nep-hea New Economics Papers
on Health Economics
Issue of 2017‒05‒07
28 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Macroeconomic Effects of Medicare By Conesa, Juan Carlos; Costa, Daniela; Kamali, Parisa; Kehoe, Timothy J.; Nygard, Vegard; Raveendranathan, Gajen; Saxena, Akshar
  2. Association of Catastrophic Neonatal Outcomes with Increased Rate of Subsequent Cesarean Deliveries By Ohad Dan; Drorith Hochner- Celnikier; Amy Solnica; Yonatan Loewenstein
  3. ‘Randomisation bias’ in the medical literature: a review By Barbara Sianesi
  4. Who receives medicaid in old age? Rules and reality By Margherita Borella; Mariacristina De Nardi; Eric French
  5. Design of optimal corrective taxes in the alcohol market By Rachel Griffith; Martin O'Connell; Kate Smith
  6. The Effect of Fuel Economy Standards on Vehicle Weight Dispersion and Accident Fatalities By Antonio Bento; Kenneth Gillingham; Kevin Roth
  7. The Effect of Stress on Later-Life Health: Evidence from the Vietnam Draft By John Cawley; Damien de Walque; Daniel Grossman
  8. Trade in Health Products: Reducing Trade Barriers for Better Health By Helble, Matthias; Shepherd, Benjamin
  9. The Relationship Between Time Preference and Depressive Tendency By Reona Fujino
  10. Bounding the Causal Effect of Unemployment on Mental Health: Nonparametric Evidence from Four Countries By Cygan-Rehm, Kamila; Kühnle, Daniel; Oberfichtner, Michael
  11. Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health By Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela
  12. The Bilateral Relationship between Depressive Symptoms and Employment Status By Bubonya, Melisa; Cobb-Clark, Deborah A.; Ribar, David C.
  13. The Impact of Parental Health on Children's Schooling and Labour Force Participation: Evidence from Vietnam By Mendolia, Silvia; Nguyen, Thi; Yerokhin, Oleg
  14. Recessions are Not Good for Your Health: the Counter-Cyclical Health Outcomes Revisited By Asali, Muhammad
  15. On the Decomposition and Dynamics of Inequality of Opportunities: A Special Focus on Early Childhood Health and Nutrition in Tunisia By Mohamed Amara; Hatem Jemmali
  16. Access to Healthcare, Utilization and Health Outcomes in Turkey By Burhan Can Karahasani; Firat Bilgel
  17. Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group By Miqdad Asaria
  18. Does the pattern of physical activity matter for health care utilization? Evidence from the Konstanz Life Study By Simon Spika; Friedrich Breyer
  19. Long-Term Outcomes of the New Jersey Nurse Faculty Preparation Program Scholars By Angela M. Gerolamo; Kara Conroy; Grace Roemer; Aline Holmes; Susan Salmond; Jennifer Polakowski
  20. Factors Contributing to Poor Satisfaction with Sleep and Healthcare Seeking Behavior in Older Adults By Abraham Olufunmilola; Jia Pu; Loren J. Schleiden; Steven M. Albert
  21. Medicare Payment for Extended Stay Services in Frontier Clinics: Impact on the Use and Cost of Emergency Care in Alaska By Boyd Gilman; Laura Ruttner; Michaella Morzuch
  22. Knowing Is Not Half the Battle: Impacts of the National Health Screening Program in Korea By Kim, Hyuncheol Bryant; Lee, Suejin; Lim, Wilfredo
  23. A Teenager in Love: Multidimensional Human Capital and Teenage Pregnancy in Ghana By Blunch, Niels-Hugo
  24. The Road to Trans-Inclusive Health Care: Policy Implications and the Critical Role of Social Work By Corinne P. Lewis
  25. Choice in the presence of experts: the role of general practitioners in patients' hospital choice By Walter Beckert; Kate Collyer
  26. New Joints: Private providers and rising demand in the English National Health Service By Elaine Kelly; George Stoye
  27. Life-cycle consumption patterns at older ages in the US and the UK: can medical expenditures explain the difference? By James Banks; Richard Blundell; Peter Levell; James Smith
  28. Spillovers of community based health interventions on consumption smoothing By Emla Fitzsimons; Bansi Malde; Marcos Vera-Hernandez

