nep-hea New Economics Papers
on Health Economics
Issue of 2017‒04‒09
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The true significance of ‘high’ correlations between EQ-5D value sets By Franz Ombler; Michael Albert; Paul Hansen
  2. Is it good to be too light? Birth weight thresholds in hospital reimbursement systems By Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie
  3. Insurance and Insurance Markets By Dionne, Georges; Harrington, Scott
  4. Data and Indicators to Measure Adolescent Health, Social Development and Well-being By Peter Azzopardi; Elissa Kennedy; George C Patton; UNICEF Office of Research - Innocenti
  5. How to Measure Enabling and Supportive Systems for Adolescent Health By Russell Viner; UNICEF Office of Research - Innocenti
  6. Improving the quality, efficiency and robustness of radiation therapy planning and delivery through mathematical optimization By Balvert, Marleen
  7. Health Shocks and Child Time Allocation Decisions by Households: Evidence from Ethiopia By Yonatan Dinku; David Fielding; Murat Genc
  8. Cohort effects in mortality modelling: a Bayesian state-space approach By Man Chung Fung; Gareth W. Peters; Pavel V. Shevchenko
  9. From Salary to the Performance-Based Remuneration of Russian Physicians: How Motivation at Work is Changing By Sergey Shishkin; Aleksandr Temnitsky
  10. Does more education always improve mental health? Evidence from a British compulsory schooling reform By Avendano, M.; de Coulon, A.; Nafilyan, V.;
  11. Does Public Health Insurance Increase Maternal Health Care Utilization in Egypt By Mesbah Sharaf; Ahmed Rashad; Elhussien I. Mansour
  12. Urban Water Disinfection and Mortality Decline in Developing Countries By Bhalotra, Sonia; Venkataramani, Atheendar S.; Diaz-Cayeros, Alberto; Miller, Grant; Miranda, Alfonso
  13. Examining the Changes in Health Investment Behavior After Retirement: A Harmonized Analysis By Motegi, Hiroyuki; Nishimura, Yoshinori; Oikawa, Masato
  14. Impact and Efficiency of the Integration of Diagnosis and Treatment of Pneumonia in Malaria Community Case Management in Madagascar By Marilys Victoire Razakamanana; Martine Audibert; Tantely Andrianantoandro; Aina Harimanana
  15. Post-neonatal Mortality Impacts Following Grants from the Gavi Vaccine Alliance: An Econometric Analysis from 2000 to 2014 By Robert John Kolesar; Martine Audibert
  16. Between global governance and state sovereignty : a case study of HIV/AIDS policy in South Africa By Makino, Kumiko
  17. Short-term impacts of solar lanterns on child health : experimental evidence from Bangladesh By Kudo, Yuya; Shonchoy, Abu S.; Takahashi, Kazushi
  18. Modelling the ambulant health-care sector in Germany By Britta Stoever

  1. By: Franz Ombler (Department of Computer Science, University of Otago, New Zealand); Michael Albert (Department of Computer Science, University of Otago, New Zealand); Paul Hansen (Department of Economics, University of Otago, New Zealand)
    Abstract: High correlation coefficients for EQ-5D value sets derived from different samples, e.g. across countries, are conventionally interpreted as evidence that the people in the respective samples have similar health-related quality of life preferences. However, EQ-5D value sets contain many inherent rankings of health state values by design. By calculating coefficients for value sets created from random data, we demonstrate that ‘high’ correlation coefficients are an artefact of these inherent rankings; e.g. median Pearson’s r = 0.783 for the EQ-5D-3L and 0.850 for the EQ-5D-5L instead of zero. Therefore, high correlation coefficients do not necessarily constitute evidence of ‘true’ associations. After calculating significance levels based on our simulations – available as a resource for other researchers – we find that many high coefficients are not as significant as conventionally interpreted, whereas other coefficients are not significant. These ‘high’ but insignificant correlations are in fact spurious.
    Keywords: Correlation; statistical significance; EQ-5D; health-related quality of life
    JEL: C12 I18
    Date: 2017–03
  2. By: Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie
    Abstract: Birth weight manipulation is common in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005–2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals’ financial incentives with respect to birth weight do not directly impact the care that newborns receive.
