nep-hea New Economics Papers
on Health Economics
Issue of 2015‒11‒15
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Approaches to Reducing Federal Spending on Military Health Care By Congressional Budget Office
  2. Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014 By Congressional Budget Office
  3. Competition and the Cost of Medicare’s Prescription Drug Program By Congressional Budget Office
  4. How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget By Congressional Budget Office
  5. Comparing the Costs of the Veterans' Health Care System with Private-Sector Costs By Congressional Budget Office
  6. Budgetary and Economic Effects of Repealing the Affordable Care Act By Congressional Budget Office
  7. Long-Run Health Effects of Sports And Exercise In Canada By Nazmi Sari; Michael Lechner
  8. Healthcare: how competition can improve management quality and save lives By Nicholas Bloom; John Van Reenen
  9. Endogenous Technology Adoption and Medical Costs By Lamiraud, Karine; Lhuillery, Stephane
  10. HIV and Rational risky behaviors: a systematic review of published empirical literature (1990-2013) By Marlène Guillon; Josselin Thuilliez
  11. An Economic Model of the Stages of Addictive Consumption By Marysia Ogrodnik
  12. Parents' education and child body weight in France: The trajectory of the gradient in the early years By Bénédicte H. Apouey; Pierre-Yves Geoffard
  13. Overconfidence and Health Insurance Participation among the Elderly By Huang, Wei; Luo, Mi
  14. Job Loss, Firm‐Level Heterogeneity and Mortality: Evidence from Administrative Data By Bloemen, Hans; Hochguertel, Stefan; Zweerink, Jochem
  15. Education, Health and Fertility of UK Immigrants: The Role of English Language Skills By Aoki, Yu; Santiago, Lualhati
  16. Electronic Health Record Adoption in US Hospitals: Progress Continues, But Challenges Persist By Julia Adler-Milstein; Catherine M. DesRoches; Peter Kralovec; Gregory Foster; Chantal Worzala; Dustin Charles; Talisha Searcy; Ashish K. Jha
  17. Development of Quality Measures for Inpatient Psychiatric Facilities: Final Report By Randall Blair; Junqing Liu; Miriam Rosenau; Michael Brannan; Natalie Hazelwood; Kelsey Farson Gray; Jonathan Brown; Eric Morris; Alyssa Hart; Kenneth Jackson; Angela Schmitt; Katherine Sobel; Mary Barton; Milesh Patel; Allison Siegwarth; Xiao Barry; Stephanie Rodriguez
  18. Midpoint Evaluation of Oregon's Medicaid Section 1115 Demonstration: Mid-2012 through Mid-2014 By Carol V. Irvin; JudyAnn Bigby; Vivian Byrd; Michael Barna; Suzie Witmer; Maureen Higgins
  19. Socioeconomic Status and PhysiciansíTreatment Decisions By Kurt R. Brekke; Tor Helge Holmäs; Karin Monstad; Odd Rune Straume
  20. Does Reference Pricing Drive Out Generic Competition in Pharmaceutical Markets? Evidence from a Policy Reform By Kurt R. Brekke; Chiara Canta; Odd Rune StraumeAuthor-Email: o.r.straume@eeg.uminho.p
  21. Do Treatment Decisions Depend on Physicians` Financial Incentives? By Kurt R. Brekke; Tor Helge Holmäs; Karin Monstad; Odd Rune StraumeAuthor-Email: o.r.straume@eeg.uminho.p
  22. Body Weight, Dieting and Obesity Traps By Barbieri, Paolo Nicola
  23. New Health Technologies and Health Workforce in Developing Economies By Driouchi, Ahmed
  24. The “Costs” of Informal Care: An Analysis of the Impact of Elderly Care on Caregivers' Subjective Well-being in Japan By Niimi, Yoko
  25. Measuring progress towards universal health coverage: with an application to 24 developing countries By Wagstaff,Adam; Cotlear,Daniel; Eozenou,Patrick Hoang-Vu; Buisman,Leander Robert
  26. Caesarean section and the manipulation of exact delivery time By Fabbri, D.;; Monfardini, C.;; Castaldini, I.;; Protonotari, A.;
  27. The health hump By Strulik, Holger

  1. By: Congressional Budget Office
    Abstract: The health care benefits provided to military service members, retirees, and their families are more generous than those generally provided through private or employment-based health insurance. Between 2000 and 2012, the cost of providing military health care increased by 130 percent (after adjusting for inflation). This report examines some options for constraining those costs. The largest savings would come from increasing cost sharing for military retirees.
