nep-hea New Economics Papers
on Health Economics
Issue of 2016‒12‒18
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Good Boss, Bad Boss, Workers' Mental Health and Productivity: Evidence from Japan By KURODA Sachiko; YAMAMOTO Isamu
  2. Closing MDG Gaps in South and South West Asia: Case of Health and Nutrtition Outcome By Chistopher Garraway; Wanphen Sreshthaputra
  3. Awareness of Causes, Consequences and Preventive Measures of Obesity among Adolescents in India By kansra, pooja
  4. The Health Workforce of the Russian Federation in the Context Of the International Trends By Christopher J. Gerry; Igor Sheiman
  5. Acute admissions to a community hospital: a descriptive cost study By Lappegard, Øystein; Hagen, Terje P.; Hjortdahl, Per
  6. Atmospheric Pollution and Child Health in Late Nineteenth Century Britain By Bailey, Roy E; Hatton, Timothy J.; Inwood, Kris
  7. The Life-cycle Benefits of an Influential Early Childhood Program By Jorge Luis Garcia; James J. Heckman; Duncan Ermini Leaf; Maria Jose Prados
  8. Health Related Quality of Life after Surgical Repair of Asymptomatic Abdominal Aortic Aneurysms By David Epstein
  9. Globally dangerous diseases: Bad news for Main Street, good news for Wall Street? By Donadelli, Michael; Kizys, Renatas; Riedel, Max
  10. The health and capacity to work of older men and women in Canada By Kevin Milligan, Tammy Schirle
  11. Identifying Discretion of Municipalities to Undertake Eligibility Assessments for Japan’s Long-Term Care Insurance Program By Nakazawa, Kasuyoshi
  12. Health communication, information technology and the public’s attitude toward periodic general health examination By Quan-Hoang Vuong
  13. Retirement Effects on the Health of the Elderly in the City of São Paulo By André Gal Mountian; Maria Dolores Montoya Diaz, Maria Lúcia Lebrão, Yeda Aparecida de Oliveira Duarte
  14. Choice of emergency health services: an experimental study By Tânia Fernandes; Anabela Botelho; Isabel Correia Dias; Lígia Costa Pinto; Jorge Teixeira; Paula Veiga-Benesch
  15. Spillovers of Community-Based Health Interventions on Consumption Smoothing By Emla Fitzsimons; Bansi Malde; Marcos Vera-Hernández
  16. Policy Choice and Product Bundling in a Complicated Health Insurance Market: Do People get it Right? By Nathan Kettlewell
  17. Utilisation and Selection in an Ancillaries Health Insurance Market By Nathan Kettlewell
  18. Innovation in hospitals: piloting a tool for investigating contributions of hospital employees to innovation By Taran Thune; Magnus Gulbrandsen
  19. Socio-Economic Factors Affecting Early Childhood Health: The Case of Turkey By Deniz Karaoğlan; Dürdane Şirin Saracoğlu
  20. Do Gifts Increase Consent to Home-based HIV Testing? A Difference-in-Differences Study in Rural KwaZulu-Natal, South Africa By Mark E. McGovern; Kobus Herbst; Frank Tanser; Tinofa Mutevedzi; David Canning; Dickman Gareta; Deenan Pillay; Till Bärnighausen
  21. Hospitals and the generic versus brand-name prescription decision in the outpatient sector By Gerald J. Pruckner; Thomas Schober
  22. The Health Care Expenditure and Income: A Global Perspective By Badi H. Baltagi; Raffaele Lagravinese; Francesco Moscone; Elisa Tosetti
  23. The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance's Pilot Program By Katharine W. V. Bradley; Dominick Esposito; Iyah K. Romm; John Loughnane; Toyin Ajayi; Rachel Davis; Teagan Kuruna
  24. Medicaid Managed Care and Working-Age Beneficiaries with Disabilities and Chronic Illnesses By Henry T. Ireys; Craig Thornton; Hunter McKay
  25. Barriers to Evidence-Based Physician Decision-Making at the Point of Care: A Narrative Literature Review By Kara Contreary; Anna Collins; Eugene C. Rich
  26. Improving the Quality of Choices in Health Insurance Markets By Jason Abaluck; Jonathan Gruber
  27. Drug Shortages, Pricing, and Regulatory Activity By Christopher Stomberg

  1. By: KURODA Sachiko; YAMAMOTO Isamu
    Abstract: It is widely believed that the relationship between a supervisor and his/her employees greatly affects employees' well-being and/or productivity. However, only a few papers in the economics literature analyze how supervisors influence employees' well-being and enhance productivity. This paper uses longitudinal data of employees with information about their immediate bosses' ability, management skills, and characteristics (such as competency, communication skills, and personality traits) to investigate the influence of supervisors on employees. The main findings are as follows. First, even after controlling for individual-specific fixed effects and other job characteristics, such as those proposed in the job strain model, we find that supervisors' good communication with staff and competency in managerial tasks significantly improve employees' mental health. Second, we find that good communication between the boss and his/her staff enhances the latter's productivity and lowers presenteeism. Third, supervisors' bad communication and low competency increase the probability of quitting. Fourth, good communication partially depends on boss-staff compatibility, which is governed in part by their combined personality traits.
