nep-hea New Economics Papers
on Health Economics
Issue of 2016‒07‒02
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Does Competition from Private Surgical Centres Improve Public Hospitals' Performance? Evidence from the English National Health Service By Zack Cooper; Stephen Gibbons; Matthew Skellern
  2. Working-Time Mismatch and Mental Health By Steffen Otterbach; Mark Wooden; Yin King Fok
  3. The Impact of Free GP Care on the Utilisation of GP Services in Ireland: An Evaluation of Different Approaches By Gorecki, Paul
  4. "Cultural Persistence" of Health Capital: Evidence from European Migrants By Joan Costa-Font; Azusa Sato
  5. The Impact of Abortion Legalization on Fertility and Maternal Mortality: New Evidence from Mexico By Clarke, Damian; Mühlrad, Hanna
  6. Age or time-to-death – what drives health care expenditures? Panel data evidence from the OECD countries By Maciej Lis
  7. Implementing the Patient-Centered Medical Home: Remaining Questions and Challenges By David Meyers; Deborah Peikes; Sheila Hanley; Thomas Graf; Pamela Eckardt; Christine Bechtel
  8. Advanced Practice Clinicians and Physicians in Primary Care: Still More Questions than Answers By Eugene C. Rich
  9. Examining Substance Use Disorder Treatment Demand and Provider Capacity in a Changing Health Care System: Initial Findings Report By Ellen Bouchery; Rebecca Morris; Jasmine Little
  10. Alternatives to Inpatient Psychiatric Services for Medicare-Medicaid Enrollees: A Case Study of Commonwealth Care Alliance By Rebecca SweetlLester; James Verdier
  11. Quality Measures for Mental Health and Substance Use: Gaps, Opportunities, and Challenges By Harold Alan Pincus; Sarah Hudson Scholle; Brigitta Spaeth-Rublee; Kimberly A. Hepner; Jonathan Brown
  12. The Impact of Late-Career Job Loss and Genotype on Body Mass Index By Lauren L. Schmitz; Dalton Conley
  13. Graphical analyses of occupation-wise suicide risk in Japan By Ikeda Shin S.
  14. A Comment on "Family Ruptures, Stress, and the Mental Health of the Next Generation" By Bearbaki, Nicolas
  15. Analyzing the Pattern of Smoker in Karachi By Alvi, Mohsin; Naz, Farah; Khan, M. Mubashir Q.; Mirza, Mohammad Haris; Ikram, Midra; Bux, Ameer
  16. Does Indonesian National Health Insurance serve a potential for improving health equity in favour of workers in informal economy? By Kartika, Dwintha Maya
  17. Impact of caregiver incentives on child health: Evidence from an experiment with Anganwadi workers in India By William A. Masters; Prakarsh Singh

  1. By: Zack Cooper; Stephen Gibbons; Matthew Skellern
    Abstract: This paper examines the impact of competition from government-facilitated entry of private, specialty surgical centres on the efficiency and case mix of incumbent public hospitals within the English NHS. We exploit the fact that the government chose the location of these surgical centres (Independent Sector Treatment Centres or ISTCs) based on nearby public hospitals' waiting times - not length of stay or clinical quality - to construct treatment and control groups that are comparable with respect to key outcome variables of interest. Using a difference-in-difference estimation strategy, we find that ISTC entry led to greater efficiency - measured by pre-surgery length of stay for hip and knee replacements - at nearby public hospitals. However, these new entrants took on healthier patients and left incumbent hospitals treating patients who were sicker, and who stayed in hospital longer after surgery.
