nep-hea New Economics Papers
on Health Economics
Issue of 2015‒10‒17
33 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Another perspective on the high uninsured-rate in the USA: Crowding out of long term health insurance by the institutional setting of the U.S. health insurance system By Ines Läufer; ; ;
  2. Arsenic Contamination of Drinking Water and Mental Health By Chowdhury, Shyamal; Krause, Annabelle; Zimmermann, Klaus F.
  3. Behavioural, Financial, and Health & Medical Economics: A Connection By Chang, C-L.; McAleer, M.J.; Wong, W-K.
  4. Child Malnutrition in Indonesia: Can Education, Sanitation and Healthcare Augment the Role of Income? By Sumarto, Sudarno; de Silva, Indunil
  5. Complexity and doctor choices when discussing contraceptives By Fiebig, D.G.;; Viney, R.;; Haas, M.;; Knox, S.;; Street, D.;; Weisberg, E.;; Bateson, D.;
  6. Correcting for Self-Reporting Bias in BMI: A Multiple Imputation Approach By Donal O'Neill;
  7. Determinants of Life Expectancy and its Prospects under the Role of Economic Misery: A Case of Pakistan By Shahbaz, Muhammad; Loganathan, Nanthakumar; Mujahid, Nooreen; Ali, Amjad; Nawaz, Ahmed
  8. Does health insurance encourage the rise in medical prices? By Dormont, B.;; Péron, M.;
  9. Effects of Forced Displacement on Health By Ivan Zilic
  10. Efficiency of health investment: education or intelligence? By Bijwaard, G.;; van Kippersluis, H.;
  11. Estimating the Relationship between Health and Employment of Russian People in Pensionable Age By Ekaterina A. Klepikova
  12. Evaluating the Impact of Social Security Benefits on Health Outcomes Among the Elderly By Padmaja Ayyagari
  13. Free primary care in Zambia: an impact evaluation using a pooled synthetic control method By Lépine, A.;; Lagarde, M.;; Le Nestour, A.;
  14. Health status over the life cycle By van Ooijen, R.;; Alessi, R.;; Knoef, M.;
  15. HIV and Rational risky behaviors: a systematic review of published empirical literature (1990-2013) By Marlène Guillon; Josselin Thuilliez
  16. How does fiscal decentralization affect within-regional disparities in well-being? Evidence from health inequalities in Italy By Di Novi, C.;; Piacenza, M.;; Robone, S.;; Turati, G.;
  17. Impact of Rainfall Shocks on Child Health: Evidence from India By Vibhuti Mendiratta
  18. Improving the AHRQ Quality Indicators: Summary of Findings and Recommendations for Improving the Methodological Approach By David Jones; Eric Schone; Frank Yoon; Alex Bohl; Sheng Wang; Mariel Finucane
  19. Large-scale health interventions and education: Evidence from Roll Back Malaria in Africa By Maria Kuecken; Josselin Thuilliez; Marie-Anne Valfort
  20. Late-Stage Pharmaceutical R & D and Pricing Policies under Two-Stage Regulation By Sebastian Jobjornsson; Martin Forster; Paolo Pertile; Carl-Fredrik Burman
  21. Learning to trust flu shots: quasi-experimental evidence on the role of learning in influenza vaccination decisions from the 2009 influenza A/H1N1 (swine flu) pandemic By Maurer, J.;; Harris, K.M.;
  22. Persistence, Mean-Reversion and Non-Linearities in Infant Mortality Rates By Luis A. Gil-Alana; Juncal Cunado; Rangan Gupta
  23. Physical Activity, Present Bias, and Habit Formation: Theory and Evidence From Longitudinal Data By Brad R. Humphreys; Jane E. Ruseski; Li Zhou
  24. Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic By Clay, Karen; Lewis, Joshua; Severnini, Edson R.
  25. Public Expenditure Projections for Health and Long-Term Care for China Until 2030 By Luca Lorenzoni; David Morgan; Yuki Murakami; Chris James
  26. Risk selection under public health insurance with opt-out By Panthöfer, S.;
  27. Smoking Bans, Cigarette Prices and Life Satisfaction By Reto Odermatt; Alois Stutzer
  28. Social interactions in inappropriate behavior for childbirth services: theory and evidence from the Italian hospital sector By Guccio, C.;; Lisi, D.;
  29. The adverse effects of incentives regulation in health care: a comparative analysis with the U.S. and Japanese hospital data By Galina Besstremyannaya
  30. The Income-Health Relationship “Beyond the Meanâ€: New Evidence from Biomarkers By Carrieri, V.;; Jones, A.M.;
  31. The Politics of Priority Setting in Health: A Political Economy Perspective - Working Paper 414 By Katharina Hauck, Peter C. Smith
  32. Trading between perceived risks and benefits related to biosimilar biological treatment in Crohn’s disease; discrete choice experiment among gastroenterologists By Baji, Petra; Gulácsi, László; Lovász, Barbara D.; Golovics, Petra A.; Brodszky, Valentin; Péntek, Márta; Rencz, Fanni; Lakatos, Péter L.
