nep-hea New Economics Papers
on Health Economics
Issue of 2016‒05‒21
forty-five papers chosen by
Yong Yin
SUNY at Buffalo

  1. Associations between Food Scarcity during Pregnancy and Children’s Survival and Linear Growth in Zambia By Jolejole-Foreman, Maria Christina; Olofin, Ibironke; Fawzi, Wafaie; Fink, Gunther
  2. Is the educational health gap increasing for women? Results from Catalonia(Spain) By Aïda Solé-Auró; Manuela Alcañiz
  3. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2016 to 2026 By Congressional Budget Office
  4. How CBO Estimates the Effects of the Affordable Care Act on the Labor Market: Working Paper 2015-09 By Edward Harris; Shannon Mok
  5. Socioeconomic inequalities in health care in England By Richard Cookson; Carol Proppper; Miqdad Asaria; Rosalind Raine
  6. Optimal hospital payment rules under rationing by random waiting By Hugh Gravelle; Fred Schroyen
  7. Surveying in Dynamic Condition and Its Integration in Structural Health Monitoring By Gheorghe Radulescu; Adrian Radulescu; Mihai Radulescu; Sanda Nas
  8. The Role of Structural Health Monitoring for the Design of the Life Cycle of Constructions By Gheorghe Radulescu; Mihai Radulescu; Adrian Radulescu; Sanda Na?
  9. Nurse Scheduling Problem By Erjon Duka
  10. Time-to-death patterns in markers of age and dependency By Timothy Riffe; Pil H. Chung; Jeroen Spijker; John MacInnes
  11. German East-West mortality difference: two cross-overs driven by smoking By Tobias C. Vogt; Alyson A. van Raalte; Pavel Grigoriev; Mikko Myrskylä
  12. Education and Health Across Lives and Cohorts: A Study of Cumulative Advantage in Germany By Liliya Leopold; Thomas Leopold
  13. Why Do Children Take Care of Their Elderly Parents? Are the Japanese Any Different? By Charles Yuji Horioka; Emin Gahramanov; Aziz Hayat; Xueli Tang
  14. Association among Socioeconomic Status, Health and Function-related Variables, and Onset of Depression in the Case of Middle-aged and Older People in Japan By SEKIZAWA Yoichi
  15. Is Marriage Protecting your Health in Recession Times? By Joan Gil
  16. Spatial spillovers and political coordination in public health provision By Castro, Marcelo; Mattos, Enlinson; Patriota, Fernanda
  17. Does physician gender influence the provision of medical care? An experimental study. By Li, JingJing; Godager, Geir; Wang, Jian
  18. The long-term impact of war on health By Michael Palmer; Cuong Nguyen; Sophie Mitra; Daniel Mont; Nora Groce
  19. Child Disability and Siblings’ Healthcare Expenditures in a Context of Child Fostering By Arlette Simo-Fotso
  20. Cutting Fertility? The Effect of Cesarean Deliveries on Subsequent Fertility and Maternal Labor Supply By Halla, Martin; Mayr, Harald; Pruckner, Gerald J.; Garcia-Gomez, Pilar
  21. Medicaid and Medicare Managed Long-Term Services and Supports: What States Are Doing By James M. Verdier
  22. Pilot Mobile Health Program: Using Mobile Technology to Reach, Educate, and Connect Pregnant and Postpartum Medicaid Enrollees By So O'Neil; Keith Kranker; George Kafkas; Margo Rosenbach
  23. Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya By Anne M. Williams; Caroline J. Chantry; Sera L. Young; Beryl S. Achando; Lindsay H. Allen; Benjamin F. Arnold; John M. Colford; Jr.; Holly N. Dentz; Daniela Hampel; Marion C. Kiprotich; Audrie Lin; Clair A. Null; Geoffrey M. Nyambane; Setti Shahab-Ferdows; Christine P. Stewart
  24. 2012 Regional Partnership Grants to Increase the Well-Being of and to Improve the Permanency Outcomes for Children Affected by Substance Abuse: Second Annual Report to Congress By Debra A. Strong; Sarah A. Avellar; Julieta Lugo-Gil; Megan Hague-Angus; Caroline Massad Francis
  25. Supporting Better Patient Decisions at the Point of Care: What Payers and Delivery Systems Can Do By Anna Collins; Cara Stepanczuk; Nyna Williams; Eugene Rich
  26. Trends in Obesity Among Social Security Disability Applicants, 2007-2013 By Jody Schimmel Hyde; Joseph Mastrianni; Yong Choi; Jae Song
  27. Informal Caregivers Research Project (INCARE): Key Informant Interview Protocol By M. Hu; C. Jacobs Johnson; J. Thomas; K. Boller; M. Young
  28. Gender Matters By Kimberly V. Smith; Claire Dye; Elizabeth Cook; Kristina Rosinsky; Mindy Scott
  29. Family Ruptures, Stress, and the Mental Health of the Next Generation By Petra Persson; Maya Rossin-Slater
  30. What is the Marginal Benefit of Payment-Induced Family Care? By Norma B. Coe; Jing Guo; R. Tamara Konetzka; Courtney Harold Van Houtven
  31. The Impact of Improving Capital Stock on the Utilization of Local Health Services: Preliminary Findings on the Evaluation of the Health Facilities Enhancement Program By Picazo, Oscar F.; Dela Cruz, Nina Ashley O.; Ortiz, Danica Aisa P.; Pantig, Ida Marie T.; Aldeon, Melanie P.; Tanghal, Juan Alfonso O.