    Date: 2014–01–16
  2. By: Congressional Budget Office
    Abstract: CBO and the staff of the Joint Committee on Taxation have lowered their estimates of the net federal cost of the ACA’s insurance coverage provisions. As reflected in CBO’s April 2014 baseline, the agencies now project a cost of $36 billion for 2014, $5 billion less than the projection made in February; and close to $1.4 trillion for the 2015–2024 period, about $100 billion less than the February projection.
    JEL: I10 I11 I13 I18 I38
    Date: 2014–04–14
  3. By: Congressional Budget Office
    Abstract: Spending for Medicare's prescription drug program (Part D) was $50 billion in 2013—about 50 percent less than CBO projected when the program was created. Lower growth rates in national drug spending and lower-than-expected enrollment primarily account for the difference. The competitive design of Part D has also constrained spending. CBO found that spending was lower in years when, and in areas of the country where, more plan sponsors competed for beneficiaries.
    JEL: I10 I11 I13 I18 I38
    Date: 2014–07–30
  4. By: Congressional Budget Office
    Abstract: Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the budgetary effects of legislative proposals to reduce fraud in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), and how those estimates are used in the Congressional budget process. What Is Fraud? For the purposes of this report, fraud is considered to be any deliberate attempt to use deception to receive a service or payment from Medicare, Medicaid, or the Children’s Health Insurance Program when the
    JEL: H60 I13 I18 K42
    Date: 2014–10–20
  5. By: Congressional Budget Office
    Abstract: Legislation enacted in 2014 calls for the Veterans Health Administration (VHA) to expand the availability of health care to eligible veterans. The structure of VHA and published studies suggest that VHA care has been less expensive than care provided by the private sector. However, limited evidence and substantial uncertainty make it difficult to reach firm conclusions about whether it would be cheaper to expand veterans' access to health care in the future through VHA facilities or the private sector.
    JEL: I13 I18
    Date: 2014–12–10
  6. By: Congressional Budget Office
    Abstract: CBO and the staff of the Joint Committee on Taxation have analyzed the main budgetary and economic effects of repealing the Affordable Care Act and concluded that doing so would probably increase federal deficits over the next decade, whether or not macroeconomic feedback to the budget is included. Such feedback would reduce deficits, but would not offset the increases in deficits stemming from the other effects of repealing the ACA.
    JEL: H20 H40 I11 I13 I18
    Date: 2015–06–19
  7. By: Nazmi Sari; Michael Lechner
    Abstract: Even though insufficient participation in physical activity is shown to be one of the major contributors to chronic diseases, and poor health, participation in physical activity still remains to be substantially low in developed countries including Canada. In this paper, we examine the long-run health effects of participation in sports and exercise among inactive Canadian adults. Based on informative Canadian panel data and semiparametric matching estimation, we show that participation in sports and exercise generally improves physical health and mental well-being of individuals. While this effect is statistically significant and persistent for men, we do not find a similar effect for women. Our results also indicate that positive health effects are only achieved with a level of physical activity that is larger than the current national and international health organizations' guidelines for the minimum level of activity.
