nep-hea New Economics Papers
on Health Economics
Issue of 2016‒08‒14
thirteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Social participation and self-rated psychological health By Fiorillo, Damiano; Lubrano Lavadera, Giuseppe; Nappo, Nunzia
  2. Is poor sanitation killing more children in rural Zimbabwe? Results of propensity score matching method By Makate, Marshall; Makate, Clifton
  3. Toward Development of a New Health Economic Evaluation Definition By Alexei Botchkarev
  4. Maybe "honor thy father and thy mother": uncertainfamily aid and the design of social long term care insurance By Canta, Chiara; Cremer, Helmuth; Gahvari, Firouz
  5. Familial effects on youth smoking in Brazil By Alberto Palloni; Laetícia De Souza; Letícia Junqueira Marteleto
  6. Health policy in emerging economies: innovations and challenges By Pedro Lara de Arruda; Jeni Vaitsman
  7. The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration By David Molitor
  8. Tobacco Regulation and Cost-Benefit Analysis: How Should We Value Foregone Consumer Surplus? By Helen Levy; Edward C. Norton; Jeffrey A. Smith
  9. The Inner Workings of the Patient Centered Medical Home Model By Guy David; Philip A. Saynisch; Aaron Smith-McLallen
  10. “Know Your Status”: The Impact of HIV testing on Time and Risk Preferences and the Implications for Behaviour By Catherine Jury
  11. Does Disease Cause Vaccination? Disease Outbreaks and Vaccination Response By Emily Oster
  12. No Pain, No Gain: The Effects of Exports on Effort, Injury, and Illness By David Hummels; Jakob Munch; Chong Xiang
  13. Economic Conditions and Children's Mental Health By Ezra Golberstein; Gilbert Gonzales; Ellen Meara

  1. By: Fiorillo, Damiano; Lubrano Lavadera, Giuseppe; Nappo, Nunzia
    Abstract: Although structural and cognitive social capital have been hypothesized to have positive influence on psychological health, few papers found positive correlation and causal relationship between social capital dimensions and psychological wellbeing. This longitudinal study investigates the effect of social participation in associations - member, active, member and active - on self-rated psychological health using five waves of the British Household Panel Survey that follows the same individuals between years 1991 and 1995. Self-rated psychological health is assessed by single items of the General Health Questionnaire (GHQ-12). Using ordered logit fixed effect methods the paper shows that being member and active in associations increases all “positive” items of self-rated psychological health and decreases two main “negative” items of psychological wellbeing.
    Keywords: Social capital, social participation, psychological health, ordered logit fixed effect, British Household Panel Survey
    JEL: C23 D71 I1 I3 Z1
    Date: 2016–08–03
  2. By: Makate, Marshall; Makate, Clifton
    Abstract: Abstract: While studies in developing countries have examined the role of maternal and socio-demographic factors on child mortality, the role of poor sanitation (open defecation) on child mortality outcomes in rural communities of sub-Saharan Africa has received less attention. This study sought to examine the link between poor sanitation and child mortality outcomes in rural Zimbabwe. The 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. Using propensity score matching, we find that children living in households with no toilet facilities are 2.43 percentage points more liable to be observed dead by the survey date, 1.3, and 2.24 percentage points more likely to die before reaching the age of one and five years respectively. We also examined the possible differences in survival among female and male children. Our results indicate that male children are more liable to be observed dead by the survey date than female children. Also, female children have a slight survival advantage over boys during the under-five period. Our results suggest the need for more investments in basic sanitary facilities in Zimbabwe’s rural areas to mitigate the potential devastating impacts of poor sanitation on child survival.
    Keywords: Keywords: Poor sanitation; propensity score matching; child mortality outcomes; Zimbabwe
    JEL: I14 I15 I18
    Date: 2016–06–10
  3. By: Alexei Botchkarev
    Abstract: Economic evaluation is a dynamically advancing knowledge area of health economics. It has been conceived to provide evidence for allocating scarce resources to gain the best value for money. The problem of efficiency of investments becomes even more crucial with advances in modern medicine and public health which bring about both improved patient outcomes and higher costs. Despite the abundance of literature on the economic evaluation concepts, some key notions including the definition of the health economic evaluation remain open for discussion. Academic literature offers a large number and growing variety of economic evaluation definitions. It testifies to the fact that existing definitions do not meet requirements of economists. The aim of this study was to examine existing definitions and reveal their common features.
