nep-hea New Economics Papers
on Health Economics
Issue of 2016‒06‒14
nineteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Regulating from the Demand Side: Public Health Insurance with Monopolistically Competitive Providers and Optional Spot Sales By Gilad Sorek; Randolph T. Beard
  3. Impact of Safer Pesticide Use on the Health of Farmers--A Study from Vietnam By Tran Huynh Bao Chau; Le Thi Quynh Anh
  4. Climate Preferences, Obesity, and Unobserved Heretogeneity in Cities By Anthony Yezer; Stephen Popick
  5. Effects of China's Rural Insurance Scheme on Objective Measures of Health By Rokicki, Slawa; Donato, Katherine Elizabeth
  6. Returns to Education: The Causal Effects of Education on Earnings, Health and Smoking By Heckman, James J.; Humphries, John Eric; Veramendi, Gregory
  7. An International Comparative Study of Financing Healthcare: The Case of Eight Developed Countries in 1990s- 2000s By Kazuaki Sato; Yui Ohtsu; Shintaro Kurachi; Leo Shimamura; Yasuto Dobashi
  8. Sustainability from the Grantee Perspective By Judith Wooldridge; Beth Stevens; Eileen Ellis; Ian Hill; Kathy Gifford; Bridget Lavin
  9. RPG Cross-Site Evaluation and Technical Assistance: Third Annual Report By Jacqueline M. Crowley; Alyson Burnett; Caroline Massad Francis; Debra A. Strong
  10. Evaluation of Health Care Innovation Awards (HCIA): Primary Care Redesign Programs, Second Annual Report Volume I By Lorenzo Moreno; Boyd Gilman; Greg Peterson; Catherine DesRoches; Sheila Hoag; Linda Barterian; Laura Blue; Katharine Bradley; Emily Ehrlich; Kristin Geonnotti; Lauren Hula; Keith Kranker; Rumin Sarwar; Rachel Shapiro; KeriAnn Wells; Joseph Zickafoose; Sandi Nelson; Kate Stewart; Frank Yoon
  11. Performing Outreach with Limited Resources: CKF Grantees' Success and Challenges Over Three Years By Brigette Courtot; Ariel Klein; Embry Howell; Sarah Benatar
  12. Why Do Children Take Care of Their Elderly Parents? Are the Japanese Any Different? By Charles Yuji Horioka; Emin Gahramanov; Aziz Hayat; Xueli Tang
  13. The Economic Consequences of Hospital Admissions By Carlos Dobkin; Amy Finkelstein; Raymond Kluender; Matthew J. Notowidigdo
  14. Health care coverage in OECD countries in 2012 By Valérie Paris; Emily Hewlett; Ane Auraaen; Jan Alexa; Lisa Simon
  15. Determinants of Low Birth Weight a Cross Sectional Study: In Case of Pakistan By Ghouse, Ghulam; Zaid, Muhammad
  16. A Spatial Diffusion Model with Common Factors and an Application to Cigarette Consumption By Carlo Ciccarelli; J. Paul Elhorst
  17. Childhood Trauma Experience and Emotion Management Skills in Predicting General Psychological Health* By Ayse Rezan ÇEÇEN EROÄžUL; Melek BEYHAN MAYDA
  18. Inequalities in Adolescent Health and Life Satisfaction: Evidence from the Health Behaviour in School-aged Children study By Yekaterina Chzhen; Zlata Bruckauf; Kwok Ng; Daria Pavlova; Torbjorn Torsheim; Margarida Gaspar de Matos; UNICEF Innocenti Research Centre
  19. Adolescent Sexual and Reproductive Health in El Salvador By Rafael Cortez; Karin-Annabela Revuelta; Yolanda Guirola

  1. By: Gilad Sorek; Randolph T. Beard
    Abstract: We study the implications of extending public-insurance coverage to an existing medical market in Salop’s spatial model of imperfect competition. In this setup a public insurer sets a price to medical providers, which must maintain their reservation pro.t from selling on the spot market directly to consumers. We show that the public insurer can manipulate this reservation profit by setting the coinsurance rate, and that setting the coinsurance rate properly yields the market first best product diversification. The results survive generalizations including moral hazard and incomplete coverage. When adding quality choice to the analysis, a minimum quality standard that is combined with a proper coinsurance rate can still support market efficiency.
