nep-hea New Economics Papers
on Health Economics
Issue of 2016‒09‒25
25 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Fasting during Ramadan and subsequent long term impact on health of children: Comparing the Foetal Origin and Predictive Adaptive Response Hypotheses By Husain, Zakir; Mukherjee, Diganta; Dutta, Mousumi; Mukhopadhyay, Susmita
  2. Credible Ecological Inference for Personalized Medicine: Formalizing Clinical Judgment By Charles F. Manski
  3. On the relationship between BMI and marital dissolution By Bellido, Héctor; Marcén, Miriam
  4. Changes in morbidity over time: Evidence from Europe By Heger, Dörte; Kolodziej, Ingo W.K.
  5. The contribution of female health to economic development By Bloom, David E.; Kuhn, Michael; Prettner, Klaus
  6. Sharing economic value between the stakeholders of a telehealth project: methodological issues? By Camille Jean; Tu-Anh Duong; Julie Stal-Le Cardinal; Marija Jankovic; Jean-Claude Bocquet; Pierre Espinoza
  7. Does competition in the out-patient sector improve quality of medical care? Evidence from administrative data By Stroka-Wetsch, Magdalena A.; Talmann, Anna; Linder, Roland
  8. Child physical development in the UK: The imprint of time and socioeconomic status By Apouey, Bénédicte H.
  9. Chinese Medical Device Market and The Investment Vector By Weifan Zhang; Rebecca Liu; Chris Chatwin
  10. Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012 By Ruwei Hu; Leiyu Shi; Hailun Liang; Geraldine Pierre Haile; De-Chih Lee
  11. Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India By Mehtabul Azam
  12. The influence of nutrition through soil type on child mortality in southern Sweden, 1850-1914 By Hedefalk, Finn; Quaranta, Luciana; Bengtsson, Tommy
  13. Descriptive Findings on the Convergence of Female and Male Mortality in Europe By Alho, Juha
  14. Keeping Workers with Medical Problems Employed: Can an Intervention That Succeeded Inside Workers’ Compensation Succeed Outside? (Policy Brief) By David Stapleton; Jennifer Christian
  15. Spillover of Ratings of Patient- and Family-Centered Care By Anna L. Christensen; Jonathan Brown; Lawrence S. Wissow; Benjamin Cook
  16. Helping Workers Who Develop Medical Problems Stay Employed: Expanding Washington's COHE Program Beyond Workers' Compensation By David Stapleton; Jennifer Christian
  17. The Effects of Minimum Wages on the Health of Working Teenagers By Averett, Susan L.; Smith, Julie K.; Wang, Yang
  18. Substance Abuse Treatment Centers and Local Crime By Bondurant, Samuel R.; Lindo, Jason M.; Swensen, Isaac D.
  19. Predicting readmissions, mortality, and infections in the ICU using Machine Learning Techniques By Álvaro Riascos; Natalia Serna; Marcela Granados; Fernando Rosso; Ramiro Guerrero
  20. How do hospital-specialty characteristics influence health system responsiveness? An empirical evaluation of in-patient care in the Italian Region of Emilia-Romagna By G. Fiorentini; S. Robone; R. Verzulli
  21. Estimating the Avertable Disease Burden and Cost-Effectiveness in Millions Saved Third Edition - Working Paper 429 By Andrew Mirelman, Amanda Glassman, and Miriam Temin
  22. Medical insurance and expenditure thresholds for Vietnamese patient satisfaction with healthcare services By Quan-Hoang Vuong; Thu Trang Vuong
  23. Dynamic Analysis of Health Status in a Small Open Economy By Kawagishi, Taketo; Nakamoto, Yasuhiro
  24. The extension of private health insurance: an inequitable and inefficient strategy By Philippe Batifoulier
  25. The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey By M François; T Hanslik; B Dervaux; Y Le Strat; C Souty; S Vaux; S Maugat; C Rondet; M Sarazin; B Heym; B Coignard; L Rossignol

  1. By: Husain, Zakir; Mukherjee, Diganta; Dutta, Mousumi; Mukhopadhyay, Susmita