    Date: 2016–12
  2. By: Chistopher Garraway (United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) South and South-West Asia Office); Wanphen Sreshthaputra (United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) South and South-West Asia Office)
    Abstract: South and South-West Asia is one of the most dynamic subregions in the world and an engine of growth for the rest of the world, yet it is likely to fail to meet some of its targets related to health and nutrition if urgent action is not taken. Drawing from the findings of the 2011-2012 ESCAP-ADB-UNDP Asia-Pacific MDG Report and that of the High-level Subregional Forum on Accelerating Achievement of the Millennium Development Goals in South Asia (New Delhi, 17-18 February 2012), this Policy Brief outlines a strategy to improve nutrition and health for all in South and South-West Asia.
    Keywords: South and South-West Asia, South Asia, Millennium Development Goals (MDGs), Health, Nutrition
  3. By: kansra, pooja
    Abstract: Background: The burden of obesity is rapidly increasing worldwide. Obesity is associated with wide range of diseases, including cardio respiratory disease such as chronic obstructive pulmonary disease and coronary heart disease. Aims: This study aimed to assess the awareness of the adolescents towards the causes, consequences and preventive measures of obesity. Methods: The present study was based on primary data. The study included 200 adolescents surveyed as per convenience sampling. The analysis was made with descriptive statistics and multivariate logistic regression. Results: The study identified that 64.0 percent of the respondents suffered from obesity at the time of survey. The logistic regression shows that obesity was associated with gender, age, education of the mother, income and eating habits of the breakfast. Thus, logistic regression clearly highlighted that obesity was associated with changing lifestyle. But, the awareness of the risk factors and the preventive measures of obesity was not clear among the adolescents. Conclusion: The present study provides sufficient evidence on the awareness of the causes, risk factors and preventive measures of obesity and calls for an immediate action to scale up cost-effective interventions for it both through private and public hospitals. Thus, study indicates a need for creating awareness among adolescents towards the consequences and preventive measures through mass media and campaigns at the schools.
    Keywords: Adolescents, Consequences, Preventive Measures, Obesity
    JEL: I12
    Date: 2016–12–06
  4. By: Christopher J. Gerry (National Research University Higher School of Economics); Igor Sheiman (National Research University Higher School of Economics)
    Abstract: Having one of the highest physician-population ratios in the world, Russia – paradoxically – also faces shortages of physicians. This paper explores the reasons for this paradox through examining the structural characteristics of the Russian health workforce and its development. In comparing Russia with mainstream European countries and in particular the ‘new” EU countries we argue that the shortage of physicians is determined mostly by the prevailing model of health workforce development with its enduring emphasis on quantitative rather than structural indicators. First, the traditional perception of physicians as inexpensive health resources determines the long-term growth of their jobs – irrespective of the new opportunities for substitution and other structural innovations. Second, there is a persistent distortion in the composition of physician supply, of which the most important is the very low share and narrow remit of primary health care providers in comparison to European standards. Third, the international trends in the division of labor between physicians, medical nurses and allied health personnel are not followed in Russia with the result of an inevitable overburden of physicians, the reproduction of a large supply of physicians, while also the paradoxical shortage. Fourth, the system of professional development of physicians does not match international standards. Although with a substantial delay, Russia has now started transition to a workforce model focused on structural characteristics of human resources and so, in the final part of the paper, these new initiatives of the Government are critically assessed.