    Keywords: Public-Insurance; Spatial Monopolistic Competition; Market Efficiency; Regulation
    Date: 2016–04
    Date: 2016
  3. By: Tran Huynh Bao Chau (College of Economics, Hue University); Le Thi Quynh Anh (College of Economics, Hue University)
    Keywords: impact, pesticide use, farmer, Vietnam
    Date: 2016–04
  4. By: Anthony Yezer (Department of Economics/Institute for International Economic Policy, George Washington University); Stephen Popick
    Abstract: Some sources of heterogeneity among cities, i.e. age, gender, race, income, and education, have been the object of substantial inquiry. The reasons are obvious. These differences are easily observed and may have important implications for economic activity. This study considers another potentially important population characteristic, obesity. Descriptive statistics reveal that the intercity variance in obesity rates is substantial. Empirical results demonstrate that demographic and regional amenity variables all have a relation to intercity differences in obesity. Because obesity is important for climate preferences, performance, and productivity, its omission from previous studies and its correlation with amenity and demographic characteristics, could create problems for empirical research. For example, it is possible to explain the recent climate preference finding by Sinha and Cropper (2015) that willingness to pay for higher summer temperature is negatively correlated, Ï = − 0.83, with preferences for higher winter temperatures.
    Keywords: Climate preferences, obesity
    JEL: I12 J10 R23
    Date: 2016–05
  5. By: Rokicki, Slawa; Donato, Katherine Elizabeth
    Abstract: Background In 2003, the Chinese government established the New Cooperative Medical Scheme (NCMS) with the goal of improving health for the country’s 800 million mostly uninsured rural residents. Using new data on objective health measures, we analyzed the program’s effectiveness in improving health for enrollees. Methods Using longitudinal data from the China Health and Nutritional Survey from 2000 to 2009 (12 080 observations across four waves), we analyzed the impact of the NCMS on objective measures of health such as blood pressure, HbA1c, and cholesterol, as well as use of preventive care. In order to overcome inherent selection bias where less healthy people are more likely to enroll in the voluntary health insurance scheme, we used intent-to-treat and instrumental variable analysis strategies, and offered evidence that these approaches can mitigate this bias. Results For every additional year of NCMS coverage, the probability of seeking preventive health care increased by 0.6 percentage points (95% CI 0.1-1.0). However, we did not find evidence that the NCMS resulted in consistent improvements in objective measures of health. Sub-group analysis suggested that lower-income communities benefited more from the program, implying that the program may have resulted in some lessening of the wealth-based disparity in health. Conclusions The NCMS does not appear to significantly improve objective measures of health. This is consistent with evaluations of health insurance programs in other countries, but in contrast to some previously reported improvements in self-reported health resulting from the NCMS.
    Date: 2016
  6. By: Heckman, James J. (University of Chicago); Humphries, John Eric (University of Chicago); Veramendi, Gregory (Arizona State University)
    Abstract: This paper estimates returns to education using a dynamic model of educational choice that synthesizes approaches in the structural dynamic discrete choice literature with approaches used in the reduced form treatment effect literature. It is an empirically robust middle ground between the two approaches which estimates economically interpretable and policy-relevant dynamic treatment effects that account for heterogeneity in cognitive and non-cognitive skills and the continuation values of educational choices. Graduating college is not a wise choice for all. Ability bias is a major component of observed educational differentials. For some, there are substantial causal effects of education at all stages of schooling.
    Keywords: education, earnings, health, rates of return, causal effects of education, cognitive skills, non-cognitive skills
    JEL: C32 C38 I12 I14 I21
    Date: 2016–05
  7. By: Kazuaki Sato (Faculty of Economics, Keio University); Yui Ohtsu (National Institute of Population and Social Security Research); Shintaro Kurachi (Graduate School of Economics, Keio University); Leo Shimamura (Faculty of Economics, Keio University); Yasuto Dobashi (Institute of Contemporary British History, King's College London)
    Abstract: This paper explores the relationship between healthcare expenditures and fiscal structures by conducting an international comparison. The difference between a social insurance scheme and a taxation scheme has long been recognized to be a major influence on fiscal resources for medical policies, but it cannot help fully explain the ease of finance. Authors present a comparative analysis of the trend of healthcare expenditures and fiscal structures in the period from 1990 to 2010 in eight countries, namely, Japan, the Netherlands, and France on the one hand (which adopted a social insurance scheme), the U.K., Sweden, Denmark, and Norway on the other (which adopted a taxation scheme). This paper found that healthcare expenditures has increased in centralized countries that have an authority to set insurance premiums or tax rates regardless of population aging.
