nep-hea New Economics Papers
on Health Economics
Issue of 2015‒10‒25
33 papers chosen by
Yong Yin
SUNY at Buffalo

  1. A Snapshot of Health Equity in Papua New Guinea: An Analysis of the 2010 Household Income and Expenditure Survey By Wayne Irava; Katie Barker; Aparnaa Somanathan; Xiaohui Hou
  2. An Economic Model of Stages of Addictive Consumption By Marysia Ogrodnik
  3. Analysis of International Experience In the Use of Health Savings Accounts and the Feasibility of Their Use in the Russian Federation By Nazarov, Vladimir; Sisigina, Natalia
  4. Be smart, live long: the relationship between cognitive and non-cognitive abilities and mortality By Öhman, Mattias
  5. Cost-Effectiveness Analysis of Results-Based Financing Programs: A Toolkit By Donald Shepard; Wu Zeng; Ha Thi Hong Nguyen
  6. Crop diversification and child health: Empirical evidence from Tanzania By Stefania Lovo; Marcella Veronesi
  7. Determinants of Wages and Assessment of the Alleged Effect of the Public Health Programs Implementation By Sokolov, Ilya; Boldareva, O.
  8. Does HIV/AIDS matter for economic growth in sub-Saharan Africa? By Mveyange Anthony; Skovsgaard Christian; Lesner Tine
  9. Effect of health on economic growth in Ghana:An application of ARDL bounds test to cointegration By Boachie, Micheal Kofi
  10. Fertility, Health and Education of UK Immigrants: The Role of English Language Skills By Yu Aoki; Lualhati Santiago
  11. Healthy(?), Wealthy, and Wise - Birth Order and Adult Health By Sandra E. Black; Paul J. Devereux; Kjell G. Salvanes
  12. Hospital trusts productivity in the English NHS: uncovering possible drivers of productivity variations By Maria Jose Aragon Aragon; Adriana Castelli; James Gaughan
  13. Incentives and Children's Dietary Choices: A Field Experiment in Primary Schools By Belot, Michèle; James, Jonathan; Nolen, Patrick J.
  14. Income and Malaria : Evidence from an agricultural intervention in Uganda By Singhal Saurabh; Pan Yao
  15. Inferring the economic standard of living and health from cohort height : Evidence from modern populations in developing countries By Canning David; Akachi Yoko
  16. Interacting Effects of State Cigarette Taxes on Smoking Participation By James M. Bishop
  17. Intergenerational transmission and the effects of health on migration By Xiao, Mimi
  18. Losing Health Insurance When Young: Impacts on Usage of Medical Services and Health By Dolores De la Mata; Carlos Felipe Gaviria
  19. Measuring mortality heterogeneity with multi-state models and interval-censored data By Alexandre Boumezoued; Nicole El Karoui; Stéphane Loisel
  20. Medicaid 1115 Demonstration Evaluation Design Plan By Carol V. Irvin; Debra Lipson; Carey Appold; Maggie Colby; Katharine Bradley; Jessica Heeringa; Jenna Libersky; Vivian L. H. Byrd; Julia Baller
  21. Mortality Risk Minimisation and Optional Martingale Representation Theorem for Enlarged Filtration By Tahir Choulli; Catherine Daveloose; Mich\`ele Vanmaele
  22. North-South Cooperation in Medical Education and Research: The European Union and South Mediterranean Economies By Driouchi, Ahmed; Achehboune, Amale
  23. Parental education and child health: Evidence from an education reform in China By Samantha B. Rawlings
  24. Pharmaceutical Patents and Generic Entry Competition: A New View on the Hatch-Waxman Act By WAN, Yunyun; MIYAGIWA, Kaz
  25. Prevention Incentives in Long-Term Insurance Contracts By Renaud Bourlès
  26. Rehabilitation of mental illness and chronic pain – the impact on sick leave and health By Hägglund, Pathric; Johansson, Per; Laun, Lisa
  27. Setting the Stage to Address the Dual Challenge of MDGs and NCDs By Anne Maryse Pierre-Louis; Katherina Ferl; Christina Dinh Wadhwani; Neesha Harnam; Montserrat Meiro-Lorenzo
  28. Stress and Coping - An Economic Approach By Klaus Wälde
  29. The Development of the Economic Model of the Drug Supply of the Population By Avxentieva, Maria; Omelyanovsky, Vitaly; Sura, Maria
  30. The differential impact of the financial crisis on health in Ireland and Greece: a quasi-experimental approach By Philipp Hessel; Sotiris Vandoros; Mauricio Avendano
  31. The economic crisis and death by suicide in Spain: Empirical evidence based on a data panel and the quantification of losses in labour productivity. By Berta Rivera; Bruno Casal; Luis Currais
  32. When Should Governments Subsidize Health? The Case of Mass Deworming By Amrita Ahuja; Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel; Shawn Powers
  33. Worms at work: Long-run impacts of a child health investment By Sarah Baird; Joan Hamory Hicks; Michael Kremer; Edward Miguel

  1. By: Wayne Irava; Katie Barker; Aparnaa Somanathan; Xiaohui Hou
    Abstract: This paper highlights challenges that the government of Papua New Guinea faces in delivering equitable health care. It analyses findings from the 2010 household survey, including sickness reporting, health service utilization and out of pocket expenditure, concluding that the poorest quintile is most vulnerable to illness, yet has the lowest utilization rates of healthcare facilities. The lack of healthcare workers and the distance to facilities are among the most dominant reasons cited for not utilizing healthcare facilities in the poorest quintile while out-of-pocket payments have minimal catastrophic impact, yet have still been found to be a barrier to utilization. The paper also sets out policy implications of these findings, including the need for the government to focus on, and prioritize, strengthening the health services delivery to achieve universal health coverage.
