nep-hea New Economics Papers
on Health Economics
Issue of 2016‒06‒25
twelve papers chosen by
Yong Yin
SUNY at Buffalo

  1. Is There a Doctor on Board? Collecting Generalizable Data on Doctoral Candidates in Germany By Anna Fräßdorf; Mathis Fräßdorf
  2. The Fatal Consequences of Grief By Bernhard Schmidpeter
  3. Analysis on Demand and Supply-side Responses during the Expansion of Health Insurance Coverage in Vietnam: Challenges and Policy Implications toward Universal Health Coverage By Midori Matsushima; Hiroyuki Yamada; Yasuharu Shimamura
  4. Immunizing networks by targeting collective influencers at a mesoscopic level By Teruyoshi Kobayashi; Naoki Masuda
  5. The Causal Effects of Education on Health Behaviors: Evidence from Turkey By Aysit Tansel; Deniz Karaoğlan
  6. Behavioral Health Integration in Primary Care: A Review and Implications for Payment Reform By Kara Zivin; Ann O'Malley; JudyAnn Bigby; Jonathan Brown; Eugene Rich
  7. Insurance and the High Prices of Pharmaceuticals By David Besanko; David Dranove; Craig Garthwaite
  8. Putting Prevention of Childhood Stunting into the Forefront of the Nutrition Agenda: A Nutrition Sector Review By Herrin, Alejandro N.
  9. Eudaimonic happiness as a leading health indicator By Bachelet, Maria; Becchetti, Leonardo; Pisani, Fabio
  10. Are Children Rational Decision Makers when they are Asked to Value their own Health? A Contingent Valuation Study Conducted with Children and their Parents By Carla Guerriero; John Cairns; Fabrizio Bianchi; Liliana Cori
  11. Estimating the membership function of the fuzzy willingness-to-pay/accept for health via Bayesian modelling By Michal Jakubczyk
  12. Medical expenses matter most for the poor: evidence from Vietnam By Quan-Hoang Vuong; Ha Nguyen

  1. By: Anna Fräßdorf; Mathis Fräßdorf
    Abstract: Despite of its relevance for science policy and the scientific community, empirical research on doctoral education in Germany is sparse. The few papers available face challenges in the sampling approach: simple random sampling is not possible, because a universal register of PhD candidates in Germany does not exist yet. This article focuses on the issues related to possible data collections for the purpose of research with respect to PhD candidates in Germany. We first outline which official information on doctoral candidates is currently available. We then give an overview of the main German survey studies on doctoral candidates with a focus on their respective sampling strategies. Finally, we discuss the three approaches which conceivably enable researchers to conduct statistical inference on the population of doctoral candidates in Germany: sampling via stratified clusters based on universities or faculties, sampling based on a screening approach, and respondent driven sampling.
    Keywords: Doctoral education, science policy, PhD candidates, sampling, data collection
    JEL: C83 I23
    Date: 2016
  2. By: Bernhard Schmidpeter
    Abstract: In this paper we investigate the effect of stress on the survival probability using a child’s death as the triggering event. Employing a propensity score weighted Kaplan-Meier estimator, we are able to explore the associated time pattern of grief without imposing assumptions on the underlying duration process. We find a non-monotonic relationship between time and relative survival rates: decreasing for 13 years after the event and slowly reversing afterward. However, even 19 years after the event bereaved parents have significantly lower survival probabilities compared to the hypothetical case, that the event had not occurred. Investigating the main reason for this development, our results indicate that bereaved parents have a higher probability of dying from natural causes, especially circulatory diseases. Interestingly, our results reveal that bereavement has a stronger impact on fathers, while we find only modest evidence for mothers. This is a novel and surprising finding as males are in general regarded as more stress resilient than females. However, this research shows that this perception is not true.
    Keywords: Bereavement, Child death, Death, Adjusted Kaplan Meier
    JEL: I12 J14 C41
    Date: 2015–09
  3. By: Midori Matsushima (Faculty of Business Administration, Osaka University of Commerce); Hiroyuki Yamada (Faculty of Economics, Keio University); Yasuharu Shimamura (Graduate School of International Cooperation Studies, Kobe University)
    Abstract: Vietnam is one of the leading countries moving towards universal health coverage (UHC) among developing and emerging countries. This paper examines how utilisation and the supply side have responded to the expansion of health insurance coverage. In the analysis, we use provincial panel data of 2006 to 2012 for every two years, which is constructed from several data sources. The results show that the utilisation has only slightly responded to the expansion of health insurance coverage, and nearly no positive supply-side response has been observed during the expansion. Also, the results of detailed analysis of health workers imply that there has been an unbalanced allocation of health workers between provincial hospitals and commune health stations despite the importance of commune health stations in providing primary healthcare. Our further analysis also reveals that the out-of-pocket (OOP) burden has not decreased and the affordability of healthcare services has not changed in response to health insurance coverage. Based on our findings, we argue that supply-side factors might have constrained utilisation, and that health insurance has hardly eased liquidity constraints.