  33. What Drives Public Health Care Expenditure Growth? Evidence from Swiss Cantons, 1970-2012 By Thomas Braendle; Carsten Colombier

  1. By: Ines Läufer; ; ;
    Date: 2014–02
  2. By: Chowdhury, Shyamal (University of Sydney); Krause, Annabelle (IZA); Zimmermann, Klaus F. (IZA and University of Bonn)
    Abstract: This paper investigates the effect of drinking arsenic contaminated water on mental health. Drinking water with an unsafe arsenic level for a prolonged period can lead to arsenicosis, which includes symptoms such as black spots on the skin and subsequent illnesses such as various cancers. We collected household survey data from Bangladesh, a country with wide arsenic contamination of groundwater to construct several measures for arsenic contamination that include the actual arsenic level in the respondent's tubewell (TW) and past institutional arsenic test results, as well as collected household members' arsenicosis symptoms and their physical and mental health. We find that suffering from an arsenicosis symptom is strongly negatively related to mental health, even more so than from other illnesses. Furthermore, individuals drinking from an untested TW have lower mental health and having to walk a longer distance to a TW also decreases mental health. Calculations of the costs of arsenic contamination reveal that the average individual would need to be compensated for suffering from an arsenicosis symptom by an amount as high as the average annual household income.
    Keywords: arsenic, water pollution, mental health, subjective well-being, environment, Bangladesh
    JEL: Q53 I10 I31
    Date: 2015–10
  3. By: Chang, C-L.; McAleer, M.J.; Wong, W-K.
    Abstract: This Opinion article briefly reviews some of the literature in behavioural and financial economics that are related to health & medical economics. We then discuss some of the research on behavioural and financial economics that could be extended to health & medical economics beyond the existing areas in theory, statistics and econometrics.
    Keywords: Behavioural economics, Financial economics, Health & medical economics, Theory, Statistics, Econometrics
    JEL: G0 I11 O16 P34
    Date: 2015–09–01
  4. By: Sumarto, Sudarno; de Silva, Indunil
    Abstract: In spite of sustained economic growth and progress in poverty reduction, the status of child nutrition in Indonesia is abysmal, with chronic malnutrition rates continuing to remain at very high levels. In this backdrop, this study attempts to shed light on the channels through which various socioeconomic risk factors affect children’s nutritional status in Indonesia. We investigated the impact of child, parental, household characteristics, access and utilization of healthcare, and income effects on children’s height-for-age and on the probability of early childhood stunting. Using recent data from IFLS surveys and Indonesia’s National Health Survey, and controlling for an exhaustive set of socioeconomic factors, the study revealed that maternal education, water and sanitation conditions, household poverty and access to healthcare strongly influence chronic malnutrition in Indonesian children. Child stunting rates were surprisingly high even in the wealthiest quintile of households, implying that income growth will not automatically solve the nutritional problem. Our findings bear important policy implications and represent a further step towards an improved understanding of the complex determinants of child malnutrition. As a policy recommendation, we suggest the implementation of direct supply-side policies aimed at child malnutrition. In particular, two kinds of strategies are noteworthy. First to maximize impact, nutrition-specific interventions targeting the poorest and high burden regions in Indonesia may include, for example, breastfeeding promotion, vitamin and mineral supplements, improved sanitation facilities, public healthcare services and insurance coverage. Second, adopting nutrition-sensitive development planning across all sectors in the country will help ensure that development agendas fully utilize their potential to contribute to reductions in child malnutrition in Indonesia .
    Keywords: Child nutrition, Malnutrition, Stunting, Quantile regression, Indonesia.
    JEL: D01 D1 I1 I12
    Date: 2015–05–05
  5. By: Fiebig, D.G.;; Viney, R.;; Haas, M.;; Knox, S.;; Street, D.;; Weisberg, E.;; Bateson, D.;
    Abstract: In order to better understand choice behaviour, econometric models need to be able to reflect the complexity of decisions that individuals routinely face. We investigate the role of choice complexity in modelling medical decision-making in the case of a doctor choosing which specific contraceptive products to discuss with their patient before ultimately making a recommendation. Clinical vignettes describing patients, developed using stated preference methods, are presented to a sample of Australian general practitioners. An econometric model is developed that captures two salient sources of complexity. The first is associated with patients with particularcombinations of clinical and demographic attributes that induce uncertainty around what product to recommend while the second captures variation in the ability of doctors to find appropriate patient-product matches. We are especially interested in the tendencies of doctors to discuss long-acting reversible contraception (LARC) in order to determine whether part of the explanation for the relatively low uptake of LARC in Australia is reluctance on the part of some doctors to even discuss these products.