    Keywords: physicians, health workforce, health workforce policy, health care systems, primary care, Russia, health reforms
    JEL: Z
    Date: 2016
  5. By: Lappegard, Øystein (Vestre Viken Hospital Trust); Hagen, Terje P. (Department of Health Management and Health Economics); Hjortdahl, Per (Department of General Practice)
    Abstract: Introduction: In several countries, health-care providers are searching for alternatives to hospitalization. In recent years, a practice has been established in Hallingdal, a rural region in Norway, in which patients with certain acute somatic illnesses are admitted to Hallingdal Sjukestugu (HSS), a community hospital 150 km from the nearest general hospital, Ringerike Sykehus (RS). A randomized, controlled study was carried out to compare health consequences, patient-perceived quality and health-care costs between patients acutely admitted to HSS and to RS. This paper discusses the topic of health-care costs. Methods: Patients intended for acute admission to HSS, as an alternative to hospitalization, were included in the study. Eligible patients were randomized to two groups; admitted to HSS (n = 33), and admitted to RS (n = 27). Costs were compared between the two groups at discharge and for the 12-month follow-up. Results: The cost of the inpatient stay at HSS was significantly lower than the cost at RS, which is explained by lower transport costs (p
    Keywords: health economy; rural health care systems; patient admission; emergency health-care services; general practitioners; community hospitals
    JEL: H42 I18
    Date: 2016–12–06
  6. By: Bailey, Roy E; Hatton, Timothy J.; Inwood, Kris
    Abstract: Atmospheric pollution was an important side effect of coal-fired industrialisation in the nineteenth century. In Britain emissions of black smoke were on the order of fifty times as high as they were a century later. In this paper we examine the effects of these emissions on child development by analysing the heights on enlistment during the First World War of men born in England and Wales in the 1890s. We use the occupational structure to measure the coal intensity of the districts in which these men were observed as children in the 1901 census. We find strong negative effects of coal intensity on height, which amounts to a difference of almost an inch between the most and least polluted localities. These results are robust to a variety of specification tests and they are consistent with the notion that the key channel of influence on height was via respiratory infection. The subsequent reduction of emissions from coal combustion is one factor contributing to the improvement in health (and the increase in height) during the twentieth century.
    Keywords: atmospheric pollution; health and height
    JEL: I15 N13 Q53
    Date: 2016–12
  7. By: Jorge Luis Garcia (The University of Chicago); James J. Heckman (The University of Chicago); Duncan Ermini Leaf (Leonard D. Schaeffer Center for Health Policy and Economics); Maria Jose Prados (Dornsife Center for Economic and Social Research)
    Abstract: This paper estimates the large array of long-run benefits of an influential early childhood program targeted to disadvantaged children and their families. It is evaluated by random assignment and follows participants through their mid-30s. The program is a prototype for numerous interventions currently in place around the world. It has substantial beneficial impacts on (a) health and the quality of life, (b) the labor incomes of participants, (c) crime, (d) education, and (e) the labor income of the mothers of the participants through subsidizing their childcare. There are substantially greater monetized benefits for males. The overall rate of return is a statistically significant 13.0% per annum with an associated benefit/cost ratio of 6.3. These estimates account for the welfare costs of taxation to finance the program. They are robust to a wide variety of sensitivity analyses. Accounting for substitutes to treatment available to families randomized out of treatment shows that boys benefit much less than girls from low quality alternative childcare arrangements.
