nep-hea New Economics Papers
on Health Economics
Issue of 2016‒04‒16
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Smoking in top-grossing US movies 2015 By Polansky, Jonathan R; Titus, Kori; Atayeva, Renata; Glantz, Stanton A PhD
  2. Assessing the impact of health care expenditures on mortality using cross-country data By Ryota Nakamura; James Lomas; Karl Claxton; Farasat Bokhari; Rodrigo Moreno Serra; Marc Suhrcke
  3. Who bears the cost of workers' health-related presenteeism and absenteeism By Atsuko Tanaka
  4. Does independent needs assessment limit supply-side moral hazard in long-term care? By Rudy Douven; Pieter Bakx; Frederik T. Schut
  5. Alcohol: Does It Make You Successful? A Longitudinal Analysis By Patrick Keller
  6. Distribution costs in home-care production: what are the effects of local regulations on productive efficiency and spatial equity? By Quitterie Roquebert
  7. Can French public hospitals make do with a dynamic and uncertain environment by developing inter-organizational restructuration strategies? By Leo Cazin
  8. Beyond Job Lock: Impacts of Public Health Insurance on Occupational and Industrial Mobility By Farooq, Ammar; Kugler, Adriana
  9. The Role of Culture in Long-term Care By Elena Gentili; Giuliano Masiero; Fabrizio Mazzonna
  10. No Free Lunch, Buddy: Housing Transfers and Informal Care Later in Life By Emanuele Ciani; Claudio Deiana
  11. US Life Expectancy: The Authors Reply By John Bound; Arline T. Geronimus; Javier M. Rodriguez; Timothy A. Waidmann
  12. Implications of Telenursing Practices on Nursing Care: Turkey Profile By Esra USLU; Menekşe Nazlı AKER; Selma İNFAL
  13. India’s Focus On Medical Diagnostic Laboratories: Indian Planning and Programmes By Rahi Jain; Bakul Rao
  15. Measuring the Appropriate Outcomes for Better Decision-Making: A Framework to Guide the Analysis of Health Policy By Matthew Calver
  16. Spending on Health Care in the Netherlands: Not going so Dutch By Pieter Bakx; Owen O’Donnell; Eddy van Doorslaer
  17. Can Basic Maternal Literacy Skills Improve Infant Health Outcomes? Evidence from the Education Act in Nepal By Vinish Shrestha
  18. Absent laws and missing women: can domestic violence legislation reduce female mortality ? By Amin,Mohammad; Islam,Asif Mohammed; Lopez Claros,Augusto
  19. Decomposing the Danger of Drinking Drivers: 1983-2012 By Dunn, Richard A.; Tefft, Nathan W.

  1. By: Polansky, Jonathan R; Titus, Kori; Atayeva, Renata; Glantz, Stanton A PhD
    Keywords: Medicine and Health Sciences, Social and Behavioral Sciences
    Date: 2016–04–01
  2. By: Ryota Nakamura (Centre for Health Economics, University of York, UK.); James Lomas (Centre for Health Economics, University of York, UK.); Karl Claxton (Centre for Health Economics, University of York, UK.); Farasat Bokhari (University of East Anglia, Norwich, UK.); Rodrigo Moreno Serra (University of Sheffield, Sheffield, UK.); Marc Suhrcke (Centre for Health Economics, University of York, UK.)
    Abstract: A significant body of literature has examined the impact of public health expenditure on mortality, using a global cross-section or panel of country-level data. However, while a number of studies do confirm such a relationship, the magnitude of the impact varies considerably between studies, and several studies show statistically insignificant effects. In this paper we re-examine the literature that identifies this effect using cross-country data. Our analysis builds on the two instrumental variables (IV) approaches embodied by key publications in the field – Bokhari et al. (2007) and Moreno-Serra and Smith (2015). Using exactly the same data and econometric specifications as the published studies, we start by successfully replicating their findings. However, further analyses using updated data and ‘streamlined’ econometric specifications, plus statistical data imputation and extensive robustness checks, reveal highly sensitive results. In particular, the relevance of the IVs is seriously compromised in the updated data, leading to imprecise estimations of the relationship. While our results should not be taken to imply that there is no true mortality-reducing impact of public health care expenditures on mortality, the findings do call for further methodological work, for instance in terms of identifying more suitable IVs or by applying other estimation strategies, in an effort to derive more robust estimates of the marginal productivity of public health care funding.
    Date: 2016–04
  3. 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
  4. 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
  5. By: Patrick Keller
    Abstract: This thesis analyzes the link between alcohol consumption and labor market outcomes, such as income, employment or hazard rate of leaving unemployment. It does so by using panel data from the German Socio-Economic Panel (SOEP) forthe period 2006 until 2010. While cross-sectional methods show a positive relationship between non-abusive alcohol consumption and labor market outcomes, fixed effects methods do not confirm a causal effect of alcohol consumption on labor market outcomes. These results suggest, that the often replicated, cross-sectional finding of a positive relationship between income and alcohol consumption (alcohol income puzzle) is due to selection bias.
