nep-hea New Economics Papers
on Health Economics
Issue of 2017‒04‒02
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Two Models of Primary Health Care Development: Russia vs. Central and Eastern European Countries By Igor Sheiman; Vladimir Shevski
  2. Optimal Progressive Income Taxation in a Bewley-Grossman Framework By Juergen Jung; Chung Tran
  3. Is there a cancer Environmental Kuznets Curve? By Tommaso Luzzati; Tommaso Rughi
  4. Testing the Grossman model of medical spending determinants with macroeconomic panel data By Jochen Hartwig; Jan-Egbert Sturm
  5. We investigate whether quality of care differs between public and private hospitals in England with data on 3.8 million publicly-funded patients receiving 133 planned (non-emergency) treatments in 393 public and 190 private hospitalsites. Private hospitals treat patients with fewer comorbidities and past hospitalisations. Controlling for observed patient characteristics and treatment type, private hospitals have fewer emergency readmissions. Conversely, after instrumenting the choice of hospital type by the difference in distances from the patient to the nearest public and the nearest private hospital, the effect of ownership is smaller and statistically insignificant. Similar results are obtained with coarsened exact matching. We also find no quality differences between hospitals specialising in planned treatments and other hospitals, nor between for-profit and not-for-profit private hospitals. Our results show the importance of controlling for unobserved patient heterogeneity when comparing quality of public and private hospitals. By Giuseppe Moscelli; Hugh Gravelle; Luigi Siciliani; Nils Gutacker
  6. Does the More Educated Utilize More Health Care Services? Evidence from Vietnam Using a Regression Discontinuity Design By Dang, Thang
  7. Artificial Neural Networks and Automatic Time Series Analysis, methodological approach, results and examples using health-related time series. By Belen Garcia Carceles; Belén García Cárceles; Bernardí Cabrer Borrás; Jose Manuel Pavía Miralles
  8. Does rising income inequality affect mortality rates in advanced economies? By Rebeira, Mayvis; Grootendorst, Paul V.; Coyte, Peter C.; Aguirregabiria, Victor
  9. Inequity in healthcare use among older people after 2008: The case of Southern European Countries By Lara Tavares; Francesca Zantomio
  10. Publicly announced speed limit enforcement and its impact on road safety: Evidence from the German Blitzmarathons By Molitor, Ramona
  11. Integrating Health Care for High-Need Medicaid Beneficiaries with Serious Mental Illness and Chronic Physical Health Conditions at Managed Care, Provider, and Consumer Levels By Jung Y. Kim; Tricia Collins Higgins; Dominick Esposito; Allison Hamblin
  12. State Strategies for Coordinating Medicaid and Housing Services By Rebecca Kleinman; Matthew Kehn; Allison Wishon Siegwarth; Jonathan Brown
  13. Public Provision of Postsecondary Education for Transition-Age Youth With Mental Health Conditions By Todd C. Honeycutt; Priyanka Anand; Max Rubinstein; Steven N. Stern
  14. Characteristics of Adults with Psychiatric Disabilities Participating in the Federal Disability Programs By Gina A. Livermore; Maura Bardos
  15. Psychiatric Versus Physical Disabilities: A Comparison of Barriers and Facilitators to Employment By Purvi Sevak; Shamima Khan
  16. Crises and mortality: Does the level of unemployment matter? By Laliotis, Ioannis; Stavropoulou, Charitini
  17. The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs By Jody Schimmel Hyde; Priyanka Anand; Maggie Colby; Lauren Hula; Paul O'Leary
  18. Unhealthy Behaviours: An International Comparison By Ferretti, Fabrizio
  19. Malaria and Early African Development: Evidence from Sickle Cell Trait By Emilio Depetris-Chauvin; David N. Weil
  20. The Financial Vulnerability of Former Disability Beneficiaries in Retirement By Jody Schimmel Hyde; April Yanyuan Wu
  21. An Analysis of Private Long-Term Disability Insurance Access, Cost, and Trends By Priyanka Anand; David Wittenburg
  22. Urban Water Disinfection and Mortality Decline in Developing Countries By Sonia R. Bhalotra; Alberto Diaz-Cayeros; Grant Miller; Alfonso Miranda; Atheendar S. Venkataramani
  23. The Impact of Public and Private Research Support on Premature Cancer Mortality and Hospitalization in the U.S., 1999-2013 By Frank R. Lichtenberg

  1. By: Igor Sheiman (National Research University Higher School of Economics); Vladimir Shevski (National Research University Higher School of Economics)
