nep-hea New Economics Papers
on Health Economics
Issue of 2016‒07‒23
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Paying for primary care: The relationship between payment for primary care physicians and selection of patients based on case-mix By David Rudoler; Raisa Deber; Adrian Rohit Dass; Janet Barnsley; Richard Glazier; Audrey Laporte
  2. Life Cycle Responses to Health Insurance Status By Florian PELGRIN; Pascal ST-AMOUR
  3. The Impact of Abortion Legalization on Fertility and Maternal Mortality: New Evidence from Mexico By Damian Clarke; Hanna Mühlrad
  4. Timely publication and sharing of trial data: opportunities and challenges for comparative effectiveness research in cardiovascular disease By Huseyin Naci; Jacob Cooper; Elias Mossialos
  5. Regional Health Care Decentralization in Unitary States: Equal Spending, Equal Satisfaction? By Joan Costa-Font; Gilberto Turati
  6. Challenges in Achieving Universal Healthcare in Ireland By Wren, Maev-Ann; Connolly, Sheelah
  7. A continuous-time stochastic model for the mortality surface of multiple populations By Peter Jevtic; Luca Regis
  8. San Diego: Major Providers Pursue Countywide Networks and New Patient Care Models By Ha Tu; Lara Converse; Annie Doubleday; Paul Ginsburg
  9. Medicaid Insurance in Old Age By Eric French
  10. Applying comprehensive nursing intervention to improve mother’s confidence and breastfeeding rate in China By Dai Hongxia
  11. Employability practices in the healthcare sector: an evidence from Poland By Izabela Marzec
  12. Cost of Caesarean Section Rates in Turkey and Their Burden in the Turkish Health Economics By Özlem Özer; Çiğdem Gün; Meltem Saygılı
  13. Perceptual Maps: An Empirical Research on Hospitals By Fatih Santas; Ahmet Kar; Gulcan Kahraman; Arzu Kursun
  14. A mathematical decaying wave illustration of qualitative mental states in depression and Post Traumatic Stress Disorder By Phil Bialobzyski
  15. Poor-quality data and cohort life tables By Petr Mazouch
  16. Does playing favorite games induce therapeutic effects? By Hye Rim Lee; Eui Jun Jeong; Joo Woo Kim
  17. Do patient satisfaction and health improvement affect sustainability of voluntary co-location clusters? Evidence from Vietnam By Quan-Hoang Vuong

  1. By: David Rudoler; Raisa Deber; Adrian Rohit Dass; Janet Barnsley; Richard Glazier; Audrey Laporte
    Abstract: This study analyzes whether primary care physicians respond to financial incentives to risk-select patients based on case-mix. We use administrative health data to compare primary care physicians across payment models in Ontario, Canada. We use a panel multinomial selection model to estimate the relationship between payment and risk-selection, while controlling for physician self-selection into payment types. After controlling for physician self-selection, we do not find evidence of risk-selection behaviour. These findings suggest that policy-makers need to be aware of self-selection when implementing payment reforms. Future work should consider the long-term effects of payment reform on access to care for patients with complex healthcare needs.
    Keywords: physician behaviour, financial incentives, administrative data, panel data
    JEL: D22 D21 I11
    Date: 2016–07
  2. By: Florian PELGRIN (EDHEC Business School); Pascal ST-AMOUR (University of Lausanne and Swiss Finance Institute)
    Abstract: Health insurance status can change over the life cycle for exogenous reasons (e.g. Medicare for the elders, PPACA for younger agents, termination of coverage at retirement in employer-provided plans). Durability of the health capital, endogenous mortality and morbidity, as well as backward induction suggests that these changes should affect the dynamic life cycle beyond the period at which they occur. The purpose of this paper is to study these lifetime effects on the optimal allocation (consumption, leisure, health expenditures), status (health, wealth and survival rates), and welfare. We analyse the impact of young (resp. old) insurance status conditional on old (resp. young) coverage through the structural estimation of a dynamic model with endogenous death and sickness risks. Our results show that young insurees are healthier, wealthier, consume more health care yet are less exposed to OOP risks, and substitute less (more) leisure before (after) retirement. Old insurees show similar patterns, except for lower precautionary wealth balances. Compulsory health insurance is unambiguously optimal for elders, and for young agents, except early in the life cycle. We draw other implications for public policy such as Medicare and PPACA.