    Abstract: The Foetal Origin Hypothesis (FOH) states that exposure to nutrition deficiency at the foetal stage results in poor anthropometric growth and a pre-disposition to have cardiac diseases, nephrological problems and diabetes at early middle age. While this hypothesis made us aware of the possibilities that health can be pre-programmed during the foetal stage, methodological problems implied that the hypothesis could not be accepted with certainty. This study is based on a primary survey of Muslim women and their children, and examines the impact of nutritional shock to the foetus in teh form of Ramadan fasting. The survey was undertaken in Basanti block, in South 24 Parganas. Lying in the Sunderban areas, this block is a chronically under-deprived area where nutrition deficiency is a common feature of life. The programming received through exposure to nutrition deficiency at the foetal stage, therefore, prepares the organism for its later life environment through its plasticity. This is called Predictive Adaptive Response (PAR). The primary survey, undertaken in 2013-2014, covered Muslim youth aged 18-22 years. The impact of foetal starvation was measured through anthropometric measurements. In all 27 indicators were studied. Simultaneously, the mothers of the respondents were surveyed. We collected information about education levels of the parents, the past occupation and standard of living, current occupation and standard of living, and information regarding the conceptions. After ascertaining using old Muslim calendars whether the foetal stage coincided with Ramadan, we also clarified whether the mother had fasted during Ramadan. This enabled us to successfully distinguish between the study and control group. Analysis of the data using multivariate regressions showed that the difference in measurements for most indicators was not statistically significant. In those cases, where the difference was found to be significant, it was those exposed to Ramadan fasting at the foetal stage who were found to be “fitter”. This is taken as preliminary evidence in support of PAR. Further testing provides evidence in support of Predictive Adaptive Response.
    Keywords: Foetal Origin Hypothesis, Predictive Adaptive Response, Genetic programming, Anthropometric development, Nutrition, India
    JEL: I31 Z13
    Date: 2016–09–18
  2. By: Charles F. Manski
    Abstract: This paper studies the ecological inference problem that arises when clinicians seek to personalize patient care by making health risk assessments conditional on observed patient attributes. Let y be a patient outcome of interest and let (x = k, w = j) be patient attributes that a clinician observes. The clinician may want to choose a care option that maximizes the patient's expected utility conditional on the observed attributes. To accomplish this, the clinician needs to know the conditional probability distribution P(y|x = k, w = j). In practice, it is common to have a trustworthy evidence-based risk assessment that predicts y conditional on a subset of the observed attributes, say x, but not conditional on (x, w). Then the clinician knows P(y|x = k) but not P(y|x = k, w = j). Partial conclusions about P(y∣x = k, w = j) may be drawn if the clinician also knows P(w = j|x = k). Tighter conclusions may be possible if he combines knowledge of P(y|x) and P(w|x) with credible structural assumptions embodying some a priori knowledge of P(y|x, w). This is the ecological inference problem studied here. A substantial psychological literature comparing actuarial predictions and informal clinical judgments has concluded that clinicians should not attempt to subjectively predict patient outcomes conditional on attributes such as w that are not utilized in evidence-based risk assessments. The analysis in this paper suggests that formalizing clinical judgment through analysis of the inferential problem may enable clinicians to make more informative personalized risk assessments.
    JEL: C18 I10
    Date: 2016–09
  3. By: Bellido, Héctor; Marcén, Miriam
    Abstract: The evolution of marital dissolutions has prompted researchers and policymakers to study their causes and consequences. While the effects of changes in the relationship status on the Body Mass Index (BMI) have been thoroughly documented (Selection, Protection, Social Obligation, and Marriage Market hypotheses), much less work has been done to analyze the impact of changes in the BMI on the probability of marital dissolution. We take advantage of the richness of the data on (pre) marital and biological history from the National Longitudinal Survey of Youth 79 (NLSY79) to estimate the effect of BMI on marital stability, following an Instrumental Variable approach. We find a small, but statistically-significant, negative effect of this indicator of health on the likelihood of marital dissolution. Supplemental analysis reveals that this effect depends on the category to which people belong according to their BMI (underweight, normal weight, and overweight-obese), and on their race.