  1. By: Conesa, Juan Carlos (Stony Brook University); Costa, Daniela (Federal Reserve Bank of Minneapolis); Kamali, Parisa (Federal Reserve Bank of Minneapolis); Kehoe, Timothy J. (Federal Reserve Bank of Minneapolis); Nygard, Vegard (Federal Reserve Bank of Minneapolis); Raveendranathan, Gajen (Federal Reserve Bank of Minneapolis); Saxena, Akshar (Harvard University)
    Abstract: This paper develops an overlapping generations model to study the macroeconomic effects of an unexpected elimination of Medicare. We find that a large share of the elderly respond by substituting Medicaid for Medicare. Consequently, the government saves only 46 cents for every dollar cut in Medicare spending. We argue that a comparison of steady states is insufficient to evaluate the welfare effects of the reform. In particular, we find lower ex-ante welfare gains from eliminating Medicare when we account for the costs of transition. Lastly, we find that a majority of the current population benefits from the reform but that aggregate welfare, measured as the dollar value of the sum of wealth equivalent variations, is higher with Medicare.
    Keywords: Medicare; Medicaid; Overlapping generations; Steady state; Transition path
    JEL: E21 E62 H51 I13
    Date: 2017–04–27
  2. By: Ohad Dan; Drorith Hochner- Celnikier; Amy Solnica; Yonatan Loewenstein
    Abstract: Objective: To evaluate whether full-term deliveries resulting in neonates diagnosed with hypoxic-ischemic encephalopathy are associated with a significant increase in the rate of subsequent unscheduled cesarean deliveries. Methods: We conducted a retrospective chart review study and examined all deliveries in the department of Obstetrics and Gynecology at Hadassah University Hospital, Mt. Scopus campus, Jerusalem, Israel during 2009-2014. We reviewed all cases of hypoxic-ischemic encephalopathy in singleton, term, liveborn deliveries and identified seven such cases: three of which were attributed to obstetric mismanagement and four which were not. We measured the rate of unscheduled cesarean deliveries before and after the events and their respective hazard ratio (HR). Results: Prior to a mismanaged delivery resulting in hypoxic-ischemic encephalopathy, the baseline rate of unscheduled cesarean deliveries was approximately 80 unscheduled cesarean deliveries for every 1,000 deliveries. In the first 4 weeks immediately after each of the three identified cases, there was a significant increase in the rate of unscheduled cesarean deliveries by an additional 48 unscheduled cesarean deliveries per 1,000 deliveries (95% CI 27-70/1,000). This increase was transient and lasted approximately 4 weeks. We estimated that each case was associated with approximately 17 additional unscheduled cesarean deliveries (95% confidence interval 8-27). There was no increase in the rate of unscheduled cesarean deliveries in cases of hypoxic-ischemic encephalopathy that were not associated with mismanagement. Conclusion: The increase in the rate of unscheduled cesarean deliveries after a catastrophic neonatal outcome may result in short-term changes in obstetricians’ risk evaluation.
    Date: 2017–04
  3. By: Barbara Sianesi (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: Randomised controlled or clinical trials (RCTs) are generally viewed as the most reliable method to draw causal inference as to the effects of a treatment, as they should guarantee that the individuals being compared differ only in terms of their exposure to the treatment of interest. This ‘gold standard’ result however hinges on the requirement that the randomisation device determines the random allocation of individuals to the treatment without affecting any other element of the causal model. This ‘no randomisation bias’ assumption is generally untestable but if violated would undermine the causal inference emerging from an RCT, both in terms of its internal validity and in terms of its relevance for policy purposes. This paper offers a concise review of how the medical literature identifies and deals with such issues.