  32. Weight loss, obesity traps and policy policies By Barbieri, Paolo Nicola
  33. Modelling mortality: Are we heading in the right direction? By O'Hare, Colin; Li, Youwei
  34. Socioeconomic Inequity in Excessive Weight in Indonesia By Aizawa, Toshiaki; Helble, Matthias
  35. Understanding the healthy lifestyle behaviors and life satisfaction of students and staff in a university By AHU ERGEN
  36. Common causes of lower limb amputation in a rural community in South Africa By Liezel Wegner; Anthea Rhoda
  37. Socioeconomic Factors of Frailty By Sirje Kree
  38. Quality of Life among Elderly in Elderly Clubs of Three Southern Border Provinces of Thailand By Paiboon Chaosuansreecharoen; Kannika Ruangdej Chaosuansreecharoen
  39. Some approaches to the issue of subjective aspects of the quality of life By Jana Å tofková; Zuzana Å tofková; Stanislav Å tofko
  40. The Effect of the Health Insurance Mandate on Labor Market Activity and Time Allocation: Evidence from the Federal Dependent Coverage Provision By Otto Lenhart; Vinish Shrestha
  41. Retiring intentions: the role of conflicts with the boss and health status as a moderator By Martha Ottenbacher
  42. Parental Alcohol Consumption and Adult Children's Educational Attainment By Lucia Mangiavacchi; Luca Piccoli
  43. Sex selection and health at birth among Indian immigrants By Libertad González Luna
  44. Medical Care within an OLG Economy with Realistic Demography By Ivan Frankovic; Michael Kuhn; Stefan Wrzaczek
  45. East Africa - Public health laboratory networking project : evaluation of performance-based financing for public health laboratories in Rwanda By Meghan Kumar; Joel Thomas Lehmann; Aniceth Rucogoza; Claver Kayobotsi; Ashis Kumar Das; Miriam Schneidman

  1. By: Jolejole-Foreman, Maria Christina; Olofin, Ibironke; Fawzi, Wafaie; Fink, Gunther
    Abstract: A growing body of literature suggests that in utero exposure to hunger negatively affects children’s survival and linear growth. In this paper, we retrospectively linked data on local agricultural output and household food reserves during the in utero period to children’s health and nutritional status in the first five years of their life. We hypothesized that seasonal variations in agricultural yields and food reserves affect the quantity and diversity of food intake during pregnancy, and that pregnancies during periods with limited food reserves are associated with poorer child health outcomes. We generated a food reserve scarcity index (FRSI) based on reported food stocks at the household level reported in post-harvest surveys from 2001-2007 and estimated associations with child survival, birth size and World Health Organization (WHO) growth Z scores using multivariable regression model. We found negative and statistically significant associations between children’s weight and height Z-scores (WAZ and HAZ) and food scarcity in all trimesters with largest associations for the first and third trimesters. While we found that food scarcity in the second trimester increases children’s mortality risk, food scarcity in early gestation had protective effects on mortality. The results suggest that policies aimed at reducing vulnerability to food scarcity require targeting the vulnerable populations and proper timing of policies. Policy implications encompass two pathways: One is through nutrition such as food aid and supplements; And with the recurrence of food scarcity problem, the second more sustainable solution is through agriculture and extension such as proper food storage.
    Keywords: Seasonal food reserves, seasonal food scarcity, Undernutrition in pregnant women, children survival and linear growth, Food Security and Poverty, International Development,
    Date: 2016
  2. By: Aïda Solé-Auró (Department of Political and Social Sciences, Pompeu Fabra University); Manuela Alcañiz (Department of Econometrics, Riskcenter-IREA, Universitat de Barcelona)
    Abstract: Background. Health expectancies vary worldwide according to socioeconomic status (SES). The lower SES usually show health disadvantage and the higher SES a health advantage compared to the average. The educational level of individuals is strongly linked to their SES. Objective. We propose to identify the evolution of SES differentials in health by gender, paying special attention to the trends for the least advantaged - low educated females. We focus on the adult Catalan population (Spain) aged 55 or older. Methods. We measured SES through education. We used individual cross-sectional data obtained in 1994 and in 2012 from the Catalan Health Survey. We examined three comprehensive health indicators to disentangle the health and disability statuses in order to document social differences in health. We applied logistic models for each indicator, controlling for socio demographic characteristics, health coverage and lifestyle. Results. Low educated males and females experienced an increase in the prevalence of functional and ADL limitations. We found an increment in the likelihood of bad health and functional limitations for the low educated between 1994 and 2012. The prevalences of smoking increased for low and middle educated females, whereas low educated males suffered a 4.1% increment of sedentarism. Having smoked in the past and leading a sedentary lifestyle increased the likelihood of bad and functional limitations. In general, double health coverage reduced the effect on reporting more health problems. Our predicted probabilities show that low educated women were more likely to self-perceive their health as bad and report functional limitations than any other group in both periods. Conclusions. Lower educated females are the most disfavored group in terms of health and personal autonomy. The gender gap between low educated men and women has reduced for self-perceiving bad health and for functional limitations between 1994 and 2012. Adopting a healthy lifestyle promotes well-being and personal autonomy. Health policies should continue to take into account that the population with lower SES is more likely to suffer from poor health and disability as they age, being the females a particularly fragile group.
    Keywords: gender inequalities, socioeconomic disparities, health indicators, educational level, Catalonia.
    Date: 2015–05
  3. By: Congressional Budget Office
    Abstract: CBO and the staff of the Joint Committee on Taxation project that the federal subsidies, taxes, and penalties associated with health insurance coverage for the noninstitutionalized population under age 65 will result in a net subsidy from the federal government of $660 billion, or 3.6 percent of GDP, in 2016. For the entire 2017–2026 period, the projected net subsidy is $8.9 trillion.
    JEL: H30 I13 I18
    Date: 2016–03–24
  4. By: Edward Harris; Shannon Mok
    Abstract: This working paper describes the methods and calculations CBO used in its August 2015 baseline projections to estimate the effects of the Affordable Care Act on the labor market.
    JEL: I18 J08
    Date: 2015–12–07
  5. By: Richard Cookson (Centre for Health Economics, University of York, UK.); Carol Proppper (Business School, Imperial College London and Centre for Market and Public Organisation, University of Bristol and CEPR); Miqdad Asaria (Centre for Health Economics, University of York, UK.); Rosalind Raine (Department of Applied Health Research, University College London)
    Abstract: This paper reviews what is known about socioeconomic inequalities in health care in England, with particular attention to inequalities relative to need that may be considered unfair (‘inequities’). We call inequalities of 5% or less between most and least deprived socioeconomic quintile groups ‘slight’; inequalities of 6-15% ‘moderate’, and inequalities of > 15% ‘substantial’. Overall public health care expenditure is substantially concentrated on poorer people. At any given age, poorer people are more likely to see their family doctor, have a public outpatient appointment, visit accident and emergency, and stay in hospital for publicly funded inpatient treatment. After allowing for current self-assessed health and morbidity, there is slight pro-rich inequity in combined public and private medical specialist visits but not family doctor visits. There are also slight pro-rich inequities in overall indicators of clinical process quality and patient experience from public health care, substantial pro-rich inequalities in bereaved people’s experiences of health and social care for recently deceased relatives, and mostly slight but occasionally substantial pro-rich inequities in the use of preventive care (e.g. dental checkups, eye tests, screening and vaccination) and a few specific treatments (e.g. hip and knee replacement). Studies of population health care outcomes (e.g. avoidable emergency hospitalisation) find substantial pro-rich inequality after adjusting for age and sex only. These findings are all consistent with a broad economic framework that sees health care as just one input into the production of health, alongside many other socioeconomically patterned inputs including environmental factors (e.g. living and working conditions), consumption (e.g. diet, smoking), self care (e.g. seeking medical information) and informal care (e.g. support from family and friends).