    Keywords: living standards, communities, equity, health service delivery, villages, workers, healthcare providers, nurse, income, health care utilization, care, health policy, ... See More + edicine, budgets, health care access, health economics, traditional medicines, financial resources, community health, age groups, services, monitoring, delivery system, urban areas, household, health care, health care workers, medical supplies, expenditures, healthcare services, health, health workers, nutrition, health posts, pocket payments, health coverage, elderly people, health service utilization, information systems, primary health care, mobile clinics, health facilities, internet, public health, health system, health information systems, children, aid, clinics, working conditions, costs, delivery of health services, financial contributions, households, patients, patient, health providers, access to care, rural areas, poverty, illness, health expenditure, health indicators, incidence, localities, population, facilities, aging, health care services, health equity, access to health services, household income, use of health services, community, epidemiology, medicines, health workforce, health care spending, hospitals, health organization, illnesses, outpatient services, health needs, health service, interview, catastrophic health expenditure, household expenditure, health services, service, health information, human development, health spending
    Date: 2015–06
  2. By: Marysia Ogrodnik (Centre d'Economie de la Sorbonne)
    Abstract: The aim of this research is to build a model of addictive consumption by taking into account consumers' growing loss of self-control, as well as their lack of empathy for their future selves. Such model reveals that individuals follow a given consumption pattern composed of five stages, and thereby, that stable addictive consumption level does not exist outside of abstention. It permits to explain how consumers modify their environment in order to get rid of their addiction and why some of them find it difficult to successfully abstain. The analysis of the model shows that they do not uniformly react to public policies according to the stage in which they are placed. I argue that an optimal policy should increase consumers' perceived losses of consuming without cutting too much their budget (as repeated price increases do). Moreover, it should be accompanied by more credible propositions of quitting strategies in order to prevent denial phenomenon and foster the decision to abstain. Furthermore, prices of such strategies should be low enough in order to favor a longer use of them and a quitting success
    Keywords: addiction; cognitive biases; consumption choice; stages of change
    JEL: D03 I12
    Date: 2015–10
  3. By: Nazarov, Vladimir (Russian presidental academy of national economy and public administration (RANEPA)); Sisigina, Natalia (Russian presidental academy of national economy and public administration (RANEPA))
    Abstract: This paper is aimed to analyze the international experience of the use of health savings accounts and possibilities of their application in the Russian practice. In the conditions of insufficient public spending on health it is particularly important to search for new mechanisms to pay for healthcare that can attract additional resources in the sector and improve the efficiency of spending. Medical savings accounts are also of interest to the Russian health care as one of the possible tools of drug insurance, provided by the drug provision of the population of the Russian Federation for the period up to 2025. The work deals with national models and possible future applications of medical savings accounts, as well as the specifics of the Russian market, influencing the choice of the model and the success of its implementation. The final chapter of the work gives general advice on incorporation of medical savings accounts in the public health system of the Russian Federation.
    Keywords: Russian economy, health savings accounts, health reform
    JEL: I11 I13 I14 I15 I18
    Date: 2015–10–16
  4. By: Öhman, Mattias (Department of Economics, Uppsala University)
    Abstract: I study the association between cognitive and non-cognitive abilities and mortality, and investigate how well income and education act as proxy measures for ability. The risk of premature mortality is estimated using Cox proportional hazard models with a dataset of 692,303 Swedish men aged 18-20 years, enlisted between the years 1969-1983, and deaths between the years 1969 and 2009. Results suggest that both cognitive and non-cognitive abilities are strongly associated with mortality, independently and through income and education. Non-cognitive ability is a stronger predictor of the risk of mortality than cognitive ability. For middle and high income earners, and individuals with a college education, there are no associations between the abilities and mortality. However, for low income earners and individuals without a college education, cognitive and non-cognitive ability have strong associations with mortality. Results are mainly driven by the bottom of the measured ability distributions.
