nep-hea New Economics Papers
on Health Economics
Issue of 2017‒01‒29
seventeen papers chosen by
Yong Yin
SUNY at Buffalo

  1. Recommendations for benefit–risk assessment methodologies and visual representations By David Hughes; E. Waddingham; S. Mt-Isa; Alesia Goginsky; Edmond Chan; Gerald Downey; C. E. Hallgreen; K.S. Hockley; J. Juhaeri; Alfons Lieftucht; M.A. Metcalf; R.A. Noel; L.D. Phillips; Deborah Ashby; Alain Micaleff
  2. Misaligned Stakeholders and Health System Underperformance By David E. Bloom; Daniel M. Cadarette; Jonty Roland; Jessica Sullivan
  3. The Role of Marriage in Fighting HIV: A Quantitative Illustration for Malawi By Jeremy Greenwood; Philipp Kircher; Cezar Santos; Michele Tertilt
  4. Trade liberalization and child mortality: a synthetic control method By Alessandro Olper; Daniele Curzi; Jo Swinnen
  5. A Simple Model on Mothers’ Autonomy, Health Inputs, and Child Health By Mandal, Biswajit; Bhattacharjee, Prasun; Banerjee, Souvik
  6. Development of Functionally Graded Implant Materials in Commercial Use By Shi, Jain
  7. Gender Disparities in Health Outcomes of Elderly Persons in India By Borooah, Vani
  8. The Effect of State Medicaid Expansions on Prescription Drug Use: Evidence from the Affordable Care Act By Ausmita Ghosh; Kosali Simon; Benjamin D. Sommers
  10. Expanding Universal Health Coverage in The Presence of Informality in Indonesia: Challenges and Policy Implications By Teguh Dartanto; Jahen Fachrul Rezki; Usman; Chairina Hanum Siregar; Hamdan Bintara; Wahyu Pramono
  11. Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster?Randomized Trial in Ghana By Slawa Rokicki; Cohen, Jessica; Joshua A. Salomon; Gunther Fink
  12. The causal effects of retirement on mental health: Looking beyond the mean effects By Kolodziej, Ingo W.K.; García-Gómez, Pilar
  13. Inspiration From The “Biggest Loser†: Social Interactions In A Weight Loss Program By Kosuke Uetake; Nathan Yang
  14. Primary Care Physicians’ Experiences With and Attitudes Toward Pediatric Quality Reporting By Joseph S. Zickafoose; Henry T. Ireys; Adam Swinburn; Lisa A. Simpson
  15. Does postponing minimum retirement age improve healthy behaviours before retirement? Evidence from middle-aged Italian workers? By Bertoni, Marco; Brunello, Giorgio; Mazzarella, Gianluca
  16. The Long Shadows of Past Insults: Intergenerational Transmission of Health over 130 Years By Andreella, ClaudiA; Karlsson, Martin; Nilsson, Therese; Westphal, Matthias
  17. Gender Peer Effects Heterogeneity in Obesity By Rokhaya Dieye; Bernard Fortin

  1. By: David Hughes; E. Waddingham; S. Mt-Isa; Alesia Goginsky; Edmond Chan; Gerald Downey; C. E. Hallgreen; K.S. Hockley; J. Juhaeri; Alfons Lieftucht; M.A. Metcalf; R.A. Noel; L.D. Phillips; Deborah Ashby; Alain Micaleff
    Abstract: Purpose The purpose of this study is to draw on the practical experience from the PROTECT BR case studies and make recommendations regarding the application of a number of methodologies and visual representations for benefit–risk assessment. Methods Eight case studies based on the benefit–risk balance of real medicines were used to test various methodologies that had been identified from the literature as having potential applications in benefit–risk assessment. Recommendations were drawn up based on the results of the case studies. Results A general pathway through the case studies was evident, with various classes of methodologies having roles to play at different stages. Descriptive and quantitative frameworks were widely used throughout to structure problems, with other methods such as metrics, estimation techniques and elicitation techniques providing ways to incorporate technical or numerical data from various sources. Similarly, tree diagrams and effects tables were universally adopted, with other visualisations available to suit specific methodologies or tasks as required. Every assessment was found to follow five broad stages: (i) Planning, (ii) Evidence gathering and data preparation, (iii) Analysis, (iv) Exploration and (v) Conclusion and dissemination. Conclusions Adopting formal, structured approaches to benefit–risk assessment was feasible in real-world problems and facilitated clear, transparent decision-making. Prior to this work, no extensive practical application and appraisal of methodologies had been conducted using real-world case examples, leaving users with limited knowledge of their usefulness in the real world. The practical guidance provided here takes us one step closer to a harmonised approach to benefit–risk assessment from multiple perspectives.