    Keywords: childcare, early childhood education, gender differences, Health, long-term prediction, quality of life, randomized trials, substitution bias
    JEL: J13 I28 C93
    Date: 2016–12
  8. By: David Epstein (Universidad de Granada. Spain. Applied Economic Department)
    Abstract: This paper describes and analyses the health related quality of life (HRQOL) reported by participants in the EVAR-1 trial over 10 years, comparing endovascular repair (EVAR) with open surgical repair of asymptomatic abdominal aortic aneurysms (AAA). HRQOL was measured by the EuroQol EQ-5D-3L instrument. Mixed models were used. Open repair has a substantial negative impact on HRQOL in the first three months following AAA repair. The impact is much smaller on patients undergoing EVAR and recovery to pre-surgery HRQOL is faster. However, by one year patients who underwent open repair report slightly better HRQOL than those with EVAR. After one year, the difference is not significant but the trend remains for patients to report slightly lower HRQOL after EVAR. HRQOL is significantly diminished in the six months after complications and re-interventions, and declines sharply and progressively in the two years up to end of life.
    Keywords: :
    Date: 2016–12–07
  9. By: Donadelli, Michael; Kizys, Renatas; Riedel, Max
    Abstract: This paper examines whether investor mood, driven by World Health Organization (WHO) alerts and media news on globally dangerous diseases, is priced in pharmaceutical companies' stocks in the United States. We concentrate on irrational investors who buy and sell pharmaceutical companies' stocks guided by beliefs as opposed to rational expectations. We argue that disease-related news (DRNs) should not trigger rational trading. We find that DRNs have a positive and significant sentiment effect among investors (on Wall Street). The effect is stronger (weaker) for small (large) companies, who are less (more) likely to engage in the development of new vaccines in the wake of DRNs. A potential negative mood (on Main Street) - induced by disease related fear - does not alter the positive sentiment effect. Our findings give rise to profitable trading strategies leading to significantly positive performances. Overall, this unparalleled research shows that large events of devastating nature to the economy can be considered as good news to some groups of interest, such as stock market traders.
    Keywords: WHO alerts,investor sentiment,pharmaceutical industry,trading strategies
    JEL: G11 G14 I11
    Date: 2016
  10. By: Kevin Milligan, Tammy Schirle (Wilfrid Laurier University)
    Abstract: We address the health capacity to work among Canadian older workers using two complementary methods, aggregate mortality risk and individual health indicators. We find that men in 2012 would need to work more than five additional years between ages 55-69 to keep pace with how much men in 1976 worked, holding health capacity constant. For working women, the comparable result is only two years more work. Most of these gaps arose before the mid-1990s, as employment advances have offset mortality improvements since then. Regionally, more than half the Ontario-Atlantic employment difference among older men is rooted in health differences.
    Keywords: Health, retirement, labour supply
    JEL: J14 J21 J26
    Date: 2016–12–01
  11. By: Nakazawa, Kasuyoshi
    Abstract: Eligibility assessments play an important role in Japan’s long-term care insurance program and have been designed so that municipalities do not have discretion in their working. However, there are doubts about eligibility assessments based on the municipal fiscal situation. This study empirically identifies the discretion of municipalities to undertake eligibility assessments employing the idea of opportunistic municipal behavior at amalgamation. Amalgamation offers municipalities an incentive to free ride (e.g., public debt accumulation) when they can subrogate the load to a new municipality after amalgamation. If so, pre-merger municipalities might increase the eligibility ratio before amalgamation. Difference-in-difference regression confirms a free-rider effect of pre-merger municipalities in the eligibility assessments for long-term care by Japanese municipalities. Smaller pre-merger municipalities increase the eligibility ratio immediately before amalgamation. These results mean that the Japanese long-term care insurance system is not managed in accordance with the institutional design.