    Keywords: Body Mass Index, Health, Divorce, Family economics
    JEL: I1 J12
    Date: 2016–09–20
  4. By: Heger, Dörte; Kolodziej, Ingo W.K.
    Abstract: The elderly are the main beneficiaries of recent gains in life expectancy in the EU. Whether the additional life time is spent in good or in poor health will drastically influence the development of health care costs as morbidity status rather than age per se determines an individual's need for health care services. However, empirical evidence on whether the prolonged lifespan is associated with a compression or an extension of morbidity is still sparse and inconclusive. In this paper, we analyse disability levels in the population 50+ in Europe by age and by proximity to death over time using longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We find that disability levels in Europe have increased due to population ageing and an increase in the prevalence of diseases. The disabling effect of health conditions remained constant over time.
    Keywords: ageing,compression of morbidity,Blinder-Oaxaca decomposition
    JEL: I10 J11 J14
    Date: 2016
  5. By: Bloom, David E.; Kuhn, Michael; Prettner, Klaus
    Abstract: We analyze the economic consequences for less developed countries of investing in female health. We do this through developing and calibrating a novel micro-founded dynamic general equilibrium model in which parents trade off the number of children against investments in their education and in which we allow for health-related gender differences in productivity. We show that better female health speeds up the demographic transition and thereby the take-off toward sustained economic growth. By contrast, male health improvements delay the transition and take-off because ceteris paribus they raise fertility. Investing in female health is therefore a potent lever for promoting development.
    Keywords: economic development,educational transition,female health,fertility transition,quality-quantity trade-off
    JEL: O11 I15 I25 J13 J16
    Date: 2016
  6. By: Camille Jean (LCPI - Laboratoire Conception de Produits et Innovation - Arts et Métiers ParisTech); Tu-Anh Duong (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec, Département de dermatologie, hôpital Henri Mondor - CHU Henri Mondor); Julie Stal-Le Cardinal (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Marija Jankovic (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Jean-Claude Bocquet (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Pierre Espinoza (Mutualité française des Côtes d’Armor - Mutualité française)
    Abstract: Introduction: The durability of telehealth projects is too often questioned by the lack of prior development of sustainable business models allowing the finding of the equilibrium of the funding for the deployment and for the operational phases. The existing medico-economic and multidisciplinary methods do not address this problem; hence a new one is needed. Materials and Methods: The complex system design tools used in the field of Industrial Engineering are used as a base for this new method. The holistic approach adopted represents an opportunity to develop sustainable business models taking into account needs and viewpoints of each stakeholder of a telehealth project. Results: The proposed method aims at creating various scenarios of business models and offering a clear vision on how the proposed changes will impact each of the stakeholders involved as well as the overall system. An example of how this can be applied is detailed. Discussion and Conclusions: The presented method allows the design of economic value sharing scenarios between all the stakeholders of a telehealth project. Its application to a particular one can act as a basis for discussions during negotiations between stakeholders. It can also support the assessment of the overall project’s sustainability.
