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on Health Economics |
| By: | Ahmed Eltobgy (Faculty of Medicine, Al-Azhar University); Abdullah Al-Temani (Faculty of Medicine, Tabuk University); Ibrahim Abdelhafiz (Faculty of Medicine, Tabuk University); Asma Alharbi (Faculty of Medicine, Tabuk University); Waad Al Nomasi (Faculty of Medicine, Tabuk University); Ashwag Al-Rwaili (Faculty of Medicine, Tabuk University) |
| Abstract: | Introduction: Doctors have long observed that their patients vary in their symptoms, their side effects from medications, and their responses to treatments. Therefore, guidelines for treatment and medication were based on what worked for the average person. Precision Medicine (PM), on the other hand, matches each patient with the treatment that will work best for them. It takes individual variation into account: variation in genes, environment, lifestyle, and even in the microscopic organisms. Beyond treating diseases, PM includes approaches to diagnostics, prevention, and screening. PM includes the concept of individualized or personalized medicine at a more exact level through advances in science and technology, such as genetics and genomics sequencing. The technology to undertake Precision Medicine Initiative (PMI) exists today, but many scientific, legal, economic and ethical problems and challenges about its practice remain unanswered. The active role and participation of family and community medicine specialty must be emphasized in regarding to big data management, geographical information systems, quality biomedical information and population based studies.Study Objectives: The study aimed to identify, describe and prioritize major implementation and challenges of PM model integration into family and community medicine practice.Materials and Methods: Internet literature survey has been conducted to identify and define the pertinent study independent (6 main physicians ‘characteristics) and dependent variables (28 problems and 15 challenges). A cross-sectional analytical design was adopted in which the multi-stage random sampling technique has recruited 300 physicians from 3 different medical colleges and 6 hospitals and they were requested to complete a self-administrated pre-coded questionnaire. The simple scoring system was used for priority assignment of PM implementation problems and challenges. The quality of the collected data was ensured and sufficient descriptive and analytic statistical analyses were done.Results: Top priority PM problems were pharmaceutical industry (1st), PM costs (2nd) and regulation of diagnostic tests (3rd). Meanwhile, the most important challenges were research issues (1st), knowledge systems (2nd) and ethical practice (3rd).Conclusion: The future of medicine based on PM is promising and a value-based healthcare model. While there is much optimism, there is also a great need for changing the current health system, solving most of the existing problems and meeting the facing challenges. What is needed now is a broad research program to encourage creative approaches to PM, test them rigorously, and ultimately use them to build the evidence base needed to guide clinical practice. |
| Keywords: | Precision Medicine, Family and Community Medicine, PM Problems, PM Challenges |
| JEL: | I00 I10 I19 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:4106500&r=hea |
| By: | Soohyun Choi (Seoul National University) |
| Abstract: | The paper attempts to identify the relationship between health perception and happiness in gender relative perspective. Even there are large volume of research, devoted to analyze gender happiness disparity, most of them neglected health aspect. Moreover, although it sounds quite obvious that happiness and health perception are correlated, it’s rather clear that happiness disparity can be explained by health disparity. The results, based on World Value Survey panel data and IV regression, verifies that health perception gender ratio has positive impact on gender happiness ratio, which implies that relatively better health perception can improve corresponding gender’s relative happiness. It can be interpreted as balanced health perception between gender will lessen the gender happiness disparity. |
| Keywords: | happiness; health perception; gender happiness disparity |
| JEL: | I14 I31 J16 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iefpro:4106734&r=hea |
| By: | Emily Sama-Miller; Lauren Akers; Andrea Mraz-Esposito; Sarah Avellar; Diane Paulsell; Patricia Del Grosso |
| Abstract: | This review, known as the Home Visiting Evidence of Effectiveness (HomVEE) project, determines which home visiting program models have sufficient evidence to meet the DHHS criteria for an “evidence-based early childhood home visiting service delivery model.†|
| Keywords: | The Patient Protection and Affordable Care Act, improve outcomes for at-risk pregnant women and mothers and children from birth through age 5, Maternal, Infant, Early Childhood Home Visiting Program (MIECHV), home visiting services |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:dedb562535124bbfb29e986500ae659c&r=hea |
| By: | Brian Goesling |