    Keywords: Household Finance, Endogenous Morbidity and Mortality Risks, Demand for Health, Medicare and Patient Protection and Affordable Care Act, Simulated Moments Estimation
    JEL: D91 G11 I13
  3. By: Damian Clarke (Department of Economics, Universidad de Santiago de Chile); Hanna Mühlrad (Department of Economics, University of Gothenburg)
    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.
    JEL: J13 I15 I18 O15
    Date: 2016–02
  4. By: Huseyin Naci; Jacob Cooper; Elias Mossialos
    Abstract: There is growing enthusiasm for the timely publication and sharing of clinical trial data. The rationale for open access includes greater transparency, reproducibility, and efficiency of the research enterprise. In cardiovascular diseases, routinely sharing clinical trial data would create opportunities for undertaking comparative effectiveness research, providing much needed evidence on how different interventions compare to each other on key outcomes. Access to individual patient-level data would strengthen the validity of such research. Novel methodological approaches like network meta-analyses using individual patient-level data could reliably compare interventions that have not been compared to each other in head-to-head trials. However, there are significant practical, methodological, financial, and legal challenges to this utopian open access that need to be continually addressed. Sharing clinical trial data openly will only occur when the previously tolerated process of clinical research involving direct ownership and secrecy is abandoned for a new culture in which medical science is open to all of its stakeholders. With this new culture, data will be accessible, reanalysis and further analysis will be considered commonplace, and comparative effectiveness research through novel synthesis approaches such as network meta-analysis can thrive—as long as measures are taken to adequately ensure the goal remains to promote public health.
    Keywords: transparency; open access; data sharing; comparative effectiveness research; network meta-analysis
    JEL: R14 J01
    Date: 2015
  5. By: Joan Costa-Font; Gilberto Turati
    Abstract: Does regional decentralization threaten the commitment to regional equality in government outcomes? We attempt to shed light on this question by drawing on unique evidence from the largest European unitary states to have engaged in countrywide health system decentralization: Italy and Spain. We estimate, decompose, and run counterfactual analysis of regional inequality in government output (health expenditure per capita) and outcome (health system satisfaction) during expansion of health care decentralization in both countries. We find no evidence of increase in regional inequalities in outcomes and outputs in the examined period. Inequalities are accounted for by differences in health system design.
    Keywords: health care decentralization, regional inequality, health care, Oaxaca decomposition
    JEL: H7 I18 I3
    Date: 2016–07
  6. By: Wren, Maev-Ann; Connolly, Sheelah
    Date: 2016–06
  7. By: Peter Jevtic (Department of Mathematics and statistics, McMaster University, Canada); Luca Regis (IMT School for Advanced Studies Lucca)
    Abstract: We formulate, study and calibrate a continuous-time model for the joint evolution of the mortality surface of multiple populations. We model the mortality intensity by age and population as a mixture of stochastic latent factors, that can be either population-specific or common to all populations. These factors are described by affine time-(in)homogenous stochastic processes. Traditional, deterministic mortality laws can be extended to multi-population stochastic counterparts within our framework. We detail the calibration procedure when factors are Gaussian, using centralized data-fusion Kalman filter. We provide an application based on the mortality of UK males and females. Although parsimonious, the specification we calibrate provides a good fit of the observed mortality surface (ages 0-99) of both sexes between 1960 and 2013.