    Keywords: Cognitive ability; non-cognitive ability; mortality; education; income
    JEL: I12 J24
    Date: 2015–09–30
  5. By: Donald Shepard; Wu Zeng; Ha Thi Hong Nguyen
    Abstract: Results-based financing (RBF), which rewards providers, users, or administrators of services upon achieving a set of verified results, has been gaining attraction in global health as a prominent approach to gain value for money. With a large number of countries adopting RBF in the recent years, evidence starts to emerge which points to the effectiveness of RBF in improving coverage and quality of important services, such as maternal and child health and reproductive health. The current toolkit aims to support country programs to assess the cost-effectiveness of RBF interventions and to facilitate cross-country comparisons of RBF programs. The toolkit is specifically tailored to supply-side RBF but its general principles apply to most health systems interventions directed at the health-related millennium development goals (MDGs). The development of the toolkit was based on actual experience of conducting a cost effectiveness analysis of Zambia’s RBF program and an extensive review of RBF programs features across the health results innovation trust fund (HRITF) portfolio. Given that RBF programs in the HRITF portfolio are typically complex health system interventions, the toolkit recommends a practical approach of adopting a program implementer’s perspective and presents different options for cost-effectiveness analysis (for selected key indicators or for an entire package of services). It also provides guidance on incorporating quality of care, which is strongly emphasized across many RBF programs.
    Keywords: child health, risks, reproductive health, vaccination, financing, antenatal care, deaths, income, quality of health care, prevention, health economics, morbidity, syphilis ... See More + community health, health care, medical records, death, death rate, incentives, health, obstetrical care, development goals, health facilities, public health, life expectancy, quality of health, hospitalization, health sector, knowledge, disabilities, choice, cost effectiveness, health status, costs, iron, immunization, patients, patient, impact of quality of care, health equipment, hospital records, intervention, health systems, fixed costs, preventive treatment, health centers, impact evaluations, health care services, health management, tuberculosis, folic acid, health organization, screening, birth rate, global health, hiv/aids, polio vaccine, mortality, general practice, counselling, equity, childbirth, health specialist, workers, surgery, quality of care, health systems strengthening, postnatal care, immunodeficiency, care, policy makers, health policy, health effects, budgets, social policy, demand, health outcomes, hepatitis b, family planning, medical equipment, expenditures, decision making, hospital costs, measurement, nutrition, service utilization, policy, quality of life, primary health care, burden of disease, internet, health results, health system, insurance, weight, pregnant women, children, disease control, evaluation, inpatient care, poverty, illness, disability, incidence, limited resources, counseling, population, polio, strategy, fees, epidemiology, registration, child health services, medicines, health projects, hospitals, health interventions, health consequences, millennium development goals, birth attendant, health service, health programs, health services, implementation, pregnancy, abortion, condoms, cleanliness, health strategy, provider payment, primary health care services
    Date: 2015–05
  6. By: Stefania Lovo; Marcella Veronesi
    Abstract: Malnutrition is recognized as a major issue among low-income households in developing countries with long-term implications for economic development. Recently, crop diversification has been recognized as a strategy to improve nutrition and health, and as a risk coping strategy used by farmers in the face of climate change. However, there is no systematic empirical evidence on the role played by crop diversification in improving human health. We use the Tanzania National Panel Survey to investigate the effects of crop diversification on child health. We use fixed effects panel estimation to control for unobserved heterogeneity, and perform several robustness checks including placebo tests to test the validity of our findings. We find a positive and significant effect of crop diversification on long-term child nutritional status, in particular for very young children and children living in households with limited market access.
    Date: 2015–10
  7. By: Sokolov, Ilya (Gaidar Institute for Economic Policy); Boldareva, O. (Russian presidental academy of national economy and public administration (RANEPA))
    Abstract: The study provides estimates of total economic losses to society from the presence of chronic diseases and other health problems, both in the long and short term. The paper presents the overall ranking of health problems on the degree of additional effects on total revenue of the company (in the long and short term). Based on estimates of the economic losses the company and discussed the degree of influence factors on the probability of getting diseases are general recommendations about the effectiveness and appropriateness of the various programs in the healthcare sector.
    Keywords: Russian economy, chronic diseases, health problems, healthcare, healthcare reform
    JEL: I11 I15 I18
    Date: 2014–07–29
  8. By: Mveyange Anthony; Skovsgaard Christian; Lesner Tine
    Keywords: Economic growth, Human capital, Macroeconomics, Population, Public health
    Date: 2015
  9. By: Boachie, Micheal Kofi
    Abstract: In this paper, the growth effect of health in Ghana is examined for the period 1982 to 2012. We use life expectancy at birth as a proxy for health, and real per capita GDP as a proxy for economic growth. After employing ARDL bounds test approach to cointegration, and controlling for the effects of education, international trade, FDI, inflation, and accumulation of physical capital, we find that economic growth is significantly driven by health, both in the short and long run. However, the favourable growth effect of health in the short run is found to be lower.The implication is that improvement in health status of the population raises output in the economy. In this regard, policy should aim at raising health sector investment and strengthen the healthcare system to improve health status.
    Keywords: Health, education, economic growth, Ghana, ARDL cointegration
    JEL: I1 O1
    Date: 2015–09–30
  10. By: Yu Aoki (University of Aberdeen); Lualhati Santiago (Warwick University, Department of Economics)
    Abstract: This paper aims to identify the causal effect of English language skills on fertility, health and education outcomes of immigrants in England and Wales. To estimate this causal effect, we use the instrumental variable estimation strategy where age at arrival in the United Kingdom (UK) is exploited to construct an instrument for language skills. The idea of exploiting age at arrival is based on the phenomenon that a person who is exposed to a new language within the critical period of language acquisition (i.e., childhood) learns the language more easily. This implies that immigrants who arrive in the UK at a young age have on average better English language skills than those who arrive when they are older. Using a unique individual-level dataset that links census and life event records for the population living in England and Wales at the 2011 Census, we find that better English language skills significantly delay the age at which a woman has her first child, lower the likelihood that she has a child in her teens, and decrease the number of children she gives birth to, but do not affect her children’s birthweight and an individual’s self-reported health. The impact on educational achievement is also considerable: better English skills significantly raise the probability of obtaining academic degrees and significantly lower the probability of having no qualifications.
