nep-hea New Economics Papers
on Health Economics
Issue of 2016‒07‒09
thirty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. Long-term care social insurance. How to avoid big losses? By Klimaviciute, Justina; Pestieau, Pierre
  2. Estimating a cost-effectiveness threshold for the Spanish NHS By Laura Vallejo-Torres; Borja García-Lorenzo; Pedro Serrano-Aguilar
  3. Health spending slowed down in spite of the crisis By DiMaggio, Marco; Haughwout, Andrew F.; Kermani, Amir; Mazewski, Matthew; Pinkovskiy, Maxim L.
  4. Mind, Behaviour and Health - a Randomised Experiment By Alem, Yonas; Behrendtz, Hannah; Belot, Michele; Bíró, Anikó
  5. What are the Health effects of postponing retirement? An instrumental variable approach By Hagen, Johannes
  6. Does Return Migration Affect Health Outcomes in Macedonia? By Petreski, Marjan
  7. Average willingness to pay for disease prevention with personalized health information By David Crainich; Louis Eeckhoudt
  8. The Intimate Link between Income Levels and Life Expectancy: Global Evidence from 213 Years By Jetter, Michael; Laudage, Sabine; Stadelmann, David
  9. Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India By Azam, Mehtabul
  10. The Causal Effect of Education on Health Behaviors: Evidence from Turkey By Tansel, Aysit; Karaoğlan, Deniz
  11. Parental Unemployment and Child Health in China By Pieters, Janneke; Rawlings, Samantha
  12. Is Childcare Bad for the Mental Health of Grandparents? Evidence from SHARE By Brunello, Giorgio; Rocco, Lorenzo
  13. Socio-economic inequalities in access to maternal and child healthcare in Nigeria: changes over time and decomposition By Oludamilola Adeyanju; Sandy Tubeuf; Tim Ensor
  14. Medicaid Rate-Setting for Managed Long-Term Services and Supports: Basic Practices for Integrated Medicare-Medicaid Programs By Maria Dominiak; Jenna Libersky
  15. Bunching at The Kink: Implications for Spending Responses to Health Insurance Contracts By Liran Einav; Amy Finkelstein; Paul Schrimpf
  16. Moneyball in Medicare By Edward C. Norton; Jun Li; Anup Das; Lena M. Chen
  17. Effects of the Minimum Wage on Infant Health By George Wehby; Dhaval Dave; Robert Kaestner
  18. Genetic Health Risks: The Case for Universal Public Health Insurance By Vicky Barham; Rose Anne Devlin; Olga Milliken
  19. Health inequality in the Russian Federation: An examination of the changes in concentration and achievement indices from 1994 to 2013 By Paul, Pavitra; Valtonen, Hannu
  20. How does the health sector benefit from trade openness? Evidence form panel data across sub-Saharan Africa countries. By Novignon, Jacob; Atakorah, Yaw Boateng
  21. South African Trends in Health Outcomes and Health-Related Behaviour: Evidence from Repeated Cross-Sectional Surveys By Kehinde Omotoso; Steven F. Koch
  22. Can Institutional Deliveries Reduce Newborn Mortality? Evidence from Rwanda By Okeke, Edward N.; Chari, Amalavoyal V.
  23. Determinants of Female Sterilization in Brazil, 2001–2007 By Amaral, Ernesto F. L.; Potter, Joseph E.
  24. Prevalence and Patterns of Health Risk Behaviors of Palestinian Youth: Findings from a Representative Survey By Glick, Peter; Brown, Ryan Andrew; Goutam, Prodyumna; Karam, Rita; Linnemayr, Sebastian; Kammash, Umaiyeh; Shaheen, Mohammed; Massad, Salwa
  25. Health IT and Ambulatory Care Quality By Gresenz, Carole Roan; Miller, Amalia R.; Laughery, Scott P.; Tucker, Catherine E.
  26. Bird Flu, the OIE, and National Regulation: The WTO’s India – Agricultural Products dispute By Chad P. Bown; Jennifer A.