| Abstract: | In this article the authors have identified and assessed more than 250 impact studies of adolescent pregnancy prevention programs. |
| Keywords: | Adolescent Pregnancy, Sexually Transmitted Infections, Teen Pregnancy, Family Support |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:cc18daa9f3224b53b58763a3ff4f0908&r=hea |
| By: | Russell P. Cole; Susan Goerlich Zief; Jean Knab |
| Abstract: | This article highlights the results of the Office of Adolescent Health’s (OAH) substantial investment in rigorous evaluations of teen pregnancy prevention (TPP) programs. |
| Keywords: | Teen Pregnancy, Evidence Standards, Family Support |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:897a729d636e4ec783fc27e864d81481&r=hea |
| By: | Crystal Blyler; Melissa Azur; Bonnie O'Day; Priyanka Anand; Allison Barrett; Kavita Choudhry; Kara Contreary; Sarah Croake; Molly Crofton; Noelle Denny-Brown; Brian Johnston; Jasmine Little; Jennifer Lyons; Brenda Natzke; Stephanie Peterson; Max Rubinstein; Allison Siegwarth; James Woerheide; Kara Zivin |
| Abstract: | Created by the Affordable Care Act in 2010 and launched by the Centers for Medicare & Medicaid Services in 2012, the Medicaid Emergency Psychiatric Services Demonstration tests the effects of waiving the “institutions for mental disease†(IMD) exclusion for Medicaid beneficiaries with emergency psychiatric conditions who were admitted to 28 private IMDs in 11 states and the District of Columbia. |
| Keywords: | Medicaid, emergency psychiatry, institution for mental diseases, IMD exclusion, inpatient care, psychiatric hospital |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:68136f5dda6f4dfe90a6302023771837&r=hea |
| By: | Brian Goesling; Mindy E. Scott; Elizabeth Cook |
| Abstract: | Students in the treatment schools reported greater exposure to information on reproductive health topics such as sexually transmitted infections, abstinence, and birth control. |
| Keywords: | Family Health, Sexuality, HealthTeacher, Cluster Randomized Trial, Teen Pregnancy, Family Support |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:288502475c6040aaafa3045a8f46b481&r=hea |
| By: | Jean Knab; Russell P. Cole; Susan Goerlich Zief |
| Abstract: | The lessons learned from these challenges laid the groundwork for a second a round of evaluation TA with a second cohort of TPP grantees that began in summer 2015. |
| Keywords: | Technical Assistance, Adolescent Pregnancy , Evidence Base, Teen Pregnancy, Family Support |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:3f5209040cea447880eb2deea49b0e59&r=hea |
| By: | Crystal Blyler; Melissa Azur; Bonnie O'Day; Priyanka Anand; Allison Barrett; Kavita Choudhry; Kara Contreary; Sarah Croake; Molly Crofton; Noelle Denny-Brown; Brian Johnston; Jasmine Little; Jennifer Lyons; Brenda Natzke; Stephanie Peterson; Max Rubinstein; Allison Siegwarth; James Woerheide; Kara Zivin |
| Abstract: | Created by the Affordable Care Act in 2010 and launched by the Centers for Medicare & Medicaid Services in 2012, the Medicaid Emergency Psychiatric Services Demonstration tests the effects of waiving the “institutions for mental disease†(IMD) exclusion for Medicaid beneficiaries with emergency psychiatric conditions who were admitted to 28 private IMDs in 11 states and the District of Columbia. |
| Keywords: | Medicaid, emergency psychiatry, institution for mental diseases, IMD exclusion, inpatient care, psychiatric hospital |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:cafb1d794ddd49feaba06739e8cc9953&r=hea |
| By: | Russell P. Cole |
| Abstract: | This is a collection of high-quality evaluations, with analyses and results that have been guarded against identifying spurious findings (P-hacking) as a result of prespecified analysis plans and multiple rounds of independent review. |
| Keywords: | Adolescent Pregnancy Prevention Programs, Teen Pregnancy, Family Support |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d81b69f483684cb78b4cf2d72ef16ea0&r=hea |
| By: | Crystal Blyler; Melissa Azur; Bonnie O'Day; Priyanka Anand; Allison Barrett; Kavita Choudhry; Kara Contreary; Sarah Croake; Molly Crofton; Noelle Denny-Brown; Brian Johnston; Jasmine Little; Jennifer Lyons; Brenda Natzke; Stephanie Peterson; Max Rubinstein; Allison Siegwarth; James Woerheide; Kara Zivin |
| Abstract: | This is an executive summary for the report summarizing the findings from the Medicaid Emergency Psychiatric Services Demonstration (MEPD) Evaluation: Volume I and Volume II. |
| Keywords: | Medicaid, emergency psychiatry, institution for mental diseases, IMD exclusion, inpatient care, psychiatric hospital |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:9e00fc275489478a8ac81a1c3d6ed4c4&r=hea |
| By: | Amy J. Pickering; Benjamin F. Arnold; Holly N. Dentz; John M. Colford Jr.; Clair Null |
| Abstract: | This article summarizes reasons for mandating independent monitoring of greenhouse gas emission reduction projects. |
| Keywords: | Climate, Low-Income Countries, Kenya, International |
| JEL: | F Z |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:f9b358a811634e0884495f6e4a6bb173&r=hea |
| By: | Bénédicte H. Apouey (PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), PSE - Paris School of Economics); Jacques Silber (Bar-Ilan University [Israël]) |
