nep-hea New Economics Papers
on Health Economics
Issue of 2017‒05‒14
twenty-two papers chosen by
Yong Yin
SUNY at Buffalo

  1. Machine Learning Techniques for Mortality Modeling By Philippe Deprez; Pavel V. Shevchenko; Mario V. W\"uthrich
  2. An ordinal measure of population health By Héctor Pifarre i Arolas; Christian Dudel
  3. Altruism of Healthcare Workers and Job Satisfaction: Findings from a survey in central Vietnam By Midori MATSUSHIMA; Hiroyuki YAMADA; Yasuharu SHIMAMURA; NGUYEN Minh Tam
  4. A Time Series Analysis-Based Forecasting Framework for the Indian Healthcare Sector By Jaydip Sen; Tamal Datta Chaudhuri
  5. Individual heterogeneity in the association between social participation and self-rated health. A panel study on BHPS By Damiano, Fiorillo; Lubrano Lavadera, Giuseppe; Nappo, Nunzia
  6. Ambulatory care at the end of a billing period By Himmel, Konrad; Schneider, Udo
  7. The marriage gap: Optimal aging and death in partnerships By Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
  8. An Equilibrium Model of the African HIV/AIDS Epidemic By Jeremy Greenwood; Philipp Kircher; Cezar Santos; Michèle Tertilt
  9. The Impact of Housing Prices on Health in U.S. Before, During and After the Great Recession By Sung, Jaesang
  10. Patient Experience Midway Through a Large Primary Care Practice Transformation Initiative By Kaylyn E. Swankoski; Deborah N. Peikes; Stacy B. Dale; Nancy A. Clusen; Nikkilyn Morrison; John J. Holland; Timothy J. Day; Randall S. Brown
  11. Development and Validation of the Modified Patient-Centered Medical Home Assessment for the Comprehensive Primary Care Initiative By Dmitriy Poznyak; Deborah N. Peikes; Breanna A. Wakar; Randall S. Brown; Robert J. Reid
  12. Consumer Response to Gastrointestinal Illness Perceived to Originate from Food Service Facilities By Erin S. Garnett; Stephanie R. Gretsch; Clair Null; Christine L. Moe
  13. Outcomes for High-Needs Patients: Practices with a Higher Proportion of These Patients Have an Edge By Dori A. Cross; Genna R. Cohen; Christy Harris Lemak; Julia Adler-Milstein
  14. Infant Mortality and the Repeal of Federal Prohibition By David S. Jacks; Krishna Pendakur; Hitoshi Shigeoka
  15. Interactions between Financial Incentives and Health in the Early Retirement Decision By Pilar García-Goméz; Titus Galama; Eddy van Doorslaer; Ángel López-Nicholás
  16. Human Capital and Shocks: Evidence on Education, Health, and Nutrition By Elizabeth Frankenberg; Duncan Thomas
  17. A Correlation between Workplace Stress and Organizational Commitment: Doctors response from Public and Private Hospitals in Karachi, Pakistan By Zehra, Syeda Zufiesha; Ather, Marium; Zehra, Beenish
  18. Demand for Narcotics in Thailand, with Policy Implications By Sukharomana, Renu; Chang, Chia-Lin
  19. (English) Pediatric Health Mobility in the Campania Region: An Interdisciplinary Study (Italiano) Mobilità sanitaria pediatrica in Regione Campania: uno studio interdisciplinare By Giuseppe Masullo; Emiliana Mangone
  20. Factors associated with the delay in seeking inpatient and outpatient care services in the Philippines By JJ Capuno; AD Kraft; LC Poco; SA Quimbo; CAR Tan, Jr.
  21. WASH for child health: Some evidence in support of public intervention in the Philippines By Joseph J. Capuno; Carlos Antonio R. Tan, Jr.; Xylee Javier
  22. Parental Work Hours and Childhood Obesity: Evidence Using Instrumental Variables Related to Sibling School Eligibility By Courtemanche, Charles; Tchernis, Rusty; Zhou, Xilin

  1. By: Philippe Deprez; Pavel V. Shevchenko; Mario V. W\"uthrich
    Abstract: Various stochastic models have been proposed to estimate mortality rates. In this paper we illustrate how machine learning techniques allow us to analyze the quality of such mortality models. In addition, we present how these techniques can be used for differentiating the different causes of death in mortality modeling.