  27. Stress, famine and the fetal programming: The long term effect of WWII in Italy By Vincenzo Atella; Edoardo Di Porto; Joanna Kopinska
  28. Disentangling Adverse Selection, Moral Hazard and Supply Induced Demand: An Empirical Analysis of The Demand For Healthcare Services By Vincenzo Atella; Alberto Holly; Alessandro Mistretta
  29. Patients’ contributions as a quid pro quo for community’s supports? Evidence from Vietnamese co-location clusters By Quan-Hoang Vuong; Ha Nguyen
  30. Increased coverage of maternal health services among the poor in western Uganda in an output-based aid voucher scheme By Obare,Francis; Okwero,Peter; Villegas,Leslie; Mills,Samuel Lantei; Bellows,Ben
  31. Smoking for the poor and vaping for the rich? Distributional concerns of new smoking methods By Carrieri, V.; Jones, A.M.

  1. By: Klimaviciute, Justina; Pestieau, Pierre
    Abstract: Long-term care (LTC) needs are expected to rapidly increase in the next decades and at the same time the main provider of LTC, namely the family is stalling. This calls for more involvement of the state that today covers less than 20% of these needs and most often in an inconsistent way. Besides the need to help the poor dependent, there is a mounting concern in the middle class that a number of dependent people are incurring costs that could force them to sell all their assets. In this paper we study the design of a social insurance that meets this concern. Following Arrow (1963), we suggest a policy that is characterized by complete insurance above a deductible amount.
    Keywords: Arrow's theorem; capped spending; long-term care insurance; optimal taxation
    JEL: H21 I13 J14
    Date: 2016–07
  2. By: Laura Vallejo-Torres; Borja García-Lorenzo; Pedro Serrano-Aguilar
    Abstract: The mean cost of an additional Quality-Adjusted Life Year (QALY) within a National Health Service (NHS) reveals how much health is lost, on average, when services currently provided by the NHS are displaced. This value has been suggested as a proxy of the average opportunity cost required to set a cost-effectiveness threshold when facing fixed budget constraints. In this paper, we generate information on the marginal cost per QALY in the Spanish NHS that can be used to inform a cost-effectiveness threshold using a pannel of quinquennial data for the 17 regional health services.
    Date: 2016–06
  3. By: DiMaggio, Marco (Columbia University); Haughwout, Andrew F. (Federal Reserve Bank of New York); Kermani, Amir (University of California, Berkeley); Mazewski, Matthew (Columbia University); Pinkovskiy, Maxim L. (Federal Reserve Bank of New York)
    Abstract: Since the end of the Great Recession, growth in health care spending has declined to historically low levels. There is disagreement over whether this decline was caused by falling incomes during the Great Recession (and therefore is likely to reverse once the recovery is complete) or whether the decline represents a structural change in the health sector (and therefore is more likely to endure). We exploit plausibly exogenous regulatory changes in the mortgage lending market to estimate causal effects of the financial boom and bust cycle on personal income in the health sector in a panel of U.S. counties. We find that counties that were exogenously more exposed to the financial crisis because of the regulatory reforms experienced a greater rise in the size of the health sector over the course of the boom and bust relative to control counties, with the differential persisting through the recovery. We also provide evidence that both the boom and the bust periods of the financial crisis increased mortality in treated counties compared to control counties.
    Keywords: health spending; Great Recession; anti-predatory lending
    JEL: E3 G28 I11
    Date: 2016–06–01
  4. By: Alem, Yonas (Department of Economics, School of Business, Economics and Law, Göteborg University); Behrendtz, Hannah (Department of Economics, University of Edinburgh); Belot, Michele (Department of Economics, University of Edinburgh); Bíró, Anikó (Department of Economics, University of Edinburgh)
    Abstract: Behavioural attitudes toward risk and time, as well as behavioural biases such as present bias, are thought to be important drivers of unhealthy lifestyle choices. This paper makes the first attempt to explore the possibility of training the mind to alter these attitudes and biases, in particular health-related behaviours, using a randomized controlled experiment. The training technique we consider is a well-known psychological technique called "mindfulness", which is believed to improve self-control and reduce stress. We conduct the experiment with 139 participants, half of whom receive a four-week mindfulness training, while the other half are asked to watch a four-week series of historical documentaries. We evaluate the impact of our interventions on risk-taking and inter-temporal decisions, as well as on a range of measures of health-related behaviours. We find evidence that mindfulness training reduces perceived stress, but only weak evidence of its impact on behavioural traits and health-related behaviours. Our findings have significant implications for a new domain of research on training the mind to alter behavioural traits and biases that play important roles in lifestyle.
