nep-hea New Economics Papers
on Health Economics
Issue of 2017‒02‒19
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Has South Africa’s Investment in Public Health Care Improved Health Outcomes? By Mr. Lucas Bidzha; Dr. Talita Greyling; Mr. Jugal Mahabir
  2. Health Insurance Expansions and Provider Behavior: Evidence from Substance Use Disorder Providers By Johanna Catherine Maclean; Ioana Popovici; Elisheva Rachel Stern
  3. The Benefits of Avoiding Cancer (or Dying from Cancer): Evidence from a Four-country Study By Alberini, Anna; Ščasný, Milan
  4. Does National Health Insurance Improve Children's Health ?National and Regional Evidence from Ghana By Lisa Bagnoli
  5. Design of optimal corrective taxes in the alcohol market By Griffith, Rachel; O'Connell, Martin; Smith, Kate
  6. Hospital Closure and Hospital Choice: How Hospital Quality and Availability will Affect Rural Residents By Premkumar, Deepak; Jones, Dave; Orazem, Peter
  7. The effect of statutory sick-pay on workers' labor supply and subsequent health By Martin Halla; Susanne Pech; Martina Zweimüller
  8. Værdibaseret styring. Er det smitsomt? Value based health care and reimbursement: Is it contagious? By Kjeld Møller, Pedersen
  9. Can Obesity Cause Depression? Using Pseudo Panel Analysis By Hyungserk Ha; Chirok Han; Beomsoo Kim
  10. The Evolution of Health Insurer Costs in Massachusetts, 2010-12 By Kate Ho; Ariel Pakes; Mark Shepard
  11. The Youngest Get the Pill: ADHD Misdiagnosis and the Production of Education in Germany By Wuppermann, Amelie; Schwandt, Hannes
  12. Antitrust Treatment of Nonprofits: Should Hospitals Receive Special Care? By Cory Capps; Dennis W. Carlton; Guy David
  13. The Effect of Working Hours on Health By Berniell, Maria Ines; Bietenbeck, Jan
  14. Mother's Education and Increased Child Survival in Madagascar: What Can We Say? By Samia Badji
  15. Dimensions of Quality of Life in Germany: Measured by Plain Text Responses in a Representative Survey (SOEP) By Wagner, Gert G.; Bruemmer, Martin; Glemser, Axel; Rohrer, Julia; Schupp, Jürgen
  16. Decomposing Medical-Care Expenditure Growth By Abe Dunn; Eli B. Liebman; Adam Shapiro
  17. Evaluation of the Vermont Pharmacy Assistance Programs for Low-Income Medicare Beneficiaries: Findings from the Enrollee and Nonenrollee Surveys By Boyd Gilman; Barbara Gage; Susan Haber; Sonja Hoover; Jeremy Green; Anne Ciemnecki; Karen CyBulski; Nancy Clusen
  18. Long-term Individual and Population Consequences of Early-life Access to Health Insurance By Étienne Gaudette; Gwyn C. Pauley; Julie Zissimopoulos
  19. Improving Patient Access to Care: Performance Incentives and Competition in Healthcare Markets By Houyuan Jiang; Zhan Pang; Sergei Savin
  20. Intergenerational transmission of nicotine within families: have e-cigarettes had an impact? By Carrieri, V.; Jones, A.M.;
  21. The impact of climate change on health expenditures By Frankovic, Ivan
  22. Informal Care and Long-term Labor Market Outcomes By Schmitz, Hendrik; Westphal, Matthias
  23. How Does Internal Migration Affect the Emotional Health of Elderly Parents Left-Behind? By Scheffel, Juliane; Zhang, Yiwei
  24. A Life Course Perspective on the Income-to-Health Relationship: Macro-Empirical Evidence from two Centuries By Nagel, Korbinian
  25. Intellectual property rights and health: The constraints of WHO authority and the rise of global health governance as an element of contestation By Hein, Wolfgang
  26. The Effect of Recreational Gambling on Regional Health Outcomes: Evidence from Canadian Provinces By Brad R. Humphreys; John A. Nyman; Jane E. Ruseski
  27. Disentangling the Gender Gap in Longevity By Trimborn, Timo; Schünemann, Johannes; Strulik, Holger

  1. By: Mr. Lucas Bidzha; Dr. Talita Greyling; Mr. Jugal Mahabir