    Keywords: physical activity, sports, exercise, subjective health, mental health, treatment effect
    JEL: I12 I18 L83 C21 C23
    Date: 2015–11
  8. By: Nicholas Bloom; John Van Reenen
    Abstract: NHS hospitals in England are rarely closed in constituencies where the governing party has a slender majority. This means that for near random reasons, those parts of the country have more competition in healthcare - which has allowed Nicholas Bloom and John Van Reenen to assess its impact on management quality and clinical performance.
    Keywords: management, hospitals, competition, productivity
    Date: 2015–11
  9. By: Lamiraud, Karine (ESSEC et THEMA (Université de Cergy Pontoise)); Lhuillery, Stephane (BETA (UMR-CNRS 7522) and ICN Business School, Nancy, France)
    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: healthcare costs; technology change; medical research
    JEL: D60 I10 O30
    Date: 2015–11–06
  10. By: Marlène Guillon (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS)
    Abstract: Risky health behaviors have the negative effect – negative externality – of the individual being able to spread the disease to others. They thus represent a threat for the society and a tragedy for public health. The objective of this study is to inquire into the nature, extent and strength of the evidence for such risky behaviors for HIV/AIDS from an economic perspective. We aim at investigating the concept of risk or prevalence-elasticity of health behaviors in the case of HIV. We did an exhaustive review of published articles in French and English indexed in the databases PubMed, ScienceDirect and Jstor between 1 January 1990 to 31 December 2013. We searched for publications empirically investigating the risk or prevalence-elasticity of behaviors in the case of HIV/AIDS and performed a bibliometric and descriptive analysis of the dataset. Of the 12,545 articles that were screened, 189 (1.5%) full-text publications studied the risk-elasticity of health behaviors that are related to HIV/AIDS. Of these 189 articles, 167 (88.4%) were quantitative studies that empirically estimated the risk-elasticity, and 22 (11.6%) were qualitative studies. We found that 55.7% of the quantitative studies included at least a correlation between HIV risk and health behaviors that supports the concept of risk or prevalence-elasticity. Moreover, we identified articles that address the reverse causality problem between HIV risk and health behaviors, by using indirect HIV risk measures, to demonstrate the existence of a responsiveness of risk/preventive behaviors to HIV risk. Finally, an in-depth analysis showed seven out of ten articles using an objective measure of risk for HIV/AIDS gave strong support to prevalence-elasticity. However, only one of the ten articles established a direct measure of prevalence-elasticity while appropriately dealing with the reverse causation problem between objective HIV risk and preventive/risk behaviors. These results stress out the need to carefully monitor programs of risk behaviors' surveillance in the context of HIV becoming chronic, especially in sub-Saharan Africa where large scale HIV treatment policies are being implemented. More evidence is needed on the strength of rational risky behaviors to maximize the public health and economic impact of large scale HIV treatment or preventive policies. With this purpose, epidemiological surveillance programs could be paired with specific behavioral surveillance programs to better inform policy makers.
    Keywords: HIV,Economic epidemiology,Prevalence-elasticity
    Date: 2015–08
  11. By: Marysia Ogrodnik (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS)
    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
    Date: 2015–10
  12. By: Bénédicte H. Apouey (PSE - Paris-Jourdan Sciences Economiques - CNRS - Institut national de la recherche agronomique (INRA) - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics); Pierre-Yves Geoffard (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics, PSE - Paris-Jourdan Sciences Economiques - CNRS - Institut national de la recherche agronomique (INRA) - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC))
    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 birth to 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: Socioeconomic Status,Body Weight,Overweight,Children,BMI-for-age z-score,Education
    Date: 2015–11
  13. By: Huang, Wei (Harvard University); Luo, Mi (New York University)
    Abstract: People may have imperfect information about their health status and thus make suboptimal decisions in insurance participation. Using national representative samples of the elderly in US and China, we find that people with lower socio-economic status and poorer health are relatively less likely to realize how unhealthy they are and this overconfidence is associated with no insurance participation. Accurate health information provided through physical examinations induces relatively higher participation among the overconfident people afterwards. These findings contribute a new explanation for the insufficient participation and advantageous selection in health insurance, and provide new insights on the insurance market and policy suggestions.
