nep-hea New Economics Papers
on Health Economics
Issue of 2016‒06‒04
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. What causes inequity in access to publicly funded health services that are supposedly free at the point of use? A case of user fee exemptions for older people in Senegal By Philipa Mladovsky; Maymouna Bâ
  2. Education, HIV Status and Risky Sexual Behavior: How Much Does the Stage of the HIV Epidemic Matter ? By Ioro, Daniela; Santaeulalia-Llopis, Raül
  3. Like Mother, Like Father? Gender Assortative Transmission Of Child Overweight By Joan Costa-Font; Mireia Jofre-Bonet
  4. The long-term health benefits of receiving treatment from qualified midwives at birth By Lazuka, Volha
  5. Surface Water Quality and Infant Mortality in China By Guojun He; Jeffrey Perloff
  6. Cost effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology By Andrew Sutton; Ravinder Vohra; Marianne Hollyman; Paul Marriott; Alessandra Buja; Derek A Alderson; Sandro Pasquali; Ewan Griffiths; On Behalf of the Choles Study Group and the West Midlands Research Collaborative
  7. Quantification of Exposure to Fecal Contamination in Open Drains in Four Neighborhoods in Accra, Ghana By Stephanie R. Gretsch; Joseph A. Ampofo; Kelly K. Baker; Julie Clennon; Clair A. Null; Dorothy Peprah; Heather Reese; Katharine Robb; Peter Teunis; Nii Wellington; Habib Yakubu; Christine L. Moe
  8. Evaluation of Health Care Innovation Awards (HCIA): Primary Care Redesign Programs, Second Annual Report, Volume II: Individual Program Summaries By Linda Barterian; Keith Kranker; Rumin Sarwar; Boyd Gilman; Greg Peterson; Catherine DesRoches; Sandi Nelson; Laura Blue; Kate Stewart; Frank Yoon; Lorenzo Moreno
  9. Improving Medicaid and SCHIP Through Simplification and Coordination By Sheila D. Hoag; Beth Stevens
  10. Medicare Advantage 2016 Spotlight: Enrollment Market Update By Gretchen Jacobson; Giselle Casillas; Anthony Damico; Tricia Neuman; Marsha Gold
  11. Impacts and Determinants of Health Levels in Low-Income Countries By Pascaline Dupas; Edward Miguel
  12. Risk Attitudes in Medical Decisions for Others: An Experimental Approach By Alejandro Arrieta; Ariadna García-Prado; Paula González; Jose Luis Pinto-Prades
  13. Getting Older and Riskier: The Effect of Medicare on Household Portfolio Choices By Marco Angrisani; Vincenzo Atella; Marianna Brunetti
  14. The impact of health on the employment and earnings of young South Africans By Chijioke O. Nwosu
  15. Psychological maternal stress is difficult to identify as a causal factor in poor infant health. We posit that the 1994 Northridge earthquake in Los Angeles, California provides a natural test of the effect of mothers' stress on infants' birth weight and gestation. Difference-in-difference results show that infants born closest to the epicenter were 0.24 percentage points more likely to be born with low birth weight. Among the subsample of mothers most susceptible to stress -- first-time, single mothers -- low birth weight was 0.65 percentage points more likely to occur. Impacts were larger and more precisely identified for women who experienced the earthquake in their first or third trimester. We find little evidence that earthquake-induced stress affected preterm delivery. By Bongkyun Kim; Celeste K. Carruthers; Matthew C. Harris
  16. Long-Run Health Consequences of Air Pollution: Evidence from Indonesia's Forest Fires of 1997 By Younoh Kim; Scott Knowles; James Manley; Vlad Radoias
  17. Birth Weight and Family Resource Allocations: New Evidence from Twins By Carrillo, B.; Branco, D.

  1. By: Philipa Mladovsky; Maymouna Bâ
    Abstract: Plan Sésame (PS) was launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. As in many countries, this user fee exemption is marred by inequitable implementation. This study seeks to identify underlying causal mechanisms to explain how and why some people were relatively less likely to have access to publicly funded health care. Explanations identified in focus group and interview data are organised into four themes: (i) PS as a poorly implemented and accessed “right” to health care; (ii) PS as a “privilege” reserved for elites; (iii) PS as a “favour” or moral obligation to friends or family members of health workers; and (iv) PS as a “curse” caused by adverse incorporation. These results are analysed through critical realist and social constructivist epistemological lenses, in order to reflect on different interpretations of causality. Within the critical realist interpretation, the results point to a process of social exclusion. However, this interpretation, with its emphasis on objective reality, is contradicted by some local, subjective experiences of inequality and corruption. An alternative social constructionist interpretation of the results is therefore explored; it is argued this may be needed to prevent relatively powerful actors’ versions of the truth from prevailing.