    Keywords: multi-population mortality, mortality surface, continuous-time stochastic mortality, Kalman filter estimation, centralized data fusion
    JEL: C13 C38 G22 J11
    Date: 2016–07
  8. By: Ha Tu; Lara Converse; Annie Doubleday; Paul Ginsburg
    Abstract: San Diego has long been a geographically well-defined health care market with high managed care penetration and a consolidated provider sector.
    Keywords: San Diego, Patient Care Models, Providers, California, health care
    JEL: I
  9. By: Eric French (University College London)
    Abstract: The old age provisions of the Medicaid program were designed to insure re- tirees against medical expenses. We estimate a structural model of savings and medical spending and use it to compute the distribution of lifetime Medicaid transfers and Medicaid valuations across currently single retirees. Compensat- ing variation calculations indicate that current retirees value Medicaid insur- ance at more than its actuarial cost, but that most would value an expansion of the current Medicaid program at less than its cost. These findings suggest that for current single retirees, the Medicaid program may be of the approximately right size.
    Date: 2016
  10. By: Dai Hongxia (Macao Polytechnic Institute, School of Health Sciences)
    Abstract: Objective: To explore mother’s breastfeeding confidence and infant feeding methods after applying comprehensive nursing intervention among postpartum women in China.Methods: The study was a prospective clinical experimental research. Using cluster sampling method, the control group (n=331) received general care with verbal education. The treatment group (n=329) received ‘comprehensive nursing intervention of exclusive breastfeeding’, include a practical handbook on breastfeeding, instruction of breastfeeding skills through face-to-face at bed-side in hospital. They completed questionnaires and Breastfeeding Self-Efficacy Scale (BSES) before discharge. The Chinese version of BSES include 32 items, to evaluate mother’s breastfeeding confidence. The score range from 32 to 160, high score represent high breastfeeding confidence. The scale’s Cronbach’α was 0.93. Statistical Package for the Social Sciences 17.0 (SPSS 17.0) was used. Results: Before discharge, the mean scores of BSES in the treatment group were 122.1±17.02, which was higher than that of the control group (113.07±18.99), p
    Keywords: Breastfeeding;Confidence;Nursing intervention;Breastfeeding rates;China;
    JEL: I00 I10
  11. By: Izabela Marzec (University of Economics in Katowice)
    Abstract: Topic and purposeHuman capital is considered as an essential driver of achieving competitive advantage in the healthcare sector. However, employment relationships in the Polish healthcare sector are changing and long-term relationships are replaced with more temporary relationships. Contrary to the situation in other sectors, this is favorable for employees of healthcare entities what stems from a growing demand for medical services. Healthcare entities attempt to attract and retain valuable employees. The possibility of employability enhancement becomes an important factor deciding about the attractiveness of the employer for many employees who look for opportunities for further career development. However, knowledge about competencies determining employability and practices of its enhancement in this sector is still poor. This paper tries to answer the questions: what are key employability competencies of employees in the healthcare sector and what are the conditions of their enhancement in healthcare organizations?MethodThe aims of the paper are realized by presenting the results of semi-structured interviews carried out with top management of 11 public healthcare entities*. Healthcare entities operating in Southern, Northern, Central, Eastern and Western Poland were targeted in order to get a more complete view of the situation. On the basis of the interviews carried out with managers of healthcare entities key employability competencies of employees and the practices of employability enhancement applied in healthcare entities are analyzed.Findings and implicationsDespite the fact that generally professional knowledge and skills were considered as the most important factor of employability in healthcare organizations the significance of some generic competences was also emphasized. It has been found that although the employees’ employability enhancement is a vital concern of the management in the examined healthcare entities, activities undertaken in this area are rather limited and primarily focused on trainings. To conclude, assuming that people and their competences are the most important capital of healthcare organizations, activities aimed at employability enhancement acquire crucial importance in healthcare entities and they should become an inherent element of HRM policy. They have to focus not only on the development of employees’ professional knowledge and skills but also generic competences which today become a significant factor determining employability in the healthcare sector.* The project was funded from the resources of the National Science Centre (Poland) granted by the decision no. DEC-2013/11/B/HS4/00561.
