nep-hea New Economics Papers
on Health Economics
Issue of 2016‒07‒30
thirty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Aging and Health Financing in the US:A General Equilibrium Analysis By Juergen Jung; Chung Tran; Matthew Chambers
  2. "The Falling Sperm Counts Story": A Limit to Growth? By Johanna Etner; Natacha Raffin; Thomas Seegmuller
  3. Economic Development and the Spread of Diseases of Affluence in EU Regions By Agata Zoltaszek; Alicja Olejnik
  4. The effects of bodyweight on wages in urban Mexico By Pierre LEVASSEUR
  5. Returns to Education: The Causal Effects of Education on Earnings, Health and Smoking By James J. Heckman; John Eric Humphries; Gregory Veramendi
  6. Aggregable Health Inequality Indices By MUSSARD Stéphane; PI ALPERIN Maria Noel; THIREAU Véronique
  7. No Pain, No Gain: The Effects of Exports on Effort, Injury, and Illness By Hummels, David; Munch, Jakob R.; Xiang, Chong
  8. Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care: Implications for Delivery Systems, Payers, and Policy Makers By Ann S. O’Malley; Anna Collins; Kara Contreary; Eugene C. Rich
  9. Quality Rating and Improvement Systems: Secondary Data Analyses of Psychometric Properties of Scale Development By Margaret Burchinal; Sandra L. Soliday Hong; Terri J. Sabol; Nina Forestieri; Ellen Peisner-Feinberg; Louisa Tarullo; Martha Zaslow
  10. Reliability of the Deployment Resiliency Assessment By Samuel E. Simon; Kate Stewart; Michelle Kloc; Thomas V. Williams; Margaret C. Wilmoth
  11. Interim Impacts of Teen PEP in New Jersey and North Caolina High Schools By Dana Rotz; Brian Goesling; Molly Crofton; Christopher Trenholm; Jennifer Manlove; Kate Welti
  12. Does Mass Deworming Affect Child Nutrition? Meta-analysis, Cost-Effectiveness, and Statistical Power By Kevin Croke; Joan Hamory Hicks; Eric Hsu; Michael Kremer; Edward Miguel
  13. The Effects of Aggregate and Gender-Specific Labor Demand Shocks on Child Health By Marianne Page; Jessamyn Schaller; David Simon
  14. State Level Income Inequality and Individual Self-Reported Health Status: Evidence from the United States By Loree, Jacob
  15. Cross-subsidization in employer-based health insurance and the effects of tax subsidy reform By Pashchenko, Svetlana; Porapakkarm, Ponpoje
  16. The Evolution of Socioeconomic-Related Inequalities in Maternal Healthcare Utilization: Evidence from Zimbabwe, 1994-2011 By Makate, Marshall; Makate, Clifton
  17. Maternal health-seeking behavior and child’s birth order: Evidence from Malawi, Uganda, and Zimbabwe By Makate, Marshall
  18. Health and Safety Risks in Britain's Workplaces: Where are They and Who Controls Them? By Alex Bryson
  19. Socio-economic impact of the Ebola Virus Disease in Guinea, Liberia and Sierra Leone By UNDP Regional Bureau for Africa
  21. Socio-Economic Impact of Ebola Virus Disease in West African Countries A call for national and regional containment,recovery and prevention By UNDP Regional Bureau for Africa
  22. Does a Ban on Informal Health Providers Save Lives? Evidence from Malawi By Godlonton, Susan; Okeke, Edward N.
  23. Life-Cycle Consumption Patterns at Older Ages in the US and the UK: Can Medical Expenditures Explain the Difference? By Banks, James; Blundell, Richard; Levell, Peter; Smith, James P.
  24. Prevalence and Patterns of Health Risk Behaviors of Palestinian Youth: Findings from a Representative Survey By Glick, Peter; Kammash, Umaiyeh; Shaheen, Mohammed; Brown, Ryan Andrew; Goutam, Prodyumna; Karam, Rita; Linnemayr, Sebastian; Massad, Salwa
  25. A Life Course Perspective on the Income-to-Health Relationship: Macro-Empirical Evidence from Two Centuries By Nagel, Korbinian
  26. Health and Work in the Family: Evidence from Spouses? Cancer Diagnoses By Pohl, R. Vincent; Jeon, Sung Hee
  27. Self-reported health in good times and in bad: Ireland in the 21st century By Kevin Denny; Patricia Franken
  28. A randomized control trial of a peer adherence and nutritional support program for public sector antiretroviral patients By Booysen,Frederik Le Roux; De Walque,Damien B. C. M.; Over,Mead; Hashimoto,Satoko; de Reuck,Chantell