    Keywords: health care, inequalities, socioeconomic factors
    JEL: I18
    Date: 2016–04
  6. By: Hugh Gravelle (Centre for Health Economics, University of York, UK.); Fred Schroyen (Department of Economics, Norwegian School of Economics, Bergen, Norway)
    Abstract: We derive optimal rules for paying hospitals in a public health care system in which providers can choose quality and random patient demand is rationed by waiting time. Since waiting time imposes real costs on patients hospital payment rules should take account of their e¤ect on waiting time as well as on quality and the number of patients treated. We develop a general stochastic model of rationing by waiting and use it to derive welfare maximising payment to hospitals linked to output, expected waiting times, quality, hospital capacity and length of stay. We show that, although prospective output pricing gives hospitals an incentive to attract patients by raising quality and reducing waiting times, it must be supplemented by prices attached to other hospital decisions and outcomes except under very strong assumptions about the welfare function, patient preferences, and whether patients lose income whilst waiting.
    Keywords: Rationing. Waiting times. Queues. Prospective payment. Hospitals
    JEL: I11 I13 I18 L51 D81
    Date: 2016–05
  7. By: Gheorghe Radulescu; Adrian Radulescu; Mihai Radulescu; Sanda Nas (Department of Engineering and Technological Management, Technical University of Cluj Napoca)
    Abstract: Tracking behavior over time of land and buildings, with a history of over 150 years, which merges with the advent of optical-mechanical instruments for measuring angles and level differences, theodolites, level, has dealt with quasi-static structural monitoring. In fact, between the observation cycles, at an interval of several months to several years, based on the evolution of the phenomenon of subsidence and landslides, there were deviations of a few millimeters or fractions of a millimeter. In this context monitoring was considered static. Surveying in dynamic conditions, appeared and was formed as a need to monitor the behavior of structures in dynamic regime. Buildings with very bold and innovative design features required in situ study of the objectives, both during execution. Basically, this process checks if the actual behavior falls under the project specifications. The opportunity of this new branch of Surveying appeared in the 1970s, but has developed at an accelerated pace in the last 20 years, primarily due to projects involving the construction of bridges and very tall buildings, where it contributed significantly in the execution by developing new tools and technologies.
    Keywords: Tracking the behavior over time of land and constructions, Surveying in dynamic conditions, Structural Health Monitoring, sensors, bridge, tall constructions
    Date: 2014–06
  8. By: Gheorghe Radulescu; Mihai Radulescu; Adrian Radulescu; Sanda Na? (Department of Engineering and Technological Management, Technical University of Cluj Napoca)
    Abstract: Structural health monitoring(SHM) is a non-destructive in-situ structural sensing and evaluation method that uses a variety of sensors attached to, or embedded in, a structure to monitor the structural response, analyze the structural characteristics for the purpose of estimating the severity of damage/deterioration and evaluating the consequences thereof on the structure in terms of response, capacity, and service-life. Various sensors and other technologies and devices obtain data that will be centralized, transmitted, processed and interpreted to continuously determine the health of the construction. SHM includes such tools, methodologies and techniques traditionally called Non-Destructive Testing (NDT) and Non-Destructive Evaluation (NDE). However, there are differences between the three concepts, on the one hand NDT, NDE and SHM on the other hand, so: NDT/NDE normally refers to a one-time assessment of the condition of materials at a single point and the effect or extent of the deterioration in the structure using equipment external to the structure. SHM normally refers to activities focused on assessing the condition of the structure or its key components based on response to various types of loads. It generally involves on-going or repeated assessment of this response.
    Keywords: Structural Health Monitoring, Non-Destructive Testing, Non-Destructive Evaluation, Sensors
    Date: 2014–06
  9. By: Erjon Duka (University Aleksander Moisiu, FASTIP, Durres, Albania)
    Abstract: In this paper, what I have been discussed, is analyzing penalties and cost shifts based on several elements for nurse scheduling problem (NSP). NSP's issue is to assign nurses to different tasks based on constraints. The problem is known to be NP-hard, in other words it does not have a solution or needs years to be solved. In this work we try to solve the problem by satisfying the constraints set, and we also include the nurse's preference and try to balance the difficulty level of all the involved nurses. We also analyze the complexity of the problem as a function of parameters such as number of nurses, number of shifts, optimality of the function. According to the importance in practice, many scientists have developed NSP problems in a satisfactory time limit.
    Keywords: NSP(Nurse Scheduling Problem), IP(Integer Programming), LIP (Linear Integer Programming), NIP(Non Linear Integer Programming), SIP(Scheduling in Integer Programming), MIP (Mixed Integer Programming), MILP(Mixed Integer Linear Programming), G-IP (Goal Programming), Constraint Programming (CP), CPLEX, Limbo ext = Integer Programming applications and Software, NP-hard(Nurse Scheduling in Integer Programming)
    JEL: C80 L11 M31
    Date: 2014–06
  10. By: Timothy Riffe (Max Planck Institute for Demographic Research, Rostock, Germany); Pil H. Chung; Jeroen Spijker; John MacInnes
    Abstract: We aim to determine the extent to which variables commonly used to describe health, wellbeing, and disability in old-age vary primarily as a function of years lived (chronological age), years left (thanatological age), or as a function of both. We analyze data from the US Health and Retirement Study to estimate chronological age and time-to-death patterns in 78 such variables. We describe results from the birth cohort born 1915-1919 in the final 12 years of life. Our results show that most markers used to study well-being in old-age vary along both the age and time-to-death dimensions, but some markers are exclusively a function of either time to death or chronological age, and others display different patterns between the sexes.
    Keywords: USA, age, demographic accounting, disability, methodology, morbidity, mortality
    JEL: J1 Z0
    Date: 2015–07
  11. By: Tobias C. Vogt (Max Planck Institute for Demographic Research, Rostock, Germany); Alyson A. van Raalte (Max Planck Institute for Demographic Research, Rostock, Germany); Pavel Grigoriev (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Before the fall of the Berlin Wall, mortality was considerably higher in the former East than West Germany. The gap narrowed rapidly after German unification, particularly for women, to the point that Eastern women aged 50-64 now have lower mortality, despite lower incomes and worse overall living conditions. Prior research shows that lower smoking rates among East German females was a major contributor to this cross-over. However since 1990, higher smoking rates have been observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differentials and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Experience from other countries show that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming a warning example of the consequences of weakening anti-smoking policies and changing behavioral norms.