    Keywords: healthcare expenditure, social insurance scheme, taxation scheme, financial structure, international comparison
    JEL: H51 I13 H77
    Date: 2016–03–30
  8. By: Judith Wooldridge; Beth Stevens; Eileen Ellis; Ian Hill; Kathy Gifford; Bridget Lavin
    Keywords: Covering Kids & Families Evaluation, Sustainability, SCHIP, Medicaid, health
    JEL: I
  9. By: Jacqueline M. Crowley; Alyson Burnett; Caroline Massad Francis; Debra A. Strong
    Abstract: Mathematica is designing and conducting a cross-site evaluation of the Congressionally authorized Regional Partnership Grants (RPG) program, and providing evaluation technical assistance to the partnerships to conduct their own independent evaluations. This report uses early cross-site evaluation data to describe the characteristics of families and children at the time of their enrollment into RPG programs.
    Keywords: children, substance abuse, regional partnership grants, evidence-based, health, child welfare
    JEL: I
  10. By: Lorenzo Moreno; Boyd Gilman; Greg Peterson; Catherine DesRoches; Sheila Hoag; Linda Barterian; Laura Blue; Katharine Bradley; Emily Ehrlich; Kristin Geonnotti; Lauren Hula; Keith Kranker; Rumin Sarwar; Rachel Shapiro; KeriAnn Wells; Joseph Zickafoose; Sandi Nelson; Kate Stewart; Frank Yoon
    Abstract: This report, the second of three planned annual reports, synthesizes findings and draws conclusions from an implementation evaluation; including the clinicians’ experiences with the initiative; and presents preliminary estimates of program impacts by type of target population for 10 PCR programs.
    Keywords: Primary care, CMS, HCIA, Delivery systems, Workforce development, Practice transformation
    JEL: I
  11. By: Brigette Courtot; Ariel Klein; Embry Howell; Sarah Benatar
    Abstract: This report synthesizes descriptions of the outreach efforts supported by the Robert Wood Johnson Foundation (RWJF) Covering Kids & Families® (CKF) program, highlighting the successes and lessons learned from these programs.
    Keywords: Covering Kids & Families Evaluation, outreach, Medicaid, SCHIP, health
    JEL: I
  12. 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.
    JEL: D12 D64 D91 E21 J14
    Date: 2016–05
  13. By: Carlos Dobkin; Amy Finkelstein; Raymond Kluender; Matthew J. Notowidigdo
    Abstract: We examine some economic impacts of hospital admissions using an event study approach in two datasets: survey data from the Health and Retirement Study, and hospital admissions data linked to consumer credit reports. We report estimates of the impact of hospital admissions on out-of-pocket medical spending, unpaid medical bills, bankruptcy, earnings, income (and its components), access to credit, and consumer borrowing. The results point to three primary conclusions: non-elderly adults with health insurance still face considerable exposure to uninsured earnings risk; a large share of the incremental risk exposure for uninsured non-elderly adults is borne by third parties who absorb their unpaid medical bills; the elderly face very little economic risk from adverse health shocks.
    JEL: D14 I10 I13
    Date: 2016–05
  14. By: Valérie Paris; Emily Hewlett; Ane Auraaen; Jan Alexa; Lisa Simon
    Abstract: This paper provides a detailed description of health coverage in OECD countries in 2012. It includes information on the organisation of health coverage (residence-based vs contributory systems), on the range of benefits covered by basic health coverage and on cost-sharing requirements. It also describes policies implemented to ensure universal health coverage –in most countries- and to limit user charges for vulnerable populations or people exposed to high health spending. The paper then describes the role played by voluntary health insurance as a secondary source of coverage. Combining qualitative information collected through a survey of OECD countries on benefits covered and cost-sharing requirements with spending data collected through the system of health accounts for 2012, this paper provides valuable information on health care coverage in OECD countries at a time universal health coverage is high on the policy agenda of many countries. Ce document fournit une description détaillée de la couverture santé dans les pays de l’OCDE en 2012. Il contient des informations sur l’organisation de la couverture santé (selon que les droits sont contributifs ou accordé à tout résident), sur l’étendue des services couverts par le régime de base et sur les contributions aux frais demandés aux usagers. Il décrit également les politiques introduites pour atteindre la couverture universelle- dans la plupart des pays ou pour les limiter les dépenses pour les usagers vulnérables ou exposés à des dépenses élevées. Ce document décrit ensuite le rôle joué par l’assurance privée volontaire en tant que source « secondaire » de couverture santé. Combinant l’information qualitative recueillie sur les services couverts et dépenses laissées à la charge des usagers lors d’une enquête menée auprès des pays de l’OCDE et les données sur les dépenses recueillies à travers les comptes de la santé, ce document fournit une information précieuse sur la couverture santé dans les pays de l’OCDE à un moment où la couverture santé universelle est une priorité politique dans de nombreux pays.