    Abstract: Introduction : La pérennité des projets de télémédecine est trop souvent remise en cause par l'absence de développement préalable de modèles économiques durables qui permettraient d'élaborer de nouvelles organisations à même d'équilibrer le financement de leur déploiement et de leur fonctionnement. Les méthodes d'évaluation médico-économiques et les méthodes multicritères existantes ne permettant pas de répondre à cette problématique, une nouvelle méthode est donc nécessaire. Matériels et Méthodes : Les outils d’analyse des systèmes complexes utilisés dans le domaine du Génie Industriel sont mobilisés pour créer cette méthode. La perspective holiste adoptée est l’occasion d’élaborer des modèles économiques plus durables pour chacun des acteurs d’un projet de télémédecine. Résultats : La méthode proposée permet de créer des scenarii variés de modèles économiques et offre une vision précise de ce que l’évolution projetée aura comme impact sur chacun des acteurs impliqués et sur le système. Un exemple d’application est détaillé. Discussion et Conclusions : La méthode présentée permet de concevoir des scenarii de partage de la valeur économique entre les acteurs d'un projet de télémédecine. Son application à un projet particulier permet de servir de support de discussion lors des négociations
    Keywords: design engineering,Business model,economic value sharing,complex system,Modèle économique,partage de la valeur,système complexe,innovation,conception
    Date: 2016–06–01
  7. By: Stroka-Wetsch, Magdalena A.; Talmann, Anna; Linder, Roland
    Abstract: We use administrative data from the largest sickness fund in Germany to analyze the relationship between the district density of general and medical practitioner and the quality of care provided to the frail elderly. The quality of care is studied considering prescriptions of potentially inappropriate drugs. We find evidence for a significant positive effect of the share of general and medical practitioners in the population on the provided outpatient health care services.
    Abstract: Im Allgemeinen gilt als eindeutig belegt, dass ein erhöhter Wettbewerb mit sinkenden Preisen und/oder steigender Qualität einhergeht. Da im deutschen Gesundheitssystem Preise für Ärztebehandlungen reguliert sind, kann Wettbewerb in diesem Bereich nur über Qualität ausgeübt werden. Um zu untersuchen ob geringer Wettbewerb, der sich im Extremfall in der Unterversorgung mit sowohl Allgemein- als auch Fachärzten in ländlichen Regionen bemerkbar macht, zu Qualitätsdefiziten führt, analysieren wir den Zusammenhang zwischen der jeweiligen Ärztedichte und der Verschreibung potenziell inadäquater Medikation. Hierzu werden Routinedaten von Deutschlands größter Krankenkasse (der Techniker Krankenkasse) mit über 10 Millionen Versicherten ausgewertet. Diese enthalten u .A. Informationen über die jährlich verschriebenen Tagesdosen von Medikamenten der Priscus-Liste, einer im Jahr 2010 veröffentlichten Aufstellung mit potenziell inadäquater Medikation für ältere Menschen. Die Ergebnisse zeigen signifikante und erhebliche Effekte der Ärztedichte auf die Menge verschriebener Tagesdosen potenziell inadäquater Präparate.
    Keywords: Priscus-list,inappropriate medication,drugs,fixed-effects,administrative data,elderly,competition,quality of medical supply
    JEL: I10
    Date: 2016
  8. By: Apouey, Bénédicte H.
    Abstract: Objectives. Social health inequalities remain a key policy challenge. The existing literature has not presented a synthetic view on the evolution of inequalities in physical development across childhood. We examine social disparities as children grow older using a range of different outcomes. Study design. Population-based secondary data analysis. Methods. We employ longitudinal data on British children ages 9 months to 12 years from the Millennium Cohort Study (N=13,811-18,987) and focus on multiple child physical measures: weight, BMI, overweight, fat mass, and waist circumference. Results. Higher family income is associated with lower BMI (for females), less body fat, and a smaller likelihood of overweight (for both genders) on average throughout childhood. When income is multiplied by three, the probability of overweight decreases by 2.8 (95% CI -0.041 to -0.016) percentage points for females and by 2.7 (95% CI -0.038 to -0.016) percentage points for males. Social inequalities in weight, BMI, overweight, and body fat significantly widen as children grow older, for both genders. For instance, for females, when income is multiplied by three, the probability of overweight decreases by 1.6 (95% CI -0.032 to -0.000) percentage points at ages 2-3, but by 8.6 (95% CI -0.112 to -0.060) percentage points at ages 10-12. Conclusions. The trajectory of social inequalities, which may reflect the cumulative effect of family socioeconomic status, is a precursor of inequalities in adulthood.
