nep-hea New Economics Papers
on Health Economics
Issue of 2017‒07‒23
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. An Examination of the Maternal Health Quality of Care Landscape in India By So O'Neil; Katie Naeve; Rajani Ved
  2. Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental Illness By Junqing Liu; Jonathan Brown; Suzanne Morton; D.E.B. Potter; Lisa Patton; Milesh Patel; Rita Lewis; Sarah Hudson Scholle
  3. Improving the efficiency and outcomes of the Slovak health-care system By Claude Giorno; Kristina Londáková
  4. Smoking kills: An economic theory of addiction, health deficit accumulation, and longevity By Strulik, Holger
  5. The Rising Cost of Ambient Air Pollution thus far in the 21st Century: Results from the BRIICS and the OECD Countries By Rana Roy; Nils Axel Braathen
  6. The effects of adult and non-adult mortality on long-run economic development: Evidence from a heterogeneous dynamic and cross-sectionally dependent panel of countries between 1800 and 2010 By Herzer, Dierk; Nagel, Korbinian
  7. Occupational Hazards and Social Disability Insurance By David Wiczer; Amanda Michaud
  8. Prevalence of neuro-musculoskeletal complications in patients with T2DM By Saif, Mehvish; Ali, Syed Zain; Zehra, Syeda Zufiesha; Zehra, Beenish
  9. Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs-lessons from chronic illness care in Hungary By Lublóy, Ágnes; Keresztúri, Judit Lilla; Benedek, Gábor
  10. How May Working Hours and Occupations Affect Arthritis? Results from a Nationally Representative Dataset By Mercan, Murat A.
  11. The Economic Functioning of Online Drugs Markets By V. Bhaskar; Robin Linacre; Stephen Machin
  12. Long-Term Demographic Forecasts and Implications for Health Care Resources and Repurposing By Eric Nauenberg; Carita Ng
  13. Making the Grossman Model Stochastic: Investment in Health as a Stochastic Control Problem By Audrey Laporte; Brian Ferguson
  14. Role of WASH and Agency in Health: A study of isolated rural communities in Nilgiris and Jalpaiguri By Ramani, Shyama V.
  15. What Sets College Thrivers and Divers Apart? A Contrast in Study Habits, Attitudes, and Mental Health By Graham Beattie; Jean-William P. Laliberté; Catherine Michaud-Leclerc; Philip Oreopoulos
  16. Check Up Before You Check Out: Retail Clinics and Emergency Room Use By Diane Alexander; Janet Currie; Molly Schnell
  17. Effects of health insurance on labour supply: A systematic review By Nga Le Thi Quynh; Groot, Wim; Tomini, Sonila M.; Tomini, Florian
  18. The Methuselah Effect: The Pernicious Impact of Unreported Deaths on Old Age Mortality Estimates By Dan A. Black; Yu-Chieh Hsu; Seth G. Sanders; Lynne Steuerle Schofield; Lowell J. Taylor

  1. By: So O'Neil; Katie Naeve; Rajani Ved
    Abstract: This review is intended to describe current issues and interventions in the delivery of maternal health care and provide a backdrop for the Foundation’s grantmaking effort.
    Keywords: Maternal health, quality of care, India
    JEL: F Z
  2. By: Junqing Liu; Jonathan Brown; Suzanne Morton; D.E.B. Potter; Lisa Patton; Milesh Patel; Rita Lewis; Sarah Hudson Scholle
    Abstract: This study highlights disparities in care for diabetes and hypertension for individuals with serious mental illness compared with the general Medicaid and Medicare populations.
    Keywords: Diabetes, Hypertension, Mental Illness
    JEL: I
  3. By: Claude Giorno (OECD); Kristina Londáková
    Abstract: Despite improvements over the past few decades, Slovak health outcomes remains poor compared with most other OECD countries, even after controlling for differences in per capita income and other social, cultural and lifestyle factors. Disparities in access to care and health outcomes between the Roma and the rest of the population are large. Moreover, the health-care system is a source of general discontent because of high out-of-pocket payments, long waiting lists for some medical services and widely perceived mismanagement of public health-care spending. Health-care spending is currently about in line with the country's standard of living. However, improving the efficiency of this sector is key: meeting the rising demand for medical services in the coming decades while containing government spending to maintain sound public finances will be challenging. The most pressing issues to be addressed concern: enhancing the efficiency and quality of primary care; addressing the shortage of nurses and replacing the large number of retiring physicians; modernising hospital infrastructure and management; further tightening control over pharmaceutical and other ancillary spending; developing a comprehensive strategy for long-term care; promoting better care access for the Roma population; and improving lifestyles through well-designed public health and disease-prevention policies.
