nep-hea New Economics Papers
on Health Economics
Issue of 2015‒11‒01
37 papers chosen by
Yong Yin
SUNY at Buffalo

  1. A Mobile Tool for Health Workers: Promising Results in Bihar, India By Evan Borkum; Data Rotz; Anu Rangarajan
  2. A Spatial Difference-in-Difference Analysis to Measure the Sugarcane Producing Impact in Respiratory Health By Andre Chagas; Carlos Azzoni; Alexandre Almeida
  3. Access to health insurance and utilization of public sector substance use treatment: Evidence from the Affordable Care Act dependent coverage provision By Brendan Saloner; Yaa Akosa Antwi; Johanna Catherine Maclean; Benjamin Lê Cook
  4. AIDS, Human Capital and Development By Rody Manuelli
  6. Bayesian nonparametric learning of switching dynamics in cohort physiological time series: application in critical care patient monitoring By Li-wei Lehman; Matthew J. Johnson; Nemati, Shamim; Ryan P. Adams; Roger G. Mark
  7. Caesarean section and the manipulation of exact delivery time By D. Fabbri; I. Castaldini; C. Monfardini; A. Protonotari
  8. Development of Organizational and Economic Grounds of Investment and Entrepreneurial Projects for Innovative Development of the Healthcare in the Medium Term Perspective By Gabueva, Larisa; Pirogov, M.
  9. Disparity in emergency medical services across Japan By Taro Takimoto; Kazuya Sakata; Kazunori Nakajima; Masaki Narukawa; Naoki Sakamoto
  10. Do healthcare financing privatisations curb total healthcare expenditures? By Wiese, Rasmus; Eriksen, Steffen
  12. Endogenous Technology Adoption and Medical Costs By Karine Lamiraud; Stephane Lhuillery
  13. Evaluation of mothers' knowledge and opinions about breast milk banking who are with 0-6 month-old-babies in T By Tuba Demirel; Hacer Alan; Sema Y; Asl Karakoç Geçici
  15. Explaining the Body Mass Index Gaps between Turkish Immigrants and Germans in West Germany 2002-2012: A Decomposition Analysis of Socio-Economic Causes By Rui Dang
  16. Gender and Health: Barriers and Opportunities for Women's Participation in the Private Health Sector in Africa By Marguerite Monnet
  17. Health Insurance Expansions and Provider Behavior: Evidence from Substance Use Disorder Providers By Johanna Catherine Maclean; Ioana Popovici; Elisheva Stern
  18. Hospital Acquisition of Physician Groups: On the Road to Value-Based or Higher-Priced Care? By James D. Reschovsky; Eugene Rich
  19. ICT adoption factors in medical hospitals: a European perspective and focus on The Netherlands By Marina Van Geenhuizen; Sander Faber
  20. Life expectancy and education: Evidence from the cardiovascular revolution By Hansen, Casper Worm; Strulik, Holger
  21. Measuring Health and Well-being of Young People in the Transfer Project By Tia Palermo; UNICEF Office of Research - Innocenti
  22. Measuring What Matters in Primary Care By Eugene Rich; Ann O'Malley
  24. Parents’ education and child body weight in France: The trajectory of the gradient in the early years By Apouey, B.H.;; Geoffard, P-Y.;
  26. Public hospital spending in England: evidence from National Health Service administrative records By Elaine Kelly; George Stoye; Marcos Vera-Hernandez
  27. Public nursery school costs and the effects of the funding reforms in Japan By Miki Miyaki
  28. Student projects for health promotion in the primary health care sector – the design process of a Self Care St By Noora Montonen; Hanna Tuohimaa; Liisa Ranta; Minna Luoto
  29. Subjective Expectations of Medical Expenditures and Insurance in Rural Ethiopia By Zelalem Yilma; Owen O’Donnell; Anagaw Mebratie; Getnet Alemu; Arjun S. Bedi
  30. Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts By Johanna Catherine Maclean; Brendan Saloner
  31. The Affordable Care Act and Access to Care for People Changing Coverage Sources By Cara Orfield; Lauren Hula; Michael Barna; Sheila Hoag
  32. The Effect of Transtheoretic Model Based Motivational Interview on Self-Efficacy, Metabolic Control and Health Behaviour in Individuals with Type 2 Diabetes Mellitus By Alime Selçuk Tosun; Handan Zincir
  33. The Fatal Consequences of Grief By Bernhard Schmidpeter
  34. The Opinions of Adolescents about Substance Abuse and Quit Using Substance By Arzu KOÇAK UYARO; Burcu CEYLAN
  35. Tobacco grower families: an institutional analysis of their quality of life and health By Sirlei Glasenapp; Leonardo Xavier da Silva; Marcia Xavier Peiter
  36. Transitions and Continuity of Care: A Discussion of Marketplace, Medicaid, and CHIP Issuers' Decisions and Strategies By Cara Orfield; Michael Barna; Lauren Hula
  37. Variable Selection for a Categorical Varying-Coefficient Model with Identifications for Determinants of Body Mass Index By Jiti Gao; Bin Peng; Zhao Ren; Xiaohui Zhang

  1. By: Evan Borkum; Data Rotz; Anu Rangarajan
    Abstract: Findings from a rigorous randomized controlled trial of an innovative, comprehensive mHealth tool for frontline health workers (FLWs) in Bihar, India, found improvements in FLW-beneficiary interactions as well as improved health outcomes for mothers and children.