    Keywords: Long-term care insurance; Eligibility assessment; Municipal amalgamation; Free-rider behavior; Difference-in-difference
    JEL: H51 H73 H75 I13 I18 R5 R51
    Date: 2016–12–13
  12. By: Quan-Hoang Vuong
    Abstract: Periodic general health examinations (GHEs) are gradually becoming more popular as they employ subclinical screenings as a means of early detection. This study considers the effect of information technology (IT), health communications and the public’s attitude towards GHEs in Vietnam. A total of 2,068 valid observations were obtained from a survey in Hanoi and its surrounding areas, out of which 42.12% said they were willing to use IT applications to recognise illness symptoms, nearly 2/3 of them rated the healthcare quality at average level or below. The data, which is processed by the BCL model, has shown that IT applications (apps) reduce hesitation toward GHEs, however, older peopleseem to have less confidence in using these apps. Health communications and government’s subsidy also increase the likelihood of people attending periodic GHEs. The probability of early check-ups where there is a cash subsidy could reach approximately 80%.
    Keywords: general health examination; subclinical screenings; ICTs; healthcare subsidy
    JEL: D12 D83 I12 I18
    Date: 2016–12–13
  13. By: André Gal Mountian; Maria Dolores Montoya Diaz, Maria Lúcia Lebrão, Yeda Aparecida de Oliveira Duarte
    Abstract: This article analyzes the effects of retirement on health of elderly residents in the city of São Paulo, between the years 2000 and 2010. In a context of population aging, it is important to know the effects of labor market exit on health of older people. We use data from Saúde, Bem Estar e Envelhecimento (SABE), longitudinal dataset with elderly in São Paulo. The fixed effect and fixed effects with instrumental variable models were estimated to take into account the possible simultaneity of the decision to stop working and the health status of individuals. Our estimates indicate that retirement improves mobility indicators, especially for men. This result suggests that an increase or setting the minimum retirement age in Brazil may be ccompanied by a rise in spending on health system
    Keywords: Retirement; Health; Elderly; Fixed Effects; Instrumental Variable
    JEL: I10 J14 C23 C26
    Date: 2016–10–25
  14. By: Tânia Fernandes (Universidade do Minho, NIMA); Anabela Botelho (Universidade de Aveiro, GOVCOPP); Isabel Correia Dias (Universidade do Minho, NIMA); Lígia Costa Pinto (Universidade do Minho, NIMA); Jorge Teixeira (Hospital de Braga); Paula Veiga-Benesch (Universidade do Minho, NIMA)
    Abstract: The Portuguese national health service (NHS) is expected to provide safe and high quality care 24 hours a day, seven days a week. Everyday, patients with non-life threatening, short-term illnesses or health problems, for which they need convenient treatment or advice, use emergency care departments at hospitals. It is estimated that about one third could have been treated, or advised elsewhere, mainly in primary care (PC), community pharmacies or the national help phone line. This “inappropriate” use of emergency care departments represents an added cost, and a decreased efficiency for the Portuguese NHS. The literature suggests several explanations, either focusing on the system, or patients. This paper analyses whether a misperception of the severity of the health condition by the patients explain the excess demand. Results show that, in fact, there is an overestimation of the degree of severity of some clinical profiles, and therefore a preference for the use of emergency departments. However, when confronted with the real severity of those clinical profiles, only 50% of the cases change the choice of the emergency department (ED). It can also be derived from the results that socio-demographic characteristics and variables related to experience, with the services, and the clinical profiles are important determinants in the perception of severity of the clinical conditions.
    Keywords: Emergency department demand; experimental economics; elicitation of beliefs
    JEL: I1
    Date: 2016–12
  15. By: Emla Fitzsimons; Bansi Malde; Marcos Vera-Hernández
    Abstract: Community-based interventions, particularly group-based ones, are considered to be a cost-effective way of delivering interventions in low-income settings. However, design features of these programs could also influence dimensions of household and community behaviour beyond those targeted by the intervention. This paper studies spillover effects of a participatory community health intervention in rural Malawi, implemented through a cluster randomised control trial, on an outcome not directly targeted by the intervention: household consumption smoothing after crop losses. We find that while crop losses reduce consumption growth in the absence of the intervention, households in treated areas are able to compensate for this loss and perfectly insure their consumption. Asset decumulation also falls in treated areas. We provide suggestive evidence that these effects are driven by increased social interactions, which could have alleviated contracting frictions; and rule out that they are driven by improved health or reductions in the incidence of crop losses.
