nep-hea New Economics Papers
on Health Economics
Issue of 2016‒02‒29
25 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Market Structure and Competition in the Health-care Industry: Results from a Transition Economy By Martin Lábaj; Alzbeta Siskovicova; Barbora Skalicanova; Peter Silanic; Christoph Weiss; Biliana Yontcheva
  2. To Charge or Not to Charge: Evidence from a Health Products Experiment in Uganda - Working Paper 387 By Greg Fischer, Dean Karlan, Margaret McConnell, and Pia Raffler
  3. The Impact of Gavi on Vaccination Rates: Regression Discontinuity Evidence - Working Paper 394 By Sarah Dykstra, Amanda Glassman, Charles Kenny, and Justin Sandefur
  4. How the New International Goal for Child Mortality Is Unfair to Africa (Again) - Working Paper 407 By Simon Lange and Stephan Klasen
  5. The political choice of social long term care transfers when family gives time and money By Philippe De Donder De Donder; Marie-Louise Leroux
  6. Mental Well-being of the Bereaved and Labor Market Outcomes By Atsuko Tanaka; Laurel Beck
  7. Intergenerational Persistence of Health in the U.S.: Do Immigrants Get Healthier as they Assimilate? By Akbulut-Yuksel, Mevlude; Kugler, Adriana D.
  8. The Role of Sickness in the Evaluation of Job Search Assistance and Sanctions By Gerard J. van den Berg; Barbara Hofmann. Arne Uhlendorff
  9. Drug patenting in India: looking back and looking forward By Bhaven N. Sampat; Kenneth C. Shadlen
  10. Financial accessibility and user fee reforms for maternal- health care in five sub-Saharan countries: a quasi-experimental analysis By Tiziana Leone; Valeria Cetorelli; Sarah Neal; Zoë Matthews
  11. High quality, patient centred and coordinated care for Alstrom syndrome: a model of care for an ultra-rare disease By Stephanie Van Groenendael; Luca Giacovazzi; Fabian Davison; Oliver Holtkemper; Zexin Huang; Qiaoying Wang; Kay Parkinson; Timothy Barrett; Tarekegn Geberhiwot
  12. Value-based assessment of new medical technologies: towards a robust methodological framework for the application of multiple criteria decision analysis in the context of health technology assessment By Aris Angelis; Panos Kanavos
  13. Overweight and obesity in low- and middle income countries: A panel-data analysis By Dimitrios Minos
  14. How medical services mask provision of non-medical supportive care in palliative oncology ? By Valérie Buthion; Nora Moumjid; Jennifer Margier
  15. Hard to forget:The long-lasting impact of war on mental health By Massimiliano Bratti; Mariapia Mendola; Alfonso Miranda
  16. Do Maternal Health Problems Influence Child's Worrying Status? Evidence from British Cohort Study By Xianhua Dai; Wolfgang Karl Härdle; Keming Yu;