    Keywords: Longitudinal Studies; Inequalities; Socioeconomic Status; Child; Physical Development.
    JEL: I14 I18
    Date: 2016–09–07
  9. By: Weifan Zhang; Rebecca Liu; Chris Chatwin
    Abstract: China has attracted increasing amounts of foreign investment since it opened its doors to the world and whilst many analysts have focused on foreign investment in popular areas, little has been written about medical device investment. The purpose of this article is to analyze the status of the Chinese medical device market from the perspective of the healthcare industry and its important market drivers; the study reveals that the medical device market has significant growth potential. This article aims to identify and assess the profitable sectors of medical device technologies as a guide for international companies and investors.
    Date: 2016–03
  10. By: Ruwei Hu; Leiyu Shi; Hailun Liang; Geraldine Pierre Haile; De-Chih Lee
    Abstract: Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. The authors explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes.
    Keywords: Racial and ethnic disparities, diabetes, mortality rates
    JEL: I
  11. By: Mehtabul Azam (Oklahoma State University)
    Abstract: Indian government launched a National Health Insurance Scheme known as Rashtriya Swasthya Bima Yojana (RSBY) in 2008 that provides cashless health services to poor households in India. We evaluate the impact of RSBY on RSBY beneficiary households' (Average Treatment Impact on the Treated) utilization of health services, per capita out-of-pocket (OOP) expenditure, and per patient OOP expenditures on major morbidities. To address the issue of non-randomness in enrollment into the scheme, we exploit the longitudinal aspect of a large nationally representative household survey data to implement difference-in-differences with matching. We find some evidence of positive impact of RSBY on utilization of health services by RSBY beneficiary households in rural India but not in urban India. However, there is no evidence that the RSBY reduced per person OOP expenditure for RSBY households in both rural and urban areas. Conditional on having received medical treatment for major morbidity, we find lower expenditure on medicine for a RSBY cardholder patient in rural areas.
    Keywords: SHI, RSBY, IHDS, out-of-pocket expenditure, health services utilization
    JEL: I1 I18 I38
    Date: 2016–09
  12. By: Hedefalk, Finn (Department of Economic History, Lund University); Quaranta, Luciana (Department of Economic History, Lund University); Bengtsson, Tommy (Department of Economic History, Lund University)
    Abstract: Child mortality differed greatly within rural regions in Europe before and during the mortality decline. Not much is known about the role of nutrition in such geographic differences, and about the factors affecting the nutritional level and hence the resistance to diseases. Focusing on nutrition, we analyse the effects of soil type, used as an indicator of the farm-level agricultural productivity and hence of nutritional status, on mortality of children aged 1-15 living in five rural parishes in southern Sweden, 1850-1914. Using longitudinal demographic data combined with unique geographic micro-data on residential histories, the effect of soil type on the mortality risks are analysed considering as outcome all-cause mortality and mortality from non-airborne and airborne infectious diseases. Soil type primarily affected the mortality of farmers’ children, but not labourers’ children. Particularly, farmers’ children residing in areas with very high proportions of clayey till (75-100% coverage) experienced lower risks of dying compared to children residing in areas with other soil types such as clay and sandy soils. Certain soil types seem to have influenced the agricultural productivity, which, in turn, affected the nutrition of the farmers’ children and thus their likelihood of dying. The results indicate a relatively important role of nutrition as a mortality predictor for these children. As, to our knowledge, the first longitudinal study on the micro-level that analyses the effects of soil type on mortality in a historical rural society, we contribute to the literature on the role of nutrition on the risk of dying in a pre-industrial society
    Keywords: child mortality; geographic context variables; GIS; historical demography; soil quality; southern Sweden
    JEL: J10 N50 N90
    Date: 2016–09–21
  13. By: Alho, Juha
    Abstract: Female life expectancy has almost universally been higher than male life expectancy. But, both have increased rapidly during the past century. European countries differ as regards the magnitude and time trends of the female-male difference. In countries that can be characterised as Egalitarian from the point of view of gender equality, the difference increased rapidly after World War II. It is thought that a major factor in this was then wider adoption of smoking on the part of males. Subsequently the gap has clearly narrowed, and it is believed that the narrowing continues. In countries that can be characterised as Traditional from the point of view of gender equality, the gap started to widen already a century ago, with acceleration after World War II. these countries show only limited evidence of subsequent narrowing. In former socialist countries the gap has been large, and shows little narrowing. These developments are described in detail by graphical displays. It is shown that considerable heterogeneity exists in the time trends within the three groups of European countries.