    Keywords: neonatal care; DRG upcoding; quantity & quality of care
    JEL: I11 I18
    Date: 2017–03
  3. By: Dionne, Georges (HEC Montreal, Canada Research Chair in Risk Management); Harrington, Scott (University of Pennsylvania)
    Abstract: Kenneth Arrow and Karl Borch published several important articles in the early 1960s that can be viewed as the beginning of modern economic analysis of insurance activity. This chapter reviews the main theoretical and empirical contributions in insurance economics since that time. The review begins with the role of utility, risk, and risk aversion in the insurance literature and then summarizes work on the demand for insurance, insurance and resource allocation, moral hazard, and adverse selection. It then turns to financial pricing models of insurance and to analyses of price volatility and underwriting cycles; insurance price regulation; insurance company capital adequacy and capital regulation; the development of insurance securitization and insurance-linked securities; and the efficiency, distribution, organizational form, and governance of insurance organizations.
    Keywords: Insurance; insurance market; risk sharing; moral hazard; adverse selection; demand for insurance; financial pricing of insurance; price volatility; insurance regulation; capital regulation; securitization; insurance-linked security; organization form; governance of insurance firms.
    JEL: D80 D81 D82 G22 G30
    Date: 2017–03–30
  4. By: Peter Azzopardi; Elissa Kennedy; George C Patton; UNICEF Office of Research - Innocenti
    Abstract: This brief focuses on quantitative data and indicators to measure adolescent health, social development and well-being. It covers: the principles of good indicator definition; common use of indicators; examples of indicators for adolescent health and social development; existing global data to describe - and populate indicators of - adolescent health and social development; and how to improve data collection efforts.The brief is one of seven on research methodologies, designed to expand and improve the conduct and interpretation of research on adolescent health and well-being in low- and middle-income countries (LMICs). Building on the recent Lancet Commission on Adolescent Health and Wellbeing, these briefs provide an overview of the methodological quality of research on adolescents. They cover topics including: indicators and data sources; research ethics; research with disadvantaged, vulnerable and/or marginalized populations; participatory research; measuring enabling and protective systems for adolescent health; and economic strengthening interventions for improving adolescent well-being.
    Keywords: adolescent health; adolescents; health; research; research methodology;
    Date: 2017
  5. By: Russell Viner; UNICEF Office of Research - Innocenti
    Abstract: Enabling and protective systems for adolescents are the family, peers and the education and legal systems. In addition to research that focuses on individual adolescents, it is also important for researchers to consider measuring social determinants when conducting research on adolescent well-being. This brief reviews the key concepts of social and structural determinants of health and the methodological issues related to their measurement in adolescence.The brief is one of seven on research methodologies designed to expand and improve the conduct and interpretation of research on adolescent health and well-being in low- and middle-income countries (LMICs). Building on the recent Lancet Commission on Adolescent Health and Wellbeing, these briefs provide an overview of the methodological quality of research on adolescents. They cover topics including: indicators and data sources; research ethics; research with disadvantaged, vulnerable and/or marginalized populations; participatory research; measuring enabling and protective systems for adolescent health; and economic strengthening interventions for improving adolescent well-being.
    Keywords: adolescent health; adolescents; protection of children;
    Date: 2017
  6. By: Balvert, Marleen (Tilburg University, School of Economics and Management)
    Abstract: Radiation therapy is an established cancer treatment which exploits ionizing radiation to harm tumourous cells. As radiation can pass through healthy tissue to reach the tumour, this treatment is particularly useful in the case of deep-seated tumours. However, it inevitably yields exposure of the healthy tissue to radiation. One can limit this exposure through the design of the treatment plan, i.e., the choice of beam location, beam intensities, delivery duration, beam collimation, and many more degrees of freedom. The treatment plan needs to be designed in such a way that the tumour receives a therapeutic dose, while limiting the dose to the surrounding healthy organs. This dissertation covers various topics in radiation therapy treatment plan optimization, and aims to improve the quality, efficiency and robustness of radiation therapy planning and delivery through mathematical optimization.
    Date: 2017
  7. By: Yonatan Dinku (Department of Economics, University of Otago, New Zealand); David Fielding (Department of Economics, University of Otago, New Zealand); Murat Genc (Department of Economics, University of Otago, New Zealand)
    Abstract: Little is currently known about the effects of shocks to parental health on the allocation of children’s time between alternative activities. Using longitudinal data from the Ethiopian Young Lives surveys of 2006 and 2009, we analyze the effect of health shocks on the amount of children’s time spent in work, leisure and education. We find that paternal illness increases the time spent in income-generating work but maternal illness increases the time spent in domestic work. Moreover, maternal illness has a relatively large effect on daughters while paternal illness has a relatively large effect on sons. Overall, parental illness leads to large and significant increases in the amount of child labour as defined by UNICEF.