    Keywords: Frontline Health Workers, Maternal and Child Health, mHealth, India
    JEL: F Z
    Date: 2015–10–20
  2. By: Andre Chagas; Carlos Azzoni; Alexandre Almeida
    Abstract: The production of ethanol and sugar from sugarcane has sharply increased in Brazil in the last 20 years, in a process of substitution of biofuel for fossil fuels. The increase in the production and the expansion of the cultivated area might have impacts on human health and employment, especially at the regional level. So far, the harvest is basically manual, involving low-skill workers. The burning of the cane is meant to increase labor productivity and has been traditionally executed. However, the burning generates a massive quantity of smoke that spread in the region, reaching neighboring cities, thus becoming a potential threat to the human health. The objective of this paper is to measure the impact of sugarcane producing, and indirectly, the burning associated to this production, on respiratory problems. We work with a balanced panel of 644 municipalities, from 2002 to 2013. We propose to use a spatial difference-in-difference method, to control for the effect of sugarcane burning on non-producing regions in the vicinity of producing regions. We conclude that sugar cane burning significantly increases the incidence of respiratory problems in producing regions. The use of a spatial diff-in-diff model allowed us to find out that the effect on non-producing nearby regions is also significant and quantitatively relevant. We make a Monte Carlo simulation and conclude that our method is able to identify effects over non treated higher than 50%.Our empirical results suggest that the effect over non-treated region is about 3/4 of the effect on producing aereas.
    Keywords: Sugarcane Producing; Health Condition; Spatial Econometrics; Spatial Diff-in-Dif
    JEL: C14 C21 Q18
    Date: 2015–10
  3. By: Brendan Saloner (Department of Health Policy and Management, Johns Hopkins University); Yaa Akosa Antwi (Department of Economics, Indiana University - Purdue University Indianapolis); Johanna Catherine Maclean (Department of Economics, Temple University); Benjamin Lê Cook (Center for Multicultural Mental Health Research, Harvard Medical School)
    Abstract: The relationship between insurance coverage and use of substance use disorders (SUDs) treatment is not well understood. SUD treatment has long been segregated from general medical care, and has had low reliance on private insurance. We examine changes in admissions to publicly-funded, specialty SUD treatment following the implementation of a 2010 Affordable Care Act provision requiring health insurers to offer dependent coverage to young adult children. We compare admissions from the 2007-2012 Treatment Episode Data Set among targeted young adults to older adults. We find that admissions to treatment declined by 11 percent among young adults after the provision. However, the share of young adults covered by private insurance increased by 9.3 percentage points and the share with private insurance as the payment source increased by 6.5 percentage points. This increase was largely offset by decreased self-payment and payment by state and local government sources, followed by decreased Medicaid payment. Public sector providers gained new revenues from private insurers, and the share of patients paying primarily out-of-pocket decreased. Our findings suggest expansions of private insurance may not increase demand for public sector treatment but could provide important revenue for existing patients.
    Keywords: Dependent care coverage; Affordable Care Act; health insurance; substance use disorder treatment
    JEL: I13 I11 I18
    Date: 2015–09
  4. By: Rody Manuelli (Washington University in St. Louis)
    Abstract: In this paper I study a model in which the existence of a 'disease environment' influences parental investment in early childhood human capital and individual schooling and on the job training decisions. The model is used to analyze the effect of HIV/AIDS on aggregate output per worker. I use a calibrated version of the model to estimate the long run impact on output per worker of increasing life expectancy for individuals who have HIV/AIDS and reducing the rate of transmission of the disease in a subset of Sub-Saharan countries. I find that the effects on output per worker, the prevalence of the diseases and the growth rate of population can be substantial.
    Date: 2015
  5. By: Demet Akarçay (Karatay University)
    Abstract: Countries have planned and implemented welfare programs according to their income levels, viewpoints about their citizens and priorities. As one of the important part of these programs, health and healthcare services have potential developmental tendency, innovation and dynamism and also, many aims required complex and life- long learning such as efficiency, efficacy within financial, social and legal obligations in order to contribute to social system. Many institutions that create social system reveal social and economic variables and factors of individuals in the society. As considering with a holistic viewpoint, health, which is one of the main institutions in this system as stated by Parsons, expresses not only physical well- being but also social and psychological well- being. In the literature, it is accepted that social and economic factors, as assessing the facts except genetic predisposition, cause mental diseases and can lead to even death. In social system that created by human beings, the importance of health institution has been highlighted to help individuals coping with mental problems, which are also conceived by their own responses and attitudes, and emphasized as a bridge to conduct preventive interventions and make possible for society to reach a ‘quality’ life. The study was designed in the light of following doctrine as that many cross national indicators can present a framework about the countries’ viewpoints for the citizens and willingness to contribute to them. Esping Anderson made the way clear to understand the value of countries to the people, as a citizenship, social or capital means. Thus, the objective of this paper is to evaluate and compare the welfare approaches and mental health policies of the countries by way of many health indicators and social rates.
    Keywords: Welfare State, Esping Anderson’s Classification, Mental Health Policies, Human Value
    JEL: H75 I39 I30
  6. By: Li-wei Lehman; Matthew J. Johnson; Nemati, Shamim; Ryan P. Adams; Roger G. Mark
  7. By: D. Fabbri; I. Castaldini; C. Monfardini; A. Protonotari
    Abstract: Physicians are often alleged responsible for the manipulation of delivery timing. We investigate this issue in a setting that negates the influence of financial incentives behind “physician’s demand induction” but allows for “risk aversion” to medical errors and “demand for leisure” motivations. Working on a sample of women admitted at the onset of labor in a big public hospital in Italy we estimate a model for the exact time of delivery as driven by individual indication to receive Caesarean Section (CS) and covariates. We find that ICS does not affect the day of delivery but leads to a circadian rhythm in the likelihood of delivery. The pattern is consistent with the postponement of high ICS deliveries in the late night\early morning shift. Our evidence hardly supports the manipulation of timing of births as driven by medical staff’s “demand for leisure”. An explanation based on “risk aversion” attitude seems more appropriate.