    Keywords: overconfidence, health, health insurance participation
    JEL: I12 I13 J14
    Date: 2015–11
  14. By: Bloemen, Hans (VU University Amsterdam); Hochguertel, Stefan (VU University Amsterdam); Zweerink, Jochem (VU University Amsterdam)
    Abstract: This paper estimates the effect of job loss on mortality for older male workers with strong labor force attachment. Using Dutch administrative data, we find that job loss due to sudden firm closure increased the probability to die within five years by a sizable 0.60 percentage points. Importantly, this effect is estimated using a model that controls for firm‐level worker characteristics, such as firm‐level average mortality rates for mortality during the four years prior to the year of observation. On the mechanism driving the effect of job loss on mortality, we provide evidence for an effect running through stress and changes in life style.
    Keywords: job loss, mortality, treatment effect
    JEL: C21 I10 J63
    Date: 2015–11
  15. By: Aoki, Yu (University of Aberdeen); Santiago, Lualhati (Office for National Statistics, UK)
    Abstract: This paper aims to identify the causal effect of English language skills on education, health and fertility outcomes of immigrants in England and Wales. We construct an instrument for language skills using age at arrival in the United Kingdom, exploiting the fact that young children learn languages more easily than older children and adults. Using a unique individual-level dataset that links 2011 census data to life event records for the population living in England and Wales, we find that better English language skills significantly lower the probability of having no qualifications and raise that of obtaining academic degrees, but do not affect child health and self-reported adult health. The impact of language on fertility outcomes is also considerable: Better English skills significantly delay the age at which a woman has her first child, lower the likelihood of becoming a teenage mother, and decrease fertility.
    Keywords: language skills, education, health, fertility
    JEL: I10 I20 J13
    Date: 2015–11
  16. By: Julia Adler-Milstein; Catherine M. DesRoches; Peter Kralovec; Gregory Foster; Chantal Worzala; Dustin Charles; Talisha Searcy; Ashish K. Jha
    Abstract: Achieving nationwide adoption of electronic health records (EHRs) remains an important policy priority.
    Keywords: Hospitals, Information Technology, EHR
    JEL: I
    Date: 2015–12–01
  17. By: Randall Blair; Junqing Liu; Miriam Rosenau; Michael Brannan; Natalie Hazelwood; Kelsey Farson Gray; Jonathan Brown; Eric Morris; Alyssa Hart; Kenneth Jackson; Angela Schmitt; Katherine Sobel; Mary Barton; Milesh Patel; Allison Siegwarth; Xiao Barry; Stephanie Rodriguez
    Abstract: As part of its National Quality Strategy, the U.S. Department of Health and Health Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the HHS Centers for Medicare and Medicaid Services (CMS) are committed to developing and implementing measures that can be used for behavioral health care quality improvement.
    Keywords: Quality measures, inpatient psychiatric facilities, behavioral health, disability
    JEL: I J
    Date: 2015–02–04
  18. By: Carol V. Irvin; JudyAnn Bigby; Vivian Byrd; Michael Barna; Suzie Witmer; Maureen Higgins
    Abstract: Oregon is using a Medicaid Section 1115 demonstration waiver to redesign the structure of its Medicaid delivery and payment systems and to drive transformation of the state’s health care system. This report summarizes the results of a midpoint evaluation of Oregon’s demonstration and the introduction of Coordinated Care Organizations (CCOs) which are the single point of accountability for health care access, quality, and outcomes of Medicaid beneficiaries.