    Keywords: randomised trials, medical,
    Date: 2016–11–21
  4. By: Margherita Borella (Institute for Fiscal Studies); Mariacristina De Nardi (Institute for Fiscal Studies and UCL, Federal Reserve Bank of Chicago, and NBER); Eric French (Institute for Fiscal Studies and IFS and UCL)
    Abstract: Medicaid is a government program that also provides health insurance to the old who have little assets and either low income or catastrophic health care expenses. We ask how the Medicaid rules map into the reality of Medicaid recipiency and what other observable characteristics are important to determine who ends up on Medicaid. The data show that both singles and couples with high retirement income can end up on Medicaid at very advanced ages. We find that, conditioning on a large number of observable characteristics, including those that directly relate to Medicaid eligibility criteria, single women are more likely to end up on Medicaid. So are non-whites, but, surprisingly, their higher recipiency is concentrated in the higher income percentiles. We also find that low-income people with a high school diploma or higher are much less likely to end up on Medicaid than their less educated counterparts. All of these effects are large and depend on retirement income in a very non-linear way.
    Keywords: Medicaid, elderly, permanent income
    JEL: H51 I13 I1
    Date: 2017–04–12
  5. By: Rachel Griffith (Institute for Fiscal Studies and IFS and Manchester); Martin O'Connell (Institute for Fiscal Studies); Kate Smith (Institute for Fiscal Studies)
    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 di fferentiated 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 fi rst best.
    Keywords: externality, corrective taxes, alcohol
    JEL: D12 D62 H21 H23
    Date: 2017–01–31
  6. By: Antonio Bento; Kenneth Gillingham; Kevin Roth
    Abstract: The firm response to regulation is seldom as controversial as in the context of fuel economy standards, a dominant policy to reduce emissions from vehicles worldwide. It has long been argued that such standards lead to vehicle weight changes that increase accident fatalities. Using unconditional quantile regression, we are the first to document the effect of the Corporate Average Fuel Economy (CAFE) standards on the vehicle weight distribution. We find that on net CAFE reduced fatalities, with lowered mean weight dominating increased dispersion. When monetized, this effect suggests positive net benefits from CAFE even with no undervaluation of fuel economy.
    JEL: H23 I18 Q48 Q58 R41
    Date: 2017–04
  7. By: John Cawley; Damien de Walque; Daniel Grossman
    Abstract: A substantial literature has examined the impact of stress during early childhood on later-life health. This paper contributes to that literature by examining the later-life health impact of stress during adolescence and early adulthood, using a novel proxy for stress: risk of military induction during the Vietnam War. We estimate that a 10 percentage point (2 standard deviation) increase in induction risk in young adulthood is associated with a 1.5 percentage point (8%) increase in the probability of being obese and a 1 percentage point (10%) increase in the probability of being in fair or poor health later in life. This does not appear to be due to cohort effects; these associations exist only for men who did not serve in the war, and are not present for women or men who did serve. These findings add to the evidence on the lasting consequences of stress, and also indicate that induction risk during Vietnam may, in certain contexts, be an invalid instrument for education or marriage because it appears to have a direct impact on health.
    JEL: H56 I1 I12 I14 I18 I31 J1 J18 N32
    Date: 2017–04
  8. By: Helble, Matthias (Asian Development Bank Institute); Shepherd, Benjamin (Asian Development Bank Institute)
    Abstract: Trade in health products has been flourishing in recent years as the demand for better health has been growing throughout the world. At the same time, trade in health products is hampered by substantive trade barriers. In this paper, we present evidence that countries around the world still apply tariffs and nontariff measures that increase prices and limit the availability of health-related products such as pharmaceuticals, vaccines, and medical equipment. The case for liberalizing trade in these products is therefore strong. In addition, we show that improving trade facilitation performance, using the World Trade Organization’s Trade Facilitation Agreement as a starting point, can be linked to improved handling of health-related products such as vaccines which, in turn, would boost usage. In the last part of the paper, we study the price differences for insulin across countries. We observe that the price of insulin has various determinants, one of them being open trade: the higher the level of competition between manufacturers, the lower the price of insulin. In summary, lowering trade barriers on health products can make a substantive contribution to building up health systems and lowering out-of-pocket payments of patients.