    Keywords: Germany, forecasts, mortality, smoking
    JEL: J1 Z0
    Date: 2016–05
  12. By: Liliya Leopold; Thomas Leopold
    Abstract: Research from the United States has supported two hypotheses about health inequality. First, educational gaps in health widen with age – the cumulative advantage hypothesis. Second, this relationship has intensified across cohorts – the rising importance hypothesis. In this article, we estimate hierarchical linear models using 22 waves of panel data (SOEP, 1992–2013) to test both hypotheses in the German context, which contrasts sharply with the U.S. in the structural forces shaping health inequality. We consider individual and contextual influences on the core association between education and health, and assess gender differences in the process of cumulative advantage. Our overall results support the cumulative advantage hypothesis, as health gaps between higher and lower educated people widen with age. Further analyses reveal that this process is gender specific. Among women, educational gaps in health are small and remain stable. Among men, these gaps not only widen rapidly with age, but also increasingly across cohorts, supporting the rising importance hypothesis.
    Date: 2016
  13. By: Charles Yuji Horioka; Emin Gahramanov; Aziz Hayat; Xueli Tang
    Abstract: In this paper, we conduct a theoretical analysis of why individuals provide care and attention to their elderly parents using a two-period overlapping generations model with endogenous saving and a “contest success function” and test this model using micro data from a Japanese household survey, the Osaka University Preference Parameter Study. To summarize our main findings, we find that the Japanese are more likely to live with (or near) their elderly parents and/or to provide care and attention to them if they expect to receive a bequest from them, which constitutes strong support for the selfish bequest motive or the exchange motive (much stronger than in the United States), but we find that their caregiving behavior is also heavily influenced by the strength of their altruism toward their parents and social norms.
    Date: 2016–05
  14. By: SEKIZAWA Yoichi
    Abstract: Although many studies show that people at low socioeconomic states (SES) are more likely to be depressed, longitudinal studies on SES and depression which take into account health and function-related variables in the case of middle-aged and older people are scarce, especially in Asian nations. By performing multivariate logistic regressions using longitudinal data from the Japanese Study of Aging and Retirement (JSTAR), we investigate the longitudinal association between SES plus health and function-related variables at baseline and an onset of depression two years later for people over the age of 50. We find that, out of the respondents who are not depressed at baseline, respondents with the lowest education levels are more likely to develop depression two years later. This result was maintained after adjusting for total family income and total wealth, but was attenuated and not significant after adjusting for health and function-related variables. We also find that those with any disability in the instrumental activities of daily living (IADL) and intellectual activities (IA) at baseline are more likely to develop depression two years later.
    Date: 2016–04
  15. By: Joan Gil
    Abstract: This paper aims to contribute to the literature on the protective effects of marriage on individuals' health by examining whether this advantage is still valid in recession times. A two stage empirical strategy is followed based on individual-level cross-section data for Spain. Using propensity score matching techniques we firstly estimate the causal impact of divorce and legal separation (marital dissolution) on mental health and binge drinking in two different points in time: before and during the economic crisis. Secondly, we examine whether there exists an incremental or detrimental effect on these health outcomes implied by the economic recession using differencein-difference (DiD) regression methods, upon conditioning on a proxy of innate health status.
    Date: 2016–05
  16. By: Castro, Marcelo; Mattos, Enlinson; Patriota, Fernanda
    Abstract: We estimate the impact of the main unconditional federal grant (Fundo de Participaçãodos Municípios - FPM) to Brazilian municipalities as well as its spillover from the neighboring cities on local health outcomes. We consider data from 2002 to 2007 (Brollo et al, 2013) and explore the FPM distribution rule according to population brackets to apply a fuzzy Regression Discontinuity Design (RDD) using cities near the thresholds. In elasticity terms, we nd a reduction on infant mortality rate (-0.18) and on morbidity rate (- 0.41), except in the largest cities of our sample. We also nd an increase on the access to the main program of visiting the vulnerable families, the Family Health Program (Programa Sa ude da Família - PSF). The e ects are stronger for the smallest cities of our sample and we nd increase: (i) On the percentage of residents enrolled in the program (0.36), (ii) On the per capita number of PSF visits (1.59), and (iii) On the per capita number of PSF visits with a doctor (1.8) and nurse (2). After we control for the FPM spillover using neighboring cities near diferent thresholds, our results show that the reduction in morbidity and mortality is largely due to the spillover e ect, but there are negative spillover on preventive actions, as PSF doctors visits and vaccination. Finally, the negative spillover e ect on health resources may be due free riding or political coordination problems, as in the case of the number of hospital beds, but also due to to competition for health professionals, as in the case of number of doctors (-0.35 and -0.87, respectively), specially general practitioners and surgeons (-1.84 and -2.45).
    Date: 2016–05–06
  17. By: Li, JingJing (Shandong University); Godager, Geir (Department of Health Management and Health Economics); Wang, Jian (Shandong University)
    Abstract: The share of female physicians in the medical workforce is increasing in many countries. An important question to consider is whether the changing gender balance in the workforce influences medical practice as a whole. This question, however, relates to whether the observed gender differences in medical practice are a result of male and female physicians having patient groups that differ systematically or whether there is indeed a difference between the providers themselves. In this paper we ask whether gender differences in provider practice are present when providers face an identical group of patients. We tested the presence of a pure gender effect by means of data from a controlled laboratory experiment. Here every provider encountered an identical patient population. We applied data from an experiment based on the design of Hennig-Schmidt, Selten, and Wiesen (2011). Medical students in the role of physicians chose the quantity of medical services to provide to their abstract patients. We tested the null hypothesis that gender does not influence the provision of health care services. In our empirical specification we estimated both the influence of gender on the quantity of medical services and whether gender influences the maximization of patient benefits. We found that we cannot reject the null hypothesis that gender does not influence the provision of medical care.
    Keywords: Gender; Physician behavior; Medical care provision; Laboratory experiment
    JEL: C91 I11
    Date: 2016–05–04
  18. By: Michael Palmer (Melbourne School of Population and Global Health, The University of Melbourne); Cuong Nguyen (Institute of Public Policy and Management, National Economics University); Sophie Mitra (Department of Economics, Fordham University); Daniel Mont (Department of Epidemiology and Population Health, University College London); Nora Groce (Department of Epidemiology and Population Health, University College London)
    Abstract: The toll of warfare is often assessed in the short run and in terms of mortality. Other aspects of health have received limited attention, especially after warfare ends. This paper estimates the impact of exposure to US Air Force bombing during 1965-1975 on the disability status of individuals in Vietnam in 2009. Using national census data and an instrumental variable approach, the paper finds a positive and statistically significant impact of war time bombing exposure on district level disability rates about forty years after the end of the war. A ten percent increase in bombing intensity approximately leads to a one percent increase in the prevalence of severe disability at the district level. Impacts are highest for severe disability and among persons born before 1976. Smaller yet significant positive impacts are observed among persons born after the war. Results suggest that the toll of warfare on health persists decades later.