    Abstract: South Africa’s total expenditure on health equates to almost 9% of its gross domestic product, which is above the average of other countries classified as middle-income countries. Notwithstanding this investment, indicators of health outcomes remain relatively lower when compared to the same countries. The aim of this paper is to investigate the effectiveness of public health expenditure in improving health outcomes in South Africa. Panel estimations techniques were used using data for the country’s nine provinces over the period 2005 to 2014. Results have shown that, on average, an increase in public health expenditure per capita leads to improvement in the under-five mortality rate. With regards to life expectancy at birth, public health expenditure was found to be statistically not significant. Control variables such as real GDP per capita, female literacy rate, immunisation coverage ratio, access to formal housing and HIV/Aids prevalence were also found to be important determinants of health outcomes in the country. The key policy implications of these findings are that government should continue to prioritise greater resource allocation to public health spending, including towards improving access to formal housing, immunisation coverage, women education and increase targeted interventions on HIV/Aids
    Keywords: Health Outcomes, Health Production Function, Public Health Expenditures, Effectiveness, Under-five Mortality Rate, Life Expectancy
    JEL: I12 I18 H51
    Date: 2017–02
  2. By: Johanna Catherine Maclean; Ioana Popovici; Elisheva Rachel Stern
    Abstract: We examine how substance use disorder (SUD) treatment providers respond to private health insurance expansions induced by state equal coverage (‘parity’) laws for SUD treatment. We use data on the near universe of specialty SUD treatment providers in the United States between 1997 and 2010 in an event study analysis. During this period, 18 states implemented parity laws. Following the passage of a state parity law we find that providers are less likely to participate in public markets, are less likely to provide charity care, increase the quantity of healthcare provided, and become more selective of the type of patients they are willing to admit.
    JEL: I1 I11 I18
    Date: 2017–01
  3. By: Alberini, Anna; Ščasný, Milan
    Abstract: We use stated-preference methods to estimate the cancer Value per Statistical Life (VSL) and Value per Statistical Case (VSCC) from a representative sample of 45-60-year olds in four countries in Europe. We ask respondents to report information about their willingness to pay for health risk reductions that are different from those used in earlier valuation work because they are comprised of two probabilities—that of getting cancer, and that of dying from it (conditional on getting it in the first place). The product of these two probabilities is the unconditional cancer mortality risk. Our hypothetical risk reductions also include two qualitative attributes—quality-of-life impacts and pain. The results show that respondents did appear to have an intuitive grasp of compound probabilities, and took into account each component of the unconditional cancer mortality risk when answering the valuation questions. We estimate the cancer VSL to be between € 1.9 and 5.7 million, depending on whether the (unconditional) mortality risk was reduced by lowering the chance of getting cancer, increasing the chance of surviving cancer, or both. The VSCC is estimated to be up to € 0.550 million euro, and its magnitude depends on the initial (conditional) cancer mortality and on the improvement in survival. We interpret these as “pure” mortality and cancer risk values, stripped of morbidity, pain or quality-of-life effects. The survey responses show that impacts on daily activities and pain have little or no effect on the WTP to reduce the adverse health risks.
    Keywords: Cancer Risk, Value of a Statistical Life, Value of a Statistical Case of Cancer, Mortality Risk Reduction, Stated Preferences, Health Economics and Policy, I18, J17, K32, Q51,
    Date: 2017–02–08
  4. By: Lisa Bagnoli
    Abstract: This paper uses a propensity score matching approach to assess the impact of Ghana’s National Health Insurance Scheme (NHIS) on health utilization and health outcomes for children under five years old using a nationally representative Multiple Indicator Cluster Survey from 2011. The results show that even though health insurance is free for children, around half of them are not insured, with the probability of enrollment being significantly affected by many characteristics. Nationally, the insurance increases both health care utilization and the overall health status of children. Nevertheless, there are important discrepancies across regional results suggesting that the largest gains are found in the poorest regions, which correspond to those with the worse average health outcomes. However, some other regions present none or only very limited gains attributable to the insurance.