    JEL: I13 I18
    Date: 2016–05–27
  15. By: Ghouse, Ghulam; Zaid, Muhammad
    Abstract: This study investigates the impact of different independent factors on birth weight of infant. The Demographic and Health Survey of Pakistan (PDHS) 2014 data are used for empirical analysis. Binomial Logit Regression is employed for analysis. The analysis revealed the significant relationship of birth weight with mother’s education; Mother’s working status, wealth index of family, gender of child, Place of residence, age of mother at first birth with birth weight of infant. The analysis also revealed that birth-interval, birth order and institutional place of delivery reduce the birth weight children. The male children are more likely to be suffering of low birth weight as compare to female children. As far as mother’s education level, her employment and wealth status increases the risk of low birth weight decreases. It has important policy implications that at least mother’s education should be part of the education policy of Pakistan. The proper medical facilities should be provided at rural areas to decrease the risk of low birth weight and child mortality as well. From the policy perspective the education on birth order and birth interval should be arranged for awareness of parents. For the long-run the socioeconomic status of the household expressed by wealth index is needed.
    Keywords: Birth weight, infant, wealth index, Birth Interval and logistic model
    JEL: I0 I3
    Date: 2016–03–30
  16. By: Carlo Ciccarelli (DEF & CEIS,University of Rome Tor Vergata); J. Paul Elhorst (University of Groningen)
    Abstract: This paper adopts a dynamic spatial panel data model with common factors to explain the non-stationary diffusion process of cigarette consumption across 69 Italian provinces over the period 1877-1913. The Pesaran (2015) CD-test and the exponent a-test of Bailey et al. (2015) are used to show that both weak and strong cross-sectional dependence are important drivers of the propagation of cigarette demand over this period. Stability tests on the coefficients and the CD-test on the residuals of the model are used to verify whether the data and both forms of cross-sectional dependence are modeled adequately. Cigarettes are found to be a normal good with an income elasticity of 0.4 and a price elasticity -0.4 in the long term. The price elasticity can be decomposed into a direct effect of -0.54 in the own region and a spillover effect to other regions of 0.15. This positive spillover effect is in line with previous spatial econometric studies which investigated cigarette demand in the U.S. states over a more recent period.
    Keywords: diffusion, non-stationarity, spatial dependence, common factors, cigarette demand
    JEL: C21 C23 N33 N93 R22
    Date: 2016–05–31
  17. By: Ayse Rezan ÇEÇEN EROÄžUL (MuÄŸla Sıtkı Kocman University); Melek BEYHAN MAYDA (Bakım Okulu ve Eğitim Merkezi Komutanlığı Rehberlik ve DanıÅŸma Müdürlüğü,)
    Abstract: The purpose of this study is to investigate the relationships between general psyhological health and childhood trauma experiences (physical abuse, physical neglect, emotional abuse and emotional neglect), emotion management skills and to examine which variables the best predictor of general psychological health (anxiety, depression, negative self, somatization, hostility). The participants of the study were 188 female (64%) , 108 male (36%) total 296 university students. The age range was from 17 to 27 (M= 20.76; SD= 1.81). To collect data Childhood Trauma Questionnaire-Short Form (Bernstein et al., 2003), Emotion Management Skills Scale (Çeçen, 2006) and Brief Symptom Inventory (Derogatis, 1992) have been applied to the students. After collecting data Pearson Momentum Correlation and Stepwise Regression statistic analysis were applied. The results indicated that there are significant negative moderate and relatively strong correlations between emotion management skills and depression, anxiety, negative self, somatization, hostility and there are significant negative correlations between emotion management and psychological abuse, psychological neglect, physical abuse, physical neglect. In addition, the results have displayed that there are positive significant correlations between psychological abuse, psychological neglect, physical abuse, physical neglect and depression, anxiety, negative self, somatization, hostility (except physical neglect and depression). The stepwise regression analyses indicated that emotion management skills and emotional abuse were the best predictor of depression (30.7 %) , anxiety (28.4%), negative self (33.6%), somatization (19.4%), hostility (23.1% total variance were explained ). *This study is a part of Melek Beyhan Mayda’s master thesis under supervision of Prof. AyÅŸe Rezan Çeçen-Erogul at the Psychological Counseling and Guidance Programme.*This study was supported by Muğla Sıtkı Koçman University BAP.