    Keywords: benefit–risk; decision-making; drug development; pharmacoepidemiology; regulation
    JEL: J1
    Date: 2016–03
  2. By: David E. Bloom (Harvard T. H. Chan School of Public Health); Daniel M. Cadarette (Harvard T. H. Chan School of Public Health); Jonty Roland (KPMG); Jessica Sullivan (Harvard T. H. Chan School of Public Health)
    Abstract: This paper summarizes the findings of the World Economic Forum’s Industry Agenda Council on the Future of the Health Sector’s two-year inquiry into underperformance of health systems. The Council found that misalignments (i.e., situations involving conflicting incentives, behaviour, structures, or policies) among key stakeholders are likely to lead to significant waste, whether measured in terms of health for money or money for health. This paper defines three types of misalignments (those due to divergent objectives, power asymmetries, and cooperation failures), offers concrete examples of each type, and includes several cross-cutting examples from three particularly burdensome disease areas: cancer, diabetes, and mental health. The Council also examined situations in which stakeholders acted to correct misalignments and reduce waste. This paper details several case studies of achieving greater alignment and enumerates a set of lessons for stakeholders. It concludes by making recommendations for future research in this domain. JEL Codes: D47, D49, I11
    Keywords: Misalignment, alignment, incentives, health, healthcare, divergent objectives, power asymmetries, cooperation failures
    Date: 2017–01
  3. By: Jeremy Greenwood (University of Pennsylvania); Philipp Kircher (European University Institute and University of Edinburgh); Cezar Santos (Getulio Vargas Foundation); Michele Tertilt (University of Mannheim)
    Abstract: How might policies that promote marriage and/or dissuade divorce help in the fight against HIV/AIDS? This question is addressed employing a choice-theoretic general equilibrium search model, using Malawi as a case study. In the framework developed, individuals can choose between married and single life. A single person can select among abstinence and sex with or without a condom. The results suggest that marriage-friendly policies can help to abate HIV/AIDS. The policy predictions that obtain from general equilibrium analysis are compared with those that arise from simulated synthetic field experiments and epidemiological studies. AEA, Papers and Proceedings, forthcoming.
    Keywords: AIDS, circumcision, condoms, general equilibrium modeling, HIV, marriage and divorce, Malawi, sex markets, search
    JEL: D10 D50 E10 I10 O11
    Date: 2017–01
  4. By: Alessandro Olper; Daniele Curzi; Jo Swinnen
    Abstract: We study the causal effect of trade liberalization on child mortality by exploiting 41 policy reform experiments in the 1960-2010 period. The Synthetic Control Method for comparative case studies allows to compare at the country level the trajectory of post-reform health outcomes of treated countries (those which experienced trade liberalization) with the trajectory of a combination of similar but untreated countries. In contrast with previous findings, we find that the effect of trade liberalization on health outcomes displays a huge heterogeneity, both in the direction and the magnitude of the estimated effect. Among the 41 investigated cases, 19 displayed a significant reduction in child mortality after trade liberalization. In 19 cases there was no significant effect, while in three cases we found a significant worsening in child mortality after trade liberalization. Trade reforms in democracies, in middle income countries and which reduced taxation in agriculture reduce child mortality more.
    Keywords: Trade liberalization, Child Mortality, Synthetic Control Method
    Date: 2017–01
  5. By: Mandal, Biswajit; Bhattacharjee, Prasun; Banerjee, Souvik
    Abstract: Using traditional health capital model of Grossman (1972) and Wagstaff (1986a) this paper attempts to fill in the theoretical missing link between mothers’ autonomy and household consumption behavior, particularly focusing on the consumption of child health inputs. It has been shown in this analysis that working mothers’ children should be of better health status. Further independent of working status of the mother, the autonomy parameter always induces consumption of more health inputs for the children. However, when autonomy is linked with mothers’ income, the basic results of the model are further strengthened. In fact, income induced autonomy may result in redefining the composite consumption good for the family as an inferior one.