    Keywords: trade; trade barriers; health products; pharmaceuticals; tariffs; non-tariff measures; trade liberalization; WTO Trade Facilitation Agreement; vaccine; insulin
    JEL: F14 I11 I15 I18
    Date: 2017–01–23
  9. By: Reona Fujino (Graduate School of Economics, Keio University)
    Abstract: In this study, we examined the relationship between time preference and depression tendency using two types of questionnaire data, which are Japan Household Panel Survey (JHPS) and Japanese Study of Aging and Retirement (JSTAR). For the empirical analysis, we applied the cross-lagged effect model and the synchronous effect model discussed in Finkel (1995), and we tested the Granger causality using the vector autoregressive model. The result showed that there was Granger causality in the direction of depression tendency to time discount rate in JHPS data. Moreover, in JHPS data, if the sample is divided by age, this causal relation was confirmed only with respect to over 50's. This result suggests that depression tendency influences time preference, which means that coping with the depression tendency makes it possible to change the time preference. Recently, approaches to depression tendency are progressing, and in particular, therapies called mindfulness are also adopted in general corporations and others. In other words, it can be interpreted that the analysis results showed that mindfulness leads to a change in time preference, that is, a decrease in time discount rate. With regard to such time preference changes, it can be said that it is desirable to use the viewpoint of virtue ethics in the framework of Bhatt et al. (2015).
    Keywords: time discount rate, depression, causal relation
    JEL: D3 D4
    Date: 2017–03–23
  10. By: Cygan-Rehm, Kamila (University of Erlangen-Nuremberg); Kühnle, Daniel (University of Erlangen-Nuremberg); Oberfichtner, Michael (University of Erlangen-Nuremberg)
    Abstract: An important, yet unsettled, question in public health policy is the extent to which unemployment causally impacts mental health. The recent literature yields varying findings, which are likely due to differences in data, methods, samples, and institutional settings. Taking a more general approach, we provide comparable evidence for four countries with different institutional settings – Australia, Germany, the UK, and the US – using a nonparametric bounds analysis. Relying on fairly weak and partially testable assumptions, our paper shows that unemployment has a significant negative effect on mental health in all countries. Our results rule out effects larger than a quarter of a standard deviation for Germany and half a standard deviation for the Anglo-Saxon countries. The effect is significant for both men and women and materialises already for short periods of unemployment. Public policy should hence focus on early prevention of mental health problems among the unemployed.
    Keywords: mental health, unemployment, bounds
    JEL: I12 J64
    Date: 2017–03
  11. By: Courtemanche, Charles (Georgia State University); Marton, James (Georgia State University); Ukert, Benjamin (University of Pennsylvania); Yelowitz, Aaron (University of Kentucky); Zapata, Daniela (Impaq International)
    Abstract: The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and non-expansion states, with the gains being larger in expansion states along some dimensions. No statistically significant effects on risky behaviors or self-assessed health emerge for the full sample. However, we find some evidence that the ACA improved self-assessed health among older non-elderly adults, particularly in expansion states.
    Keywords: Affordable Care Act, health insurance, Medicaid, health, obesity, smoking, drinking
    JEL: I12 I13 I18
    Date: 2017–03
  12. By: Bubonya, Melisa (Melbourne Institute of Applied Economic and Social Research); Cobb-Clark, Deborah A. (University of Sydney); Ribar, David C. (University of Melbourne)
    Abstract: This paper analyzes the bilateral relationship between depressive symptoms and employment status. We find that severe depressive symptoms are partially a consequence of economic inactivity. The incidence of depressive symptoms is higher if individuals have been out of a job for an extended period. Men's mental health falls as they exit the labor force, while women's worsens only after they have been out of the labor force for a period of time. Entering unemployment is also associated with a substantial deterioration in mental health, particularly for men. We also find that severe depressive symptoms, in turn, lead to economic inactivity. Individuals are less likely to be labor force participants or employed if they experience severe depressive symptoms. Men's probability of being unemployed rises dramatically with the onset of depressive symptoms; women's unemployment is increased by protracted depressive symptoms.