    Keywords: Health-related behaviours; Behavioural traits; Present Bias; Stress; Experiment.
    JEL: C81 C91 D81 I10 I12
    Date: 2016–06
  5. By: Hagen, Johannes (Department of economics, Uppsala university)
    Abstract: This essay estimates the causal effect of postponing retirement on a wide range of health outcomes using Swedish administrative data on cause-specific mortality, hospitalizations and drug prescriptions. Exogenous variation in retirement timing comes from a reform which raised the age at which broad categories of Swedish local government workers were entitled to retire with full pension benefits from 63 to 65. Instrumental variable estimation results show no evidence that postponing retirement impacts mortality or health care utilization.
    Keywords: Health; mortality; Health care; pension reform; retirement
    JEL: I18 J22 J26
    Date: 2016–06–15
  6. By: Petreski, Marjan
    Abstract: The objective of the paper is twofold: i) to investigate if living and working abroad has a meaningful role to play for the health of the return migrant; and ii) to understand if there are any spillovers of return-migrant member onto health conditions of the family members left behind. To that end, we use the DoTM Migration Survey 2009, as well a propensity score matching to address selectivity on observables and IV for the selectivity on unobservables. We also pursue interviews to contextualize the return migration – health nexus. Results suggest that when equalized on observables, return migrants have better health than non-migrants. Though, the reverse causality channel (less healthy individuals are more inclined to return) works to attenuate the true effect of return migration on health. Results further suggest a positive spillover effect of return migration on the health of the family members left behind, being mainly driven by the work of remittances sent while abroad, and not the returned wealth or the health knowledge transfer.
    Keywords: return migration, health, Macedonia
    JEL: F22 I19
    Date: 2016–05
  7. By: David Crainich (CNRS-LEM 9221 and IESEG School of Management); Louis Eeckhoudt (IESEG School of Management (LEM 9221-CNRS))
    Abstract: Personal health related information modifies individuals’ willingness to pay for disease programs inasmuch as it allows health status assessment based on intrinsic (instead of average) characteristics. In this paper, we examine the effect that personalized about the baseline probability of disease has on the average willingness to pay programs reducing either the probability of disease (self-protection) or the severity of disease (self-insurance). We show that such an information rises the average willingness to pay for self-protection while it increases the average willingness to pay for self-insurance if health and wealth are complements (i.e. the marginal utility of wealth rises with health).
    Keywords: Personalized health information; disease prevention; willingness to pay
    JEL: D81 I18
    Date: 2016–02
  8. By: Jetter, Michael (University of Western Australia); Laudage, Sabine (University of Bayreuth); Stadelmann, David (University of Bayreuth)
    Abstract: Contrary to previous findings, we find a systematic and economically sizeable relationship between income levels and life expectancy in a panel dataset of 197 countries over 213 years. By itself, GDP/capita explains more than 64 percent of the variation in life expectancy. The Preston curve prevails, even when accounting for country- and time-fixed effects, country-specific time trends, and alternative control variables. Quantile regressions and instrumental variable estimations suggest this link to be persistent across different levels of life expectancy and unaffected by reverse causality. If policymakers want to prolong people's lives, economic growth appears to be the predominant medicine.
    Keywords: historical panel data, income levels, life expectancy, quantile regression analysis
    JEL: I15 I31 J11 H51
    Date: 2016–06
  9. By: Azam, Mehtabul (Oklahoma State University)
    Abstract: Indian government launched the Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance scheme, in 2008 that provides cashless health services to poor households in India. We evaluate the impact of RSBY on RSBY beneficiary households' (average treatment impact on the treated) utilization of health services, per capita out-of-pocket (OOP) expenditure, and per patient OOP expenditures on major morbidities. To address the issue of non-randomness in enrollment into the scheme, we exploit the longitudinal aspect of a large nationally representative household survey data to implement a difference-in-difference with matching. We find some evidence of positive impact of RSBY on utilization of health services by RSBY beneficiary households in rural India but not in urban India. However, there is no evidence that the RSBY reduced per person OOP expenditure for RSBY households in both rural and urban areas. Conditional on having received medical treatment for major morbidity, we find that RSBY increased probability of hospitalization and being treated by a government doctor in rural areas but no significant impact in urban areas. We also find lower expenditure on medicine for a RSBY cardholder patient in rural areas.