    Keywords: Hospital Competition, Public-Private Competition, Market Entry, Market Structure, Outsourcing, Hospital Efficiency, Risk Selection, Cherry Picking
    JEL: C23 H57 I11 L1 L33 R12
    Date: 2016–06
  2. By: Steffen Otterbach; Mark Wooden; Yin King Fok
    Abstract: Nationally representative panel survey data for Germany and Australia are used to investigate the impact of working-time mismatches (i.e., differences between actual and desired work hours) on mental health, as measured by the Mental Component Summary Score from the SF-12. Fixed effects and dynamic linear models are estimated, which, together with the longitudinal nature of the data, enable person-specific traits that are time invariant to be controlled for. The incorporation of dynamics also reduces concerns about the potential effects of reverse causation. The results suggest that overemployment (working more hours than desired) has adverse consequences for the mental health of workers in both countries. Underemployment (working fewer hours than desired), however, seems to only be of significance in Australia.
    Keywords: Australia; Germany; mental health; Mental Component Summary Score (SF-12); longitudinal data; work hours; working-time mismatch
    JEL: I12 J22
    Date: 2016
  3. By: Gorecki, Paul
    Abstract: The successful implementation of free GP care for all private patients in Ireland requires an estimate of the likely change in the number of GP visits occasioned by this policy so as: (i) to set the capitation fee; and (ii) to ensure adequate supply of GPs is in place. The paper examines two methodologies to derive such estimates: retrospective patient self-reporting or recall (e.g. Growing Up in Ireland, The Irish Longitudinal Study on Ageing); and, GP practice records. Estimates based on six GP practices by Behan (2013, 2014) substantial overestimate of the likely impact of free GP care. McGovern’s (2015) more recent estimates for the HSE, based on patient recall, used in forecasting future demand for GPs to 2025 also appear to be biased upward. The underlying studies, assumptions and papers are not, however, cited. This should be corrected. A proper debate and discussion can then take place concerning the optimal phasing in of free GP care.
    Date: 2016–06
  4. By: Joan Costa-Font; Azusa Sato
    Abstract: El efecto de la cultural sanitaria sobre la producción de salud, y más concretamente el capital sanitaria, es una cuestión poco estudiada pero de elevada importancia. La salud depende de decisiones individuales que pueden estar altamente motivadas por valores sociales que son específicos del grupo cultural al que pertenece cada individuo. Este trabajo es el primero en analizar empíricamente la persistencia cultural del capital sanitario. Específicamente, en este artículo examinamos la persistencia entre la salud auto reportada del individuo que clasificamos como inmigrante de primera y segunda generación (en treinta países europeos de la muestra), con las salud auto reportada media de sus países de origen (más de 91 países del mundo).
    Date: 2016–06
  5. By: Clarke, Damian (Department of Economics, Universidad de Santiago de Chile); Mühlrad, Hanna (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: We examine the effect of a large-scale, free, elective abortion program implemented in Mexico City in 2007. Prior to this program, all states and districts in Mexico had very limited, or no, access to elective abortion. A localized reform in Mexico City resulted in a sharp increase in the request and use of early term elective abortions: approximately 90,000 abortions were administered by public health providers in the four years following the reform, versus only 62 in the five years preceding the reform. We provide evidence using national vital statistics data from Mexico covering over 23 million births and over 11,000 cases of maternal deaths. Our difference-in-difference estimates suggest that this program resulted in a reduction in births by 2.3 to 3.8% among women aged 15-44 and by 5.1 to 7.1% among teenage women (15-19 year-olds). Similar results are found for maternal mortality, for which we find a sharp fall in the rate of maternal deaths, by 8.8 to 16.2% for women aged 15-44 and by 14.9 to as much as 30.3% among teenagers. All told, the reform appears to increase the average age of women at first birth, and reduce the number of mothers giving birth at higher parities.
    Keywords: Fertility; Maternal Mortality; Abortion legalization; Mexico
    JEL: I15 I18 J13 O15
    Date: 2016–06
  6. By: Maciej Lis
    Abstract: The most important engines for the growth of aggregate health care expenditures (HCE) in last 50 years in OECD have been growth of income, technological progress in medicine and their interaction with institutional setting. The accelerating ageing is expected to additionally fuel the growth of HCE. The interaction between the growth factors with age is crucial for understanding the impact of ageing on health care expenditures. We propose a non-linear framework for testing the dynamics of the interaction of the growth of HCE with age structure. This framework utilizes the micro and cohort evidence from other studies on the shape of HCE and time-to-death. We have found that the growth of health care expenditure in recent decades in 26 OECD was concentrated on the close-to-death expenditures. Close-to-death HCE demonstrated twice higher growth rates than expenditures more distant from death. No clear dynamics of age pattern has been however identified.