  17. Profiling the US Sick Leave Landscape By Susser, Philip; Ziebarth, Nicolas R.
  18. Does Medicaid Coverage for Pregnant Women Affect Prenatal Health Behaviors? By Dave, Dhaval M.; Kaestner, Robert; Wehby, George
  19. Malaria and Education: Evidence from Mali By Josselin Thuilliez; Hippolyte d'Albis; Hamidou Niangaly; Ogobara Doumbo
  20. Reference pricing with endogenous generic entry By Kurt R. Brekke; Chiara Canta; Odd Rune Straume
  21. Public Spending Efficiency in the OECD: Benchmarking Health Care, Education and General Administration By Richard Dutu; Patrizio Sicari
  22. The Perils of Climate Change: In Utero Exposure to Temperature Variability and Birth Outcomes in the Andean Region By Molina, Oswaldo; Saldarriaga, Victor
  23. Effect of smoking and other economic variables on wages in the Euro Area. By Bondzie, Eric Amoo
  24. Modeling public health care expenditure using patient level data: Empirical evidence from Italy By Vincenzo Atella; Federico Belotti; Valentina Conti; Claudio Cricelli; Joanna Kopinska; Andrea Piano Mortari
  25. A review of pay-for-performance programs in the inpatient sector in OECD countries By Milstein, Ricarda; Schreyögg, Jonas

  1. By: Martin Lábaj (Institute of Economic Research SAS); Alzbeta Siskovicova; Barbora Skalicanova; Peter Silanic; Christoph Weiss; Biliana Yontcheva
    Abstract: The present paper provides first empirical evidence on the relationship between market size and the number of fi rms in the health-care industry for a transition economy. We estimate market size thresholds required to support diff erent numbers of suppliers (fi rms) for three occupations in the health-care industry in a large number of distinct geographic markets in Slovakia, taking into account the spatial interaction between local markets. The empirical analysis is carried out for three time periods (1995, 2001 and 2010) characterizing diff erent stages of the transition process. Our results suggest that the relationship between market size and the number of fi rms diff ers both across industries, and across periods. Furthermore, we fi nd evidence for correlation in entry decisions across administrative borders.
    Keywords: entry thresholds, competition, Slovakia, health-care industry
    JEL: L22 D22
    Date: 2015–12–10
  2. By: Greg Fischer, Dean Karlan, Margaret McConnell, and Pia Raffler
    Abstract: In a field experiment in Uganda, we find that demand after a free distribution of three health products is lower than after a sale distribution. This contrasts with work on insecticide-treated bed nets, highlighting the importance of product characteristics in determining pricing policy. We put forward a model to illustrate the potential tension between two important factors, learning and anchoring, and then test this model with three products selected specifically for their variation in the scope for learning. We find the rank order of shifts in demand matches with the theoretical prediction, although the differences are not statistically significant.
    Keywords: subsidies; health; pricing; learning
    JEL: D11 D12 D83 I11 I18 O12
    Date: 2014–11
  3. By: Sarah Dykstra, Amanda Glassman, Charles Kenny, and Justin Sandefur
    Abstract: Since 2001, an aid consortium known as Gavi has accounted for over half of vaccination expenditure in the 75 eligible countries with an initial per capita GNI below $1,000. Regression discontinuity (RD) estimates show aid significantly displaced other immunization efforts and failed to increase vaccination rates for diseases covered by cheap, existing vaccines. For some newer and more expensive vaccines, i.e., Hib and rotavirus, we found large effects on vaccination and limited fungibility, though statistical significance is not robust. These RD estimates apply to middle-income countries near Gavi's eligibility threshold, and cannot rule out differential effects for the poorest countries.
    Keywords: aid, vaccination, immunization, fungibility, regression discontinuity
    JEL: F35 H51 I15 O11
    Date: 2015–02
  4. By: Simon Lange and Stephan Klasen
    Abstract: Despite unprecedented progress towards lower under-five mortality in high-mortality countries in recent years, a large fraction of these countries will not attain the numerical target under Millennium Development Goal (MDG) 4, a reduction of the mortality rate by two-thirds compared to levels in 1990. Nevertheless, many stakeholders have argued that the post-2015 agenda should contain a level-end goal for under-five mortality and recent accelerations in the rate of reduction in under-five mortality have been cited as a cause for optimism. We argue in this paper that one key fact about relative changes in mortality rates is a lack of persistence. We find robust evidence for substantial mean reversion in the data. Hence, recent accelerations observed for countries in Sub-Saharan Africa are an overly optimistic estimate of future reductions. At the same time, progress as required by the old MDG4 coincides very much with our projections for Sub-Saharan Africa and other regions. Thus, while MDG4 has been rightly criticized as overly ambitious and unfair to Africa for the 1990-2015 period, such a goal seems more appropriate for the 2005-2030 period. We also offer a discussion of likely drivers of future reductions in child deaths.