  29. Child and Adolescent Obesity in Ireland: A Longitudinal Perspective By Madden, D.
  30. Hospital competition with heterogeneous patient groups: Incentives and regulation By Vomhof, Markus

  1. By: Juergen Jung; Chung Tran; Matthew Chambers
    Abstract: We quantify the effects of population aging on the US healthcare system. Our analysis is based on a stochastic general equilibrium overlapping generations model of endogenous health accumulation calibrated to match pre-2010 U.S. data. We find that population aging not only leads to large increases in medical spending but also a large shift in the relative size of public vs. private insurance. Without the Affordable Care Act (ACA), aging itself leads to a 36:6 percent increase in health expenditures by 2060 and a 5 percent increase in GDP which is driven by the expansion of the healthcare sector. The group-based health insurance (GHI) market shrinks, while the individual-based health insurance (IHI) market and Medicaid expand significantly. Additional funds equivalent to roughly 4 percent of GDP are required to finance Medicare in 2060 as the elderly dependency ratio increases. The introduction of the ACA increases the fraction of insured workers to 99 percent by 2060, compared to 81 percent without the ACA. This additional increase is mainly driven by the further expansion of Medicaid and the IHI market and the stabilization of the GHI market. Interestingly, the ACA reduces aggregate health care spending by enrolling uninsured workers into Medicaid which pays lower prices for medical services. Overall, the ACA adds to the fiscal cost of population aging mainly via the Medicare and Medicaid expansion.
    Keywords: Population aging, calibrated general equilibrium OLG model, health expenditures, Medicare & Medicaid, Affordable Care Act 2010, Grossman model of health capital, endogenous health spending and financing.
    JEL: H51 I13 J11 E21 E62
    Date: 2016–07
  2. By: Johanna Etner (University Paris Ouest Nanterre la Défense, EconomiX and Climate Economics Chair); Natacha Raffin (University Paris Ouest Nanterre la Défense, EconomiX and Climate Economics Chair); Thomas Seegmuller (Aix-Marseille University (Aix-Marseille School of Economics)-CNRS-EHESS)
    Abstract: We develop an overlapping generations model of growth, in which agents differ through their ability to procreate. Based on epidemiological evidence, we assume that pollution is a cause of this health heterogeneity, affecting sperm quality. Nevertheless, agents with impaired fertility may incur health treatments in order to increase their chances of parenthood. In this set-up, we analyse the dynamic behaviour of the economy and characterise the situation reached in the long run. Then, we determine the optimal solution that prevails when a social planner maximises a Millian utilitarian criterion and propose a set of available economic instruments to decentralise the optimal solution. We underscore that to correct for both the externalities of pollution and the induced-health inefficiency, it is necessary to tax physical capital while it requires to overall subsidy mostly harmed agents within the economy. Hence, we argue that fighting against the sources of an altered reproductive health is more relevant than directly inciting agents to incur health treatments.
    Keywords: Pollution; Growth; Fertility; Health.
    JEL: O44 Q56 I18
    Date: 2016–07–04
  3. By: Agata Zoltaszek (Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz); Alicja Olejnik (Department of Spatial Econometrics, Faculty of Economics and Sociology, University of Lodz)
    Abstract: Diseases of affluence (diseases of the XXI c., Western diseases) by definition should have higher prevalence and/or mortality rates in richer and more developed countries than in poorer, underdeveloped states. Therefore, it has been indicated that it is the civilizational progress (directly or indirectly via changes in lifestyle, diet, physical activity, stress, etc.) that stimulates epidemic outbreaks of some illnesses (cancer, diseases of respiratory and cardiovascular systems, diabetes, mental disorders). On the other hand substantial financial resources, highly qualified medical personnel, and cutting-edge technology of richer states, should allow for effective preventions, diagnostics, and treatment of these diseases. The European Union as a whole, as well as all its member states and their regions, may be considered “highly developed” in economic sense. Does it, however, mean that EU can be perceived as homogeneous in the sense of diseases of affluence epidemiology? Are the relatively small differences in economic regional development (compared to worldwide inequalities) significant factor in the spatial distribution of diseases of affluence? To evaluate the possible dispersion in the epidemiology of some of potential Western diseases and their relation with regional development tools of spatial statistics have been incorporated. The research covers 261 EU NUTS 2 regions for the years 2003-2010. These research may provide some answers to the existence and epidemiology of hypothetical diseases of affluence as well as in recognizing spatial patterns of prevalence and mortality rates for these illnesses.