    Keywords: Social exclusion; older people; universal health coverage; user fees; Senegal; critical realism
    JEL: E6
    Date: 2016–05
  2. By: Ioro, Daniela; Santaeulalia-Llopis, Raül
    Abstract: We study the relationship between education and HIV status using nationally representative data from 39 Demographic and Health Surveys (DHS) in Sub-Saharan Africa. First, we construct an innovative algorithm that systematically defines aggregate stages of the HIV epidemic in a comparable manner across time and across space. Second, we exploit the variation in the aggregate HIV stages in the DHS data, and find that the education gradient in HIV shows a U-shaped (positive-zero-positive) pattern over the course of the epidemic. Further, educational disparities in the number of extramarital partners are largely consistent with the evolution of the education gradient in HIV. We propose a simple theoretical model of risky sex choices that accounts for these stylized facts.
    Keywords: Education, HIV, Risky sex, Epidemiological stages
    JEL: I15 I25
    Date: 2016
  3. By: Joan Costa-Font; Mireia Jofre-Bonet
    Abstract: Una de las principales explicaciones del aumento de la obesidad y el sobrepeso infantil está en la transmisión de estilos de vida poco saludables por parte de los padres. En el presente trabajo se contrasta esta hipótesis utilizando una base de datos única y representativa que recoge información anual desde 1996 a 2009 sobre el paso y la altura de padres e hijos en Inglaterra.
    Date: 2016–05
  4. By: Lazuka, Volha (Department of Economic History, Lund University)
    Abstract: Socio-economic differences in health and mortality are substantial and increasing today in many developed countries. The sources of these differences remain debated. There is an expanding literature showing that early-life conditions are linked to health in adulthood and old age. However, our knowledge about whether beneficial treatments in early life influence later health is still limited. Using longitudinal individual-level data from the Scanian Economic Demographic Database (Sweden) for individuals born between 1881 and 1930 and observed from birth until the age 80, this paper explores the long-term health effects of being born assisted by a qualified midwife. Treatment data is obtained from midwife reports for approximately 7,200 children, which includes information on the type of treatment at birth as well as child and mother health. In a setting of home deliveries, midwives not only provided skilled assistance at childbirth, but also strictly followed disinfection instructions and checked child and mother health within three weeks after birth. Our findings show that individuals treated by qualified midwives at birth and in the first month of life have lower all-cause mortality between ages 15 and 39 and lower mortality from cardiovascular diseases and diabetes between ages 40 and 80, compared to individuals delivered by traditional midwives. The effects are larger for individuals originating from more affluent families. These findings are linked to reductions in exposure to infectious diseases and their interplay with family responses to better infant health.
    Keywords: early-life; qualified midwifery; mortality; morbidity; life-course; Sweden
    JEL: H41 I15 J13
    Date: 2016–05–23
  5. By: Guojun He (Department of Economics, Hong Kong University of Science and Technology; Division of Social Science, Hong Kong University of Science and Technology; Division of Environment, Hong Kong University of Science and Technology; Institute for Emerging Market Studies, Hong Kong University of Science and Technology); Jeffrey Perloff (Department of Agricultural and Resource Economics, UC Berkeley)
    Abstract: Surface water pollution has a significant, non-monotonic effect on the infant mortality rate in China. As surface water quality deteriorates, the infant mortality rate first increases and then decreases. Thus, moderate levels of pollution are the most dangerous.
