nep-hea New Economics Papers
on Health Economics
Issue of 2016‒04‒09
28 papers chosen by
Yong Yin
SUNY at Buffalo

  1. "Subsidies, Information, and the Timing of Children’s Health Care in Mali" By Anja Sautmann; Samuel Brown; Mark Dean
  2. Interaction, Protection and Epidemics By Sanjeev Goyal; Adrien Vigier; ;
  3. Is Health Care Infected by Baumol’s Cost Disease? Test of a New Model Using an OECD Dataset By Akinwande A. Atanda; Andrea K. Menclova; W. Robert Reed
  4. State and Local Determinants of Employment Outcomes among Individuals with Disabilities By Purvi Sevak; John O'Neill; Andrew Houtenville; Debra L. Brucker
  5. Health care expenditures, age, proximity to death and morbidity: implications for an ageing population By Daniel Howdon; Nigel Rice
  7. Who bears the cost of workers' health-related presenteeism and absenteeism By Atsuko Tanaka
  8. Does independent needs assessment limit supply-side moral hazard in long-term care? By Rudy Douven; Pieter Bakx; Frederik T. Schut
  9. The health of nations By Williams, John C.
  10. Healthcare expenditures growth: the red herring of demographic ageing? By Marianne Tenand
  11. Parallel Trade of Pharmaceuticals: The Danish Market for Statins By Susan J. Méndez
  12. Sanitation and child health in India By Britta Augsburg; Paul Rodríguez-Lesmes
  13. Cognitive Ability and the Mortality Gradient by Education: Selection or Mediation? By Bijwaard, Govert; Jones, Andrew M.
  14. The Market for Paid Sick Leave By Markussen, Simen; Røed, Knut
  15. Uptake of Health Insurance and the Productive Safety Net Program in Rural Ethiopia By Shigute, Zemzem; Mebratie, Anagaw Derseh; Sparrow, Robert; Yilma, Zelalem; Alemu, Getnet; Bedi, Arjun S.
  16. An Empirical Analysis on the Determinants of Overweight and Obesity in China By Ping Gao; Junyi Shen
  17. Cities Expanding Health Access for Children and Families By Cara Orfield; Sheila Hoag; Debra Lipson
  18. Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked By Hanming Fang; Qing Gong
  19. Beyond Job Lock: Impacts of Public Health Insurance on Occupational and Industrial Mobility By Ammar Farooq; Adriana Kugler
  20. The Inclusive Cost of Pandemic Influenza Risk By Victoria Y. Fan; Dean T. Jamison; Lawrence H. Summers
  21. Sex Differences in Early-Age Mortality: The Preconception Origins Hypothesis By Roland Pongou
  22. Sunlight in Utero and Allergic and Asthmatic Emergencies By David Slusky
  23. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century By Anne Case; Angua Deaton
  24. The Systematic Assessment of Health Worker Performance: A Framework for Analysis and its Application in Tanzania By kenneth L. Leonard; Melkiory C. Masatu; Christopher H. Herbst; Christophe Lemiere
  25. Unemployment and mortality : evidence from the great recession By Nguyen,Ha Minh; Nguyen,Huong
  26. Acute health shocks and labour market outcomes By Jones, M.A,;; Rice, N,;; Zantomio, F,;
  27. Cost-effectiveness of intravenous 5 mg zoledronic acid to prevent subsequent clinical fractures in postmenopausal women after hip fracture: A model-based analysis By Bleibler, Florian; König, Hans-Helmut
  28. Are patients and relatives the better innovators? The case of medical smartphone applications By Goeldner, Moritz; Herstatt, Cornelius

  1. By: Anja Sautmann; Samuel Brown; Mark Dean
    Abstract: We study the impact of subsidies (which remove cost barriers) and healthworker visits (which remove informational barriers) on over- and underuse of primary care, using a randomized control trial across 1532 children in Mali. Providing children with access to primary healthcare is an important development goal. Yet the subsidies needed to achieve this may lead to inefficient overuse, particularly if parents have difficulty assessing their child’s need for care. For the treatment of acute illness, price elasticities cannot be used to determine welfare effects, because they do not provide information on whether care is used effectively, which in turn depends on when it is sought. We propose a dynamic model of healthcare timing and define over- and underuse as seeking care too early or too late during an illness spell. We then use nine weeks of daily health records to identify misuse in our sample relative to WHO standards of care. Hazard estimates of care seeking show substantial underuse, but almost no overuse in our population. The primary barrier to the optimal timing of care seeking is cost, not information: subsidies increase care seeking by about 250%, and only 18% of this increase constitutes overuse. In contrast, healthworkers do little to reduce (already minimal) overuse, and may increase underuse when not paired with free care, as we predict in our dynamic model. Free care increases the value of care consumed without crowding out private spending, and it reduces mothers’ concern and average illness duration.