    Keywords: diseases of affluence, health, socioeconomic development, spatial analysis
    JEL: I14 I15 O18 O57
    Date: 2016–06
  4. By: Pierre LEVASSEUR
    Abstract: The effects of bodyweight on wages seem to be closely linked to the level of development of the country concerned. In rich countries, overweight and obese workers seem usually penalized, whereas in the poorest societies the fattest tend to earn more. However, in several emerging economies such as Mexico, the nature of the effect is complex and remains still unknown. Given a complex nutritional situation where hunger and obesity coexist, the literature suggests a quadratic relationship in these countries. The main objective of this study is to explore the impact of bodyweight on wages in urban Mexico using panel data from the Mexican Family Life Survey. Two main methodological treatments are highlighted. First, we implement a two-stage model, based on an expanded Mincer earning function, to control for potential sample selection bias and endogeneity problems. Second, we use complementary parametric and semi-parametric estimators in order to analyze accurately the nature of the relationship. Our results show that the effects of bodyweight on wages in Mexico depend on the kind of contract and gender. For employees with formal contracts, BMI tends to have a negative and linear impact on wages, especially for women. By contrast, we find a positive but non-significant causal relationship between bodyweight and wages for employees with informal contracts. Note that this surprising result could concern women particularly. However, the difficulty in well identifying the earning function of such informal employments is likely to overstate this positive effect.
    Keywords: Mexico; emerging countries; wage; kind of contract; bodyweight; obesity.
    JEL: O15 O17 O12 I13 J31 J71
    Date: 2016
  5. By: James J. Heckman (The University of Chicago); John Eric Humphries (University of Chicago, Department of Economics); Gregory Veramendi (W.P. Carey School of Business, Arizona State University)
    Abstract: This paper estimates returns to education using a dynamic model of educational choice that synthesizes approaches in the structural dynamic discrete choice literature with approaches used in the reduced form treatment effect literature. It is an empirically robust middle ground between the two approaches which estimates economically interpretable and policy-relevant dynamic treatment effects that account for heterogeneity in cognitive and non-cognitive skills and the continuation values of educational choices. Graduating college is not a wise choice for all. Ability bias is a major component of observed educational differentials. For some, there are substantial causal effects of education at all stages of schooling.
    Keywords: education, Earnings, Health, rates of return, causal effects of education, cognitive skills, non-cognitive skills
    JEL: C32 C38 I12 I14 I21
    Date: 2016–06
  6. By: MUSSARD Stéphane; PI ALPERIN Maria Noel; THIREAU Véronique
    Abstract: An aggregable family of multidimensional concentration indices is characterized, in order to be consistent with a property of exogenous risk factors, i.e. health risks for which agents are not responsible for. The family of concentration indices (or achievement indices by duality) lies in the class of polynomial functions. Necessary and suffcient conditions are stated in order to rank two health distributions thanks to the generalized concentration curves. It is shown that the properties of mirror and symmetry are compatible with a sub-family of concentration indices being polynomial functions. A dominance criterion exists for this sub-family of indices, provided that the decision maker is an inequality lover.
    Keywords: Concentration; Dominance; Health inequality; Mirror; Symmetry
    JEL: D60 I10
    Date: 2016–07
  7. By: Hummels, David (Purdue University); Munch, Jakob R. (University of Copenhagen); Xiang, Chong (Purdue University)
    Abstract: Increased job effort can raise productivity and income but put workers at increased risk of illness and injury. We combine Danish data on individuals' health with Danish matched worker-firm data to understand how rising exports affect individual workers' effort, injury, and illness. We find that when firm exports rise for exogenous reasons: 1. Workers work longer hours and take fewer sick-leave days; 2. Workers have higher rates of injury, both overall and correcting for hours worked; and 3. Women have higher sickness rates. For example, a 10% exogenous increase in exports increases women's rates of injury by 6.4%, and hospitalizations due to heart attacks or strokes by 15%. Finally, we develop a novel framework to calculate the marginal dis-utility of any non-fatal disease, such as heart attacks, and to aggregate across multiple types of sickness conditions and injury to compute the total utility loss. While the ex-ante utility loss for the average worker is small relative to the wage gain from rising exports, the ex-post utility loss is much larger for those who actually get injured or sick.