    Keywords: water quality; water pollution; infant mortality
    JEL: Q53 I1
    Date: 2016–06
  6. By: Andrew Sutton (Leeds Institute of Health Sciences, University of Leeds, Leeds, UK); Ravinder Vohra (Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK); Marianne Hollyman (West Midlands Surgical Research Collaborative, Queen Elizabeth Hospital, Birmingham UK); Paul Marriott (Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK); Alessandra Buja (Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, Padova, Italy); Derek A Alderson (Academic Department of Surgery, University of Birmingham, Birmingham, UK); Sandro Pasquali (Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK); Ewan Griffiths (Department of Upper Gastro-Intestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK); On Behalf of the Choles Study Group and the West Midlands Research Collaborative
    Abstract: Introduction: The optimum timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy, performed during index admission can reduce length of stay with similar rates of conversion to open surgery, complications, and mortality compared to a ‘delayed’ operation following discharge, while others have described that cholecystectomy performed during the index acute admission results in higher morbidity, extended length of stay, and increasing costs. This study examines the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. Methods:Using data from a prospective population based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model.Results: Emergency cholecystectomy was found to be less costly (£4,570 vs. £4,720) and more effective (0.8868 vs. 0.8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60% likely to be cost-effective across willingness to pay values for the QALY from £0 to £100,000. Discussion: This analysis demonstrates that emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and the health care provider due to the reduced costs.
    Keywords: laparoscopic cholecystectomy, acute gallbladder, economic evaluation, decision tree, cost-utility analysis
    JEL: I15
    Date: 2016
  7. By: Stephanie R. Gretsch; Joseph A. Ampofo; Kelly K. Baker; Julie Clennon; Clair A. Null; Dorothy Peprah; Heather Reese; Katharine Robb; Peter Teunis; Nii Wellington; Habib Yakubu; Christine L. Moe
    Abstract: In low-income countries, rapid urbanization adds pressure to already stressed water and sanitation systems that are critical to the health of communities.
    Keywords: Water, sanitation, Accra, Ghana, fecal contamination, international
    JEL: F Z
  8. By: Linda Barterian; Keith Kranker; Rumin Sarwar; Boyd Gilman; Greg Peterson; Catherine DesRoches; Sandi Nelson; Laura Blue; Kate Stewart; Frank Yoon; Lorenzo Moreno
    Keywords: Primary Care Redesign, Implementation Evaluation, Impact Evaluation, Delivery Systems Innovation, Clinician Behavior, Workforce Development, Medicare, Medicaid
    JEL: I
  9. By: Sheila D. Hoag; Beth Stevens
    Abstract: This highlight memo examines grantees’ and state officials’ opinions on their success in improving Medicaid and SCHIP using the simplification and coordination strategies.
    Keywords: Covering Kids & Families Evaluation, Medicaid, SCHIP, simplification, coordination, health
    JEL: I
  10. By: Gretchen Jacobson; Giselle Casillas; Anthony Damico; Tricia Neuman; Marsha Gold
    Abstract: The number and share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade, and this trend in enrollment growth is continuing in 2016.
    Keywords: Medicare Advantage, Enrollment, Premiums, Medicare Part D, Quality Measures
    JEL: I
  11. By: Pascaline Dupas; Edward Miguel
    Abstract: Improved health in low-income countries could considerably improve wellbeing and possibly promote economic growth. The last decade has seen a surge in field experiments designed to understand the barriers that households and governments face in investing in health and how these barriers can be overcome, and to assess the impacts of subsequent health gains. This chapter first discusses the methodological pitfalls that field experiments in the health sector are particularly susceptible to, then reviews the evidence that rigorous field experiments have generated so far. While the link from in utero and child health to later outcomes has increasingly been established, few experiments have estimated the impacts of health on contemporaneous productivity among adults, and few experiments have explored the potential for infrastructural programs to impact health outcomes. Many more studies have examined the determinants of individual health behavior, on the side of consumers as well as among providers of health products and services.
    JEL: C93 I1 O1
    Date: 2016–05
  12. By: Alejandro Arrieta (Florida International University); Ariadna García-Prado (Universidad Pública de Navarra); Paula González (Universidad Pablo de Olavide); Jose Luis Pinto-Prades (Universidad de Navarra)
    Abstract: The aim of this paper is to investigate how risk attitudes in medical decisions for others vary across health contexts. A lab experiment was designed to elicit the risk attitudes of 257 students by assigning them the role of a physician who must decide between treatments for patients. An interval regression model was used to estimate individual coefficients of relative risk aversion, and an estimation model was used to test for the effect of type of medical decision and experiment design characteristics on elicited risk aversion. We find that: (i) risk preferences for decisions involving life expectancy are different from those involving quality of life, but risk aversion prevails in all types of medical decisions; (ii) students enrolled in health-related degrees show a higher degree of risk aversion; and (iii) real rewards for third parties (patients) make subjects less risk-averse. The results underline the importance of accounting for doctors’ attitudes towards risk in medical decision-making.