    JEL: I11 L23 C35 C51
    Date: 2015–10
  8. By: Gabueva, Larisa (Russian presidental academy of national economy and public administration (RANEPA)); Pirogov, M. (Independent)
    Abstract: The rules of the federal regulatory documents are, in our opinion, the practical basis for the development of entrepreneurial projects and public-private partnerships, in accordance with which medical organizations implementing the program of state guarantees must comply with the standard-issue equipment by health care workers to enable them to perform medical services and diagnostics of certain set and quality within the approved standards of treatment of diseases (prevention, rehabilitation, etc.). Lack of targeted sources of federal and regional budgets for the resumption of the material and technical resources for the keeping the standards of care may be subject to revocation of licenses, fines inspection bodies, public complaints. In this regard, the search for alternative sources for purchasing regular equipment and (or) its financial rent (leasing) leads to the development of partnerships with private investors and the need to meet all the standard appointments of treatment entails the search forms to attract private companies to perform them.
    Keywords: healthcare, investments, innovations
    Date: 2014–07–01
  9. By: Taro Takimoto; Kazuya Sakata; Kazunori Nakajima; Masaki Narukawa; Naoki Sakamoto
    Abstract: By using a prospective, nation-wide, population-based out-of-hospital cardiac arrest (OHCA) database (All-Japan Utstein Registry, January 1, 2005 to December 31, 2012), we examined the disparity in emergency medical services across Japan and found significant disparities among prefectures. By dividing Japan into seven parts, Hasegawa et al. (2013) analysed regional variability in survival outcomes of OHCA and found a two-fold regional difference in neurologically favourable survival after OHCA. However, seven regions are constructed of North, Northeast, East, Central, Midwest, West, South, and Japan has 47 prefectures. Each prefecture grouped in the same region would be different from others in many aspects. To identify regional disparities more in prehospital care and in-hospital post-resuscitation care, we investigated survival outcomes of OHCA in prefecture levels. As the budgets of central and local governments are not unrestrained but restricted all over the world, the findings in the paper would be beneficial to consider optimal level of regional emergency medical services.
    Keywords: Emergency Medical Service; Disparity among Prefectures
    JEL: I14 C25
    Date: 2015–10
  10. By: Wiese, Rasmus; Eriksen, Steffen (Groningen University)
    Date: 2015
  11. By: Zuhrem Ergun (Selcuk University)
    Abstract: As the competition between the organizations increases, the organizations are no longer able to create differentiation in product and service that they are trying to find new ways to create difference. Abstract values become more important than material sources, in this context intangible values are much more important than anything, and the most important of these are ‘Corporate Reputation’ and ‘Service Quality’.In particular, corporate reputation is important to be addressed in health service sector. As the main point in this service is human health, how the customers perceive reputation and service quality becomes important. The frequency and content demanded from health sector is affected by the management and staff quality of organization, whether the service is reliable or not, the effectiveness of the communication in the environment and social responsibility consciousness towards society.In the light of this information, our aim is to determine whether there is a difference between the effects of corporate reputation in perceived service quality at hospitals and the perceived service quality by the customers through comparing public and private hospitals.
    Keywords: corporate reputation, service quality, perceived service quality.
    JEL: M00 I11 D41
  12. By: Karine Lamiraud (THEMA - Théorie économique, modélisation et applications - Université de Cergy Pontoise - CNRS, ESSEC - Economics Department - Essec Business School); Stephane Lhuillery (BETA - Bureau d'économie théorique et appliquée - CNRS - Université Louis Pasteur - Strasbourg I, ICN Business School - Université de Nancy)
    Abstract: Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare costs covered by basic health insurance while controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. Our results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare costs while increased availability of PTCA facilities is associated with reductions in per capita spending. Nevertheless, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies which did not control for the possible endogeneity of the availability of technologies.
    Keywords: medical research, technology change,healthcare costs
    Date: 2015–10
  13. By: Tuba Demirel (Selcuk University); Hacer Alan (Selcuk University); Sema Y (Selcuk University); Asl Karakoç Geçici (Training and Research Hospital of Konya)
    Abstract: Introduction: Breast milk is the optimum exclusive source of nutrition for the first six months of life. Both mothers and infants have got some problem about breast feeding. Brest milk important especially for premature baby who in intensive care. Method: This descriptive study aim was to evaluate of mother's knowledge and opinions about breast milk banking who were with 0-6 month-old-babies in Konya/Turkey. To calculate the sample size were used in the formula which is the number of individuals in the target group of unknown samples and found 126 but we accessed 200 mothers. Data was collected via face to face interviews and a questionnaire form which consists of demographic as well as breast milk related questions. Necessary permits were obtained both from the ethical and from mothers prior to research. Data analysis were conducted using SPSS 20 program utilizing number, percentage, mean, standard deviation and chi square tests.Results: The average age of mothers was 26.63 ± 6.18 and 42.3% graduated from elementary school. It was found that 59.5% of women had normal labor and had got avagera 2 times. 80.09% of women stated that they were willingly of their last pregnancy. 51.8% of gender the babies were boys. 21.7% of mothers couldn’t breastfeed immediately after birth and 33.6% had problems related to breastfeeding. The most common problem about breastfeeding was related the baby had been in intensive care. 98.2% of mothers said that breastfed is important for infant. 16.4% of women had got some knowledge about breastfeeding banking, 37.3% had got some information about wet nurse in Islam and 62.3% thought about that breast milk banking should be establish in Turkey. 34.1% of mother wanted to give their milk if needed to provide benefits to newborns, 35.5% didn’t want to give their milk for their religions, 67.3% said they didn’t want to get milk for newborn from a milk bank in terms of infectious diseases and they stated that to be a wet nurse (77.3%) they must get permission from their husbands.Conclusion: Most of mothers were aware of the importance of breastfeeding for babies and had expressed that breast milk banks should establish in Turkey. There are some provisions to be a wet nurse for Islam but 37.3% of mothers aware of wet nurse.