    Keywords: employability, HRM, healthcare sector
    JEL: J24 O15 I19
  12. By: Özlem Özer (Mehmet Akif Ersoy University, Faculty of Economics and Administrative Sciences, Department of Healthcare Management); Çiğdem Gün (Mehmet Akif Ersoy University, Faculty of Health Sciences, Department of Nursing); Meltem Saygılı (Kırıkkale University, Faculty of Health Sciences, Department of Healthcare Management)
    Abstract: Caesarean section is generally recommended when it is not possible to confidently complete the vaginal birth or there is a certain risk of increase in the morbidity and mortality rates of mother and/or infant due to vaginal birth. Even though caesarean section is recommended only under certain conditions, the rate of caesarean sections has shown a significant tendency of increase in recent years in Turkey. The increase of caesarean sections, which are more costly compared to normal births, causes an unnecessary cost for the national economy. The objective of this study is to give information about the rates of caesarean sections in Turkey, make assumptions about the approximate costs of normal births and caesarean sections and their postpartum outcomes in our country, and propose solutions for decreasing the rates of caesarean sections and thus, the economic burden it causes in our country.
    Keywords: Caesarean section, cost, Turkey
    JEL: I19
  13. By: Fatih Santas (Hacettepe University); Ahmet Kar (Hacettepe University); Gulcan Kahraman (Hacettepe University); Arzu Kursun (Giresun University)
    Abstract: Competition has increased among all health care providers in the provision of health care services in Turkey with the increasing role of the private sector. Perception management of health care consumers has gained importance. In order to be preferred by health care consumers, it is necessary for managers to determine how the perception of health care organizations. This study aims to determine the perception of health care consumers related to public, university and private hospitals. For this purpose, survey was applied to 283 patients who got health care services in outpatient services in a public hospital in Giresun in Turkey. The study shows that there is a statistically significant relationship between hospital preference of consumers and gender, age, income, health insurance and number of hospital visit last one year. The research demonstrates that consumers perceive private hospitals operating in the city center of Giresun on the first rank at the five dimensions (staff behavior, service quality, physical facilities, reputation and cost to consumer).
    Keywords: Health Care Marketing, Consumer, Perceptual Maps, Hospitals
    JEL: M00 I11
  14. By: Phil Bialobzyski (Northwest Community College)
    Abstract: In the physical sciences the mathematical wave model is used to accurately describe various phenomenon including sound and light. Can the wave model be used to help describe and illustrate the qualitative aspects of mental states? In a visual qualitative approach a decaying wave model is used to describe and illustrate mental states associated with depression and PTSD.Wave phenomenon is mathematically described by the following equation.f(t) = ACos( ωt + φ )Where A is amplitude, ω is the angular frequency and φ is the phase shift. With an exponential decay factor and a vertical shift function the wave equation becomes the description for a vertically shifted decaying wave.f(t) = A exp( –γt )Cos( ωt + φ ) + C(t)where γ is the exponential decay factor and C(t) is a vertical shift function. Model discussion In the model, the positive vertical axis are increasing stressors and the negative vertical axis are increasing depressors, time is on the horizontal axis. It is postulated that each person oscillates in mental stressor depressor states around an equilibrium level identified at the stressor depressor axis. These equilibrium levels are determined by ambient environmental mental stress, peer group, physical environment and traumatic/ depressive event history. A stressful event can be illustrated as a decaying wave with initial amplitude far above the equilibrium level. The wavelength and γ of the decaying wave may be a function of early intervention and treatment. The wave may decay back to equilibrium or the equilibrium stress level can be vertically shifted, raised or lowered, depending upon the event. Vertical equilibrium level shifting and the application of wave properties such as constructive and destructive interference are graphically presented in the model. Stressor and depressor ‘forces’ are hypothesized to bring the individual back to their and their peer group’s equilibrium level. These ‘forces’ could take the form of therapeutic regimens and environment or peer group changes.Critical regions in stress and depression are postulated where stress or depression are beyond personal endurance. This model can be used as a clinical aid to help patients visualize their mental states involving PTSD and depression. Future studies could attempt to quantitate the period and γ exponential decay factor parameters from published studies as a function of intervention and treatment in PTSD and depression.