    Keywords: SHI, RSBY, IHDS, out-of-pocket expenditure, health services utilization
    JEL: I1 I18 I38
    Date: 2016–06
  10. By: Tansel, Aysit (Middle East Technical University); Karaoğlan, Deniz (Middle East Technical University)
    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
  11. By: Pieters, Janneke (Wageningen University); Rawlings, Samantha (University of Reading)
    Abstract: This paper studies the causal effect of maternal and paternal unemployment on child health in China, analyzing panel data for the period 1997-2004, when the country underwent economic reforms leading to massive layoffs. We find that paternal unemployment reduces child health, while maternal unemployment has beneficial child health impacts. Analysis of channels shows that paternal and maternal unemployment have different effects on income, time use, mothers' blood pressure, and certain health investments, including children's diets. Our results support the notion that traditional gender roles can explain why mothers and fathers' unemployment affect child health so differently.
    Keywords: child health, unemployment, nutrition, China
    JEL: I12 J13 J69 O15
    Date: 2016–06
  12. By: Brunello, Giorgio (University of Padova); Rocco, Lorenzo (University of Padova)
    Abstract: We estimate the causal effects of regular and occasional grandchild care on the depression of grandmothers and grandfathers, using data from the Survey on Health, Ageing and Retirement in Europe and an instrumental variables strategy which exploits the variation in the timing of interviews across individuals and the fact that childcare declines with the age of grandchildren. We find that 10 additional hours of childcare per month, a 31 percent increase with respect to the sample average, increases the probability of developing depressive symptoms by 3.0 to 3.2 percentage points for grandmothers and by 5.4 to 5.9 percentage points for grandfathers. These results suggest that policies that substitute informal with formal childcare can improve the mental wellbeing of grandparents.
    Keywords: childcare, grandparents, depression, Europe
    JEL: J13 I12
    Date: 2016–06
  13. By: Oludamilola Adeyanju (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Sandy Tubeuf (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Tim Ensor (Leeds Institute of Health Sciences, University of Leeds)
    Abstract: This paper examines socio-economic inequalities in maternal and child health care in Nigeria over an 18-year period. Studies demonstrate that maternal and child mortality is much higher amongst the poor in low-income countries, with access to health care concentrated among the wealthiest. Evidence suggests that in Nigeria inequalities in access to quality services continue to persist. We use data from two rounds of the Nigerian Demographic and Heath Survey (NDHS) conducted in 1990 and 2008 and measure inequalities in maternal and child health care variables across socio-economic status using concentration curves and indices. Factors contributing to the inequalities are investigated using decomposition analysis. The results show that in 1990, maternal access to skilled assistance during delivery had the highest levels of inequalities. It reveals that child and maternal health inequalities appear to be determined by different factors and while inequalities in child care have declined, inequalities in maternal care have increased. We discuss the findings in relation to the much greater attention paid to child health programmes. The findings of this study call for specific maternal programmes targeting the poor, less educated and rural areas in Nigeria.
    Keywords: Socio-economic, social inequality, access, health care utilization, child health, maternal health, concentration curve, concentration indices, decomposition
    JEL: I10 I14 I18
    Date: 2016
  14. By: Maria Dominiak; Jenna Libersky
    Abstract: Setting capitation rates for Medicaid managed long-term services and supports (MLTSS) programs is an important challenge for states. This brief summarizes basic approaches to rate-setting and risk mitigation, and presents operational challenges for states to consider in developing their MLTSS rate-setting strategy.
