nep-hea New Economics Papers
on Health Economics
Issue of 2016‒10‒23
thirty-two papers chosen by
Yong Yin
SUNY at Buffalo

  1. Health Care Adherence and Personalized Medicine By Mark Egan; Tomas Philipson
  2. Hospital policy and productivity: Evidence from German states By Karmann, Alexander; Roesel, Felix
  3. Do you have to win it to fix it? A longitudinal study of lottery winners and their health care demand By Terence C. Cheng; Joan Costa-i-Font; Nattavudh Powdthavee
  4. Late-in-Life Risks and the Under-Insurance Puzzle By John Ameriks; Joseph Briggs; Andrew Caplin; Matthew D. Shapiro; Christopher Tonetti
  5. Why Don’t Commercial Health Plans Use Prospective Payment? By Laurence Baker; M. Kate Bundorf; Aileen Devlin; Daniel P. Kessler
  6. Behavioral Welfare Economics and FDA Tobacco Regulations By Philip DeCicca; Donald S. Kenkel; Feng Liu; Hua Wang
  7. The effects of industrial work on income and health: Experimental evidence from Ethiopia By Blattman, Christopher; Dercon, Stefan
  8. The Impact of Stock Market Fluctuations on the Mental and Physical Wellbeing of Children By Chad Cotti; David Simon
  9. Patient Cost Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design By Hsing-Wen Han; Hsien-Ming Lien; Tzu-Ting Yang
  10. Cost-Sharing and Drug Pricing Strategies : Introducing Tiered Co-Payments in Reference Price Markets By Herr, Annika; Suppliet, Moritz
  11. The organization of working time and its effects in the health services sector : a comparative analysis of Brazil, South Africa and the Republic of Korea By Messenger, Jon C.; Vidal, Patricia.
  12. The effects of non-standard forms of employment on worker health and safety By Quinlan, Michael.
  13. Long term care protection for older persons : a review of coverage deficits in 46 countries By Scheil-Adlung, Xenia.
  14. Is the Distribution of Cardiovascular Risks Really Improving ? A Robust Analysis for France. By Fatiha Bennia; Nicolas Gravel
  15. Do Doctors Prescribe Antibiotics Out of Fear of Malpractice? By Panthöfer, S.
  16. Fertility and HIV risk in Africa By Yao, Yao
  17. Investigating the determinants of smoking cessation: from the desire to quit to the effective attempt By Marysia Ogrodnik
  18. Is there a Retirement-Health Care utilization puzzle? Evidence from SHARE data in Europe. By Eve Caroli; Claudio Lucifora; Daria Vigani
  19. Impact of Paid Family Leave of California on Delayed Childbearing and on Infant Health Outcomes By Sara Oloomi
  20. The Role of Indicators in Policy Formulation: The Case of Maternal and Child Health Care Policy in the Philippines By Cuenca, Janet S.
  21. Breastfeeding and Early Childhood Outcomes: Is There a Causal Relationship? By Masayuki Onda
  22. Counterfactual approach with survival or time to event outcomes: An application to an exhaustive cohort of Epithelial Ovarian Carcinoma in the Rhône-Alps region of France By Marius Huguet; Lionel Perrier; Olivia Ballyc; Xavier Joutard; Nathalie Havet; Fadila Farsi; David Benayoun; Pierre De Saint Hilaire; Dominique Beal Ardisson; Magali Morelle; Isabelle Ray-Coquard
  23. On the Road to Universal Children's Coverage: A Final Update on the KidsWell Campaign (Issue Brief) By Victoria Peebles; Sheila Hoag; Michaella Morzuch; Linda Barterian; Debra Lipson
  24. Calorie Overestimation Bias and Fast Food Products: The Effects of Calorie Labels on Perceived Healthiness and Intent to Purchase By Simon Hedlin
  25. Supporting Advocacy to Achieve Universal Children's Health Coverage: Final Report on the KidsWell Campaign By Victoria Peebles; Sheila Hoag; Michaella Morzuch; Linda Barterian; Debra Lipson
  26. Moving the Needle on Health Insurance Coverage: Evaluation of the Cities Expanding Health Access for Children and Families Project By Michaella Morzuch; Sheila Hoag
  27. Cost of illness for outpatients attending public and private hospitals in Bangladesh By Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff
  28. Estimating the Heterogeneous Welfare Effects of Choice Architecture: An Application to the Medicare Prescription Drug Insurance Market By Jonathan D. Ketcham; Nicolai V. Kuminoff; Christopher A. Powers
  29. What is the Added Value of Preschool? Long-Term Impacts and Interactions with a Health Intervention By Rossin-Slater, Maya; Wüst, Miriam
  30. Dynamics in Health and Employment: Evidence from Indonesia By Mani, Subha; Mitra, Sophie; Sambamoorthi, Usha
  31. Parents' education and child body weight in France: The trajectory of the gradient in the early years By Bénédicte H. Apouey; Pierre-Yves Geoffard
  32. HIV and Rational risky behaviors: a systematic review of published empirical literature (1990-2013) By Marlène Guillon; Josselin Thuilliez

  1. By: Mark Egan (University of Chicago); Tomas Philipson (University of Chicago Harris School)