    Keywords: health, modelling
    JEL: H51 I12 I18 J14
    Date: 2016–04
  7. By: David Meyers; Deborah Peikes; Sheila Hanley; Thomas Graf; Pamela Eckardt; Christine Bechtel
    Keywords: Patient-Centered Medical Home, CHCE
    JEL: I
  8. By: Eugene C. Rich
    Abstract: This journal article contributes to the growing evidence base on the relationship between primary care physicians and advanced practice clinicians—including nurse practitioners and physician assistants—particularly in terms of care delivery.
    Keywords: nurse practitioner, primary care, physician training, advanced practice clinicians, physician assistant, health policy
    JEL: I
  9. By: Ellen Bouchery; Rebecca Morris; Jasmine Little
    Abstract: This report summarizes the current state of substance use disorder prevalence, treatment, and workforce capacity.
    Keywords: substance use, behavioral health, health policy, opioid, alcohol, treatment, heroin-use
    JEL: I
  10. By: Rebecca SweetlLester; James Verdier
    Keywords: behavioral health, crisis stabilization units, dual eligible
    JEL: I
  11. By: Harold Alan Pincus; Sarah Hudson Scholle; Brigitta Spaeth-Rublee; Kimberly A. Hepner; Jonathan Brown
    Abstract: Following up on its Crossing the Quality Chasm report, in 2006 the Institute of Medicine issued a report that included sweeping recommendations to improve the quality of behavioral health care in the United States.
    Keywords: Mental Health/ Substance Use, Quality Measures, Quality Improvement
    JEL: I
  12. By: Lauren L. Schmitz; Dalton Conley
    Abstract: This study examines whether the effect of job loss on body mass index (BMI) at older ages is moderated by genotype using twenty years of socio-demographic and genome-wide data from the Health and Retirement Study (HRS). To avoid any potential confounding we interact layoffs due to a plant or business closure—a plausibly exogenous environmental exposure—with a polygenic risk score for BMI in a regression-adjusted semiparametric differences-in-differences matching framework that compares the BMI of those before and after an involuntary job loss with a control group that has not been laid off. Results indicate genetically-at-risk workers who lost their job before they were eligible for Social Security benefits, or before age 62, were more likely to gain weight. Further analysis reveals heterogeneous treatment effects by demographic, health, and socioeconomic characteristics. In particular, we find high risk individuals who gained weight after a job loss were more likely to be male, in worse health, single, and at the bottom half of the wealth distribution. Across the board, effects are concentrated among high-risk individuals who were not overweight prior to job loss, indicating unemployment at older ages may trigger weight gain in otherwise healthy or normal weight populations.
    JEL: I1 J63 J69
    Date: 2016–06
  13. By: Ikeda Shin S. (National Graduate Institute for Policy Studies)
    Abstract: I construct data on the numbers of workers and suicide victims in their working ages in Japan from 1980 to 2010 for each of 10 occupation classes and for males and females separately. I document a complex transition of the job profiles of occupation classes, and establish a correspondence between Japanese and international job classifications. Four general characteristics of occupation-wise suicide risk in Japan emerge from graphical analyses of constructed data. First, heterogeneous aging patterns of suicide deaths and numbers of workers create complex aging patterns of suicide rates. Second, the age-adjustment and stabilizations of suicide rates are crucial for an accurate measurement and a fair comparison of suicide risk for workers in each occupation or over the entire economy. Third, the surge of overall suicide risk in Japan since 1998 might be driven by that in few occupations for each gender. Particularly, (a) a high suicide-risk profiles for male workers in agricultural, forestry and fishery and jobless categories has been stable over time, hence not a main culprit of such surge, and (b) less informative patterns of female suicide rates may be a consequence of the cancellations of higher suicide risk in some occupations and lower suicide risk in any other occupations during such surge. Fourth, gender- and occupation-wise pattern of suicide risk is further confounded with heterogeneity across regions.
