nep-hea New Economics Papers
on Health Economics
Issue of 2017‒07‒09
eight papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Effect of Antimalarial Campaigns on Child Mortality and Fertility in Sub-Saharan Africa By Joshua Wilde; Bénédicte H. Apouey; Gabriel Picone; Joseph Coleman
  2. Is it good to be too light? Birth weight thresholds in hospital reimbursement systems By Reif, S.; Wichert, S.; Wuppermann, A.;
  3. Malaria Prevalence, Indoor Residual Spraying, and Insecticide Treated Net Usage in Sub-Saharan Africa By Gabriel Picone; Robyn Kibler; Benedicte Apouey
  4. Quality of care: Measuring a neglected driver of improved health By Yoko Akachi; Margaret E. Kruk
  5. Health Inequalities for Immigrants in Canada : Quebec versus the Rest of Canada By LEBIHAN, Laetitia; MAO TAKONGMO, Charles Olivier; McKELLIPS, Fanny
  7. Caregivers in the family: daughters, sons and social norms By F. Barigozzi; H. Cremer; K. Roeder
  8. Protecting Calorie Intakes against Income Shocks By Stephanie von Hinke; George Leckie

  1. By: Joshua Wilde (Department of Economics, University of South Florida); Bénédicte H. Apouey (Paris School of Economics); Gabriel Picone (Department of Economics, University of South Florida); Joseph Coleman (Department of Economics, University of South Florida)
    Abstract: We examine to what extent recent declines in mortality and fertility in sub-Saharan Africa can be attributed to insecticide-treated bed nets (ITNs). Exploiting the rapid increase in ITNs during the mid-2000s, we employ a difference-in-differences estimation strategy to identify the causal effect of ITNs on mortality and fertility. We show that ITNs reduced all-cause child mortality, but surprisingly increased total fertility rates in spite of reduced desire for children and increased contraceptive use. We explain this paradox by showing evidence for an unexpected increase in fecundity and sexual activity due to the better health environment after the ITN distribution.
    Keywords: Malaria, Bed nets, Child mortality, Fertility, Sub-Saharan Africa
    JEL: I15 J13 O10
    Date: 2017–06
  2. By: Reif, S.; Wichert, S.; Wuppermann, A.;
    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: 2017–06
  3. By: Gabriel Picone (Department of Economics, University of South Florida); Robyn Kibler (Department of Economics, University of South Florida); Benedicte Apouey (Paris School of Economics, CNRS)
    Abstract: This paper examines the extent to which bed net usage is responsive to changes in malaria prevalence and whether indoor residual spraying crowds out bed net usage. We show that malaria prevalence increases the probability of sleeping under an insecticide treated net but the implied elasticities are below one. For children under five, a one percentage point increase in malaria prevalence increases the probability of sleeping under a bed net by 0.41 percentage point. We find that indoor residual spraying does not crowd out bed net usage. Instead, children under five who live in houses that were recently sprayed are 3.1 percentage points more likely to sleep under a bed net.
    Keywords: Malaria prevalence, Indoor residual spraying, Insecticide treated nets
    JEL: I12 I15 I18 H4
    Date: 2017–02
  4. By: Yoko Akachi; Margaret E. Kruk
    Abstract: The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and wellbeing. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to healthcare practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
    Date: 2017
  5. By: LEBIHAN, Laetitia; MAO TAKONGMO, Charles Olivier; McKELLIPS, Fanny
    Abstract: Little is known about immigrant health inequalities in Canada by province. To address this knowledge gap, we compare multiple health indicators among immigrants in Quebec, immigrants in the rest of Canada and Canadian-born individuals. The literature emphasizes that it is more difficult for immigrants in Quebec to integrate into the job market compared to immigrants in other Canadian provinces. There is an important link between the labour market situation of immigrants and their mental and physical health. Our results---obtained from data in the Canadian Community Health Survey (CCHS)---show that well-being and health indicators worsen significantly for immigrants in Quebec compared to their counterparts in the rest of Canada and Canadian-born individuals. This is particularly true for mental health and life satisfaction.
    Keywords: immigrants, Canadian-born, well-being, health, Quebec.
    JEL: I14 I30 J10
    Date: 2017–01
  6. By: Ashwinin Hegde; Kashianth Metri; Promila Chwadhary; Natesh Babu; H R Nagendra
    Abstract: There is a high prevalence of chronic health problems in elderly persons which significantly affects their mental health, sleep quality and quality of life (QoL). Practice of yoga known to enhance physical and mental health. Present pilot study intended to evaluate the effects of Integrated Yoga (IY) practice on sleep quality, mental health and QoL of elderly individuals suffering from chronic health condition(s). Twenty-eight elderly persons residents of Bangalore, India (13 males) within the age range 65-80 years (with group mean±SD; 68.8±5.4 yrs) having chronic health problem(s) underwent 1 month of IY, 60 minutes/day for 6 days/week. We excluded the subjects if they; had compromised cardiac functioning; were on sleep medication; underwent abdominal surgery; were on anti-psychotic medications; had exposure to any form of yoga in past one year. All the subjects were assessed for cardiac variables, mental health parameters, sleep quality and quality of life at baseline after one month. It was observed a significant decrease in pulse rate (p
    Date: 2017–06
  7. By: F. Barigozzi; H. Cremer; K. Roeder
    Abstract: Daughters are the principal caregivers of their dependent parents. In this paper, we study long-term care (LTC) choices by bargaining families with mixed- or same-gender siblings. LTC care can be provided either informally by children, or formally at home or in an institution. A social norm implies that daughters suffer a psychological cost when they provide less informal care than the average child. We show that the laissez-faire (LF) and the utilitarian first-best (FB) differ for two reasons. First, because informal care imposes a negative externality on daughters via the social norm, too much informal care is provided in LF. Second, the weights children and parents have in the family bargaining problem might differ in general from their weights in social welfare. We show that the FB allocation can be achieved through a system of subsidies on formal home and institutional care. Except when children and parents have equal bargaining weights these subsidies are gender-specific and reflect Pigouvian as well as "paternalistic" considerations.
    JEL: D13 H23 H31 I19
    Date: 2017–06
  8. By: Stephanie von Hinke; George Leckie
    Abstract: Whether and how changes in economic circumstances or household income affect individuals’ diet and nutritional intakes is of substantial interest for policy purposes. This paper examines the extent to which, as well as how individuals protect their calorie intakes in the face of unanticipated shocks to household income. Our results suggest that households use substitution, disproportionally cutting back spending on non-foods to protect spending on foods, change the composition of the consumption basket, and increase the consumption of ‘cheaper’ calories. Taken together, we find that total nutritional intakes are almost fully protected against income shocks, with only very small changes in actual calorie intakes. Specifically, we find that 12-16% of the effect of permanent income shocks on food expenditures is transmitted to calorie intakes, with 84–88% protected through insurance mechanisms.
    Keywords: Nutritional intakes, food expenditures, income shocks.
    JEL: I1 I30 D12
    Date: 2017–06–30

This nep-hea issue is ©2017 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.