    Keywords: MDGs, SDGs, under-five mortality, Africa
    JEL: I15 I18 J11 J18 O21
    Date: 2015–06
  5. By: Philippe De Donder De Donder; Marie-Louise Leroux
    Abstract: We develop a model where families consist of one parent and one child, with children differing in income and all agents having the same probability of becoming dependent when old. Young and old individuals vote over the size of a social long term care transfer program, which children complement with help in time or money to their dependent parent. Dependent parents have an intrinsic preference for help in time by family members.   We first show that low (resp., high) income children provide help in time (resp. in money), whose amount is decreasing (resp. increasing) with the child's income. The middle income class may give no family help at all, and its elderly members would be the main beneficiaries of the introduction of social LTC transfers. We then provide several reasons for the stylized fact that there are little social LTC transfers in most countries. First, social transfers are dominated by help in time by the family when the intrinsic preference of dependent parents for the latter is large enough. Second, when the probability of becoming dependent is lower than one third, the children of autonomous parents are numerous enough to oppose democratically the introduction of social LTC transfers. Third, even when none of the first two conditions is satisfied, the majority voting equilibrium may entail no social transfers, especially if the probability of becoming dependent when old is not far above one third. This equilibrium may be local (meaning that it would be defeated by the introduction of a sufficiently large social program). This local majority equilibrium may be empirically relevant whenever new programs have to be introduced at a low scale before being eventually ramped up.
    Keywords: Majority Voting, local Condorcet winner, crowding out, intrinsic preference for informal help, tax reform,
    JEL: H55 I13 D91
    Date: 2015–06–11
  6. By: Atsuko Tanaka (University of Calgary); Laurel Beck
    Abstract: This paper examines how grief caused by the death of an immediate family member affects labor force outcomes through adverse changes to mental health for elderly Americans. To deal with measurement issues, we differentiate mental health conditions from personality by exploiting a panel data. We also apply factor analysis to create a synthetic indicator for mental well-being. We find that, whichever mental well-being measure is used, bereavement of a family causes poor mental health conditions to a significant extent, and associated distraction following bereavement have adverse impacts on labor market outcomes for elderly Americans.
    Date: 2015–11–19
  7. By: Akbulut-Yuksel, Mevlude; Kugler, Adriana D.
    Abstract: It is well known that a substantial part of income and education is passed on from parents to children, generating substantial persistence in socio-economic status across generations. In this paper, we examine whether another form of human capital, health, is also largely transmitted from generation to generation, contributing to limited socio-economic mobility. Using data from the NLSY, we first present new evidence on intergenerational transmission of health outcomes in the U.S., including weight, height, the body mass index (BMI), asthma and depression for both natives and immigrants. We show that both native and immigrant children inherit a prominent fraction of their health status from their parents, and that, on average, immigrants experience higher persistence than natives in weight and BMI. We also find that mothers’ education decreases children’s weight and BMI for natives, while single motherhood increases weight and BMI for both native and immigrant children. Finally, we find that the longer immigrants remain in the U.S., the less intergenerational persistence there is and the more immigrants look like native children. Unfortunately, the more generations immigrant families remain in the U.S., the more children of immigrants resemble natives’ higher weights, higher BMI and increased propensity to suffer from asthma.
    Keywords: health status; immigrants; intergenerational mobility
    JEL: I12 I14 J61 J62
    Date: 2016–02
  8. By: Gerard J. van den Berg; Barbara Hofmann. Arne Uhlendorff
    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 a vacancy referral increases the transition rate into work and that such accepted jobs go along with lower wages. We also find a positive effect of a vacancy referral on the probability of reporting sick. This effect is smaller at high durations, which suggests that the relative attractiveness of vacancy referrals increases over the time spent in unemployment. Overall, around 9% of sickness absence during unemployment is induced by vacancy referrals.