    Keywords: Female advantage, historical mortality data, life expectancy, mortality, survival probabilities
    Date: 2016–09–20
  14. By: David Stapleton; Jennifer Christian
    Abstract: This policy brief considers one option: making Washington State’s Centers for Occupational Health and Education (COHE) program, a care coordination and quality improvement initiative that has been effective inside the state’s workers’ compensation system available to workers with non-compensable medical conditions.
    Keywords: disability, employment, return-to-work, early intervention, workers’ compensation
    JEL: I J
  15. By: Anna L. Christensen; Jonathan Brown; Lawrence S. Wissow; Benjamin Cook
    Abstract: As primary care models increasingly include nonphysician team members, more attention should be paid to patient- and family-centered care (PFCC) among medical assistants (MAs). The aims of this article are to describe parent perceptions of PFCC by MAs and assess associations between MA PFCC and other perceptions of their care experience.
    Keywords: primary care, patient- and family-centered care, medical assistants
    JEL: I
  16. By: David Stapleton; Jennifer Christian
    Abstract: This is one of three policy action papers prepared in Year 3 of the Stay-at-Work/Return-to Work Policy Collaborative, an initiative funded by the Office of Disability Employment Policy in the U.S. Department of Labor.
    Keywords: disability, employment, return-to-work, early intervention, workers’ compensation
    JEL: I J
  17. By: Averett, Susan L. (Lafayette College); Smith, Julie K. (Lafayette College); Wang, Yang (University of Wisconsin-Madison)
    Abstract: This paper examines the effect of minimum wage increases on the self-reported health of teenage workers. We use a difference-in-differences estimation strategy and data from the Current Population Survey, and disaggregate the sample by race/ethnicity and gender to uncover the differential effects of changes in the minimum wage on health. We find that white women are more likely to report better health with a minimum wage increase while Hispanic men report worse health.
    Keywords: minimum wage, self-reported health, teenagers
    JEL: I10 I18 J15 J16
    Date: 2016–09
  18. By: Bondurant, Samuel R. (Texas A&M University); Lindo, Jason M. (Texas A&M University); Swensen, Isaac D. (Montana State University)
    Abstract: In this paper we estimate the effects of expanding access to substance-abuse treatment on local crime. We do so using an identification strategy that leverages variation driven by substance-abuse-treatment facility openings and closings measured at the county level. The results indicate that substance-abuse-treatment facilities reduce both violent and financially motivated crimes in an area, and that the effects are particularly pronounced for relatively serious crimes. The effects on homicides are documented across three sources of homicide data.
    Keywords: substance abuse treatment, crime, homicides
    JEL: I12 K14 K42
    Date: 2016–09
  19. By: Álvaro Riascos; Natalia Serna; Marcela Granados; Fernando Rosso; Ramiro Guerrero
    Abstract: Health care at the Intensive Care Unit (ICU) is both expensive for hospitals and strenuous for doctors. Early detection of risk factors associated to readmissions, mortality, and infections in the ICU, can improve patient care quality and reduce costs in the long-run. In this article we use machine learning techniques to predict those three outcomes using patient-level data of the ICU of a high complexity hospital in Colombia. Our results show that pathologies of the aorta, cancer, neurologic and respiratory diseases as well as invasive procedures such as dialysis, tracheostomy, and bronchoscopy are positively correlated to the probability of readmission, death, and catheter infections in the ICU. The area under the ROC curve for the first outcome ranges between 71 and 74%, for the second between 76 and 81%, and for the third between 88 and 92%. We estimate a model that competes against the APACHE II scoring system and achieve the same predictive power using less information about the patient.