    Keywords: Language skills, fertility, health, education, natural experiment
    JEL: I10 I20 J13
    Date: 2015–08
  11. By: Sandra E. Black; Paul J. Devereux; Kjell G. Salvanes
    Abstract: While recent research finds strong evidence that birth order affects children’s outcomes such as education, IQ scores, and earnings, the evidence for effects on health is more limited. This paper uses a large dataset on the population of Norway and focuses on the effect of birth order on a range of health and health-related behaviors, outcomes not previously available in datasets of this magnitude. Interestingly, we find complicated effects of birth order. First-borns are more likely to be overweight, to be obese, and to have high blood pressure and high triglycerides. So, unlike education or earnings, there is no clear first-born advantage in health. However, later-borns are more likely to smoke and have poorer self-reported physical and mental health. They are also less likely to report that they are happy. We find that these effects are largely unaffected by conditioning on education and earnings, suggesting that these are not the only important pathways to health differentials by birth order. When we explore possible mechanisms, we find that smoking early in pregnancy is more prevalent for first pregnancies than for later ones. However, women are more likely to quit smoking during their first pregnancy than during later ones, and first-borns are more likely to be breast-fed. These findings suggest a role for early maternal investment in determining birth order effects on health.
    Keywords: Birth order; Early childhood investment; Health
    JEL: I1 J1
    Date: 2015–07
  12. By: Maria Jose Aragon Aragon (Centre for Health Economics, University of York, UK.); Adriana Castelli (Centre for Health Economics, University of York, UK); James Gaughan (Centre for Health Economics, University of York, UK.)
    Abstract: In 2009, the NHS Chief Executive warned that a potential funding gap of £20 billion should be met by extensive efficiency savings by March 2015. Our study investigates possible drivers of differential Trust performance (productivity) for the years 2010/11-2012/13. Productivity is measured as Outputs/Inputs. We extend previous productivity work at Trust level by including a fuller range of care settings, including Inpatient, A&E and Community Care, in our output measure. Inputs include staff, equipment, and capital resources. We analyse variation in Total Factor and Labour Productivity with ordinary least squares regressions. Explanatory variables include efficiency in resource use measures, Trust and patient characteristics. We find productivity varies substantially across Trusts but is consistent across time. Larger Trusts are associated with lower productivity. Patient age groups treated is also found to be important. Foundation Trust status is associated with lower Total Factor Productivity, while treating more patients in their last year of life is surprisingly associated with higher Labour Productivity. Variation in productivity is persistent across years, and not fully explained by case-mix adjustment. A lack of convergence in productivity may indicate outstanding scope to improve Trust productivity based on mimicking the practises of the most productive providers.
    Keywords: Hospital, productivity indices, productivity variation
    Date: 2015–10
  13. By: Belot, Michèle (University of Edinburgh); James, Jonathan (University of Bath); Nolen, Patrick J. (University of Essex)
    Abstract: We conduct a field experiment in 31 primary schools in England to test the effectiveness of different temporary incentive schemes, an individual based incentive scheme and a competitive scheme, on increasing the choice and consumption of fruit and vegetables at lunchtime. The individual scheme has a weak positive effect whereas all pupils respond to positively to the competitive scheme. For our sample of interest, the competitive scheme increases choice of fruit and vegetables by 33% and consumption of fruit and vegetables by 48%, twice and three times as much as the individual incentive scheme, respectively. The positive effects generally carry over to the week immediately following the treatment but we find little evidence of any effects six months later. Our results show that incentives can work, at least temporarily, to increase healthy eating but there are large differences in effectiveness between schemes and across demographics such as age and gender.
    Keywords: incentives, health, habits, child nutrition, field experiments
    JEL: J13 I18 I28 H51 H52
    Date: 2015–10
  14. By: Singhal Saurabh; Pan Yao
    Abstract: We exploit a spatial discontinuity in the coverage of an agricultural extension program in Uganda to causally identify its effects on malaria. We find that eligibility for the program reduced the incidence of malaria by 8.8 percentage points, with childre
    Keywords: Administrative law, Agriculture, Economic development, Health, Income, Microeconomics, Regression analysis
    Date: 2015
  15. By: Canning David; Akachi Yoko
    Abstract: Average adult height is a physical measure of the biological standard of living of a population. While the biological and economic standards of living of a population are very different concepts, they are linked and may empirically move together. If this
    Keywords: Economic development, Economic growth, Health, Population
    Date: 2015
  16. By: James M. Bishop (Oklahoma State University)
    Abstract: A state cigarette tax increase may deter some residents from smoking, but other residents may avoid the higher tax by purchasing cigarettes from another state. Using U.S. health survey micro data from 1999 to 2012, this paper measures how border-crossing opportunities affect the smoking deterrence achieved by a cigarette tax increase. I estimate by two-way fixed effects regression that a $1 state cigarette tax increase decreases the smoking rate by an additional 0.58 percentage points for each dollar of cigarette tax in the nearest lower-tax state. However, each successive $1 tax increase decreases the smoking rate by 0.38 fewer percentage points than the last. I show that the signs of these terms can be theoretically derived without parametric assumptions. I observe that, as both home and nearest lower taxes rose from 1999 to 2012, the mean effectiveness of a home state tax increase remained roughly constant over the period. My results imply that the lowest-tax states are those with the greatest power to reduce the national smoking rate.