    Date: 2017–05
  2. By: Héctor Pifarre i Arolas (Max Planck Institute for Demographic Research, Rostock, Germany); Christian Dudel (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: -
    JEL: J1 Z0
    Date: 2017–05
  3. By: Midori MATSUSHIMA (Faculty of Business Administration, Osaka University of Commerce); Hiroyuki YAMADA (Faculty of Economics, Keio University); Yasuharu SHIMAMURA (Graduate School of International Cooperation Studies, Kobe University); NGUYEN Minh Tam (Hue University of Medicine and Pharmacy)
    Abstract: Despite the value of altruism in this field of work, existing research across the world has not addressed its role in job satisfaction. We conduct quantitative analysis by using data collected from healthcare workers at primary facilities in central Vietnam in 2014, which includes a hypothetical question regarding the "dictator game" to obtain healthcare workers' altruism. The results of a regression analysis show that a higher level of altruism is associated with lower job satisfaction. Further analysis reveals that more altruistic workers have lower satisfaction on healthcare quality they provide at their work in particular. This study contributes to previous knowledge on healthcare workers' satisfaction by observing the role of altruism, which has not been sufficiently examined in previous studies.
    Keywords: altruism; job satisfaction; healthcare workers; Vietnam
    JEL: C12 D64 I12
    Date: 2017–04
  4. By: Jaydip Sen; Tamal Datta Chaudhuri
    Abstract: Designing efficient and robust algorithms for accurate prediction of stock market prices is one of the most exciting challenges in the field of time series analysis and forecasting. With the exponential rate of development and evolution of sophisticated algorithms and with the availability of fast computing platforms, it has now become possible to effectively and efficiently extract, store, process and analyze high volume of stock market data with diversity in its contents. Availability of complex algorithms which can execute very fast on parallel architecture over the cloud has made it possible to achieve higher accuracy in forecasting results while reducing the time required for computation. In this paper, we use the time series data of the healthcare sector of India for the period January 2010 till December 2016. We first demonstrate a decomposition approach of the time series and then illustrate how the decomposition results provide us with useful insights into the behavior and properties exhibited by the time series. Further, based on the structural analysis of the time series, we propose six different methods of forecasting for predicting the time series index of the healthcare sector. Extensive results are provided on the performance of the forecasting methods to demonstrate their effectiveness.
    Date: 2017–04
  5. By: Damiano, Fiorillo; Lubrano Lavadera, Giuseppe; Nappo, Nunzia
    Abstract: In the last ten years interest in social capital as mechanism for understanding actual and perceived health has been increasing among economists. Although pathways by which social participation, as dimension of social capital, may have positive effect on health are well understood, empirical evidence on the relationship between social participation and self-rated health is mixed and it has never addressed the empirical problem of individual heterogeneity. This longitudinal study investigates the relationship between social participation (being member, active, and both member and active) in associations and self-rated health taking into account individual heterogeneity bias. The paper uses five waves of the British Household Panel Survey from 1991 to 1995 (unbalanced panel N=45,745). Three types of estimations are implemented. The first is an OLS with fixed effects on the original ordinal variable self-rated health (SOH). The second uses a dichotomization of the ordered variable self-rated (SOH2) and applies a logistic fixed effect estimation. The last estimator is the ordered logit with fixed effects implemented by Baetschmann et al. (2015). All the empirical estimations show a positive and weak significant relationship between active membership and self-rated health.