    Keywords: Intensive Care Unit, machine learning, readmissions, mortality, catheter infections.
    Date: 2016–08–28
  20. By: G. Fiorentini; S. Robone; R. Verzulli
    Abstract: Several studies of health system responsiveness focus on the demand-side by investigating the association between socio-demographic characteristics of patients and their reported level of responsiveness. However, little is known about the influence of supply-side factors. This paper addresses that research gap by analysing the role of hospital-specialty characteristics in explaining variations in patients’ evaluation of responsiveness from a sample of about 38,700 in-patients treated in public hospitals within the Italian Region of Emilia-Romagna. The analysis is carried out by adopting a two-step procedure. First, we use patients’ self-reported data to derive five measures of responsiveness at the hospitalspecialty level. By estimating a generalised ordered probit model, we are able to correct for variations in individual reporting behaviour due to the health status of patients and their experience of being in pain. Secondly, we run cross-sectional regressions in order to investigate the association between patients’ responsiveness and potential supply-side drivers, including waiting times, staff workload, the level of spending on non-clinical facilities, the level of spending on staff education and training, and the proportion of staff expenditure between nursing and administrative staff. Results suggest that responsiveness is to some extent influenced by the supply-side drivers considered.
    JEL: I10 I11 I19 C25 C50
    Date: 2016–09
  21. By: Andrew Mirelman, Amanda Glassman, and Miriam Temin
    Abstract: Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact evaluations, with the objective of illustrating how economic evaluation can be used in decision making and to provide further evidence on the extent of health gains produced for the funding provided. We reviewed the evidence and calculated the averted disease burden and cost-effectiveness for a selected group of public health successes, finding that large health gains have been achieved in programs that represent good value for money. Since these cases represent known successes, this is to be expected; however, some key issues emerge. In many cases, estimates of cost-effectiveness are not available for programs at scale and thus estimating efficiency losses and scale-up dynamics is only possible with modeling and by making large assumptions. When assessed in reference to the GDP per capita of the country, many of the programs compare favorably, though the GDP per capita threshold may not be the correct figure for making decisions. Health systems and sectoral interventions, such as those that address access to care or provide resources directly (e.g. cash transfers), present difficulties when estimating standard measures of cost-effectiveness. These difficulties can be partially overcome with high quality studies that evaluate implementation or by using alternative measures of efficiency such as those relating to administrative efficiency. The lessons learned from calculating the cost-effectiveness for many scaled-up programs across a range of health areas and country settings provides lessons for future considerations of the value of scaling up effective health interventions in national health programs.
    Keywords: Health, Medical Care, Medico Economic, Cost-Effectiveness, Program Evaluation
    JEL: H5 H43 H51 I1 I10 I12 I13 I14 I18
    Date: 2016–07
  22. By: Quan-Hoang Vuong; Thu Trang Vuong
    Abstract: This short communication report some new results obtained from a medical survey among 900 Vietnamese patients. Both income and medical expenditure have positive influence to improving patient satisfaction. But insurance reimbursement rate has negative influence. Patients with residency status are more demanding than those without. The more seriously ill, the less patients find the health services to be satisfactory. The probability of satisfaction conditional on insurance reimbursement is lower for patients with residency status, and higher for those without. There exist thresholds of income, expenditures and insurance reimbursement rate, surpassing which probabilistic trends switch. The expenditure threshold for resident patients is almost three times that for nonresidents. The computed “insurance threshold” exists only within the group of non-resident patients, ~65%, suggesting that getting a reimbursement rate higher than this can be very difficult. Therefore, the government's ambitious goal of universal coverage may be both unrealistic and too rigid as patients with different conditions show different perceptions toward healthcare services.