    Keywords: Breast milk, Breast milk banking, Baby Health
    JEL: I19
  14. By: Muammer Canbaz (Selcuklu Anatolian School); Sefa Lok (Selcuk University Faculty of Sport Science); Metin Sahin (Selcuk University Faculty of Sport Science); Neslihan Lok (Akdeniz University Faculty of Nursing)
    Abstract: Introduction and Aim: The importance of physical activity and exercise is increasing nowadays. Physical activity is essential for healthy individuals and healthy societies considering the benefits of it. Taekwondo is a sport that requires intense training. However, referees are not subject to the same conditions. Therefore, the aim of this study was to evaluate the relationship between the physical activity levels and quality of life of taekwondo referees.Methods:The study population consisted of taekwondo referees working in Turkey. The study sample consisted of 324 taekwondo referees who were willing to participate. Data were collected with face-to-face interviews,a socio-demographic questionnaire, the SF-36 quality of life scale and the International Physical Activity Questionnaire – Short Form. Data were analyzed using Chi-square test, Student’s t test, Mann-Whitney and Kruskal-Wallis test and Pearson’s correlation test. Results:The study found that 47% of the participants were female, their mean age was 33.28±3.35 and the average duration of working as a referee was 2.72±8:42. In terms of physical activity levels, 2.1% of the participants were inactive, 27.6%were minimally active,and 70.3% were very active. Considering the physical activity levels based on gender, the male participants were physically more active than the female ones (p<0.05). Regarding the quality of life scores of the participants, the physical health mean score was 77.5±15.2 while the mental health mean score was 77.4±19.1. There was a strong positive correlation between the participants’physical activity levels and the quality of life mean scores, a strong positive correlation was found (r=0.145, p=0.001).Conclusion:This study found that there was a strong direct relationship between the physical activity level and quality of life of the participants, and quality of life would improveas physical activity levels increased. The importance of being physically active for leading a quality life and being healthy was shown once again. The study also concluded that taekwondo refereesare physically as active as athletes.
    Keywords: Taekwondo, Physical aktivity, Quality life
  15. By: Rui Dang
    Abstract: In this paper, we decompose body mass index (BMI) differences between Turkish immigrants and Germans in West Germany for women and men. We focus on isolating the part of BMI differences that can be explained by differences in observed socioeconomic status from the part attributable to differences in coefficients. Our results reveal that female Turkish immigrants are on average more obese than female Germans; however, there exists no significant difference in obesity among males. Our results also indicate that differences in socioeconomic status between female Turkish immigrants and Germans explain significant parts of the obesity disparities between these two groups.
    Keywords: BMI disparity; Turkish immigrants in Germany; Decomposition; Quantile regression
    JEL: J15 I14 C21
    Date: 2015
  16. By: Marguerite Monnet
    Abstract: Despite their strong contribution to the overall world economic growth, gender gaps are wide in many countries in sub Saharan Africa and low representation of women in the private health sector is wider than in other sectors. While women and youth use the majority of health services both private and public, women are underrepresented as private health care providers and have limited access to financing to open their own private practices. This landscape has prompted the HNP Global Practice to take a critical look at the factors which hamper the growth of female and young private health practitioners vis a vis their male counterparts (usually older and more experienced in their profession). This assessment provides information on ways to close the gap which exists between male private service providers and female providers as well as recommends ways in which the existing gaps can be addressed. The assessment also provides the basis for further developing a strong public- private dialogue in health while providing avenues for building capacities for women to fully contribute to the development of the private health sector through the development of training module to be administered in private training schools as a pilot in Burkina Faso and Mali.
    Keywords: health care providers, birth, risks, specialist, socialization, physician, physiotherapists, financing, abuse, midwifery, pharmacists, donor, deaths, psychology, laws ... See More + doctors, sexes, health education, community health, discrimination, mothers, health care, infertility, death, health, health professionals, dentistry, gender perspective, environmental health, personal information, public health, health sector, knowledge, disabilities, youths, maternity leave, workplace, pregnancies, immunization, patient, patients, intervention, secondary schools, specialists, double burden, migration, nurses, health management, observation, access to health services, health professional, gender norms, male, gender inequalities, mortality rate, extended families, genital mutilation, interview, gender issues, mental health, mortality, general practice, midwife, medical doctor, workers, doctor, health care provision, gender differences, nurse, woman, lifestyle, sex-disaggregated data, care, gender, medicine, health outcomes, health training, victims, personal life, dental health, stress, dentists, youth, decision making, nutrition, mother, workshops, pharmacist, masculinity, health policies, internet, sex, health care professionals, weight, physicians, sexual harassment, children, genders, females, clinics, working conditions, father, gender analysis, midwives, general practitioners, donors, therapists, population, medical doctors, risk-taking, strategy, males, siblings, registration, families, child health services, women, medicines, hospitals, dentist, mutilation, gender roles, cultural factors, health service, female, dental assistants, health services, implementation, male health, nursing, nursing homes
    Date: 2015–05
  17. By: Johanna Catherine Maclean (Department of Economics, Temple University); Ioana Popovici (Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University); Elisheva Stern (Department of Economics, Temple University)
    Abstract: We examine how substance use disorder (SUD) treatment providers respond to private health insurance expansions induced by state parity laws for SUD treatment. We use data on the near universe of specialty SUD treatment providers in the United States 1997-2009. During this period, 16 states implemented SUD parity laws. Our findings suggest that admissions and client volumes increase following parity law passage, treatment shifts to less intensive settings, and quality is unchanged. Providers alter the type of payment they accept and patients they admit. We find no evidence that SUD parity laws improve public health, proxied by overdose deaths.