    Date: 2016
  2. By: Sanjeev Goyal; Adrien Vigier; ;
    Abstract: Individuals respond to the risk of infectious diseases by restricting interaction and by investing in protection. We develop a model that examines the trade-off between these two actions and the consequences for disease prevalence. There exists a unique equilibrium: individuals who invest in protection choose to interact more relative to those who do not invest in protection. Changes in the contagiousness of the disease have nonmonotonic effects: as a result interaction initially falls and then rises, while disease prevalence too may initial increase and then decline. We then consider a society with two communities that differ in their returns from interaction - High and Low. Individuals in isolated communities exhibit different behavior: the High community has a higher rate of protection and interaction and a lower rate of infection. Integration amplifies these differences.
    Date: 2014–06–10
  3. By: Akinwande A. Atanda; Andrea K. Menclova (University of Canterbury); W. Robert Reed (University of Canterbury)
    Abstract: Rising health care costs are a policy concern across the OECD and relatively little consensus exists concerning their causes. One explanation that has received revived attention is Baumol’s Cost Disease (BCD). However, developing a theoretically-appropriate test of BCD has been a challenge. In this paper, we construct a two-sector model firmly based on Baumol’s axioms. We then theoretically derive two propositions that can be tested using observable variables. In particular, we predict that: 1) the relative price index of the health care sector, and 2) the share of total labor employed in the health care sector should both be positively related to economy-wide productivity. Using annual data from 27 OECD countries over the years 1995-2013, we show that empirical evidence for the existence of BCD in health care is sensitive to model specification and disappears once we address spurious correlation due to contemporaneous trending and other econometric issues.
    Keywords: Baumol’s Cost Disease, OECD, health care industry, panel data
    JEL: I11 J30 E24
    Date: 2016–04–03
  4. By: Purvi Sevak; John O'Neill; Andrew Houtenville; Debra L. Brucker
    Abstract: In the United States, employment rates among individuals with disabilities are persistently low but vary substantially. In this study, we examine the relationship between employment outcomes and features of the state and county physical, economic, and policy environment among a national sample of individuals with disabilities. To do so, we merge a set of state- and county-level environmental variables with data from the 2009–2011 American Community Survey accessed in a U.S. Census Research Data Center. We estimate regression models of employment, work hours, and earnings as a function of health conditions, personal characteristics, and these environmental features. We find that certain environmental variables are significantly associated with employment outcomes. Although the estimated importance of environmental variables is small relative to individual health and personal characteristics, our results suggest that these variables may present barriers or facilitators to employment that can explain some geographic variation in employment outcomes across the United States.
    Keywords: Disability; employment; area effects.
    Date: 2016–03
  5. By: Daniel Howdon (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK.); Nigel Rice (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK.)
    Abstract: This paper uses Hospital Episode Statistics, English administrative data, to investigate the growth in admitted patient health care expenditures and the implications of an ageing population. We use two samples of around 40,000 individuals who a) used inpatient health care in the financial year 2005/06 and died by 2011/12 and b) died in 2011/12 and had some hospital utilisation since 2005/06. We use a panel structure to follow individuals over seven years of this administrative data, containing estimates of inpatient health care expenditures (HCE), information regarding individuals’ age, time-to-death (TTD), morbidities at the time of an admission, as well as the hospital provider, year and season of admission. We show that HCE if principally determined by proximity to death rather than age, and that proximity to death is itself a proxy for morbidity.