    Abstract: Non-adherence in health care results when a patient does not initiate or continue care that a provider has recommended. Previous research identifies non-adherence as a major source of waste in US health care, totaling approximately 2.3% of GDP, and has proposed a plethora of interventions to raise adherence. However, health economics provides little explicit analyses of the important dynamic demand behavior that drives non-adherence, and it is often casually attributed to uninformed patients. We argue that whereas providers may be more informed about the population-wide effects of treatments, patients are more informed about the individual-specific value of treatment. We interpret a patient’s decision to adhere to a treatment regime as an optimal stopping problem in which patients learn the value of a treatment through treatment experience. We derive strong positive and normative implications resulting from interpreting non-adherence as an optimal stopping problem. Our positive analysis derives an “adherence survival function,†depicting the share of patients still on treatment as a function of time, and predicts how various observable factors alter adherence. Our normative analysis derives the efficiency effects of non-adherence and the conditions under which adherence is too high or low. We consider the efficiency implications of this analysis for common adherence interventions. We argue that personalized medicine is intimately linked to adherence issues. It replaces the learning through treatment experience with a diagnostic test, and thereby speeds up the learning process and cuts over-adherence and raises under-adherence. We assess the quantitative implications of our analysis by calibrating the degree of over- and under-adherence for one of the largest US drug categories: cholesterol-reducing drugs. Contrary to frequent normative claims of under-adherence, our estimates suggest the efficiency loss from over-adherence is over 80% larger than from under-adherence, even though only 43% of patients fully adhere.
    Date: 2016
  2. By: Karmann, Alexander; Roesel, Felix
    Abstract: Total factor productivity (TFP) growth allows for additional health care services under restricted resources. We examine whether hospital policy can stimulate hospital TFP growth. We exploit variation across German federal states in the period 1993 to 2013. State governments decide on hospital capacity planning (number of hospitals, departments and beds), ownership, medical students, and hospital investment funding. We show that TFP growth in German hospital care reflects quality improvements rather than increases in output volumes. Second-stage regression results indicate that reducing the length of stay is generally a proper way to foster TFP growth. The effects of other hospital policies depend on the reimbursement scheme: under activity-based (DRG) hospital funding, scope-related policies (privatization, specialization) come with TFP growth. Under fixed daily rate funding, scale matters to TFP (hospital size, occupancy rates). Differences in capitalization in East and West Germany allows to show that deepening capital may enhance TFP growth if capital is scarce. We also show that there is less scope for hospital policies after large-scale restructurings of the hospital sector.
    Keywords: Hospitals,TFP,Productivity,Policy,Germany
    JEL: I11 I18 O47
    Date: 2016
  3. By: Terence C. Cheng; Joan Costa-i-Font; Nattavudh Powdthavee
    Abstract: We exploit lottery wins to investigate the effects of exogenous changes to individuals' income on the utilization of health care services, and the choice between private and public health care in the United Kingdom. Our empirical strategy focuses on lottery winners in an individual fixed effects framework and hence the variation of winnings arises from within-individual differences in small versus large winnings. The results indicate that lottery winners with larger wins are more likely to choose private health services than public health services from the National Health Service. The positive effect of wins on the choice of private care is driven largely by winners with medium to large winnings (win category > $500 (or US$750); mean = $1922:5 (US$2,893.5), median = $1058:2 (US$1592.7)). There is some evidence that the effect of winnings vary by whether individuals have private health insurance. We also find weak evidence that large winners are more likely to take up private medical insurance. Large winners are also more likely to drop private insurance coverage between approximately 9 and 10 months earlier than smaller winners, possibly after their winnings have been exhausted. Our estimates for the lottery income elasticities for public health care (relative to no care) are very small and are not statistically distinguishable from zero; those of private health care range from 0 { 0.26 for most of the health services considered, and 0.82 for cervical smear.