    Keywords: mothers’ autonomy, child health, health demand, behavioral factors
    JEL: D1 D11 I12 I18
    Date: 2016
  6. By: Shi, Jain
    Abstract: Total hip replacements (THR) and total knee replacements (TKR) are the most frequently performed surgeries in the world. Some problems appeared after implantation was solved step by step in terms of prophylaxis against infection and thrombosis, but there are some major problems remain to be solved. In total hip replacement, the femoral stem is still under many investigations performed by lots of researchers. The researchers have investigated the ways of producing a femoral stem in order to improve the corrosion resistance and the mechanical properties. For instance, one of the main problems in this area is related to the resorption of the bone due to the high value of Young’s modulus of metallic part of the implant. Therefore, when the femoral stem is located in the bone, the stresses are concentrated on the down part of the implant which mainly causes pain for the patient. Another problem is related to the metallic ion releasing which causes inflammatory reaction for the body. After the implantation, the fixation of the implant inside the bone tissue is the main important issue, thus the femoral stem material needs to be biocompatible and needs to have suitable conditions for growing the bone tissue. There are several materials such as stainless steel, titanium and its alloys, cobalt-chromium based alloys suitable for producing femoral stem. Cobalt-chromium based alloys are strong, hard and also have good corrosion resistant. These alloys are used in a variety of joint replacement implants that require a long service life. Although, Co-Cr based alloys show a good background, there is still has some problems to be solved like lack of bioactivity, metallic ion releasing, aseptic loosening and high value of Young’s modulus.
    Keywords: Total hip replacements, CoCrMo-based implant materials
    JEL: Q01
    Date: 2016–11–05
  7. By: Borooah, Vani
    Abstract: This paper uses data from India’s National Sample Survey (NSS), relating to respondents’ health outcomes between January and June 2014, to quantify a particular form of gender inequality: inequality in self-rated health (SRH) outcomes between men and women aged 60 years or over. In so doing, it makes five contributions to the existing literature. The first is in terms of analytical technique: this study contains a more detailed and nuanced exposition of the regression results than in previous studies. Second, it controls for environmental factors - like poor drainage, lack of toilets, or ventilation in the kitchen - which might adversely impact on health and, in particular, affect the health of women more than that of men. Third, it takes account of interaction effects by which the effect of a variable on an elderly person’s SRH differed according to whether the person was male or female. Lastly, it examines whether SRH is correlated with objective health outcomes. In particular, this study answers two central questions: Did men and women, considered collectively, have significantly different likelihoods of ‘poor’ SRH between the different regions/income classes/social groups/education levels? Did men and women, considered separately, have significantly different likelihoods of a ‘poor’ SRH within a region/income class/social group/education level?
    Keywords: India, NSS Health Survey, health outcomes, gender, disparity
    JEL: I14 I18
    Date: 2016–02
  8. By: Ausmita Ghosh; Kosali Simon; Benjamin D. Sommers
    Abstract: This study provides a national analysis of how the 2014 Affordable Care Act (ACA) Medicaid expansions have affected aggregate prescription drug utilization. Given the prominent role of prescription medications in the management of chronic conditions, as well as the high prevalence of unmet health care needs in the population newly eligible for Medicaid, the use of prescription drugs represents an important measure of the ACA’s policy impact. Prescription drug utilization also provides insights into whether insurance expansions have increased access to physicians, since obtaining these medications requires interaction with a health care provider. We use 2013-2015 data from a large, nationally representative, all-payer pharmacy transactions database to examine effects on overall prescription medication utilization as well as effects within specific drug classes. Using a differences-in-differences (DD) regression framework, we find that within the first 15 months of expansion, Medicaid-paid prescription utilization increased by 19 percent in expansion states relative to states that did not expand; this works out to approximately seven additional prescriptions per year per newly enrolled beneficiary. The greatest increases in Medicaid prescriptions occurred among diabetes medications, which increased by 24 percent. Other classes of medication that experienced relatively large increases include contraceptives (22 percent) and cardiovascular drugs (21 percent), while several classes more consistent with acute conditions such as allergies and infections experienced significantly smaller increases. As a placebo test, we examine Medicare-paid prescriptions and find no evidence of a post-ACA effect. Both expansion and non-expansion states followed statistically similar trends in Medicaid prescription utilization in the pre-policy era, offering support for our DD approach. We did not observe reductions in uninsured or privately insured prescriptions, suggesting that increased utilization under Medicaid did not substitute for other forms of payment. Within expansion states, increases in prescription drug utilization were larger in geographical areas with higher uninsured rates prior to the ACA. Finally, we find some suggestive evidence that increases in prescription drug utilization were greater in areas with larger Hispanic and black populations.