    Keywords: war, post-conflict, disability, health, Vietnam
    JEL: C4 H7 I1 P2
    Date: 2016–04
  19. By: Arlette Simo-Fotso (Ined)
    Abstract: Bien qu’il existe de nombreuses études évaluant les implications du handicap d’un enfant en termes de dépenses de santé pour l’enfant déficient, quasiment aucune de celles-ci n’évalue les externalités que celui-ci peut avoir sur les autres membres de la fratrie. L’objectif de ce travail est d’examiner l’effet du handicap d’un enfant sur les dépenses de santé de l’ensemble des enfants d’un ménages au Cameroun. Cette étude contribue à la littérature existante, premièrement en interrogeant l’existance d’arbitrages au sein des ménages en matière d’allocation des dépenses de santé en présence d’un enfant déficient. Deuxièmement, elle prend en compte les configurations familiales propres au contexte de l’étude en faisant une distinction des enfants suivant le lien de filiation avec le chef du ménage (CM). Elle utilise à cette fin les données de l’enquête DHS-MICS de 2011. Ce qui permet d’aboutir au résultat que, dans l’ensemble, le handicap accroît significativement les dépenses mensuelles de santé des enfants qui en sont porteurs mais reste sans effet sur les dépenses de santé des autres enfants de la famille. Chez les enfants confiés, le fait d’être handicapé accroît les dépenses de santé mensuelles de 684 Fcfa tandis que le handicap des enfants biologiques du CM est source de dépenses de santé de 138 Fcfa inférieures. Cela s’explique par le fait que les enfants handicapés qui demeurent dans leur famille biologique sont porteurs de handicap beaucoup moins sévère.
    Date: 2016
  20. By: Halla, Martin (University of Innsbruck); Mayr, Harald (University of Zurich); Pruckner, Gerald J. (University of Linz); Garcia-Gomez, Pilar (Erasmus University Rotterdam)
    Abstract: The incidence of Cesarean deliveries (CDs) has been on the rise. The procedure's cost and benefits are discussed controversially; in particular, since non-medically indicated cases seem widespread. We study the effect of CDs on subsequent fertility and maternal labor supply. Identification is achieved by exploiting variation in the supply-side's incentives to induce non-medically indicated CDs across weekdays. On weekends and public holidays obstetricians' are less likely to induce CDs (due tighter capacity constraints in hospital). On Fridays and other days preceding a holiday, they face an increased incentive to induce CDs (due to their demand for leisure on non-working days). We use high-quality administrative data from Austria. Women giving birth on different weekdays are pre-treatment observationally identical. Our instrumental variable estimates show that a non-planned CD at parity one decreases life cycle fertility by almost 17 percent. This reduction in fertility translates into a temporary increase in maternal employment.
    Keywords: Caesarean delivery, Caesarean section, fertility, female labor supply
    JEL: I12 J13 J11 J22 J21
    Date: 2016–04
  21. By: James M. Verdier
    Keywords: Medicaid, Medicare, Long-term services and supports, LTSS
    JEL: I
    Date: 2016–02–02
  22. By: So O'Neil; Keith Kranker; George Kafkas; Margo Rosenbach
    Abstract: Launched in 2014, the three-year Pilot Mobile Health Program is an innovative approach to engaging pregnant and postpartum women enrolled in Medicaid.
    Keywords: Maternal and infant health, Centers for Medicare & Medicaid Services, CMS, Centers for Medicaid and CHIP Services, CMCS, Medicaid, Pilot Mobile Health Program, mHealth, perinatal health, postpartum health, health text-messaging, Text4baby
    JEL: I
  23. By: Anne M. Williams; Caroline J. Chantry; Sera L. Young; Beryl S. Achando; Lindsay H. Allen; Benjamin F. Arnold; John M. Colford; Jr.; Holly N. Dentz; Daniela Hampel; Marion C. Kiprotich; Audrie Lin; Clair A. Null; Geoffrey M. Nyambane; Setti Shahab-Ferdows; Christine P. Stewart
    Abstract: Most lactating Kenyan women consumed less than the estimated average requirement of vitamin B-12 and had low breast milk vitamin B-12 concentrations.
    Keywords: animal-source foods, breast milk, lactation, vitamin B-12, Kenya, Africa, hunger, food security
    JEL: F Z
  24. By: Debra A. Strong; Sarah A. Avellar; Julieta Lugo-Gil; Megan Hague-Angus; Caroline Massad Francis
    Abstract: This is a description of the activities of the 17 partnerships in year two, their implementation progress and local evaluation designs, and the status of their evaluation and data collection planning including successes and challenges.
    Keywords: children, substance abuse, regional partnership grants, evidence-based, health, child welfare
    JEL: I
  25. By: Anna Collins; Cara Stepanczuk; Nyna Williams; Eugene Rich
    Abstract: In this brief, we use four typical clinical cases to explore the barriers to and facilitators of patients’ decisions at the point of care.
    Keywords: Point of Care, Patient, Payers, Delivery Systems, Health
    JEL: I
    Date: 2016–02–10
  26. By: Jody Schimmel Hyde; Joseph Mastrianni; Yong Choi; Jae Song
    Keywords: obesity, social security, disability, applicants
    JEL: I J
    Date: 2016–02–10
  27. By: M. Hu; C. Jacobs Johnson; J. Thomas; K. Boller; M. Young
    Keywords: Informal Caregivers Research Project , INCARE, Key Informant Interview Protocol
    JEL: I
  28. By: Kimberly V. Smith; Claire Dye; Elizabeth Cook; Kristina Rosinsky; Mindy Scott
    Abstract: Gender Matters program, an innovative comprehensive sexuality education curriculum that aims to reduce teen pregnancy and associated sexual risk behaviors.
    Keywords: teen pregnancy, sex education, adolescents, PPA
    JEL: I
  29. By: Petra Persson; Maya Rossin-Slater
    Abstract: This paper studies how in utero exposure to maternal stress from family ruptures affects later mental health. We find that prenatal exposure to the death of a maternal relative increases take-up of ADHD medications during childhood and anti-anxiety and depression medications in adulthood. Further, family ruptures during pregnancy depress birth outcomes and raise the risk of perinatal complications necessitating hospitalization. Our results suggest large welfare gains from preventing fetal stress from family ruptures and possibly from economically induced stressors such as unemployment. They further suggest that greater stress exposure among the poor may partially explain the intergenerational persistence of poverty.