    Keywords: health care expenditures, ageing, time-to-death, morbidity
    JEL: H51 J11 I19
    Date: 2015–01
  6. By: Michela Ponzo; Vincenzo Scoppa (Dipartimento di Economia, Statistica e Finanza, Università della Calabria)
    Abstract: We use a Regression Discontinuity Design (RDD) to evaluate the impact of cost-sharing on the use of health services. In the Italian health system, individuals reaching age 65 and earning low incomes are given total exemption from cost-sharing for health services consumption. Since the probability of exemption changes discontinuously at age 65, we use a Fuzzy RDD in which the age threshold is used as an instrument for exemption. We find that prescription drug consumption, specialist visits and diagnostic checks remarkably increase with exemption. However, using several measures of health outcomes we do not find any change in individual health.
    Keywords: Health Insurance, Healthcare Demand, Cost-Sharing, Moral Hazard, Health Outcomes, Fuzzy Regression Discontinuity Design, Instrumental Variables
    JEL: I10 I13 I11 I18 C26
    Date: 2016–03
  7. By: Atsuko Tanaka (University of Calgary)
    Abstract: With an aging population and a rising prevalence of chronic conditions in the United States (U.S.), it is important to understand what happens when workers suffer unanticipated reductions in productivity. This paper investigates who pays for the loss caused by labor productivity reductions---a phenomenon often described as “presenteeism†or “absenteeism†---due to a stroke. Using the Health and Retirement Study (HRS) data, I find that, in the case of older workers, the employer often pays through higher costs of labor, rather than the worker through lower wages, because wages and earnings remain at the level before the worker had a stroke despite reduced hours. The existence of such rigidity in the employment contract translates to an increase in calculated hourly wages. Thus, this study warns that wages, earnings, or salaries cannot be clearly interpreted as accurate values of the marginal product of labor.
    Date: 2016–03–25
  8. By: Rudy Douven; Pieter Bakx; Frederik T. Schut
    Abstract: The decision about the amount and type of care that a patient needs may be entrusted to health care providers or be delegated to an independent assessor. An independent assessment limits the scope for supply-side moral hazard and occurs frequently in long-term care (LTC), e.g. in the Netherlands, Germany, Belgium, Switzerland, and Japan. The characteristics of LTC, the potential lack of incentives for efficient use for consumers, providers and third-party payers, and the absence of other restrictions of supply and demand, suggest that there may be room for excessive LTC use in the Netherlands, so there might be a case for independent needs assessment. Unique individual level data about LTC-eligibility decisions and use show that consumers make use of the indicated type of care but that for virtually all subgroups in the population there is considerable non-take-up, meaning that the independent assessment does not limit the amount of care that patients use. This finding suggests that the independent needs assessment may only have a small effect on preventing supply-side moral hazard in LTC.
    JEL: H51 I11 I13 I18 L13 L33
    Date: 2016–03
  9. By: Williams, John C. (Federal Reserve Bank of San Francisco)
    Abstract: Presentation to the National Interagency Community Reinvestment Conference, Los Angeles, California, February 10, 2016
    Date: 2016–02–10
  10. By: Marianne Tenand (ENS Paris - École normale supérieure - Paris, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics)
    Abstract: Demographic ageing is often deemed responsible for the massive increase in health expenditures experienced by developed countries. As the elderly consume more medical care than the rest of the population, how could the increase in the share of the 60 + not lead to a marked expansion of healthcare public and private budgets? Despite its apparent logics, such reasoning is fallacious: it ignores that medical care consumption depends on many factors beyond age, which have tremendously evolved in the last decades and may change again in the future. Based on French stylized facts, this article provides an overview of the international literature that aimed at disentangling the respective roles of population ageing and of the non-demographic factors in explaining the dynamics of health expenditures. Paradoxically, technical medical progress has been a major contributor to the increase of healthcare spending. Results from economics research lead to qualify the impact of demographic trends and call for more attention to the public policies decisions that shape healthcare systems.