    Keywords: generic drugs, health policy, medical demography, medical prevention, pharmaceutical expenditure
    JEL: I10 I11 I13 I14 I18
    Date: 2017–07–19
  4. By: Strulik, Holger
    Abstract: In this paper I unify the economic theories of addiction and health deficit accumulation and develop a life cycle theory in which individuals take into account the fact that the consumption of addictive goods reduces their health and longevity. I distinguish two types of addiction: perfect and common. Individuals with perfect addiction perfectly control their addiction. Individuals with common addiction, though otherwise rational and forward looking, fail to fully understand how their addiction develops. I argue that the life cycle consumption pattern predicted for common addiction is more suitable for motivating empirically observable patterns of addictive goods consumption. I take the case of smoking as unhealthy behavior, calibrate the model with U.S. data, and apply it in order to investigate the life cycle patterns of smoking and quitting smoking and the socioeconomic gradients of unhealthy consumption and longevity.
    Keywords: addiction,unhealthy behavior,health investments,aging,longevity
    JEL: D11 D91 E21 I10 I12
    Date: 2017
  5. By: Rana Roy; Nils Axel Braathen
    Abstract: This paper presents updated results for the cost of ambient air pollution in 41 countries: the 6 major emerging economies known as the BRIICS – Brazil, Russia, India, Indonesia, China and South Africa – and the 35 member-countries of the OECD. It draws on the epidemiological evidence base assembled in the Global Burden of Disease Study 2015, in order to detail results for mortalities from ambient air pollution (AAP) – ambient particulate matter pollution (APMP) and ambient ozone pollution (AOP) – in each of these 41 countries, at successive five-year intervals from 2000 to 2015.
    Keywords: Air pollution, Cost-Benefit Analysis, Mortality, Value of Statistical Life
    JEL: D61 Q51 Q53
    Date: 2017–07–19
  6. By: Herzer, Dierk (Helmut Schmidt University, Hamburg); Nagel, Korbinian (Helmut Schmidt University, Hamburg)
    Abstract: This study examines the effects of adult and non-adult mortality on the long-run level of income in a heterogeneous dynamic and cross-sectionally dependent panel. Employing data for 20 countries between 1800 and 2010, it is found that (i) while non-adult mortality has no long-run effect on GDP per capita, reductions in adult mortality lead to statistically and economically significant increases in the long-run level of per capita income; (ii) there are no significant differences in the long-run effects of adult mortality and non-adult mortality on GDP per capita before and after the onset of the demographic transition; and (iii) mortality in middle adulthood has the greatest impact on economic development, whereas early adulthood mortality and mortality in later adulthood have little to no impact on the long-run level of per capita income.
    Keywords: Life expectancy; Adult mortality; Non-adult mortality; Economic development; Heterogeneous panel data models; Cross-sectional dependence; Demographic transition
    JEL: C23 I15 J11 O11
    Date: 2017–07–13
  7. By: David Wiczer (FRB St. Louis); Amanda Michaud (Indiana University)
    Abstract: Using retrospective data, we introduce evidence that occupational exposure significantly affects disability risk. Incorporating this into a general equilibrium model, social disability insurance (SDI) affects welfare through (i) the classic, risk-sharing channel and (ii) a new channel of occupational reallocation. Both channels can increase welfare, but at the optimal SDI they are at odds. Welfare gains from additional risk-sharing are reduced by overly incentivizing workers to choose risky occupations. In a calibration, optimal SDI increases welfare by 2.6% relative to actuarially fair insurance, mostly due to risk sharing.
    Date: 2017
  8. By: Saif, Mehvish; Ali, Syed Zain; Zehra, Syeda Zufiesha; Zehra, Beenish
    Abstract: Diabetes mellitus affects normal metabolizing body function and causes long term organs dysfunctions like blindness, kidney failure, neuropathy and autonomic dysfunction. The musculoskeletal is also affected by T2DM and causes pain, dysfunctions, and disabilities. Thus, this study is to find the prevalence of neuro-musculoskeletal complications in patients with T2DM. This cross sectional survey was conducted in various public and private sector hospitals of four major cities of Pakistan (Islamabad, Karachi, Lahore, and Sargodha) from 1st May to 31st December 2015. The patients of type II diabetes mellitus with both gender and age above 40 were included, and patients with active systemic disease of bones and soft tissues were excluded. A self-structured questionnaire was developed, reviewed by experts, and finalized after calculating their recommendations. The questionnaire was distributed among 600 patients, out of whom 500 patients responded. The non-probability convenient sampling technique was used for data collection. The data was analyzed by SPSS and percentages were calculated to estimate the neuro-musculoskeletal complications in patients with T2DM. The prevalence of neuro-musculoskeletal complication in type II Diabetes mellitus was 100 %, while the frozen shoulder, tingling sensations and ants crawling sensations (61%) were equally the most common neuro-musculoskeletal complications followed by knee pain (53%), low back pain (43%).The most involved age group was 61 to 65 years and 58% patients were with positive family history. The most commonly used way of treatment was medications (90%) and physical therapy (10%). It was proved in study that frozen shoulder, altered sensations, knee pain and back pain have high association with long duration of T2DM.There is association between long duration of diabetes mellitus and neuro-musculoskeletal complications. It is concluded that the prevalence of neuro-musculoskeletal complications is high among patients of T2DM and commonly affects shoulder, back, knee and altered sensation in legs. These are most commonly managed with medications followed by physical therapy.