    Keywords: Self-rated health, social participation, individual heterogeneity, social capital, ordered logit fixed effects model, British Household Panel Survey
    JEL: C10 C33 C35 I1 Z0
    Date: 2017–04
  6. By: Himmel, Konrad; Schneider, Udo
    Abstract: The ambulatory physician payment system in the German Social Health Insurance (SHI) offers incentives to reduce practice activity at the end of a billing period. Most services within a period are reimbursed at full cost only up to a certain threshold. Furthermore, capitated payments make follow-up treatments within a billing period less profitable. Using claims data from Germany's largest sickness fund with about nine million members, we find a decrease of all services limited by a threshold at the end of a billing period and an immediate increase at the beginning of the following period. For services that are not limited, we do not find an effect. An increase of ambulatory emergencies at the end of a billing period suggests a negative welfare effect for patients.
    Keywords: ambulatory care,expenditure targets,global budget,physician payment,health care utilization
    JEL: I11 H51
    Date: 2017
  7. By: Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
    Abstract: Married people live longer than singles but how much of the longevity differential is causal and what the particular mechanisms are is not fully understood. In this paper we propose a new approach, based on counterfactual computational experiments, in order to asses how much of the marriage gap can be explained by public-goods sharing and collective bargaining of partners with different preferences and biology. For that purpose we integrate cooperative decision making of a couple into a biologically-founded life-cycle model of health deficit accumulation and endogenous longevity. We calibrate the model with U.S. data and perform the counterfactual experiment of preventing the partnership. We elaborate three economic channels and find that, as singles, men live 8.5 months shorter and women 6 months longer. We conclude that about 30% of the marriage gain in longevity of men can be motivated by economic calculus while the marriage gain for women observed in the data is attributed to selection or other (non-standard economic) motives.
    Keywords: health,aging,longevity,marriage-gap,gender-specific preferences,unhealthy behavior
    JEL: D91 J17 J26 I12
    Date: 2017
  8. By: Jeremy Greenwood (University of Pennsylvania); Philipp Kircher (EUI and University of Edinburgh); Cezar Santos (FGV/EPGE); Michèle Tertilt (University of Mannheim)
    Date: 2017–05
  9. By: Sung, Jaesang
    Abstract: I estimate the effects of U.S. Metropolitan Statistical Area (MSA) housing prices on a variety of health outcomes and risky health behaviors separately for homeowners and tenants. The constructed dataset consists of information on individuals from the 2002 - 2012 Behavioral Risk Factor Surveillance System (BRFSS) combined with homeownership data from the March Current Population Survey (CPS) and housing prices from Freddie Mac. I estimate positive results for homeowners in terms of their health and negative results for tenants. I also find increases in risky behaviors among tenants associated with increases in housing prices, which may be driving the reduction in their health status. Those estimated effects are concentrated on low income homeowners and tenants. The estimated contemporaneous effects do not persist in the long run while the effects of an increase in housing prices on being obese become more pronounced for homeowners, resulting in worse self-reported health.
    Keywords: Housing prices, Wealth inequality, Health, Risky behaviors, Homeowners, Tenants
    JEL: I12 I14 I18
    Date: 2017–04–21
  10. By: Kaylyn E. Swankoski; Deborah N. Peikes; Stacy B. Dale; Nancy A. Clusen; Nikkilyn Morrison; John J. Holland; Timothy J. Day; Randall S. Brown
    Abstract: The study examines how experience changed between the first and second years of Comprehensive Primary Care (CPC), how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience.
    Keywords: patient experience, primary care, transformation initiative, comprehensive primary care
    JEL: I
  11. By: Dmitriy Poznyak; Deborah N. Peikes; Breanna A. Wakar; Randall S. Brown; Robert J. Reid
    Abstract: To describe the modified Patient-Centered Medical Home Assessment (M-PCMH-A) survey module developed to track primary care practices’ care delivery approaches over time, assess whether its underlying factor structure is reliable, and produce factor scores that provide a more reliable summary measure of the practice's care delivery than would a simple average of question responses.
    Keywords: patient-centered medical home, Comprehensive Primary Care Initiative
    JEL: I
  12. By: Erin S. Garnett; Stephanie R. Gretsch; Clair Null; Christine L. Moe
    Abstract: Consumer responses to food product recalls have been documented, but there is little information on how consumers respond to illnesses or outbreaks associated with food service facilities.