    Keywords: demand shocks, worker effort, health
    JEL: I1 F1 J2 F6
    Date: 2016–07
  8. By: Ann S. O’Malley; Anna Collins; Kara Contreary; Eugene C. Rich
    Abstract: The authors examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers.
    Keywords: decision making, evidence-based care, guidelines, health care delivery system, attitudes
    JEL: I
  9. By: Margaret Burchinal; Sandra L. Soliday Hong; Terri J. Sabol; Nina Forestieri; Ellen Peisner-Feinberg; Louisa Tarullo; Martha Zaslow
    Abstract: The results of this secondary data analysis simulating a QRIS validation using six large early care and education datasets demonstrate several issues that should be considered when constructing, validating, and making changes to existing quality ratings.
    Keywords: QRIS, Quality rating and improvement systems, secondary data analyses, psychometric properties, scale development, early childhood
    JEL: I
  10. By: Samuel E. Simon; Kate Stewart; Michelle Kloc; Thomas V. Williams; Margaret C. Wilmoth
    Abstract: This article describes the reliability of the instruments embedded in a mental health screening instrument designed to detect risky drinking, depression, and post-traumatic stress disorder among members of the Armed Forces.
    Keywords: Mental Health screening, Military Medicine
    JEL: I J
  11. By: Dana Rotz; Brian Goesling; Molly Crofton; Christopher Trenholm; Jennifer Manlove; Kate Welti
    Abstract: Teen PEP, an in-school, peer-to-peer sexual health promotion program that combines peer-led interactive workshops and peer-driven school-wide initiatives in an effort to reduce sexual risk behaviors and associated outcomes among high school students.
    Keywords: Sex education, adolescent health, peer-led, school-wide, teen pregnancy, unprotected sex, HIV, STIs, teens, contraceptives, abstinence
    JEL: I
  12. By: Kevin Croke; Joan Hamory Hicks; Eric Hsu; Michael Kremer; Edward Miguel
    Abstract: The WHO has recently debated whether to reaffirm its long-standing recommendation of mass drug administration (MDA) in areas with more than 20% prevalence of soil-transmitted helminths (hookworm, whipworm, and roundworm). There is consensus that the relevant deworming drugs are safe and effective, so the key question facing policymakers is whether the expected benefits of MDA exceed the roughly $0.30 per treatment cost. The literature on long run educational and economic impacts of deworming suggests that this is the case. However, a recent meta-analysis by Taylor-Robinson et al. (2015) (hereafter TMSDG), disputes these findings. The authors conclude that while treatment of children known to be infected increases weight by 0.75 kg (95% CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. We update the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, such as deriving standard errors from p-values when the standard errors are not reported in the original article. The updated sample includes twice as many trials as analyzed by TMSDG, substantially improving statistical power. We find that the TMSDG analysis is underpowered: it would conclude that MDA has no effect even if the true effect were (1) large enough to be cost-effective relative to other interventions in similar populations, or (2) of a size that is consistent with results from studies of children known to be infected. The hypothesis of a common zero effect of multiple-dose MDA deworming on child weight at longest follow-up is rejected at the 10% level using the TMSDG dataset, and with a p-value
    JEL: C49 I15 I18 O15
    Date: 2016–07
  13. By: Marianne Page; Jessamyn Schaller; David Simon
    Abstract: In this paper, we estimate the relationship between cyclical changes in aggregate labor market opportunities and child health outcomes. In addition to using state unemployment rates to proxy for labor market conditions, as is common in the existing literature, we construct predicted employment growth indices that allow us to separately identify demand-induced changes in labor market opportunities for fathers and mothers. In contrast with prominent studies of adult health, we find no evidence that negative shocks to general economic conditions are associated with improvements in contemporaneous measures of children’s health. We do find, however, that focusing on gender-inclusive economic variables obscures the extent to which the labor market affects children. Specifically, we find evidence that improvements in labor market conditions facing women are associated with worse child health, while improvements in men’s labor market conditions have smaller positive effects on child health. These patterns, which are consistent with previous findings on the effects of individual parental employment and job displacement, suggest that family income and maternal time use are both important mechanisms mediating the effects of aggregate labor market conditions on child health.