    Keywords: choice models; complex decisions; medical decision making; long-acting reversible contraception; clinical vignettes;
    JEL: I10 J13 C25 C81
    Date: 2015–09
  6. By: Donal O'Neill (Department of Economics, Finance and Accounting, Maynooth University.);
    Abstract: Measurement error in BMI is known to be a complex process has serious consequences for traditional estimators. In this paper I examine the extent to which Stochastic Multiple Imputation approaches can successfully addressing this problem. Using both Monte Carlo simulations and real world data I show how the MI approach can provide an effective solution to measurement error in BMI in appropriate circumstances. The MI approach yields consistent estimates that efficiently use all the available data.
    Date: 2015
  7. By: Shahbaz, Muhammad; Loganathan, Nanthakumar; Mujahid, Nooreen; Ali, Amjad; Nawaz, Ahmed
    Abstract: The present study investigates the determinants of life expectancy in the presence of economic misery using Pakistan’s time series data over the period of 1972-2012. The stationary properties of the variables are examined by applying unit root test accommodating structural breaks. The ARDL bounds testing approach to cointegration is applied to examine the long run relationship between the variables. Our findings show that cointegration between the variables is confirmed. Moreover, health spending improves life expectancy. Food supply contributes to life expectancy. A rise in economic misery deteriorates life expectancy. Urbanization enhances life expectancy while illiteracy declines it. The causality analysis reveals that life expectancy is Granger cause of health spending, food supply, economic misery, urbanization and illiteracy. This paper opens up new insights for policy making authorities to consider the role of economic misery while formulating comprehensive economic policy to improve life expectancy in Pakistan.
    Keywords: Life expectancy, Economic misery, Pakistan
    JEL: C5
    Date: 2015–10–06
  8. By: Dormont, B.;; Péron, M.;
    Abstract: Our purpose is to evaluate the influence of health insurance coverage on the use of specialists who balance bill. We estimate the impact on patients' behavior of a shock consisting of better coverage of balance billing, while controlling for supply side drivers. We use a panel data set of 43,111 French individuals observed between January 2010 and December 2012. Individuals are observed when they are all covered by the same supplementary insurer, with no coverage for balance billing, and after 3,819 of them switched to other supplementary insurers which offer better coverage. Our estimations show that better coverage contributes to a rise in medical prices by increasing the demand for specialists who balance bill: for individuals who enjoy better coverage the proportion of consultations of specialists who balance bill is increased by 9%, and balance billing charged per consultation by 32%. However, the impact of the coverage shock depends on local supply side organization. When the proportion of specialists who do not balance bill their patients is high enough, patients have a real choice between specialist type: there is neither evidence of an inflationary effect of supplementary coverage, nor of limits in access to care due to balance billing.
    Keywords: health insurance; balance billing; health care access;
    JEL: I13 I18 C23
    Date: 2015–09
  9. By: Ivan Zilic
    Abstract: This paper analyzes health consequences of forced civilian displacement that occurred during the war in Croatia 1991-1995 which accompanied the demise of Yugoslavia. Using the Croatian Adult Health Survey 2003 we test whether displacement is relevant in explaining various dimensions of measured and self-assessed health. We adopt an instrumental variable approach where civilian casualties per county are used as an instrument for displacement. We find robust significant adverse effects on self-assessed health, on probability of suffering from systolic and diastolic hypertension, and on mental health and role emotional SF-36 dimensions. We also address possible channels of adverse effect, and find that displacement did not induce a change in healthy behaviors, and that the negative effect of displacement is channeled through adverse economic conditions that the displaced individuals face.
    Keywords: conflict, migration, health.
    JEL: I10 O12 O15
    Date: 2015–09
  10. By: Bijwaard, G.;; van Kippersluis, H.;
    Abstract: In this paper we hypothesize that education is associated with a higher efficiency of health investment, yet that this efficiency advantage is solely driven by intelligence. We operationalize efficiency of health investment as the probability of dying conditional on a certain hospital diagnosis, and estimate a multistate structural equation model with three states: (i) healthy, (ii) hospitalized, and (iii) death. We use data from a Dutch cohort born around 1940 that links intelligence tests at age 12 to later-life hospitalization and mortality records. The results suggest that higher intelligence induces the higher educated to be more efficient users of health investment - intelligent individuals have a clear survival advantage for most hospital diagnoses - yet for unanticipated health shocks and diseases that require complex treatments such as COPD, education still plays a role.