    Keywords: health insurance; health; health care utilization; children; Ghana; propensity score matching
    JEL: H51 I38 I10
    Date: 2017–02
  5. By: Griffith, Rachel; O'Connell, Martin; Smith, Kate
    Abstract: Alcohol consumption is associated with costs to society due to its impact on crime and health. Tax can lead consumers to internalise these externalities. We study optimal corrective taxation in the alcohol market. We allow for the fact that the externality generating commodity (ethanol) is available in many differentiated products, over which consumers might have heterogeneous preferences, and that there may also be heterogeneity in marginal externalities across consumers. We show that, if there is correlation in preferences and marginal externalities, setting different tax rates across products can improve welfare relative to a single tax rate on ethanol. We estimate a model of demand in the UK alcohol market and numerically solve for the optimal tax rates. Moving to an optimal system that taxes alcohol types at different rates would close half of the welfare gap between the current UK system and the first best.
    Keywords: Alcohol; corrective taxes; externality
    JEL: D12 D62 H21 H23
    Date: 2017–02
  6. By: Premkumar, Deepak; Jones, Dave; Orazem, Peter
    Abstract: This study estimates a model of rural patient hospital choice between the nearest rural hospital, the nearest urban hospital, or the nearest research hospital. We present separate estimates for inpatient and outpatient visits, for different diagnoses, and for emergency and nonemergency admissions. The analyses illustrate the tradeoffs between hospital quality and distance in deciding whether to choose the nearest hospital or to travel farther for an alternative. The model parameters are used to simulate two hospital closing scenarios for both outpatient and inpatient data: 1) closing 25% of lowest quality rural hospitals and 2) closing 15% of the least used rural hospitals. Closing 25% of the lowest quality rural hospitals results in a 20.7% increase in expected distance and a 7.7% increase in expected hospital quality for those with inpatient ailments. Closing the least used hospitals modestly increases average distance but lowers average quality. We conclude that closing the lowest quality rural hospitals is a better policy prescription than closing the least used hospitals since closing low quality hospitals results in a substantial increase in average quality of hospital with only a slight increase in distance traveled for chosen hospitals.
    Date: 2016–11–29
  7. By: Martin Halla; Susanne Pech; Martina Zweimüller
    Abstract: Social insurance programs typically comprise sick-leave insurance. An important policy parameter is how the costs of lost productivity due to sick leave are shared between workers, firms, and the social security system. We show that this sharing rule affects not only absence behavior but also workers' subsequent health. To inform our empirical analysis, we propose a model in which workers' absence decisions are conditional on the sharing rule, health, and a dismissal probability. Our empirical analysis is based on high-quality administrative data sources from Austria. Identification is based on idiosyncratic variation in the sharing rule caused by different policy reforms and sharp discontinuities at certain job tenure levels and firm sizes. An increase in either the workers' or the firms' cost share, both at public expense, decreases the number of sick-leave days. Policy-induced variation in sick leave has a significant effect on subsequent healthcare costs. The average worker in our sample is in the domain of presenteeism, that is, an increase in sick leave due to reductions in workers' or firms' cost share would reduce healthcare costs and the incidence of workplace accidents.
    Keywords: statutory sick-pay, sick leave, presenteeism, absenteeism, moral hazard, healthcare cost
    JEL: I18 J22 J38
    Date: 2017–02
  8. By: Kjeld Møller, Pedersen (COHERE)
    Abstract: The current fashion in health policy is value based health care in the sense that Michael Porter has introduced, starting with his 2006-book on Redefining Health Care – Creating Value-based competition on results. The question is: Is it a genuine innovation, or is it a quasi-innovation that is easily misunderstood or misapplied and will fade away in a very few years to be substituted by a new fad? Surprisingly, value based health care has not yet been subject to critical scrutiny. This working paper has three aims: A rather critical appraisal along with a very rare undertaking in health policy analysis: The tracing of how an idea/concept has been spread and promoted (who, where, how) internationally and in Denmark. The third aim is to look at relevance for Danish health care by asking: Is it an alternative to the current activity based reimbursement regime: DRG-based reimbursement, and will the outcome-focused approach put the patient first and in the center (patient-focused health care)? The brief answers to the two questions are: No and yes respectively. Value based health care has three main components: 1. Focus on outcome (health status changes), 2. Value based reimbursement, and 3. The organization of health care along diagnostic/disease lines (Integrated