    Abstract: Alors que les efforts de stabilisation des dépenses publiques se pour-suivent dans l'Union européenne, les regards se tournent vers les ressources financières consacrées à la santé, lesquelles représentent en moyenne 9 % du produit intérieur brut (PIB) dans les pays de l'OCDE (Organisation de coopération et de développement économiques) [1]. Largement socialisées en Europe, les dépenses de santé y ont crû continuellement depuis 1960 1 , beaucoup plus rapidement que le revenu national. Or, dès les années 1980, des travaux académiques, relayés par les organismes internationaux, ont prédit que cette hausse était appelée à s'amplifier avec l'accélération du vieillissement démo-graphique [2]. S'appuyant sur des travaux de synthèse existants [3, 4], cet article propose un tour d'horizon de la littérature qui a depuis cherché à isoler et à quantifier l'impact du vieillissement de la population sur la dynamique des dépenses de santé. Si les résultats laissent penser que la hausse devrait se poursuivre à l'avenir, ils permettent également de mettre à distance les discours alarmistes faisant du « papy boom » le synonyme d'une explosion des dépenses de santé. Le vieillissement démographique apparaît comme un facteur secondaire au regard du rôle joué par le progrès technique et les choix politiques 1 Si on fait abstraction de la baisse enregistrée en 2010, consécutivement à la crise économique.
    Keywords: Ageing population,Health Care Expenditure,Vieillissement démographique,Dépenses de santé
    Date: 2016
  11. By: Susan J. Méndez (Melbourne Institute of Applied Economics and Social Research, The University of Melbourne)
    Abstract: The goal of this paper is to investigate and quantify the impact of parallel trade in markets for pharmaceuticals. The paper develops a structural model of demand and supply using data on prices, sales and characteristics of statins, medicines used in the treatment for high cholesterol, in Denmark. The model provides a framework to simulate outcomes under a complete ban of parallel imports, keeping other regulatory schemes unchanged. There are two sets of key results from prohibiting parallel imports. The first set focuses on price effects, which differ substantially along two dimensions: the patent protection status of the molecule and the type of the firm. On average, prices increase more in markets where the molecule has lost patent protection. On the other dimension, both generic firms and original producers increase their pharmacy purchase prices when competition from parallel importers is removed. Given the prevailing reimbursement rules, most changes in pharmacy purchase prices are absorbed by the government. The final price paid by consumers after reimbursement increases more for original firms than for generic producers. The second set of empirical results reports the effects on market participants. My model takes into consideration consumers’ preferences allowing them to substitute between products. Prohibiting parallel imports induces consumers to substitute towards original products for which they have stronger preferences. In sum, banning parallel imports leads to (i) an increase in variable profits for original producers and a decrease for generic firms, (ii) an increase in governmental health care expenditures, and (iii) a decrease in consumers’ welfare. Classification-I18, H51
    Keywords: Pharmaceutical markets, parallel trade, regulation, welfare analysis
    Date: 2016–02
  12. By: Britta Augsburg (Institute for Fiscal Studies and Institute for Fiscal Studies); Paul Rodríguez-Lesmes (Institute for Fiscal Studies)
    Abstract: Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Speci cally, we examine the e ffects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. We use instrumental variables to control for endogeneity of sanitation usage coverage. We fi nd that sanitation coverage plays a signi cant and positive role in height growth during the fi rst years of life.
    Keywords: child health; sanitation coverage; open defecation; India
    Date: 2015–12
  13. By: Bijwaard, Govert (NIDI - Netherlands Interdisciplinary Demographic Institute); Jones, Andrew M. (University of York)
    Abstract: Large differences in mortality rates across those with different levels of education are a well- established fact. This association between mortality and education may partly be explained by confounding factors, including cognitive ability. Cognitive ability may also be affected by education so that it becomes a mediating factor in the causal chain. In this paper we estimate the impact of education on mortality using inverse probability weighted (IPW) estimators, using either cognitive ability as a selection variable or as a mediating variable. We develop an IPW estimator to analyse the mediating effect in the context of survival models. Our estimates are based on administrative data, on men born in 1944-1947 who were examined for military service in the Netherlands between 1961-1965, linked to national death records. For these men we distinguish four education levels and we make pairwise comparisons. From the empirical analyses we conclude that the mortality differences observed by education are only attributable to education effects for highly educated individuals. For less educated individuals the observed mortality gain is mainly attributable to differences in cognitive ability.