    Keywords: physicians, risk aversion, health contexts, laboratory experiment, multiple price list format.
    JEL: I1 C91 D81
    Date: 2016–05
  13. By: Marco Angrisani (CESR, University of Southern California); Vincenzo Atella (CEIS,University of Rome "Tor Vergata"); Marianna Brunetti (DEF and CEIS, Università di Roma "Tor Vergata" and CeFin)
    Abstract: The rise of health-care costs has become an increasingly important contributor to financial risk for households. To the extent that these costs can be large, unpredictable, and not fully insured, they represent a source of background risk that could potentially deter households’ financial risk taking. Using longitudinal data from the Health and Retirement Study over the period 1992-2012, we adopt a fixed-effects estimation strategy to empirically test whether universal health insurance, such as the one provided by Medicare to over-65 Americans, acts as a shelter against this background risk and, in turn, promotes household stock holding. We find that households in poor health status, who face a higher risk of large medical expenses, are significantly less likely to hold stocks than their healthier counterparts. Yet, this gap is, for the most part, eliminated by Medicare eligibility. Notably, this offsetting effect is primarily experienced by households without private health insurance over the observation period. Our results are robust to several sample selections and model specifications.
    Keywords: Household portfolios; Health status; Medicare; Health insurance
    JEL: D14 I13 G11
    Date: 2016–05–31
  14. By: Chijioke O. Nwosu
    Abstract: This paper estimates the impact of health on employment and earnings among individuals aged 15-39 years in South Africa. Though one of the richest countries in Africa, South Africa is plagued by substantial disease burden especially from communicable diseases, injuries, maternal and child mortality, and non-communicable diseases. The country also has very high unemployment rates, with the unemployment rate among those aged 15-24 years exceeding 50% in 2014 (according to the International Labour Organization definition). The National Income Dynamics Study, a nationally representative panel survey of South African individuals and households, is used for the analysis. Using the second and third data waves (collected in 2010 and 2012 respectively) and controlling for genetic unobserved heterogeneity using sibling fixed effects, we find robust negative and statistically significant impact of adverse health status on employment and wages. These findings indicate that ill health is an added hindrance to young South Africans’ employment and earnings, and is therefore likely to worsen poverty. Health policy can be a tool for improving the employment and earnings of young South Africans.
    Keywords: Health; Employment; Wages; Youth; South Africa
    JEL: I15 J21 J31 O12
    Date: 2016
  15. By: Bongkyun Kim (Department of Economics, University of Tennessee); Celeste K. Carruthers (Department of Economics, University of Tennessee); Matthew C. Harris (Department of Economics, University of Tennessee)
    Keywords: Maternal stress, birth outcomes, natural disasters
    JEL: I10 I12
    Date: 2016–05
  16. By: Younoh Kim (Department of Economics, Eastern Michigan University); Scott Knowles; James Manley (Department of Economics, Eastern Michigan University); Vlad Radoias (Department of Economics, Towson University)
    Abstract: While many studies in the medical literature documented causal relationships between air pollution and negative health outcomes immediately following exposure, much less is known about the long run health consequences of pollution exposure. Using the 1997 Indonesian forest fires as a natural experiment, we estimate the long term effects of air pollution on health outcomes. We take advantage of the longitudinal nature of the Indonesia Family Life Survey (IFLS), which collects detailed individual data on a multitude of health outcomes, in both 1997 and 2007. We find significant negative effects of pollution, which persist in the long run. Men and the elderly are impacted the most, while children seem to recover almost completely from these early shocks.
    Keywords: Air Pollution, Health, Indonesia.
    JEL: I1 Q53
    Date: 2016–05
  17. By: Carrillo, B.; Branco, D.
    Abstract: It is now widely recognized that birth endowments can have long-lasting effects on later-life outcomes. An intriguing question is how parents respond to shifts in child endowments. Some of the estimates in literaturemay be affected by small samples and unobservable mother-specific factors, limiting the power of policy implications. We exploit variation within twins to estimate the effect of birth weight on health investments in children. Using data from 68 developing countries, we find that lower birth weight babies receive less health care investments in infancy. These effects are larger for countries with higher infant mortality rates, lower life expectancy,and poorer sanitation facilities. Collectively, the findings suggest that parental behaviors contribute to amplify the baseline effects of birth endowments on long-run outcomes.
    Keywords: twins; birth weight; parental investments;
    JEL: D1 I1 J1
    Date: 2016–05

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