    Keywords: education; intelligence; health; multistate duration model;
    JEL: C41 I14 I24
    Date: 2015–09
  11. By: Ekaterina A. Klepikova (National Research University Higher School of Economics)
    Abstract: This paper provides an analysis of the labor supply of Russian people in pensionable age. It aims to answer two questions: (1) whether bad health is an important limitation for labor activity and (2) whether a greater pension benefit could be a stimulus for delayed retirement. This is an empirical work based on data of the Russia Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE) from 2000-2010. Findings suggest that the most important factor of labor supply is income, and it is more significant for people with higher education. Bad health contributes to leaving the labor force, but the effect is smaller than income’. Some policy implications are also suggested based on the empirical results of the study
    Keywords: labor supply, health, pensionable age, postponement of retirement, Russia, RLMS-HSE.
    JEL: C2 J1 J2
    Date: 2015
  12. By: Padmaja Ayyagari
    Abstract: Given concerns about the depletion of the Social Security Trust Fund, policymakers are considering several proposals to improve the financial sustainability of the program, including some that would lower benefits over time. The extent to which reductions in Social Security benefits impact individual health and well-being is not well understood. Using data from a nationally representative survey of older adults, we examine the impact of changes in Social Security income on a broad range of elderly health outcomes, including cognitive function, depression, disability and self-rated health. Prior literature has documented a positive association between income and health. However, this association may reflect unmeasured confounders that are correlated with both income and health (e.g. childhood environment) or may reflect the impact of health on income. To address these concerns and to identify the causal impact of income on health, we employ an instrumental variables strategy based on changes in Social Security income due to amendments to the Social Security Act in the 1970s. We discuss the implications of our findings for aging populations and for public policy.
    Date: 2015–09
  13. By: Lépine, A.;; Lagarde, M.;; Le Nestour, A.;
    Abstract: We estimate the impacts of user fee removal in Zambia using a pooled synthetic control method. We find no evidence that user fee removal changed health seeking behaviours, even among the poorest. We show that these results are not attributable to the imperfect implementation of the policy. Nonetheless, our results confirm that the policy virtually eliminated medical expenditures, thereby providing financial protection to health services users. Since the poorest individuals were found to be less likely to use care and had lower expenses, ceteris paribus, the policy effect was similar to a transfer of US$2.22 per medical visit for the total sample but of only US$0.65 for the poorest people.
    Keywords: user fees; health care use; health expenditure; provider choice; synthetic control; propensity score matching; difference-in-differences; Zambia;
    JEL: C01 C20 I18
    Date: 2015–09
  14. By: van Ooijen, R.;; Alessi, R.;; Knoef, M.;
    Abstract: We construct a health measurement model which combines panel data on self-reported health with a rich set of health measures from administrative medical records. Our estimated health model allows us to predict healthstatus for the population at large. We account both for unobserved heterogeneity and for the persistence in unobserved health shocks. To account for inconsistent reporting in self-reported health we propose a `corrected' health measure. We show that this `corrected' measure substantially increases the estimated persistence in health status. We use predicted health status to study the evolution of health as individuals age. Moreover, we analyzehow health interacts with economic variables and education. We find a strong gradient in education; the age at which health starts to decline at a greater rate differs by education and gender.
    Keywords: self-reported health; administrative data; health dynamics; health index; socio-economic status;
    JEL: C42 I12
    Date: 2015–09
  15. By: Marlène Guillon (Paris School of Economics); Josselin Thuilliez (Centre d'Economie de la Sorbonne - Paris School of Economics)
    Abstract: Risky health behaviors have the negative effect – negative externality – of the individual being able to spread the disease to others. They thus represent a threat for the society and a tragedy for public health. The objective of this study is to inquire into the nature, extent and strength of the evidence for such risky behaviors for HIV/AIDS from an economic perspective. We aim at investigating the concept of risk or prevalence-elasticity of health behaviors in the case of HIV. We did an exhaustive review of published articles in French and English indexed in the databases PubMed, ScienceDirect and Jstor between 1 January 1990 to 31 December 2013. We searched for publications empirically investigating the risk or prevalence-elasticity of behaviors in the case of HIV/AIDS and performed a bibliometric and descriptive analysis of the dataset. Of the 12,545 articles that were screened, 189 (1.5%) full-text publications studied the risk-elasticity of health behaviors that are related to HIV/AIDS. Of these 189 articles, 167 (88.4%) were quantitative studies that empirically estimated the risk-elasticity, and 22 (11.6%) were qualitative studies. We found that 55.7% of the quantitative studies included at least a correlation between HIV risk and health behaviors that supports the concept of risk or prevalence-elasticity. Moreover, we identified articles that address the reverse causality problem between HIV risk and health behaviors, by using indirect HIV risk measures, to demonstrate the existence of a