    Keywords: Unemployment, vacancy referrals, physician, wage, unemployment insurance, monitoring, moral hazard
    JEL: J64 J65 C41 C21
    Date: 2016
  9. By: Bhaven N. Sampat; Kenneth C. Shadlen
    JEL: L81
    Date: 2015
  10. By: Tiziana Leone; Valeria Cetorelli; Sarah Neal; Zoë Matthews
    Abstract: Objectives: Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or receiving a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Setting: Women’s experience of user fees in five African countries. Primary and secondary outcome measures: Using quasi experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. Participants: We analysed data from consecutive surveys in five countries: two case countries that experienced reforms (Ghana and Burkina Faso) in contrast to three that did not experience reforms (Zambia, Cameroon, Nigeria). Results: User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest) and non-educated women and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared to Ghana. Conclusions: Findings show a clear positive impact on access when user fees are removed but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the two case countries. This calls for more research into the impact of reforms on quality of care.
    JEL: E6
    Date: 2016–01–28
  11. By: Stephanie Van Groenendael; Luca Giacovazzi; Fabian Davison; Oliver Holtkemper; Zexin Huang; Qiaoying Wang; Kay Parkinson; Timothy Barrett; Tarekegn Geberhiwot
    Abstract: Background: Patients with rare and ultra-rare diseases make heavy demands on the resources of both health and social services, but these resources are often used inefficiently due to delays in diagnosis, poor and fragmented care. We analysed the national service for an ultra-rare disease, Alstrom syndrome, and compared the outcome and cost of the service to the standard care. Methods: Between the 9th and 26th of March 2014 we undertook a cross-sectional study of the UK Alstrom syndrome patients and their carers. We developed a semi-structured questionnaire to assess our rare patient need, quality of care and costs incurred to patients and their careers. In the UK all Alstrom syndrome patients are seen in two centres, based in Birmingham, and we systematically evaluated the national service and compared the quality and cost of care with patients’ previous standard of care. Results: One quarter of genetically confirmed Alstrom syndrome UK patients were enrolled in this study. Patients that have access to a highly specialised clinical service reported that their care is well organised, personalised, holistic, and that they have a say in their care. All patients reported high level of satisfaction in their care. Patient treatment compliance and clinic attendance was better in multidisciplinary clinic than the usual standard of NHS care. Following a variable costing approach based on personnel and consumables’ cost, our valuation of the clinics was just under £700/patient/annum compared to the standard care of £960/patient/annum. Real savings, however, came in terms of patients’ quality of life. Furthermore there was found to have been a significant reduction in frequency of clinic visits and ordering of investigations since the establishment of the national service. Conclusions: Our study has shown that organised, multidisciplinary “one stop” clinics are patient centred and individually tailored to the patient need with a better outcome and comparable cost compared with the current standard of care for rare disease. Our proposed care model can be adapted to several other rare and ultra-rare diseases.
    Keywords: alstrom syndrome; rare disease; multidisciplinary clinics; national service
    JEL: J50
    Date: 2015–11–24
  12. By: Aris Angelis; Panos Kanavos
    Abstract: In recent years, multiple criteria decision analysis (MCDA) has emerged as a likely alternative to address shortcomings in health technology assessment (HTA) by offering a more holistic perspective to value assessment and acting as an alternative priority setting tool. In this paper, we argue that MCDA needs to subscribe to robust methodological processes related to the selection of objectives, criteria and attributes in order to be meaningful in the context of healthcare decision making and fulfil its role in value-based assessment (VBA). We propose a methodological process, based on multi-attribute value theory (MAVT) methods comprising five distinct phases, outline the stages involved in each phase and discuss their relevance in the HTA process. Importantly, criteria and attributes need to satisfy a set of desired properties, otherwise the outcome of the analysis can produce spurious results and misleading recommendations. Assuming the methodological process we propose is adhered to, the application of MCDA presents three very distinct advantages to decision makers in the context of HTA and VBA: first, it acts as an instrument for eliciting preferences on the performance of alternative options across a wider set of explicit criteria, leading to a more complete assessment of value; second, it allows the elicitation of preferences across the criteria themselves to reflect differences in their relative importance; and, third, the entire process of preference elicitation can be informed by direct stakeholder engagement, and can therefore reflect their own preferences. All features are fully transparent and facilitate decision making.