    Keywords: healthcare; provider behavior; substance use disorders; health insurance mandates
    JEL: I1 I11 I18
    Date: 2015–09
  18. By: James D. Reschovsky; Eugene Rich
    Abstract: An important goal of the Affordable Care Act is to transform the US health care system from one characterized by high costs, poor quality, and fragmented care to one focused on comprehensive, coordinated, and efficient care.
    Keywords: Hospital acquisition, physician groups, health care costs
    JEL: I
    Date: 2015–10–19
  19. By: Marina Van Geenhuizen; Sander Faber
    Abstract: The Netherlands can be seen as one of the best healthcare systems in Europe. However, ICT application in hospitals in this country is somewhat behind the Nordic countries, with many hospitals ?stuck? in the stage of search and ?being interested? without a subsequent move to testing and actual implementation. This situation contradicts the expected gains of ICT use in making healthcare more effective and efficient, and making it less expensive, and is difficult to understand given the fact that eHealth has been on the European Commission Information Society?s policy agenda for more than a decade. With respect to Europe, there is a considerable variability in adoption levels, with Nordic countries like Finland, Sweden, Denmark and Estonia at the highest level of adoption and countries in Eastern Europe and Greece staying behind at the lowest level. To better understand these differences, we develop a model of organizational adoption of ICT in hospitals and explore this model using a database of 30 hospitals in the Netherlands. Some of the factors in the model inhibit characteristics that could be different between countries, in terms of finance (budgets), overall ICT use and national culture. In the empirical part, we test the validity of some constructs and use structural equation modeling. Not surprisingly, size of the hospital plays a role, while organizational readiness and support of the top management of the hospital have an important influence as well, partially directly and indirectly. Outcomes of the analysis also include non-linear influences on adoption and potentially reversed causality in particular stages of the adoption process. The study provides the following new elements: a more detailed look at adoption (more stages compared to previous research), design and testing of various constructs concerning adoption, exploration of an extended TOE (technological, organizational and environmental) framework in a hospital setting, and use of a specific PLS-SEM to identify non-linear relations in a relatively small sample. The paper concludes with a summary of interpretations and with some suggestions for improvement of eHealth policies, given the influence of hospital size, organizational readiness and management support on ICT adoption, and a different national context within Europe.
    Keywords: ICT; adoption; hospitals; readiness; management; The Netherlands; Europe
    JEL: D83 I18 O32
    Date: 2015–10
  20. By: Hansen, Casper Worm; Strulik, Holger
    Abstract: This paper exploits the unexpected decline of deaths from cardiovascular diseases since the 1970s as a large positive health shock that affected predominantly old-age mortality; i.e., the fourth stage of the epidemiological transition. Using a differences-in-differences estimation strategy, we find that U.S. states with higher levels of cardiovascular-disease mortality prior the 1970s experienced greater increases in adultlife expectancy and higher education enrollment. Our estimates suggest that the cardiovascular revolution caused an increase in life expectancy of 1.5 years and an increase in education enrollment of 9 percentage points, i.e. 52 percent of the observed increase from 1960 to 2000.
    Keywords: adult life expectancy,higher education,cardiovascular diseases,differences-in-differences strategy
    JEL: I15 J24 N30 O10 O40
    Date: 2015
  21. By: Tia Palermo; UNICEF Office of Research - Innocenti
    Abstract: During the past decade, over a dozen government-run cash transfer programmes have been launched in sub-Saharan Africa, and there is growing evidence of their ability to improve a range of development outcomes. Comparing longitudinal data in four focus countries, this paper looks at a variety of emotional and physical aspects of young people’s development during their transition to adulthood.
    Date: 2015
  22. By: Eugene Rich; Ann O'Malley
    Abstract: Numerous studies have confirmed the central role of excellent primary care to any health system. Yet how to define the presence of excellent primary care remains a challenge.
    Keywords: Primary Care, health system, comprehensive care, coordinated care
    JEL: I
    Date: 2015–10–06
  23. By: Abdullah Kilci (Selcuk University Health Sciences Institute); Sefa Lok (Selcuk University Faculty of Sport Medicine)
    Abstract: Introduction and Aim: There has been a dramatic increase in the use of doping agents today. Used by athletes to increase strength, endurance and speed, AAS lead to various negative effects on the human body despite enhancing performance and strength. The purpose of this study was to investigate the morphometric effects of testosterone supplementation on certain extremity bones in young swim-trained rats.Methods: The study was conducted with a total of 24 30-day-old male Wistar rats obtained from Selcuk University Experimental Medicine Research and Application Center. The rats were divided into four equal groups of six: control (C), exercise (E), testosterone (T) and testosterone+exercise (TE) groups. The appropriate weekly dose was adjusted for the rats in the testosterone-treated group according to their body weights. The front and rear extremity bones of the materials were dissected and the uncovered humerus and femur bones were dried. The length, corpus thickness, cortex cortical thickness and medulla diameter points of each bone were determined and the morphometric measurements were taken. The results were presented as Mean±SD. Data were analyzed through comparison between the groups by using ANOVA and Duncan test. The significance level was set at P<0.05.Results: The femur and humerus lengths of the TE, T, E, and C groups were compared and the respective lengths were femur; 32.24±1.04 for the C group, 32.23±0.28 for the E group, 31.12 for the TE group and 30.72±30.93 for the T group, humerus; 25,74±0,77 for the C group, 25,66±0,25 fot the E group, 24,68±0,53 for the TE group and 24,58±0,41 for the T group. The femur and humerus bones of the rats in the groups given testosterone supplementation (TE and T) were significantly shorter than those of the rats in the other two groups (p<0.05). However, there were not any statistical differences among the TE, T, E, and C groups in terms of cortex, corpus and medullary diameter measurements of the femur and humerus bones (of p>0.05).Conclusion: The results of the study showed that testosterone supplementation stopped the growth of femur and humerus by causing premature epiphyseal closure in them. Also, even exercise did not reduce the adverse effects of testosterone supplementation. Although some athletes think that prohibited agents used as AAS affect performance positively, these agents should not be used because of their adverse effects on athletes’ health and because they are against sports ethics.
