nep-hea New Economics Papers
on Health Economics
Issue of 2016‒01‒03
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Social Health Insurance: A Quantitative Exploration By Juergen Jung; Chung Tran
  2. Long-Term Health Effects of Vietnam War's Herbicide Exposure on the Vietnamese Population By Nikolay Gospodinov; Hai V. Nguyen
  3. Heterogeneity In General Practitioner's Preferences for Quality Improvement Programs: A Choice Experiment And Policy Simulation in France By Mehdi Ammi; Christine Peyron
  4. Lifecycle Effects of a Recession on Health Behaviors: Boom, Bust, and Recovery in Iceland By Tinna Laufey Àsgeirsdòttir, Hope Corman, Kelly Noonan, Nancy E. Reichman; Hope Corman; Kelly Noonan; Nancy E. Reichman
  5. Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes? By Rudy Douven; Minke Remmerswaal; Robin Zoutenbier
  6. The Integration of Energy, Environment and Health Policies in China: A Review By Huijie Yan
  7. The Effects of Motherhood By Markussen, Simen; Strøm, Marte
  8. Long-Term Consequences of Access to Well-Child Visits By Bütikofer, Aline; Loken, Katrine Vellesen; Salvanes, Kjell G.
  9. Same Program, Different Outcomes: Understanding Differential Effects from Access to Free, High-Quality Early Care By Chaparro, Juan; Sojourner, Aaron J.
  10. The Caregiving Responsibilities of Retirees: What Are They and How Do They Affect Retirees' Well-being? By Kalenkoski, Charlene M.; Oumtrakool, Eakamon
  11. Quality Reporting on Medicare's Compare Sites: Lessons Learned from Consumer Research, 2001-2014 By Margaret Gerteis; Cicely Thomas; Lauren Blatt; Sally Crelia; Alyson Marano Ward; Kelly Moriarty; Monica Sarmiento; Myra Tanamor; Russ Tisinger
  12. The impact of access to health facilities on maternal care use and health status: Evidence from longitudinal data from rural Uganda By Fredrick Manang; Chikako Yamauchi
  13. A Critical Analysis of Purchasing of Health Services in the Philippines: A Case Study of PhilHealth By Picazo, Oscar F.; Ho, Beverly Lorraine C.; Ulep, Valerie Gilbert T.; Pantig, Ida Marie T.
  14. The demand for health microinsurance services: assessment of the contribution effort using microeconomic data By El Aida, Kawtar; El Kadiri, Mounir; Mourji, Fouzi
  15. Sugar Cane Burning and Human Health: a Spatial Difference-in-Difference Analysis By André Luis Squarize Chagas; Alexandre N. Almeida, Carlos Roberto Azzoni
  16. The Effect of Public Health Expenditure on Infant Mortality: Evidence from a Panel of Indian States, 1983-84 to 2011-12 By Barenberg, Andrew J.; Basu, Deepankar; Soylu, Ceren
  17. Infant mortality and the role of seigneurial tenure in Canada East, 1851 By Arsenault Morin, Alex; Geloso, Vincent; Kufenko, Vadim

  1. By: Juergen Jung; Chung Tran
    Abstract: We quantify the welfare implications of three alternative approaches to providing social health insurance: (i) a mix of private and public health insurance (US-style), (ii) compulsory universal public health insurance (UPHI), and (iii) private health insurance for workers combined with government subsidies and price regulation. We use a Bewley-Grossman lifecycle model calibrated to match the lifecycle structure of earnings and health risks in the US. For all three systems we find that welfare gains triggered by a combination of improvements in risk sharing and wealth redistribution dominate welfare losses caused by tax distortions and ex-post moral hazard effects. Overall, the UPHI system outperforms the other two systems in terms of welfare gains if the coinsurance rate is properly designed. A switch from the US system to a well-designed UPHI system results in large welfare gains. However, such a radical reform faces political impediments due to opposing welfare effects across different income groups.