    Keywords: education, mortality, inverse probability weighting, mediators, mixed proportional hazard
    JEL: C41 I14 I24
    Date: 2016–03
  14. By: Markussen, Simen (Ragnar Frisch Centre for Economic Research); Røed, Knut (Ragnar Frisch Centre for Economic Research)
    Abstract: In many countries, general practitioners (GPs) are assigned the task of controlling the validity of their own patients' insurance claims. At the same time, they operate in a market where patients are customers free to choose their GP. Are these roles compatible? Can we trust that the gatekeeping decisions are untainted by private economic interests? Based on administrative registers from Norway with records on sick pay certification and GP-patient relationships, we present evidence to the contrary: GPs are more lenient gatekeepers the more competitive is the physician market, and a reputation for lenient gatekeeping increases the demand for their services.
    Keywords: absenteeism, gatekeeping, competition, role-conflicts
    JEL: H55 I11 I18
    Date: 2016–03
  15. By: Shigute, Zemzem (ISS, Erasmus University Rotterdam); Mebratie, Anagaw Derseh (ISS, Erasmus University Rotterdam); Sparrow, Robert (Wageningen University); Yilma, Zelalem (ISS, Erasmus University Rotterdam); Alemu, Getnet (University of Addis Ababa, Ethiopia); Bedi, Arjun S. (ISS, Erasmus University Rotterdam)
    Abstract: Due to lack of well-developed insurance, credit and labor markets, rural families in Ethiopia are exposed to a range of covariate and idiosyncratic risks. In 2005, to deal with the consequences of covariate risks, the government implemented the Productive Safety Net Program (PSNP) - an active labor market program to build rural assets, and in 2011, to mitigate the financial consequences of ill-health, the government introduced a pilot Community Based Health Insurance (CBHI) Scheme. This paper explores whether scheme uptake and retention is affected by access to the PSNP. Based on several rounds of household level panel data and qualitative information, the analysis shows that participating in the PSNP increases the probability of CBHI uptake by 24 percentage points and enhances scheme retention by 10 percentage points. Analysis of the channels through which the PSNP influences CBHI uptake indicates that the bulk of the effect may be attributed to explicit and implicit pressure applied by government officials on PSNP beneficiaries. Whether this is a desirable approach is debatable. Nevertheless, the results suggest that membership in existing social protection programs may be leveraged to spread new schemes and potentially accelerate poverty reduction efforts.
    Keywords: productive safety net program, active labor market program, Ethiopia, community based health insurance, uptake of health insurance
    JEL: J65 J48 I13
    Date: 2016–03
  16. By: Ping Gao (Graduate School of Economics, Kobe University); Junyi Shen (Research Institute for Economics & Business Administration (RIEB), Kobe University, Japan)
    Abstract: Overweight and obesity in adult populations is considered to be a growing epidemic worldwide, and appears to be rapidly increasing in China. From 1992 to 2002, the incidence of overweight in adults increased by 39.0%, while that of obesity doubled. To identify the determinants of adult overweight and obesity in China, micro-level data from a questionnaire survey entitled the "Preference Parameters Study," which was conducted by the Global Centers of Excellence program at Osaka University, were analyzed. In addition to the entire sample, data from urban and rural subsamples were also analyzed in order to investigate whether the determinants of overweight and obesity differed. The results suggested that body mass index (BMI) is correlated with subjective well-being, gender, age, labor intensity and drinking and eating habits among urban respondents, and with age, monthly income, number of siblings and eating habits among rural respondents.
    Keywords: Body mass index (BMI), Overweight and obesity, Urban residents, Rural residents, China
    JEL: C21 D12 I12
    Date: 2016–03
  17. By: Cara Orfield; Sheila Hoag; Debra Lipson
    Abstract: More than 16,000 uninsured children and parents nationwide enrolled in or renewed health insurance through the Cities Expanding Health Access for Children and Families initiative. The program helped protect and improve public health by using enrollment campaigns targeted at families who were eligible for but not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The initiative was sponsored by the Atlantic Philanthropies, administered by the National League of Cities, and evaluated by Mathematica Policy Research.