    Abstract: The paper explores primary health care models in Russia and in Central and Eastern European (CEE) countries. Starting with the similar model, they have taken totally different ways of primary health care transformation, including the role of general practitioner, multi-specialty polyclinics and private sector. The comparison of this diversity, based on the conceptual framework of Primary Health Care Activity Monitor in Europe, demonstrated that the scores of primary care in Russia are relatively lower, particularly in the dimensions of accessibility, comprehensiveness, continuity and coordination of care. The score of the selected efficiency indicators is also relatively low. The major reasons for this are discussed, including the lack of strategic vision on the role of primary care, an excessive specialization of primary care and the delay with a shift to a general practitioner model. A debatable issue of primary care extended composition (the involvement of a growing number of specialists) is also addressed. The conceptual presumption that an extended composition presents new opportunities for more integrated care and better performance has not been supported by the evidence. Big multi-specialty policlinics in Russia don’t demonstrate advantages over solo and group GP practices that dominate in CEE countries. The potential of polyclinics is not used because of the lack of specific activities for integration. It is argued that new specialists in the practices can strengthen primary care only when they support generalists rather than replace them. The lesson learnt from CEE countries is that substantial changes are needed to overcome the lagging status of primary care in Russia, including overcoming the excessive specialization of primary care, the replacement of district physicians by general practitioners, developing the forms of independent practices operating in parallel with polyclinics and competing with them
    Keywords: Health policy Primary health care General practitioner Polyclinics Coordination of Care
    JEL: Z
    Date: 2017
  2. By: Juergen Jung (Department of Economics, Towson University); Chung Tran (Research School of Economics, The Australian National University)
    Abstract: We study the optimal progressivity of income taxation in a Bewley-Grossman model of health capital accumulation where individuals are exposed to earnings and health risks over the lifecycle. We impose the U.S. tax and transfer system and calibrate the model to match U.S. data. We then optimize the progressivity of the income tax code. The optimal income tax system is more progressive than current U.S. income taxes with zero taxes at the lower end of the income distribution and a marginal tax rate of over 50 percent for income earners above US$ 200,000. The Suits index—a Gini coefficient for the income tax contribution by income—is around 0.53 and much higher than 0.17 in the U.S. benchmark tax system. Welfare gains from switching to the optimal tax system amount to over 5 percent of compensating consumption. Moreover, we find that the structure of the health insurance system affects the degree of optimal progressivity of the income tax system. The introduction of Affordable Care Act in 2010—a program that redistributes wealth from high income and healthy types, to low income and sicker types—reduces the optimal progressivity level of the income tax system. Finally, we demonstrate that the optimal tax system is sensitive to the parametric specification of the income tax function and the transfer policy.
    Keywords: Health risk, inequality, tax progressivity, Suits index, social insurance, optimal tax, general equilibrium.
    JEL: E62 H24 I13 D52
    Date: 2017–03
  3. By: Tommaso Luzzati; Tommaso Rughi
    Abstract: The observed increasing burden of cancer can be considered as good news, being the outcome of better life conditions and higher life expectancy. At the same time, changes in life-styles(e.g. diet, smoking, physical inactivity) and environmental quality brought about by economic development are also important riskfactors in cancer. This piece of research aims at empirically assessing the role of economic development in new cancer cases (incidence). Consistently with the literature on the Environmental Kuznets Curve (EKC), we adopt a coarse-grained approach rather than zooming into the very complicated determinants of the phenomenon under inquiry. The novelty is that we focus on impacts on humans rather than on pressures such as emissions or concentrations. After reviewing the main statistical evidence and etiological Hypotheses about cancer, we run several econometric models to assess the role of per capita income after controlling for life expectancy and diagnostic capacity. We investigated both aggregated cancers, and the most eight important site organ cancers. Data suggest that the increasing cancer incidence is also due to life-styles and environmental degradation. .
