nep-hea New Economics Papers
on Health Economics
Issue of 2016‒02‒12
fifteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Role of Model Specification in Estimating Health Care Demand By Hossein Kavand; Marcel-Cristian Voia
  2. Sleep and Human Capital: Evidence from Daylight Saving Time By Lawrence Jin; Nicolas Ziebarth
  3. A Public Health Analysis of Two Proposed Marijuana Legalization Initiatives for the 2016 California Ballot: Creating the New Tobacco Industry By Barry, Rachel A MA; Glantz, Stanton A PhD
  4. Productivity of the English NHS: 2013/14 update By Chris Bojke; Adriana Castelli; Katja GraÅ¡iÄ; Daniel Howdon; Andrew Street
  5. The Role of Sickness in the Evaluation of Job Search Assistance and Sanctions By Berg, Gerard van den; Hofmann, Barbara; Uhlendorff, Arne
  6. Gluttony and Sloth? calories, labour market activity and the rise of obesity By Griffith, Rachel; Lluberas, Rodrigo; Luhrmann, Melanie
  7. The Cost of Binge Drinking By Francesconi, Marco; James, Jonathan
  8. An exploratory study of Tourist-patient satisfaction and behavioral intentions in medical tourism: Post-hoc segmentation By Nahla Ben Yekhlef Boukadida; Salah Boumaiza
  9. E-Cigarette Use Among US Adolescents: Secondhand Smoke at Home Matters By Xiao Zhang; Jia Pu
  10. Empowering the “Cheerersâ€: Role of Surgical Intensive Care Unit Nurses in Enhancing Family Resilience By Lauren Ellis; Jessica Gergen; Leah Wohlgemuth; Marie T. Nolan; Rebecca Aslakson
  11. A normative foundation for equity-sensitive health evaluation: the role of relative comparisons of health gains By Juan D. Moreno-Ternero; Lars P. Osterdal
  12. Effects of China’s Rural Insurance Scheme on Objective Measures of Health By Slawa Rokicki; Katherine Donato
  13. A Simultaneous Equation Approach to Estimating HIV Prevalence with Non-Ignorable Missing Responses By Giampiero Marra; Rosalba Radice; Till Bärnighausen; Simon N. Wood; Mark E. McGovern
  14. Urbanization and Inequality in Hypertension Diagnosis and Medication in Indonesia By Helble, Matthias; Aizawa, Toshiaki
  15. Social Health Insurance: A Quantitative Exploration By Juergen Jung; Chung Tran

  1. By: Hossein Kavand (Department of Economics, Carleton University); Marcel-Cristian Voia (Department of Economics, Carleton University)
    Abstract: Zero inflation and over-dispersion issues can significantly affect the predicted probabilities as well as lead to unreliable estimations in count data models. This paper investigates whether considering this issue for German Socioeconomic Panel (1984-1995), used by Riphahn et al (2003), provides any evidence of misspecification in their estimated models for the adverse selection and moral hazard effects. The paper has the following contributions: first, it shows that estimated parameters for adverse selection and moral hazard effects are sensitive to the model choice; second, the random effects panel data as well as standard pooled data models do not provide reliable estimates for health care demand (doctor visits); third, it shows that by appropriately accounting for zero inflation and over-dispersion there is no evidence of adverse selection behaviour and that moral hazard plays a positive and significant role for the number of doctor visits. These results are robust for both males and females’ subsamples as well as for the full data sample.
    Keywords: over-dispersion, zero-inflated distribution, adverse selection, moral hazard
    Date: 2016–01
  2. By: Lawrence Jin; Nicolas Ziebarth
    Abstract: This paper is one of the first to test for a causal relationship between sleep and human capital. It exploits the quasi-experimental nature of Daylight Saving Time (DST), up to 3.4 million BRFSS respondents from the US, and all 160 million hospital admissions from Germany over one decade. We find evidence of mild negative health effects when clocks are set forward one hour in spring. When clocks are set back one hour in fall, effectively extending sleep duration for the sleep deprived by one hour, sleep duration and self-reported health increase and hospital admissions decrease significantly for four days.
    Keywords: sleep, human capital, Daylight Saving Time (DST), BRFSS, hospital admissions, sleep deprivation
    JEL: H41 I18 I31
    Date: 2016–01
  3. By: Barry, Rachel A MA; Glantz, Stanton A PhD
    Keywords: Medicine and Health Sciences, Social and Behavioral Sciences
    Date: 2016–02–01
  4. By: Chris Bojke (Centre for Health Economics, University of York, UK.); Adriana Castelli (Centre for Health Economics, University of York, UK.); Katja GraÅ¡iÄ (Centre for Health Economics, University of York, UK.); Daniel Howdon (Centre for Health Economics, University of York, UK.); Andrew Street (Centre for Health Economics and Department of Health Sciences, University of York, UK.)