    Keywords: mental health, unemployment, labor market status, HILDA survey, depressive symptoms, depression
    JEL: J01 J64 I14
    Date: 2017–03
  13. By: Mendolia, Silvia (University of Wollongong); Nguyen, Thi (University of Wollongong); Yerokhin, Oleg (University of Wollongong)
    Abstract: This paper investigates the relationship between parental health shocks and children's engagement in education and labour market, using a panel data survey of Vietnamese families, interviewed between 2004 and 2008. While there is substantial evidence showing the intergenerational transmission of health, the literature investigating the impact of parental health on children's educational and labour market outcomes is limited, especially in developing countries. We use child fixed effects and control for a detailed set of household and local area characteristics. Our main findings show that maternal illness substantially decreases chances of being enrolled in school for children between 10 and 23 years old and, at the same time, increases the children's likelihood of entering the labour market and working more hours for children aged 10-15 years old. The effect is particularly pronounced for girls, who seem to experience worst adverse consequences in terms of education and labour market engagement.
    Keywords: children's education, child labour, parental illness
    JEL: I10 I14 I24
    Date: 2017–03
  14. By: Asali, Muhammad
    Abstract: The net, positive, effect of unemployment at conception on birth outcomes in developed countries is likely overestimated in the literature. This is the consequence of ignoring the effects of unemployment during pregnancy. Using data from Israel, we not only confirm this finding but also find that the harmful effects of unemployment in the third trimester are large enough to offset any preceding positive effects. Stress and nutritional deficiencies due to economic contractions during pregnancy are at least as important as the positive self-selection at conception. This finding calls for policy intervention to support pregnant women even in developed countries.
    Keywords: recession; health outcomes; birth weight; developed countries
    JEL: E24 E32 I12
    Date: 2015–06
  15. By: Mohamed Amara; Hatem Jemmali (Faculty of Economic Sciences and Management of Sousse)
    Abstract: It is widely recognized in the public health literature that health and nutrition during the early childhood period have important long-term and sometimes irreversible consequences on health and wellbeing later in life. In this paper, we attempt to analyze deeply the patterns of inequality of opportunity in health and nutrition outcomes among under-five children in Tunisia. In order to attain such objective, we use several tools, including comparison of the distributions of considered outcomes across a number of circumstances groups; computation of the Human Opportunity Index and estimation of the relative contributions of circumstances using the Shapley decomposition. The main finding reveal reasonable and low levels of inequality in access to all basic healthcare services and nutrition except access to improved water and sanitation. The parents' education, wealth and location of residence are key factors causing such low inequalities. Without more inclusive and pro-poor policy interventions, there are few chances for children belonging in poor families and living in marginalized rural areas to spring out of the poverty lived by their parents.
    Date: 2017–11–05
  16. By: Burhan Can Karahasani; Firat Bilgel (Okan University, Turkey)
    Abstract: This paper examines the link between healthcare access/utilization and health outcomes in Turkey within a spatial framework. Our initial set of findings highlight an overall duality in health indicators which is getting stronger once spatial dimension is included. Specifically we find wider spatial dichotomy for health outcomes relative to access and utilization measures. Finally once we consider unobserved heterogeneity, spatial spillovers and spatial variability; our results pin point a non-robust link between healthcare access/utilization measures and health outcomes which works better among the already developed regions of Turkey. Overall our combined results indicate an ongoing polarization of health-based human capital development which coincides with local variations of the relationship between healthcare access/utilization and outcomes in Turkey.
    Date: 2017–04–26
  17. By: Miqdad Asaria (Centre for Health Economics, University of York, York, UK.)
    Abstract: This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12. The results presented here can be used by costeffectiveness analysts to populate their extrapolation models when estimating future health care costs. The results will also be of interest to the broader community of health researchers as they illustrate how NHS spending is distributed across different subgroups within the population.