Practice Units). To this can be added, for instance, the need for an IT infrastructure. Only 1 and 2 are addressed here. The promotion of the concept has been located in two cities: Boston and Stockholm. In Boston, Porter’s Institute for Strategy and Competitiveness, Boston Consulting Group along with the New England Journal of Medicine have been instrumental in spreading the thinking, and tireless promotion by Porter himself, occasionally in tandem with Robert Kaplan. In Stockholm, the consulting house IVBAR with good ties to Porter and the Karolinska Institute/Hospital has been instrumental and the consortium Sveus (7 counties that to varying degrees experiment with some of the ideas), essentially supported and managed by IVBAR which manages the homepage of Sveus. In Denmark, the idea has been promoted by Danish Regions with support from IVBAR – though, in fairness it should be noted that the 2011-pampflet on Quality Based Health Care was the independent starting point by establishing an agenda of ‘quality – not quantity’. One particular challenge posed by an essentially American developed concept is to distinguish purely American issues from the more universal relevance. For instance, the idea of bundling of services in a US context is marred by the fact that the Medicare DRG rates do not include physicianpayment, which for instance is the case in Denmark – where DRG is hence (possibly along the DAGS for ambulatory hospital treatment) essentially bundled services in a hospital context – hence to a considerable degree diminishing the novelty of bundling. Examples like these abound – requiring the reader to have a good understanding of both the US and the national context. Value based reimbursement has three components (at least judging from the Swedish examples within eight diagnoses – with spine surgery, hip and knee replacement as the most frequently promoted, also by Porter): Bundled payment; a warranty component and a P4P-component, with the last two components making up less than 10% of the total reimbursement – and lacking arguments for how to calculate these two components. The costing of the bundled payment apparently ought to be done using time based ABC a la modum Kaplan. Claims about savings using bundled payment are not substantiated in a causal sense. Six Danish pilot studies of value based health care are discussed briefly noting that the relationship to the concept is very weak. A recent working paper from Danish Regions looks in some detail at value based reimbursement – with P4P being the link to ‘value based’. The outcome dimension is addressed in a Danish context by reference to an ongoing promising project about PRO and PROM data. However, many loose ends remain – in particular with regard to the applicability at the population level. In addition, there is a need for coupling this patient centered outcome approach to the existing clinical quality databases and the recently introduced eight national objectives for the Danish health system.
    Keywords: Value based health care; value based payment; reimbursement; outcome
    JEL: I11 I18
    Date: 2017–02–07
  9. By: Hyungserk Ha (Youth Independence & Competencies Research Office, National Youth Policy Institute, Sejong, Republic of Korea); Chirok Han (Department of Economics, Korea University, Seoul, Republic of Korea); Beomsoo Kim (Department of Economics, Korea University, Seoul, Republic of Korea)
    Abstract: The U.S. ranks ninth in obesity in the world (Forbes, 2007), and approximately 7% of the U.S. adults experience major depressive disorder. Social isolation from the stigma attached to obesity might trigger depression. This paper examines this impact of obesity on depression. To overcome the endogeneity problem we construct pseudo panel data using Behavioral Risk Factor Surveillance System for the 1997-2008 periods.The results are robust and found that BMI has a positive effect on depression days and fraction of depressed. We attempt to overcome endogeneity problem by using pseudo panel approach and find that an increase in the BMI would increase depression days (or being depressed) statistically significantly and big in magnitude.
    Keywords: Obesity, Depression
    Date: 2017
  10. By: Kate Ho (Columbia University); Ariel Pakes (Harvard University); Mark Shepard (Harvard University)
    Abstract: We analyze the evolution of health insurer costs in Massachusetts between 2010-2012, paying particular attention to changes in the composition of enrollees. This was a period in which Health Maintenance Organizations (HMOs) increasingly used physician cost control incentives but Preferred Provider Organizations (PPOs) did not. We show that cost growth and its components cannot be understood without accounting for (i) consumers’ switching between plans, and (ii) differences in cost characteristics between new entrants and those leaving the market. New entrants are markedly less costly than those leaving (and their costs fall after their entering year), so cost growth of continuous enrollees in a plan is significantly higher than average per-member cost growth. Relatively high-cost HMO members switch to PPOs while low-cost PPO members switch to HMOs, so the impact of cost control incentives on HMO costs is likely different from their impact on market-wide insurer costs.