    JEL: I10 I31 J13
    Date: 2016–05
  30. By: Norma B. Coe; Jing Guo; R. Tamara Konetzka; Courtney Harold Van Houtven
    Abstract: Research on informal and formal long-term care has centered almost solely on costs; to date, there has been very little attention paid to the benefits. This study exploits the randomization in the Cash and Counseling Demonstration and Evaluation program and instrumental variable techniques to gain causal estimates of the effect of family involvement in home-based care on health care utilization and health outcomes. We find that family involvement significantly decreases Medicaid utilization. Importantly, we find family involvement significantly lowers the likelihood of urinary tract infections, respiratory infections, and bedsores, suggesting that the lower utilization is due to better health outcomes.
    JEL: I1 I13 I28
    Date: 2016–05
  31. By: Picazo, Oscar F.; Dela Cruz, Nina Ashley O.; Ortiz, Danica Aisa P.; Pantig, Ida Marie T.; Aldeon, Melanie P.; Tanghal, Juan Alfonso O.
    Abstract: This impact evaluation of the Health Facilities Enhancement Program (HFEP) of the Department of Health provides a preliminary analysis on its effects, particularly on the utilization of local health services, due to the improvement in capital stock. Furthermore, the evaluation attempts to present certain problems and issues encountered in the implementation of the program. The first part of this paper provides a general overview of what an impact evaluation is and gives the sampling frame of the study. Site visits were conducted in 107 hospitals/infirmaries and 159 rural health units/city health offices. These include HFEP-recipient and a few non-HFEP recipient facilities. An overview of facilities that received HFEP grants is then provided, as well as the completion and functionality of HFEP infrastructure projects in visited facilities. In the conduct of the impact evaluation, health service utilization through number of birth deliveries, outpatient consultations, and inpatients was compared in both HFEP and non-HFEP facilities. The aim is to identify trends and patterns in utilization, if there is an increase. Subsequently, bottlenecks in the evaluation were also revealed, particularly in comparing the volume of services before, during, and after HFEP. In connection to this, some analytical challenges concerning confounding factors and some proposed analytical approaches in undertaking an impact evaluation of capital investments are also given. The final part of this paper provides a conclusion on the impact of HFEP in health utilization, and some proposed areas for further study and research.
    Keywords: Philippines, Health Facilities Enhancement Program (HFEP), impact evaluation, health facilities, health infrastructure, medical equipment, health utilization
    Date: 2016
  32. By: Barbieri, Paolo Nicola
    Abstract: This paper presents a theoretical investigation into why losing weight is so difficult even in the absence of rational addiction, time-inconsistent preferences or bounded rationality. We add to the existing literature by focusing on the role that individual metabolism and physical activity have on weight loss. The results from the theoretical model provides multiple steady states and a threshold revealing a situation of obesity traps that the individual must surpass in order to successfully lose weight. Any weight-loss efforts that the individual undertakes have to surpass this threshold in order to result in permanent weight loss, otherwise the individual will gradually regain weight and converge to his or her previous body weight. In addition to this we study how price policies affect individual behavior. We show that food taxes, in the long run, increases body weight, even if food consumption decreases; while price policies aimed at promoting physical activity are able to sustain healthier lifestyle, fitness accumulation and a decreases in body weight.
    Keywords: Obesity, Dieting, Optimal Control, Multiple Equilibria.
    JEL: D91 I12 I18
    Date: 2016–05–16
  33. By: O'Hare, Colin; Li, Youwei
    Abstract: Predicting life expectancy has become of upmost importance in society. Pension providers, insurance companies, government bodies and individuals in the developed world have a vested interest in understanding how long people will live for. This desire to better understand life expectancy has resulted in an explosion of stochastic mortality models many of which identify linear trends in mortality rates by time. In making use of such models for forecasting purposes we rely on the assumption that the direction of the linear trend (determined from the data used for fitting purposes) will not change in the future, recent literature has started to question this assumption. In this paper we carry out a comprehensive investigation of these types of models using male and female data from 30 countries and using the theory of structural breaks to identify changes in the extracted trends by time. We find that structural breaks are present in a substantial number of cases, that they are more prevalent in male data than in female data, that the introduction of additional period factors into the model reduces their presence, and that allowing for changes in the trend improves the fit and forecast substantially.
    Keywords: Mortality; stochastic models; structural breaks; forecasting
    JEL: C51 C52 C53 G22 G23 J11
    Date: 2016–05–16
  34. By: Aizawa, Toshiaki (Asian Development Bank Institute); Helble, Matthias (Asian Development Bank Institute)
    Abstract: Exploiting the Indonesian Family Life Survey, this paper studies the transition of socioeconomic related disparity of excess weight, including overweight and obesity, from 1993 to 2014. First, we show that the proportions of overweight and obese people in Indonesia increased rapidly during the time period and that poorer income groups exhibited the strongest growth of excess weight. Using the concentration index we find that prevalence of overweight and obesity affected increasingly poorer segments of Indonesian society. Third, decomposing the concentration index of excess weight in 2000 and 2014 for both sexes, our results suggest that most parts of the concentration index can be explained by the unequal distribution of living standards, sanitary conditions, the possession of vehicles, and home appliances. Finally, decomposing the change in the concentration index of excess weight from 2000 to 2014, we show that a large part of the change can be explained by the decrease in inequality in living standards, and improved sanitary conditions and better availability of home appliances in poorer households.
    Keywords: Obesity prevalence; socioeconomic disparity; Indonesian Family Life Survey
    JEL: I14 I15 I18 I24
    Date: 2016–05–15
    Abstract: Being healthy is an important aspect in life satisfaction. The factors that effect the health status of an individual are named as the environmental factors, economical factors, socio-cultural factors, genetic factors, access to health services and life style. Since it can be controlled by the individual, lifestyle is a topic with great importance. Healthy lifestyle is defined as “the individual’s control over her/his behaviors which can affect her/his health status and while orginising the daily activities, choosing the behaviors that are appropriate to her/his health status†. Healthy lifestyle behaviors are healthy nutrition, stress management, regular exercise, spiritual wellbeing, high quality interpersonal relations and taking the health responsibility. So, understanding the healthy lifestyle level and life satisfaction of individuals is important for health and education institutions, companies and governments to define their strategies accordingly. This quantitative study involves 205 Turkish individuals (students, academic staff and administrative staff) from a university in Istanbul. Data were obtained from self-administered questionnaires with 26 questions. The study examines the characteristics of the respondents regarding demographics, healthy lifestyle behaviors and life satisfaction. Some differences in sample’s healthy lifestyle dimensions were determined according to demographic variables after factor analysis, T-test, ANOVA and regression analysis. This research presents the opportunity for further qualitative research in healthy lifestyle habits among university students.
