nep-hea New Economics Papers
on Health Economics
Issue of 2016‒09‒11
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. So Many Hospitals, So Little Information: How Hospital Value Based Purchasing is a Game of Chance By William C. Horrace,; Andrew I. Friedson; Allison F. Marier
  2. Diet Quality of American Young Children by WIC Participation Status: Data from the National Health and Nutrition Examination Survey, 2005-2008 By Elizabeth Condon; Susan Drilea; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
  3. Early Experiences Engaging Patients Through Patient and Family Advisory Councils By Deborah Peikes; Ann S. O'Malley; Claire Wilson; Jesse Crosson; Rachel Gaddes; Brenda Natzke; Timothy J. Day; DeAnn Cromp; Rosalind Keith; Jasmine Little; James Ralston
  4. Diet Quality of Americans by SNAP Participation Status: Data from the National Health and Nutrition Examination Survey, 2007-2010 By Elizabeth Condon; Susan Drilea; Keri Jowers; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
  5. Diet Quality of American School Children by National School Lunch Program Participation Status: Data from the National Health and Nutrition Examination Survey, 2005-2010 By Elizabeth Condon; Susan Drilea; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
  6. The Effects of Early Pregnancy on Education, Physical Health and Mental Distress: Evidence from Mexico By Gunes, Pinar; Tsaneva, Magda
  7. Location, quality and choice of hospital: Evidence from England 2002/3 - 2012/13 By Giuseppe Moscelli; Luigi Siciliani; Nils Gutacker; Hugh Gravelle
  8. The Effects of Pharmaceutical Innovation on Cancer Mortality Rates By Dubois, Pierre; Kyle, Margaret
  9. Global Action to Drive Innovation in Alzheimer's Disease and Other Dementias: Connecting Research, Regulation and Access By OECD
  10. Child and Adolescent Obesity in Ireland: A Longitudinal Perspective By David (David Patrick) Madden
  11. Professional profile and education framework for managers in the Croatian health tourism sector By Milena Peršić; Dubravka Vlašić
  12. Health insurance thresholds and policy implications: a Vietnamese medical survey in 2015 By Thu Trang Vuong; Ha Nguyen; Quan-Hoang Vuong
  13. Self-reported health in good times and in bad: Ireland in the 21st century By Kevin Denny; Patricia Franken
  14. The impact of diabetes on labour market outcomes in Mexico: a panel data and biomarker analysis By Till Seuring; Pieter Serneels; Marc Suhrcke
  15. The Mortality Effects of Retirement: Evidence from Social Security Eligibility at Age 62 By Maria D. Fitzpatrick; Timothy J. Moore
  16. The effects of non-adherence on health care utilisation: panel data evidence on uncontrolled diabetes By Joan Gil; Antonio Sicras-Mainar; Eugenio Zucchelli
  17. Smile or Die: Can Subjective Well-Being Increase Survival in the Face of Substantive Health Impairments? By Martin Binder; Guido Buenstorf
  18. YOLO: Mortality Beliefs and Household Finance Puzzles By Raphael Schoenle; Kristian Ove Myrseth; Rawley Heimer

  1. By: William C. Horrace, (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Andrew I. Friedson (Department of Economics, University of Colorado Denver); Allison F. Marier
    Abstract: As part of the 2010 Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing payment reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. This results in point allocation under the payment formula that is random for a large proportion of the hospitals. An alternative payment plan is discussed.
    Keywords: Pay-for-Performance, Hospital Value Based Purchasing, Hospital Quality Scores, Ordinal Ranking, Indistinguishability
    JEL: H51 I18
    Date: 2016–08
  2. By: Elizabeth Condon; Susan Drilea; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
    Abstract: This report provides information on the quality of young children’s diets from multiple perspectives, including usual nutrient intakes and food consumption patterns.
    Keywords: diet quality, American young children, WIC, National Health, Nutrition Examination Survey
    JEL: I0 I1
  3. By: Deborah Peikes; Ann S. O'Malley; Claire Wilson; Jesse Crosson; Rachel Gaddes; Brenda Natzke; Timothy J. Day; DeAnn Cromp; Rosalind Keith; Jasmine Little; James Ralston
    Abstract: Primary care practices are increasingly asked to engage patients in improving care delivery.