    Keywords: Consumer survey, Foodborne outbreaks, Norovirus
    JEL: I0 I1
  13. By: Dori A. Cross; Genna R. Cohen; Christy Harris Lemak; Julia Adler-Milstein
    Abstract: High-value primary care for high-needs patients—those with multiple physical, mental, or behavioral health conditions—is critical to improving health system performance
    Keywords: Chronic Care, Organization and Delivery of Care, Primary Care, Quality Of Care
    JEL: I
  14. By: David S. Jacks (Simon Fraser University); Krishna Pendakur (Simon Fraser University); Hitoshi Shigeoka (Simon Fraser University)
    Abstract: Exploiting a newly constructed dataset on county-level variation in prohibition status from 1933 to 1939, this paper asks two questions: what were the effects of the repeal of federal prohibition on infant mortality? And were there any significant externalities from the individual policy choices of counties and states on their neighbors? We find that dry counties with at least one wet neighbor saw baseline infant mortality increase by roughly 3% while wet counties themselves saw baseline infant mortality increase by roughly 2%. Cumulating across the six years from 1934 to 1939, our results indicate an excess of 13,665 infant deaths that could be attributable to the repeal of federal prohibition in 1933.
    Keywords: federal prohibition, infant mortality, policy externalities
    JEL: H73 I18 J10 N30
    Date: 2017–05
  15. By: Pilar García-Goméz (Erasmus University); Titus Galama (University of Southern California); Eddy van Doorslaer (Erasmus University); Ángel López-Nicholás (Universidad Politécnica de Cartagena)
    Abstract: We present a theory of the relation between health and retirement that generates testable predictions regarding the interaction of health, wealth and financial incentives in retirement decisions. The theory predicts (i) that wealthier individuals (compared to poorer individuals) are more likely to retire for health reasons (affordability proposition), and (ii) that health problems make older workers more responsive to nancial incentives encouraging retirement (reinforcement proposition). We test these predictions using administrative data on older employees in the Dutch healthcare sector for whom we link adverse health events, proxied by unanticipated hospitalizations, to information on retirement decisions and actual incentives from administrative records of the pension funds. Exploiting unexpected health shocks and quasi-exogenous variation in nancial incentives for retirement due to reforms, we account for the endogeneity of health and nancial incentives. Making use of the actual individual pension rights diminishes downward bias in estimates of the effect of pension incentives. We find support for our affordability and reinforcement propositions. Both propositions require the bene ts function to be convex, as in our data. Our theory and empirical findings highlight the importance of assessing nancial incentives for their potential reinforcement of health shocks and point to the possibility that di erences in responses to nancial incentives and health shocks across countries may relate to whether the benefit function is concave or convex.
    Keywords: pensions, Health, retirement, disability, health investment, lifecycle model, health capital, optimal control
    JEL: C33 D91 H55 I10 I12 J00 J24 J26 J45
    Date: 2017–05
  16. By: Elizabeth Frankenberg (Duke University); Duncan Thomas (Duke University)
    Abstract: Human capital, including health and nutrition, has played a key role in the literature on poverty traps. Economic shocks that affect human capital during early life are thought to translate into permanently reduced levels of human capital and, thereby, push individuals into poverty. Three potential concerns in this literature are explored with empirical evidence drawn from primary longitudinal survey data collected before and after two major shocks in Indonesia: the 1998 financial crisis and the 2004 Indian Ocean tsunami. First, it is very hard to identify shocks that are unanticipated and uncorrelated with other factors that affect human capital outcomes. Second, and related, there is abundant evidence that individuals, families and communities invest in strategies that are designed to mitigate the impact of such shocks. The nature and effectiveness of the myriad array of these behaviors vary with the context in ways that are not straightforward to measure or model. Third, the impacts of shocks on human capital outcomes in the short and longer-term may differ precisely because of the behavioral changes of individuals and their families so that drawing inferences about the longer-term impacts based on negative impacts in the short term can be very misleading. The picture of remarkable resilience that emerges from investigating the impacts of major shocks on child health and human capital in Indonesia is nothing short of stunning.