responsiveness of risk/preventive behaviors to HIV risk. Finally, an in-depth analysis showed seven out of ten articles using an objective measure of risk for HIV/AIDS gave strong support to prevalence-elasticity. However, only one of the ten articles established a direct measure of prevalence-elasticity while appropriately dealing with the reverse causation problem between objective HIV risk and preventive/risk behaviors. These results stress out the need to carefully monitor programs of risk behaviors' surveillance in the context of HIV becoming chronic, especially in sub-Saharan Africa where large scale HIV treatment policies are being implemented. More evidence is needed on the strength of rational risky behaviors to maximize the public health and economic impact of large scale HIV treatment or preventive policies. With this purpose, epidemiological surveillance programs could be paired with specific behavioral surveillance programs to better inform policy makers
    Keywords: HIV; Economic epidemiology; Prevalence-elasticity
    JEL: I10 I11
    Date: 2015–08
  16. By: Di Novi, C.;; Piacenza, M.;; Robone, S.;; Turati, G.;
    Abstract: This paper aims at investigating empirically the impact of fiscal decentralization reforms on inequality in well-being. In particular, we look at the effects on health inequalities following the assignment of larger tax power to the Italian Regions for financing their health expenditure, starting from the end of the Nineties. Exploiting large differences in the size of the tax base across Regions, we find that fiscal decentralization processes that attribute a greater tax power to lower government tiers, besides reducing inefficiencies of healthcare policies, seem to be effective in reducing also within-regional disparities in health outcomes. However, thedegree of economic development – on which depends the actual fiscal autonomy from Central government – significantly affects the effectiveness of these reforms and highlights the importance to take properly into account the specific features of the context where the decentralization of power is implemented.
    Keywords: fiscal decentralization; regional governments; healthcare policy; health inequalities;
    JEL: H75 I14 I1 R50
    Date: 2015–09
  17. By: Vibhuti Mendiratta (PSE - Paris-Jourdan Sciences Economiques - CNRS - Institut national de la recherche agronomique (INRA) - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics)
    Abstract: While there is evidence of discrimination against girls in the allocation of resources within a household under normal circumstances, it would be worthwhile to explore the effect of extreme conditions such as rainfall shocks on the outcomes of surviving girls and boys. In this paper, I estimate the impact of rainfall shocks in early childhood on the anthropometric outcomes of girls and boys aged 13-36 months in rural India. I find that adverse negative rainfall shocks (in utero and first year after birth) negatively impact height for age and weight for age for both girls and boys. Further, I explore two channels through which rainfall affects child health: by affecting the relative price of parent's time in childcare and through income (as rainfall generates variation in income through its effect on agricultural output). I find that positive rainfall has a positive effect on agricultural yield and arguably income in India. This is further supported by the finding that negative shocks are harder to insure in poorer states and poorer households as reflected by the poor anthropometric outcomes of children.
    Keywords: Anthropometric outcomes,Rainfall,India
    Date: 2015–10
  18. By: David Jones; Eric Schone; Frank Yoon; Alex Bohl; Sheng Wang; Mariel Finucane
    Keywords: quality measurement, patient safety, mortality, AHRQ, risk adjustment, reliability adjustment, shrinkage, smoothing, empirical Bayes, hospital characteristics
    JEL: I
    Date: 2014–12–22
  19. By: Maria Kuecken (Centre d'Economie de la Sorbonne - Paris School of Economics); Josselin Thuilliez (Centre d'Economie de la Sorbonne - Paris School of Economics); Marie-Anne Valfort (Centre d'Economie de la Sorbonne - Paris School of Economics)
    Abstract: Replying on microeconomic data, we examine the impact of the Roll Back Malaria (RBM) campaigns on the educational attainment of primary schoolchildren across 14 countries in Sub-Saharan Africa. Combining a difference-in-differences approach with an instrumental variables analysis, we exploit exogenous variation in pre-campaign malaria risk and exogenous variation in exposure to the timing and disbursements of the RBM campaign. In 13 of 14 countries, the RBM campaign substantially improved schooling attainment at an average cost of $ 13.19 per additional year, which is highly cost-effective as compared to standard educational interventions
    Keywords: Health; education; Africa; spillovers; quasi-experiment; Roll Back Malaria
    JEL: I15 I21 O15
    Date: 2013–10
  20. By: Sebastian Jobjornsson; Martin Forster; Paolo Pertile; Carl-Fredrik Burman
    Abstract: We present a model combining the two regulatory stages relevant to the approval of a new health technology: the authorisation of its commercialisation and the insurer’s decision about whether to reimburse its cost. We show that the degree of uncertainty around the true value of the insurer’s maximum willingness to pay for a unit increase in effectiveness has a non-monotonic impact on the price of the innovation, the firm’s expected profit and the optimal sample size chosen for the clinical trial. A key result is that there exists a range of values of the uncertainty parameter over which a reduction in uncertainty benefits the firm, the insurer and patients. We consider how different policy parameters may be used as incentive mechanisms, and the incentives to invest in R&D for marginal projects such as those targeting rare diseases. The model is calibrated using data on a new treatment for cystic fibrosis.