    Keywords: universal health coverage, Vietnam, utilisation, supply
    JEL: I13 I18
    Date: 2016–05–23
  4. By: Teruyoshi Kobayashi (Graduate School of Economics, Kobe University); Naoki Masuda (Graduate School of Economics, Kobe University)
    Abstract: A practical approach to protecting networks against epidemic processes such as spreading of infectious diseases, malware, and harmful viral information is to remove some influential nodes beforehand to fragment the network into small components. Because determining the optimal order to remove nodes is a computationally hard problem, various approximate algorithms have been proposed to efficiently fragment networks by sequential node removal. Morone and Makse proposed an algorithm employing the non-backtracking matrix of given networks, which outperforms various existing algorithms. In fact, many empirical networks have community structure, compromising the assumption of local tree-like structure on which the original algorithm is based. We develop an immunization algorithm by synergistically combining the Morone-Makse algorithm and coarse graining of the network in which we regard a community as a supernode. In this way, we aim to identify nodes that connect different communities at a reasonable computational cost. The proposed algorithm works more efficiently than the Morone-Makse and other algorithms on networks with community structure.
    Date: 2016–06
  5. By: Aysit Tansel (Department of Economics, METU; Institute for the Study of Labor (IZA) Bonn, Germany; Economic Research Forum (ERF) Cairo, Egypt); Deniz Karaoğlan (Visiting Scholar, Department of Economics, METU)
    Abstract: This study provides causal effect of education on health behaviors in Turkey which is a middle income developing country. Health Survey of the Turkish Statistical Institute for the years 2008, 2010 and 2012 are used. The health behaviors considered are smoking, alcohol consumption, fruit and vegetable consumption, exercising and one health outcome namely, the body mass index (BMI). We examine the causal effect of education on these health behaviors and the BMI Instrumental variable approach is used in order to address the endogeneity of education to health behaviors. Educational expansion of the early 1960s is used as the source of exogenous variation in years of schooling. Our main findings are as follows. Education does not significantly affect the probability of smoking or exercising. The higher the education level the higher the probability of alcohol consumption and the probability of fruit and vegetable consumption. Higher levels of education lead to higher BMI levels. This study provides a baseline for further research on the various aspects of health behaviors in Turkey.
    Keywords: Turkey, Health Behaviors, Education, Instrumental Variable Estimation
    JEL: I10 I12 I19
    Date: 2016–06
  6. By: Kara Zivin; Ann O'Malley; JudyAnn Bigby; Jonathan Brown; Eugene Rich
    Abstract: This issue brief describes why behavioral health integration in primary care is so important in terms of improving care quality and reducing costs.
    Keywords: primary care, behavioral health, payment reform, AHRQ, MACRA, MIPS, CMS
    JEL: I
  7. By: David Besanko; David Dranove; Craig Garthwaite
    Abstract: We present a model in which prospective patients are liquidity constrained, and thus health insurance allows patients access to treatments and services that they otherwise would have been unable to afford. Consistent with large expansions of insurance in the U.S. (e.g., the Affordable Care Act), we assume that policies expand the set of services that must be covered by insurance. We show that the profit-maximizing price for an innovative treatment is greater in the presence of health insurance than it would be for an uninsured population. We also show that consumer surplus is less than it would be if the innovation was not covered. These results show that even in the absence of moral hazard, there are channels through which insurance can negatively affect consumer welfare. Our model also provides an economic rationale for the claim that pharmaceutical firms set prices that exceed the value their products create. We empirically examine our model's predictions by studying the pricing of oncology drugs following the 2003 passage of Medicare Part D. Prior to 2003, drugs covered under Medicare Part B had higher prices than those that would eventually be covered under Part D. In general, the trends in pricing across these categories were similar. However, after 2003 there was a far greater increase in prices for products covered under Part D, and as result, products covered by both programs were sold at similar prices. In addition, these prices were quite high compared to the value created by the products---suggesting that the forced bundle of Part D might have allowed firms to capture more value than their products created.
    JEL: H0 H51 I0 I1 I11 L1 L13
    Date: 2016–06
  8. By: Herrin, Alejandro N.
    Abstract: In 2015, based on the latest survey of the Food Nutrition Research Institute, childhood stunting affected one-third (33%) of children under five years. This is equivalent to 3.78 million children in 2015. Moreover, there has been little progress in reducing stunting prevalence in the last 20 years. The strategic importance of stunting prevention cannot be overemphasized in view of its short- and long-term consequences on health, learning, and economic productivity, and the short period of time that it can be effectively prevented (the first 1000 days from conception to age 2 years). Moreover, cost-effective interventions to address the situation are known and regularly updated. Assessments of specific nutrition projects have uncovered various implementation issues of targeting, coordination, management structures, logistics, and sustainability. On the other hand, recent sector-level assessment has uncovered a number of structural issues of governance--local mobilization to implement nutrition program; limited resources for nutrition; and organizational--effective coordination by the National Nutrition Council National Secretariat in a devolved set-up. Responding to these structural issues requires a new approach to address them. An approach suggested in the paper is to take advantage of existing opportunities offered, first, by the increasing global interest in child stunting, and second, by the existing platforms for identifying the poor and for delivering and financing health services. The paper outlines an approach for consideration and discussion.