    Keywords: Economic growth, Cancer, Cancer-EKC, environmental degradation, life-styles.
    Date: 2016–01–01
  4. By: Jochen Hartwig (Professur für Wirtschaftspolitik, Faculty of Economics and Business Administration, Chemnitz University of Technology, CESifo Munich, Germany); Jan-Egbert Sturm (KOF Swiss Economic Institute, ETH Zurich, Switzerland, CESifo Munich, Germany)
    Abstract: Michael Grossman’s human capital model of the demand for health has been argued to be one of the major achievements in theoretical health economics. Attempts to test this model empirically have been sparse, however, and with mixed results. These attempts so far relied on using – mostly cross-sectional – micro data from household surveys. For the first time in the literature we bring in macroeconomic panel data for 29 OECD countries over the period 1970-2010 to test the model. In order to check the robustness of the results for the determinants of medical spending identified by the model, we include additional covariates that have been suggested as determinants for medical spending in an Extreme Bounds Analysis (EBA) framework. The preferred model specifications (including the robust covariates) lend some support to the empirical relevance of the determinants of medical spending identified by the Grossman model, except for the relative medical price.
    Keywords: Medical spending, Grossman model, Extreme Bounds Analysis, OECD panel
    JEL: C12 C23 I10 I12
    Date: 2017–02
  5. By: Giuseppe Moscelli (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK); Hugh Gravelle (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK.); Luigi Siciliani (Department of Economics and Related Studies, University of York, York, UK); Nils Gutacker (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK)
    Keywords: ownership, hospital, quality, choice, distance, endogeneity.
    JEL: C36 H44 I11 L33
    Date: 2017–03
  6. By: Dang, Thang
    Abstract: In 1991 Vietnam implemented a compulsory schooling reform that provides this paper a natural experiment to estimate the causal effect of education on health care utilization measured by the probability of doctor visit, the frequency of doctor visit and per visit out-of-pocket expenditure with a regression discontinuity design. The paper finds that schooling induces considerable impacts on health care utilization although the signs of the impacts changes with specific types of health care service examined. In particular, increased education aggrandizes inpatient utilization whereas it reduces outpatient health care utilization for both public and private health sectors. The estimates are strongly robust to various windows of the sample choice. The paper also discovers that the links between education and health insurance or income play very essential roles as potential mechanisms to explain the causal impacts of education on health care utilization in Vietnam.
    Keywords: Education; health care utilization; regression discontinuity design; Vietnam
    JEL: I12 I21 J13
    Date: 2017–03–18
  7. By: Belen Garcia Carceles; Belén García Cárceles; Bernardí Cabrer Borrás; Jose Manuel Pavía Miralles
    Abstract: Time series modeling by the use of automatic signal extraction methods has been widely studied and used in different contexts of economic analysis. The methodological innovation of ARIMA / SARIMA models estimation made significant contributions to the understanding of temporal dynamics of events, even when the time structure was apparently irregular and unpredictable. The popularity of these models was reflected in the development of applications that implemented algorithms that automaticaly extract temporal patterns of the series and provide a reasonably accurate adjustment by a mathematical model, making it also in a quick and consistent manner. One of the most common use of these programs is in the univariate analysis context, to achieve its filtering for its posterior use in a multivariate structure. However, there is significant untapped potential in the results provided by those applications. In this paper there's a description of the methodology with which the use of TRAMO SEATS and X13 ARIMA is implemented directly in a multivariate structure. Specifically, we have applied data analysis techniques related to artificial neural networks. UNder the neural networks philosophy, events are conceived as linked nodes which activate or not depending on the intensity of an imput signal. At that point come into play STRETCH or X13. To illustrate the methodology and the use of the model, series of health-related time are used, and a consistent model able to "react" to the dynamic interrelations of the variables considered is described. Standard panel data modeling is included in the example and compared with the new methodology.