    Keywords: parental illness; child labour; Ethiopia
    JEL: D13 I12 I21 O15
    Date: 2017–04
  8. By: Man Chung Fung; Gareth W. Peters; Pavel V. Shevchenko
    Abstract: Cohort effects are important factors in determining the evolution of human mortality for certain countries. Extensions of dynamic mortality models with cohort features have been proposed in the literature to account for these factors under the generalised linear modelling framework. In this paper we approach the problem of mortality modelling with cohort factors incorporated through a novel formulation under a state-space methodology. In the process we demonstrate that cohort factors can be formulated naturally under the state-space framework, despite the fact that cohort factors are indexed according to year-of-birth rather than year. Bayesian inference for cohort models in a state-space formulation is then developed based on an efficient Markov chain Monte Carlo sampler, allowing for the quantification of parameter uncertainty in cohort models and resulting mortality forecasts that are used for life expectancy and life table constructions. The effectiveness of our approach is examined through comprehensive empirical studies involving male and female populations from various countries. Our results show that cohort patterns are present for certain countries that we studied and the inclusion of cohort factors are crucial in capturing these phenomena, thus highlighting the benefits of introducing cohort models in the state-space framework. Forecasting of cohort models is also discussed in light of the projection of cohort factors.
    Date: 2017–03
  9. By: Sergey Shishkin (National Research University Higher School of Economics); Aleksandr Temnitsky (National Research University Higher School of Economics)
    Abstract: This paper examines changes in the motivation of physicians at work since the start of the salary reforms in 2008. These reforms included a shift from a fixed salary system to performance-based remuneration and an overall increase in salaries. The data of six surveys of health workers from 2007–2016 were used to reveal physician’s motives at work and to track the changes during this period. The changes were minor, and the directions of these changes were contrary to the expected strengthening of financial motivation at work: the importance of earning money is no longer primary. The share of doctors willing to work more and better on the condition of linking salary with labour contribution did not increase. In contrast, almost 66% of physicians believe that they are working at a high level of quality and performance.The majority of physicians desire an increase in the base salary, not the performance-based part. Doctors who receive bonuses for the intensity, quality and performance of their work, and those who have a higher salary overall also wish to see a higher base salary. This is a clear indication that they wish to strengthen the protective function of the base salary rather than to have increased opportunities for earning money
    Keywords: health care, physicians, salary, performance based remuneration, motivation at work, incentives.
    JEL: I18 J08 J31
    Date: 2017
  10. By: Avendano, M.; de Coulon, A.; Nafilyan, V.;
    Abstract: In this paper, we test whether education has a causal effect on mental health by exploiting a compulsory schooling reform in 1972, which raised the minimum school leaving age from 15 to 16 years old in Great Britain. Using a regression discontinuity design, we provide robust evidence that although the reform increased educational attainment, it also increased the prevalence of depression and other mental health conditions in adulthood. Our results do not imply that more schooling per se leads to poorer mental health, but rather suggest that forcing low achieving teenagers to remain in an academic environment may have long-term unintended consequences on their mental health.
    Keywords: Mental health; education; compulsory schooling; UK;
    JEL: I12 I21 I28
    Date: 2017–04
  11. By: Mesbah Sharaf; Ahmed Rashad (Frankfurt School of Finance and Management, Germany); Elhussien I. Mansour
    Abstract: We assess the impact of health insurance on the utilization of maternal health care services in Egypt. A propensity score matching is used to control for baseline differences in the characteristics of the insured and uninsured women, to determine the difference in health care utilization between the two groups that is attributed solely to the health insurance coverage. The results yield that the national health insurance has a strong positive impact on most of the maternal healthcare indicators. Public health insurance coverage increases the likelihood of receiving antenatal care by about 7%, delivering in a public health facility by 8%, and the likelihood that a newborn receive vitamin A dose after delivery by 8.2%. However, women who are less educated, from a poor household, and rural regions, are less likely to be covered by a health insurance. The findings of this study would guide intervention measures that aim at improving health care utilization especially among the poor and other vulnerable groups.