    Keywords: Testosterone, Exercise, Femur, Humerus
  24. By: Apouey, B.H.;; Geoffard, P-Y.;
    Abstract: This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991-2010 period, we examine the existence of inequalities in maternal and paternal education and child reported body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents’ education – maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents’ education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birthto age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight.
    Keywords: children; BMI-for-age z-score; body weight; overweight; socioeconomic status; education;
    JEL: I12
    Date: 2015–10
    Abstract: INTRODUCTION Compared with other health professionals, a psychiatric nurse builds a greater degree of communication with individuals who have psychiatric disorders during the period of hospitalization. In this context, the main objective of this study is to illustrate the opinions and suggestions of psychiatric nurses about stigmatization of schizophrenia. Problem Statement1-What do the psychiatric nurses think about stigmatization of schizophrenia? 2-What do the psychiatric nurses think about the prevention of stigmatization of schizophrenia? MATERIALS AND METHODOLOGY In pursuit of the objective of this qualitative study, the author asked open-ended questions of 15 nurses who worked in a psychiatry clinic in a hospital in Turkey. A semi-structured form was used for these participants to put forward their suggestions and opinions about stigmatization for schizophrenia. FINDINGSAn analysis of the data set revealed that a majority of the participants described schizophrenia as a disorder characterized by a change in the perception of reality, and all of them said that the diagnosis of schizophrenia played an important role in the period of stigmatization. Moreover, they added that the period of stigmatization initiated with the diagnosis of schizophrenia. Nearly all of the nurses who participated in this study agreed that training was important in the struggle against stigmatization of schizophrenia, and it was necessary for this training to address families, society, and health professionals. In addition, it was stressed that the media's power over attitudes in society should be used positively in this struggle, and that schizophrenia patients should be treated in an integrated manner with the society. Another noteworthy finding was that two participants thought that whatever is attempted, the struggle with stigmatization of schizophrenia is impossible; the most significant reason for that being the societally stereotyped negative thoughts and prejudices towards these patients.RESULTS AND SUGGESTIONS This study concluded that it is not a realistic expectation to completely eliminate the stigmatization of schizophrenia, and that it would take a very long time to change attitudes. It should be the main aim of work against stigmatization to change incorrect judgments. To this end, programs focused on developing consciousness in families, society, and health professionals are very important.1.Instructors review the curricula of nursing programs,2.Clinicians prepare plans for in-service training, and3.Researchers conduct experimental studies and evaluate the results of these studies.
    Keywords: Stigmatization, shizophrenia, psychiatric nursing
    JEL: I10
  26. By: Elaine Kelly (Institute for Fiscal Studies and Institute for Fiscal Studies); George Stoye (Institute for Fiscal Studies and Institute for Fiscal Studies); Marcos Vera-Hernandez (Institute for Fiscal Studies and University College London)
    Abstract: Health spending per capita in England has more than doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the lifecycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after age 70. Spending is highly concentrated in a small section of the population: with 32% of all hospital spending accounted for by 1% of the general population, and 18% of spending by 1% of all patients. There is persistence in spending over time with patients with high spending more likely to have spending in subsequent years, and those with zero expenditures more likely to remain out of hospital.
    Keywords: Health; public spending; hospitals
    JEL: H51 I10 I11
    Date: 2015–08
  27. By: Miki Miyaki (Rikkyo University, College of Business)
    Abstract: With the social demand for childcare service diversifying and local governments becoming increasingly cash-strapped, the proportion of public nursery schools in the childcare sector has been shrinking in recent years. The funding reforms of 2004, which abolished the national subsidy to public nursery schools, are seen as one of the triggers of this phenomenon. Using a panel dataset of 983 municipalities across the nation, this paper investigates the impact of the reforms on the operating costs of public nursery schools. We found that different municipalities responded differently to the reforms. In areas with relatively large populations, fiscally stronger municipalities were likely to spend less on public nursery schools in the wake of the reforms, while municipalities in smaller cities spent more. Besides, municipalities that were not compensated for the loss of the national subsidy reduced expenditures in large cities. In small cities, on the other hand, such municipalities actually increased expenditures.
    Keywords: operating cost, public nursery school, funding reform, difference-in-differences approach
    JEL: H71 H75 H77
    Date: 2015–10
  28. By: Noora Montonen (Laurea University of Applied Sciences); Hanna Tuohimaa (Laurea University on Applied Sciences); Liisa Ranta (Laurea University of Applied Sciences); Minna Luoto (Federation of Municipalities, Karviainen)
    Abstract: Health promotion is seen as an important part of health care in Finland. However, at the same time, limited resources hinder the possibilities to develop health promoting measures on the local level, in municipalities and in health centres offering primary health services for local residents. In this paper, an example is given of how a local university of applied sciences and its students can work as enablers of health promotion in collaboration with regional health service providers. When working in real-life development projects, the students gain experience at the same time as the health care sector and the local residents benefit from the end results, providing a win-win situation for all parties. A case in point is the development process of two Self-Care Stations in two municipalities in the western Uusimaa region in southern Finland, in the municipalities of Karkkila and Vihti. The Self-Care Stations are easy-access services for giving opportunities to monitor one’s health and get information by oneself, at a suitable time, in order to take more responsibility for the self-management of one’ own health. At the same time, Self Care Stations relieve the nurses’ time from blood pressure measurements to be devoted to life-style counselling. The Self Care Stations have proven to be an important part of the service palette of the health centres. According to the feedback, the Self Care Stations in Karkkila and Vihti have succeeded in raising the clients' awareness of their own health and their own possibilities to have an influence on it. The Self Care Station piloting presented in this paper has been transformed into an ongoing service.