    Keywords: Rare Diseases; Pharmaceutical Pricing and Reimbursement; Optimal Sample Size
    JEL: L5 H51 I11 I18
    Date: 2015–10
  21. By: Maurer, J.;; Harris, K.M.;
    Abstract: This paper studies consumer learning in influenza vaccination decisions, i.e., potential causal effects of past experiences of being vaccinated on current use of influenza vaccine. Existing structural models of demand usually identify consumer learning parametrically based on functional form assumptions within dynamic forward-looking Bayesian demand models. To the best of our knowledge, we are the first to explore the potential role of consumer learning in pharmaceutical demand within a reduced form instrumental variable framework. The emergence of a new virus strain (influenza A H1N1/09) during the 2009 influenza pandemic resulted in the use of two different influenza vaccines each recommended for distinct population subgroups. We used these exogenous inputs to vaccination decisions to construct instrumental variables for the effect of past influenza vaccination experiences on the demand model for pandemic vaccine. We find large causal effects of seasonal vaccination on pandemic vaccination with changes in perceived vaccination safety being an important pathway. Our results suggest aimportant role of learning in vaccination decisions. Our findings further highlight that expanding uptake of seasonal vaccination is an important component of pandemic preparedness.
    Keywords: pharmaceutical demand; influenza vaccination; consumer learning; preventive care use; pandemic preparedness; instrumental variable estimation;
    JEL: I10 I11 I18
    Date: 2015–09
  22. By: Luis A. Gil-Alana (University of Navarra, Pamplona, Spain); Juncal Cunado (University of Navarra, Pamplona, Spain); Rangan Gupta (Department of Economics, University of Pretoria)
    Abstract: This study examines the time series behavior of infant mortality rates within a long memory approach with non-linear trends using data for 37 countries. The main results show significant differences both in the degree of integration and non-linearities among the analyzed series. Furthermore, non-linearities in the time trends are found in most of cases, in contrast with the main assumption of linearity used in the literature. Finally, the results on the integration order of the series have important policy implications in many areas, such as on international convergence in mortality rates, on the income and infant mortality relationship, and, on whether health policy interventions will have transitory or permanent effects on infant mortality rates.
    Keywords: Infant mortality rates, fractional integration, non-linearities
    JEL: C22 C32 H51 I18
    Date: 2015–10
  23. By: Brad R. Humphreys (West Virginia University, Department of Economics); Jane E. Ruseski (West Virginia University, Department of Economics); Li Zhou (University of Alberta, Department of Economics)
    Abstract: We investigate temporal decisions to participate in exercise in a dynamic model featuring present bias and habit formation. The model highlights naivete about present bias and projection bias about habit formation/decay and implies that promoting participation in physical activity must both encourage the inactive to start and discourage the active from quitting as behavioral biases apply to both. Our empirical analysis using data from the British Household Panel Survey (BHPS) develops evidence consistent with predictions about present bias and habit formation/decay and an interesting asymmetry between starting and quitting that furthers understanding of existing empirical evidence.
    Keywords: present-bias, physical activity, habit formation, habit decay, projection bias
    JEL: D1 I12 L83
    Date: 2015–08
  24. By: Clay, Karen (Carnegie Mellon University); Lewis, Joshua (University of Montreal); Severnini, Edson R. (Carnegie Mellon University)
    Abstract: This paper uses the 1918 influenza pandemic as a natural experiment to examine whether air pollution affects susceptibility to infectious disease. The empirical analysis combines the sharp timing of the pandemic with large cross-city differences in baseline pollution measures based on coal-fired electricity generating capacity for a sample 183 American cities. The findings suggest that air pollution exacerbated the impact of the pandemic. Proximity to World War I military bases and baseline city health conditions also contributed to pandemic severity. The effects of air pollution are quantitatively important. Had coal-fired capacity in above-median cities been reduced to the median level, 3,400-5,860 pandemic-related infant deaths and 15,575-23,686 pandemic-related all-age deaths would have been averted. These results highlight the complementarity between air pollution and infectious disease on health, and suggest that there may be large co-benefits associated with pollution abatement policies.