    Keywords: participatory community interventions; spillovers; consumption smoothing; Sub-Saharan Africa
    JEL: E21 G22 O12 O13
    Date: 2016–10
  16. By: Nathan Kettlewell (School of Economics, UNSW Business School, UNSW)
    Abstract: This paper evaluates health insurance policy selection and how this interacts with product bundling by using a discrete choice experiment closely calibrated to the Australian private health insurance market. The experimental approach overcomes some limitations of revealed preference research in this area. The results indicate that consumers are likely to make choices that violate expected utility theory, use heuristic decision strategies, and over-insure relative to minimising out-of-pocket costs. Decision quality is significantly lower when choosing a bundled hospital/ancillaries health insurance policy (compared to stand-alone ancillaries cover), which is the policy type most consumers purchase in Australia.
    Keywords: health insurance, heuristics, choice consistency, discrete choice experiment, latent class logit
    JEL: I13 D81 D03
    Date: 2016–10
  17. By: Nathan Kettlewell (School of Economics, UNSW Business School, UNSW)
    Abstract: I study two important aspects of the Australian private ancillaries health insurance (PAHI) market. First, I estimate the effect of PAHI on utilisation of various health services using instrumental variable methods to identify causal effects. Next I test for the presence and direction of selection effects by identifying variables not used in pricing that influence both the insurance and utilisation decision. PAHI covers a wide range of out-of-hospital health services, including many discretionary and preventative services. The most quantitatively important are dental, optometry, physiotherapy and chiropractic. I find that PAHI does increase utilisation of health services, particularly the probability of visiting a dentist, physiotherapist, chiropractor, osteopath or acupuncturist. I find evidence of selection effects in the sense that a number of different variables can predict a person's propensity to insure as well as their propensity to utilise health services. The variables that I identify generally result in adverse selection to insurers for higher frequency health services, although selection bias is more heterogeneous for lower frequency services. There is little evidence of self-selection based on the joint probability of different health services, which indicates that diversified policy menus are a possible strategy for addressing adverse selection in the PAHI market.
    Keywords: health insurance, moral hazard, adverse selection, favourable selection
    JEL: I13 D82
    Date: 2016–10
  18. By: Taran Thune (TIK Center for Technology, Innovation and Culture, University of Oslo, Norway); Magnus Gulbrandsen (TIK Center for Technology, Innovation and Culture, University of Oslo, Norway)
    Abstract: This paper addresses the question of how hospital employees contribute to the generation of innovations and to what extent hospitals function as a conducive environment for innovative work. The motivation behind this exploratory study was primarily to identify the diversity of innovation activities in hospitals, with the goal of developing and testing a survey tool that can adequately capture this diversity. Although conceptual and empirical research on the characteristics of medical and health related innovations has been carried out, the role of hospitals in such innovations is more often assumed rather than empirically tested. We argue that innovation in public hospitals is still not well understood and contribute to understanding through a pilot study carried out in four public hospitals in Norway. A preliminary analysis indicates that there are different modes of innovative work in hospitals, as suggested by some of the literature, and that different kinds of employees are involved in distinct sets of activities. The survey tool that we developed seems to be able to capture the diversity of innovation-related activities, but there were problematic aspects related to the sampling and recruitment of respondents. Suggestions for further exploration and testing are discussed.