    JEL: I1 J0 J23
    Date: 2016–07
  14. By: Loree, Jacob
    Abstract: The relative income hypothesis theorizes an individual’s income, relative to the income of their peers, adversely affects their health. There is empirical evidence to support the relative income hypothesis, showing a negative statistical relationship between income inequality and health. The literature is unsettled on the relevant level of geography to measure income inequality, as well as other control variables in the estimation. This paper contributes to this literature by asking how state level income inequality affects the probability of an individual having excellent self-reported health. The relative income hypothesis is tested using individual level data from the Current Population Survey in the United States, and is supplemented with state level income inequality and healthcare spending data from 1996-2009. A logit model with clustered standard errors is employed, with marginal effects reported. Results suggest no statistically significant effects within the full sample. However, if the analysis is restricted to the five most or least equal states, there is a statistically significant relationship between income inequality and health. The most equal states exhibit a positive (but small) relationship between inequality and health, while the least equal exhibit a negative (but small) relationship. While a statistically significant association is found for these samples, the point estimates are not economically significant. The results are robust to the specific income inequality measure, lag structure of income inequality, and time period of analysis. The results do not support the relative income hypothesis. The implication is the effect of income inequality on health may be overstated
    Keywords: Gini Coefficient, Health Inequality, Income Inequality, Self-reported Health
    JEL: D63 I12 I14
    Date: 2015–08
  15. By: Pashchenko, Svetlana; Porapakkarm, Ponpoje
    Abstract: A major source of insurance coverage for non-elderly adults in the US is the employer-based health insurance market. Every participant in this market receives a tax subsidy because premiums are excluded from taxable income. However, people have different incentives to participate in the employer-based pool - since premiums are independent of individual risk, high-risk individuals receive implicit cross-subsidies from low-risk individuals. In this paper, we explore several ways to reform the tax subsidy by taking this implicit cross- subsidization into account. Using a general equilibrium heterogeneous agents model, we find that even though the complete elimination of the tax subsidy leads to the unraveling of the employer-based pool, there is still room for substantial savings by targeting the tax subsidy. More specifically, the same level of risk-sharing in the employer-based market can be achieved at one- third of the current costs if i) the tax subsidy is targeted only towards low- risk individuals who have weak incentives to participate in the pool, and ii) employer-based insurance premiums become age-adjusted. To improve the welfare outcome of this reform, the modified tax subsidy should also be targeted to low-income individuals.
    Keywords: health insurance, tax subsidies, tax deductions, general equilibrium, life-cycle, health reform
    JEL: D52 D91 E2 E21 E65 H20 I10
    Date: 2013–05–08
  16. By: Makate, Marshall; Makate, Clifton
    Abstract: Abstract: Inequalities in maternal healthcare are pervasive in the developing world, a fact that has led to questions about the extent of these inequalities across socioeconomic groups. Yet, despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to examine and document the trends in the inequalities in prenatal care use, professional delivery assistance, and the receipt of information on pregnancy complications in Zimbabwe. We assess the extent to which the observed inequalities have been pro-poor or pro-rich. The empirical analysis uses data from four rounds of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1994, 1999, 2005/06 and 2010/11. Three binary indicators were used as measures of maternal health care utilization; (1) the receipt of four or more antenatal care visits, (2) the use of professional delivery assistance, and (3) the receipt of information regarding pregnancy complications for the most recent pregnancy. We measure and explain inequalities in maternal health care use using Erreyger’s corrected concentration index. A decomposition analysis was conducted to determine the contributions of each determining factor to the measured inequalities. We found a significant and persistently pro-rich distribution of inequalities in professional delivery assistance and knowledge regarding pregnancy complications was observed between 1994 and 2010/11. Also, inequalities in prenatal care use were pro-rich in 1994, 2005/06 and 2010/11 periods and pro-poor in 1999. Furthermore, we stratified the results by rural or urban status. The results reveal a rising trend in observed inequalities in maternal health care use over time. Our findings suggest that addressing inequalities in maternal healthcare utilization requires coordinated public health policies targeting the more poor and vulnerable segments of the population in Zimbabwe.