    Keywords: Cigarette Taxes, Smoking, Tax Avoidance, Border-crossing
    JEL: I12 I18 H26 H73
    Date: 2015–10
  17. By: Xiao, Mimi
    Abstract: This thesis conducts empirical analysis on the intergenerational transmission of adiposity, using various types of data from various countries; the same intergenerational transmission in China and how it varies with the family socioeconomic factors and age levels; the way in which health impinges on the decision to migrate in China. In the first empirical chapter we find that the intergenerational elasticity of adiposity is relatively constant – at 0.2 per parent, and this elasticity is comparable across time and countries. Quantile estimates suggest that this intergenerational transmission mechanism is more than double for the fattest children as it is for the thinnest children. The second empirical chapter examines the intergenerational transmission of adiposity in China: we use BMI z-score as another measure of adiposity, the longitudinal structure of CHNS data (1993-2009) allows us to control for individual fixed effects or family fixed effects and focus on changes in BMI z-score over the life cycle. We report patterns of the intergenerational relationship of BMI z-score varying by family socio-economic factors and the age of the child, the magnitude of this relationship reaches the peak over the stage between childhood and later adolescence. In the third empirical chapter, which also uses the CHNS data, we examine whether migrants are healthier than those who do not migrate in the places of origin in the context of internal migration in China. Based on the relative wage rates, costs of migration and the assumption of optimization, we set up a theoretical model and estimate the effects of health on the migration probability, we find that people self-evaluating as having “good” or “excellent” health are more likely to migrate, this health effects vary with the type of occupation, we also find evidence on the indirect health effects which operates through the education attainment.
    Date: 2015–06
  18. By: Dolores De la Mata (The Institute of Economics, Zagreb); Carlos Felipe Gaviria (The Institute of Economics, Zagreb)
    Abstract: In this study we exploit a regulation in Colombia that exogenously changes health insurance coverage of young adult dependents, specifically those turning 18 years old, to analyze the effects of losing health insurance coverage on their health service usage and health status. We assess this effect using a regression discontinuity design (RDD) and data from the Encuesta Nacional de Calidad de Vida Survey for Colombia from 2010 to 2013. Losing coverage implies an increase in the cost of some medical services which may reduce their consumption (i.e. preventive services). Additionally, since under Colombian regulations, emergency department (ED) visits cannot be denied to anyone, regardless of health insurance status, uninsured young adults tend to use this service more instead of regular medical services (such as preventive healthcare or visits to physicians or specialists). We find, consistent with the change in relative prices, that losing health insurance when turning 18 years old increases the visits to the ED, reduces preventive care visits with a physician, and reduces the usage of other medical services. These results imply a substitution of cheaper medical services for more expensive ones when individuals turn 18 years old in Colombia.
    Keywords: Health Insurance, Young Adults, Healthcare Usage, Emergency Department Visits, Columbia’s Healthcare System, Regression Discontinuity, Developing Country
    JEL: G22 I13 I18
    Date: 2015–08
  19. By: Alexandre Boumezoued (LPMA - Laboratoire de Probabilités et Modèles Aléatoires - UPMC - Université Pierre et Marie Curie - Paris 6 - UP7 - Université Paris Diderot - Paris 7 - CNRS); Nicole El Karoui (LPMA - Laboratoire de Probabilités et Modèles Aléatoires - UPMC - Université Pierre et Marie Curie - Paris 6 - UP7 - Université Paris Diderot - Paris 7 - CNRS); Stéphane Loisel (SAF - Laboratoire de Sciences Actuarielle et Financière - UCBL - Université Claude Bernard Lyon 1)
    Abstract: In this paper, our aim is to measure mortality rates which are specific to individual observable factors when these can change during life. The study is based on longitudinal data recording marital status and socio-professional features at census times, therefore the observation scheme is interval-censored since individual characteristics are only observed at isolated dates and transition times remain unknown. To this aim, we develop a parametric maximum likelihood estimation procedure for multi-state models that takes into account both interval-censoring and reversible transitions. This method, inspired by recent advances in the statistical literature, allows us to capture characteristic-specific mortality rates, in particular to recover the mortality compensation law at high ages, but also to capture the age pattern of characteristics changes. The dynamics of several population compositions is addressed, and allows us to give explanations on the pattern of aggregate mortality, as well as on the impact on typical life insurance products. Particular attention is devoted to characteristics changes and parameter uncertainty that are both crucial to take into account.