| Abstract: | A country’s performance in health attainment refers to both its achievement (level) and its improvement (evolution) in the health domain. Studies on performance generally measure health attainment using the average health level of the population, and quantify health improvement employing the change in attainment over time. However this approach is flawed because the change in attainment does not satisfy good properties, on the one hand, and because health attainment should not only account for the average health level, but also for disparities in health in the population, on the other hand. We propose a solution to the first limitation by following the lead of Kakwani (1993), who uses achievement and improvement measures which are based on attainment measures and which satisfy important properties. For the second limitation, we extend the work of Kakwani and propose new definitions of attainment that account for the average health level but also for health inequalities in the population. Specifically, we focus on overall and social health inequalities and on the health of the poor. By including these new attainment variables into Kakwani’s indices, we generate new classes of achievement and improvement indices. Using data on 11 low and middle-income Asian countries in the twenty-first century, we highlight that child and maternal health have generally improved in recent decades, due to both an increase in the average health level and a decrease in inequalities. |
| Keywords: | achievement indices,improvement indices,health inequalities,Asia,child health,maternal health |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-01357085&r=hea |
| By: | Bruno Crepon; Julie Pernaudet |
| Abstract: | Disadvantaged youth are particularly at risk of under-investing in their health. Costs of healthcare and bias in health needs perceptions are likely to be key factors of underinvestment. Relying on a randomized experiment, we find that providing them with personalized information both on public health insurance and on their health status based on a medical diagnosis raises their curative and preventive investments. More specifically, they are more likely to consult a psychologist and to use contraception, while depression and risky sexual behaviors are key issues in this population. In order to distinguish between the two barriers, financial constraints and underestimation of health needs, we also test a program providing information on public health insurance only. This limited program improves their medical coverage in the same way as the combined program, but it does not translate into higher health investments. These findings highlight the importance of taking into account the role of subjective perceptions of health needs when considering health decisions among disadvantaged youth. |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:feb:natura:00558&r=hea |
| By: | Lauren Hersch Nicholas; Johanna Catherine Maclean |
| Abstract: | We study the effect of state medical marijuana laws (MMLs) on labor supply and health outcomes among older adults; the demographic group with the highest rates of many chronic conditions for which marijuana may be an effective treatment. Using 1992 - 2012 Health and Retirement Study data to estimate differences-in-differences models, we find that MML implementation leads to increases in labor supply among older adults along with improvement in health for older men and mixed health effects for women. These effects should be considered as policymakers determine how best to regulate access to medical marijuana. |
| JEL: | I10 I18 J20 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:22688&r=hea |
| By: | Adamson Muula; Joep van Oosterhout; Laura Derksen |
| Abstract: | The HIV epidemic in southern Africa has important consequences for economic development. The epidemic could be stopped by a universal test and treat policy, as antiretroviral drugs block the spread of the virus. However, demand for HIV testing and treatment are surprisingly low. This paper develops a model in which the decision to seek an HIV test is a signal of infection, and those who seek a test are subject to statistical discrimination from potential sexual partners. We evaluate an information experiment designed to test the theory, and find evidence that this form of discrimination is a significant barrier to HIV testing. In particular, we provide information at the community level on the public benefit of antiretroviral therapy: because the drugs prevent HIV transmission, a person who is tested and treated for HIV is a relatively safe sexual partner. This information reduces discrimination and increases HIV testing, with the strongest effects in communities where the new information becomes common knowledge. The results demonstrate that discrimination towards HIV positive individuals can be due to rational behavior by a misinformed public, and that providing new information can be an effective way to mitigate its effects. |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:feb:natura:00550&r=hea |
| By: | David M. Cutler; Wei Huang; Adriana Lleras-Muney |