    JEL: J1
    Date: 2016–01–06
  13. By: Dimitrios Minos (Georg-August University Göttingen)
    Abstract: The rather small literature on obesity in developing countries mainly uses descriptive statistics and cross section analysis to focus on rising income levels as the source of rapidly increasing obesity rates. This paper uses a new panel dataset comprised of WHO and World Bank data for 126 low- and middle income countries to focus on rapid and urbanization as the main driver of rising obesity levels. The results of the fixed effects estimation suggest that urbanization and lifestyle changes associated with the “Nutrition Transition” are responsible for the phenomenon. Moreover, time invariant effects such as tradition and culture account for the differences in overweight and obesity rates across countries. These findings raise new questions and open up paths for further research and can also lead to direct policy implications drawn from the “Urban Agriculture” literature.
    Keywords: obesity; nutrition transition; developing countries
    JEL: I12 I18 P46
    Date: 2016–02–11
  14. By: Valérie Buthion (COACTIS - UL2 - Université Lumière - Lyon 2 - Université Jean Monnet - Saint-Etienne); Nora Moumjid (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université Jean Monnet - Saint-Etienne - PRES Université de Lyon - CNRS - Centre National de la Recherche Scientifique, Centre Léon Bérard - CRLCC Léon Bérard); Jennifer Margier (CHU - Centre Hospitalier Universitaire [Grenoble], GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université Jean Monnet - Saint-Etienne - PRES Université de Lyon - CNRS - Centre National de la Recherche Scientifique)
    Abstract: OBJECTIVES In the context of cancer, non-medical supportive care improves quality of life. While policymakers expect it to be cheaper than high-tech medical care, we hypothesized that it is in fact embedded in and camouflaged by hospital medical services. METHODS In a cross-sectional descriptive study, we conducted qualitative interviews with healthcare providers, patients and family caregivers in France. We first performed a functional analysis to identify non-medical supportive care functions provided or received and then developed a one day cohort study of patient in hospital or hospital at home to determine which non-medical care functions were provided and in what priority. RESULTS 79 healthcare providers, patients and family caregivers were interviewed and 109 patient files were analysed in the cohort study. Providers declared they were highly solicited for non-medical reasons like moral, emotional support, or respite, that we listed and grouped into 5 categories: physical, moral, or financial support, coordination of care and dealing with legal and technical constraints. The cohort study determined that 30 patients (27%) were hospitalised for non-medical reasons. A diversity of services were provided: physical support (n=4), moral support (n=13), financial support (n=1), coordination of care dysfunction (n=12), legal constraint (n=1). CONCLUSION Medical care is not sufficient for the support of advanced cancer patients. Even though equivalence of care is guaranteed at home, non-medical services are provided within hospital because they are not provided or funded anywhere else. Non-medical care performs a variety of social, financial, psychological and legal functions needed by patients and family caregivers.
    Keywords: supportive care,healthcare system barriers,patient relation,family caregivers,oncology healthcare providers
    Date: 2015–06
  15. By: Massimiliano Bratti (DEMM, Università degli Studi di Milano, Institute for the Study of Labor (IZA), Centro Studi Luca d’Agliano (LdA)); Mariapia Mendola (DEMS, Università degli Studi di Milano–Bicocca, Institute for the Study of Labor (IZA), Centro Studi Luca d’Agliano (LdA)); Alfonso Miranda (CIDE, Institute for the Study of Labor (IZA))
    Abstract: This paper examines the impact of war trauma experienced during the 1992-1995 Bosnia and Herzegovina conflict on individual mental health. By using a medically-validated depression scale and an instrumental-variable approach we show that, six years after the conflict, traumatised individuals are significantly more likely to be at risk of depression. Results are robust to a number of sensitivity checks accounting for individual geographical mobility and different treatment intensities, and suggest that the negative effects of war trauma are not mainly mediated by physical health problems. Moreover, war trauma has sizeable negative effects on individual labour market outcomes.