    Keywords: health insurance
    JEL: I11 I13 L10
    Date: 2017–02
  11. By: Wuppermann, Amelie; Schwandt, Hannes
    Abstract: Attention Deficit/Hyperactivity Disorder (ADHD) is a leading diagnosed health condition among children in many developed countries but the causes underlying these high levels of ADHD remain highly controversial. Recent research for the U.S., Canada and some European countries shows that children who enter school relatively young have higher ADHD rates than their older peers, suggesting that ADHD may be misdiagnosed in the younger children due to their relative immaturity. Using rich administrative health insurance claims data from Germany we study the effects of relative school entry age on ADHD risk in Europe's largest country and relate the effects for Germany to the international evidence. We further analyze different mechanisms that may drive these effects, focusing on physician supply side and demand side factors stemming from the production of education. We find robust evidence for school-entry age related misdiagnosis of ADHD in Germany. Within Germany and internationally, a higher share of misdiagnoses are related to a higher overall ADHD level, suggesting that misdiagnoses may be a driving factor of high ADHD levels. Furthermore, the effects in Germany seem to be driven by teachers and parents in an attempt to facilitate and improve the production of education.
    JEL: I10 I21 J13
    Date: 2016
  12. By: Cory Capps; Dennis W. Carlton; Guy David
    Abstract: Nonprofit hospitals receive favorable tax treatment in exchange for providing socially beneficial activities. Extending this rationale would suggest that, insofar as suppression of competition would allow nonprofits to cross-subsidize care for needy populations, nonprofit hospital mergers should be evaluated differently than mergers of for-profit hospitals. However, this rationale rests upon the premise that nonprofit hospitals with greater market power provide more care to the needy. In this paper, we develop a theoretical model showing that the welfare implications of an antitrust policy that favors nonprofit hospitals depends on the link between market power and charity care provision. To test the link, we use three measures of charity care—two dollar-denominated and one based on service volume—to study charity care provision by for-profit and non-profit hospitals under different competition conditions. Using detailed California data from 2001 to 2011, we find no evidence that nonprofit hospitals are more likely than for-profit hospitals to provide more charity care, or to offer more unprofitable services, when competition falls. Overall, while some courts have given deference to defendants’ nonprofit status, our study finds no empirical evidence that such hospitals provide greater charity care as they have greater market power.
    JEL: I11 L22 L31
    Date: 2017–02
  13. By: Berniell, Maria Ines (European University Institute); Bietenbeck, Jan (Lund University)
    Abstract: Does working time causally affect workers' health? We study this question in the context of a French reform which reduced the standard workweek from 39 to 35 hours, at constant earnings. Our empirical analysis exploits variation in the adoption of this shorter workweek across employers, which is mainly driven by institutional features of the reform and thus exogenous to workers' health. Difference-in-differences and lagged dependent variable regressions reveal a negative effect of working hours on self-reported health and positive effects on smoking and body mass index, though the latter is imprecisely estimated. Results are robust to accounting for endogenous job mobility and differ by workers' occupations.
    Keywords: working hours, health, smoking, BMI
    JEL: I10 I12 J22
    Date: 2017–01
  14. By: Samia Badji (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)
    Abstract: This paper aims to assess whether a causal effect exists between maternal education and child survival in Madagascar. The omission of factors such as mother's health, innate ability and time preferences could lead to an overestimation of the true effect of education. The case of sub-Saharan Africa where child mortality rates are the highest, is overlooked by most of the causal evidence gathered so far for developing countries. The present paper attempts to redress this omission through the adoption of a careful empirical strategy. The analysis sheds light on the mechanisms at stake based on information on hygiene practices, housing conditions and the health care administered before, during and after childbirth. The results demonstrate that mothers' education has a positive and strong effect on their offsprings' survival probabilities. Wealth on its own has a strong effect but seems to account for only a third of the effect of maternal education. Abstract This paper aims to assess whether a causal effect exists between maternal education
    Keywords: child mortality,mother's education,Africa,Madagascar
    Date: 2016
  15. By: Wagner, Gert G. (DIW Berlin); Bruemmer, Martin (University of Leipzig); Glemser, Axel (Kantar Public); Rohrer, Julia (Max Planck Institute for Human Development); Schupp, Jürgen (DIW Berlin)
    Abstract: This paper demonstrates how quality of life can be measured by plain text in a representative survey, the German Socio Economic Panel Study (SOEP). Furthermore, the paper shows that problems that are difficult to monitor, especially problems like the state of the European Union, long-term climate change but also the national debt or problems with the quality of consumer goods (like food) and services (like medical treatment), are not issues of particular importance to the majority of people. Developments and risks that are difficult to monitor and only have long-term effects should be left primarily to the discourse conducted by experts and the politically-minded "elites", the avant garde. And in representative democracies it is ultimately the parliamentarians who must decide. Parliamentarians are likely able to make somewhat better decisions using modern representative surveys and national dialogues than they would be without these instruments of civic participation. Nevertheless, improved civic participation cannot replace parliaments.