    Keywords: Philippines, health service delivery, childhood stunting, maternal and child care, micronutrients
    Date: 2016
  9. By: Bachelet, Maria (Associazione Italiana per la Cultura della Cooperazione e del Non Profit); Becchetti, Leonardo (Associazione Italiana per la Cultura della Cooperazione e del Non Profit); Pisani, Fabio (Associazione Italiana per la Cultura della Cooperazione e del Non Profit)
    Abstract: Eudaimonic happiness (measured in terms of sense of life) is a relatively unexplored subjective wellbeing indicator. The empirical findings presented in this paper show that it has a significant and quantitatively remarkable correlation with the future insurgence of some chronic diseases and the reduction of most functionalities in the ageing population. These results document that eudaimonic happiness is a relevant leading indicator of future health outcomes and expenditure and that its impact is independent from that of the traditional life satisfaction measure.
    Keywords: eudaimonic satisfaction; health outcomes; functionalities; life satisfaction
    JEL: I12 I31
    Date: 2016–06–14
  10. By: Carla Guerriero (Università di Napoli Federico II and CSEF); John Cairns (London School of Hygiene and Tropical Medicine); Fabrizio Bianchi (IFC CNR Pisa); Liliana Cori (IFC CNR Pisa)
    Abstract: Despite the importance of including children’s preferences in the valuation of their own health benefits no study investigated the ability of children to understand willingness to pay questions. Using a contingent valuation study we elicit children’s and parents’ willingness to pay (WTP) to reduce children’s risk of an asthma attack. Our results suggest that children are able to understand and value their own health risk reductions and their ability to do so improves with age. Child age was found to be inversely related to parents’ and children’s WTP. The results also suggest that non-paternal altruism is predictive of children’s WTP. For parents, care for their own-health, was found to be inversely related with their WTP for children’s risk reductions. Comparison of parents’ vs. children WTP suggest that parents are willing to sacrifice for their child’s health risk reduction an amount that is approximately twice the size of their children. The analysis of matched pairs of parents and children suggest that there are within-household similarities as the child’s WTP is positively related to parents’ WTP.
    Keywords: willingness to pay, contingent valuation, children’s preferences, children’s rationality
    Date: 2016–06–18
  11. By: Michal Jakubczyk
    Abstract: Determining how to trade off individual criteria is often not obvious, especially when attributes of very different nature are juxtaposed, e.g. health and money. The difficulty stems both from the lack of adequate market experience and strong ethical component when valuing some goods, resulting in inherently imprecise preferences. Fuzzy sets can be used to model willingness-to-pay/accept (WTP/WTA), so as to quantify this imprecision and support the decision making process. The preferences need then to be estimated based on available data. In the paper I show how to estimate the membership function of fuzzy WTP/WTA, when decision makers’ preferences are collected via survey with Likert-based questions. I apply the proposed methodology to an exemplary data set on WTP/WTA for health. The mathematical model contains two elements: the parametric representation of the membership function and the mathematical model how it is translated into Likert options. The model parameters are estimated in a Bayesian approach using Markov-chain Monte Carlo. The results suggest a slight WTPWTA disparity and WTA being more fuzzy as WTP. The model is fragile to single respondents with lexicographic preferences, i.e. not willing to accept any trade-offs between health and money.
    Keywords: willingness-to-pay/accept, fuzzy set, membership function, preference elicitation
    JEL: J17 C11 C13 D71
    Date: 2016–04
  12. By: Quan-Hoang Vuong; Ha Nguyen
    Abstract: Introduction: Less developed countries, Vietnam included, face serious challenges of inefficient diagnosis, inaccessibility to healthcare facilities, and high medical expenses. Information on medical costs, technical and professional capabilities of healthcare providers and service deliveries becomes influential when it comes to patients' decision on choices of healthcare providers.Methods: The study employs a data set containing 1,459 observations collected from a survey on Vietnamese patients in late 2015. The standard categorical data analysis is performed to provide statistical results, yielding insights from the empirical data.Results: Patients' socio-economic status (SES) is found to be associated with the degree of significance of key factors (i.e. medical costs, professional capabilities and service deliveries), but medical expenses are the single most important factor that influence a decision by the poor, 2.28 times as critical as the non-poor. In contrary, the non-poor tend to value technical capabilities and services more, with odds ratios being 1.54 and 1.32, respectively.Discussion: There exists a risk for the poor in decision making based on medical expenses solely. The solution may rest with: a) improved health insurance mechanism; and, b) obtaining additional revenues from value-added services, which can help defray the poor's financial burdens.
    Keywords: Medical expenses; Healthcare information; Healthcare policy; Patients' socio-economic status; Sociology of patients
    JEL: I12 Z13
    Date: 2016–06–17

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