    Date: 2017–03–30
  12. By: Bhalotra, Sonia; Venkataramani, Atheendar S.; Diaz-Cayeros, Alberto; Miller, Grant; Miranda, Alfonso
    Abstract: Historically, improvements municipal drinking water quality contributed significantly to mortality decline in wealthy countries. However, water disinfection has not produced equivalent benefits in developing countries today. We investigate this puzzle by analyzing a large-scale municipal water disinfection program in Mexico in 1991 that dramatically increased access to chlorinated water. On average, we find that the program led to a 37 to 48% decline in diarrheal mortality among children and was highly cost-effective ($1,310 per life-year saved). However, age (degradation) of water pipes and insufficient complementary sanitation infrastructure attenuated these benefits. Countervailing behavioral responses, although present, appear to be less important.
    Date: 2017–03–22
  13. By: Motegi, Hiroyuki; Nishimura, Yoshinori; Oikawa, Masato
    Abstract: This study examines the effects of retirement on health investment behaviors. We conduct a large-scale international comparison of the change in health investment behaviors after retirement among 9 developed countries, using harmonized datasets. We find that the changes in some of health investment behaviors (e.g., Exercise) are improved in most of the countries. With respect to exercise, the change in the opportunity cost to exercise after retirement is a possible reason to explain this improvement.
    Keywords: retirement, health investment behaviors, global aging data
    JEL: I12 J26
    Date: 2017–03–20
  14. By: Marilys Victoire Razakamanana (CERDI - Centre d'études et de recherches sur le developpement international - Université d'Auvergne - Clermont-Ferrand I - Centre National de la Recherche Scientifique); Martine Audibert (CERDI - Centre d'études et de recherches sur le developpement international - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique); Tantely Andrianantoandro (CUM - Catholic University of Madagascar - Université de Madagascar); Aina Harimanana (PIM - Pasteur Institute of Madagascar - Institut Pasteur)
    Abstract: In Madagascar, in February 2014, the Ministry of Health and UNICEF implemented a program integrating the diagnosis and treatment of pneumonia into malaria community case management. The objectives of this program were to improve the management of cases of malaria and pneumonia by community health workers to alleviate the problem of accessibility to care and to reduce the number of severe cases treated at health facilities. This paper aims to assess the effectiveness and the efficiency of this. Two districts were taken into account: Andapa received only basic activities ensuring the functionality of the community sites (control district) and Antalaha where all activities related to the program were implemented (treated district). To assess the impact of the program, we use the difference in difference methodology and we compare the period before the implementation of the program in January 2014 and the period when the program is implemented in February 2016. Then cost-effectiveness analysis was made. In Antalaha, although the program has no significant impact on pneumonia, the situation is better than that of Andapa, as in the case of malaria management, the difference is significant between the two districts. The cost-effectiveness analysis also demonstrated that the cost per case of additional malaria and pneumonia treated by CHWs is 2.52 USD (2.44-3.50). However, skills of CHWs should be strengthened especially concerning pneumonia cases management.
    Keywords: Madagascar,Malaria,Pneumonia,Community health workers,Difference in difference methodology,Cost-effectiveness.
    Date: 2017–02–28
  15. By: Robert John Kolesar (CERDI - Centre d'études et de recherches sur le développement international - Université Clermont-Auvergne); Martine Audibert (CERDI - Centre d'études et de recherches sur le developpement international - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We completed a retrospective multivariate panel and longitudinal trend study to evaluate the effect of Gavi Vaccine Alliance grants on vaccine-preventable disease (VPD) post-neonatal mortality. Feasible Generalized Least Squares (fGLS) regression analysis was used to examine the association between VPD post-neonatal mortality rates and Gavi funding. We also applied segmented regression analysis to assess the structural trend in VPD post-neonatal mortality rates, the impact of Gavi funding, and trend changes following Gavi support. We separately tested a composite VPD mortality rate and five vaccine-preventable mortality rates: pertussis, meningitis, measles, diarrhea, and pneumonia (lower-respiratory infection) as dependent variables. All 77 countries eligible for Gavi assistance from 2000 to 2014 were included in the study. To isolate the effect of Gavi funding in our primary model, we controlled for known and likely predictors of child mortality. Among other factors, Gavi investment and corruption control/system efficiency are important elements to reduce vaccine-preventable mortality rates. For every $1 per capita invested by the Gavi Vaccine Alliance, there are highly statistically significant effects- decreasing the vaccine-preventable disease post-neonatal mortality rate by 2.535 per 1,000 live births. We also found Gavi investments to be significantly associated with reductions in four vaccine preventable disease-specific rates: pertussis, meningitis, diarrhea, and pneumonia. Furthermore, we found Gavi support to be significantly associated with both immediate impacts and trend changes on vaccine-preventable mortality rates. We conclude that Gavi investments in developing country immunization programs have measurably contributed to reductions in post-neonatal VPD mortality rates. Furthermore, we found evidence of a longer term catalytic effect of Gavi funding with accelerated reductions in the trend for post-neonatal meningitis, diarrhea, and pneumonia mortality rates.