    Keywords: quality of life, dimensions, open-ended questions, automated text analysis, German Socio Economic Panel Study, SOEP
    JEL: B41 C81 C83 C88 D69 I31 Z13
    Date: 2017–01
  16. By: Abe Dunn; Eli B. Liebman; Adam Shapiro
    Abstract: Medical-care expenditures have been rising rapidly, accounting for over 17 percent of GDP in 2012. In this study, we assess the sources of the rising medical-care expenditures in the commercial sector. We employ a novel framework for decomposing expenditure growth into four components at the disease level: service price growth, service utilization growth, treated disease prevalence growth, and demographic shift. The decomposition shows that growth in prices and treated prevalence are the primary drivers of medical-care expenditure growth over the 2003 to 2007 period. There was no growth in service utilization at the aggregate level over this period. Price and utilization growth were especially large for the treatment of malignant neoplasms. For many conditions, treated prevalence has shifted towards preventive treatment and away from treatment for late-stage illnesses.
    JEL: I10 I11
    Date: 2017–02
  17. By: Boyd Gilman; Barbara Gage; Susan Haber; Sonja Hoover; Jeremy Green; Anne Ciemnecki; Karen CyBulski; Nancy Clusen
    Keywords: Vermont Pharmacy Assistance Low-Income Medicare Beneficiaries Enrollee Nonenrollee survey
    JEL: I
  18. By: Étienne Gaudette (University of Southern California); Gwyn C. Pauley (University of Southern California); Julie Zissimopoulos (University of Southern California)
    Abstract: Gaining access to health insurance in childhood has been associated with improved childhood health and educational attainment. Expansions in health insurance access have steadily lowered the rates of uninsured children and may have long term consequences for adult health and well being. This paper analyzes the impact of gaining health insurance in childhood on health and economic outcomes during adulthood using dynamic microsimulation. We find disease prevalence at age 65 falls for most chronic conditions, with the exception of cancer. We also find increased access to health insurance in childhood results in 11 additional months of life expectancy and 16 additional months lived free of disability. There is no change in total lifetime medical spending, although both Medicaid and Medicare expenditures fall. Lifetime earnings increase by about 8% for individuals who gain the benefits of childhood health insurance.
    Date: 2016–10
  19. By: Houyuan Jiang (Cambridge Judge Business School, University of Cambridge); Zhan Pang (College of Business, City University of Hong Kong); Sergei Savin (The Wharton School, University of Pennsylvania)
    Abstract: Performance-based compensation is gaining popularity as a mechanism for incentivizing providers of health-care services to improve the quality of patient care. This paper investigates the effects of introducing performance-based incentives in a competitive healthcare market. In particular, we consider a market in which a payer (e.g. a government agency) applies a compensation contract to competing healthcare service providers in order to achieve a certain level of patient access to care, as measured by the expected time patients have to wait to receive care. In our model, we use M/M/1 queueing dynamics to describe patient service processes and assume that patient demand for care delivered by a particular provider is increasing in the level of access to care the provider ensures and decreasing in the levels of access to care at competing providers. Our analysis indicates that the presence of competition between providers may signi cantly alter the intended effect of performance-based incentives. In particular, we show that the joint effect of incentives and competition depends on two factors: 1) the aggressiveness of patient access targets that the payer imposes on providers, and 2) patient sensitivity to the level of access to care. When the payer uses a "soft" approach to performance-based compensation by incentivizing but not requiring that providers reach an access-level target, the incentives and competition can produce opposing effects on patient access to care when aggressive service-level targets are used in the presence of access-sensitive patients or when moderate service-level targets are introduced in environments where patients a exhibit low degree of sensitivity to the level of access to care. In particular, we show that while moderate service-level targets can lead to an improvement in patient access to care when applied to a monopolistic provider, competition in settings with access-insensitive patients may diminish or even reverse this improvement. Under the "strict" approach to performance-based compensation, when the payer designs performance incentives to minimize the cost of imposing a common access-level target on all providers, the impact of competition on the level of incentivization required is also influenced by the patient population type: for access-sensitive patients, competitive pressure lowers the level of incentivization required to achieve a particular level of patient access to care, while for patients with low access sensitivity the effect of competition is to increase the incentivization level required. At the same time, the reduction in payers' costs resulting from the presence of competition is more pronounced in environments with access-insensitive patients.
