nep-hea New Economics Papers
on Health Economics
Issue of 2016‒04‒23
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  2. Economic Valuation of health Impacts of Haze Pollution in Malaysia By Jamal Othman; Mazrura Sahani; Mastura Mahmud; Md. Khadzir Sheikh Ahmad
  3. How do Hospitals Adopt Advanced Treatment Techniques? An assessment through the records of AMI patients in Japan By SUGIHARA Shigeru; ICHIMIYA Hiroki; INUI Tomohiko; ITO Yukiko; SAITO Yukiko; IGARASHI Isao; KAWABUCHI Koichi
  4. Why Do People Overwork at the Risk of Impairing Mental Health? By KURODA Sachiko; YAMAMOTO Isamu
  5. Absenteeism and productivity: the experience rating applied to employer contributions to health insurance By Sébastien Ménard; Coralia Quintero
  6. Electronic Health Records and Clinical Routines: Convergence and Divergenc By Andrei M. Korbut
  7. Welfare analysis of rationing in health care provision By Laura Levaggi; Rosella Levaggi
  8. (Not so) Gently down the stream: river pollution and health in Indonesia By Teevrat Garg; Stuart Hamilton; Jacob Hochard; Evan Plous; John Talbot
  9. Beyond Job Lock: Impacts of Public Health Insurance on Occupational and Industrial Mobility By Ammar Farooq; Adriana Kugler
  10. Pharmaceutical Expenditure And Policies: Past Trends And Future Challenges By Annalisa Belloni; David Morgan; Valérie Paris
  11. Your Retirement and My Health Behaviour: Evidence on Retirement Externalities from a Fuzzy Regression Discontinuity Design By Müller, Tobias; Shaikh, Mujaheed
  12. Suicide, age, and wellbeing: an empirical investigation By Anne Case; Angus Deaton
  13. Transnational Health Insurance Schemes: A New Avenue for Congolese Immigrants in Belgium to Care for Their Relatives' Health from Abroad? By Jean-Michel Lafleur; Olivier Lizin
  14. Taxonomy of Challenges in Medical Laboratory Diagnostic Services By Rahi Jain; Bakul Rao
  15. 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
  16. Quality competition and hospital mergers: An experiment By Han, Johann; Kairies-Schwarz, Nadja; Vomhof, Markus
  17. A Longitudinal Analysis of Fast-Food Exposure On Child Weight Outcomes: Identifying Causality Through School Transitions By Dunn, Richard A.; Nayga, Rodolfo M., Jr.; Thomsen, Michael; Heather L. Rouse

  1. 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
  2. By: Jamal Othman (Department of Agricultural and Resource Economics, Faculty of Economics, Universiti Kebangsaan Malaysia); Mazrura Sahani (Universiti Kebangsaan Malaysia); Mastura Mahmud (Universiti Kebangsaan Malaysia); Md. Khadzir Sheikh Ahmad (Universiti Kebangsaan Malaysia)
    Keywords: haze, malaysia
    Date: 2016–03
  3. By: SUGIHARA Shigeru; ICHIMIYA Hiroki; INUI Tomohiko; ITO Yukiko; SAITO Yukiko; IGARASHI Isao; KAWABUCHI Koichi
    Abstract: For better clinical outcomes in hospitals, some advanced but costly techniques are often required. Facing these trade-offs of cost and quality, hospitals decide when and what techniques to apply. This paper investigates the spread of some advanced materials, mechanical devices, or procedures for acute myocardial infarction (AMI) through 11,120 patients' records in 92 hospitals in Japan. Since the daily cost of hospital services is fixed under a nationwide health insurance policy, we can assume almost uniform revenue constraints for treatment. The decisions of hospitals therefore are worth comparing. We measure the hospitals' propensities to adopt technologies and compare these with hospital-level mortality of AMI. In addition, we argue whether the spread of technical progress can be explained by geography (distance between the hospitals), or by governance under a hospital group. First, the results show that the propensities to adopt the advanced techniques vary greatly among hospitals, and these varieties explain hospital-level mortalities. Second, the physical distance between hospitals show a negative correlation to the spread of the same techniques. Finally, we observe similar decision patterns for hospitals under the same health care group.