    Keywords: Lottery wins; Health care; Income elasticity; Public-private
    JEL: D1 H42 I11
    Date: 2016
  4. By: John Ameriks; Joseph Briggs; Andrew Caplin; Matthew D. Shapiro; Christopher Tonetti
    Abstract: Individuals face significant late-in-life risks, including needing long-term care (LTC). Yet, they hold little long-term care insurance (LTCI). Using both “strategic survey questions,” which identify preferences, and stated demand questions, this paper investigates the degree to which a fundamental lack of interest and poor product features determine low LTCI holdings. It estimates a rich set of individual-level preferences and uses a life-cycle model to predict insurance demand, finding that better insurance would be far more widely held than are products in the market. Comparing stated and model-predicted demand shows that flaws in existing products provide a significant, but partial, explanation for this under-insurance puzzle.
    JEL: D14 D91 E21 G22 H31 I13 J14
    Date: 2016–10
  5. By: Laurence Baker; M. Kate Bundorf; Aileen Devlin; Daniel P. Kessler
    Abstract: One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. “Prospective” payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System and commercial insurance plans covering the nonelderly through the Health Care Cost Institute to measure the extent of prospective payment in 303 metropolitan statistical areas during 2008-12. We report three key findings. First, commercial insurance payments are less prospective than Medicare payments. Second, the extent of prospective payment in commercial insurance varies more than in Medicare, both across hospitals and geographic areas. Third, differences in prospective payment across hospitals are positively associated with the extent of hospital competition, the share of the hospital’s commercially insured patients covered by managed-care insurance, and the share of the hospital’s patients covered by Medicare’s Prospective Payment System.
    JEL: I1 I13
    Date: 2016–10
  6. By: Philip DeCicca; Donald S. Kenkel; Feng Liu; Hua Wang
    Abstract: The U.S. 2009 Tobacco Control Act opened the door for new anti-smoking policies by giving the Food and Drug Administration broad regulatory authority over the tobacco industry. We develop a behavioral welfare economics approach to conduct cost-benefit analysis of FDA tobacco regulations. We use a simple two-period model to develop expressions for the impact of tobacco control policies on social welfare. Our model includes: nudge and paternalistic regulations; an excise tax on cigarettes; internalities created by period 1 versus period 2 consumption; and externalities from cigarette consumption. Our analytical expressions show that in the presence of uncorrected externalities and internalities, a tax or a nudge to reduce cigarette consumption improves social welfare. In sharp contrast, a paternalistic regulation might either improve or worsen social welfare. Another important result is that the social welfare gains from new policies do not only depend on the size of the internalities and externalities, but also depend on the extent to which current policies already correct the problems. We link our analytical expressions to the graphical approach used in most previous studies and discuss the information needed to complete cost-benefit analysis of tobacco regulations. Finally, we use our model as a framework to re-examine the evidence base regarding the size of the relevant internalities.
    JEL: I0 I18 I28
    Date: 2016–10
  7. By: Blattman, Christopher; Dercon, Stefan
    Abstract: Activists criticize the poor wages and working conditions in industrial firms. Others counter that these industrial jobs offer wage premiums and steady hours. We worked with five Ethiopian industrial firms to randomize entry-level applicants to one of three treatment arms: a job offer; a control group; or an improved self-employment option, $300 grants plus business training. Industrial jobs offered more hours than the informal sector but lower wages, and had little impact on incomes after a year. Most applicants quit the sector quickly, finding industrial jobs unpleasant and risky. Indeed, serious health problems rose one percentage point for every month of industrial work. Meanwhile, the grants stimulated self-employment, raising earnings by 33%. On balance, these Ethiopian industrial jobs appear to be unremarkable low-skill employment options, with serious health risks, that poor people take to cope with bad shocks and avoid when informal employment options are available.
    Keywords: cash transfers; employment; entrepreneurship; factories; field experiment; wage labor
    JEL: F16 J24 J81 O14 O17
    Date: 2016–10
  8. By: Chad Cotti (University of Wisconsin Oshkosh); David Simon (University of Connecticut)
    Abstract: The stock market crash of 2008 caused a severe impact to households. Earlier research has explored the impacts of a stock market crash on life wellbeing, psychological stress, and adult health behaviors. We extend this literature by documenting impacts of stock market fluctuations on a range of child outcomes; including effects on both mental and physical health. We show a negative effect of a market crash on hospitalizations, child reported health status, sick days from school, and emotional difficulties. Both graphical and regression based analysis reveal that our results are not driven by a pre-trend of declining child health before the market crash.