    Keywords: Patient and Family Advisory Council, patient engagement, quality improvement, primary care, patient-centered medical home
    JEL: I
  4. By: Elizabeth Condon; Susan Drilea; Keri Jowers; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
    Abstract: This report provides information on the quality of SNAP participants’ diets from multiple perspectives, including usual nutrient intakes and food consumption patterns.
    Keywords: Diet Quality, SNAP Participation Status, National Health and Nutrition Examination Survey
    JEL: I0 I1
  5. By: Elizabeth Condon; Susan Drilea; Carolyn Lichtenstein; James Mabli; Emily Madden; Katherine Niland
    Abstract: This study provides information on the quality of school children’s diets from multiple perspectives, including usual nutrient intakes and food consumption patterns.
    Keywords: Diet Quality , National School Lunch Program Participation Status, National Health and Nutrition Examination Survey, NSLP
    JEL: I0 I1
  6. By: Gunes, Pinar (University of Alberta, Department of Economics); Tsaneva, Magda (Clark University)
    Abstract: This paper estimates the effects of early pregnancy on education, labor force participation, physical and mental health, and preventive health behaviors of young girls in Mexico. In order to overcome the selection bias, this paper employs a propensity score matching analysis using a nationally representative longitudinal data from the Mexican Family Life Survey. In the short run, early pregnancy increases the probability of being overweight and anemic, and reduces physical activity; however, it does not affect mental health. The results also demonstrate that early pregnancy increases the probability of dropping out of high school and reduces labor force participation. Finally, the effect on being overweight operate through reduced education and physical activity, and moreover, the effect persists in the long run.
    Keywords: Early Pregnancy; Human Capital; Mexico
    JEL: I10 J13
    Date: 2016–09–01
  7. By: Giuseppe Moscelli (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, UK.); Luigi Siciliani (Department of Economics and Related Studies, University of York, UK); Nils Gutacker (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, UK.); Hugh Gravelle (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, UK.)
    Abstract: We investigate (a) how patient choice of hospital for elective hip replacement is influenced by distance, quality and waiting times, (b) differences in choices between patients in urban and rural locations, (c) the relationship between hospitals’ elasticities of demand to quality and the number of local rivals, and how these changed after relaxation of constraints on hospital choice in England in 2006. Using a data set on over 500,000 elective hip replacement patients over the period 2002/3 to 2012/13 we find that patients became more likely to travel to a provider with higher quality or lower waiting times, the proportion of patients bypassing their nearest provider increased from 25% to almost 50%, and hospital elasticity of demand with respect to own quality increased. By 2012/13 average hospital demand elasticity with respect to readmission rates and waiting times were 0.2 and 0.04. Providers facing more rivals had demand that was more elastic with respect to quality and waiting times. Patients from rural areas have smaller disutility from distance.
    Keywords: hospital, choice, quality, waiting times, distance, rurality,
    JEL: I11 I18 L15 R22
    Date: 2016–01
  8. By: Dubois, Pierre; Kyle, Margaret
    Abstract: Cancer is a leading cause of death in developed countries, and cancer treatments are the top category of pharmaceutical spending in the United States and Europe. This paper assesses whether novel cancer therapies are associated with a reduction in mortality. Using panel data from 11 developed countries, we study the relationship between mortality attributed to a specific cancer site and the availability of pharmaceutical treatments. The cross-country and cross-site variation over time allows us to isolate the decline in mortality attributable to new drugs from that due to changes in lifestyle and environmental factors. We correct for the endogeneity of mortality and the availability of new treatments using instrumental variables. On average, our results show a decline in mortality of 8-9% is associated with the availability of one new treatment for a cancer site. The gains vary across countries and cancer sites. Based on spending from 2000-2011, costs per statistical life saved ranged from $11-12K for bladder and liver cancers to over $150K for cervical, melanoma and stomach cancers. Across countries, Switzerland had the largest spending per statistical life at approximately $66K, while the UK had the lowest with $19K.