    Keywords: Medicaid, section 1115 demonstration, system transformation, payment reform, accountable care organization
    JEL: I
    Date: 2015–04–30
  19. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Tor Helge Holmäs (Uni Rokkan Centre; and Health Economics Bergen (HEB)); Karin Monstad (Uni Rokkan Centre; and Health Economics Bergen (HEB)); Odd Rune Straume (Universidade do Minho - NIPE)
    Abstract: This paper aims at shedding light on the social gradient by studying the relationship between socioeconomic status (SES) and provision of health care. Using administrative data on services provided by General Practitioners (GPs) in Norway over a five year period (2008-12), we analyse the quantity, composition and value of services provided by the GPs according to patients' SES measured by education, income or ethnicity. Our data allow us to control for a wide set of patient and GP characteristics. To account for (unobserved) heterogeneity, we limit the sample to patients with a specific disease, diabetes type 2, and estimate a model with GP fixed effects. Our results show that patients with low SES visit the GPs more often, but the value of services provided per visit is lower. The composition of services varies with SES, where patients with low education and African or Asian ethnicity receive more medical tests but shorter consultations, whereas patients with low income receive both shorter consultations and fewer tests. Thus, our results show that GPs differentiate services according to SES, but give no clear evidence for a social gradient in health care provision.
    Keywords: Socio-economic status, Primary care; General Practitioners
    JEL: I11 I14 I18
    Date: 2015
  20. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Chiara Canta (Department of Economics, Norwegian School of Economics); Odd Rune StraumeAuthor-Email: o.r.straume@eeg.uminho.p (Universidade do Minho - NIPE)
    Abstract: In this paper we study the impact of reference pricing (RP) on entry of generic firms in the pharmaceutical market. For given prices, RP increases generic firms' expected profit, but since RP also stimulates price competition, the impact on generic entry is theoretically ambiguous. In order to empirically test the effects of RP, we exploit a policy reform in Norway in 2005 that exposed a subset of drugs to RP. Having detailed product-level data for a wide set of substances from 2003 to 2013, we find that RP increased the number of generic drugs. We also find that RP increased market shares of generic drugs, reduced the prices of both branded and generic drugs, and led to a (weakly significant) decrease in total drug expenditures. The reduction in total expenditures was relatively smaller than the reduction in average prices, reflecting the fact that lower prices stimulated total demand.
    Keywords: Pharmaceuticals; Reference pricing; Generic entry
    JEL: I11 I18 L13 L65
    Date: 2015
  21. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Tor Helge Holmäs (Uni Rokkan Centre; and Health Economics Bergen); Karin Monstad (Uni Rokkan Centre; and Health Economics Bergen); Odd Rune StraumeAuthor-Email: o.r.straume@eeg.uminho.p (Universidade do Minho - NIPE)
    Abstract: We study whether and how physicians respond to nancial incentives, making use of detailed register data on the health-care services provided to patients by general practitioners (GPs) in Norway over a six-year period (2006-11). To identify GPs' treatment responses, we exploit that specialisation in general medicine entitles the GPs to a higher consultation fee, implying a change in total and relative fee payments. To control for demand and supply factors related to becoming a specialist, we estimate a GP fixed effect model focusing on a narrow time window around the date of specialist certi cation. Our results show a sharp response by the GPs immediately after obtaining specialist certi fication and thus a higher consultation fee: the number of visits increase, while the treatment intensity (prolonged consultations, lab tests, medical procedures) decline. These fi ndings are consistent with a theory model where (partly) profit motivated GPs face excess demand and income effects are sufficiently small. Finally, we find no evidence for adverse health effects (measured by emergency care centre visits) on patients due to the change in GPs' treatment behaviour after becoming a specialist.