    Keywords: healthcare competition, waiting time target, performance-based incentives
    Date: 2017–01
  20. By: Carrieri, V.; Jones, A.M.;
    Abstract: Using an objective biomarker of both active and passive smoking (saliva cotinine), we estimate a Galtonian regression of nicotine transmission and test whether the use of new nicotine delivery products (i.e. e-cigarettes and other NDP) by parents reduces nicotine transmission to children through passive smoking. To test the latter effect, we use a variety of strategies encompassing the inclusion of interaction terms between cotinine levels and NDP utilization in the Galtonian regression, an IV strategy to deal with potential endogeneity of NDP utilization and a before-after analysis which exploits the spread in the use of e-cigarettes in England from 2010. Using matched parent-child data from the Health Survey for England from 2002 to 2014, we find evidence of a strong intergenerational transmission of nicotine and that transmission is twice the size for mothers compared to fathers. Moreover, all of our empirical strategies lead us to conclude that the introduction of NDP has lowered intergenerational transmission of nicotine to 70-80% of the level without NDP. Following the externality argument, these results suggest that lower taxation of these devices is justified.
    Keywords: Nicotine; passive smoking; intergenerational mobility; Galtonian regression; electronic cigarettes; tobacco taxes;
    JEL: I12 D62
    Date: 2017–02
  21. By: Frankovic, Ivan
    Abstract: We study the effect of climate-induced health risks within a continuous time OLG economy with a realistic demography and endogenous mortality. Climate change impacts the economy through two channels. First, a degrading environmental quality increases mortality, affecting the demand for health care. Second, production losses are caused through deteriorating climate conditions and lead to reductions in income. We explore how individuals respond to these climate change impacts with respect to their life-cycle decisions and assess the overall effect on aggregate health care demand. We put special focus on age-specific vulnerabilities of climateinduced health risks and explore the response to climate change across age-groups. We solve the model numerically and show that health care demand is subject to two opposing forces. While climate-induced mortality increases demand for medical care, reduced income tends to lower health spending, particularly among the elderly. Moreover, we find that age-specific vulnerabilities to climate change considerably shape the effect on aggregate health care demand. Our analysis, thus, highlights the important role of a full life-cycle perspective in the estimation of climate-induced health costs.
    Keywords: climate change,climate-induced health risks,life-cycle model,health care,value of life
    JEL: D91 I12 I15 J11 J17 Q54
    Date: 2017
  22. By: Schmitz, Hendrik; Westphal, Matthias
    Abstract: In this paper we estimate long-run effects of informal care provision on female caregivers’ labor market outcomes. We assess effects up to eight years after care provision and, thereby, complement the previous literature that focuses on short-run-effects. We compare a static version, where average effects of care provision in a certain year on later labor market outcomes are estimated, to a partly dynamic version where the effects of up to three consecutive years of care provision are analyzed. Our results suggest that there are significant initial negative effects of informal care provision on the probability to work full-time. The reduction in the probability to work full-time by 4 percentage points is persistent over time. Effects on the probability of being in the labor force are quite small, however, high care intensity strongly reduces the probability to be in the labor force eight years after the start of the episode. Short-run effects on hourly wages are zero but we find considerable long-run wage penalties. All in all, we find considerable negative labor market effects even several years the end of informal care provision.
    JEL: J22 I10 J14
    Date: 2016
  23. By: Scheffel, Juliane; Zhang, Yiwei
    Abstract: The ageing population resulting from the one-child policy and the massive internal migration in China pose major challenges to elderly care in rural areas where elderly support is based on a traditional inter-generational family support mechanism. We use data from the first two waves of the China Health and Retirement Longitudinal Study to examine how migration of an adult child affects the emotional health of elderly parents left-behind. We identify the effects by applying fixed-effects and instrumental variable regressions which both identify the effect based on different sources of variation. We find that migration significantly reduces overall life-satisfaction by 8.8 percent and leads to an 8.7 (12 percent) percent higher probability of suffering from depressive symptoms (loneliness). Emotional health outcomes drastically deteriorate with reduced emotional support. In contrast to other developing countries, remittances cannot buffer the negative effects of emotional health. As emotional health is a key determinant of the overall health status, our findings have significant impacts for rural areas.