| Abstract: | Using data covering over 100 birth-cohorts in 32 countries, we examine the short- and long-term effects of economic conditions on mortality. We find that small, but not large, booms increase contemporary mortality. Yet booms from birth to age 25, particularly those during adolescence, lower adult mortality. A simple model can rationalize these findings if economic conditions differentially affect the level and trajectory of both good and bad inputs into health. Indeed, air pollution and alcohol consumption increase in booms. In contrast, booms in adolescence raise adult incomes and improve social relations and mental health, suggesting these mechanisms dominate in the long run. |
| JEL: | H51 I1 I38 J10 N10 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:22690&r=hea |
| By: | Christel Vermeersch; Pablo Celhay; Paul Gertler; Paula Giavagnoli |
| Abstract: | We show that fixed costs of adjustment as opposed to low returns likely explain why better quality care practices diffuse slowly in the medical industry. Using a randomized field experiment conducted in Argentina, we find that temporary financial incentives paid to health clinics for the early initiation of prenatal care 'nudged' providers to test and develop new data driven strategies to locate and encourage likely pregnant women to seek care in the first trimester of pregnancy. These innovations raised the rate of early initiation of prenatal care by 34% while the incentives were being paid in the treatment period. We follow health clinics over time and find that this increase persisted for at least 24 months after the incentives ended. In the absence of incentives, even though it is in the clinics' interest to stimulate early initiation of care, the presence of hard to change habits and cost of experimentation made it too expensive to develop and implement new methods to increase early initiation of care. Despite the large increases in early initiation of prenatal care, we find no effects on health outcomes. |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:feb:natura:00537&r=hea |
| By: | Max, Wendy PhD; Sung, Hai-Yen PhD; Lightwood, James PhD |
| Keywords: | Medicine and Health Sciences, Social and Behavioral Sciences |
| Date: | 2016–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ctcres:qt4g6677fq&r=hea |
| By: | Max, Wendy PhD; Sung, Hai-Yen PhD; Lightwood, James PhD |
| Keywords: | Medicine and Health Sciences, Social and Behavioral Sciences |
| Date: | 2016–10–11 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ctcres:qt9w38h5rn&r=hea |
| By: | Marius Huguet (Univ Lyon, Université Lyon 2, F-69007 Lyon, France); Lionel Perrier (Université de Lyon, Lyon, F-69007, France ; Cancer Centre Léon Bérard; Lyon, F-69008, France ; CNRS, GATE Lyon Saint- Etienne, Ecully, F-69130, France); Olivia Ballyc (Cancer Centre Léon Bérard; Lyon, F-69008, France); Xavier Joutard (Grequam-UMR 7316, Aix-Marseille University, Marseille, France); Nathalie Havet (Université de Lyon, Lyon, F-69007, France ; CNRS, GATE Lyon St Etienne,F-69130 Ecully, France); Fadila Farsi (Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France); David Benayoun (Hospital Lyon Sud, Pierre-Bénite, France); Pierre de Saint Hilaire (University Hospital of Lyon, Department of medicine. Lyon, France); Dominique Beal Ardisson (Private Hospital Jean Mermoz, Lyon, France); Magali Morelle (Université de Lyon, Lyon, F-69007, France ; Cancer Centre Léon Bérard; Lyon, F-69008, France ; CNRS, GATE Lyon Saint- Etienne, Ecully, F-69130, France); LIsabelle Ray-Coquard (Univ Lyon, Leon Berard Cancer Centre , EA7425 HESPER, F-69008 Lyon, France) |
| Abstract: | Epithelial Ovarian Carcinoma (EOC) is a disease with poor prognosis, most often diagnosed at an advanced stage, thus necessitating aggressive and complex surgery. The aim of this study was to compare Progression Free Survival (PFS) at 1st line treatment of EOC patients treated in high vs low-volume hospitals. This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients treated in first line during 2012 in the Rhone-Alps Region of France. In order to control for selection bias, a multivariate analysis and the Inverse Probability Weighting (IPW) using the propensity score were adopted. An Adjusted Kaplan Meier Estimator (AKME) and a univariate Cox model in the weighted sample were then applied in order to determine the impact of the centralization of care on EOC. Patients treated in lower volume hospitals had a probability of relapse (including death) that was 1.5 times higher than for patients treated in higher volume hospitals (p=0.02). As reported in other countries, the concentration of care for EOC has a significant positive impact on patient outcomes. |
| Keywords: | Counterfactual; Disease management programme; France; Epithelial Ovarian Cancer; Propensity score; Centralization of care |
| JEL: | C14 I14 I18 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:gat:wpaper:1622&r=hea |
| By: | Yves-André FAURE |