    Keywords: Health, poverty traps, natural disaster, resilience, long-term outcomes
    JEL: I10 I20 O10 O15
    Date: 2017–05
  17. By: Zehra, Syeda Zufiesha; Ather, Marium; Zehra, Beenish
    Abstract: The study inspects the correlation between occupational stress and organizational commitment among doctors working in public and private sectors of Karachi. The self-constructive survey questionnaire is circulated through convenience sampling techniques and gathered 1039 responses (public hospital=549 and private hospitals=490). A five-point likert scale measured response ranges from strongly agree (1) to strongly disagree (5) while 10-item scale was used to evaluate occupational stress. Additionally, dimensions of organizational commitment; affective, normative and continuance commitment were evaluated on a scale containing 6-items. The data was analyzed through SPSS 23. As interpreted from results, there is a weak positive linear relationship between AC and personal factor and organizational factor. Likewise, NC shares a weak positive linear relationship with personal resources and organizational factor. Similarly, CC has a weak positive linear relationship with personal factor and personal resources. However, AC has a strong negative relationship with personal resources while NC also has a strong negative relationship with personal factor. In a similar manner, CC has a weak negative linear relationship with organizational factor. Moreover, level of stress and commitment among doctors working in public hospitals is relatively low in contrast to private hospitals. In addition, males are under more stress. However, AC and NC are relatively high in females while CC is more in males.
    Keywords: Occupational Stress; Organizational Commitment; Public and Private Hospitals; Doctors; Personal Factors; Personal Resources; Organizational Factors
    JEL: C0 I10 I12 I19 I31 M0 M10 M12
    Date: 2017–04–01
  18. By: Sukharomana, Renu; Chang, Chia-Lin
    Abstract: The paper examines the demand for narcotic drugs, based on Becker (1968), as purported rational behavior of human beings. The results from sampling surveys in eight provinces in Thailand in 2014, representing nationwide drug users/addicts, show that the demand for narcotics (amphetamines, ice drug, and marijuana) are price inelastic (between -0.533 and -0.701), as well as normal goods. The key econometric coefficients in models A and B are 0.192 and 0.0467, respectively, and an increase in income will lead to an increase in the demand for narcotics. In addition, factors affecting the demand for narcotics are the age and age squared of the user, friendship, family member relationship, social relationship, reasons for drug use, risk behavior, and expected punishment. Public policy implications are also proposed and analysed.
    Keywords: Price elasticity of demand, Narcotics, Amphetamines, Ice drug, Marijuana, Policy implications.
    JEL: K42 L65 Q21
    Date: 2017–05–12
  19. By: Giuseppe Masullo; Emiliana Mangone
    Abstract: (English) Through an interdisciplinary approach, the following pages will analyse first those structural factors crucially influencing the decision to contact a health service outside one’s residence region in order to solve one’s health conditions. We will see that many of these choices are attributable to differences – both real and perceived – in the supply of regional health services, partly as a result of some important reforms that occurred in recent decades in the National Health System. We will next discuss the phenomenon more in detail, referring particularly to the pediatric health mobility from health services within the Campania Region to those of other regions, reconstructed through both the analysis of hospital discharge records (in Italian SDO) and the testimonies of pediatricians in some regional provinces. (Italiano) Attraverso un approccio interdisciplinare, nelle pagine successive, saranno analizzati dapprima i fattori strutturali che si rivelano determinanti nel condizionare la decisione di rivolgersi a un servizio sanitario fuori regione per risolvere i propri problemi di salute, come si vedrà molte di queste scelte sono riconducibili alle differenze - sia reali sia percepite – nell’offerta di servizi sanitari regionali, anche a seguito di alcune riforme importanti intervenute negli ultimi decenni nel Sistema Sanitario Nazionale. Successivamente, si entrerà più nel merito del fenomeno, in particolare prendendo come riferimento il caso della migrazione sanitaria pediatrica dai servizi della Regione Campania verso i servizi sanitari di altre Regioni, ricostruito sia attraverso l’analisi delle schede di dimissione ospedaliera (SDO) sia attraverso le testimonianze dei pediatri di famiglia di alcune province campane.
