Abstract: The 2010 Affordable Care Act (ACA) Medicaid expansions aimed to improve access to care and health status among low-income non-elderly adults. Previous work has established a link between Medicaid coverage expansion and reduced mortality (Sommers, Baicker and Epstein, 2012), but the mechanism of this reduction is not clearly understood. Prior to the ACA, one of the largest policy changes in non-elderly adult Medicaid access was a 2005 contraction through which nearly 170,000 enrollees lost Medicaid coverage in Tennessee. We exploit this change in Medicaid coverage to estimate its causal impact on inpatient hospitalizations. We find evidence that the contraction decreased the share of hospitalizations covered by Medicaid by 21 percent and increased the share uninsured by nearly 61 percent, relative to the pre-reform levels and to other states. We also find that 75 percent of the increase in uninsured hospitalizations originated from emergency department visits, a pattern consistent with losing access to medical homes. However, uninsured hospitalizations increased for both avoidable and unavoidable conditions at the same rate, which does not suggest a lack of preventive care. Although there may be limited symmetry in response to Medicaid expansion and contraction, these findings are also consistent with the substantial decrease in uncompensated care costs in the states that have thus far expanded Medicaid under the ACA. These results also help shed light on the mechanisms by which Medicaid might affect mortality for non-elderly adults.
    JEL: I13
    Date: 2015–09
  27. By: Xesfingi, Sofia; Karamanis, Dimitrios
    Abstract: Aim: The purpose of this research is to investigate in- and out-patients' satisfaction as revealed by their intention to recommend the Konstantopouleio General Hospital of Athens to friends and family. Material/Methodology/Approach: The final sample of the study consisted of 745 inpatients and 420 outpatients from a survey performed from June 2011 till October 2012. An ordered logit approach was used allowing the analysis of the satisfaction's response categories. Results: Findings demonstrate that the attention provided by medical and nursery stuff along with the hospital environment, are positively correlated with patients’ satisfaction for both groups of in- and out-patients. Among the demographic factors, the positive age effect is present in both groups, while the perceived health status plays a positive and significant role in shaping in-patient satisfaction, and education and insurance associate with out-patient satisfaction. Conclusions: Our study confirms the important role of all measures with respect to hospital performance. In general, hospitals and healthcare systems that invest in citizens’ evaluation evolvement programmes, will acquire valuable information to perform important transformational changes in healthcare services.
    Keywords: healthcare, health system performance, in- and out-patient satisfaction, Greece, ordered logit.
    JEL: I10 I18 I19 I38
    Date: 2015–09–16
  28. By: Ghosh, Dona
    Abstract: Quality of Life (QoL) is a complex, scattered and multidimensional approach that depends on an extensive set of biological to psychological indicators passing through various socio-economic interactions. It induces enormous heteroscedasticity among individuals in the way of ageing and spurs difference in each elderly from the other. Most of the researchers attempted either to identify indicators or develop indexes to channelize the multidimensionality towards measuring subjective appraisal of QoL but in depth analysis especially, regarding perception of female elderly is missing, even in the era of feminization of ageing i.e. increasing number of female elderly to old age, particularly in mostly and second mostly populated countries like China and India. This study mainly focuses on the gender dimension along with various socio-economic and health constructs in China and India. There are two objectives. Firstly, to analyze the difference across gender with respect to self-perceived Quality of Life (QoL) in different socio-economic and health related contexts. Secondly, to find out the determinants of QoL and try to find out whether sex is an important factor in this regard. The first section of the study consists of the descriptive statistics across gender in both the countries according to their subjective QoL, which is measured on a five point likert scale and further reduced in a trichotomous scale: Good, Moderate and Poor. In the second section Ordered Logit Regression Model has been adopted. Moreover, in determining the control variables three indexes (co-morbidity index, active daily work index and mood index) have been formulated. In both the countries females have a higher percentage to report about moderate, poor or very poor QoL, while men mostly reported very good or good QoL. The results show that age, active of daily work index, mood index and co-morbidity index have significant impact on QoL. Moreover, for females, the odds of poor QoL versus the combined moderate and good are 0.07597 times lower than for males, given the other variables are held constant.
    Keywords: Quality of Life; Gender; Active Daily Work Index; Co-morbidity Index; Mood Index
    JEL: I14
    Date: 2015–08–24
  29. By: Mulatu F. Zerihun (Tshwane University of Technology, Pretoria, South Africa); Juncal Cunado (University of Navarra, Pamplona, Spain); Rangan Gupta (Department of Economics, University of Pretoria)
    Abstract: This paper examines the asymmetric behaviour of health care expenditure and disposable income in the 50 US states over the period 1966-2009 using nonparametric Triples test techniques. The results suggest that for 23 US states, real per capita health expenditures are characterized by asymmetric behaviour, while real per capita personal disposable income series exhibit asymmetric behaviour in 7 US states. Therefore, the main findings question the adequacy of linear models when modelling the behaviour of these two series.
    Keywords: Asymmetric behaviour, Triples test, Per capita real healthcare expenditure, Per capita real personal disposable income, US states
    JEL: C22 C32 H51 I18
    Date: 2015–09
  30. By: Asifa Batool (University of agriculture faisalabad)
    Abstract: Poverty increased in Pakistan since the 1990s, after decline within the previous two decades. However, Pakistan is bearing an alarmingly high burden of communicable diseases which are mostly related to poverty. These diseases are mostly exacerbated by malnutrition and maternal risks. The present study attemps to find out the impact and effect of poverty on the health of women. Present study was conducted in the District Khewra. Three localities (low, medium and high social class) were selected for data collection. A multi-stage sampling techniques were be applied for data collection. At the first stage three localities low, medium and high social class i.e. Dandot, PMDC and ICI Colony were selected randomly from the selected Khewra city, at the second stage six Mohalas (two from each locality) were selected randomly and the third stage 120 respondents (20 from each mohala) were selected randomly. A well-designed schedule interviews to collect information and data collection was developed for the purpose. Collected information were analyzed by using descriptive and inferential statistics. It was found the health facilities were available in Khewra city. Majority of the respondents i.e. 62.5 percent were unexpectedly satisfied to some degree with facilities related to health, while 47.5 percent of the women faced problems related to health. The first child was delivered at home by 58.3% of the respondents. Only 15.8 percent of the respondents used contraceptive methods. A major number i.e. 70.0 percent of the respondents had the opinion that they did not face any miscarriage in their life. It was found that there is a positive and significant relation among education level & income of the respondents with their health status. It is recommended that education level should be increase among women, because educated women have more awareness about their health and protective measures and more economic opportunities should be arrange for women
    Keywords: EducationIncomeHealth status
    JEL: A14

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