| Abstract: | In the field of the fight against the HIV / AIDS substantial resources have been used regularly both in all of Brazil to Fortaleza. All these means affected populations more numerous and demographic cohorts constantly renewed and sexually active. One would therefore expect that all of these initiatives have had the effect of making effective incentives for voluntary practice test. However quantitative and qualitative researches shows that if the number of tests performed has steadily increased over time, they raise the reluctance persists continuously as in the general population as well as than in the social categories considered vulnerable because most exposed than others to the risk of being affected by HIV / AIDS.\r\nThe question suggested by this situation is to try to identify and characterize the factors that make intelligible the persistence of resistance to the voluntary practice test or, equivalently, to understand the limitations of the effectiveness of incentives to take the test. We question here especially the world of local institutions, public ones and those within the third sector, involved in the fight against HIV / AIDS. This institutional landscape, despite or because of its thickness and its complexity, presents a number of shortcomings, limitations, dysfunctions that tend to weaken the expected efficacy of the structures, reduce the universalizing objective of test campaigns, hinders the understanding of the information generated around this struggle by the people.\r\nThe survey results suggest that, in a context of individual and collective factors, maintaining these complex relationships, the local institutional apparatus, despite efforts to raise the level of participation in HIV testing, contributes to a climate of uncertainty and lack of knowledge about the existence and importance of the test. The overall incentive system in practice has not achieved the desired effectiveness. And the persistence of vulnerabilities and the survival of reluctance and resistance to HIV meet involuntary allies in the actual functioning of local institutions. |
| Keywords: | HIV / AIDS, resistance to HIV / AIDS tests, vulnerable groups, Brazil, Fortaleza, local public institutions, local civil organizations. |
| JEL: | D64 D73 H51 H75 I18 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:grt:wpegrt:2016-21&r=hea |
| By: | Timothy Halliday (Department of Economics, University of Hawaii); John Lynham (Department of Economics, University of Hawaii); Aureo de Paula (UCL, S~aoPauloSchoolofEconomics) |
| Abstract: | The negative consequences of long-term exposure to particulate pollution are well established but many studies find no effect of short-term exposure on health outcomes. The high correlation of industrial pollutant emissions complicates the estimation of the impact of individual pollutants on health. In this study, we use emissions from Kilauea volcano, which are uncorrelated with other pollution sources, to estimate the impact of pollutants on local emergency room (ER) admissions and a precise measure of costs. A one standard deviation increase in particulates leads to a 23-36% increase in expenditures on ER visits for pulmonary outcomes, mostly among the very young. Even in an area where air quality is well within the safety guidelines of the U.S. Environmental Protection Agency, this estimate is much larger than those in the existing literature on the short term effects of particulates. No strong effects for cardiovascular outcomes are found. |
| Keywords: | Pollution, Health, Volcano, Particulates, SO2 |
| JEL: | H51 I12 Q51 Q53 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:hai:wpaper:201620&r=hea |
| By: | Eileen Appelbaum |
| Abstract: | On Monday, September 26, private equity firm Cerberus Capital Management announced that Medical Properties Trust Inc. (MPT) would buy all of Steward Health Care’s hospital properties. The real estate investment firm agreed to pay $1.2 billion for the properties and a further $50 million for a 5 percent equity stake in the health care system. Still struggling financially after six years of private equity ownership, Steward will lease back the properties for its hospitals and other facilities, paying rent to MPT. The deal will pay back Cerberus’ initial investment in Steward and more, although the total amount the PE firm and its investors will receive has not been revealed. The deal will also pay down all of the company’s more than $400 million debt and provide a payoff for top executives. Steward will receive an undisclosed amount to try once again to revive its failed strategy to acquire additional hospitals outside of Massachusetts and grow into a national powerhouse. |
| JEL: | G G2 G28 G3 G38 |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:epo:papers:2016-18&r=hea |
| By: | Escobal, Javier (Grupo de Análisis para el Desarrollo (GRADE)); Benites, Sara (Grupo de Análisis para el Desarrollo (GRADE)) |