    Date: 2016–06
  9. By: Hsing-Wen Han (Department of Accounting, Tamkang University); Hsien-Ming Lien (Department of Public Finance, National Chengchi University); Tzu-Ting Yang (Institute of Economics, Academia Sinica, Taipei, Taiwan)
    Abstract: This paper exploits longitudinal insurance claims data and a cost-sharing subsidy that has exempted copayment and coinsurance of healthcare services for children under the age of 3 in Taiwan. We use a regression discontinuity design to estimate its effect on children’s healthcare utilization. Our results show that cost-sharing subsidy significantly increases the utilization of outpatient care, especially low-value care at high-cost hospitals. In contrast, the utilization of inpatient care is price insensitive. Finally, we find that a lower level of cost-sharing has little impact on children’s health.
    Date: 2016–10
  10. By: Herr, Annika; Suppliet, Moritz (Tilburg University, Center For Economic Research)
    Abstract: Health insurances curb price insensitive behavior and moral hazard of insureds through different types of cost-sharing, such as tiered co-payments or reference pricing. This paper evaluates the effect of newly introduced price limits below which drugs are exempt from co-payments on the pricing strategies of drug manufacturers in reference price markets. We exploit quarterly data on all prescription drugs under reference pricing available in Germany from 2007 to 2010. To identify causal effects, we use instruments that proxy regulation intensity. A difference-in-differences approach exploits the fact that the exemption policy was introduced successively during this period. Our main results first show that the new policy led generic firms to decrease prices by 5 percent on average, while brand-name firms increase prices by 7 percent after the introduction. Second, sales increased for exempt products. Third, we find evidence that differentiated health insurance coverage (public versus private) explains the identifed market segmentation.
    Keywords: pharmaceutical prices; cost-sharing; co-payments; reference pricing; regulation; firm behavior; health insurance
    JEL: I1 L11
    Date: 2016
  11. By: Messenger, Jon C.; Vidal, Patricia.
    Abstract: This study of the organization of working time and its effects in the health services sector was managed by Jon Messenger, ILO Inclusive Labour Markets, Labour Relations and Working Conditions Branch (INWORK), in collaboration with Christiane Wiskow, ILO Sectoral Activities Department (SECTOR). Research assistance for the preparation of this report synthesizing the findings of the country case studies conducted in Brazil, the Republic of Korea, and South Africa was provided by Patricia Vidal, including a desk review and qualitative analysis of the effects of working time arrangements on workers' well-being and individual and organizational performance.
    Keywords: arrangement of working time, health service, medical personnel, hours of work, work life balance, comparative study, Brazil, Korea R, South Africa, aménagement du temps de travail, service de santé, personnel médical, durée du travail, conciliation travail-vie personnelle, étude comparative, Brésil, Corée R, Afrique du Sud, ordenamiento del tiempo de trabajo, servicio de salud, personal médico, horas de trabajo, conciliación vida familiar y laboral, estudio comparativo, Brasil, Corea R, Sudáfrica
    Date: 2015
  12. By: Quinlan, Michael.
    Abstract: The past 40 years have witnessed significant changes to work arrangements globally. Overall, the changes have been characterised by less contract duration and job security, more irregular working hours (both in terms of duration and consistency), increased use of third parties (temporary employment agencies), growth of various forms of dependent self-employment (like subcontracting and franchising) and also bogus/informal work arrangements (i.e. arrangements deliberately outside the regulatory framework of labour, social protection and other laws).
    Keywords: precarious employment, temporary employment, informal employment, self employment, occupational health, occupational safety, working conditions, hours of work, employment policy, emploi précaire, emploi temporaire, emploi informel, travail indépendant, santé au travail, sécurité du travail, conditions de travail, durée du travail, politique de l'emploi, empleo precario, empleo temporal, empleo informal, trabajo por cuenta propia, salud en el trabajo, seguridad en el trabajo, condiciones de trabajo, horas de trabajo, política de empleo
    Date: 2015
  13. By: Scheil-Adlung, Xenia.
    Abstract: This paper: (i) examines long-term care (LTC) protection in 46 developing and developed countries covering 80 per cent of the world’s population; (ii) provides (data on LTC coverage for the population aged 65+; (iii) identifies access deficits for older persons due to the critical shortfall of formal LTC workers; (iv) presents the impacts of insufficient public funding, the reliance on unpaid informal LTC workers and high out-of-pocket payments (OOP); and (v) calls for recognizing LTC as a right, and mainstreaming LTC as a priority in national policy agendas given the benefits in terms of job creation and improved welfare of the population.