    Keywords: war trauma, mental health, depression, Bosnia and Herzegovina
    JEL: I1 O1
    Date: 2016–01
  16. By: Xianhua Dai; Wolfgang Karl Härdle; Keming Yu;
    Abstract: The influence of maternal health problems on child’s worrying status is important in practice in terms of the intervention of maternal health problems early for the influence on child’s worrying status. Conventional methods apply symmetric prior distributions such as a normal distribution or a Laplace distribution for regression coefficients, which may be suitable for median regression and exhibit no robustness to outliers. This work develops a quantile regression on linear panel data model without heterogeneity from a Bayesian point of view, i.e., upon a location-scale mixture representation of the asym- metric Laplace error distribution, this work provides how the posterior distribution can be sampled and summarized by Markov chain Monte Carlo method. Applying this approach to the 1970 British Cohort Study data, it finds that a different maternal health problem has different influence on child’s worrying status at different quantiles. In addition, applying stochastic search variable selection for maternal health problems to the 1970 British Cohort Study data, it finds that maternal nervous breakdown, in this work, among the 25 maternal health problems, contributes most to influence the child’s worrying status.
    Keywords: British Cohort Study data; Bayesian inference; Quantile regression; Asym- metric Laplace error distribution; Markov chain Monte Carlo; Variable selection
    JEL: C11 C38 C63
    Date: 2014–03
  17. By: Susser, Philip (Cornell University); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper profiles the sick leave landscape in the US – the only industrialized country without universal access to paid sick leave or other forms of paid leave. We exploit the 2011 Leave Supplement of the American Time Use Survey (ATUS), a representative and comprehensive database on sick leave in the US. The two binary outcome variables measure (i) access to paid sick leave and (ii) suppressed sick leave ("presenteeism"). Thirty-five percent of US full-time employees lack access to paid sick leave. Low-income employees, service sector employees, and those in poor health have the lowest coverage rates. We estimate that, each week, up to three million US employees suppress their need for sick leave and engage in presenteeism behavior. These are primarily women with children and low-wage sector jobs.
    Keywords: sick leave, paid leave, medical leave, unpaid leave, low-income employees, gender inequality, presenteeism, US
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2016–02
  18. By: Dave, Dhaval M. (Bentley University); Kaestner, Robert (University of Illinois at Chicago); Wehby, George (University of Iowa, NBER)
    Abstract: Despite plausible mechanisms, little research has evaluated potential changes in health behaviors as a result of the Medicaid expansions of the 1980s and 1990s. In this paper, we provide the first national study of the effects of Medicaid on health behaviors for pregnant women, which is a group of particular interest given evidence of the importance of prenatal health to later life outcomes. We exploit exogenous variation from the Medicaid income eligibility expansions for pregnant women during late-1980s through mid-1990s to examine the effects of these policy changes on smoking, weight gain and other maternal health indicators. We find that the 13 percentage point increase in Medicaid eligibility during the study period was associated with approximately a 3 percent increase in smoking and a small increase in pregnancy weight gain for most of the sample. The increase in smoking, which is a significant cause of poor infant health, may partly explain why Medicaid expansions have not been associated with substantial improvement in infant health.