    Keywords: Health insurance; threshold; medical expenditures; healthcare policy; Vietnam
    JEL: I18
    Date: 2016–09–22
  23. By: Kawagishi, Taketo; Nakamoto, Yasuhiro
    Abstract: Considering that people can invest in their health-related quality of life, we investigate the effects of public policies (the investment subsidy policy and the direct transfer of investment commodities) on the health-related quality of life in the small open economy. Our main findings are that a temporary increase in these public policies conducted by the domestic government does not have positive impacts on the health-related quality of life in the long run; and alternatively, the foreign aid in the form of direct transfer of investment commodities improves their health.
    Keywords: Health-related quality of life; Temporary effects of public policies; Foreign aid
    JEL: F41 H21 I12 I18
    Date: 2016–07–08
  24. By: Philippe Batifoulier (CEPN - Centre d'Economie de l'Université Paris Nord - Université Paris 13 - USPC - Université Sorbonne Paris Cité - CNRS - Centre National de la Recherche Scientifique)
    Abstract: The privatisation of health care in Europe is shifting the cost burden from public insurance to private insurance and making health care one of the new driving forces behind capitalism. It is supported by the economic theory of health insurance, which argues that public health coverage creates a perverse incen-tive, while private insurance helps to make patients more responsible. However, not only is this strategy inequitable, it is also inefficient because it generates additional expenditure.
    Keywords: healthcare
    Date: 2016–04–08
  25. By: M François (UFR des sciences de la santé Simone Veil - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines, iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale); T Hanslik (Hôpital Ambroise Paré, UVSQ - Université de Versailles Saint-Quentin-en-Yvelines); B Dervaux (CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]); Y Le Strat (Institut de Veille Sanitaire (INVS)); C Souty (iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale); S Vaux (Institut de Veille Sanitaire (INVS)); S Maugat (Institut de Veille Sanitaire (INVS)); C Rondet (UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie - UPMC - Université Pierre et Marie Curie - Paris 6); M Sarazin (iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale); B Heym (Hôpital Ambroise Paré); B Coignard (Institut de Veille Sanitaire (INVS)); L Rossignol (iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale)
    Abstract: Background: Urinary tract infections (UTIs) are among the most common bacterial infections. Despite this burden, there are few studies of the costs of UTIs. The objective of this study was to determine the costs of UTIs in women over 18 years of age who visit general practitioners in France. Methods: The direct and indirect costs of clinical UTIs were estimated from societal, French National Health Insurance and patient perspectives. The study population was derived from a national cross-sectional survey entitled the Drug-Resistant Urinary Tract Infection (Druti). The Druti included every woman over 18 years of age who presented with symptoms of UTI and was conducted in France in 2012 and 2013 to estimate the annual incidence of UTIs due to antibiotic-resistant Enterobacteriaceae in women visiting general practitioners (GPs) for suspected UTIs. Results: Of the 538 women included in Druti, 460 were followed over 8 weeks and included in the cost analysis. The mean age of the women was 46 years old. The median cost of care for one episode of a suspected UTI was €38, and the mean cost was €70. The annual societal cost was €58 million, and €29 million of this was reimbursed by the French National Health Insurance system. In 25 % of the cases, the suspected UTIs were associated with negative urine cultures. The societal cost of these suspected UTIs with negative urine cultures was €13.5 million. No significant difference was found between the costs of the UTIs due to antibiotic-resistant E. coli and those due to wild E. coli (p = 0.63). Conclusion: In the current context in which the care costs are continually increasing, the results of this study suggests that it is possible to decrease the cost of UTIs by reducing the costs of suspected UTIs and unnecessary treatments, as well as limiting the use of non-recommended tests.
    Keywords: Primary care,Urinary tract infection,Cost of illness
    Date: 2016

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