    Keywords: Health capital, lifecycle health risk, incomplete insurance markets, social insurance, optimal policy, dynamic general equilibrium with idiosyncratic shocks
    JEL: I13 D52 E62 H31
    Date: 2015–12
  2. By: Nikolay Gospodinov; Hai V. Nguyen
    Abstract: Background: Long-term health effects of exposure to Agent Orange have been a subject of debate and controversy. Most studies on Agent Orange health effects were based on small samples. The objective of this population-based study is to determine whether Agent Orange exposure increases the risks of cancer and hypertension for the Vietnamese population. Methods: This study employs a quasi-experiment research design to estimate the causal long term effect of Agent Orange on incidences of cancer and hypertension for Vietnamese population. Specifically, difference-in-differences regressions are estimated which compute the difference between the Agent Orange-affected cohort versus the unaffected cohort in a treated area (where the Agent Orange was sprayed) and compare that difference with the similar difference computed for the control area (where the Agent Orange was not used). Results: People who were directly exposed to Agent Orange spraying have a higher risk of developing cancer. Agent Orange exposure appears to raise significantly the risk of hypertension for those who lived as well as those who were born during the spraying period. The most harmful effects of Agent Orange occur in areas that received the largest amounts of herbicide spray. Interpretation: The results provide statistical evidence for the harmful effects inflicted by herbicide exposure on the Vietnamese population. Our findings of elevated risk of cancer and hypertension complement the small-sample studies conducted for the Vietnam War veterans and raise warnings for the use of Agent Orange and other herbicides in populated areas.
    Keywords: agent orange, difference-in-differences, herbicide exposure, Vietnam war
    Date: 2015–12
  3. By: Mehdi Ammi; Christine Peyron
    Abstract: Despite increasing popularity, quality improvement programs (QIP) have had modest and variable impacts on enhancing the quality of physician practice. We investigate the heterogeneity of physicians' preferences as a potential explanation of these mixed results in France, where the national voluntary QIP – the CAPI – has been cancelled due to its unpopularity. We rely on a discrete choice experiment to elicit heterogeneity in physicians' preferences for the financial and non-financial components of QIP. Using mixed and latent class logit models, results show that the models should be used in concert to shed light on different aspects of the heterogeneity in preferences. In particular, the mixed logit demonstrates that heterogeneity in preferences is concentrated on the pay-for-performance component of the QIP, while the latent class model shows that physicians can be grouped in four homogenous groups with specific preference patterns. Using policy simulation, we compare the French CAPI with other possible QIPs, and show that the majority of the physician subgroups modelled dislike the CAPI, while favouring a QIP using only non-financial interventions. We underline the importance of modelling preference heterogeneity in designing and implementing QIPs.
    Keywords: quality improvement programs, general practitioners, discrete choice experiment, mixed logit, latent class logit, policy simulation
    JEL: I11 I18 C25
    Date: 2015–12
  4. By: Tinna Laufey Àsgeirsdòttir, Hope Corman, Kelly Noonan, Nancy E. Reichman; Hope Corman; Kelly Noonan; Nancy E. Reichman
    Abstract: This study uses individual-level longitudinal data from Iceland, a country that experienced a severe economic crisis in 2008 and substantial recovery by 2012, to investigate the extent to which the effects of a recession on health behaviors are lingering or short-lived and to explore trajectories in health behaviors from pre-crisis boom, to crisis, to recovery. Health-compromising behaviors (smoking, heavy drinking, sugared soft drinks, sweets, fast food, and tanning) declined during the crisis, and all but sweets continued to decline during the recovery. Health-promoting behaviors (consumption of fruit, fish oil, and vitamin/minerals and getting recommended sleep) followed more idiosyncratic paths. Overall, most behaviors reverted back to their pre-crisis levels or trends during the recovery, and these short-term deviations in trajectories were probably too short-lived in this recession to have major impacts on health or mortality. A notable exception is for alcohol consumption, which declined dramatically during the crisis years, continued to fall (at a slower rate) during the recovery, and did not revert back to the pre-crisis upward trend during our observation period. These lingering effects, which directionally run counter to the pre-crisis upward trend, suggest that alcohol is a potential pathway by which recessions improve health and/or reduce mortality.