    Keywords: Medicaid, insurance, moral hazard, health, smoking, weight, prenatal care, infant health
    JEL: D1 H0 I12 I13 I18
    Date: 2016–02
  19. By: Josselin Thuilliez (Centre d'Economie de la Sorbonne - Paris School of Economics); Hippolyte d'Albis (Paris School of Economics - Centre d'Economie de la Sorbonne); Hamidou Niangaly (Malaria Research and Training Center - University of Bamako); Ogobara Doumbo (Malaria Research and Training Center - University of Bamako)
    Abstract: This article examines the influence of malaria on human capital accumulation in the village of Diankabou in Mali. To account for malaria endogeneity and its interaction with unobservable risk factors, we exploit natural variations in malaria immunity across individuals of several sympatric ethnic groups – the Fulani and the non-Fulani – who differ in their susceptibility to malaria. The Fulani are known to be less susceptible to malaria infections, despite living with a similar malaria transmission intensity to those seen among other ethnic groups. We also use natural variation of malaria intensity in the area (during and after the malaria transmission season) and utilize this seasonal change as a treatment. We find that malaria has an impact on cognitive and educational outcomes in this village. We discuss the implications of this result for human capital investments and fertility decisions with the help of a quantity-quality model
    Keywords: Malaria; Immunity; Education; Cognition; Fertility
    JEL: O12 I15 I25
    Date: 2016–01
  20. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Chiara Canta (Department of Economics, Norwegian School of Economics); Odd Rune Straume (Universidade do Minho - NIPE)
    Abstract: In this paper we study the effect of reference pricing on pharmaceutical prices and ex-penditures when generic entry is endogenously determined. We develop a Salop-type model where a brand-name producer competes with generic producers in terms of prices. In the market there are two types of consumers: (i) brand biased consumers who choose between brand-name and generic drugs, and (ii) brand neutral consumers who choose between the different generic drugs. We find that, for a given number of firms, reference pricing leads to lower prices of all products and higher brand-name market shares compared with a reimbursement scheme based on simple coinsurance. Thus, in a free entry equilibrium, the number of generics is lower under reference pricing than under coinsurance, implying that the net effects of reference pricing on prices and expenditures are ambiguous. Allowing for price cap regulation, we show that the negative effect on generic entry can be reversed, and that reference pricing is more likely to result in cost savings than under free pricing. Our results shed light on the mixed empirical evidence on the effects of reference pricing on generic entry.
    Keywords: Pharmaceuticals; Reimbursement schemes; Generic entry
    JEL: I11 I18 L13 L51
    Date: 2015
  21. By: Richard Dutu; Patrizio Sicari
    Abstract: In many OECD countries changes in demography and health conditions are putting pressure on public finance. To prevent further expansion of government spending as a percentage of GDP, public spending efficiency will need to be raised. This paper uses data envelopment analysis (DEA) to assess the efficiency of welfare spending in a sample of OECD countries around 2012, focussing on health care, secondary education and general public services. The DEA model has a two input-one output structure, with at least one of the variables representing a composite indicator controlling for country-specific factors (socio-economic environment and life-style factors, for example). We find wide dispersion in efficiency measures across OECD countries and provide possible quantified improvements for both output and input efficiency. Efficience de la Dépense Publique dans l'OCDE : Évaluation des secteurs de la Santé, l'Éducation et l'Administration Générale Les changements en cours en matière de démographie et de santé dans de nombreux pays de l’OCDE exercent une pression sur les finances publiques. Pour éviter une hausse continue des dépenses publiques en pourcentage du PIB, l'efficience des dépenses publiques devra être augmentée. Ce document utilise l'analyse dite data envelopment analysis (DEA) pour évaluer l'efficience des dépenses publiques en 2012 dans un échantillon de pays de l'OCDE dans le domaine de la santé, de l'enseignement secondaire et de l’administration générale. Le modèle DEA a une structure à deux entrées - une sortie, avec au moins une des variables représentant un indicateur composite afin de contrôler les spécificités de chaque pays (environnement socio-économique et les facteurs de style de vie, par exemple). Nous trouvons une grande divergence des mesures d'efficience de la dépense publique au sein de pays de l'OCDE, et mesurons les améliorations possibles pour chaque pays en termes d’efficience.