    Abstract: The issue of NHS productivity currently holds substantial public attention, particularly given the efficiency challenge set out in the Five Year Forward View published by NHS England and other national bodies 2014. In 2015 the Department of Health appointed a Minister (Parliamentary under Secretary of State) with a specific ministerial brief for NHS productivity. This report is the latest in a regular series of NHS productivity measures produced by the Centre for Health Economics. This report updates the time-series of National Health Service (NHS) productivity to account for growth between 2012/13 and 2013/14. NHS output encompasses all activity, as valued by administrative costs, for NHS patients, and is measured by combining data from Reference Costs, Hospital Episode Statistics, Prescription Cost Analysis, and the GP Patient Survey.
    Date: 2016–01
  5. By: Berg, Gerard van den; Hofmann, Barbara; Uhlendorff, Arne
    Abstract: Unemployment insurance agencies may combat moral hazard by punishing refusals to apply to assigned vacancies. However, the possibility to report sick creates an additional moral hazard, since during sickness spells, minimum requirements on search behavior do not apply. This reduces the ex ante threat of sanctions. We analyze the effects of vacancy referrals and sanctions on the unemployment duration and the quality of job matches, in conjunction with the possibility to report sick. We estimate multi-spell duration models with selection on unobserved characteristics. We find that vacancy referrals increase the transition to work and that these jobs go along with a lower wage. However, we also find a positive effect of receiving a vacancy referral on the probability of reporting sick. This effect is smaller at high durations, which suggests that the value of a vacancy referral increases over the time spent in unemployment. Overall, around 9% of sickness absence during unemployment is induced by vacancy referrals.
    Keywords: monitoring; moral hazard; physician; unemployment; unemployment insurance; vacancy referrals; wage
    JEL: C21 C41 J64 J65
    Date: 2016–01
  6. By: Griffith, Rachel; Lluberas, Rodrigo; Luhrmann, Melanie
    Abstract: The rise in obesity has largely been attributed to an increase in calorie consumption. We show that official government household survey data suggest that calories have declined in England from 1980 to 2013; while there has been an increase in calories from food out at restaurants, fast food, soft drinks and confectionery, overall there has been a decrease in total calories purchased. Households have shifted towards more expensive calories, both by substituting away from home production towards market production, and substituting towards higher quality foods. We show that this decline in calories can be rationalised with weight gain by the decline in the strenuousness of work and daily life.
    Keywords: nutrition; obesity; time use
    JEL: I12
    Date: 2016–01
  7. By: Francesconi, Marco; James, Jonathan
    Abstract: We estimate the effect of binge drinking on accident and emergency attendances, road accidents, arrests and the number of police officers on duty using a variety of unique data from Britain and a two-sample minimum distance estimation procedure. Our estimates, which reveal sizeable effects of bingeing on all outcomes, are then used to monetize the short-term externalities of binge drinking. We find that these externalities are on average £4.9 billion per year ($7 billion), about £80 for each man, woman and child liing in the UK. The price that internailizes this externality is equivalent to an additional 9p per alcoholic unit, implying a 20% increase with respect to the current avarage prices.
    Date: 2015
  8. By: Nahla Ben Yekhlef Boukadida (ERMA - Entreprises et Recherche en Marketing - faculté des sciences économiques et de gestion de tunis); Salah Boumaiza (ERMA - Entreprises et Recherche en Marketing - faculté des sciences économiques et de gestion de tunis)
    Abstract: This study is an exploration of international tourist-patients’ satisfaction and their behavioral intentions toward a medical destination. The main objective here was to determine whether the perception of price fairness and the positive perception of doctor quality play a positive role in the post-purchase behavior. The proposed model was tested with a PLSPM that is adapted to non-normal data and the small sample size. The results of global model (whole sample) showed that there is heterogeneity in responses obtained. Therefore, a REBUS-PLS analysis was conducted to detect latent segments. The result sets of this research bring a new light on the post-consumption behavior of the tourist-patient. They are discussed at the end of this paper with their theoretical and managerial implications.
    Keywords: Medical tourism, post-consumption behaviors, doctor quality, price value, segmentation
    Date: 2015–05–08
  9. By: Xiao Zhang; Jia Pu
    Abstract: The association between smoking habits of the family and e-cigarette use was mediated through secondhand smoke exposure.
    Keywords: Electronic cigarettes, Secondhand smoke exposure, Adolescents
    JEL: I
    Date: 2016–01–18
  10. By: Lauren Ellis; Jessica Gergen; Leah Wohlgemuth; Marie T. Nolan; Rebecca Aslakson
    Abstract: Nurses note unique stresses faced by families of patients in surgical intensive care units.
    Keywords: Nurses, Surgical Intensive Care Unit, Family Resilience
    JEL: I
    Date: 2016–01–30
  11. By: Juan D. Moreno-Ternero (U. Pablo de Olavide y CORE, Université catholique de Louvain); Lars P. Osterdal (University of Southern Denmark)
    Abstract: We explore in this paper the relationship between equity-sensitive population health evaluation measures and normative concerns for relative comparisons of health gains. Such a relationship allows us to characterize focal equity-sensitive models for the evaluation of population health. Instances are the so-called multiplicative Quality Adjusted Life Years (QALYs) and multiplicative Healthy Years Equivalent (HYEs), as well as generalizations of the two. Our axiomatic approach assumes social preferences over distributions of individual health states experienced in a given period of time. It conveys informational simplicity, as it does not require information about individual preferences on health.