    Keywords: Spain, Germany, Netherlands, Sweeden, Belgium., Modeling: new developments, Forecasting and projection methods
    Date: 2015–07–01
  8. By: Rebeira, Mayvis; Grootendorst, Paul V.; Coyte, Peter C.; Aguirregabiria, Victor
    Abstract: What effect does rising income inequality have on mortality rates in developed countries? In particular, does the rise of the super-wealthy or the top 0.01% of the population effect overall health of the population? This paper focuses on the effect of rising income inequality on mortality rates of men and women in a subset of OECD countries over six decades from 1950-2008. The authors used adult mortality as the outcome measure and the inverted Pareto-Lorenz coefficient as the preferred measure of income inequality and obtained the latest and precise data on the income inequality measure. They used a panel co-integration econometric framework to address some of the challenges posed by more conventional methods. The findings show that for industrialized countries with co-integrated series, income inequality appears to have a long-run significant negative effect on mortality risk for both men and women, that is, an increase in income inequality does not appear to lower annualized adult mortality rates.
    Keywords: income inequality,mortality,health,panel co-integration
    JEL: I1 C1
    Date: 2017
  9. By: Lara Tavares (CAPP, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa & CICS.NOVA, Centro Interdisciplinar de Ciências Sociais, Universidade Nova de Lisboa); Francesca Zantomio (Department of Economics, University Of Venice Cà Foscari)
    Abstract: Despite the sizeable cuts in public healthcare spending, part of the austerity measures recently undertaken in Southern European countries, little attention has been devoted to monitoring distributional aspects of healthcare usage. This study aims at measuring socioeconomic inequities in primary and secondary healthcare experienced some time after the crisis onset in Italy, Spain and Portugal. The analysis, based on data drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE), focuses on older people, who generally face significantly higher healthcare needs, and whose health appeared to have worsened in the aftermath of the crisis. The Horizontal Inequity indexes reveal remarkable socioeconomic inequities in older people’s access to secondary healthcare in all three countries. In Portugal, the one country facing most severe healthcare budget cuts and where user charges apply also to GP visits, even access to primary care exhibits a significant pro-rich concentration. If reducing inequities in older people’s access to healthcare remains a policy objective, austerity measures maybe pulling the Olive belt countries further away from achieving it.
    Keywords: Healthcare access, Older People, Horizontal Equity, Concentration Index
    JEL: I13 I14 H51
    Date: 2017
  10. By: Molitor, Ramona
    Abstract: This paper studies a unique traffic law enforcement campaign in Germany and its impact on road safety. Key features of the campaign are (1) repeated one-day lasting massive speed limit monitoring (so called Blitzmarathons) and (2) a media campaign that informs the public in advance about the timing, extent, and purpose of the speed limit monitoring. Using administrative records on all police reported vehicle crashes in Germany from 2011 to 2014 and generalized difference-indifferences estimations, we find an eight percent reduction in the number of traffic accidents and a nine percent reduction in the number of slightly injured during Blitzmarathon-day compared to regular days. The effect begins to emerge with the onset of the media campaign, one to three days before a Blitzmarathon. However, while the initiators of the Blitzmarathons intended a permanent change in road safety, we do not find that the reduction in traffic accidents persists beyond a Blitzmarathon-day. In terms of mechanisms, we show that a substitution of traffic from motorized vehicles to other modes of transport not targeted by the Blitzmarathons does not drive our results, and we demonstrate that overall driving speed is lower during a Blitzmarathon-day compared to other days. Given the general relevance of traffic law enforcement strategies, our result have important implications for policy makers beyond the German context.
    Keywords: traffic,law enforcement,safety,accidents
    JEL: H76 K42 R41
    Date: 2017
  11. By: Jung Y. Kim; Tricia Collins Higgins; Dominick Esposito; Allison Hamblin
    Abstract: The authors describe the early efforts of the HealthChoices HealthConnections pilot program for adult Medicaid beneficiaries with serious mental illness and co-occurring chronic conditions, which used a navigator model in 3 southeastern Pennsylvania counties.