    Keywords: recessions, health behaviors, Iceland, economic crisis, economic recovery
    Date: 2015–12
  5. By: Rudy Douven; Minke Remmerswaal; Robin Zoutenbier
    Abstract: This study compares different responses to financial incentives between self-employed providers in Dutch mental health care. We find that these different responses are related to differences in treatment duration and treatment outcome. In 2008, a new compensation scheme was introduced for self-employed mental health care providers in the Netherlands. The compensation that self-employed psychologists and psychiatrists received for each patient is based on the total treatment duration. The compensation increases step-wise after 800, 1800 and 3000 minutes of treatment with a large amount. It therefore provides strong financial incentives for providers to prolong their treatment till just after the threshold. Using a large administrative dataset, we exploit these different responses by providers to separate more extrinsically from non-extrinsically motivated providers. We find that the majority of the providers are, to some degree, extrinsically motivated and strategically set treatment duration to exploit the thresholds in the compensation scheme. Some providers choose to end all treatments at 800, 1800 or 3000 minutes, most providers choose to occasionally set the treatment duration strategically and some providers do not take the thresholds into account at all. Next, we study total treatment duration and treatment outcomes of all providers. Treatment outcome is measured with the increase of the GAF score of patients (the Global Assessment of Functioning is a subjective assessment by the provider regarding the mental well-being of the patient and the patient's functioning in daily life). We find that non-extrinsically motivated providers, who do not strategically set treatment duration, treat mental health patients shorter, receive less compensation and report better treatment outcomes, as measured by the improvement in GAF score. This suggests that the compensation scheme rewards inefficient or low quality providers.
    JEL: H51 I11 J22 M52
    Date: 2015–12
  6. By: Huijie Yan (AMSE - Aix-Marseille School of Economics - EHESS - École des hautes études en sciences sociales - Centre national de la recherche scientifique (CNRS) - Ecole Centrale Marseille (ECM) - AMU - Aix-Marseille Université)
    Abstract: The goal of sustainable development is far from being achieved in China. In this context, this paper aims to provide an overview of China’s energy, environment and health policies over the past 30 years and discuss whether the previous policies have fully integrated the energy, environment and health issues in its sustainable development agenda. From the overview, we observe that the energy policies accelerating energy industrial upgrading, stimulating development of new energy sources, deregulating energy pricing mechanism, promoting energy saving and seizing the opportunity of green growth are conducive to an improvement of environmental conditions and public health in China. However, the environmental policies are not effectively implemented and subsequently they could not succeed in reducing environmental risks on public health and putting pressure on enterprises to efficiently use energy. The health policies have not taken real actions to focus with any specificity on energy-induced or pollution-induced health problems.
    Keywords: energy,environment,health,China
    Date: 2015–12
  7. By: Markussen, Simen (Ragnar Frisch Centre for Economic Research.); Strøm, Marte (Institute for Social Research and ESOP, University of Oslo)
    Abstract: We use miscarriage as a biological shock to fertility in order to estimate the causal impact of motherhood on labor market outcomes. The number of instruments is increased by exploiting the response-heterogeneity to miscarriage along three dimensions: time, age, and birth order. This allows us to separately identify the effect of the first, second and third child as well as the effects of pregnancy and caretaking for small children. We find each child reduces female earnings by around 18%, only part of it due to reduced work hours. We find no evidence of an adverse health effect of having children.
    Keywords: female labor supply; health; motherhood; fertility shock
    JEL: C26 I10 J13 J22
    Date: 2015–11–30
  8. By: Bütikofer, Aline (Norwegian School of Economics); Loken, Katrine Vellesen (University of Bergen); Salvanes, Kjell G. (Norwegian School of Economics)
    Abstract: A growing literature documents the positive long-term effects of policy-induced improvements in early-life health and nutrition. However, there is still scarce evidence on early-life health programs targeting a large share of the population and the role of such programs in increasing intergenerational mobility. This paper uses the rollout of mother and child health care centers in Norway, which commenced in the 1930s, to study the long-term consequences of increasing access to well-child visits. These well-child visits included a physical examination and the provision of information about adequate infant nutrition. Our results indicate that access to mother and child health care centers had a positive effect on education and earnings: access in the first year of life increased the completed years of schooling by 0.15 years and earnings by two percent. The effects were stronger for children from a low socioeconomic background. In addition, we find that individuals suffer from fewer health risks at age 40 and positive effects on adult height, which support the fact that better nutrition within the first year of life is the likely mechanism behind our findings. While there is increasing knowledge on the benefits of various types of early childhood programs, the costs are often neglected, making it hard to compare different programs. We add to this by showing that investments in mother and child health care centers pass a simple cost-benefit analysis.