    Date: 2016–12
  19. By: Deniz Karaoğlan (Department of Economics, Bahçeşehir University); Dürdane Şirin Saracoğlu (Department of Economics, METU)
    Abstract: In this study we examine the association between parents’ socioeconomic status (SES) and childhood health in Turkey, a middle income, developing country using the 2013 round of Demographic Health Survey (DHS) data set. In our investigation, we focus on children from 7 to 59 months old and as a measure of health status, we use the height-for-age z-score, which is the measure of stunting and wasting. In order to overcome the biases with respect to age and gender, we calculate the child’s standardized height measure. Using classical regression techniques, after controlling for the child’s birth order, birth weight, mother’s height, mother’s breastfeeding, nutrition status and pre-school attendance, the impact of parent’s SES on child’s health measures is assessed, and parents’ SES indicators include region of residence, number of household members, father’s presence, parents’ education and work status, and household wealth index based on the household’s asset holdings. Our results indicate that while mother’s education and occupation type are among the leading factors that affect the child’s health status, urban residence appears to be the dominant factor which positively affects child’s health: SES of families proxied by living conditions and infrastructure factors such as sanitation, access to clean water, availability of electricity, which are under the control of local governments, as well as access to health care services must be improved for better child health.
    Keywords: Health, children, z-score, household socioeconomic status, Turkey
    JEL: C20 I15 J13
    Date: 2016
  20. By: Mark E. McGovern; Kobus Herbst; Frank Tanser; Tinofa Mutevedzi; David Canning; Dickman Gareta; Deenan Pillay; Till Bärnighausen
    Abstract: Despite the importance of HIV testing for controlling the HIV epidemic, testing rates remain low. Efforts to scale up testing coverage and frequency in hard-to-reach and at-risk populations commonly focus on home-based HIV testing. This study evaluates the effect of a gift (a US $5 food voucher for families) on consent rates for home-based HIV testing. We use data on 18,478 individuals (6,418 men and 12,060 women) who were successfully contacted to participate in the 2009 and 2010 population-based HIV surveillance carried out by the Wellcome Trust's Africa Health Research Institute in rural KwaZulu-Natal, South Africa. Of 18,478 potential participants contacted in both years, 35% (6,518) consented to test in 2009, and 41% (7,533) consented to test in 2010. Our quasi-experimental difference-in-differences approach controls for unobserved confounding in estimating the causal effect of the intervention on HIV-testing consent rates. Allocation of the gift to a family in 2010 increased the probability of family members consenting to test in the same year by 25 percentage points [95% confidence interval (CI) 21--30 percentage points; P less than 0.001]. The intervention effect persisted, slightly attenuated, in the year following the intervention (2011). In HIV hyperendemic settings, a gift can be highly effective at increasing consent rates for home-based HIV testing. Given the importance of HIV testing for treatment uptake and individual health, as well as for HIV treatment-as-prevention strategies and for monitoring the population impact of the HIV response, gifts should be considered as a supportive intervention for HIV-testing initiatives where consent rates have been low.
    Keywords: Gift-voucher Intervention; Incentives; Difference-in-Differences; Home-based HIV Testing; South Africa
    JEL: J10 I10
    Date: 2016–12
  21. By: Gerald J. Pruckner; Thomas Schober
    Abstract: Healthcare payers try to reduce costs by promoting the use of cheaper generic drugs. We show strong interrelations in drug prescriptions between the inpatient and outpatient sectors by using a large administrative dataset from Austria. Patients with prior hospital visits have a significantly lower probability of receiving a generic drug in the outpatient sector. The size of the effect depends on both the patient and doctor characteristics, which could be related to the differences in hospital treatment and heterogeneity in the physicians’ adherence to hospital choices. Our results suggest that hospital decisions create spillover costs in healthcare systems with separate funding for inpatient and outpatient care.
    Keywords: Prescription decision, generic drugs, physician behavior, hospitals.
    JEL: I11 I13 I18 H51
    Date: 2016–11
  22. By: Badi H. Baltagi (Center for Policy Research, Maxwell School, Syracuse University, 426 Eggers Hall, Syracuse, NY 13244); Raffaele Lagravinese (University of Bari); Francesco Moscone (Brunel University); Elisa Tosetti (Brunel University)
    Abstract: This paper investigates the long-run economic relationship between health care expenditure and income in the world using data on 167 countries over the period 1995-2012, collected from the World Bank data set. The analysis is carried using panel data methods that allow one to account for unobserved heterogeneity, temporal persistence, and cross-section dependence in the form of either a common factor model or a spatial process. We estimate a global measure of income elasticity using all countries in the sample, and for sub-groups of countries, depending on their geo-political area and income. Our findings suggest that at the global level, health care is a necessity rather than a luxury. However, results vary greatly depending on the sub-sample analyzed. Our findings seem to suggest that size of income elasticity depends on the position of different countries in the global income distribution, with poorer countries showing higher elasticity.