    Keywords: Rate-setting, Medicaid managed care, long-term services and supports, Financial Alignment Demonstrations, dual eligibles
    JEL: I J
  15. By: Liran Einav; Amy Finkelstein; Paul Schrimpf
    Abstract: A large literature in empirical public finance relies on “bunching” to identify a behavioral response to non-linear incentives and to translate this response into an economic object to be used counterfactually. We conduct this type of analysis in the context of prescription drug insurance for the elderly in Medicare Part D, where a kink in the individual’s budget set generates substantial bunching in annual drug expenditure around the famous “donut hole.” We show that different alternative economic models can match the basic bunching pattern, but have very different quantitative implications for the counterfactual spending response to alternative insurance contracts. These findings illustrate the importance of modeling choices in mapping a compelling reduced form pattern into an economic object of interest.
    JEL: D12 G22
    Date: 2016–06
  16. By: Edward C. Norton; Jun Li; Anup Das; Lena M. Chen
    Abstract: US policymakers place a high priority on tying Medicare payments to the value of care delivered. A critical part of this effort is the Hospital Value-based Purchasing Program (HVBP), which rewards or penalizes hospitals based on their quality and episode-based costs of care. Within HVBP, each patient affects hospital performance on a variety of quality and spending measures, and performance translates directly to changes in program points and ultimately dollars. In short, hospital revenue from a patient consists not only of the DRG payment, but also consists of that patient’s marginal future reimbursement. We estimate the magnitude of the marginal future reimbursement for individual patients across each type of quality and performance measure. We describe how those incentives differ across hospitals, including integrated and safety-net hospitals. We find some evidence that hospitals improved their performance over time in the areas where they have the highest marginal incentives to improve care.
    JEL: I11 I13 I18
    Date: 2016–06
  17. By: George Wehby; Dhaval Dave; Robert Kaestner
    Abstract: The minimum wage has increased in multiple states over the past three decades. Research has focused on effects on labor supply, but very little is known about how the minimum wage affects health, including children’s health. We address this knowledge gap and provide an investigation focused on examining the impact of the effective state minimum wage rate on infant health. Using data on the entire universe of births in the US over 25 years, we find that an increase in the minimum wage is associated with an increase in birth weight driven by increased gestational length and fetal growth rate. The effect size is meaningful and plausible. We also find evidence of an increase in prenatal care use and a decline in smoking during pregnancy, which are some channels through which minimum wage can affect infant health.
    JEL: I1 I3 J2 J3
    Date: 2016–06
  18. By: Vicky Barham (Department of Economics, University of Ottawa, Ottawa, ON); Rose Anne Devlin (Department of Economics, University of Ottawa, Ottawa, ON); Olga Milliken (Department of Economics, University of Ottawa, Ottawa, ON)
    Abstract: This paper examines the role of the public sector in providing genetic insurance and health care when health risks are genetically determined at conception. We characterize the ex ante efficient outcome (where individuals are placed behind the veil of ignorance), and demonstrate that this outcome cannot be achieved by private health insurance markets or by a government which cannot commit to a once-and-for-all transfer policy. In contrast, the desired outcome can be attained through public provision of universal health (genetic) insurance and of genetic testing, coupled with a public pension scheme.
    Keywords: Public health insurance; Genetic insurance; Genetic testing; Ex ante efficiency; Time inconsistent policy
    JEL: H51 I18 G22
    Date: 2016
  19. By: Paul, Pavitra; Valtonen, Hannu
    Abstract: Background: To assess and quantify the magnitude of health inequalities ascribed to socioeconomic strata from 1994 to 2013 in the Russian Federation. Methods: A balanced sample of 1,496 adult individuals extracted from the 1994 wave of the Russian Longitudinal Monitoring Survey (RLMS) is followed for stated self-perceived health status until 2013. The socioeconomic strata (SES) index is constructed with a set of variables (adult equivalent household income, ownership of assets and living conditions) by applying principal component analysis (PCA). We use a regression-based concentration index to measure differences in self-perceived health status. Finally, we examine the degree of aversion to inequalities in self-perceived health status between the worse-off and the better-off with the achievement index. Results: By 2013, the mean standardized self-perceived health status has improved by 4.6 % compared to 1994. The absolute size of Concentration Index (CI) for non - standardized self-perceived health status is reduced by 44.27 % from 1994 to 2013. No systematic trend emerges in the evolution of CI for self-perceived health status of the Russians over the 19 year period. However, avoidable inequalities in self-perceived health status of the Russian population is reduced by almost 60 % over the two decades (1994–2013). Conclusion: SES, as defined with objective indicators, shows little consistency in association with self-perceived health status in the Russian Federation. This study highlights the need for future research that considers the context of stated self-perceived health status in the realm of subjective socioeconomic status (SSS).