    Keywords: Gender discrimination, microaggression, trauma, safe spaces, prejudice
    Date: 2016–09
  9. By: OECD
    Abstract: Policymakers and the research community have an integral leadership role to foster collaborative efforts to deliver the best available science for evidence based policies and approval processes. The second Lausanne Workshop of December 2015 reviewed the policy and stakeholder actions needed to accelerate biomedical research and health innovation for Alzheimer’s disease and other dementias. The agenda featured developments in regulatory and access pathways for potential innovations in dementia. Participants discussed the perspectives of regulators and payers, specifically the evidence and tools needed to support regulatory and payer evaluation of innovations. A particular focus was placed on the large and growing societal implications of Alzheimer’s disease and the heightened urgency to define sustainable access strategies for future diagnostics and therapies. There is consensus across all stakeholders to move from global agenda setting in Alzheimer’s disease to action oriented programmes and implementation.
    Date: 2016–09–09
  10. By: David (David Patrick) Madden
    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: 2016–08
  11. By: Milena Peršić (Faculty of Tourism and Hospitality Management, Opatija, University of Rijeka, Croatia); Dubravka Vlašić (Faculty of Tourism and Hospitality Management, Opatija, University of Rijeka, Croatia)
    Abstract: Purpose of this research is to indicate the importance of influential factors, relevant for shaping the profile of managers in the Croatian health tourism sector, based on the following research questions: (1) Are these kinds of requirements defined in the Croatian strategic documents and to what extent? (2) Is the development of health tourism in Croatia following the global trends and tourism market needs? (3) Are capabilities provided by the Croatian Qualification Framework (CROQF) good starting point for achieving an interdisciplinary education for management in the health-tourism sector? (4) How should the education framework for manager be designed in order to be able to respond to the challenges in the health tourism? Methodology – To answer these questions the authors conducted the research in 2015. The representative sample consisted of all Croatian health spa/resorts (3), 90% of special hospitals (10) and the most important thermal-spa hotels (4). The achieved results were critically reviewed according to the theoretical knowledge and globally recognized practice. In this process the basic hypothesis that “in Croatia relevant preconditions for interdisciplinary education of manager, necessary for the development of health-tourism on a new basis, have not been created yet” was proven. Findings – The goal of this paper is to recognize the best way for shaping interdisciplinary approach of specific knowledge, skills and competencies directed to achieve the synergy among medical, wellness and spa services, that will be presented in accordance with the global trends and modern customer needs. Ensuring appropriate human resources with the specific interdisciplinary knowledge, skills and competencies in order to achieve the ambitious targets of institutions involved in the health-tourism services, For this purpose the legal framework and the achievement of best practice, will be taken into account. Contribution to the theory is recognized through defining interdisciplinary approach to creating a profile of manager education for health-tourism business needs. Contribution to the practice is recognized through assessment the areas and activity that should be improved, gaining knowledge through new interdisciplinary programs as a prerequisite for increasing the healthtourism efficiency and effectiveness.
    Keywords: curriculum, Croatian Qualifications Framework, interdisciplinary approach, manager’s education, health-tourism business
    JEL: L83
    Date: 2016–04
  12. By: Thu Trang Vuong; Ha Nguyen; Quan-Hoang Vuong
    Abstract: In this research, we use a survey dataset from 900 Vietnamese patients, of which 605 have health insurance, to establish empirical relations between medical expenditures, actual insurance coverage rate, residency status, socioeconomic status of patients and their perceived dis/satisfaction toward the health insurance services/values. The results show that actual insurance coverage and medical expenditures contribute to higher probabilities of satisfaction, but with coverage rate having much higher influence. In addition, threshold insurance coverage and expenditures are estimated, showing that perceptions are immensely heterogeneous regarding values of benefits, following which the poor and non-resident patients being those most efficient for the healthcare system to target and demonstrate positive policy changes. This group's threshold coverage is only 63.4%, a little above the current mean 58%. Finally, as the universal insurance and full coverage is impossible, Vietnamese health insurance policy should switch to support the most vulnerable, with more flexible health insurance and financing options as the current system has proved too rigid to be of value to the poor.