    Keywords: PTSD depression wave model clinical tool
  15. By: Petr Mazouch (University of Economics, Prague)
    Abstract: Data for cohort life tables and its quality is very important information and good data is the basic assumption to construct any model. For cohort life tables information about mortality for 100 years is needed. As is known many regions have problem with some short time periods with weak or no information about mortality patterns in detailed structure. Aim of the paper is to describe possible way how to solve the problem with short periods with low quality data and to evaluate impact of this to the total cohort mortality. Information about cohort mortality is very important for many institutions as pension funds, government and others.
    Keywords: Cohort, Mortality, Life tables, Estimate
    JEL: C80 J10
  16. By: Hye Rim Lee (Konkuk University); Eui Jun Jeong (Konkuk University); Joo Woo Kim (Konkuk University)
    Abstract: The present research was conducted to examine whether players’ life and game self-efficacy as experienced through their favorite gaming activities have therapeutic effects on their sense of depression, loneliness, and aggression. Importantly, we have investigated their relationships in an integrated path model using sub-factors of each construct. With survey data from 1227 South Korean online gamers, the current study used a path model to examine differences between the variables. We found that life and game self-efficacy were significantly negatively and positively related to degrees of depression and loneliness, respectively. Implications for game use as a potential therapeutic tool are discussed.
    Keywords: life self-efficacy, game self-efficacy, depression, loneliness, therapeutic approach
    JEL: Z00
  17. By: Quan-Hoang Vuong
    Abstract: Background: Over the past 15 years or so the phenomenon of voluntarily co-located patients communities has been emerging. Patients, especially the poor, have chosen to live together, seeking/lending supports from/to one another. Nonetheless, despite the existence of these communities, little is researched or known about how those co-located patients as main subjects of the clusters perceive the value they receive and see their future connection to the communities they are, or were, living in. Answering these questions helps us to better understand the prospect of those community, in terms of sustainability.Methods: The study employs the method of categorical data analysis, specifically multiple logistic regressions, to investigate relationships between groups of factors such as perceived degrees of satisfaction with financial means provided by the communities, and reported health improvements (predictor variables), and patients' short- and longer-term commitments to these communities (response variable).Results: All groups of factors, and variables entering the analytical models, have shown statistical significance upon successful estimations based on the provided empirical data sets. The results suggest two meaningful empirical relationships following the data modeling efforts: 1) between financial stress facing patients and the financial benefits they received from the community, and their propensity to stay connected to it; and 2) between general level of satisfaction, health improvements, and patients' long-term commitment to these communities. Overall all, financial benefits and health improvements are found to influence a significant increase in probabilities for patients to become committed to their communities in the short and long term, respectively.Conclusions: This study is to inform policy makers and social workers in healthcare sector about the realities that patients choose to stick to the co-location clusters have an economic reason: finding means to fight their financial hardship. This may suggest a higher degree of complication in dealing with social matters for poor patients than many previously thought of. The issue of suitable income-generating jobs for patient may probably be ignored by the majority of the public by only focusing on charity programs a0nd giving in-kind donations (which turn out to be not very useful). With respect to social policies, it is noteworthy that patients are not those who seek to ask for supports but can potentially be the donors as suggested by the evidence found that the probability of staying committed to the community increase upon completion of medical treatments, seeing health conditions improve.
    Keywords: Voluntary communities; Co-location clusters; Financial benefits; Low-income countries; Vietnam
    JEL: I12 I19
    Date: 2016–07–13

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