    Date: 2016–06
  14. By: Bearbaki, Nicolas
    Abstract: Persson and Rossin-Slater (2016b) claim to provide the first causal estimates of the effects of fetal stress exposure on mental health later in life. They emphasize that their analysis is the first to address non-random exposure to a relative’s death and the endogeneity of gestation length to fetal stress. In light of discoveries regarding prior literature, we find these claims to be exaggerated and misleading.
    Keywords: family ruptures, fetal stress exposure
    JEL: I1 I12
    Date: 2016–06–02
  15. By: Alvi, Mohsin; Naz, Farah; Khan, M. Mubashir Q.; Mirza, Mohammad Haris; Ikram, Midra; Bux, Ameer
    Abstract: An attempt was made to know the about the smoking tenure, patterns and quantity of smoking consumption. Smoking is a common behavior among youngsters and it has been increasing day by day due to quick availability of the product. In order to assess smoking patterns the data was collected from different areas of Karachi including educational and non-educational with minimum qualification FA and age from 18 to onward. The self made scale was used to achieve the objective of the study. The sample size was 288, male=260 and female=22 were approached randomly by convenient sampling method. Results indicated that there are on smoking tenure the scores were male (x=2.94, sd=.885) and female (x=1.68, sd=.64) and significant difference was found (t(280)= 6.50, p= .123, F=2.39) but there was no significant difference on number of packets consumed (t(280)= 64.47, p= .801, F=.064). The following results indicate that there is difference in smoking tenures of the sample group but number of packets consumption is much more equal among the identified population.
    Keywords: Smoking Pattern, T-test, Karachi
    JEL: C8 D1 D6 D7 I1 O1
    Date: 2016–02–25
  16. By: Kartika, Dwintha Maya
    Abstract: This study examines whether Indonesian national health insurance system promotes health equity in favour of informal economy workers. It first lays out the theoretical justification on the need of social protection, particularly health protection for informal workers. The paper argues that the absence of health protection for vulnerable informal workers in Indonesia has reinforced health inequity between formal and informal workers, thus provides a justification on extending health protection to this segment. It then boils down its analysis on existing BPJS Health scheme, a government-run national health insurance, and to what extent this scheme serves the needs of informal workers in Indonesia. The finding suggests that several factors (contributory premium, access to healthcare services and politicisation of national healthcare) are responsible for adversely incorporating informal workers; hence fail to promote health equity in favour of vulnerable workers in informal economy.
    Keywords: National Health Insurance; Informal Economy; Universal Health Coverage; Indonesia; Informal workers; Health financing; Social Security; Social Protection; WHO; ILO; BPJS;
    JEL: E26 I1 I13 I14 I15 I18 J46 O17 O29 Y40
    Date: 2015–08
  17. By: William A. Masters; Prakarsh Singh
    Abstract: This paper provides evidence for the effectiveness of performance pay among government caregivers to improve child health in India. In a controlled study of 160 daycare centers serving over 4000 children, we randomly assign workers to receive performance pay or fixed bonuses of roughly similar expected value, and test for differences in malnutrition among the children in their care. We find that performance pay reduces the prevalence of weight-for-age malnutrition by about 5 percentage points in 3 months. This effect is sustained in the medium term with a renewal of incentives but the differential growth rate fades away once the scheme is discontinued. Fixed bonuses lead to smaller-sized effects and only in the medium-term. Both treatments appear to improve worker effort and communication with mothers, who in turn feed a more calorific diet to their children at home.
    Keywords: Performance Pay, Public Health Information, Child Malnutrition
    JEL: O1 I1 M5
    Date: 2016

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