    Keywords: health insurance; threshold; medical expenditures; healthcare policy; Vietnam
    JEL: I18 I10
    Date: 2016–09–01
  13. By: Kevin Denny; Patricia Franken
    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.
    Keywords: Self-reported health; Well-being; Recession; Unemployment; Ireland
    JEL: I18 I14 J60
    Date: 2016–08
  14. By: Till Seuring (Norwich Medical School, University of East Anglia, Norwich, UK); Pieter Serneels (School of International Development, University of East Anglia, Norwich, UK); Marc Suhrcke (Centre for Health Economics, University of York, York, UK.)
    Abstract: There is limited evidence on the labour market impact of diabetes, and existing evidence tends to be weakly identified. Making use of Mexican panel data to estimate individual fixed effects models, we find evidence for adverse effects of self-reported diabetes on employment probabilities, but not on wages or hours worked. Complementary biomarker information for a cross section indicates a large diabetes population unaware of the disease. When accounting for this, the negative relationship of self-reported diabetes with employment remains, but does not extend to those unaware. This difference cannot be explained by more severe diabetes among the self-reports, but rather worse general health.
    Keywords: diabetes, labour market, Mexico, biomarker, panel data
    Date: 2016–08
  15. By: Maria D. Fitzpatrick; Timothy J. Moore
    Abstract: Social Security eligibility begins at age 62, and approximately one third of Americans immediately claim benefits upon reaching that age. We study the link between retirement and health by examining whether mortality changes discontinuously at this threshold. Using mortality data that covers the entire U.S. population and includes exact dates of birth and death, we document a robust two percent increase in overall male mortality immediately after age 62. The rise in mortality is closely connected to changes in labor force participation, implying that mortality increases by approximately 20 percent among those who stop working because Social Security is available.
    Date: 2016–08
  16. By: Joan Gil; Antonio Sicras-Mainar; Eugenio Zucchelli
    Abstract: We use longitudinal administrative data from Spain (2004-2010) to identify and quantify the effects of uncontrolled type 2 diabetes on health care utilisation.
    Date: 2016–09
  17. By: Martin Binder (Bard College Berlin); Guido Buenstorf (University of Kassel)
    Abstract: A robust relationship between subjective well-being and mortality has been established in the literature. While this relationship has been confirmed for many measures and data sets, few studies address how it is affected by concrete diseases. In this paper we assess for the British Household Panel Survey (BHPS) data set from 1991-2008 how life satisfaction interacts with twelve concrete health impairments. Specifically, we analyze whether subjective well-being predicts longer survival in the panel for individuals having the respective impairments. We find that cancer, chest pains and diabetes consistently decrease survival in our sample, even controlling for the severity of health problems. But our results cast doubt on strong claims for the benefits of well-being on mortality: while life satisfaction generally predicts longer survival in the data set, this finding is not robust to controlling for the endogeneity of subjective well-being, and we do not find significant interactions between substantive health impairments and life satisfaction. Higher subjective well-being may keep you healthy, but once you have gotten sick, it does not predict your survival.
    Keywords: subjective well-being, health, survival analysis, longevity, BHPS, life satisfaction
    JEL: I31 I12 C41
    Date: 2016
  18. By: Raphael Schoenle (Brandeis University); Kristian Ove Myrseth (University of St. Andrews); Rawley Heimer (Federal Reserve Bank of Cleveland)
    Abstract: Subjective mortality beliefs affect pre- and post-retirement consumption and savings decisions, as well as portfolio allocation. Our new survey evidence shows that younger individuals overestimate their mortality at short horizons while older individuals over-estimate their long-run chances of survival. The formation of these beliefs across age cohorts can be attributed to overweighting the most salient causes-of-death, which change over the life-cycle. This bias matters empirically: Survival expectations correlate with heterogeneity in ï¬ nancial education and investment behavior. These beliefs make the young (old) more impatient (patient), and when embedded in a conventional dynamic life-cycle model with pre-cautionary savings, they cause the young to under-save (they have 10% less saved upon retirement) and retirees to not fully draw down their assets (they consume 12% less during retirement). In addition, we propose a few mechanisms through which mortality beliefs could affect the equity premium, particularly through a reduction in the risk free rate.
    Date: 2016

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