| Abstract: | The paper explores whether or not there is evidence for a causal link between maternal depression symptomatology and child wellbeing. Considering three rounds of data from the Peruvian Young Lives (PYL) longitudinal study sample, the paper explores this relationship by using the SRQ-20 instrument, which is typically used as a screening tool for common mental disorders, and by collecting information about mothers’ socioeconomic characteristics and their children’s well-being outcomes. We found a low correlation of SRQ-20 scores across rounds, suggesting that the instrument may be capturing short-term depression or anxiety symptoms rather than chronic mental illness. Furthermore, the SRQ-20 instrument is correlated both with characteristics of the mother and with child well-being indicators, which change over time (nutritional, health, and educational outcomes as well as feelings and attitudes). The study shows that the magnitude of the relationship between the mental health indicator and the child well-being outcomes may be severely biased in a regression that neglects the possible endogeneity of the mental health indicator. Finally, besides maternal age, education, and ethnicity background, socioeconomic shocks are a key determinant of both depression and anxiety symptoms as well as of child well-being outcomes in the first year following birth of the child (PYL round one), where SRQ-20 scores were the highest. |
| Keywords: | Salud mental, Análisis causal, Perú, SRQ-20, Mental health, Causation, Causal analysis, Inference, Peru |
| JEL: | I10 I30 |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:gad:avance:0023&r=hea |
| By: | Rowena Jacobs (Centre for Health Economics, University of York, York, UK.); Martin Chalkley (Centre for Health Economics, University of York, York, UK.); María José Aragón (Centre for Health Economics, University of York, York, UK.); Jan R. Böhnke (HYMS and Department of Health Sciences, University of York, York, UK); Mike Clark (PSSRU, London School of Economics, London, UK); Valerie Moran (Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK); Simon Gilbody (2HYMS and Department of Health Sciences, University of York, York, UK) |
| Abstract: | The primary method of funding NHS mental health services in England has been block contracts between commissioners and providers, with negotiations based on historical expenditure. There has been an intention to change the funding method to make it similar to that used in acute hospitals (called the National Tariff Payment System or NTPS, formerly known as Payment by Results (PbR)) where fixed prices are paid for each completed treatment episode. Within the mental health context this funding approach is known as episodic payment. Patients are categorised into groups with similar levels of need, called clusters. The mental health clustering tool (MHCT) provides a guide for assignment of patients to clusters. Fixed prices could then be set for each cluster and providers would be paid for the services they deliver within each cluster based on these fixed prices, although the emphasis to date has been on local pricing. For this episodic payment system to work, the MHCT needs to assign patients to clusters, such that they are homogenous in terms of 1) patient need, and 2) resource use. |
| Keywords: | Mental Health, Payment System, National Tariff Payment System (NTPS), episodic payment, Mental Health Clustering Tool (MHCT), Mental Health Services Dataset (MHSDS), Health of the Nation Outcome Scale (HoNOS). |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:137cherp&r=hea |
| By: | Kieron Barclay (Max Planck Institute for Demographic Research, Rostock, Germany); Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany) |
| Abstract: | As parental ages at birth continue to rise, concerns about the effects of fertility postponement on offspring are increasing as well. Advanced maternal and paternal ages have been associated with a range of negative health outcomes for offspring, including decreased longevity. The literature, however, has neglected to examine the benefits of being born at a later date. We analyse mortality among 1.9 million Swedish men and women born in 1938-1960, and use a sibling comparison design that accounts for all time invariant factors shared by the siblings. We show that there are no adverse effects of childbearing at advanced maternal ages, and that offspring mortality declines monotonically with advancing paternal age. This positive effect is attributable to the increase in life expectancy over successive birth cohorts, which dominates over individual-level factors that may have negative effects on offspring longevity, such as reproductive ageing. |
| Keywords: | Sweden, ageing, longevity, mortality, parents, reproduction |
| JEL: | J1 Z0 |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:dem:wpaper:wp-2016-011&r=hea |
| By: | Lightwood, James PhD; Glantz, Stanton A PhD |
| Keywords: | Medicine and Health Sciences, Social and Behavioral Sciences |
| Date: | 2016–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ctcres:qt9g738223&r=hea |
| By: | Lauren Hoehn Velasco (Boston College) |
| Abstract: | This study estimates the impact of an American rural public health program on child mortality over 1908 to 1933. Due to the absence of sanitation and child-oriented health services outside of urban areas, public and private agencies sponsored county-level health departments (CHDs) throughout the US. Variation in the location and timing of the CHDs identifies improvements in population health, which are captured entirely by children. Mortality declines emerge in infancy and gradually decay through childhood. Adversely affected areas with either an ample population of nonwhites or greater levels of preexisting infectious disease undergo larger reductions in mortality. |