    Keywords: education, Public spending efficiency, healthcare, DEA, santé, dépense publique, efficience, éducation
    JEL: H11 H51 H52
    Date: 2016–02–18
  22. By: Molina, Oswaldo; Saldarriaga, Victor
    Abstract: The discussion on the effects of climate change on human activity has primarily focused on how increasing temperature levels can impair human health. However, less attention has been paid to the effect of increased climate variability on health. We investigate how in utero exposure to temperature variability, measured as the fluctuations relative to the historical local temperature mean, affects birth outcomes in the Andean region. Our results suggest that exposure to a temperate one standard deviation relative to the municipality’s long-term temperature mean during pregnancy reduces birth weight by 20 grams and increases the probability a child is born with low birth weight by 10 percent. We also explore potential channels driving our results and find some evidence that increased temperature variability can lead to a decrease in health care and increased food insecurity during pregnancy.
    Keywords: Climate Change, Temperature Variability, Birth Weight, Health
    JEL: I10 I15 J13 Q54
    Date: 2016–02–02
  23. By: Bondzie, Eric Amoo
    Abstract: The smoking effects on wages has been examined in this work using different econometric methodologies with the use of European Community Household Panel (ECHP) datasets. We employ econometric tools like Instrumental Variable technique, Heckman correction factor, Endogenous Switching and Matching estimates. The initial results from regression estimates (OLS and IV methods) revealed that the wage gap between smokers and non-smokers ranges 1% to 22.7%. Moreover, endogenous switching and matching estimator also showed a negative average treatment effect of approximately 47% and 4.3% to 6.9% respectively. Thus smokers observed less wage effects is explained in part by real effects on their health status and a measure of unobserved preferences.
    Keywords: Smoking, Wages differentials, Econometric Approaches and Euro Area.
    JEL: C18 I12 J31 O52
    Date: 2016–02–03
  24. By: Vincenzo Atella (CEIS,University of Rome "Tor Vergata"); Federico Belotti (CEIS,University of Rome "Tor Vergata"); Valentina Conti (EIS,University of Rome "Tor Vergata"); Claudio Cricelli (SIMG); Joanna Kopinska (CEIS, University of Rome "Tor Vergata"); Andrea Piano Mortari (CEIS, University of Rome "Tor Vergata")
    Abstract: In this work we present some results obtained with a unique database of patient level data collected through GPs. The availability of such data opens new scenarios and paradigms for the planning and management of the health care system and for policy impact evaluation studies. The dataset, representative of the Italian population, contains detailed information on prescribed drugs, laboratory tests, outpatient visits and hospitalizations of more than 2 millions patients, managed by 900 GPs overtime. This pool of registers has produced a stock of information on about 25 millions of medical diagnosis, 100 millions of laboratory and diagnostic tests, 10 millions of blood pressure measurements and 50 millions of drug prescriptions. Using this novel dataset we analyze the expenditures of the Italian NHS over time, across age and geographical areas for the period from 2004 to 2011.
    Keywords: cost analysis, big data, disease burden, Electronic Medical Records, primary care, cost sharing
    JEL: I18 C81
    Date: 2016–02–10
  25. By: Milstein, Ricarda; Schreyögg, Jonas
    Abstract: Background: Across the member countries of the Organisation for Economic Co-operation and Development (OECD), pay-for-performance (P4P) programs have been implemented in the inpatient sector to improve the quality of care provided by hospitals. However, little is known about whether such programs can live up to expectations. Thus far, evaluations and reviews have focused on the ambulatory care sector in Anglo-Saxon countries. The transferability of lessons learned to the inpatient sector, however, is limited. Objectives: We aimed to provide an overview of existing P4P programs in the inpatient sector in the OECD countries and to assemble information on their effects. Furthermore, we attempted to identify whether evaluations of such programs allow preliminary conclusions to be drawn about the effects of P4P. [...]
    Keywords: hospitals,pay-for-performance,quality,health system,health policy
    JEL: I10 I11 I18
    Date: 2015

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