    Keywords: pollution, infectious disease, mortality, 1918 influenza pandemic
    JEL: N32 N52 I15 I18 Q53 Q56 Q58
    Date: 2015–10
  25. By: Luca Lorenzoni; David Morgan; Yuki Murakami; Chris James
    Abstract: In recent years, China has seen an unprecedented expansion of health insurance for its population in its quest to achieve universal health coverage. By 2011, 95% of the Chinese population was insured up from less than 50% in 2005 through public or employer-based insurance schemes. As part of this move, the structure of health care financing has shifted significantly, such that public sources in 2013 funded well over half of all health spending, compared with just over a third in the early 2000s. In that context, it is important to determine the main drivers of future growth in health spending in the medium term, to assess the possible impact on public budgets. Using a component-based health expenditure model developed at the OECD, future projections of public spending on health care and long-term care are made for OECD and key emerging economies, including China. The uniform cross-country framework allows for consistent international comparisons under different cost-pressure and cost-containment scenarios.<BR>Ces dernières années, la Chine a connu une expansion sans précédent de la population couverte par l’assurance maladie dans sa quête pour une assurance maladie universelle. Dès 2011, 95% de la population chinoise était assurée contre moins de 50 % en 2005 par le biais de l’assurance maladie publique. Dans cette même mouvance, la structure du financement des soins de santé s'est déplacée de manière significative, au point que plus de la moitié des dépenses de santé est financée publiquement en 2013, contre un peu plus d'un tiers au début des années 2000. Dans ce contexte, il est important de déterminer les principaux moteurs de la croissance future des dépenses de santé à moyen terme, afin d'évaluer l'impact possible sur les budgets publics. En utilisant un modèle component-based des dépenses de santé développé à l'OCDE, des projections de la dépense publique en soins de santé et de longue durée, ont été réalisées pour les pays de l’OCDE et quelques pays émergents, incluant la Chine. L’utilisation d’une méthodologie unique pour l’ensemble des pays permet des comparaisons internationales cohérentes, avec différents scénarios de tension sur les coûts et de maitrise des coûts.
    JEL: H51 I12 J11
    Date: 2015–10–12
  26. By: Panthöfer, S.;
    Abstract: This paper examines risk selection in a parallel public and private health insurance system in which some, but not all, individuals can purchase substitutive private insurance by opting out of otherwise mandatory public insurance. Using a theoretical model, I show that public insurance is adversely selected when insurers and insureds are symmetrically informed about health-related risks, and that there can be any type of selection (advantageous or adverse) when insureds are privately informed. Using the German Socio-Economic Panel, I present evidence on the selection between public and private health insurance in Germany, which is one of the countries with such a health insurance system. I find that: (1) public insurance is adversely selected, (2) individuals adversely select public insurance based on self-assessed health and advantageously select public insurance based on risk aversion, and (3) there is evidence suggesting the presence of asymmetric information between private insurers and their clients.
    Keywords: public and private health insurance; risk selection; asymmetric information;
    JEL: D82 H51 I13
    Date: 2015–09
  27. By: Reto Odermatt; Alois Stutzer
    Abstract: The consequences of tobacco control policies for individual welfare are difficult to assess, even more so when related consumption choices challenge people's willpower. We therefore evaluate the impact of smoking bans and cigarette prices on subjective well-being by analyzing data for 40 European countries and regions between 1990 and 2011. We exploit the staggered introduction of bans and apply an imputation strategy to study the effect of anti-smoking policies on people with different propensities to smoke. We find that higher cigarette prices reduce the life satisfaction of likely smokers. Overall, smoking bans are barely related to subjective well-being, but increase the life satisfaction of smokers who would like to quit smoking. The latter finding is consistent with cue-triggered models of addiction and the idea of bans as self-control devices.
    Keywords: Smoking bans; cigarette prices; life satisfaction; addiction; self-control
    JEL: D03 D62 H25 H30 I18
    Date: 2015–10
  28. By: Guccio, C.;; Lisi, D.;
    Abstract: Empirical evidence supports the conjecture that social interactions among agents can produce both positive and negative effects. We build on this literature by exploring the role of social interactions in the hospital sector using the large incidence of cesarean sections, usually considered an inappropriate outcome in the childbirth service. In doing so, we lay out a simple model of hospitals’ behavior where the effect of peers’ behavior emerges simply by sharing the same institutional authority responsible for auditing inappropriate behavior. In this setting, enforcement congestion induces a peer effect among hospitals that could make inappropriate behaviors more likely. Then, using the risk-adjusted cesarean section rate of a large panel of Italian hospitals, we empirically investigate whether the behavior of each hospital is affected by the behavior of hospitals withinthe same region, after controlling for demand, supply, and financial factors. In particular, our empirical test employs both peer effects estimate and the spatial econometric approach, exploiting the panel dimension of our data. Both estimates show a significant and strong presence of peer effects among hospitals. We interpret this evidence as a presence of constraint interactions within the hospital sector, which has important implications for healthcare policies against inappropriateness.