    Keywords: healthy lifestyle, life satisfaction, health status
    JEL: I31 I00 I19
  36. By: Liezel Wegner (University of the Western Cape); Anthea Rhoda (University of the Western Cape)
    Abstract: Aim: To determine the most common cause of lower limb amputation in a rural setting in South Africa.Methods: The study was set in the four district hospitals and one regional hospital in a rural health district in northern Kwa-Zulu Natal. A mixed methods approach was used to collect data, and the specific type of design that was applied in this study was a concurrent convergent design. Data was collected in three stages independently of one another (two quantitative and one qualitative stage), and the findings was triangulated in order to come to a conclusion. Stage one was a quantitative retrospective document analysis, stage two utilised a longitudinal prospective descriptive design and stage three consisted of semi-structured interviews with surgeons and amputees. Results: An average of 20 lower limb amputations were performed on a monthly basis in the regional hospital, and 71% of the people who lost their lower limbs were also diabetic. Of the diabetic population who lost lower limbs, 81% were also diagnosed with hypertension. Discussion/Conclusion: A relatively large number of lower limb amputations per month are performed at this rural regional hospital on a relatively young population. Contrary to what is reported in the literature relating to the common causes of lower limb amputation in a rural setting in developing countries, diabetes mellitus was identified as the leading cause of lower limb loss. This information can assist to inform health promotion and diabetes and amputation prevention strategies in rural settings.
    Keywords: Amputation, rural, cause
  37. By: Sirje Kree (Tartu City Government)
    Abstract: Frailty is a risk factor for morbidity and mortality in older people. About 4-17% of elderly people living at home are frail, about 3-7% of elderly in age group 65-74 years and about 32% in age group 90 years. About 33-51% of elderly people in hospital care are frail. Several studies reported association between socioeconomic factors and health status. The social factors as risk factors for the development of frailty should be assessed and taken into account when evaluating elderly person’s prevention and treatment programs. In medical context the social factors are often ignored. Social frailty can be measured through the Tilburg Indicator. There are three criteria: living alone, lack of contacts and lack of support. If someone meets at least two of these three criteria, they are taken as socially frail.EAKAS study in Estonia reported that 63% of elderly in elderly home were living alone before getting to institutional care. 23% of elderly in elderly homes feels alone. Strong and supportive relations with family are in 50% of elderly in institutional care. About 27% of elderly in institutional care would like to go back to their homes or family.Socioeconomic factors such as education, income, relations, neighbourhood and etc influence on frailty and its outcomes such as mortality and disability- Frailty persons are at higher risk of hospitalization, institutional care and mortality.
    Keywords: Frailty, elderly, health, socioecomomic status
  38. By: Paiboon Chaosuansreecharoen (Sirindhorn College of Public Health, Trang); Kannika Ruangdej Chaosuansreecharoen (Sirindhorn College of Public Health, Trang)
    Abstract: Aim: This study aimed to measure the quality of life (QoL) among elderly in strong elderly club of three southern border provinces and to identify its some determinant factors.Background: The insurgence of violence in three southern border provinces of Thailand that began in January 2004 is directly or indirectly affecting the lives of up to a million elderly living in Narathiwat, Pattani, and Yala. The violence included bomb attacks and daily killings of state officials and local villagers. Currently, the violence has increased in complexity, frequency and severity. Thai Government is concerned with providing for sustained social welfare for the aging population. The government implemented a policy of elderly club in all sub-districts, places where older persons in the local area can gather and enjoy social activities. Thus, it is believed that the elderly club is one strategy to improve well-being among elderly living in three southern border provinces. Methods: This was cross-sectional survey of a random sample of members of strong elderly club in three southern border provinces. The constructively QoL was measured on economic, social, environmental, health, and attitudinal domain. The study participants were interviewed at their elderly clubs. Descriptive statistics were used in this study. The analytical procedure of stepwise multiple regressions were conducted to predict QoL determinant.Findings: The results revealed that elderly who were member of the strong elderly club in three southern border provinces showed high level of QoL (Economic domain = 54.4%, Social domain = 76.8%, Environmental domain = 97.6%, Health domain = 69.6%, Attitudinal domain = 94.4% and Total QoL = 86.8%). The stepwise multiple regression analysis indicated that the best fit model included six predictors of frequency of elderly club participation, having money saving, social capital on social network component, life satisfaction and happiness, feeling of safety from violence and age. All six predictors could explain 59.9% of the variance of QoL. Of the six predictor variables, a stepwise multiple regression analysis indicated that frequency elderly club participation was most strongly related to QoL. Age was negative associated with QoL.Implications: The result has shown that active members have higher QoL than non-active members. Thus, the community must recognize the value of nurturing the well-being of the elderly in order to maintain an active club that enhances the quality of life of the elderly in the three southern border provinces.
    Keywords: Quality of Life, Elderly Club, Three Southern Border Provinces of Thailand
    JEL: I00
  39. By: Jana Å tofková (Žilinská univerzita v Žiline); Zuzana Å tofková (Žilinská univerzita v Žiline); Stanislav Å tofko (Žilinská univerzita v Žilne)
    Abstract: The concept of the measurement of quality of life is used to evaluate the general state of well-being of individual persons and society. The quality of life should not be exchanged with the concept of standard of living, which is primarily based on income. The objective quality of life issues are based on measurements of so called "hard data", i.e. data from institutions and organizations that include financial accounts, civil records, medical statistics, pollution and other information that are routinely collected. Subjective aspect of quality of life is evaluated on the degree of satisfaction with various items and needs. This is a category associated with subjective perceptions of their lives within a system of values and within certain social, economic and political conditions. Subjective indicators (feelings of happiness, satisfaction, etc.) are usually measured and evaluated on the basis of quantitative and qualitative research. Some results of the survey of quality of life are shown in this paper. Several results of a survey conducted point on the subjective perception for example safety and other factors.
    Keywords: quality of life, subjective aspect, survey
    JEL: I39
  40. By: Otto Lenhart (Department of Economics, Emory University); Vinish Shrestha (Department of Economics, Towson University)
    Abstract: The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: 1) Young adults substitute employer sponsored insurance for dependent coverage, 2) Affected individuals reduce their work time and switch from full- to part-time employment, and 3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.
    Keywords: Dependent coverage mandate, labor market outcomes, time use.
    JEL: I13 J22 I12
    Date: 2016–04
  41. By: Martha Ottenbacher
    Abstract: This paper considers an employee's retirement intentions and its influencing factors. The role of conflicts that an employee experiences with his/her boss and the role of his/her health status are analyzed using Socio-Economic Panel (SOEP) data. Estimation results show that conflicts matter as well as an individual's health status when considering the probability of retirement. Having conflict with the boss rises the probability of retiring intentions significantly, even after accounting for a wide set of controls. Employees in good health have fewer intentions to retire. Split into subgroups, there appears to be a slight but notable moderating role of health status: Among healthy employees conflict with the boss raises retirement intentions even more. This suggests that healthy people (compared to unhealthy people) may well be able to continue working but not necessarily do so because social factors - namely conflict with the boss - become more important.