    Keywords: healthchoices, healthconnections, medicaid beneficiaries, mental illness, managed care
    JEL: I J
  12. By: Rebecca Kleinman; Matthew Kehn; Allison Wishon Siegwarth; Jonathan Brown
    Abstract: This article reports findings from case studies of 4 states (Illinois, Louisiana, Massachusetts, and Tennessee) that used different approaches to coordinate Medicaid services with temporary or permanent housing supports for individuals with psychiatric disabilities.
    Keywords: Medicaid, Housing services, Illinois, Louisiana, Massachusetts, Tennessee
    JEL: I
  13. By: Todd C. Honeycutt; Priyanka Anand; Max Rubinstein; Steven N. Stern
    Abstract: The authors examine the role of state vocational rehabilitation (VR) agencies (SVRA) in providing postsecondary education support to transition-age youth with and without mental health conditions (MHC) to provide insights into who receives such supports and the association between the receipt of postsecondary education support and successful VR exits.
    Keywords: Disability, Postsecondary education, transition-age youth, mental health
    JEL: I J
  14. By: Gina A. Livermore; Maura Bardos
    Abstract: Findings suggest that beneficiaries with psychiatric disabilities face numerous significant employment obstacles that would need to be addressed for supported employment or similar approaches to be successful.
    Keywords: disability, psychiatric disabilities, employment
    JEL: I J
  15. By: Purvi Sevak; Shamima Khan
    Abstract: This study aims to better identify barriers to and facilitators of employment for individuals with psychiatric disabilities and how these factors may differ for individuals with physical disabilities.
    Keywords: disability, employment, psychiatric disabilities, physical disabilities
    JEL: I J
  16. By: Laliotis, Ioannis; Stavropoulou, Charitini
    Abstract: We study whether mortality responds non-linearly and asymmetrically to unemployment in the context of national economic crises. Although both the assumption of linearity and symmetry have been challenged in other domains, this has been hitherto neglected in the mortality-unemployment literature. Greece offers an ideal setting to our study as unemployment had been moderately falling for about a decade till mid-2008 when it sharply and suddenly increased as a result of a severe economic crisis. Contrary to previous literature, our results from regional panel data estimates (1999q1-2013q4) indicate a countercyclical behaviour of total mortality and a further deteriorating crisis effect. We provide robust evidence that mortality is both non-linear and asymmetric, which suggests that the effect on the number of deaths changes for very high values of unemployment and depends on its direction. Both non-linearity and asymmetry are driven by those above 65 years old. Our findings have important methodological implications and suggest that empirical investigations on fluctuations, recessions and mortality should consider possible non-linear and asymmetric behaviours.
    Keywords: Mortality; Unemployment; Crisis; Non-linearity; Asymmetry; Greece
    JEL: E32 I10 J60
    Date: 2017–03–23
  17. By: Jody Schimmel Hyde; Priyanka Anand; Maggie Colby; Lauren Hula; Paul O'Leary
    Abstract: In this paper, we estimate the impact of Medicaid expansions via the Patient Protection and Affordable Care Act (ACA) on applications to federal disability programs in 15 states that expanded Medicaid in 2014.
    Keywords: Medicaid, Affordable Care Act, health reform, disability, SSDI, SSI
    JEL: I J
  18. By: Ferretti, Fabrizio
    Abstract: In the current global economy, chronic non-communicable diseases (NCDs) have become the leading cause of death and a major health concern for both developed and developing countries. Among other factors, the worldwide spread of NCDs is driven by the globalisation of unhealthy habits. The purpose of this paper is to develop a simple statistic to measure, at the national level, the average population’s exposure to the main NCDs modifiable risk factors. The approach and methodology followed by the United Nations Development Programme to compute the Human Development Index (HDI) is applied to four basic indicators of NCD-related preventable risk factors (alcohol consumption, excess caloric intake, non-balanced diet and tobacco use) in 112 countries worldwide in 2012–14.We obtain a summary composite index, which we call the Unhealthy Behaviour Index (UBI), which ranks countries by the average level of the unhealthy habits (drinking, eating and smoking) of their populations.We find that Belarus and Russian federation are the two countries with the unhealthiest NCD-related lifestyle.With the exception of Canada, the first twenty populations more exposed to the main NCDs preventable risk factors all live in European countries, and mainly in countries of Eastern Europe. Overall, the UBI tends to increase along with the level of human development. In medium, high and very high HDI countries, however, the same level of human development may be associated with very different kinds of NCD-related lifestyles. Finally, economic growth may push populations toward either more unhealthy or healthy habits, depending on the countries’ level of development; the elasticity of unhealthy habits with respect to income per capita is positive (but less than one: on average 0.6) until $30,000, decreases as income rises, and becomes negative (around -0.3) in very high income countries.