    Keywords: social protection, long term care, older people, elder care, care worker, working conditions, social policy, public expenditure, deficit, developed countries, developing countries, protection sociale, soins de longue durée, personnes âgées, soins aux personnes âgées, personnel soignant, conditions de travail, politique sociale, dépenses publiques, déficit, pays développés, pays en développement, protección social, cuidados de larga duración, personas de edad avanzada, asistencia a las personas de edad avanzada, cuidador, condiciones de trabajo, política social, gasto público, déficit, países desarrollados, países en desarrollo
    Date: 2015
  14. By: Fatiha Bennia (SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants - Université de la Méditerranée - Aix-Marseille 2 - AMU - Aix Marseille Université - APHM - Assistance Publique - Hôpitaux de Marseille); Nicolas Gravel (AMSE - Aix-Marseille School of Economics - EHESS - École des hautes études en sciences sociales - Centre national de la recherche scientifique (CNRS) - Ecole Centrale Marseille (ECM) - AMU - Aix Marseille Université)
    Abstract: In this paper, we appraise the recent evolution of the distribution of individuals’ risk of cardiovascular diseases (CVD) in France among both men and women using new normative criteria. An individual risk of CVD is described by a probability of getting such a disease. Building on the framework of Gravel and Tarroux (2015), we assume that individuals, who differ by their income, have Von Neuman-Morgenstern (VNM) preferences over such risks. We appeal to Harsanyi’s aggregation theorem to provide empirically implementable dominance criteria that coincide with the unanimity, taken over a large class of such individual preferences, of anonymous and Pareto-inclusive VNM social rankings of distributions of individuals’ risk of CVD. The implementable criteria that we obtain are Sequential headcount poverty dominance and Sequential headcount affluence dominance. We apply these criteria to the distribution of cardiovascular risks among French men and women on the 2006-2010 period. Probabilities of CVD are assigned to individuals on the basis of a logit model estimated on both the men and the women samples for each of the two years. Our main empirical result is that men and women were differently affected by evolution in the distribution of CVD risks between 2006 and 2010. Specifically, the distribution improved for women but did not improve for men.
    Keywords: ex ante social welfare,risk,dominance,state-dependent expected utility,poverty,health,cardiovascular diseases
    Date: 2016–05
  15. By: Panthöfer, S.
    Abstract: This paper investigates whether doctors prescribe antibiotics to protect themselves against potential malpractice claims. Using data from the National Ambulatory Medical Care Survey on more than half a million outpatient visits between 1993 and 2011, I find that doctors are 6% less likely to prescribe antibiotics after the introduction of a cap on noneconomic damages. Over 140 million discharge records from the Nationwide Inpatient Sample do not reveal a corresponding change in hospital stays for conditions that can potentially be avoided through antibiotic use in the outpatient setting. These findings, as well as a stylized model of antibiotic prescribing under the threat of malpractice, suggest that liability-reducing tort reforms can decrease the amount of antibiotics that are inappropriately prescribed for defensive reasons.
    Keywords: antibiotic misuse; antibiotic resistance; liability pressure; defensive medicine;
    JEL: I11 I18 K13
    Date: 2016–09
  16. By: Yao, Yao
    Abstract: This paper examines the role of social and cultural norms regarding fertility in women’s HIV risk in Sub-Saharan Africa. Fertility, or the ability to bear children, is highly valued in most African societies, and premarital fertility is often encouraged in order to facilitate marriage. This, however, increases women’s exposure to HIV risk by increasing unprotected premarital sexual activity. I construct a lifecycle model that relates a woman’s decisions concerning sex, fertility and education to HIV risk. The model is calibrated to match Kenyan women’s data on fertility, marriage and HIV prevalence. Quantitative results show that fertility motives play a substantial role in women’s, especially young women’s, HIV risk. If premarital births did not facilitate marriage, the HIV prevalence rate of young women in Kenya would be one-third lower. Policies that subsidize income, education, and HIV treatment are evaluated. I find that education subsidy would reduce young women’s HIV risk most effectively by raising the opportunity cost of premarital childrearing.
    Keywords: HIV, Fertility, Africa, Women's health,
    Date: 2016
  17. By: Marysia Ogrodnik (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Smoking behavior involves complex mechanisms such as addiction (physical and psychological dependence, self-control, social smoking) and smoking related perceptions (self-exempting beliefs ans smoking norms). The latter evolve through consumption career described by the stages of change. Those effects are tested on a sample of French smokers who completed an online-survey. A first model tests the role of addiction on the motivation to quit. The results show a strong relationship: physical and psychological dependence are positively related to the motivation to quit, as self-control is negatively related. Moreover, as cigarette consumption becomes more anchored in everyday life and more solitary, reported motivation to quit increases. The second model, studies the relationship between smoking related perceptions and motivation to quit. Results show that smoking denormalization beliefs increase, and self-exempting beliefs decrease across the smoking career. In order to re-establish smokers' self-control, public policies should act on physical dependence (by helping consumers to adopt a smoking cessation strategy through the funding of different kind of treatments), but also on environmental cues that trigger the desire to smoke (by limiting them). The second possible strategy is to act on the relationship between smoking-related beliefs and the motivation to quit by promoting nudges, normative change, and moderate fear-appealing campaigns associated to high levels of efficacy and self-efficacy.