    Keywords: conflicts with the boss, retirement intentions, health status
    JEL: J26 J29 I12 M54
    Date: 2016
  42. By: Lucia Mangiavacchi (Universitat de les Illes Balears); Luca Piccoli (Universitat de les Illes Balears)
    Abstract: This study analyses whether parents' alcohol consumption can affect long run children's educational attainments. Using 19 waves of the Russia Longitudinal Monitoring Survey (RLMS), where individuals and their families are followed from childhood to adulthood, this study analyses how parental alcohol consumption during childhood (between 1994 and 2001) may affect children's educational attainment about twelve years later (from 2006 to 2014). Panel estimations show that mother total grams of alcohol consumption during childhood is consistently negatively associated with adult children educational outcomes, as the probability of having an university degree, the highest level of education achieved and years of schooling. By using direct observation of past parental behaviour, the proposed empirical strategy avoids endogeneity issues that may arise when using contemporaneous retrospective information, while endogeneity deriving from unobserved characteristics determining both parental drinking and adult children educational attainment is addressed using an Hausman-Taylor estimator. This permits the identification of a negative causal relationship between mother alcohol consumption during childhood and long-run children's educational attainment. The study also explores the transmission mechanisms suggested by the literature, identifying a possible role for possible excessive prenatal exposure to alcohol, family disruption, health issues during childhood, parental care needs and intergenerational transmission of drinking habits of the father.
    Keywords: alcohol consumption, children education, parents problem-drinking, intergenerational transmissions, RLMS, Russia.
    JEL: D1 I1 I2 I3
    Date: 2016
  43. By: Libertad González Luna
    Abstract: I use birth-certificate data for Spain to document extremely son-biased sex ratios at birth among Indian immigrants. I also show that the children of Indian immigrants display poor health outcomes during infancy, although there is no evidence of a gender gap in infant health. I provide evidence suggesting that the poor outcomes of Indian children at birth can be attributed to the low health endowments of Indian mothers, while the absence of a gender gap is driven by the fact that the parents who would invest less in girls are less likely to carry the pregnancies of girls to term (more likely to practice sex-selective abortion).
    Keywords: fertility, sex ratio, abortion, sex selection, son preference, infant health, immigration, India, Spain.
    JEL: J13 I15
    Date: 2016–03
  44. By: Ivan Frankovic; Michael Kuhn; Stefan Wrzaczek
    Abstract: We study the role of health care within a continuous time economy of overlapping generations subject to endogenous mortality. The economy consists of two sectors: final goods production and a health care sector, selling medical services to individuals. Individuals demand health care with a view to lowering mortality over their life-cycle. We derive the age-specific individual demand for health care based on the value of life as well as the resulting aggregate demand for health care across the population. We then characterize the general equilibrium allocation of this economy, providing both an analytical and a numerical representation. We study the allocational impact of a medical innovation both in the presence and absence of anticipation; and a temporary baby boom. We place particular emphasis on disentangling general equilibrium from partial equilibrium impacts and identifying the relevant transmission channels.
    Keywords: Couple employment, European Social Survey, labour supply, preferences, economic crisis
    Date: 2016–03
  45. By: Meghan Kumar; Joel Thomas Lehmann; Aniceth Rucogoza; Claver Kayobotsi; Ashis Kumar Das; Miriam Schneidman
    Abstract: This report summarizes the main findings from the application of performance based incentives linked to progress on a standardized, globally recognized metric - the stepwise laboratory improvement process towards accreditation (SLIPTA) checklist - under the East Africa Public Health Laboratory Networking Project (EAPHLNP) in Rwanda. ... See More + The lab performance-based financing (PBF) pilot was introduced in the context of a well-established national PBF program dating back to the early 2000s. The flexible nature of the EAPHLNP and the favorable context in Rwanda provided an ideal backdrop to introduce PBF incentive payments to accelerate progress of five project supported labs towards accreditation. The evaluation found improved laboratory performance at all project-supported laboratories in Rwanda as measured by the SLIPTA scores. For the first time, laboratories were bringing in PBF revenues, instilling a culture of continuous quality improvements, and focusing management attention on accreditation. PBF appears to have contributed to an accelerated change, with PBF laboratories experiencing an overall greater increase in SLIPTA scores compared to project-supported laboratories in the other countries. No clear patterns were found in terms of improved test volumes or test accuracy, which were not part of the pilot scheme. While it was difficult to disentangle the effects of different interventions, the evaluation found a system-strengthening value to combining investments in modernizing laboratories, and strengthening human resources with PBF. Relationships between laboratory staff and clinicians improved, with laboratory managers having a greater voice in hospital management and lab staff increasingly valued and respected by clinicians. A spirit of teamwork prevailed at participating sites. Other countries considering PBF mechanisms for public health laboratories need to take into account lessons learned and assess the features which may be relevant to their own contexts. PBF schemes for laboratories need to be viewed as an integral part of a package of interventions that contribute to enhanced performance.
    Keywords: waste, risks, quantitative research, rights, supervision, equipment, customer, communication technologies, knowledge sharing, time, prevention, morbidity, community health ... See More + data collection, information, monitoring, health care, effects, health, capacity building, verification, planning, research design, management systems, pilot project, turnaround times, measures, public health, qualitative data, enabling environment, satellite, hospitalization, experimental design, cells, hardware, knowledge, immune system, institutions, data, exercises, scenarios, laboratory equipment, patient, patients, tests, performance indicators, intervention, laboratory technicians, laboratories, targets, trigger, nurses, laboratory infrastructure, documents, laboratory accreditation, sciences, consultant, web, standardization, field work, indicators, research, customer service, material, standards, data analysis, work environment, testing services, interview, inventory, improvement, mortality, testing, grants, capabilities, specimens, infrastructure, methods, technology, transaction, interviews, travel, safety officer, workers, procurement, quality management, payout, patient satisfaction, best practices, results, surveillance, validity, age, health authorities, health policy, raw data, quantitative data, health outcomes, management system, stress, samples, size, measurement, fund management, labs, nutrition, confidentiality, surveys, web portal, primary health care, citizens, internet, regression analysis, result, weight, physicians, ict, creative solutions, theory, technical staff, lab, network, evaluation, human resources, sampling, isolation, performance, research findings, innovation, performance indicator, certificates, sites, protocol, financial support, institutionalization, research methods, communication, statistical analysis, strategy, laboratory, institutional framework, child health services, methodology, hospitals, communications technology, technologies, financial constraints, implementation, health services, uses, quality of service, innovations, informants, missing data, service providers
    Date: 2016–04

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