    Keywords: collaboration, health promotion, self care, self care station, student project
  29. By: Zelalem Yilma (Erasmus University Rotterdam); Owen O’Donnell (Erasmus University Rotterdam); Anagaw Mebratie (Erasmus University Rotterdam); Getnet Alemu (Addis Ababa University, Ethiopia); Arjun S. Bedi (Erasmus University Rotterdam, the Netherlands)
    Abstract: Little is known about perceptions of medical expenditure risks despite their presumed relevance to health insurance demand. This paper reports on a unique elicitation of subjective probabilities of medical expenditures from rural Ethiopians who are offered the opportunity to purchase health insurance. We find that expectations are positively correlated with past expenses to a degree that exceeds the serial correlation in realized expenditures, suggesting overestimation of persistence and underestimation of the potential gains from insurance. Despite the fact that forecast expenditures do predict realized expenditures to some extent, there is no evidence that expectations influence the decision to take out health insurance, although plans to insure are positively related to the perceived dispersion of medical expenses.
    Keywords: Subjective probability; medical expenditure; out-of-pocket payments; adverse selection; health insurance; Ethiopia
    JEL: D82 D84 I13 O12
    Date: 2015–10–26
  30. By: Johanna Catherine Maclean (Department of Economics, Temple University); Brendan Saloner (Department of Health Policy and Management, Johns Hopkins University)
    Abstract: Major expansions of health insurance coverage provide new revenue opportunities for safety-net providers, but may also create new capacity pressures for these providers. We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment - a type of safety net healthcare – providers' behaviors using a differences-in-differences design. We test whether the reform influenced admissions, daily censuses (the number of clients in treatment on a given day), services offered, and accepted forms of payment. Our findings suggest that Massachusetts providers altered their care practices following the reform. Admissions increased by 17.1% and daily censuses increased by 4.7%. The number of services offered increased by 3.5%, programs for special populations decreased by 24.1%, and use of pharmacotherapies increased by 11.3%. Massachusetts providers increased acceptance of private insurance increased by 2.7%. We find that such providers were less likely to accept self-pay (1.7%) and provide uncompensated care (1.4%). Responsiveness was generally greater for for-profit than nonprofit providers. These findings suggest that, following major healthcare reform, Massachusetts SUD treatment providers absorbed a larger number of individuals seeking treatment, but effects on quality of care were somewhat mixed and individuals without insurance may have experienced difficulty in accessing care.
    Keywords: healthcare; safety net; provider behavior; substance use disorders; healthcare reform
    JEL: I1 I11 I18
    Date: 2015–09
  31. By: Cara Orfield; Lauren Hula; Michael Barna; Sheila Hoag
    Abstract: As the Patient Protection and Affordable Care Act ushers in a new era in health care coverage and delivery, significant changes to the health insurance landscape have personal implications for individuals whose insurance options change.
    Keywords: Affordable Care Act, Access to care, Coverage Sources
    JEL: I
    Date: 2015–11–01
  32. By: Alime Selçuk Tosun (Health Science Faculty/Selcuk University); Handan Zincir (Health Science Faculty/Erciyes University)
    Abstract: This study was conducted to determine the effect of Transtheoretic Model based motivational interview on self-efficacy, metabolic control and health behaviour in individuals with Type 2 Diabetes Mellitus.This randomized controlled and single-blind study was conducted with totally 50 individuals, being 25 in the intervention group and 25 in the control group who applied to Erciyes University Faculty of Medicine Endocrinology and Metabolism outpatient clinic between the dates of January 8th and November 18th in 2014. Ethical approval from the Ethics Committee of Clinical Researches and written informed consent from the participants were obtained. Data were collected using Self-Efficacy Scale in Type 2 Diabetics, Metabolic Control Follow-Up Schedule, Blood Sugar Follow-Up Form, Medication Use Follow-Up Schedule, Walking Follow-Up Schedule, Food Consumption Record Form and Behaviour Change Stage Diagnostic Form in Individuals with Type 2 Diabetes Mellitus. Interviews were carried out once a month or once in 15 days for a period of 30-45 minutes when they were suitable. By the end of the study, 9.12±1.20 motivational interviews on average were held. Data were analysed with Independent Samples t test for normal distributed variables; Mann-Whitney U and Wilcoxon test for non-normally distributed variables. Chi-square test was used for comparing categorical variables. p<0.05 was set as statistically significant. It was found at the end of the study that self-efficacy score and the number of steps increased and metabolic parameters (fasting blood glucose, HbA1c, body weight, body mass index, waist circumference, blood pressure, blood lipids (except for HDL-C)) decreased on the sixth month compared to the first follow-up in the intervention group. The differences between follow-ups were significant (except for HDL-C) (p<0.05) while the difference in self-efficacy, fasting blood glucose, postprandial blood glucose, HbA1c, body weight, body mass index, waist circumference were significant compared to the control group except for blood pressure and blood lipids (p<0.05). It was determined that an increase was provided in the number of individuals who are in the action phase for nutrition, exercise and medication use which was significantly different compared to the control group (p<0.05).It was determined that Transtheoretic Model based motivational interview increased the level of self-efficacy, improved metabolic parameters and a progress was made in the nutrition, exercise and medication use behaviour stages within six months in the individuals with Type 2 Diabetes Mellitus.