    Keywords: Achievement, Aversion, Concentration, Distributionally-sensitive, Health inequalities, Positive-externality, Self-perceived, Subjective socioeconomic status, Russia.
    JEL: I14
    Date: 2015–08–13
  20. By: Novignon, Jacob; Atakorah, Yaw Boateng
    Abstract: The linkages between international trade integration and economic performance has received significant attention from both policy makers and researchers. There seem to be consensus in the literature to suggest that improved trade openness corresponds to improved economic growth. A missing link in the literature is how trade openness affects specific sectors of the economy. Here we argue that trade openness has significant impact on population health and health financing. The study employed panel data for forty-two (42) Sub-Saharan African (SSA) countries over the period 1995-2013. Population health status was measured by total life expectancy at birth, infant mortality rate and under-five mortality rate. Three main estimation procedures were used; (i) Fixed effect (FE), (ii) Random Effect (RE) and (iii) the Generalized Method of Moments (GMM) models were employed in estimating the relationships. The results showed a positive and significant relationship between trade openness and life expectancy, negative and significant relationship between trade openness and infant mortality rate and negative relationship between trade openness and under-five mortality rate. A positive relationship between trade openness and health financing. The findings of the study support international trade integration across countries in SSA and emphasizes the need for countries to be conscious of gains from trade within sub-sectors of the economy.
    Keywords: International trade, health status, health financing, SSA
    JEL: E0 F1 I1
    Date: 2016–06–28
  21. By: Kehinde Omotoso (Department of Economics, University of Pretoria); Steven F. Koch (Department of Economics, University of Pretoria)
    Abstract: This study examines trends in ill-health status, medical aid coverage and public health care facility utilisation across a spectrum of socio-demographic variables, using population- weighted General Household Surveys (GHS) covering the years 2004-2014. As there are few obvious patterns in the raw health variables' time series, the analysis, which is descriptive in nature, relies upon both parametric and nonparametric analysis to smooth the time series in order to outline a few general trends. Over time, medical aid coverage and the general population's `preference' for public health care decreased by 0.2% and 0.1% per year, respectively, while reports of ill-health status increased by 0.4% annually. Moreover, the probability that an individual, who is covered by a medical aid scheme, would utilize public health care decreased by 44%.
    Date: 2016–06
  22. By: Okeke, Edward N.; Chari, Amalavoyal V.
    Abstract: Current global health policies emphasize institutional deliveries as a pathway to achieving reductions in newborn mortality in developing countries. There is however remarkably little evidence regarding a causal relationship between institutional deliveries and newborn mortality. In this paper we take advantage of a shock to institutional deliveries provided by the randomized rollout of a government performance-based financing (PBF) program in Rwanda, to provide the first estimates of this causal effect. Using a combination of difference-in-differences and regression discontinuity approaches, we find that program-induced increases in the rate of institutional delivery have not been successful in reducing the rate of newborn mortality. The findings suggest that attempts to increase institutional deliveries without addressing supply-side constraints are unlikely to result in the large reductions in mortality that policy makers expect.
    Keywords: health production, infant mortality, institutional births
    JEL: C93 D01 D03 I12
    Date: 2014–12
  23. By: Amaral, Ernesto F. L.; Potter, Joseph E.
    Abstract: This study aims to investigate the determinants of female sterilization in Brazil. The analysis is innovative because it adds the time of exposure to the risk of sterilization into survival models. The models control for postpartum duration, age at delivery, parity at delivery, place of delivery, region of residence at the time of interview, color/race, and years of schooling at the time of interview. Data is from the 2006 Brazilian National Survey on Demography and Health of Children and Women (PNDS). The strongest probability that sterilization might occur was observed among women who gave birth at private hospitals and received support from health insurance companies at childbirth. The findings suggest years of schooling do not predict the risk of sterilization. The higher chances of getting sterilized among black women are specific to the public sector at higher-order postpartum duration (interval sterilization).