    Keywords: addiction,motivation,self-control,smoking,stages of change
    Date: 2016–07
  18. By: Eve Caroli; Claudio Lucifora (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore); Daria Vigani (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore)
    Abstract: We investigate the causal impact of retirement on health care utilization. Using SHARE data (from 2004 to 2013) for 10 European countries, we show that health care utilization increases when individuals retire. This is true both for the number of doctor’s visits and for the intensity of medical care use (defined as the probability of going more than 4 times a year to the doctor’s). This increase turns out to be driven by visits to general practitioners’, while specialists’ visits are not affected. We also find that the impact of retirement on health care utilization is significantly stronger for workers retiring from jobs characterized by long hours worked - more than 48 hours a week and/or being in the 5th quintile of the distribution of hours worked. This suggests that at least part of the increase in medical care use following retirement is due to the decrease in the opportunity cost of time faced by individuals when they retire.
    Keywords: Retirement, Health, Health Care Utilization.
    JEL: J26 I10 C26
    Date: 2016–10
  19. By: Sara Oloomi
    Abstract: This paper investigates the impact of the Paid Family Leave (PFL) Act of California on the timing of first births for mothers, as well as infant health outcomes. Using a Difference in Difference (DID) methodology and Vital Statistics data from National Center for Health Statistics (NCHS), I find that PFL of California reduces birth delay by encouraging women over 35 years old to have their first child 2 years earlier. This policy improves infant health outcomes for new mothers at delayed childbearing by reducing incidence of low birth weight (
  20. By: Cuenca, Janet S.
    Abstract: The study examines the role of maternal mortality rate (MMR) and infant mortality rate (IMR) in policy formulation in the Philippines, specifically the controversial legislation of Republic Act 1034, otherwise known as “The Responsible Parenthood and Reproductive Health Act of 2012”. It involves taking stock and analysis of various Congressional Records and Senate Journals, particularly those relating to House Bill No. 4244 (An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development, and for Other Purposes) and Senate Bill No. 2865 (An Act Providing for a National Policy Reproductive Health and Population and Development), respectively. The findings of the study show that MMR and IMR have political influence on policy formulation.
    Keywords: Philippines, indicators, role of indicators, policy formulation, maternal mortality rate (MMR), infant mortality rate (IMR)
    Date: 2016
  21. By: Masayuki Onda
    Abstract: This paper examines the impact of breastfeeding on early childhood outcomes. Using Birth Cohort of Early Childhood Longitudinal Survey data and employing a recently developed econometric technique, we estimate the upper and lower bounds of the effect of breastfeeding on early childhood health and cognitive ability. We find that even a small fraction of selection on unobservables explains the entire effect of breastfeeding on early childhood outcomes.
  22. By: Marius Huguet (UL2 - Université Lumière - Lyon 2); Lionel Perrier (Centre Léon Bérard [Lyon], GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université Jean Monnet - Saint-Etienne - PRES Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Olivia Ballyc (Centre Léon Bérard [Lyon]); Xavier Joutard (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - ECM - Ecole Centrale de Marseille - AMU - Aix Marseille Université - EHESS - École des hautes études en sciences sociales - Université Paul Cézanne - Aix-Marseille 3 - Université de la Méditerranée - Aix-Marseille 2 - CNRS - Centre National de la Recherche Scientifique); Nathalie Havet (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université Jean Monnet - Saint-Etienne - PRES Université de Lyon - CNRS - Centre National de la Recherche Scientifique, UL2 - Université Lumière - Lyon 2); Fadila Farsi (Réseau Espace Santé Cancer, Rhône-Alpes); David Benayoun (Department of Radiation Oncology, Centre Hospitalier Universitaire Lyon Sud, Pierre Benite, France - Hospices Civils de Lyon); Pierre De Saint Hilaire (Hopital universitaire de Lyon - Hôpital Universitaire de Lyon); Dominique Beal Ardisson (Hôpital privé Jean Mermoz); Magali Morelle (Centre Léon Bérard [Lyon]); Isabelle Ray-Coquard (Service d'Oncologie Médicale - Centre Léon Bérard [Lyon])
    Abstract: Epithelial Ovarian Carcinoma (EOC) is a disease with poor prognosis, most often diagnosed at an advanced stage, thus necessitating aggres sive 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 o n 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: T Counterfactual, Disease management programme, France, Epithelial Ovarian Cancer, Propensity score, Centralization of care
    Date: 2016
  23. By: Victoria Peebles; Sheila Hoag; Michaella Morzuch; Linda Barterian; Debra Lipson
    Abstract: The primary goal of the KidsWell Campaign was to ensure access to health insurance for all children, which in turn was expected to lead to improved health outcomes. KidsWell sought to achieve this aim through a two-fold strategy: by protecting and expanding children’s health insurance coverage and by building a lasting child advocacy infrastructure to maintain gains in children’s health care coverage.