    Date: 2017–04
  18. By: Simon Spika (Department of Economics, University of Konstanz); Friedrich Breyer (Department of Economics, University of Konstanz, Germany)
    Abstract: Physical activity has been shown to be associated with reduced direct health care utilization and expenditure. For the health effect of physical activity, however, not only the total amount but also the intensity and frequency of physical activity is important. This paper uses data from the Konstanz Life-Study and a hurdle-model to estimate the impact of physical activity patterns on the number of physician visits. The results indicate that in the case of women, vigorous physical activity reduces the number of visits given a positive usage, whereas in the case of men, vigorous physical activity reduces the probability of a first visit. The results however, have to be interpreted with caution because of the limited accuracy of the self-declared physical activity by the participants of the Konstanz Life-Study, collected with the IPAQ-SF questionnaire.
    Keywords: Physical activity; health care utilization; Konstanz Life Study
    Date: 2017–01–16
  19. By: Angela M. Gerolamo; Kara Conroy; Grace Roemer; Aline Holmes; Susan Salmond; Jennifer Polakowski
    Abstract: Findings suggest that a faculty preparation program that targets doctoral students and includes financial support, socialization to the faculty role, and formal education courses produces graduates who maintain a career in nursing education for up to three years after program completion.
    Keywords: Faculty preparation, Nurse faculty shortage, Program design
    JEL: I
  20. By: Abraham Olufunmilola; Jia Pu; Loren J. Schleiden; Steven M. Albert
    Abstract: To identify factors influencing older adults' poor satisfaction with sleep and their current healthcare seeking behaviors.
    Keywords: Poor sleep satisfaction, Sleep health, Sleep disturbance, Sleep complaints, Healthcare seeking behaviors, Older adults
    JEL: I
  21. By: Boyd Gilman; Laura Ruttner; Michaella Morzuch
    Abstract: The goal of this study was to assess the impact of providing enhanced Medicare payments to frontier clinics for extended stay services on the use and cost of emergency care.
    Keywords: Medicare, Rural Health, Ambulatory/Outpatient Care, Health Care Costs
    JEL: I
  22. By: Kim, Hyuncheol Bryant (Cornell University); Lee, Suejin (Cornell University); Lim, Wilfredo (Mathematica Policy Research)
    Abstract: Health screening provides information on disease risk and diagnosis, but whether this promotes health is unclear. We estimate the impacts of the National Health Screening Program in Korea for diabetes, obesity, and hyperlipidemia. In this setting, information on disease risk and prompting for a secondary examination vary at different biomarker thresholds. We find evidence for increased diabetes medication and weight loss around the high risk threshold for diabetes, where information is combined with prompting for a secondary examination and subsequent medical treatment. However, we find no differences around other thresholds, where information is not combined with further intervention.
    Keywords: health behavior, hyperlipidemia, diabetes, obesity, information, health screening
    JEL: I12 I18
    Date: 2017–03
  23. By: Blunch, Niels-Hugo (Washington and Lee University)
    Abstract: I examine teenage pregnancy in Ghana, focusing on the role and interplay of Ghanaian and English reading skills, formal educational attainment, and adult literacy program participation. Pursuing several alternative identification strategies three main results are established. First, I confirm the finding from previous studies that educational attainment is negatively related to teenage pregnancy. Second, however, once Ghanaian and English reading skills are introduced, the association between educational attainment and teenage pregnancy decreases or disappears altogether. Third, for the girls who have not completed primary school, adult literacy program participation is associated with a much lower probability of experiencing a teenage pregnancy.
    Keywords: teenage pregnancy, human capital, literacy, adult literacy programs, Ghana
    JEL: I21 J24
    Date: 2017–03
  24. By: Corinne P. Lewis
    Abstract: The umbrella term “transgender†broadly refers to those who identify with, express, or exhibit behavior consistent with a gender that differs from that which was assigned at birth.