    Date: 2016
  6. By: Quitterie Roquebert (EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics, CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Poster for the labex OSE meeting 2015. Research project :Distribution costs in home-care production: what are the effects of local regulations on productive efficiency and spatial equity? Research questions : In home-care production, how do production costs vary with the geographical location of users? What are the effects of local public regulation in terms of productive efficiency and spatial equity?
    Keywords: long term care,home-care-services
    Date: 2015–12–14
  7. By: Leo Cazin (CGS i3 - Centre de Gestion Scientifique i3 - MINES ParisTech - École nationale supérieure des mines de Paris - PSL - PSL Research University - CNRS - Centre National de la Recherche Scientifique)
    Abstract: For a few years, public hospitals in France and in most of developed countries have had to deal with major issues. New legislations have recently been introduced, such as a prospective payment system (PPS: hospitals are reimbursed depending of the amount of services they provide), which aims at developing “business-like” management models, according to the New Public Management principles (Osborne & Gaebler 1994). Therefore, the dominant institutional logic in healthcare organizations is shifting, sometimes in very short periods of time, from “medical professionalism” to “business-like healthcare” (Reay & Hinings 2005). The PPS is a pro-competitive trigger, since hospitals are encouraged to develop their activity in order to generate more income by gaining market shares (Moisdon 2013). What is more, public hospitals often have to cope with a major problem of medical workforce shortages (Kroezen et al. 2015), which threatens the existence of some activities in a lot of institutions, particularly in remote areas. Furthermore, the evolution of medical practices, for instance the ambulatory turning point which consists in reducing, when possible, patient stay in hospitals to less than 24 hours, brings about a series of organizational concerns, as hospitals will be asked to cooperate with different stakeholders about healthcare pathways. All in all, as in many developed countries, hospitals are pressurized into providing better care at an affordable cost, in a dynamic and uncertain environment, with potentially clashing demands. In order to generate a transformation of the French public hospitals territory organization, and so as to meet the challenges mentioned above, the French government has implemented a set of tools aiming at fostering restructuration between neighbouring hospitals, thanks to cooperation and merger processes. For instance, a law voted in 2009 provided hospitals with the possibility to cooperate in Territory Hospital Communities. Private clinics have been dramatically restructured in the past two decades amongst integrated networks, but public hospitals, which have been used to working relatively autonomously, have not followed this process to the same extent in France (Delas 2011). The results that the government was calling for have not been rather mixed so far. Given this relative failure, the State has decided to step up a gear by making cooperation mandatory. By the end of 2016, all hospitals will have to be part of a Territory Hospital Group. Territory organization of healthcare providers is regulated by Regional Health Agencies (RHA), whose mission is to promote restructuration leading to a better access to healthcare at an affordable cost. The purpose of this paper is to contribute to the management literature about organizational change implementation in the case of inter-hospital reorganization, by analysing restructuring processes under way in France. The empirical material collected will be used to answer the following research questions: 1. To what extent are inter-hospital restructuring strategies an answer to uncertainty (such as the lack of medical resources) and pro-competitive triggers (e.g. the PPS) they have to cope with? 2. Is the transformation of the French public hospitals territory organisation led thanks to a regulated restructuration process, or is it the result of “making do” bottom-up strategies (sometimes partially unsuccessful) between hospitals? The study was carried out thanks to two different case studies that analysed inter-organizational restructuration strategies in two French public hospital groups. Qualitative data was collected mainly by carrying out 30 semi-structured interviews with different stakeholders involved in the processes. This paper shows that even though the necessity of performing inter-hospital restructuration in globally accepted by the different stakeholders, the conditions to implement this process raise a number of concerns. The role and missions of the regulatory institutions is not always clearly defined. Moreover, because of multiple factors that will be presented, it may be observed that inter-hospital restructuration is more often the result of “making do” bottom-up strategies, with uneven results, rather than that of a rational and wider regulation.
    Keywords: French public hospitals,inter-organizational restructuration,Regional Health Agencies,Making do,Regulation
    Date: 2016–07–07
  8. By: Farooq, Ammar (Georgetown University); Kugler, Adriana (Georgetown University)
    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.