    Date: 2016–08
  4. By: Canta, Chiara; Cremer, Helmuth; Gahvari, Firouz
    Abstract: We study the role and design of private and public insurance programs when informal care is uncertain. Children's degree of altruism is represented by a parameter which is randomly distributed over some interval. The level of informal care on which dependent elderly can count is therefore random. Social insurance helps parents who receive a low level of care, but it comes at the cost of crowding out informal care. Crowding out occurs both at the intensive and the extensive margins. We consider two types of LTC policies. A topping up (TU ) scheme provides a transfer which is non exclusive and can be supplemented. An opting out (OO) scheme is exclusive and cannot be topped up. TU will involve crowding out both at the intensive and the extensive margins, whereas OO will crowd out solely at the extensive margin. However, OO is not necessarily the dominant policy as it may exacerbate crowding out at the extensive margin. Finally, we show that the distortions of both policies can be mitigated by using an appropriately designed mixed policy.
    Keywords: Long term care, uncertain altruism, private insurance, public insurance, topping up, opting out.
    JEL: H2 H5
    Date: 2016–07
  5. By: Alberto Palloni (IPC-IG); Laetícia De Souza (IPC-IG); Letícia Junqueira Marteleto (IPC-IG)
    Abstract: "This One Pager summarises the key results found in Palloni, de Souza and Marteleto (2016). That study estimates the magnitude and direction of effects of parental and sibling smoking on adolescent smoking behaviour in Brazil, the most populous country in Latin America, where the smoking epidemic is in the early to intermediate stages". (...)
    Keywords: Familial effects, youth, smoking, Brazil
    Date: 2016–08
  6. By: Pedro Lara de Arruda (IPC-IG); Jeni Vaitsman (IPC-IG)
    Abstract: "Over the last decade, the global health agenda has converged around proposals for the construction of policies and interventions towards greater equity. Despite the great diversity in their historical and institutional contexts, developing countries face similar health care challenges, including inequity regarding access to services and to quality medicines, the prevention and control of communicable and non-communicable diseases, and the strengthening of capacities in scientific and technological development". (...)
    Keywords: Health policy, emerging economies,innovations, challenges
    Date: 2016–06
  7. By: David Molitor
    Abstract: Physician treatment choices for observably similar patients vary dramatically across regions. This paper exploits cardiologist migration to disentangle the role of physician-specific factors such as preferences and learned behavior versus environment-level factors such as hospital capacity and productivity spillovers on physician behavior. Physicians who start in the same region and subsequently move to dissimilar regions practice similarly before the move, but each percentage point change in practice environment results in an immediate 2/3 percentage point change in physician behavior, with no further changes over time. This suggests environment factors are twice as important as physician-specific factors for explaining regional disparities.
    JEL: H51 I11 I18
    Date: 2016–08
  8. By: Helen Levy; Edward C. Norton; Jeffrey A. Smith
    Abstract: Recent tobacco regulations proposed by the Food and Drug Administration have raised a thorny question: how should the cost-benefit analysis accompanying such policies value foregone consumer surplus associated with regulation-induced reductions in smoking? In a model with rational and fully informed consumers, this question is straightforward. There is disagreement, however, about whether consumers are rational and fully informed, and the literature offers little practical guidance about what approach the FDA should use if they are not. In this paper, we outline the history of the FDA’s recent attempts to regulate cigarettes and other tobacco products and how they have valued foregone consumer surplus in cost-benefit analyses. We discuss the evidence on whether consumers are fully informed about the risks of smoking and whether their choices are rational, reviewing the competing arguments made by different authors about these questions. We describe the appropriate approach to welfare analysis under different assumptions about consumer information and rationality. Based on our reading of the theoretical and empirical literatures, we advocate using a behavioral public finance framework borrowed from the literature on environmental regulation. This approach applies standard tools of welfare analysis while allowing consumer behavior to deviate from rationality and full information without requiring specific assumptions about the reason for the deviation. The use of this approach would substantially reduce the confusion currently surrounding welfare analysis of tobacco regulation.