    Keywords: health policy , social work , transgender persons
    JEL: I
  25. By: Walter Beckert (Institute for Fiscal Studies and Birkbeck, University of London); Kate Collyer (Institute for Fiscal Studies)
    Abstract: This paper considers the micro-econometric analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). It proposes a two-stage choice model that encompasses both, patient and GP level optimization, and it discusses identifi cation. The empirical analysis demonstrates biases and inconsistencies that arise when strategic pre-selection is not properly taken into account. We fi nd that patients defer to GPs when assessing hospital quality and focus on tangible attributes, like hospital amenities; and that GPs, in turn, as patients' agents present choice options based on quality, but as agents of health authorities also consider their financial implications.
    Keywords: Discrete choice, patient, principal, GP, agent, expert, endogenous choice sets, competition, hospital choice, elective medical procedure.
    Date: 2016–11–14
  26. By: Elaine Kelly (Institute for Fiscal Studies and Institute for Fiscal Studies); George Stoye (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: Reforms to public services have extended consumer choice by allowing for the entry of private providers. The aim is to generate competitive pressure to improve quality when consumers choose between providers. However, for many services new entrants could also affect whether a consumer demands the service at all. We explore this issue by considering how demand for elective surgery responds following the entry of private providers into the market for publicly funded health care in England. For elective hip replacements, we find that demand shifts account for at least 7% of public procedures conducted by private hospitals. These results are robust to instrumenting for location using the presence of existing healthcare facilities. Exploiting rarely used clinical audit data, we show that these additional procedures are not substitutions from privately funded procedures, and represent new surgeries, at least within a given year. The increase in volumes resulting from a demand shift improve consumer welfare, but impose fiscal costs, and do not contribute the original aim of the reforms to stimulate competition. This is an updated version of W15/22 New joints: private providers and rising demand in the English National Health Service.
    Keywords: public service choice; healthcare demand; geographic variation
    JEL: I11 I18 L33
    Date: 2016–08–26
  27. By: James Banks (Institute for Fiscal Studies and University of Manchester); Richard Blundell (Institute for Fiscal Studies and IFS and UCL); Peter Levell (Institute for Fiscal Studies and Institute for Fiscal Studies); James Smith (Institute for Fiscal Studies and RAND)
    Abstract: In this paper we document significantly steeper declines in nondurable expenditures in the UK compared to the US, in spite of income paths being similar. We explore several possible causes, including different employment paths, housing ownership and expenses, levels and paths of health status, number of household members, and out-of -pocket medical expenditures. Among all the potential explanations considered, we find that those to do with healthcare—differences in levels and age paths in medical expenses—can fully account for the steeper declines in nondurable consumption in the UK compared to the US.
    Keywords: Life-Cycle, Consumption, Medical Expenditures
    JEL: D10 D11 D12 D14 D91
    Date: 2016–09–09
  28. By: Emla Fitzsimons (Institute for Fiscal Studies and Institute of Education, University of London); Bansi Malde (Institute for Fiscal Studies and Institute for Fiscal Studies); Marcos Vera-Hernandez (Institute for Fiscal Studies and University College London)
    Abstract: Community-based interventions, particularly group-based ones, are considered to be a cost-effective way of delivering interventions in low-income settings. However, design features of these programs could also influence dimensions of household and community behaviour beyond those targeted by the intervention. This paper studies spillover effects of a participatory community health intervention in rural Malawi, implemented through a cluster randomised control trial, on an outcome not directly targeted by the intervention: household consumption smoothing after crop losses. We find that while crop losses reduce consumption growth in the absence of the intervention, households in treated areas are able to compensate for this loss and perfectly insure their consumption. Asset decumulation also falls in treated areas. We provide suggestive evidence that these effects are driven by increased social interactions, which could have alleviated contracting frictions; and rule out that they are driven by improved health or reductions in the incidence of crop losses.
    Keywords: participatory community interventions, spillovers, consumption smoothing, Sub-Saharan Africa
    JEL: E21 G22 O12 O13
    Date: 2016–10–18

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