    Keywords: Medicaid, CHIP, Advocacy, ACA, Uninsured, KidsWell
    JEL: I
  24. By: Simon Hedlin
    Abstract: In 2014, the United States Food and Drug Administration announced that chain restaurants with 20 or more locations would be required to put calorie labels on the menu. The merits of the policy depend in large part on three empirical issues: 1) if calorie labels help correct calorie under- or overestimation biases; 2) if the labels lead to changes in consumer behavior, which may improve physical health; and 3) if they have an impact on psychological health. This paper presents data from an online experiment (N = 1,323) in which participants were randomly presented with pictures of food and drink items from major fast-food companies either with or without calorie labels. The following findings are reported. First, there was calorie overestimation bias among participants, and the respondents thought, on average, that products contained more calories than was actually the case. Second, calorie labels both made participants perceive the products as healthier, and made them more likely to intend to purchase said items. Third, calorie labels did not have any discernible effects either on the expected utility from consuming the products, or on the participants? experienced well-being. Thus, while calorie labels did not appear to have any negative effects on psychological health, they did seem to correct a calorie overestimation bias, which may inadvertently improve the perceived healthiness of foods and beverages high in calories, and could also potentially lead consumers to buy more, rather than fewer, such products.
    Date: 2016–01
  25. By: Victoria Peebles; Sheila Hoag; Michaella Morzuch; Linda Barterian; Debra Lipson
    Abstract: When the Patient Protection and Affordable Care Act (ACA) passed in 2010, about 6.2 million children were uninsured; of those, nearly 70 percent were already eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) but not enrolled (Kenney et al. 2012). Recognizing the many benefits for children from having health insurance and identifying the ACA as an opportunity to close the children’s coverage gap, in 2011 the Atlantic Philanthropies (Atlantic) created the KidsWell campaign.
    Keywords: Medicaid, CHIP, Advocacy, ACA, Uninsured, KidsWell
    JEL: I
  26. By: Michaella Morzuch; Sheila Hoag
    Abstract: The Cities Expanding Health Access for Children and Families (CEHACF) project was designed to capitalize on both cities’ responsibility for protecting the health and well-being of their residents and municipal leaders’ platform for engaging residents. The project’s overarching goal was to empower municipal leaders in competitively selected cities to partner with community stakeholders to find uninsured children already eligible for, but not enrolled in, public coverage available through Medicaid and CHIP—and, potentially, their adult parents who were newly eligible for Medicaid or marketplace coverage through ACA rules—and enroll them. Beginning in January 2013, CEHACF engaged selected cities on children’s coverage issues through a three-stage, competitive grant-making process.
    Keywords: Medicaid, CHIP, ACA, Cities, Outreach, Enrollment
    JEL: I
  27. By: Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff
    Abstract: Background A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient’s total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh. Methods The study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment. Results The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient’s income, gender, age or illness. Conclusion Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.
    Keywords: Total cost of outpatients, Direct cost, Indirect cost, Health care, Public vs private, Bangladesh
    JEL: I1 I11 I13 I18
    Date: 2015–12–13
  28. By: Jonathan D. Ketcham; Nicolai V. Kuminoff; Christopher A. Powers
    Abstract: We develop a structural model for bounding welfare effects of policies that alter the design of differentiated product markets when some consumers may be misinformed about product characteristics and inertia in consumer behavior reflects a mixture of latent preferences, information costs, switching costs and psychological biases. We use the model to analyze three proposals to redesign markets for Medicare prescription drug insurance: (1) reducing the number of plans, (2) providing personalized information, and (3) defaulting consumers to cheap plans. First we combine administrative and survey data to determine which consumers make informed enrollment decisions. Then we analyze the welfare effects of each proposal, using revealed preferences of informed consumers to proxy for concealed preferences of misinformed consumers. Results suggest that each policy produces large gains and losses for some consumers, but the menu reduction would unambiguously harm most consumers whereas personalized information would unambiguously benefit most consumers.