    Keywords: mortality heterogeneity,longevity risk,multi-state models,interval-censoring,parametric maximum likelihood
    Date: 2015–10–14
  20. By: Carol V. Irvin; Debra Lipson; Carey Appold; Maggie Colby; Katharine Bradley; Jessica Heeringa; Jenna Libersky; Vivian L. H. Byrd; Julia Baller
    Abstract: This report lays out the general design and approach Mathematica will use to evaluate four different types of Medicaid section 1115 demonstration waivers: (1) Delivery System Reform Incentive Payments (DSRIP), (2) Premium Assistance Medicaid expansions, (3) Beneficiary Engagement/Premium Payment demonstrations, and (4) Managed Long-Term Services and Supports programs. This plan focuses on the research questions that will guide the work and discusses relevant outcome measures, data sources, and general methodological approaches.
    Keywords: Medicaid, section 1115 demonstrations, delivery system reform, provider incentive payments, premium assistance, beneficiary engagement, premium payments, managed long-term services and supports, MLTSS
    JEL: I J
    Date: 2015–05–15
  21. By: Tahir Choulli; Catherine Daveloose; Mich\`ele Vanmaele
    Abstract: In this paper we consider a market model where there are two levels of information, the public information generated by the financial assets and a larger flow of information that contains additional knowledge about a death time of an insured. By using the expansion of filtration, the death uncertainty and its entailed risk are fully considered without any mathematical restriction. In this context, which catches real features such as correlation between market model and time of death, we address the risk-minimisation problem for a large class of equity-linked mortality and/or mortality contracts. The stochastic innovation, that we propose herein, consists of singling out three classes of martingales in the large filtration. One of these classes is generated by a new process, up to our knowledge, that has nice features. The three orthogonal martingale classes are vital pillars for establishing our optional martingale representation theorem, when (local) martingales of the large filtration are stopped at the death time. This constitutes our first main original contribution, while the second main contribution lies in describing, as explicit as possible, the optimal strategy when hedging mortality risks using the optional martingale representation.
    Date: 2015–10
  22. By: Driouchi, Ahmed; Achehboune, Amale
    Abstract: The objective of this paper is to show the need for further cooperation around medical education and research through the mobility of medical doctors. Three important implicit players are identified and include medical schools, public authorities and the business related to health-care. These players from North and South are assumed to engage in cooperation around medical education, medical research and health development. The triple helix approach and the support of Information and Communication Technologies (ICTs) are the foundations of the model. The empirical part introduces the on-going international cooperative frameworks between the European Union and South Mediterranean countries and identifies possibilities of expansion. The paper shows how such as a framework could be expanded to generate further benefits with win-win outcomes to both Northern and Southern economies. The emphasis placed on the European Union and Arab countries provides further evidence for the pursuit and expansions of collaborations and dialogues on health and mobility of medical doctors.
    Keywords: Keywords: Existing Collaborations, Triple Helix Framework, Medical Doctors, Medical Education and Research.
    JEL: I1 I3 O1
    Date: 2015–10–19
  23. By: Samantha B. Rawlings (University of Aberdeen)
    Abstract: This paper investigates the impact of parental education on child health, exploiting a compulsory schooling law implemented in China in 1986 that extended schooling from 6 to 9 years. It finds that it is maternal, rather than paternal, education that matters most for child health. There are also important differences in the effect according to child gender. An additional year of mother’s education raises boys height-for-age by 0.163 standard deviations, whilst there is no statistically significant effect on girls height. Parental education appears to have little effect on weight-for-age of children. Estimated effects on height are driven by the rural sample, where an additional year of mother’s education raises boys height for age by 0.228 standard deviations and lowers the probability of a boy being classified as stunted by 6.6 percentage points. Results therefore suggest that - at least in rural areas - son preference in China has additional impacts beyond the sex-ratio at birth.
    Keywords: Intergenerational Mobility, Health, China
    JEL: C21 I12 I21
    Date: 2015–08
  24. By: WAN, Yunyun; MIYAGIWA, Kaz
    Abstract: We present a formal analysis that sheds new light on the Hatch-Waxman Act. Hatch-Waxman restores incentives to develop new drugs by extending the patent life for them, but also promotes generic entry by reducing entry costs and by providing 180-day marketing exclusivity to a first challenger to the patent. Although these two objectives appear incompatible, our model shows that marketing exclusivity, with a significant entry cost reduction, contributes to incentive restoration. It finds however that social welfare is lower with marketing exclusivity. Finally, our analysis suggests that marketing exclusivity not be granted in the case of drugs for rare diseases.