| Keywords: | mortality, health, development, rural population, demographic transition |
| JEL: | I15 I18 N31 N32 O12 O18 |
| Date: | 2016–10–01 |
| URL: | http://d.repec.org/n?u=RePEc:boc:bocoec:919&r=hea |
| By: | Joan Costa-Font; Sergi Jiménez-Martín; Cristina Vilaplana |
| Abstract: | The expansion of long-term care (LTC) coverage may improve health system efficiency by reducing hospitalisations (bed-blocking), and pave the way for the implementation of health and social care coordination plans. We draw upon the quasi-experimental evidence from the main expansion of long term care increase subsidisation in Spain in 2007 to examine the causal effect of the expansion of LTC subsidisation and coordination on hospitalisations (both on the internal and external margin) and the hospital length of stay. In addition, we examine the 2012 austerity budget cuts that reduced the subsidy. We find robust evidence of a reduction in hospitalisations and the length of stay after the expansion of LTC subsidisation. However, the reduction in hospitalisations is heterogeneous to the existence of health and social care coordination plans and type of subsidy. Overall, we estimate savings related to hospitalisations of up to 11% of total hospital costs. Consistently, subsidy reduction is found to attenuate bed-blocking gains. |
| Keywords: | hospitalisation, long-term care reform, Spain, bed-blocking, hurdle Poisson model. |
| JEL: | I18 J14 H53 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:upf:upfgen:1535&r=hea |
| By: | Joan Costa-Font; Sergi Jiménez-Martín; Cristina Vilaplana-Prieto |
| Abstract: | We still know little about what motivates the informal care arrangements provided in old age. The introduction of demand-side subsidies such as unconditional caregiving allowances (cash benefits designed either to incentivize the provision of informal care, or compensate for the loss of employment of informal caregivers) provide us with an opportunity to gain a further understanding of the matter. In this paper we exploit a quasi-natural experiment to identify the effects of the inception in 2007 (and its reduction in 2012) of a universal caregiving allowance on both the supply of informal care, and subsequent intergenerational transfer flows. We find evidence of a 30% rise in informal caregiving after the subsidy, and an increase (reduction) in downstream (upstream) intergenerational transfers of 29% (and 15%). Estimates were heterogeneous by income and wealth quantiles. Consistently, the effects were attenuated by a subsequent policy intervention; the reduction of the subsidy amidst austerity cuts in 2012. |
| Keywords: | caregiving, intergenerational transfers, difference-in-differences, long-term care, family transfers, exchange motivation, caregiving allowances, demand-side subsidies. |
| JEL: | I18 D14 G22 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:upf:upfgen:1537&r=hea |
| By: | Pierre Picard (Ecole Polytechnique [Palaiseau] - Ecole Polytechnique) |
| Abstract: | In the linear coinsurance problem, examined Örst by Mossin (1968), a higher risk aversion with respect to wealth in the sense of ArrowPratt implies a higher optimal coinsurance rate. We show that this property does not hold for health insurance under ex post moral hazard, i.e., when illness severity cannot be observed by insurers and policyholders decide on their health expenditures. The optimal coinsurance rate trades o§ a risk sharing e§ect and an incentive e§ect, both related to risk aversion. |
| Keywords: | Health insurance, ex post moral hazard, coinsurance |
| Date: | 2016–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-01353597&r=hea |
| By: | Johanna Etner (EconomiX - UPOND - Université Paris Ouest Nanterre La Défense - CNRS - Centre National de la Recherche Scientifique, Climate Economics Chair - University Paris Dauphine); Natacha Raffin (EconomiX - UPOND - Université Paris Ouest Nanterre La Défense - CNRS - Centre National de la Recherche Scientifique, Climate Economics Chair - University Paris Dauphine); Thomas Seegmuller (AMSE - Aix-Marseille School of Economics - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université - ECM - Ecole Centrale de Marseille - EHESS - École des hautes études en sciences sociales) |
| 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 |
| Date: | 2016–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-01346098&r=hea |
| By: | Pierre Martinon (Commands - Control, Optimization, Models, Methods and Applications for Nonlinear Dynamical Systems - CMAP - Centre de Mathématiques Appliquées - Ecole Polytechnique - Polytechnique - X - CNRS - Centre National de la Recherche Scientifique - Inria Saclay - Ile de France - Inria - Institut National de Recherche en Informatique et en Automatique - ENSTA ParisTech UMA - Unité de Mathématiques Appliquées - Univ. Paris-Saclay, ENSTA ParisTech - École Nationale Supérieure de Techniques Avancées - Univ. Paris-Saclay, ENSTA ParisTech - École Nationale Supérieure de Techniques Avancées - Polytechnique - X - CNRS - Centre National de la Recherche Scientifique); Pierre Picard (Ecole Polytechnique [Palaiseau] - Ecole Polytechnique); Anasuya Raj (Ecole Polytechnique [Palaiseau] - Ecole Polytechnique) |