    JEL: D02 D61 D81 I11
    Date: 2016–10
  29. By: Rossin-Slater, Maya (University of California, Santa Barbara); Wüst, Miriam (Danish National Centre for Social Research (SFI))
    Abstract: We study the impact of targeted high quality preschool over the life cycle and across generations, and examine its interaction with a health intervention during infancy. Using administrative data from Denmark together with variation in the timing of program implementation between 1933 and 1960, we find lasting benefits of access to preschool at age 3 on outcomes through age 65 – educational attainment increases, income rises (for men), and the probability of survival increases (for women). Further, the benefits persist to the next generation, who experience higher educational attainment by age 25. However, exposure to a nurse home visiting program in infancy reduces the added value of preschool. The positive effect of preschool is lowered by 85 percent for years of schooling (of the first generation) and by 86 percent for adult income among men.
    Keywords: preschool, intergenerational, interactions
    JEL: I38 I14 J13
    Date: 2016–10
  30. By: Mani, Subha (Fordham University); Mitra, Sophie (Fordham University); Sambamoorthi, Usha (West Virginia University)
    Abstract: This paper examines the consequences of disability, identifying for the first time, the separate impacts of onsets and recoveries from disability on both employment status and hours worked using panel data from Indonesia. We find that changes in physical functioning have no affect hours worked among the employed. However, we find that onsets of physical limitations lead to an increase in the probability of leaving employment, while recoveries increase the probability of returning to work. We also find a larger effect among self-employed workers compared to salaried workers. These results overall point towards a need for social protection policies with a focus on health, disability, and employment in Indonesia.
    Keywords: health, disability, aging, employment, hours worked, Indonesia
    JEL: I12 J32 J24
    Date: 2016–10
  31. 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); Pierre-Yves Geoffard (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))
    Abstract: This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991-2010 period, we examine the existence of inequalities in maternal and paternal education and child reported body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents’ education – maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents’ education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birth to age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight.
    Keywords: Socioeconomic Status,Body Weight,Overweight,Children,BMI-for-age z-score,Education
    Date: 2015–11
  32. By: Marlène Guillon (PSE - Paris School of Economics); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Risky health behaviors have the negative effect – negative externality – of the individual being able to spread the disease to others. They thus represent a threat for the society and a tragedy for public health. The objective of this study is to inquire into the nature, extent and strength of the evidence for such risky behaviors for HIV/AIDS from an economic perspective. We aim at investigating the concept of risk or prevalence-elasticity of health behaviors in the case of HIV. We did an exhaustive review of published articles in French and English indexed in the databases PubMed, ScienceDirect and Jstor between 1 January 1990 to 31 December 2013. We searched for publications empirically investigating the risk or prevalence-elasticity of behaviors in the case of HIV/AIDS and performed a bibliometric and descriptive analysis of the dataset. Of the 12,545 articles that were screened, 189 (1.5%) full-text publications studied the risk-elasticity of health behaviors that are related to HIV/AIDS. Of these 189 articles, 167 (88.4%) were quantitative studies that empirically estimated the risk-elasticity, and 22 (11.6%) were qualitative studies. We found that 55.7% of the quantitative studies included at least a correlation between HIV risk and health behaviors that supports the concept of risk or prevalence-elasticity. Moreover, we identified articles that address the reverse causality problem between HIV risk and health behaviors, by using indirect HIV risk measures, to demonstrate the existence of a responsiveness of risk/preventive behaviors to HIV risk. Finally, an in-depth analysis showed seven out of ten articles using an objective measure of risk for HIV/AIDS gave strong support to prevalence-elasticity. However, only one of the ten articles established a direct measure of prevalence-elasticity while appropriately dealing with the reverse causation problem between objective HIV risk and preventive/risk behaviors. These results stress out the need to carefully monitor programs of risk behaviors' surveillance in the context of HIV becoming chronic, especially in sub-Saharan Africa where large scale HIV treatment policies are being implemented. More evidence is needed on the strength of rational risky behaviors to maximize the public health and economic impact of large scale HIV treatment or preventive policies. With this purpose, epidemiological surveillance programs could be paired with specific behavioral surveillance programs to better inform policy makers.
    Keywords: HIV,Economic epidemiology,Prevalence-elasticity
    Date: 2015–10–30

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