    Keywords: Health, insurance, coverage, ACA, cities, CHIP, Medicaid, enrollment, foundations
    Date: 2016–03–29
  18. By: Hanming Fang; Qing Gong
    Abstract: Medicare overbilling refers to the phenomenon that providers report more and/or higher-intensity service codes than actually delivered to receive higher Medicare reimbursement. We propose a novel and easy-to-implement approach to detect potential overbilling based on the hours worked implied by the service codes physicians submit to Medicare. Using the Medicare Part B Fee-for-Service (FFS) Physician Utilization and Payment Data in 2012 and 2013 released by the Centers for Medicare and Medicaid Services (CMS), we first construct estimates for physicians' hours spent on Medicare Part B FFS beneficiaries. Despite our deliberately conservative estimation procedure, we find that about 2,300 physicians, or 3% of those with a significant fraction of Medicare Part B FFS services, have billed Medicare over 100 hours per week. We consider this implausibly long hours. As a benchmark, the maximum hours spent on Medicare patients by physicians in National Ambulatory Medical Care Survey data are 50 hours in a week. Interestingly, we also find suggestive evidence that the coding patterns of the flagged physicians seem to be responsive to financial incentives: within code clusters with different levels of service intensity, they tend to submit more higher intensity service codes than unflagged physicians; moreover, they are more likely to do so if the marginal revenue gain from submitting mid- or high-intensity codes is relatively high.
    JEL: H51 I13 I18
    Date: 2016–03
  19. By: Ammar Farooq; Adriana Kugler
    Abstract: We examine whether greater Medicaid generosity encourages mobility towards riskier but better jobs in higher paid occupations and industries. We use Current Population Survey Data and exploit variation in Medicaid thresholds across states and over time through the 1990s and 2000s. We find that moving from a state in the 10th to the 90th percentile in terms of Medicaid income thresholds increases occupational and industrial mobility by 7.6% and 7.8%. We also find that higher income Medicaid thresholds increase mobility towards occupations and industries with greater wage spreads and higher separation probabilities, but with higher wages and higher educational requirements.
    JEL: I13 J6
    Date: 2016–03
  20. By: Victoria Y. Fan; Dean T. Jamison; Lawrence H. Summers
    Abstract: Estimates of the long-term annual cost of global warming lie in the range of 0.2-2% of global income. This high cost has generated widespread political concern and commitment as manifested in the Paris agreements of December, 2015. Analyses in this paper suggest that the expected annual cost of pandemic influenza falls in the same range as does that of climate change although toward the low end. In any given year a small likelihood exists that the world will again suffer a very severe flu pandemic akin to the one of 1918. Even a moderately severe pandemic, of which at least 6 have occurred since 1700, could lead to 2 million or more excess deaths. World Bank and other work has assessed the probable income loss from a severe pandemic at 4-5% of global GNI. The economics literature points to a very high intrinsic value of mortality risk, a value that GNI fails to capture. In this paper we use findings from that literature to generate an estimate of pandemic cost that is inclusive of both income loss and the cost of elevated mortality. We present results on an expected annual basis using reasonable (although highly uncertain) estimates of the annual probabilities of pandemics in two bands of severity. We find: 1. Expected pandemic deaths exceed 700,000 per year worldwide with an associated annual mortality cost of estimated at $490 billion. We use published figures to estimate expected income loss at $80 billion per year and hence the inclusive cost to be $570 billion per year or 0.7% of global income (range: 0.4-1.0%). 2. For moderately severe pandemics about 40% of inclusive cost results from income loss. For severe pandemics this fraction declines to 12%: the intrinsic cost of elevated mortality becomes completely dominant. 3. The estimates of mortality cost as a % of GNI range from around 1.6% in lower-middle income countries down to 0.3% in high-income countries, mostly as a result of much higher pandemic death rates in lower-income environments. 4. The distribution of pandemic severity has an exceptionally fat tail: about 95% of the expected cost results from pandemics that would be expected to kill over 7 million people worldwide.
    JEL: H51 I15 I18
    Date: 2016–03
  21. By: Roland Pongou (Department of Economics, University of Ottawa)
    Abstract: The preconception origins hypothesis holds that some of the preconception and prenatal environmental factors that have been shown to determine the offspring sex ratio also explain sex differences in early-age mortality (Pongou 2013). It extends and complements the biological hypothesis, which affirms that the mortality sex gap originates in biological and genetic differences between the sexes. As such, it offers a broad framework for understanding changes in male–female differences in early-age mortality across space and over time. I argue that this hypothesis is consistent with the concurrent increase in the proportion of female births and in the relative mortality of female to male infants in the United States since World War II.