    Keywords: Developing countries,Financing,Vaccines,Immunizations,Mortality reduction
    Date: 2017–03–08
  16. By: Makino, Kumiko
    Abstract: Global governance has become an increasingly popular concept among international relations scholars for analyzing how non-state actors participate in the governance of various issues of global common interest. HIV/AIDS policy is one of the key fields in which the prominent features of global governance are found. This paper discusses how the global governance of HIV/AIDS intersects with state sovereignty issues by examining the case of South Africa, a country seriously affected by the disease and one of the principal loci of contestation over the direction of HIV/AIDS policy.
    Keywords: Diseases, Medical care, Social policy, South Africa, Exports, Information technology, FDI
    JEL: F15 O14 O30
    Date: 2017–03
  17. By: Kudo, Yuya; Shonchoy, Abu S.; Takahashi, Kazushi
    Abstract: We implemented a 16-month randomized field experiment in unelectrified areas of Bangladesh to identify health impacts of solar lanterns among school-aged children. Our analysis of various health-related indicators?self-reporting, spirometers, and professional medical checkups?showed modest improvements in eye redness and irritation but no noticeable improvement in respiratory symptoms among treated students. Varying the number of solar products received within treatment households did not alter these results. This limited health benefit was not caused by nonutilization of the products by treated children, spillover effects from treated to control students, or treatment heterogeneity resulting from unfavorable family cooking environments.
    Keywords: Health and hygiene, Children, Energy, Clean energy, Indoor air pollution, Randomized control trials, Solar light
    JEL: O13 Q42 I15
    Date: 2017–03
  18. By: Britta Stoever
    Abstract: The health-care sector in Germany is highly regulated. It provides ambulant and in-patient services. On the ambulant side, the National Association of Statutory Health Insurance Physicians (NASHIP) and the regional Associations of Statutory Health Insurance Physicians (ASHIPs) control the labour market for physicians: they determine the number, type and locations of medical practices in Germany relying on a demand-oriented planning method called “Bedarfsplanung”. A model that equally considers supply and demand side of the medical market can improve this planning process. Only with the concurrent modelling of both market sides a supply tailored to suit the market need of medical services can be achieved. Demand depends on the size and the age structure of the population. With increasing age the probability and the number of diseases increase. Moreover, older people show different kind of diseases than younger people. The number and specialisation of physicians should hence be adapted to demographic change. This is a long-term process, because medical doctors pass a long training, starting with academic studies and ending with medical specialisation. The latter is a necessary precondition for working in the ambulant sector. Within the research project QuMed a comprehensive model was constructed that considers the supply of and the demand for physicians in great detail. It encompasses the whole medical market, i.e. the ambulant and in-patient side. The data basis consists of official data from the Federal Statistical Office and the German Medical Association as well as special data with restricted access from the ASHIPs and the federal registry of physicians. The supply side is modelled using a stock-flow-approach including the complete professional life of a physician. The stock is given by the existing number of physicians registered in the data bank of the federal registry of physicians and the German Medical Association. The inflow of medical specialists is estimated considering the number and age structure of students and the composition of the complete group of physicians (ambulant, in-patient and others). The outflow depends on the age structure of the physicians. Changes between both sectors, ambulant and in-patient, are allowed for (given the specialisation condition) and they are used to equalise possible shortages in the ambulant sector. The demand side depends on demographic change and differentiates between age, sex and indications (choice of medical specialist) of patients. Combining demographic information with billing data collected by the ASHIPs (number of patients and cases treated by 24 different specialists) for the ambulant sector as well as health statistics (Federal Statistical Office) for the in-patient sector the future demand for medical services can be projected. Thus, medical specialties that profit from ageing (e.g. urology) or are faced with a diminishing need (e.g. paediatricians) can be identified. Comparing demand and supply helps to determine shortages or sectors with a sufficient number of specialists so that the planning process can be adapted and improved. Moreover, competing relations between ambulant and in-patient sectors for specialists can be detected. First results show, that ageing has a clear impact on the future needed specialisation of physicians. The applied method provides the opportunity to enhance the planning of the medical market, to identify undesirable trends and to calculate simulations for impact analysis.
    Keywords: Germany, Labor market issues, Forecasting and projection methods
    Date: 2016–07–04

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