    Keywords: Health Expenditure; Panels; Income Elasticity; World; Exploring the Geography of Health
    JEL: C31 C33 H51
    Date: 2016–11
  23. By: Katharine W. V. Bradley; Dominick Esposito; Iyah K. Romm; John Loughnane; Toyin Ajayi; Rachel Davis; Teagan Kuruna
    Abstract: This issue brief describes a business case assessment of a community paramedicine pilot program. The program was established to address patients’ non-emergency needs in the home, by expanding the role of emergency medical services personnel to encompass outpatient urgent and primary care.
    Keywords: community paramedicine, paramedic, ambulance, emergency department
    JEL: I
  24. By: Henry T. Ireys; Craig Thornton; Hunter McKay
    Abstract: Even after a decade of study, there are still many questions about how working-age adults with disabilities or chronic illnesses are faring in Medicaid managed care.
    Keywords: Medicaid, Managed Care, Working-age beneficiaries, Disabilities, Chronic Illness
    JEL: I J
  25. By: Kara Contreary; Anna Collins; Eugene C. Rich
    Abstract: In this paper, the authors conduct a narrative literature review using four real-world cases of clinical decisions to show how barriers to the use of evidence-based medicine affect physician decision-making at the point of care, and where adjustments could be made in the healthcare system to address these barriers.
    Keywords: Point of care, Evidence Based, Physician Decision Making
    JEL: I
  26. By: Jason Abaluck; Jonathan Gruber
    Abstract: Insurance product choice is a central feature of health insurance markets in the United States, yet there is ongoing concern over whether consumers choose appropriately in such markets – and little evidence on solutions to any choice inconsistencies. This paper addresses these omissions from the literature using novel data and a series of policy interventions across school districts in the state of Oregon. Using data on enrollment and medical claims for school district employees, we first document large choice inconsistencies, with the typical employee foregoing savings of more than $600 in their insurance plan choice. We then consider three types of interventions designed to improve choice quality. We first show that interventions to promote more active choice are unlikely to improve choice quality based on existing patterns of plan switching. We then implement a randomized trial of decision support software to illustrate that it has little impact on plan choices, largely because of consumer avoidance of the recommendations. Finally, we show that restricting the choice set size facing individuals does significantly reduce their foregone saving and total costs. This is not because individuals choose worse with larger choice sets, but rather because larger choice sets feature worse choices on average that are not offset by individual re-optimization.
    JEL: I11 I13
    Date: 2016–12
  27. By: Christopher Stomberg
    Abstract: This study examines the patterns and causes of shortages in generic non-injectable drugs (e.g., tablets and topicals) in the United States. While shortages for injectable drugs have garnered more attention, shortages of other forms of prescription drugs have also been on the increase. In fact, they follow a strikingly similar trend with a number of important tablet drugs having recently been affected by shortage. This poses important questions about the root causes of these trends since most explanations found in the literature are specific to generic injectable drugs. Using a simple heuristic framework, three contributing factors are explored: regulatory oversight, potential market failures in pricing/reimbursement, and competition. This paper features an empirical examination of the contribution of changes in regulatory oversight to drug shortages. A pooled dynamic regression model using FDA data on inspections and citations reveals a statistically significant relationship between FDA regulatory activity (inspections and citations) and drug shortage rates. This result cuts across both injectable and non-injectable drugs, and could reveal a transition in equilibrium quality that should be transitory in nature, but it should also be interpreted with care given the other factors likely affecting shortage rates.
    JEL: I11 L11 L5
    Date: 2016–12

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