    Keywords: social interactions; peer effects; cesarean section; spatial econometrics;
    JEL: I11 C31
    Date: 2015–09
  29. By: Galina Besstremyannaya (CEFIR at New Economic School)
    Abstract: The paper analyzes the effect of incentives regulation, when the yardstick competition approach is supplemented with a performance tax on providers. In an application to prospective payments in health care in the U.S. and Japan, we show differential effects of value-based purchasing, when price-setting is related to benchmark values of quality measures or length-of-stay. The predictions of our theoretical model, as well as empirical results offer persuasive evidence that unintended effects appear for best-performing hospitals. Patient experience/clinical-process-of-care measures significantly decrease in the top percentiles of the U.S. hospitals owing to the reform. Similarly, length of stay significantly increases for most diagnosis-related groups at Japanese hospitals in percentiles with the lowest length of stay. A natural experiment aimed at best-practice rate-setting diminishes the undesired effects of the reform.
    Keywords: quantile regressions, prospective payment, hospital financing
    JEL: C22 C23 D21 D22 I18
    Date: 2015–10
  30. By: Carrieri, V.;; Jones, A.M.;
    Abstract: This paper offers new evidence on the income-health relationship by analyzing the income gradient across the full distribution of four blood-based biomarkers: cholesterol, fibrinogen, glycated haemoglobin and ferritin. We use an unconditional quantile approach based on recentered influence function (RIF) regressions and apply an Oaxaca-Blinder decomposition at various quantiles of biomarker distributions to explain gender differentials in biomarkers. Using ten waves of the Health Survey for England (from 2003 to 2012) we find a non-linear relationship between income and biomarkers and a higher income gradient at the highest quantiles of the biomarker distributions. Moreover, we find that there is an important heterogeneity in the association of health to income across genders which varies significantly along the biomarker distribution and accounts for a substantial percentage of the gender differentials in observed health.
    Keywords: biomarkers; unconditional quantile regression; decomposition analysis; health inequalities;
    JEL: C1 C5 I14
    Date: 2015–09
  31. By: Katharina Hauck, Peter C. Smith
    Abstract: Many health improving interventions in low-income countries are extremely good value for money. So why has it often proven difficult to obtain political backing for highly cost-effective interventions such as vaccinations, treatments against diarrhoeal disease in children, and preventive policies such as improved access to clean water, or policies curtailing tobacco consumption? We use economic models of public choice, supported by examples, to explain how powerful interests groups, politicians or bureaucrats who pursue their own objectives, or voting and institutional arrangements in countries have shaped health priority setting. We show that it may be perfectly rational for policy makers to accommodate these constraints in their decisions, even if it implies departing from welfare maximizing solutions.
    Keywords: health, priority setting, politics, vaccinations
    JEL: I18 H51 D72 D61
    Date: 2015–09
  32. By: Baji, Petra; Gulácsi, László; Lovász, Barbara D.; Golovics, Petra A.; Brodszky, Valentin; Péntek, Márta; Rencz, Fanni; Lakatos, Péter L.
    Abstract: Objective: The objective of the study is to explore preferences of gastroenterologists for biosimilar drugs in Crohn’s Disease and reveal trade-offs between the perceived risks and benefits related to biosimilar drugs. Method: Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May, 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator) 2) severity of disease 3) availability of continuous medicine supply 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator 2) willing to consider biosimilar for biological-naïve patients only 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. Results: Men, senior consultants, working in IBD center and treating more patients are more likely to willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in the case biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% vs 11% for new patients, and 44% vs 56% for patients already treated with biological. Conclusions: Gastroenterologists were willing to trade between perceived risks and benefits of biosimilars. The continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.
    Keywords: risk perception, biologicals, biosimilars, Crohn’s Disease, Discrete Choice Experiment, Preferences
    JEL: D12 I12 I18
    Date: 2015–10–01
  33. By: Thomas Braendle; Carsten Colombier (University of Basel)
    Abstract: <span style="font-size:10.0pt; font-family: CMR10" lang="EN-US">A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate supply and demand-side determinants, factors from political economy and health policy reforms into an empirical analysis of the highly decentralized Swiss health care system. We compile a novel data set of the cantonal health care expenditure in Switzerland spanning the period 1970 - 2012. Using dynamic panel estimation methods, we find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules and mandatory fiscal referenda, do not appear to limit public health care expenditure growth.</span>
    Keywords: Public health care expenditure, Panel data, Fiscal rules, Political selection
    JEL: H75 D72 C23 I18
    Date: 2015

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