    Keywords: Socioeconomic-related inequality; maternal healthcare utilization; Erreygers concentration index; Zimbabwe
    JEL: I12 I14
    Date: 2016–04–28
  17. By: Makate, Marshall
    Abstract: Factors influencing maternal health-seeking behavior before and shortly after birth have been widely studied, while the role of birth order in shaping these actions is infrequently examined. This study sought to examine the critical role played by a child’s birth order in altering the maternal health-seeking behavior of women in developing countries. The analysis uses the most recent rounds of the nationally representative standard Demographic and Health Survey for Malawi, Uganda, and Zimbabwe. The empirical analysis utilizes two-level random intercept logistic regression models to assess the potential influence of birth order on prenatal care utilization, birth in a health facility, and breastfeeding. We find that women in Malawi, Uganda, and Zimbabwe were 34.9%, 34.6%, and 43.5% respectively, less liable to complete more than four prenatal care visits for a fifth or later born child than they are for a first born child. Women in Malawi, Uganda, and Zimbabwe were 56.4%, 58.8%, and 77.2% respectively less liable to give birth to a fifth born child in a hospital facility. Also, women who seek prenatal care in Malawi were 50.9% less liable to experience a neonatal death. Also, in Malawi and Zimbabwe the odds of a child dying before reaching the age of one year were 23.7% and 41.6% respectively. Breastfeeding had a protective effect on child survival in all the countries. Overall, we found that women tend to make low investments in maternal health and child well-being for higher order births than they do for first order births. This suggests the need for providers to encourage and re-educate mothers on the importance of investments in maternal health inputs even for higher order births.
    Keywords: Birth order; prenatal care; facility delivery; breastfeeding; sub-Saharan Africa
    JEL: I1 I14 J13
    Date: 2016–06–10
  18. By: Alex Bryson (University College London, National Institute of Social and Economic Research and Institute for the Study of Labor)
    Abstract: This is the first paper to identify the correlates of workplace managers' perceptions of the health and safety risks faced by workers and the degree to which workers have control over those risks. The risks workers face and the control they have over those risks are weakly negatively correlated. Managerial risk ratings are positively associated with both injury and illness rates, but not with absence rates. The control rating is also positively associated with injury and illness rates, but it is negatively correlated with absence rates. Workers are more likely to be exposed to health and safety risks when their workplace is performing poorly and where it has been adversely affected by the recession. Union density is positively associated with risks but is not associated with worker control over risks. Having on-site worker representatives dealing with health and safety is linked to lower risks than direct consultation between management and employees over health and safety. However, there is no evidence that particular types of health and safety arrangement are related to worker control over health and safety risks.
    Keywords: Workplace safety; Working conditions; Unions
    JEL: J81
    Date: 2016–03–30
  19. By: UNDP Regional Bureau for Africa (UNDP Regional Bureau for Africa)
    Abstract: Ebola is hurting economies and livelihoods, slashing gross domestic output, threatening food security,reducing opportunities for jobs and livelihoods, and slowing down foreign investment. All of these consequences are robbing people of a well-deserved peace and promising development gains.
    Keywords: Africa; Ebola
    JEL: D13
    Date: 2014–11
  20. By: UNDP Regional Bureau for Africa (UNDP Regional Bureau for Africa)
    Abstract: The infection rate is slowing down and the number of survivors is growing across the three epicentre countries, but pockets of new infections still remain a serious concern.
    Keywords: Africa; Ebola
    JEL: D13
    Date: 2014–12
  21. By: UNDP Regional Bureau for Africa (UNDP Regional Bureau for Africa)
    Abstract: This report is unique. It is the first report to undertake an assessment of the Ebola virus disease (EVD) for each of the 15 West African countries, breaking away from the tradition of focusing on the three epicentre countries. It is also the first to assess the impact of EVD on poverty incidence and food security in both the three epicentre countries and other non-West African countries. The estimation approach of the socio-economic impact, which allows for consistency checks, is also different from that of other studies.