    Keywords: contraceptive agents, female, sterilization, reproductive health, Brazil
    Date: 2015–02
  24. By: Glick, Peter; Brown, Ryan Andrew; Goutam, Prodyumna; Karam, Rita; Linnemayr, Sebastian; Kammash, Umaiyeh; Shaheen, Mohammed; Massad, Salwa
    Abstract: Very little is known about youth health risk behaviors such as drug and alcohol use and sexual activity in the Middle East and North Africa, and in the Occupied Palestinian Territories specifically. This lack of information, together with a lack of open discussion of these topics, leaves public health authorities in the region unprepared to deal with emerging public health threats at a time when major social and economic changes are increasing the risks that young men and women face. The Palestinian Youth Health Risk Study was designed to address these gaps in knowledge. It is the first in the region to collect large scale, representative survey data from youth on key risk behaviors (smoking, alcohol and drug use, and sexual activity as well as interpersonal violence). The study investigates the prevalence and patterns of these risk behaviors as well as of mental health, perceptions of the risks of such behaviors, and the factors increasing vulnerability to as well as protection from engagement in them.
    Date: 2015–12
  25. By: Gresenz, Carole Roan; Miller, Amalia R.; Laughery, Scott P.; Tucker, Catherine E.
    Abstract: US government investments in health information technology (IT) have focused on giving incentives for digital health records in hospital settings and by individual physicians. We evaluate the omission of ambulatory care centers, by studying the effects of healthcare IT on ambulatory care quality, which we measure using the rate of hospital admissions for conditions identified as sensitive to ambulatory care quality, using data from Medicare and the Nationwide Inpatient Sample. Results from difference-indifferences models that control for location and time fixed effects, as well as observable factors related to healthcare quality and population demographics, indicate that increased ambulatory IT adoption lowers local area ambulatory care sensitive (ACS) hospitalizations, suggesting quality improvements. The magnitudes imply that a 45% increase in ambulator IT adoption in a county (the average increase over our sample period 2003-2012) lowers the ACS admission rate in that county by about 1.6%.
    Date: 2015–11
  26. By: Chad P. Bown; Jennifer A.
    Abstract: This paper provides a legal-economic assessment of issues arising in the Panel Report over the WTO’s India – Agricultural Products dispute, one of a growing list of disputes arising at the intersection of the WTO and domestic regulatory policy over human, animal or plant health. This dispute featured allegations that India’s import measures applied against avian influenza (AI) infected countries over poultry and related products were too restrictive, in light of the World Organisation for Animal Health’s (OIE’s) scientifically-motivated standards and guidelines. We rely on insights from a set of economic models of commercial poultry markets in the presence of negative externalities such as AI. We use such models to motivate critical tradeoffs arising at the intersection of government regulatory regimes designed to deal with AI, and how they fit alongside trade agreements such as the WTO and standard-setting bodies such as the OIE, which combine to impose constraints on regulatory and trade policy. While we find the institutional design of the OIE to be well-motivated and we are in broad agreement with the overall thrust of the Panel Report in the dispute, we also highlight a number of subtle issues which pose long-term challenges for the multilateral trading system’s ability to balance trade rules with public health concerns.
    Keywords: WTO, dispute settlement, bird flu, OIE, health regulation, avian influenza
    JEL: F13
    Date: 2015–10
  27. By: Vincenzo Atella (CEIS,University of Rome "Tor Vergata"); Edoardo Di Porto (University of Naples Federico II, CSEF and UCFS Uppsala University); Joanna Kopinska (CEIS, University of Rome "Tor Vergata")
    Abstract: This paper analyses the effect of in utero and at birth exposure to WWII intensity on long-run health and economic outcomes. We link individual clinical electronic records collected by General Practitioners (GPs) for a large sample of Italian adults with detailed information on the intensity of exposure to WWII con ict, disaggregated by month and province of birth. Under weak assumptions, which we discuss and test carefully, our analysis provides a lower bound of the long-run causal effect of WWII intensity on adult health. We show that individuals exposed to intense WWII con icts while in utero are more likely to present health problems In particular, we find that early life stress caused by the war increases the probability of Dislipidemia and Depression, while famine increases the probability of Diabetes and Obesity. We find that these effects are heterogeneous across the trimester of exposure during pregnancy and across moments of outcome realisation later in life.