    Keywords: General Practitioners; Fee-for-service; Profit-motivation Creation-Date: 2015
    JEL: H42 H51 I11 I18
  22. By: Barbieri, Paolo Nicola
    Abstract: This paper presents a theoretical investigation into why losing weight is so difficult even in the absence of rational addiction, time-inconsistent preferences or bounded rationality. We add to the existing literature by focusing on the role that individual metabolism has on weight loss. The results from the theoretical model provides multiple steady states and a threshold revealing a situation of ''obesity traps" that the individual must surpass in order to successfully lose weight. Given such a threshold we investigate if a short-run incentive scheme for weight loss is able to promote persistent weight-losses and what features an incentive scheme should have in order to sustain permanent weight loss. We find that a lump-sum incentive scheme is not always able to lead the individual to permanent weight loss. On the contrary, a non-decreasing incentive scheme with rewards for weight loss according to levels of body weight (i.e. progressive), is able to sustain a steady state reduction in body weight and food consumption.
    Keywords: Obesity, Dieting, Optimal Control, Multiple Equilibria.
    JEL: D91 I12 I18
    Date: 2015–10
  23. By: Driouchi, Ahmed
    Abstract: Abstract This paper focuses on the importance of human health resources in relation to current and future trends in health. It is based on syntheses of reports, publications and economic development processes related to the increasing needs for skilled human resources in health systems that are under both high demand but also under the requirements of new health technologies. A special emphasis is placed on developing countries where series of constraints could lead to limit the provision of access to health care under shortage of skilled labor. The human resources related risks at both levels of developed and developing economies are also discussed even though emergent and developed countries have generated new instruments to limit the negative effects of these constraints. Finally, if the expansion of access to new health technologies could be achieved within the world global health system framework, requirements of increasingly needed human resources and skills are shown.
    Keywords: Keywords: Medical Human Resources-Medical Technologies-Density of Medical Personnel-Global Health Systems.
    JEL: I10 I15
    Date: 2015–11–09
  24. By: Niimi, Yoko
    Abstract: This paper examines the impact of providing informal care to elderly parents on caregivers' subjective well-being using unique data from the "Preference Parameters Study" of Osaka University, a nationally representative survey conducted in Japan. The estimation results indicate heterogeneous effects: while informal elderly care does not have a significant impact on the happiness level of married caregivers regardless of whether they take care of their own parents or parents-in law and whether or not they reside with them, it has a negative and significant impact on the happiness level of unmarried caregivers who take care of their parents outside their home. These findings shed light on the important role that formal care services could play in reducing the burden on caregivers, particularly unmarried caregivers who presumably receive less support from family members.
    Keywords: Aging; Caregiving; Elderly Care; Happiness; Informal Care; Japan; Long-term Care Insurance; Parental Care; Subjective Well-being
    JEL: D10 I18 I31 J14
    Date: 2015–11–12
  25. By: Wagstaff,Adam; Cotlear,Daniel; Eozenou,Patrick Hoang-Vu; Buisman,Leander Robert
    Abstract: The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ?mashup? index that captures both aspects of UHC: that everyone?irrespective of their ability-to-pay?gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35?57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data?by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.
    Keywords: Health Systems Development&Reform,Housing&Human Habitats,Health Monitoring&Evaluation,Health Economics&Finance,Health Law
    Date: 2015–11–03
  26. By: Fabbri, D.;; Monfardini, C.;; Castaldini, I.;; Protonotari, A.;
    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 leisureâ€. An explanationbased on “risk aversion†attitude seems more appropriate.
    Keywords: timing of delivery; physician incentives; caesarean section; scheduling;
    JEL: I11 L23 C35 C51
    Date: 2015–10
  27. By: Strulik, Holger
    Abstract: In this paper, I suggest a novel explanation for a hump-shaped ageconsumption profile, based on human aging. The model integrates health in the utility function and utilizes recent estimates on the effects of health on the marginal utility of consumption. The parsimonious model has a closed-form solution for the age of peak consumption and the consumption level at that age relative to initial consumption. A calibration of the model with data from gerontology produces an empirically plausible hump in consumption.
    Keywords: health,aging,life-cycle consumption
    JEL: D91 E21 I10
    Date: 2015

This nep-hea issue is ©2015 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.