    Keywords: Africa; Commodity
    JEL: D13
    Date: 2015–02
  22. By: Godlonton, Susan; Okeke, Edward N.
    Abstract: Informal health providers ranging from drug vendors to traditional healers account for a large fraction of health care provision in developing countries. They are, however, largely unlicensed and unregulated leading to concern that they provide ineffective and, in some cases, even harmful care. A new and controversial policy tool that has been proposed to alter household health seeking behavior is an outright ban on these informal providers. The theoretical effects of such a ban are ambiguous. In this paper, we study the effect of a ban on informal (traditional) birth attendants imposed by the Malawi government in 2007. To measure the effect of the ban, we use a difference-in-difference strategy exploiting variation across time and space in the intensity of exposure to the ban. Our most conservative estimates suggest that the ban decreased use of traditional attendants by about 15 percentage points. Approximately three quarters of this decline can be attributed to an increase in use of the formal sector and the remainder is accounted for by an increase in relative/friend-attended births. Despite the rather large shift from the informal to the formal sector, we do not find any evidence of a statistically significant reduction in newborn mortality on average. The results are robust to a triple difference specification using young children as a control group. We examine several explanations for this result and find evidence consistent with quality of formal care acting as a constraint on improvements in newborn health.
    Keywords: informal health providers, government bans, child mortality
    JEL: I12 I15 O15
    Date: 2015–06
  23. By: Banks, James; Blundell, Richard; Levell, Peter; Smith, James P.
    Abstract: Our data indicate significantly steeper declines in nondurable expenditures in the UK compared to the US in spite of income paths at older ages exhibiting similar declines. We examine several possible causes, including different employment paths, housing ownership and expenses, levels and paths of health status, and out-of -pocket medical expenditures. Among all the factors we considered, we find that differences in levels, age paths, and uncertainty in medical expenses is the most likely reason for the steeper declines in nondurable expenses in the US compared to the UK.
    JEL: D12 D14 D91
    Date: 2015–04
  24. By: Glick, Peter; Kammash, Umaiyeh; Shaheen, Mohammed; Brown, Ryan Andrew; Goutam, Prodyumna; Karam, Rita; Linnemayr, Sebastian; 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: 2016–07
  25. By: Nagel, Korbinian (Helmut Schmidt University, Hamburg)
    Abstract: The epidemiological literature discusses two contrary hypotheses that describe life course variations in the income-to-health relationship: the cumulative advantage and the age as leveller hypothesis. Since related micro level studies are criticised due to an income-rank effect, this study transfers the investigation of both hypotheses to a macro level with a long time horizon. It asks whether increases in per capita income improve population health and whether the improvements differ across population age groups. The analysis uses an unbalanced panel data set with 20 countries and up to 211 years, and relies on an error correction and common factor framework to investigate the long-run equlibrium relationship between income and selected measures of age specific population health. A significant effect of per capita income on survival rates is found for middle ages but not for very young and for old ages. From this it can be concluded that while the cumulative advantage theory describes the transition from young to middle ages, the transition from middle to old ages corresponds to the age as leveller mechanism.
    Keywords: Population Health; Economic Development; Panel Time Series Analysis; Cumulative Advantage; Age as Leveller
    JEL: C22 I15 J11
    Date: 2016–07–26
  26. By: Pohl, R. Vincent; Jeon, Sung Hee
    Abstract: Changes in health status may affect not just the individuals who experience such changes, but also their family members. For example, if the main earner in a family loses his or her ability to generate income due to a health shock, it invariably affects the financial situation of the spouse and other dependents. In addition, spouses and working-age children may themselves increase or reduce their labour supply to make up for the lost income (?added worker effect?) or care for a sick family member (?caregiver effect?). Since consumption smoothing and self-insurance occur at the household level, the financial effects of health for other family members have important policy implications. To shed light on such effects, this study analyzes how one spouse?s cancer diagnosis affects the employment and earnings of the other spouse and (before-tax) total family income using administrative data from Canada.
    Keywords: Diseases and health conditions, Health, Labour, Wages, salaries and other earnings
    Date: 2016–07–22
  27. By: Kevin Denny (School of Economics and Geary Institute for Public Policy, University College Dublin); Patricia Franken (University College Dublin)
    Abstract: The Great Recession has renewed interest in whether and how health responds to macroeconomic changes. Ireland provides a convenient natural experiment to examine this since a period of sustained high growth and low unemployment – the so-called Celtic Tiger period- gave way to a deep recession following the economic crisis in 2008. We use data from the Statistics on Income and Living Conditions survey (SILC), to explore what happened to self-reported health over the period 2002-2014. While some sub-populations experienced pro-cyclical effects on self-rated health, in general we find no evidence that the proportion of the population in poor health was higher after the onset of the economic crisis. However a multivariate model implies that there was some effect at the top of the health distribution with a higher unemployment rate switching individuals from being in “very good health” to “good health”. Effect sizes are much larger for females than males.