    Keywords: Childhood trauma experiences, emotion management skills, general psychological health, university students
  18. By: Yekaterina Chzhen; Zlata Bruckauf; Kwok Ng; Daria Pavlova; Torbjorn Torsheim; Margarida Gaspar de Matos; UNICEF Innocenti Research Centre
    Abstract: International studies of inequalities in adolescent health tend to focus on the socio-economic gradient in average outcomes rather than their dispersion within countries. Although understanding the extent to which differences in health are related to socio-economic disadvantage is important, focusing exclusively on socio-economic status risks neglecting differences in the distribution of health outcomes within and between countries. To fill this research gap, this study analyses variation in the extent of inequality in the lower half of the distribution in five indicators of adolescent health and well-being – health symptoms, physical activity, healthy eating, unhealthy eating, and life satisfaction – across EU and/or OECD countries that took part in the latest cycle of the Health Behaviour in School-aged Children study.
    Keywords: adolescent health; household surveys; inequality; physical development;
    Date: 2016
  19. By: Rafael Cortez; Karin-Annabela Revuelta; Yolanda Guirola
    Abstract: The aim of the study is to understand the sexual and reproductive health (SRH) behavior and determinants among adolescents in El Salvador using data from a survey of 1,258 adolescents’ aged 10-19 and 12 interviews with representatives from the Ministry of Health (MOH), Ministry of Education (MOE), nongovernmental organizations (NGOs), and United Nation (UN) agencies. The study found that adolescents were not educated enough on their sexual and reproductive health rights (SRHR), and have limited use of and access to contraceptives. Alcohol and violence were found to be associated with risky sexual behavior, requiring a multisectoral response from the government and civil society. Adolescents need to receive earlier and more accurate information on their SRHR; and this information should be disseminated in a way that empowers adolescents to make responsible decisions about their sexual reproductive health. The MOE can play a vital role in informing adolescents in this area, and adjust these programs when necessary. Further, the role of parents is critical, as the study found that adolescents are not receiving adequate and enough SRHR information from their parents. In addition, the MOH needs to offer adolescent-friendly health services, which includes trained health personnel. Although adolescents stated that the maternal and child health programs offered were satisfactory and the government has made an effort at educating adolescents on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), both the promotion of contraceptive methods and monitoring adolescent SRHR remain as key challenges to be addressed by multisectoral interventions.
    Keywords: pregnant adolescents, use of contraception, sex education, child health, adolescent deaths, risks, social norms, sexually active, reproductive health, sex workers, early ... See More + pregnancy, maternal morbidity, contraception, informed consent, people, peer education, contraceptive knowledge, unsafe abortions, kidney diseases, older adolescents, bisexual, sexual partners, human immunodeficiency virus, prevention, laws, sexual behaviour, intergenerational transmission, morbidity, syphilis, suicide, health education, later adolescence, sexual health, social work, services, health care, sexually transmitted infections, intimate partner, puberty, multiple sexual partners, health, depression, holistic approach, crime, alcohol, first pregnancy, public health, first sexual encounter, births to adolescents, maternal mortality, machismo, knowledge, disabilities, sexually active females, homosexuals, pregnant adolescent, access to health information, pregnancies, abortions, pill, premarital sexual activity, adolescent-friendly health services, boys, mental illness, sexuality, aging, reproductive health education, nurses, adolescent mothers, unmarried adolescents, stis, reproductive rights, violence, gender norms, sexual orientation, immune deficiency syndrome, mortality rate, sexual intercourse, first sex, basic human rights, adolescent fertility, interview, mortality, adolescent boys, social support, health promotion, risky sexual behavior, people with disabilities, adulthood, childbirth, illegal abortions, sexual reproductive health, reproductive health rights, sexual abuse, workers, female adolescents, iuds, contraceptives, adolescence, aged, influenza, social services, population studies, average age, adolescent girls, schools, immunodeficiency, age, births, female behaviour, health outcomes, sexual activity, alcoholics, hepatitis b, victims, female condoms, family planning, adolescent females, youth, decision making, national family health survey, nutrition, adolescents, adolescent pregnancy, masculinity, contraceptive use, sexual encounter, internet, risk factors, sexual behavior, death among adolescents, sex, role in society, weight, human rights, pregnant women, sexual harassment, homosexuality, children, unmarried women, morning after pill, maternal deaths, health for all, contraceptive methods, friendly health services, adolescent, young women, sexual behaviours, infections, young people, sexually active adolescents, onset of puberty, marital status, girls, behaviours, gonorrhea, maternal mortality rate, siblings, families, child health services, sexual violence, married adolescents, pregnancy outcomes, aids, adolescent pregnancies, health services, mental, pregnancy, abortion, alcohol consumption, condoms, adolescent girl
    Date: 2015–06

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