    Date: 2016–03
  4. By: KURODA Sachiko; YAMAMOTO Isamu
    Abstract: Using longitudinal data of Japanese workers, this study investigates the relationship between overwork and mental health. Conventional labor supply theory assumes that people allocate their hours of work and leisure to maximize personal utility. However, people sometimes work too long (overwork) and, by doing so, impair their physical and/or mental health. We introduce non-pecuniary factors into the conventional utility function. Empirical analysis reveals a non-linear relationship between the number of hours worked and job satisfaction. We find that job satisfaction rises when people work more than 55 hours weekly. However, we also find that hours worked linearly erode workers' mental health. These findings imply that people who overvalue job satisfaction work excessive hours and, as a consequence, damage their mental health. We find that people form incorrect beliefs about the mental health risks of overwork, leading them to work longer hours. These results might justify interventions, such as capping the number of hours worked to reduce related mental issues.
    Date: 2016–03
  5. By: Sébastien Ménard (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique, GAINS - Groupe d'Analyse des Itinéraires et des Niveaux Salariaux - UM - Université du Maine); Coralia Quintero (Universidad de Guanajuato)
    Abstract: In this paper we analyze the effects of introducing experience rating on the employer contributions to health insurance. Generally, theoretical literature explains absenteeism by the workers’ behavior. However, working conditions also has an effect on the use of sick leaves. As a result, Firms proposing good working conditions support the costs generated by the other firms. This implies a reduction of the good quality jobs on the benefit of the bad quality jobs. In this paper, we propose to introduce a modulation of employer contributions to health insurance based on historical rates of absenteeism. We show that the experience rating improves the productivity of the economy and welfare, when the unemployed are able to direct their research towards the good-quality jobs
    Keywords: productivity,Health Insurance, experience rating
    Date: 2015–12
  6. By: Andrei M. Korbut (National Research University Higher School of Economics)
    Abstract: The article is based on the preliminary results of author’s current study of the implementation of electronic health records in one of Russian outpatient clinics. Interviews with doctors, developers, managers of the State Department of Healthcare, IT-specialists, and clinic’s head, as well as observations of doctors’ everyday work, show that one of the key problems in the transition from paper to electronic record-keeping is how new information system transforms (or fails to transform) doctors’ routine, habitual activities. The article suggests that the widespread view of habitual action as an action in accordance with a preliminary scheme – a view that forms a basis for the majority of medical information systems – does not describe the actual structure of healthcare activities. The analysis of how doctors perceive and use electronic health records in their daily practice demonstrates that a situational approach to routine actions is more adequate. For example, the use of so-called “templates” that are created by doctors within the electronic health records cannot be understood without reference to the situational context of professional activities. Doctors, creating and using various “templates,” do this in such ways that allow them to make these health records circumstantially understandable. The view of routine activities as situated, concerted achievements not only proves the possibility of a new approach to the description of habitual actions’ role and place in the structure of social action, but can be important for the design and evaluation of professional information systems.
    Keywords: electronic health records, habits, situated action, templates, routine medical practice.
    JEL: Z
    Date: 2016
  7. By: Laura Levaggi; Rosella Levaggi
    Abstract: We study the welfare properties of direct restrictions based on cost-effectiveness and indirect methods represented by waiting lists in a public health care system. Health care is supplied for free by the public health sector, but patients can choose to address their demand elsewhere by stipulating a private health care insurance policy to avoid restrictions. Our model shows that if the individual response to treatment is independent of income and cannot be observed by the patient, the choice of opting out simply depends on income and the redistributive effects of both instruments are quite similar. In general, restrictions may only improve welfare of relatively rich individuals, usually those that opt out of the public health care system. Form a policy point of view, our model casts serious doubts upon the use of these instruments for redistributive purposes.
    Keywords: Waiting lists, Explicit restrictions, Welfare analysis, Redistribution
    JEL: I11 I18 H51
  8. By: Teevrat Garg; Stuart Hamilton; Jacob Hochard; Evan Plous; John Talbot
    Abstract: Waterborne diseases are the leading cause of mortality in developing countries. We emphasize a previously ignored cause of diarrhea – upstream river bathing. Using newly constructed data on upstream-downstream hydrological linkages along with village census panel data in Indonesia, we find that upstream river bathing can explain as many as 7.5% of all diarrheal deaths. Our results, which are net of avoidance behavior, show no effect of trash disposal on diarrheal infections. Furthermore we find that individuals engage in avoidance behavior in response to trash disposal visible pollutants) but not river bathing (invisible pollutants). We conduct policy simulations to show that targeting upstream individuals could generate substantial environmental and health savings relative to targeting downstream individuals. This provides a potential roadmap for low- and middle-income countries with limited resources for enforcement of water pollution.