    Date: 2016–07–22
  28. By: Booysen,Frederik Le Roux; De Walque,Damien B. C. M.; Over,Mead; Hashimoto,Satoko; de Reuck,Chantell
    Abstract: Access to antiretroviral treatment has expanded rapidly in South Africa, making it the country in the world with the largest treatment program. As antiretroviral treatment coverage continues to rise in resource-constrained settings, effective community-based adherence support interventions are of central importance in ensuring the long-term sustainability of treatment. This paper reports the findings from a randomized control trial of a peer adherence and nutritional support program implemented in a public health care setting in South Africa's antiretroviral treatment program. The analysis assesses the impact of these peer adherence and nutritional support interventions on self-reported adherence, timeliness of clinic and hospital visits, and immunologic response to antiretroviral treatment. Peer adherence and nutritional support improved the timeliness of adults´ clinic and hospital visits for routine follow-up while on antiretroviral treatment. Peer adherence support impacted positively on immunologic response to antiretroviral treatment. Scale-up of effective and sustainable community-based, peer-driven adherence and nutritional support interventions should form part of the United Nations AIDS Treatment 2.0 strategy's community mobilization and health system strengthening pillar.
    Date: 2016–07–21
  29. By: Madden, D.
    Abstract: This paper examines developments in childhood and adolescent obesity in Ireland using two waves of the Growing Up in Ireland survey. Obesity appears to level off between the two waves though there is tentative evidence that the socioeconomic gradient, measured with respect to maternal education and family income, becomes steeper. Exploiting the longitudinal nature of the data, transitions into and out of obesity are examined, with higher rates of transition into obesity observed for those whose mothers have the lowest level of education. Decomposition of the concentration index with respect to income reveals a greater role for income related obesity mobility rather than obesity related income mobility.
    Keywords: obesity; socioeconomic gradient; longitudinal
    JEL: I12 I14
    Date: 2016–07
  30. By: Vomhof, Markus
    Abstract: Competing hospitals may not only use quality of service to attract patients but also their specialization profile. Applying a Hotelling-duopoly and interpreting respectively quality and specialization as vertical and horizontal differentiation, we analyze the optimal allocation in both dimensions for hospitals. To account for heterogeneity in preferences as well as in the health status, two patient groups are introduced. These groups differ in two parameters, (i) treatment costs and (ii) preference for a good match between patients' needs and hospitals' specialization profile. Moreover, we derive the optimal reimbursement scheme a regulator is able to achieve. The results show that the hospitals' specialization decision is determined mainly by two relations: which group is more profitable for hospitals and which group is endowed with the higher preference for a good match. The reimbursement scheme a regulator implements deviates from a pure cost partitioning scheme. In particular, the regulator aims at inducing higher quality by exploiting the heterogeneity in preferences.
    Abstract: Im Wettbewerb stehende Krankenhäuser könnten nicht nur Qualität, sondern auch ihr Spezialisierungsprofil nutzen, um attraktiver für Patienten zu werden. Wir wenden ein Hotelling Duopol mit vertikaler und horizontaler Differenzierung an, wobei erstere als Qualität und letztere als Spezialisierung interpretiert wird, um die optimale Allokation für Krankenhäuser in beiden Dimensionen zu untersuchen. Um Heterogenität in Präferenzen und im Gesundheitsstatus zu beachten, werden zwei Patientengruppen eingeführt. Diese Gruppen unterscheiden sich in zwei Parametern, (i) den Behandlungskosten und (ii) der Präferenz für eine gute Übereinstimmung zwischen den Bedürfnissen der Patienten und der Spezialisierung der Krankenhäuser. Zudem bestimmen wir das optimale Vergütungssystem, das mit Hilfe eines Regulators erreicht werden kann. Die Ergebnisse zeigen, dass die Spezialisierungsentscheidung von Krankenhäusern durch zwei Relationen bestimmt wird: Welche Gruppe ist für Krankenhäuser profitabler und welche Gruppe ist mit der stärkeren Präferenz für eine gute Übereinstimmung ausgestattet. Das Vergütungssystem des Regulators weicht von einer reinen Kostenaufteilung ab. Der Regulator möchte eine höhere Qualität erreichen, indem er die Heterogenität in den Präferenzen ausnutzt.
    Keywords: hospital competition,heterogeneity,hotelling-duopoly,regulation
    JEL: I11 I18 L13
    Date: 2016

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