    Keywords: Sex differences in early-age mortality; preconception origins hypothesis; biological hypothesis
    JEL: J10 I10
    Date: 2015
  22. By: David Slusky (Princeton University)
    Abstract: American asthma and allergy rates have risen substantially over the past generation, as individuals have spent more time indoors and as vitamin D levels (which sunlight exposure promotes) have plummeted. Using a within birth-month-county estimator, I find that cohorts with a relatively sunny second trimester in utero had lower per capita rates of asthma emergencies by 0.6 percentage points (6%), consistent with the medical literature that links second trimester maternal vitamin D levels to lung development. This result is driven by the male per capita rate, and the effect is counterintuitively greater in counties with higher median incomes and for white individuals. Given the high cost of emergency department visits and the low cost of vitamin D supplements, this finding motivates a cost effective solution. Results on allergy emergency rates are inconclusive. Asthma results are robust to include relative sunlight levels before conception and after birth, whereas allergy results are not.
    Keywords: asthma, allergies, sunlight, vitamin D supplements, emergency department
    JEL: I12 I15
    Date: 2014–06
  23. By: Anne Case (Princeton University); Angua Deaton (Princeton University)
    Abstract: This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.
    Date: 2015–09
  24. By: kenneth L. Leonard; Melkiory C. Masatu; Christopher H. Herbst; Christophe Lemiere
    Abstract: This paper introduces a simple framework for understanding the dimensions and determinants of health worker performance based on the idea that there can be three different gaps affecting performance: a knowledge gap, the knowledge-capacity gap and the capacity-performance gap. The paper argues that performance is determined by a combination of competence, capacity and effort, and that any of these elements may lead to poor performance, and applies this framework to the measurement of health worker performance in Tanzania. Whilst discussing and highlighting key findings related to the assessment of health worker performance in Tanzania, the overarching objective of the paper is to offer a systematic way to analyze health worker performance through primary data collection and analysis to benefit researchers and countries beyond Tanzania.
    Keywords: pharmacy, health care providers, infant mortality rates, sutures, determinants of health, access to health care, employment, treatment, health service delivery, diagnosis ... See More + deaths, income, quality of health care, drug supply, public sector, doctors, health economics, health research, health care, drugs, health care workers, effects, health care facilities, incentives, health, health workers, breast cancer, prescriptions, health facilities, symptom, public health, quality of health, health sector, knowledge, choice, animal health, workplace, diseases, costs, voluntary sector, patients, patient, life, demand for health services, intervention, probability, health systems, health centers, medication, nurses, observation, medical care, health care quality, medical officers, symptoms, work environment, outpatient services, health care outcomes, hiv/aids, health services research, interview, mortality, health care system, medical service providers, cancer, availability of drugs, infant mortality, diagnoses, health care sector, clinician, emergency medicine, health specialist, workers, fever, quality of care, patient satisfaction, amodiaquine, basic needs, care, health policy, medicine, demand, diarrhea, std, preventive health services, income countries, adequate care, medical personnel, malnutrition, private sector, measurement, nutrition, medical officer, syringes, malaria, rest, primary health care, pneumonia, internet, exposure, health system, outpatient care, low income, health care delivery, children, malaria symptoms, clinicians, clinics, evaluation, bandages, human resources, demand for health, illness, infants, all, population, medical doctors, child deaths, fees, families, medicines, forceps, hospitals, certification, illnesses, health service, health services, private sectors, demand for services, financial incentives, visits, nursing, medical training
    Date: 2015–08
  25. By: Nguyen,Ha Minh; Nguyen,Huong
    Abstract: Did unemployment in the Great Recession hurt people's health? The broad answer is no: job losses have statistically insignificant impacts on mortality. The exogenous sources of job losses in a U.S. county is the tradable job losses driven by external demand collapses during the Great Recession. The insignificant relationship holds for males and females, for all age groups, and for almost all categories of mortality. Three important exceptions are Alzheimer's, poisoning, and homicide.