    Date: 2016–04
  9. 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
  10. By: Annalisa Belloni; David Morgan; Valérie Paris
    Abstract: Across OECD countries, pharmaceutical spending reached around USD 800 billion in 2013, accounting for about 20% of total health spending on average when pharmaceutical consumption in hospital is added to the purchase of pharmaceutical drugs in the retail sector. This paper looks at recent trends in pharmaceutical spending across OECD countries. It examines the drivers of recent spending trends, highlighting differences across therapeutic classes. While the consumption of medicines continues to increase and to push pharmaceutical spending up, cost-containment policies and patent expiries of a number of top-selling products have exerted downward pressure on pharmaceutical expenditures in recent years. This resulted in a slower pace of growth over the past decade. The paper then looks at emerging challenges for policy makers in the management of pharmaceutical spending. The proliferation of high-cost specialty medicines will be a major driver of health spending growth in the coming years. While some of these medicines bring great benefits to patients, others provide only marginal improvements. This challenges the efficiency of pharmaceutical spending. Les dépenses pharmaceutiques ont atteint environ 800 milliards USD en 2013 dans les pays de l’OCDE, soit environ 20 % en moyenne des dépenses de santé totales lorsque l’on ajoute la consommation hospitalière de produits pharmaceutiques à l’achat de médicaments au détail. Ce document examine les tendances récentes en matière de dépenses pharmaceutiques dans les pays de l’OCDE. Il examine les déterminants de l’évolution récente des dépenses, en soulignant les différences entre les classes de médicaments. Alors que la consommation de médicaments continue d’augmenter et de pousser à la hausse les dépenses pharmaceutiques, les politiques de maîtrise des coûts et l'expiration des brevets d'un certain nombre de produits les plus vendus ont exercé une pression à la baisse sur ces dépenses au cours des dernières années. Cela a entraîné un ralentissement de la croissance au cours de la dernière décennie. Le document se penche ensuite sur les défis émergents pour les décideurs politiques en ce qui concerne la gestion des dépenses pharmaceutiques. La prolifération de médicaments de spécialité à coût élevé sera un moteur important de la croissance des dépenses de santé dans les années à venir. Alors que certains de ces médicaments apportent de grands avantages aux patients, d'autres ne fournissent que des améliorations marginales. Cela remet en question l'efficacité des dépenses pharmaceutiques.
    Keywords: health, public health expenditures, pharmaceutical policy, pharmaceutical expenditure, public health, santé, dépenses pharmaceutiques, politique pharmaceutique, dépenses publiques de santé
    JEL: I18
    Date: 2016–04–21
  11. By: Müller, Tobias; Shaikh, Mujaheed
    Abstract: This paper presents evidence on intra-household retirement externalities by assessing the causal effect of partner's retirement on own health behaviour in Europe. We identify partner's retirement effects by applying a fuzzy regression discontinuity (RD) framework using retirement eligibility as an exogenous instrument for partner's retirement status. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) we find that while partner's retirement increases own physical activity, it also increases smoking by up to 7 cigarettes a day and increases alcohol intake by 1-2 drinks per day. Furthermore, we find that physical activity increases only for individuals that are themselves retired pointing toward compensated effects that arise due to husband's and wife's retirement being complements. Similarly, an increase in alcohol intake is observed only if the individuals are themselves retired and an increase in smoking is only observed if the partner is a smoker suggesting mutual positive externalities and leisure complementarities.
    Keywords: Retirement Externalities, Health Behaviour, Fuzzy Regression Discontinuity Design
    JEL: C26 I12 J26
    Date: 2016
  12. By: Anne Case (Princeton University); Angus Deaton (Princeton University)
    Abstract: Suicide rates, life evaluation, and measures of affect are all plausible measures of the mental health and well being of populations. Yet in the settings we examine, correlations between suicide and measured well being are at best inconsistent. Differences in suicides between men and women, between Hispanics, blacks, and whites, between age groups for men, between countries or US states, between calendar years, and between days of the week, do not match differences in life evaluation. By contrast, reports of physical pain are strongly predictive of suicide in many contexts. The prevalence of pain is increasing among middle-aged Americans, and is accompanied by a substantial increase in suicides and deaths from drug and alcohol poisoning. Our measure of pain is now highest in middle age—when life evaluation and positive affect are at a minimum. In the absence of the pain epidemic, suicide and life evaluation are likely unrelated, leaving unresolved whether either one is a useful overall measure of population wellbeing.