| Abstract: | We analyze the design of optimal medical insurance under ex post moral hazard, i.e., when illness severity cannot be observed by insurers and policyholders decide on their health expenditures. We characterize the trade-o§ between ex ante risk sharing and ex post incentive compatibility, in an optimal revelation mechanism under hidden information and risk aversion. We establish that the optimal contract provides partial insurance at the margin, with a deductible when insurersí rates are a§ected by a positive loading, and that it may also include an upper limit on coverage. We show that the potential to audit the health state leads to an upper limit on out-of-pocket expenses. |
| Keywords: | background risk, optimal control,health insurance, ex post moral hazard, audit |
| Date: | 2016–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-01348551&r=hea |
| By: | Uzzoli, Annamária |
| Abstract: | Since the middle of the 1990s, Hungary has seen substantial increases in life expectancy. Despite this improvement, many health outcomes remain poor, placing Hungary among the countries in the European Union with worse health status. Based on the general state of health of the population, Hungary belongs with the middle-ground countries of the world. Majority of the health indicators are worse than the average of OECD’s values, and this is especially true regarding the mortality rate of the middle-aged male population. The main objective of the study is to investigate health inequalities with regional differences in Hungary. It is still worth explaining how health inequalities and inequities have changed in terms of space and time after the Hungarian economic and political transition. The territorial range of the study includes the national and regional levels (NUTS3) with the micro-regional level (LAU1). The statistical analysis is based on the use of life expectancy in addition to some mortality indicators. Data for 1990–2014 were examined to define health effects of the Hungarian transition as well as the consequences of the latest economic crisis. Improvements in health along with growth of regional inequalities were found in Hungary since the second half of the 1990s. Larger relative inequalities were observed between Western and Eastern Hungary based on its higher and lower income. Gender differences are also significant in life expectancy. Poor health among the unemployed people was detected, which is a socio-economic effect of the latest economic crisis. In Hungary, income-related health inequalities persist; however, their degree has changed in space and time over the last 25 years. For a comprehensive description of health in Hungary, assessment of the poor health of lower income social groups and the regional level of health inequalities is needed. |
| Keywords: | health inequalities, health transition, regional differences, Hungary |
| JEL: | I14 I15 R10 R11 R13 |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:74504&r=hea |
| By: | Carine Milcent (PSE - Paris School of Economics, PSE - Paris-Jourdan Sciences Economiques - CNRS - Centre National de la Recherche Scientifique - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENS Paris - École normale supérieure - Paris - École des Ponts ParisTech (ENPC), CEPREMAP - Centre pour la recherche économique et ses applications) |
| Abstract: | How has this administrative change affcted the healthcare providers behaviour? Using a unique longitudinal database with 145 million stays, I study the dependence of the severity classification associated with hospital stays on a financial incentive, as well as the resulting budgetary reallocations. The classification of diagnosis-related groups (DRGs) in France changed in 2009. The number of groups was multiplied by 4. Controlling for pathology indicators and hospital fixed e↵ects, I unambiguously demonstrate that a finer classification led to an “upcoding” of stays. Because of a fixed annual budget at the national level, these results directly imply that the upcoding led to a budget reallocation which increased the share of health spending that went to for-profit hospitals, at the expense of public nonresearch hospitals. This budget reallocation did not correspond to any change in the actual production of care. |
| Keywords: | Hospital stays,Diagnosis-related groups (DRGs),Upcoding,heterogeneity in responses |
| Date: | 2016–07 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:halshs-01340557&r=hea |
| By: | Peter Dolton; Vikram Pathania |
| Abstract: | Can increased access to GPs reduce overcrowding in hospitals' Accidents & Emergency departments? Research by Peter Dolton and Vikram Pathania assesses whether weekend GP opening hours introduced in 2013 in four surgeries in London made patients less likely to use A&E services. |
| Keywords: | National Health Service, UK health service, doctors |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:cep:cepcnp:482&r=hea |