    Keywords: Population health, equity, HYEs, QALYs, relative comparisons, axioms.
    JEL: D63 I10
    Date: 2016–01
  12. By: Slawa Rokicki; Katherine Donato
    Abstract: In 2003, the Chinese government established the New Cooperative Medical Scheme (NCMS) with the goal of improving health for the country’s 800 million mostly uninsured rural residents. Using new data on objective health measures, we analyzed the program’s effectiveness in improving health for enrollees. Using longitudinal data from the China Health and Nutritional Survey from 2000 to 2009 (12 080 observations across four waves), we analyzed the impact of the NCMS on objective measures of health such as blood pressure, HbA1c, and cholesterol, as well as use of preventive care. In order to overcome inherent selection bias where less healthy people are more likely to enroll in the voluntary health insurance scheme, we used intent-to-treat and instrumental variable analysis strategies, and offered evidence that these approaches can mitigate this bias. For every additional year of NCMS coverage, the probability of seeking preventive health care increased by 0.6 percentage points (95% CI 0.1-1.0). However, we did not find evidence that the NCMS resulted in consistent improvements in objective measures of health. Sub-group analysis suggested that lower-income communities benefited more from the program, implying that the program may have resulted in some lessening of the wealth-based disparity in health. The NCMS does not appear to significantly improve objective measures of health. This is consistent with evaluations of health insurance programs in other countries, but in contrast to some previously reported improvements in self-reported health resulting from the NCMS.
    Keywords: China, Health insurance, Biomarkers, Objective health
    JEL: I13 I15
    Date: 2016–02
  13. By: Giampiero Marra; Rosalba Radice; Till Bärnighausen; Simon N. Wood; Mark E. McGovern
    Abstract: Estimates of HIV prevalence are important for policy in order to establish the health status of a country's population and to evaluate the effectiveness of population-based interventions and campaigns. However, participation rates in testing for surveillance conducted as part of household surveys, on which many of these estimates are based, can be low. HIV positive individuals may be less likely to participate because they fear disclosure, in which case estimates obtained using conventional approaches to deal with missing data, such as imputation-based methods, will be biased. We develop a Heckman-type simultaneous equation approach which accounts for non-ignorable selection, but unlike previous implementations, allows for spatial dependence and does not impose a homogeneous selection process on all respondents. In addition, our framework addresses the issue of separation, where for instance some factors are severely unbalanced and highly predictive of the response, which would ordinarily prevent model convergence. Estimation is carried out within a penalized likelihood framework where smoothing is achieved using a parametrization of the smoothing criterion which makes estimation more stable and efficient. We provide the software for straightforward implementation of the proposed approach, and apply our methodology to estimating national and sub-national HIV prevalence in Swaziland, Zimbabwe and Zambia.
    Keywords: Heckman-Type Selection Model, HIV, Penalized Regression Splines, Selection Bias, Simultaneous Equation Models, Spatial Dependence
    JEL: C30 J10
    Date: 2016–02
  14. By: Helble, Matthias (Asian Development Bank Institute); Aizawa, Toshiaki (Asian Development Bank Institute)
    Abstract: Urbanization has been progressing quickly in Indonesia and the consequences on health and health inequities are still not well understood. In this paper, we present new empirical evidence on the differences in the utilization of health care services between rural and urban areas as well as for the respective health inequities. Exploiting the rich dataset of the Indonesian Family Life Survey, this paper measures the socioeconomic inequality of health care utilization for the case of the diagnosis of hypertension and its medication. In the Indonesian Family Life Survey, about 45% of all respondents over the age of 39 were found to suffer from hypertension (average systolic blood pressure higher than 140). However, more than half of the people with hypertension have never been diagnosed by a health care professional, and only a small fraction of the people suffering from hypertension are taking medicine for it. Our analysis further shows that diagnosis and medication rates are significantly higher in urban areas than in rural areas, implying that urban areas offer better access to health care services and medicines. Calculating concentration indices, we find that underdiagnosis of hypertension is more prevalent among the poor and this health inequality is more pronounced in rural areas. For the case of medication, we are unable to detect strong evidence of inequality either in rural or urban areas, as most Indonesians with hypertension do not take medicine irrespective of their socioeconomic status. Finally, decomposition analysis shows that the inequality in education, living standards, sanitary conditions, and the possession of vehicle and home appliances can explain a large fraction of the inequality of diagnosis and medication.
    Keywords: hypertension; health care; health services; Indonesia; urbanization
    JEL: I14 I15 I18
    Date: 2016–02–01
  15. By: Juergen Jung (Department of Economics, Towson University); Chung Tran (Research School of Economics, The Australian National University)
    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: 2016–02

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