    Keywords: Medicaid, job lock, public health insurance occupational mobility, industrial mobility, occupational mismatch
    JEL: I13 J6
    Date: 2016–03
  9. By: Elena Gentili (Institute of Economics (IdEP), Università della Svizzera Italiana (USI), Switzerland); Giuliano Masiero (Institute of Economics (IdEP), Università della Svizzera Italiana (USI), Switzerland; Department of Management, Information and Production Engineering (DIGIP), University of Bergamo, Italy); Fabrizio Mazzonna (Institute of Economics (IdEP), Università della Svizzera Italiana (USI), Switzerland)
    Abstract: The aim of this paper is to assess the role of culture in shaping individual preferences to- wards different long-term care (LTC) arrangements. The analysis uses Swiss data from two administrative databases covering the universe of formal LTC providers between 2007 and 2013. Switzerland is a multi-cultural confederation where state administrative borders do not always coincide with cultural groups. For this reason, we exploit the within-state variation in cultural groups to show evidence about cultural differences in LTC use. In particular, we use spatial regression discontinuity design (RDD) at the language border between French-speaking and German-speaking individuals living in bilingual cantons to provide causal interpretation of the differences in formal LTC use between these two main cultural groups. Our results suggest a strong role of culture in shaping household decisions about formal LTC use. In particular, elderly people residing in regions speaking a Latin language (French, Italian and Romansh) use home-based care services more intensely and enter in nursing homes at older ages and in worse health conditions with respect to elderly people in German regions. This difference across the two cultural groups are driven by different preferences towards LTC arrangements.
    Keywords: Long-term care, Culture, Spatial RDD
    JEL: I11 I18 C26
    Date: 2016–04–04
  10. By: Emanuele Ciani; Claudio Deiana
    Abstract: Previous empirical literature on intergenerational transfers of assets and services has mostly focused on the contemporary exchange or on the bequest motive. Differently, using Italian data, we provide evidence that parents who help their adult children with housing at the time of marriage are rewarded by higher chances of receiving informal care later in life. We show that this relation is robust to controlling for a wide set of individual and family characteristics and we discuss three possible explanations: (i) increased geographical distance; (ii) parents' reinforcement through support for the production of grandchildren; (iii) correlation with future financial transfers.
    Keywords: informal care, grandchildren care, proximity, intergenerational transfers
    JEL: J12 J13 J14
    Date: 2016–03
  11. By: John Bound; Arline T. Geronimus; Javier M. Rodriguez; Timothy A. Waidmann
    Keywords: US Life Expectancy
    JEL: I
    Date: 2016–03–31
  12. By: Esra USLU (Selcuk Universty); Menekşe Nazlı AKER (Selcuk Universty); Selma İNFAL (Selcuk Universty)
    Abstract: This systematic review evaluates the telenursing interventions and their efficiency in patient care. This study was conducted using scientific search engines such as Ulakbim Medical Data Base, Turkish Medline Data Base, National Thesis Center, Turkish Citation Index, Academic Index. As determined, keywords were searched in several combinations. A total of five articles that met the inclusion criteria were involved in the evaluation. This systematic review shows that the studies on this issue are very limited in terms of quantitative perspective but the results are positive. In this context, it is suggested that the number of randomized controlled studies which are evaluating the effectiveness of the care with tele nursing practices are increased and similar studies are planned with various patient groups.
    Keywords: Telenursing, care, nursing, Turkey
    JEL: I10
  13. By: Rahi Jain (Indian Institute of Technology Bombay (IITB)); Bakul Rao (Indian Institute of Technology Bombay (IITB))
    Abstract: Healthy lives and well being for all is one of the goals in Sustainable Development Goals 2030 (SDG) that is strongly dependent on a nation’s healthcare system. In any modern healthcare system, laboratory diagnostics play a crucial role for effective system’s functioning as it helps in evidence based decision-making but the focus on laboratory diagnostics system is inadequate especially nationally. However, globally and nationally problems in laboratory diagnostic systems have been raised, but more focus is demanded. This study focuses on understanding the government past Five-yearhealth plans and current national health programmes to understand the focus given to the laboratory systems both historically and in present. This will allow in filling the gap of linking the current status of laboratory systems with the historical approaches of India. This linkage will enable a more comprehensive understanding of the India’s current state of laboratory diagnostic system and will help current and future planners and decision makers like Niti Aayog in better decision-making.The study performed two phases of inductive approach based content analysis. The first phase is involved in the analysis of the Five-Year health plans for understanding the focus areas in health sector over the years. Second Phase is involved in the analysis of major health programmes for understanding the current focus areas of medical diagnostic laboratory system in the health sector. The study has found that laboratory diagnostics was given focus in the various health plans but the scope and the depth of discussion was very limited. Further, the focus on laboratory diagnostic systems and its various components is found to be variable among all major national health programmes and very limited. The study concludes that the India’s focus on the laboratory diagnostic system is very limited and inadequate.