    Keywords: well-child visits, early-life interventions, health and inequality
    JEL: I14 I15 I18 I20 J30
    Date: 2015–12
  9. By: Chaparro, Juan (University of Minnesota); Sojourner, Aaron J. (University of Minnesota)
    Abstract: The Infant Health and Development Program (IHDP) was designed to promote the development of low-birth weight (up to 2,500 grams) and premature (up to 37 weeks gestational age) infants. There is evidence that the IHDP intervention, a randomly-assigned bundle of services including primarily free, high-quality child care from 12 to 36 months, boosted cognitive and behavioral outcomes by the time participants at the end of the intervention. The literature has established that the intervention was more effective among the subsample of heavier low birth weight (2,000-2,500 grams) than among those born lighter. Among the heavier group, it was more effective for children from lower-income families. Families who participated in the intervention were diverse in key observable characteristics like income, race or ethnicity. In addition, families reallocated their time in different ways when then had the opportunity to use the free services provided by the IHDP. The goal of this paper is to understand the economic decisions and constraints faced by households who gained access to the IHDP and explain their differential behavior. In order to do so, we propose an economic model, construct measures of theoretically-relevant drivers of postnatal investment decisions, and explore patterns of heterogeneity in parental response and child development along these dimensions.
    Keywords: human capital, early childhood, experiment
    JEL: J13 J24 O15
    Date: 2015–12
  10. By: Kalenkoski, Charlene M. (Texas Tech University); Oumtrakool, Eakamon (Texas Tech University)
    Abstract: Using data from the 2010 and 2012 American Time Use Surveys (ATUS) and the associated Well-being Modules, this paper examines how caregiving affects the well-being of retirees who are caregivers. Different caregiving activities are examined, including caring for household children, caring for non-household children, caring for household adults, and caring for non-household adults. Different aspects of well-being are examined, including how meaningful respondents find their activities and how happy, sad, tired, in pain, and stressed their activities make them. The results show that, controlling for selection into caregiving, most caregiving negatively affects the well-being of retirees. This suggests that policies that remove some of the caregiving burden from retirees would increase their well-being.
    Keywords: caregiving, well-being, retirement, time use
    JEL: D10 D13
    Date: 2015–12
  11. By: Margaret Gerteis; Cicely Thomas; Lauren Blatt; Sally Crelia; Alyson Marano Ward; Kelly Moriarty; Monica Sarmiento; Myra Tanamor; Russ Tisinger
    Abstract: This report synthesizes findings from consumer research on Medicare’s Compare sites that Mathematica Policy Research and L&M Policy Research conducted under multiple contracts with the Centers for Medicare & Medicaid Services (CMS) from 2001 through 2014.
    Keywords: consumer engagement, quality measurement and reporting
    JEL: I
    Date: 2015–12–14
  12. By: Fredrick Manang (National Graduate Institute for Policy Studies); Chikako Yamauchi (National Graduate Institute for Policy Studies)
    Abstract: Maternal and child mortality remains high in developing countries. While timely antenatal care and delivery at formal facility are recommended, many mothers do not use them. This paper investigates whether newly established health facilities affect maternal health care utilization as well as the health of mothers and children. In order to deal with possibly endogenous facility placement, we apply the community-level and mother-level fixed effects models to the new, decade-long panel data from rural Uganda. Results demonstrate differential roles played by large facilities and small clinics. Openings of large facilities increase the probability of delivery at formal facility, attended by trained personnel. This is accompanied by an increased use of inexpensive transportation modes such as walking and own bicycle to delivery places. Weak evidence is also found for reduced degree of selective infant survival. New community-level clinics, on the other hand, increase regular antenatal care usage and reduce complications during delivery. These results suggest that accessible clinics help pregnant mothers to avoid preventable problems through early diagnosis of risky cases and/or treatment of existing diseases. Overall, these findings underscore the importance of providing good access to health facilities, in particular to community-level clinics, in order to promote the utilization of maternal care and improve maternal and infant health.