    JEL: I15 J14 O15
    Date: 2016
  24. By: Nagel, Korbinian
    Abstract: The epidemiological literature discusses two contrary hypotheses that can represent the income-to-health relationship from a life course perspective: the ``cumulative advantage'' and the ``age as leveller'' hypothesis. The aim of this study is to transfer the investigation of both hypotheses to a macro level with long time horizon. It asks whether increases in per capita income improves population health and whether the improvements differ across population age groups. Using an unbalanced panel data set with 20 countries and with up to 211 years, the analysis relies on the Westerlund (2007) error correction methodology to detect long-run causality and on the Pesaran (2006) framework to quantify the effect magnitude. A significant effect of per capita income on survivability is only found for middle age groups. The analysis detects no significant effect on survivability of the very young and of old ages. These findings provide evidence for both hypotheses during several stages of life: while the ``cumulative advantage'' theory serves for describing the transition from young to middle ages, the transition from middle to old ages corresponds to the ``age as leveller'' mechanism.
    JEL: I15 J11 C22
    Date: 2016
  25. By: Hein, Wolfgang
    Abstract: This paper links the main issues of the project "Contested World Order" (WZB, GIGA, HSFK) to the policy field of global health: the authority of the institutional setting, and the preferences and strategies of rising powers and non-state actors (NStAs) - the assumed protagonists of recent power shifts. The first part discusses the loss of WHO authority since the rise of Global Health Governance, and WHO's fight to reassert its position. The core of the paper deals with the conflict on intellectual property rights (IPRs) and access to medicines as a central issue in global health. Between 1995 and 2005, civil society organizations (CSOs) and some emerging powers fought successfully for improving access conditions under the TRIPS agreement (Doha Declaration). WHO's activities to regain the initiative led to the adoption of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (2008) (GSPoA). Chapter 4 analyses the role of NStAs and rising powers (notably BRICS) during negotiations on implementing GSPoA. While CSOs insisted on a binding R&D treaty, BRICS countries finally agreed to more modest results. They support the welfare-orientation and the intergovernmental character of WHO but without seriously challenging basic rules in the global economy. Finally, consensus within WHO was restraint to issues which did not touch the basic IPR framework.
    Keywords: WHO authority,global health governance,intellectual property rights,access to medicines,GSPoA,non-state actors,rising powers,Autorität der WHO,Global Health Governance,intellektuelle Eigentumsrechte,Zugang zu Medikamenten,GSPoA,nicht-staatliche Akteure,Rising Powers
    Date: 2016
  26. By: Brad R. Humphreys (West Virginia University, Department of Economics); John A. Nyman (University of Minnesota, School of Public Health); Jane E. Ruseski (West Virginia University, Department of Economics)
    Abstract: The relationship between gambling and health has important economic and public policy implications. We develop causal evidence on this relationship using data from the Canadian Community Health Survey and exploiting regional variation in access to legal gambling. Empirical models treat gambling as an endogenous regressor in explaining regional variation in health outcomes. Results from instrumental variable and bivariate probit models show recreational gambling has no or a negative impact on the probability of having certain chronic conditions and a positive impact on life satisfaction, differing from past studies that find a positive association between problem gambling and adverse health outcomes.
    Keywords: gambling, health outcomes, bivariate probit, instrumental variables
    JEL: I18 L83 R28
    Date: 2016–12
  27. By: Trimborn, Timo; Schünemann, Johannes; Strulik, Holger
    Abstract: In developed countries, women are expected to live about 4-5 years longer than men. In this paper we develop a novel approach in order to gauge to what extent gender health differences in longevity can be attributed to gender-specific preferences and health behavior. For that purpose we set up a physiologically founded model of health deficit accumulation and calibrate it using recent insights from gerontology. From fitting life cycle health expenditure and life expectancy we obtain estimates of the gender-specific preference parameters. We then perform the counterfactual experiment of endowing women with the preferences of men. In our benchmark scenario this reduces the gender gap in life expectancy from 4.6 to 2.1 years, suggesting that 54 percent of women's superior longevity can be attributed to preferences and health behavior. When we add gender-specific preferences for unhealthy consumption, the model can motivate up to 91 percent of the gender gap. Our theory explains also why the gender gap narrows with rising income.
    JEL: D91 J17 J26
    Date: 2016

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