    Keywords: Type 2 Diabetes Mellitus; Transtheoretic Model; Motivational interview; Self-efficacy; Behavioural change.
  33. By: Bernhard Schmidpeter
    Abstract: In this paper we investigate the effect of stress on the survival probability using a child’s death as the triggering event. Employing a propensity score weighted Kaplan-Meier estimator, we are able to explore the associated time pattern of grief without imposing assumptions on the underlying duration process. We find a non-monotonic relationship between time and relative survival rates: decreasing for 13 years after the event and slowly reversing afterward. However, even 19 years after the event bereaved parents have significantly lower survival probabilities compared to the hypothetical case, that the event had not occurred. Investigating the main reason for this development, our results indicate that bereaved parents have a higher probability of dying from natural causes, especially circulatory diseases. Interestingly, our results reveal that bereavement has a stronger impact on fathers, while we find only modest evidence for mothers. This is a novel and surprising finding as males are in general regarded as more stress resilient than females. However, this research shows that this perception is not true.
    Keywords: Bereavement, Child death, Death, Adjusted Kaplan Meier
    JEL: I12 J14 C41
    Date: 2015–09
  34. By: Arzu KOÇAK UYARO (Graduate School of Health Sciences); Burcu CEYLAN (Graduate School of Health Sciences)
    Abstract: Substance abuse which has biological,social and spiritual dimensions is a major problem affecting the whole community,especially young people.It seems to start at a young age the addiction and the rate of substance abuse is higher in young age in the world and in our country .In this study, it aimed to determine the opinions of adolescents about substance abuse and non-abuse of substance and quit using substance. Designed on the model of appropriate qualitative research of this study was conducted with AMATEM hospitalized in the clinical adolescents and adolescents who had never met substances. Data were collected using semi-structured interview form,encoding is used and were analyzed using data reduction method by the investigators with 20 individuals who accepted to participate. When the data set analyzed; it is seen that dependent adolescents defined the addiction as a habit with no barriers, friend and associated with substance deprivation crisis. Peer influence and domestic problems were also identified as the main cause of the addiction. If those are non-dependent adolescents have described the addiction mostly as to get away from problems and associated with early death. They also stated that the addiction is due to the emulation and curiosity. All participants emphasized that the basic factor for cessation of the addiction is self control and cessation responsibility belongs to dependent person but in long-term substance use is too hard to cessation. It is seen that dependent adolescents stated that the treatment is espacially difficult because of substance deprivation crisis while all of non-dependent adolescents expressed that addiction can be treated. At the same time, all participants conceived that services related to the treatment of the substance abuse should be continuously and free, both the adolescents and the family-oriented training should continue in the post treatment and increasing leisure time activities is important during the treatment process. As a result, the perceptions about substance abuse and addiction process of dependent and non-dependent adolescents are made difference. Contunity of treatment services,education programs appear to be similar to the views on the holistic approach. In this regard it is important to offer a holistic approach to treatment services and after the treatment, supporting the adolescent and family with periodic monitoring traning programs.
    Keywords: Adolescence, substance abuse, quit substance
    JEL: I10
  35. By: Sirlei Glasenapp; Leonardo Xavier da Silva; Marcia Xavier Peiter
    Abstract: The health of both farmers and consumers of tobacco has attracted the attention of international organizations. The Framework Convention of Tobacco Control (FCTC), in its article 18, emphasizes the responsibility of countries with respect to protection of the environment and human health in the tobacco production process, since its cultivation brings serious risks to the environment and the health of farmers. Tobacco has established itself as one of the main agricultural products grown in the central region of Rio Grande do Sul, Brazil. The production structure is made up mostly of small family farms with intensive use of labor of work and has in tobacco plants the main source of income. The purpose of the article is to identify the risks to which tobacco farming families are exposed and consequences on quality of life and health of workers in the rural areas. In research conducted by Lecours (2011), there is a series of impacts on tobacco farmer's health, the main risks associated with tobacco growing: the disease of green leaf, pesticide exposure, respiratory problems, and musculoskeletal injuries and skin diseases. The research is characterized as qualitative and descriptive and the data collection was carried out through field research, through semi-structured interviews and participant observation with producer families of tobacco, in the municipalities of Agudo and Paraíso do Sul. It can be seen that there are eminent risks highlighted in the literature on health of tobacco farmers, symptoms of green leaf disease were highlighted by most families, besides the exposure to pesticides. It is noticed that the FCTC controls are still weak and do not look to the risks of tobacco in the first link in the chain, which are the families that produce it.
    Keywords: Tobacco; health; families.
    JEL: I19
    Date: 2015–10
  36. By: Cara Orfield; Michael Barna; Lauren Hula
    Abstract: This report is the second in a two-part study aimed at learning more about how easily individuals can maintain their primary care physicians as they transition across programs. In this report, we explore in more depth the reasons behind issuer decisions on program participation and provider network design, how they respond to and perceive the federal and state regulatory framework in which they operate, and major lessons learned during the first open enrollment period.
    Keywords: Continuity of care, Affordable Care Act, Medicaid/CHIP coverage, access to care
    JEL: I
    Date: 2014–11–03
  37. By: Jiti Gao; Bin Peng; Zhao Ren; Xiaohui Zhang
    Abstract: In this paper, we propose a variable selection procedure based on the shrinkage estimation technique for a categorical varying-coefficient model. We apply the method to identify the relevant determinants for body mass index (BMI) from a large amount of potential factors proposed in the multidisciplinary literature, using data from the 2013 National Health Interview Survey in the United States. We quantify the varying impacts of the relevant determinants of BMI across demographic groups.
    Keywords: ody Mass Index; Obesity; Varying-Coefficient; Variable Selection
    JEL: C13 C14 I15
    Date: 2015

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