    JEL: I3
    Date: 2015–06
  13. By: Jean-Michel Lafleur (Université de Liège); Olivier Lizin (Université de Liège)
    Keywords: Congo, Belgium
    Date: 2014–09
  14. By: Rahi Jain (Indian Institute of Technology Bombay (IITB)); Bakul Rao (Indian Institute of Technology Bombay (IITB))
    Abstract: The Sustainable development goals 2030 has focused on human health and is dependent on a nation’s healthcare system. Medical diagnostic laboratory services (MDLS) plays an important role in the modern healthcare system as it significantly helps in evidence-based decision-making. The MDLS suffers from many issues identified both globally as well as nationally with steps taken to address those challenges. However, constrained understanding of challenges affecting MDLS made it difficult to design interventions which can cater to laboratory systems in more holistic and standardised manner. Accordingly, it is required to categorize and develop the taxonomy of the various challenges existing in MDLS that will help in defining the scope of challenges and will provide an overview of the various challenges to which a laboratory can get exposed to. This study develops the taxonomy of challenges that can be encountered in MDLS using systematic review. Further, the existence of those challenges in the Indian context is determined that will potentially validate theoretically identified challenges. In the study, the analysis for Indian context is performed using content analysis over the content collected by interacting with various health experts like doctors, lab managers and lab technicians coming from different type of laboratories. The study identified 30 challenges which are categorized in the three-layer hierarchy. The first layer consisted of two challenges followed by eight challenges in the second layer and 20 challenges in the third layer. Out of the 20 challenges in the last layer, 16 challenges could be identified in the Indian context based on the content analysis of the experts interactions. The study concludes that the challenges exist for the MDLS which could be categorized into three layers.
    Keywords: Medical Laboratory, laboratory services, laboratory challenges, Indian laboratory
  15. 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
  16. By: Han, Johann; Kairies-Schwarz, Nadja; Vomhof, Markus
    Abstract: Based on a Salop model with regulated prices, we investigate quality provision behavior of competing hospitals before and after a merger. For this, we use a controlled laboratory experiment where subjects decide on the level of treatment quality as head of a hospital. We find that the post-merger average quality is significantly lower than the average pre-merger quality. However, for merger insiders and outsiders, average quality choices are significantly higher than predicted for pure profit maximizing hospitals. We show that the upward deviation is potentially driven by altruistic behavior towards patients. Furthermore, we fi nd that in case sufficient cost synergies are realized by the merged hospitals, this yields a significant increase in average quality choices compared to the scenario without synergies. Finally, we find that our results do not change when comparing individual to team decisions.
    Abstract: Auf Grundlage eines Salop-Modells mit regulierten Preisen wird in dieser Arbeit das Qualitätssetzungsverhalten konkurrierender Krankenhäuser vor und nach einer Fusion untersucht. Hierfür wird ein kontrolliertes Laborexperiment verwendet, in welchem die Probanden in der Rolle eines Leiters eines Krankenhauses über die Behandlungsqualität entscheiden. Dabei finden wir nach der Fusion einen signifikanten Rückgang in der durchschnittlichen Höhe der bereitgestellten Qualität im Vergleich zur Wettbewerbssituation vor der Fusion. Jedoch setzen die Markakteure nach der Fusion - unabhängig davon, ob sie zu den fusionierten Krankenhäusern gehören oder als allein operierendes Krankenhaus agieren - durchschnittlich eine signifikant höhere Marktqualität als die für profitmaximierende Krankenhäuser vorhersagte. Wir zeigen, dass man diese Abweichung nach oben auf altruistische Motive gegenüber den Patienten zurückführen kann. Des Weiteren finden wir in einem Vergleichsszenario mit hinreichend starken Kostensynergien auf Seiten der fusionierten Krankenhäuser signifikant höhere Qualitäten als im Fall ohne Kostensynergien. Unsere Resultate bleiben auch robust, wenn Gruppenentscheidungen statt Individualentscheidungen betrachtet werden.
    Keywords: hospital mergers,quality competition,altruism,laboratory experiment
    JEL: C91 C92 I11 L13 L44
    Date: 2016
  17. By: Dunn, Richard A. (University of Connecticut); Nayga, Rodolfo M., Jr. (Bates College); Thomsen, Michael (University of Arkansas); Heather L. Rouse (University of Arkansas for Medical Sciences)
    Abstract: This paper employs a novel identification strategy based on changes in the route students would use to commute between their home and their school as they transition to higher grades housed in different schools to investigate the effect of fast-food availability on childhood weight outcomes by gender, race and location. Using a longitudinal census of height and weight for public school students in Arkansas, we find no evidence that changes in fast-food exposure are associated with changes in BMI z-score. Our findings suggest that laws restricting fast-food restaurants from areas near schools are neither effective nor efficient means of improving public health.
    Keywords: Fast-food, childhood obesity
    JEL: I10 R12 R40
    Date: 2014–09

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