    Keywords: Economic growth, Unhealthy habits, Non-communicable diseases, Human development, Unhealthy Behaviour Index
    JEL: I12 I15 O10
    Date: 2015–10–05
  19. By: Emilio Depetris-Chauvin; David N. Weil
    Abstract: We examine the effect of malaria on economic development in Africa over the very long run. Using data on the prevalence of the mutation that causes sickle cell disease we measure the impact of malaria on mortality in Africa prior to the period in which formal data were collected. Our estimate is that in the more afflicted regions, malaria lowered the probability of surviving to adulthood by about ten percentage points, which is roughly twice the current burden of the disease. The reduction in malaria mortality has been roughly equal to the reduction in other causes of mortality. We then ask whether the estimated burden of malaria had an effect on economic development in the period before European contact. Examining both mortality and morbidity, we do not find evidence that the impact of malaria would have been very significant. These model-based findings are corroborated by a more statistically-based approach, which shows little evidence of a relationship between malaria ecology and population density or other measures of development, using data measured at the level of ethnic groups.
    Date: 2016
  20. By: Jody Schimmel Hyde; April Yanyuan Wu
    Abstract: This brief considers the post-retirement financial well-being of workers based on whether they received Social Security Disability Insurance (DI).
    Keywords: Disability, retirement, well-being, SSDI, Social Security
    JEL: I J
  21. By: Priyanka Anand; David Wittenburg
    Abstract: The authors use data from the National Compensation Survey to examine private long-term disability insurance access, cost, and trends over time.
    Keywords: Private disability Insurance, employment benefits
    JEL: I J
  22. By: Sonia R. Bhalotra; Alberto Diaz-Cayeros; Grant Miller; Alfonso Miranda; Atheendar S. Venkataramani
    Abstract: Historically, improvements in the quality of municipal drinking water made important contributions to mortality decline in wealthy countries. However, water disinfection often does not produce equivalent benefits in developing countries today. We investigate this puzzle by analyzing an abrupt, large-scale municipal water disinfection program in Mexico in 1991 that increased the share of Mexico’s population receiving chlorinated water from 55% to 85% within six months. We find that on average, the program was associated with a 37 to 48% decline in diarrheal disease deaths among children (over 23,000 averted deaths per year) and was highly cost-effective (about $1,310 per life year saved). However, we also find evidence that age (degradation) of water pipes and lack of complementary sanitation infrastructure play important roles in attenuating these benefits. Countervailing behavioral responses, although present, appear to be less important.
    JEL: H41 I18 J11
    Date: 2017–03
  23. By: Frank R. Lichtenberg
    Abstract: We use data from PubMed and other sources to examine the impact of public and private research support on premature (before ages 75, 65, and 55) cancer mortality and hospitalization, by estimating difference-in-differences models based on longitudinal, cancer-site-level data on about 30 cancer sites. The estimates indicate that cancer sites about which more research-supported articles were published since the 1970s had larger reductions in premature mortality and hospitalization during the period 1999-2013, controlling for the change in the number of people diagnosed. Cancer sites for which more non-research-supported articles were published did not have larger reductions in premature mortality or hospitalization. The research support that contributed to articles published during 1987-2001 reduced premature (before age 75) mortality at an average annual rate of 0.9% during the period 1999-2013, and it reduced the number of years of potential life lost before age 75 due to cancer in 2013 by 566 thousand. The research support that contributed to articles published during 1984-1998 reduced hospital discharges at an average annual rate of 4.1% during the period 1999-2013, and it reduced the number of hospital discharges due to cancer in 2013 by 566 thousand.
    JEL: I10 I18 J11 O3
    Date: 2017–03

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