    Keywords: innovation, generic entry competition, patent, pharmaceuticals, Hatch-Waxman
    JEL: I18 K23 L13
    Date: 2015–08–30
  25. By: Renaud Bourlès (AMSE - Aix-Marseille School of Economics - EHESS - École des hautes études en sciences sociales - Centre national de la recherche scientifique (CNRS) - Ecole Centrale Marseille (ECM) - AMU - Aix-Marseille Université)
    Abstract: Long-term insurance contracts are widespread, particularly in public health and the labor market. Such contracts typically involve monthly or annual premia which are related to the insured’s risk profile, where a given profile might change based on observed outcomes which depend on the insured’s prevention efforts. The aim of this paper is to analyze the latter relationship. In a two-period optimal insurance contract in which the insured’s risk profile is partly governed by the effort he puts on prevention, we find that both the insured’s risk aversion and prudence play a crucial role. If absolute prudence is greater than twice absolute risk aversion, moral hazard justifies setting a higher premium in the first period but also greater premium discrimination in the second period. For specific utility functions, moreover, an increase in the gap between prudence and risk aversion increases the initial premium and the subsequent premium discrimination. These results provide insights on the tradeoffs between long-term insurance and the incentives for primary prevention arising from risk classification, as well as between inter- and intra-generational insurance.
    Keywords: long-term insurance, classification risk, moral hazard, prudence
    Date: 2015–10
  26. By: Hägglund, Pathric (Swedish Social Insurance Inspectorate (ISF)); Johansson, Per (IFAU - Institute for Evaluation of Labour Market and Education Policy); Laun, Lisa (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: This paper exploits a government initiative to analyze the effect of cognitive behavioral therapy (CBT) for individuals with mild or moderate mental illness and multidisciplinary treatment (MDT) for individuals with pain in back and shoulders. We employ a propensity score matching approach to study the effects on sick leave, health care consumption and drug prescriptions. We find that CBT improved health and prevented sick leave for individuals who were not on sick leave when treatment was initiated but had no effect for individuals who were on sick leave when the treatment was initiated. MDT was a failure regardless of the individual’s sick leave status at the time of treatment. MDT increased sick leave while having no long term impact on either health care visits or drug prescriptions.
    Keywords: Mental diseases; chronic pain; sick leave; propensity score matching
    JEL: H43 I13 J22
    Date: 2015–10–05
  27. By: Anne Maryse Pierre-Louis; Katherina Ferl; Christina Dinh Wadhwani; Neesha Harnam; Montserrat Meiro-Lorenzo
    Abstract: The purpose of this discussion paper is to assist countries in exploring synergies in service delivery and disease dynamics that can positively affect both non-communicable diseases (NCDs) and the Millennium Development Goals (MDGs). The paper examines the challenges countries face in addressing both infectious and non-communicable diseases, and highlights examples of integrated interventions in addressing this double burden of disease. Many low- and middle-income countries are faced with a rising burden of NCDs while working to improve health outcomes to meet health-related MDGs. This dual challenge takes place in an environment of increasingly limited resources, which is why the efficient integration of prevention, diagnosis and treatment of NCDs with MDG-related activities will be, in many instances, the best option these countries will have to address such challenges. Brazil’s Family Health Program and Turkey’s Health Transformation Program provide useful examples to draw on, and have been highlighted in this paper. Both programs have demonstrated impressive results, which can serve as an impetus for countries to take action.
    Keywords: psychosocial support, child health, antiretroviral therapies, risks, treatment, diagnosis, counselors, chronic diseases, vaccination, stroke, diabetes mellitus, midwifery ... See More + prevention, laws, disease burden, morbidity, health education, sexual health, community health, health care, death, death rate, cervical cancer, health, depression, back pain, health workers, eating habits, breast cancer, high blood pressure, smokers, hypertension, rubella, sexually transmitted infection, public health, day care, life expectancy, hospitalization, knowledge, diabetes, analgesics, workplace, diseases, occupational health, iron, immunization, infectious diseases, patients, patient, life, smoking, intervention, leukemia, health indicators, mental illness, aging, nurses, health management, violence, anxiety, pollution, tuberculosis, gynecology, screening, cardiovascular disease, hiv/aids, mental health, mortality, general practice, health promotion, palliative care, cancer, childbirth, pregnancy complications, medical research, workers, surgery, prognosis, influenza, ncd, hiv, tb, surveillance, immunodeficiency, lifestyle, health policy, health effects, morality, noncommunicable diseases, health outcomes, hygiene, hepatitis b, dental health, family planning, medical supplies, decision making, therapies, chemotherapy, nutrition, injuries, malaria, quality of life, primary health care, burden of disease, internet, risk factors, vaccines, weight, physicians, communicable diseases, pregnant women, maternal health, obesity, cardiovascular diseases, children, disease, liver cancer, clinics, infection, disability, physical activity, all, hospitalizations, maternal and child health, blood sugar, strategy, epidemiology, sodium, families, medicines, hospitals, health interventions, aids, health services, implementation, mental, pregnancy, alcohol consumption, condoms, food industry, nursing, breastfeeding
    Date: 2014–05
  28. By: Klaus Wälde (Johannes-Gutenberg University Mainz and CESifo)
    Abstract: Stress is ubiquitous in society. In our model, stressors translate into subjective stress via an appraisal process. Stress reduces instantaneous utility of an individual directly and via a cognitive load argument. Coping can be functional and under the control of the individual or more automatic with dysfunctional features. We predict the occurrence and frequency of uncontrolled coping - emotional outbursts - as a function of an individual's personality and environment. Outbursts cannot always be avoided. Delaying emotional outbursts artifcially can lead to even more outbursts. Looking at the effect of psychotherapy shows that expecting little and being emotional can help maximizing well-being.