    Keywords: War exposure; Stress; Famine; Fetal programming; Charlson Index; Chronic diseases; Health expenditure; Italy.
    JEL: D14 I13 G11
    Date: 2016–06–23
  28. By: Vincenzo Atella (CEIS,University of Rome "Tor Vergata"); Alberto Holly (IEMS University of Lausanne, Universidade Nova de Lisboa, Lisbon,); Alessandro Mistretta (Bank of Italy and Università di Roma Tor Vergata.)
    Abstract: In the healthcare sector, Adverse Selection (AS), Moral Hazard (MH) and Supply Induced Demand (SID) are three very important phenomena that affect patients' behaviour. Despite there exists a vast theoretical and empirical literature on these phenomena, so far, no contribution has been able to approach them jointly. This is mostly due to the difficulty to model the joint determinants of health service utilisation and health insurance choice by means of a tractable structural simultaneous equation model. In this paper, we provide a solution to this problem and estimate a simultaneous four equation structural model with four latent variables, where the first two equations are meant to deal with the adverse selection issue, while the third and fourth equation deal with moral hazard and SID issues. A closed form solution for the likelihood function - which guarantees an exact solution - is maximised by the means of FIML, using a large cross-sectional dataset from the Italian healthcare system. Empirical analysis has confirmed the theoretical predictions of our structural model. In particular, we find evidence of AS in the choice of private insurance and SID, but do not find MH behaviour on the patient side. These results are extremely important from a health policy perspective, given the existing debate on the development of a second pillar in the financing of the healthcare system in Italy and Europe.
    Keywords: Quadrivariate probit, FIML, Supply induced demand, Moral hazard, Adverse selection, Health insurance.
    JEL: I13 I11 D82 C35
    Date: 2016–06–28
  29. By: Quan-Hoang Vuong; Ha Nguyen
    Abstract: This paper studies the emerging societal phenomenon of voluntarily co-located patients communities, by examining a data set containing 336 responses from four such co-location clusters in Hanoi, Vietnam. The analysis successfully models the data employing the baseline category logits framework. The results obtained from the analysis show that patients co-living in these clusters contribute their resources (financial and in-kind) in hope of community's supports during their medical treatments. They also contribute voluntary services and share information/experiences with the community, with different beliefs on expected outcome with respect to their possible benefits provided by their communities. Patients value the business community's supports––a reflection of better awareness of corporate social responsibilities––higher, and are more skeptical toward expected benefits from the public health system. The results represent one of first attempts in understanding this special type of somewhat isolated circles of desperate patients who have been excluded from Vietnam's fast-growing emerging market economy.
    Keywords: Health behavior; co-located patients community
    JEL: I12 I19
    Date: 2016–06–22
  30. By: Obare,Francis; Okwero,Peter; Villegas,Leslie; Mills,Samuel Lantei; Bellows,Ben
    Abstract: Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities? claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.
    Keywords: Gender and Health,Health Systems Development&Reform,Health Monitoring&Evaluation,Population Policies,Housing&Human Habitats
    Date: 2016–06–20
  31. By: Carrieri, V.; Jones, A.M.
    Abstract: We compare income-related inequalities in the use of traditional and of new smoking methods (e-cigarettes and other nicotine delivery products (NPD)) and we apply a regression-based decomposition method for rank- dependent inequality measures to estimate the source of inequalities in the new smoking methods. Using data from the 2013 wave of the Health Survey for England, we find that taking into account the new smoking methods reduces the extent of pro-poor inequalities in smoking. Significant pro-rich inequalities are found in ecig and NDP consumption due to higher take-up among richer, younger and better-educated smokers. These patterns might lead to a long-run equilibrium with higher average health and higher socioeconomic health inequalities.
    Keywords: smoking; income-related health inequalities; electronic-cigarettes;
    JEL: I12 I14
    Date: 2016–06

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