    Keywords: India Health Sector, India health plans, India health programmes
  14. By: MERVE ÇELİK (Anadolu University)
    Abstract: Human capital is an important aspect in the endogeneous growth theme. One of the main causes of economic performance which countries have is giving importance about human capital. Health indicators which are accepted as human capital factor are important about having thought related to development stages of countries. There is a close relationship between economic growth-development and health status in the societies. In this study, rate of health expenditures in GDP and exchange rates of them related to the years were given. These rates were investigated based on samples of other OECD countries and Turkey’s developments in years. Development of health expenditures and annual increase rates in these countries were explained via graphs and figures. Descriptive analysis method was used while representating changes. Moreover reasons of these changes were revealed in this study.
    Keywords: Economic growth, health, human capital, health expenditures,GDP
    JEL: I10 O40 I15
  15. By: Matthew Calver
    Abstract: Many existing economic evaluations of health policy recognize multidimensional outcomes and the importance of equally distributing the benefits, but do not to incorporate all relevant outcomes into a single comprehensive metric for cost-benefit analysis. The Organization for Economic Co-operation and Development’s (OECD’s) inclusive growth framework offers a novel approach for improved evaluation of policies which can address these concerns by aggregating societal outcomes in terms of income, life expectancy, unemployment rates and inequality into a single measure of living standards. We discuss the inclusive growth framework in the context of health policy and how it can be utilized by business leaders and policymakers to make superior policy decisions. Using an inclusive growth index of living standards developed by the OECD, we decompose growth in living standards (as defined by the OECD) due to increased life expectancy in Canada between 2000 and 2011 by cause of death and estimate the equivalent value of these reductions in mortality in terms of billions of dollars of income. We discuss factors underlying these reductions in mortality and suggest how they have been linked to policy. This exercise illustrates one way in which the inclusive growth framework can be used to evaluate the impacts of health policy.
    Keywords: Living Standards, Life Expectancy, Health Policy, Inequality, Canada
    JEL: I18 I12 I38 I31 N32 N42
    Date: 2016–03
  16. By: Pieter Bakx (Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, the Netherlands); Owen O’Donnell (Erasmus University Rotterdam, the Netherlands, University of Thessaloniki, Greece); Eddy van Doorslaer (Erasmus University Rotterdam, the Netherlands)
    Abstract: The Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor.
    Keywords: Health expenditure; Long-term care; Social insurance; the Netherlands
    JEL: D12 I13 I14
    Date: 2016–04–08
  17. By: Vinish Shrestha (Department of Economics, Towson University)
    Abstract: I evaluate the effect of basic maternal literacy skills such as the ability to read, write, and the highest level of schooling on child health outcomes in Nepal. The National Education System Plan in 1971 reshaped the education system of Nepal by increasing access to education among females. Using within cohort and across district variations in educational outcomes due to the reform, I find that improvements in basic maternal literacy skills reduce infant mortality. Access to clean water supply, and a reduction in gender inequality among relatively educated mothers are some potential mechanisms contributing to improvements in infant mortality.
    Keywords: Mother's literacy, infant mortality, returns to education.
    JEL: I10 I15
    Date: 2016–04
  18. By: Amin,Mohammad; Islam,Asif Mohammed; Lopez Claros,Augusto
    Abstract: This study contributes to the literature on legal institutions and determinants of adult mortality. The paper explores the relationship between the presence of domestic violence legislation and women-to-men adult mortality rates. Using panel data for about 95 economies between 1990 and 2012, the analysis finds that having domestic violence legislation leads to lower women-to-men adult mortality rates. According to conservative estimations, domestic violence legislation would have saved about 33 million women between 1990 and 2012. The negative relationship between domestic violence legislation and women-to-men adult mortality rates is robust to several checks and also confirmed using the instrumental variables approach.
    Keywords: Gender and Health,Gender and Development,Gender and Law,Adolescent Health,Population Policies
    Date: 2016–04–05
  19. By: Dunn, Richard A. (University of Connecticut); Tefft, Nathan W.
    Abstract: This paper estimates the relative risk of drunk-drivers causing a fatal accident using imputed values for BAC from the Fatality Analysis Reporting System for three time periods. In addition, we develop an econometric approach that allows the decomposition of fatal accident risk into two components: the relative probability of a drunk-driver causing a serious accident and the probability of dying in a serious accident. Our results suggest that the relative risk of drunk drivers causing a fatal accident increased by approximately one-third from 1983-1993 to 2004-2013. Further, the increase in relative risk was caused almost entirely by an increase in the relative risk of drunk drivers causing a serious accident. In contrast, the relative risk of a drunk driver dying in a serious accident was nearly unchanged. We also find that there has been a decrease in the incidence of drunk driving, as well as the external cost associated with drunkdriving.
    Keywords: drunk-driving, motor vehicle fatality, externality, FARS
    Date: 2014–09

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