    Keywords: Stress, coping, personality, controlled vs. automatic reaction, emotional outbursts, optimal stopping problem
    JEL: D03 D91 I12
    Date: 2015–10–06
  29. By: Avxentieva, Maria (Russian presidental academy of national economy and public administration (RANEPA)); Omelyanovsky, Vitaly (Russian presidental academy of national economy and public administration (RANEPA)); Sura, Maria (Russian presidental academy of national economy and public administration (RANEPA))
    Abstract: The authors performed clinical and economic modeling of the introduction of outpatient drug supply of working age patients with arterial hypertension (AH) in view of adherence to treatment in the Russian Federation and made proposals that increase the efficiency of drug supply programs while containing costs. According to a systematic review of research, provided that patients medications for ?80% of days treatment period, the frequency of hospitalizations in patients with cardiovascular disease can be reduced by 1.43 times. By reducing the frequency of hospitalizations reduced the burden on the state management of patients with hypertension, including costs associated with hospitalization, medical emergencies (direct medical costs), the payment of temporary disability benefits (direct non-medical costs), as well as the loss of gross domestic product (indirect costs). Despite significant cost savings by reducing the frequency of hospital admissions - 4.5 billion rubles per year for a group of 5 million people (registered patients of working age with hypertension in the Russian Federation), the necessary amount of additional funds in the case of implementation of the program of outpatient drug supply will be from 3.3 billion rubles to 22.8 billion rubles in year depending on the price of drugs and the chosen strategy of public funding. However, in certain segments of patients (eg, pharmacotherapy of patients of working age with stage I hypertension) introducing mechanisms to cover the costs of drug therapy by the state can be cost-effective in the short term (1 year). Additional economic benefits of public investment in this amount of 91.7 million rubles up to 802.5 million rubles.
    Keywords: health care, financing, health policy, Russia, budget
    Date: 2015–09–20
  30. By: Philipp Hessel; Sotiris Vandoros; Mauricio Avendano
    Abstract: Objectives: Greece and Ireland suffered an economic recession of similar magnitude, but whether their health has deteriorated as a result has not yet been well established. Study design: Based on five waves (2006-2010) of the European Union Statistics of Income and Living Conditions (EU-SILC) survey we implemented a difference-in-differences (DID) approach that compared trends in self-rated health in Greece and Ireland before and after the crisis with trends in a ‘control’ population (Poland) that did not experience a recession and had health trends comparable to both countries before the crisis. Methods: Logistic regression using a difference-in-differences (DID) approach. Results: A simple examination of trends suggests that there was no significant change in health in Greece or Ireland following the onset of the financial crisis. However, DID estimates that incorporated a control population suggest an increase in the prevalence of poor-self rated health in Greece (OR=1.216; CI=1.11 - 1.32). Effects were most pronounced for older individuals and those living in high-density areas, but effects in Greece were overwhelmingly consistent in different population sub-groups. In contrast, DID estimates revealed no effect of the financial crisis on the prevalence of poor self-rated health in Ireland (OR=0.97; CI=0.81-1.16). Conclusions: DID estimates suggest that the financial crisis led to higher prevalence of reporting poor health in Greece but not in Ireland. Although our research design does not allow us to directly assess the role of specific policies, contextual factors including policy responses may have contributed to the different effect of the crisis on the health of the two countries.
    Keywords: economics; health policy; public health; self-rated health; crisis
    JEL: F3 G3 E6
    Date: 2014–10
  31. By: Berta Rivera; Bruno Casal; Luis Currais
    Abstract: In 2013, the suicide rate in Spain went up by more than 9% with respect to the previous year. Suicide thus became the first cause of death between the ages of 15 and 44. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this study, the panel data technique used demographic-type variables and those related to the economic cycle. We also used the suicide rates for the Spanish regions in the period between 2002 and 2013. Moreover, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Consequently, an estimate is made of the losses in labour productivity owing to these suicides. The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 37,250 potential years of working life were lost in 2012. This has an estimated cost of over 534 million Euros. The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.
    Keywords: Suicide rates; economic crisis; unemployment; lost labour productivity, Spain.
    JEL: I18 I31 H75
    Date: 2015–10
  32. By: Amrita Ahuja; Sarah Baird (George Washington University); Joan Hamory Hicks (University of California, Berkeley); Michael Kremer (Harvard University); Edward Miguel (University of California, Berkeley); Shawn Powers
    Date: 2014–10
  33. By: Sarah Baird (George Washington University); Joan Hamory Hicks (University of California, Berkeley); Michael Kremer (Harvard University); Edward Miguel (University of California, Berkeley)
    Abstract: This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased education among women and labor supply among men, with accompanying shifts in labor market specialization. Ten years after deworming treatment, women who were eligible as girls are 25% more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and entrepreneurship. Men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in entrepreneurship, are more likely to hold manufacturing jobs, and miss one fewer meal per week. We estimate an annualized financial internal rate of return of at least 32.2%.
    Date: 2015–07

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