    JEL: I1 I13
    Date: 2017–01
  9. By: Deniz Karaoğlan (Bahcesehir University, Department of Economics.); Aysit Tansel (Department of Economics, Middle East Technical University, 06531 Ankara, Turkey, Institute for Study of Labor (IZA), P.O. Box 7240, D-53072 Bonn, Germany, and Economic Research Forum (ERF) Cairo,)
    Abstract: This study investigates the factors that may influence the obesity in Turkey which is a developing country by implementing Quantile Regression (QR) methodology. The control factors that we consider are education, labor market outcomes, household income, age, gender, region and marital status. The analysis is conducted by using the 2008, 2010 and 2012 waves of the Turkish Health Survey (THS) prepared by the Turkish Statistical Institute (TURKSTAT). The obesity indicator in our study is the individual’s Body Mass Index (BMI). QR regression results provide robust evidence that additional years of schooling has negative effect on individual’s BMI and this effect significantly raises across different quantiles of BMI. QR results also indicate that males tend to have higher BMI at lower quantiles of BMI, whereas females have higher BMI at the top quantiles. This implies that females have higher tendency to be obese in Turkey. Our findings also imply that the positive effect of age on individual’s BMI levels raises across the quantiles at a decreasing rate. In addition, the effect of living in urban or rural areas do not significantly differ at the highest quantile distributions of BMI. Our results also reveal that the negative effect of being single on BMI increases gradually in absolute value across the quantiles of BMI implying that single individuals have less tendency to be obese or overweight compared to the married or widowed/divorced individuals. Moreover, the negative effect of being in labor force on individual’s BMI increases across the quantiles of BMI implying that an individual is more likely to be obese if he/she is out of labor force. Finally, the impact of household income on BMI is positive and significant at all quantiles.
    Date: 2017
  10. By: Teguh Dartanto; Jahen Fachrul Rezki; Usman; Chairina Hanum Siregar; Hamdan Bintara; Wahyu Pramono (LPEM, Faculty of Economics and Business, University of Indonesia)
    Abstract: The implementation of national health insurance in Indonesia since 2014 has brought out the missing middle problem in which the non-poor informal sectors have remained uncovered from the health care due to self-enrollment. Therefore, achieving UHC in Indonesia will take a long process, especially when the proportion of non-poor informal sector in total population is large enough. This study aims at examining three main issues that may have become obstacles for informal sectors to join the program: (1) observing supply side readiness, (2) examining affordable premium and willingness to pay of informal sectors, and (3) exploring why informal workers have been reluctant to join the national health insurance. This study reports that around 53.7% of Sub National Government (SNG) faced a shortage of health facilities of 59,387 beds, though in some regions had surplus of beds (per 1000 people). This study also finds that a single premium for all over Indonesia is unfair and unaffordable for some people living in eastern part of Indonesia. Observing 400 households working in informal sectors and applying Triple Bounded Dichotomies Choice Contingent Valuation Method (TCCVM) to observe the Willingness to Pay (WTP), this study finds that around 70% of respondents had the desire to join the health insurance, but their willingness to pay of the premium was lower than the current rate. The current premium seemed less affordable for informal sectors; thus, this created a barrier for them to enthusiastically join the new health insurance program. Our econometric estimations confirm that availability of hospital, insurance literacy, experiences of inpatients and outpatients, number of family member, sex of head of household, access to internet and household income are highly correlated to the likelihood of informal sectors joining the national health insurance (NHI). Moreover, in contrast with findings from many other studies, the insurance premium is surprisingly not the main reason for informal sectors to join the program; rather, the main obstacle is the lack of insurance literacy. Consequently, the necessary condition for mandating informal sectors to join the program is an improvement of insurance literacy, while the sufficient conditions are supply-side readiness and affordable premium. This study calls for a massive campaign to educate the public about the importance of health insurance.
    Keywords: Returns to Scale
    JEL: H40
    Date: 2015–11
  11. By: Slawa Rokicki; Cohen, Jessica; Joshua A. Salomon; Gunther Fink
  12. By: Kolodziej, Ingo W.K.; García-Gómez, Pilar
    Abstract: We analyze the causal effect of retirement on mental health, exploiting differences in retirement eligibility ages across countries and over time using data from the Survey of Health, Ageing and Retirement in Europe. We estimate not only average effects, but also use distributional regression to examine whether these effects are unequally distributed across the mental health distribution. We find unequally distributed protective effects of retirement on mental health. These gains are larger among those above the clinically defined threshold of being at risk of depression. The preserving effects are larger for women, blue collar workers and those in social networks.