    JEL: D61 I12 I18
    Date: 2016–07
  9. By: Guy David; Philip A. Saynisch; Aaron Smith-McLallen
    Abstract: The patient-centered medical home (PCMH) is a model for restructuring primary care with a focus on improved access to care and clinical excellence. However, to date, the evidence on its effect on healthcare utilization and expenditures has been quite mixed. One possible reason for this may lie in the flexibility with which a practice can meet the thresholds for PCMH recognition, adopting practice reforms in vastly different domains. Hence, practices with the same recognition level may in fact demonstrate divergent capabilities, and subsequently have different leverage over the achievement of the PCMH goals. We study this idea by using previously unavailable data that spans all PCMH recognition domains. The richness of our data allows us to group practices into clusters based on their choice of attributes during the recognition process, and then examine the performance of individual clusters in reducing healthcare utilization and expenditures. We find that treating the PCMH model as an undifferentiated intervention obscures meaningful variation in implementation across practices. In particular, clusters emphasizing practice improvements like use of decision support, enhanced access to care and population management tools have demonstrated some success in impacting utilization and expenditures patterns after PCMH recognition.
    JEL: I1 I10 I13 I18 L21 L23
    Date: 2016–07
  10. By: Catherine Jury
    Abstract: It has been suggested that voluntary counselling and testing (VCT) may help to reduce the transmission of HIV. Although evidence in support of this claim is mixed, little is known about the channels through which VCT may affect sexual decision-making. The purpose of this study is to test whether learning one’s HIV status has an impact on risky sexual behaviour through the channel of time and risk preferences. Using data from the Malawi Longitudinal Study of Families and Health (MLSFH), the impact of learning HIV results on these preferences, two years ex post, is measured. Secondly, the role of VCT and time and risk preferences in explaining risky sexual behaviour is analysed. Potential endogeneity problems associated with self-selection into learning results and reverse causality between learning results and preferences are overcome by use of an IV strategy. Randomly assigned vouchers to collect results as well as distance to VCT centres are used as instrumental variables for VCT attendance. Difference-in-difference methodology is used to test robustness of the results. Findings indicate little evidence of an enduring impact of VCT on time and risk preferences and risky sexual behaviour. Furthermore, results suggest that preferences are, on average, not a channel through which VCT affects behaviour. Thus, although VCT may affect sexual decision-making in the short-run, as found in some previous studies, such effects may significantly diminish over time and are likely not via the channel of altered preferences for time and risk.
    Keywords: HIV/AIDS; Voluntary Counselling and Testing; Risk Aversion; Time Preference
    JEL: D83 D90 I12 I18
    Date: 2016
  11. By: Emily Oster
    Abstract: Childhood vaccinations are an important input to disease prevention, but vaccination rates have declined over the last decade due largely to parental fears about vaccine dangers. Education campaigns on the safety of vaccines seem to have little impact. Anecdotal evidence on disease outbreaks suggests that they may prompt vaccination behavior. I use newly compiled data on vaccinations and outbreaks to estimate whether vaccinations respond to disease outbreaks. I find that the pertussis vaccination rate increases among children at school entry following an outbreak in the year prior. A large outbreak in the county can decrease the share of unvaccinated children by 28% (1.2 percentage points). These responses do not reflect true changes in the future disease risk. I argue these facts may be explained by a model in which perceived risk of disease is influenced by whether a household is aware of any cases of disease. This suggests better “promotion” of outbreaks could enhance the response. I use survey data from health departments to show that states which directly coordinate outbreak responses have substantially larger vaccination increases in the wake of an outbreak, suggesting centralized management may better take advantage of this opportunity.
    JEL: I12 I18
    Date: 2016–07
  12. By: David Hummels; Jakob Munch; Chong Xiang
    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.
    JEL: F1 F6 I1 J2 J3
    Date: 2016–07
  13. By: Ezra Golberstein; Gilbert Gonzales; Ellen Meara
    Abstract: Research linking economic conditions and health largely ignores children’s mental health problems, which are the most common and consequential health issues for children and adolescents. We examine the effects of unemployment rates and housing prices on child and adolescent mental health and use of special education services for emotional problems in the 2001-2013 National Health Interview Survey. Mental health status declines as economic conditions deteriorate, and this result is pervasive across nearly every subgroup we examine, including families least likely to experience job loss. The use of special education services for emotional problems also rises when economic conditions worsen.
    JEL: I1
    Date: 2016–07

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