    Date: 2015–12
  13. By: Picazo, Oscar F.; Ho, Beverly Lorraine C.; Ulep, Valerie Gilbert T.; Pantig, Ida Marie T.
    Abstract: This study is a critical analysis of health services purchasing undertaken by the PhilHealth, which implements the National Health Insurance Program of the Philippines. Purchasing is about how an institution should determine, negotiate for, and obtain health services on behalf of a group of people that has contributed resources, either through taxes, premiums, or point-of-service payments, in exchange for anticipated health services. The study employs a principal/agent framework for analyzing three critical relationships: that between the purchaser and health-care providers, between the purchaser and citizens (or members of Philhealth), and between the purchaser and the government, both as regulator and as funder of services, at the national government and local government levels. The study is an analysis of the key alignments and variances of purchasing practices vis-a-vis the "design" and the theoretical ideal in each of the three relationships. To do this, the study employs an extensive document review as well as key informant interviews of decisionmakers and other stakeholders, including PhilHealth management and staff, the Department of Health, provider representatives, and consumer representatives. It is part of a multicountry analysis of purchasing of health services in selected African and Asian health-financing organizations. It also provides key findings and policy implications.
    Keywords: Philippines, PhilHealth, purchasing of health services, strategic purchasing, active purchasing, health-care financing
    Date: 2015
  14. By: El Aida, Kawtar; El Kadiri, Mounir; Mourji, Fouzi
    Abstract: This paper analyzes subscription and willingness to pay (WTP) effort decisions among microcredit clients for a health microinsurance service in Morocco. We use data from a survey conducted among 562 microcredit clients belonging to two instututions. To estimate clients WTPs’ efforts, we choose the contingent valuation method. We analyze the different steps of decision by using simple and generalized Tobit. The results highlight the effect of socio-economic and financial variables including clients’ participation in formal and informal insurance mechanisms. We explain that they think in terms of substitution in one case, and complementarity in the other. The effect of savings reveals that clients want to maximize the collective utility of their households.
    Keywords: health microinsurance, contingent valuation, Tobit, willingness to pay
    JEL: C34 I11 I13 Q51
    Date: 2015–02–06
  15. By: André Luis Squarize Chagas; Alexandre N. Almeida, Carlos Roberto Azzoni
    Abstract: The production of ethanol and sugar from sugar cane 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 burning on respiratory problems of children, teenagers and elderly people. We work with a balanced panel of 644 municipalities, from 2002 to 2011. We use a spatial difference-in-difference technique, 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, at least 66% of the effect on producing regions
    Keywords: Sugar Cane Burning; Health Condition; Spatial Econometrics
    JEL: C14 C21 Q18
    Date: 2015–12–04
  16. By: Barenberg, Andrew J.; Basu, Deepankar; Soylu, Ceren (Department of Economics, University of Massachusetts, Amherst)
    Abstract: Using a panel data set of Indian states between 1983-84 and 2011-12, this paper studies the impact of public health expenditure on the infant mortality rate (IMR), after controlling for other relevant covariates like per capita income, female literacy, and urbanization. We find that public expenditure on health care reduces IMR. Our baseline specification shows that an increase in public health expenditure by 1 percent of state-level GDP is associated with a reduction in the IMR by about 8 infant deaths per 1000 live births. We also find that female literacy and urbanization reduces the IMR.
    Keywords: infant mortality rate, public health expenditure, female literacy, India
    JEL: E12 E20
    Date: 2015
  17. By: Arsenault Morin, Alex; Geloso, Vincent; Kufenko, Vadim
    Abstract: This paper aims to explain differences in infant mortality across the colony of Quebec, known in the 1850s as Canada East, by institutional settings. Areas settled under French laws (known as seigneurial law) implied important transfers from peasants to landlords through private taxes and duties, restrictions on mobility, scant provision of public goods and disincentives to invest in agricultural productivity. As a result, areas under this law system tended to be poor and prone to high mortality. Upon conquering Quebec, the British maintained French land laws but, in 1791, the boundaries of its application were frozen - all newly settled lands would be under British land laws. By 1851, the two legal systems had cohabited for six decades - allowing us to compare them. Using the 1851 census, we argue that French seigneurial law - which reduced living standards through a variety of channels - translated into higher rates of infant mortality. After estimating a Zero-inflated Negative Binomial Regression we find that the effect of seigneurial tenure results in an increase in infant death rates from 43.79 to 44.89 for the age group below one and from 5.21 to 5.277 for the age group from one to five. Additionally, we conduct robustness checks by limiting the sample to large settlements and changing the age groups for the dependent variable.
    Date: 2015

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