    Keywords: retirement,mental health,economics of the elderly,distributional regression
    JEL: I10 J14 J26
    Date: 2017
  13. By: Kosuke Uetake; Nathan Yang
    Abstract: We investigate the role of heterogeneous peer effects in encouraging healthy and sustainable lifestyles. Our analysis revolves around one of the largest and most extensive databases about weight loss, which contains well over 10 million observations that track individual participants’ meeting attendance and progress in a large national weight loss program. A few key findings emerge. First, while higher weight loss among average performing peers leads to lower future weight loss for an individual, the effect of the top weight loss performer among peers leads to greater future weight loss for that same individual. Second, the discouraging effects from average peers and encouraging effects from top performing peers are magnified for individuals who struggled with weight loss in the past. Third, the encouraging effect of top performers has a long-run impact on an individual’s weight loss success. Finally, we provide suggestive evidence that the discrepancy between the top and average performer effects is not likely an artifact of salience or informativeness of top performers, but instead, driven by its positive impact on the motivation to accomplish weight loss goals. Given our empirical findings, we discuss managerial implications on meeting design.
    Keywords: big data, customer development, customer relationship management, healthy and sustainable living, subscription services, weight management
    Date: 2017–01
  14. By: Joseph S. Zickafoose; Henry T. Ireys; Adam Swinburn; Lisa A. Simpson
    Abstract: While pediatric quality reporting is considered a promising strategy, in this study state efforts appeared insufficient to overcome the barriers to using reports to guide practice-based quality improvement.
    Keywords: primary care , physician survey , quality measurement , quality reporting
    JEL: I
  15. By: Bertoni, Marco (university of padova); Brunello, Giorgio (university of padova); Mazzarella, Gianluca (university of padova)
    Abstract: By increasing the residual working horizon of employed individuals, pension reforms that raise minimum retirement age are likely to affect the returns to investments in health-promoting behaviours before retirement, with consequences for individual health. Using the exogenous variation in minimum retirement age induced by a sequence of Italian pension reforms during the 1990s and 2000s, we show that Italian males aged 40 to 49 reacted to the longer time to retirement by raising regular exercise and by reducing smoking and regular alcohol consumption. Dietary habits were also affected, with positive consequences on obesity and self-reported satisfaction with health.
    JEL: H55 I12 J26
    Date: 2016
  16. By: Andreella, ClaudiA (University of Duisburg-Essen); Karlsson, Martin (University of Duisburg-Essen); Nilsson, Therese (Research Institute of Industrial Economics (IFN)); Westphal, Matthias (University of Duisburg-Essen)
    Abstract: This paper investigates the intergenerational transmission of health in the very long run. Using a unique purpose-built administrative dataset on individuals born in Sweden between 1930–34 and their parents, we study the intergenerational transmission (IGT) of health and the impact of previous generations’ health shocks on socioeconomic outcomes. Our results provide strong evidence in favour of IGT of health, in particular for males. In contrast to the existing literature that focuses on early life health outcomes, our paper shows that the effect on later-life mortality might be even more relevant. However, the story appears to be complex and multi-faceted: the IGT exhibits an inverted socioeconomic gradient, and the impact on socioeconomic outcomes is often very different from the effect on health.
    Keywords: Early environment; Intergenerational transmission; Barker hypothesis; Maternal
    JEL: I12 J13
    Date: 2016–05–31
  17. By: Rokhaya Dieye; Bernard Fortin
    Abstract: This paper explores gender peer effects heterogeneity in adolescent Body Mass Index (BMI). We propose a utility-based non-cooperative social network model with effort technology. We allow the gender composition to influence peer effects. We analyze the possibility of recovering the fundamentals of our structural model from the best-response functions. We provide identification conditions of these functions generalizing those of the homogeneous version of the model. Extending Liu and Lee [2010], we consider 2SLS and GMM strategies to estimate our model using Add Health data. We provide tests of homophily in the formation of network and reject them after controlling for network (school) fixed effects. The joint (endogenous plus contextual) gender homogeneous model is rejected. However, we do not reject that the endogenous effects are the same.This suggests that the source of gender peer effects heterogeneity is the contextual effects. We find that peers’ age, parents’ education, health status, and race are relevant for the latter effects and are gender-dependent.
    Keywords: Obesity, Social Networks, Gender, Heterogeneity, Peer Effects, Identification, Add Health.
    JEL: L12 C31 Z13 D85
    Date: 2017

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