    Keywords: (English) Passive mobility; Health System; Pediatrician; Campania Region; Focus Group (Italiano) Mobilità passiva; Sistema sanitario; Pediatra; Regione Campania; Focus group
    Date: 2016
  20. By: JJ Capuno (School of Economics, University of the Philippines Diliman); AD Kraft (School of Economics, University of the Philippines Diliman); LC Poco (School of Economics, University of the Philippines Diliman); SA Quimbo (School of Economics, University of the Philippines Diliman); CAR Tan, Jr. (School of Economics, University of the Philippines Diliman)
    Abstract: Despite the country's policies and programs towards universal health care, health is not improving as well as expected, which suggests that households still face significant barriers to their choice of and access to health care, and their timing of use of health services. Using a nationally representative sample of households, we investigate the factors that affect the timing of outpatient care and inpatient care utilization. We define two indicators of delay in seeking care, namely: one for outpatient care, as the number of days from onset of symptom until visit of a clinic or provider, and another for inpatient care, as the number of days from doctor's advice until hospital confinement. Given our dependent variables are measured in terms days until visit, we estimate proportional hazard models (Cox, Weibull and Gompertz) to identify the significant factors associated with delay in seeking health care services. The factors associated with delay are classified in terms of health needs, financial access, physical access, opportunity costs, other household factors and location. Our findings suggest health needs and opportunity costs are the main factors associated with the delay in seeking outpatient and inpatient care services among Filipinos in need of medical attention. Perhaps more importantly from a policy perspective, we also find that physical and financial access variables do not significantly affect timing of care. We draw some implications from the results on increasing access to health care, through improvements in awareness of social health insurance and in the actual quality of health facilities. We also identify directions for future research.
    Keywords: Outpatient care; inpatient care; delay in seeking health care; health care utilization; social health insurance; Philippines
    JEL: I12 D12 I19
    Date: 2017–05
  21. By: Joseph J. Capuno (School of Economics, University of the Philippines Diliman); Carlos Antonio R. Tan, Jr. (School of Economics, University of the Philippines Diliman); Xylee Javier (School of Economics, University of the Philippines Diliman)
    Abstract: Like in many developing countries, diarrheal diseases remain a top cause of child mortality and morbidity in the Philippines. Partly to address this problem, the government has undertaken programs to expand access to safe water and sanitation facilities, especially among poor households. To assess the impact of such interventions on child health, we apply propensity score matching technique on the pooled data from the last five rounds of the National Demographic and Health Survey. We find that improved water and improved sanitation each reduced the probability of child diarrhea in 1993-2008 by around two percentage points. In 2013, improved water reduced the probability by about 7 percentage points, while improved sanitation do not seem to have statistically significant effect. These results lend support to the government’s programs to widen access to safe water and sanitation facilities as measures to improve child health.
    Keywords: Water and sanitation; child health; Philippines
    JEL: I12 I18 O53
    Date: 2016–09
  22. By: Courtemanche, Charles (Georgia State University); Tchernis, Rusty (Georgia State University); Zhou, Xilin (Georgia State University)
    Abstract: This study exploits plausibly exogenous variation from the youngest sibling's school eligibility to estimate the effects of parental work on the weight outcomes of older children in the household. Data come from the 1979 cohort of the National Longitudinal Survey of Youth linked to the Child and Young Adult Supplement. We first show that mothers' work hours increase gradually as the age of the youngest child rises, whereas mothers' spouses' work hours exhibit a discontinuous jump at kindergarten eligibility. Leveraging these insights, we develop an instrumental variables model that shows that parents' work hours lead to larger increases in children's BMI z-scores and probabilities of being overweight and obese than those identified in previous studies. We find no evidence that the impacts of maternal and paternal work are different. Subsample analyses find that the effects are concentrated among advantaged households, as measured by an index involving education, race, and mother's marital status.
    Keywords: childhood obesity, maternal employment, women's labor supply
    JEL: I12 J22
    Date: 2017–04

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