    Keywords: Labor Policies,Health Systems Development&Reform,Health Monitoring&Evaluation,Labor Markets,Population Policies
    Date: 2016–03–16
  26. By: Jones, M.A,;; Rice, N,;; Zantomio, F,;
    Abstract: We investigate the labour supply response to acute health shocks experienced in the post-crash labour market by individuals of working age, using data from Understanding Society. Identification exploits uncertainty in the timing of an acute health shock, defined by the incidence of cancer, stroke, or heart attack. Results, obtained through a combination of coarsened exact and propensity score matching, show acute health shocks significantly reduce participation, with younger workers displaying stronger labour market attachment. The impact on older, more educated, women suggests an important role for preferences, financial constraints, and intra-household division of labour determining labour supply decisions.
    Keywords: health shocks; labour supply; panel data; matching methods;
    JEL: C14 I10 J22
    Date: 2016–03
  27. By: Bleibler, Florian; König, Hans-Helmut
    Abstract: Fractures are associated with high economic costs, increased mortality and loss of health related quality of life. Studies have shown that individuals with prior fractures have an increased risk of experiencing subsequent fractures. Therefore secondary fracture prevention appears useful to reduce further fractures in high risk individuals, e.g., in individuals with a prior hip fracture. A clinical trial (HORIZON-RFT) showed that a yearly dose of 5mg intravenous zoledronic acid (IZA) had a fracture-reducing effect in individuals with a prior hip fracture. As to our knowledge no evidence about the cost-effectiveness of IZA is available, the objective of this study is to evaluate the cost-effectiveness of 5mg IZA in women with a previous hip fracture in comparison to no intervention. For this reason a previously published discrete event simulation model which simulates the natural occurrences of different fractures was enhanced. The main enhancements of the model were the inclusion of medication persistence and potential residual treatment effects of IZA. Model input data in terms of epidemiologic, economic and medication effectiveness data was taken from multiple sources. Quality adjusted life years (QALY) were used as effect measure. Costs were considered from a societal perspective for the year 2009. Costs and QALYs were discounted by 3%. As main outcome we calculated the incremental cost-effectiveness ratio (€/QALY) and constructed cost-effectiveness acceptability curve (CEAC) to represent the parameter uncertainty around our results. In the base-case analysis the model showed an ICER of 11,602 €/QALY with incremental costs and QALYs of 21.8€ and 0.0018762 QALYs, respectively. At ICER thresholds of 12,500 €/QALY and 80,000€/QALY the CEAC showed a probability for cost-effectiveness of 48% and 93%, respectively. The result of the model suggest that yearly 5 mg intravenous zoledronic acid is a cost-effective intervention in postmenopausal women after a hip fracture.
    Keywords: cost-effectiveness,fractures,zoledronic acid,discrete event simulation
    Date: 2016
  28. By: Goeldner, Moritz; Herstatt, Cornelius
    Abstract: Prior research has shown that users are a valuable resource for identifying new product or service innovations. However, few scholars have analyzed how different user types such as intermediate and end users are interacting along the value chain of an emerging new product and how they contribute to innovation. Further, user innovation success in the market is often unclear, since very few innovations diffuse directly to customers from the user innovators. We analyze different innovative contributions of intermediate and end users that have been sold and evaluated within the healthcare sector. Several studies in the healthcare sector have shown that healthcare professionals are an important source of innovation. Yet, to date, companies and scholars have paid little attention to the end users of medical devices: patients. We focus on the innovative behavior of patients and their relatives, their motivations, and their contributions to improving the quality of their own and ultimately of other patients' therapy. We analyze innovations of producers, healthcare professionals, patients, and relatives in the German, UK, and U.S. markets for medical smartphone apps (Apple App Store) and conduct 16 semi-structured interviews. Our findings show that users develop around 46% of all medical smartphone applications (apps). We analyzed 510,229 user ratings and found that apps designed by patients, relatives, and healthcare professionals are rated significantly better by App Store customers than apps created by professional software companies. Apps developed by patients' relatives achieve significantly more downloads and generate on average three times higher revenues per year. The initial medical smartphone app developments in the early days of the Apple App Store were mainly triggered by healthcare professionals. The interview data shows the extensive medical knowledge of patients and their relatives, particularly those with chronic diseases. The overall findings are in line with a current literature stream that indicates that patients are gaining more influence on their treatment, are better informed, and are taking more actions to increase their quality of life. Commercial healthcare companies should take advantage of this and should consider including patients and relatives into their product development.
    Keywords: user innovation,patient,relative,healthcare professional,m-health,medical,smartphone applications,app,apps
    Date: 2016

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