    Keywords: T2DM, neuro-musculoskeletal, complications, frozen shoulder, Range of motion
    JEL: I1 I10 I11 I12 I18 I19
    Date: 2017–03–10
  9. By: Lublóy, Ágnes; Keresztúri, Judit Lilla; Benedek, Gábor
    Abstract: Improved patient care coordination is critical for achieving better health outcome measures at reduced cost. Better integration of primary and secondary care in chronic illness care and utilizing the advantages of better collaboration between general practitioners and specialists may support these conflicting goals. Assessing patient care coordination at system level is, however, as challenging as achieving it. Based on prescription data from a private data vendor company, we develop a provider-level care coordination measure to assess the function of primary care at system level. We aim to provide empirical evidence for the possible impact of patient care coordination in chronic illness care—we investigate whether the type of collaborative relationship general practitioners have built up with specialists is associated with prescription drug costs. To our knowledge, no large-scale quantitative study has ever investigated this association. We find that prescription drug costs for patients treated by general practitioners who build up strong collaborative relationships with specialists are significantly lower than for patients treated by general practitioners characterized by fragmented collaborative structures. If future system-level studies in other settings confirm that total healthcare costs are indeed lower for patients treated in strong collaborative structures, then healthcare strategists need to advocate a healthcare system with lower care fragmentation on the interface of primary and secondary care. Regulating access to secondary care might result in significant cost savings through improved care coordination.
    Keywords: chronic illness care, care coordination, primary care, secondary care, administrative data, prescription drug costs
    JEL: C12 H51 I18
    Date: 2017–05–15
  10. By: Mercan, Murat A.
    Abstract: Objective: Even though many studies have focused on the relationship between osteoarthritis and occupation, few studies have examined the relationship between arthritis and working hours; this paper seeks to fill this gap in the literature. Methods: We used a Cox regression method for the sample from Health and Retirement Survey. Results: We found that working more hours reduces the probability of arthritis among older workers in the United States. We also showed which occupations put workers at greater risk for developing arthritis. Conclusion: It is important to understand the risk of arthritis in an elderly workforce because of its policy implications on ideas such as restricting weekly working hours. Therefore, this study’s findings may raise questions about the need for initiatives in the European Union and other countries that regulate the permitted length of work schedules.
    Keywords: arthritis; working hours; the United States
    JEL: I10 J22
    Date: 2016–11–23
  11. By: V. Bhaskar; Robin Linacre; Stephen Machin
    Abstract: The economic functioning of online drug markets using data scraped from online platforms is studied. Analysis of over 1.5 million online drugs sales shows online drugs markets tend to function without the significant moral hazard problems that, a priori, one might think would plague them. Only a small proportion of online drugs deals receive bad ratings from buyers, and online markets suffer less from problems of adulteration and low quality that are a common feature of street sales of illegal drugs. Furthermore, as with legal online markets, the market penalizes bad ratings, which subsequently lead to significant sales reductions and to market exit. The impact of the well-known seizure by law enforcement of the original Silk Road and the shutdown of Silk Road 2.0 are also studied, together with the exit scam of the market leader at the time, Evolution. There is no evidence that these exits deterred buyers or sellers from online drugs trading, as new platforms rapidly replaced those taken down, with the online market for drugs continuing to grow.
    Keywords: dark web, drugs
    JEL: K42
    Date: 2017–07
  12. By: Eric Nauenberg; Carita Ng
    Abstract: We examine long-term demographic forecasts to determine whether increases in the senior population will be followed by a decrease once the baby-boom generation passes. Planners may therefore need to flexibly assign resources to allow for future repurposing of investments. Forecasts in the U.S. and Canada indicate that the number of seniors in the population will plateau by the year 2045 with levels roughly maintained until at least 2060; thus, repurposing may be unnecessary. Increases in life-expectancy, immigration age structures, and echoes of the baby-boom generation in later years are expected to help maintain this plateau. While there is no observable decrease in the senior population by 2060, there is uncertainty around the expected rate of decline in health of this generation. Depending on this trajectory, community-level social supports could play a large role in maintaining senior health and independence as long as possible.
    Keywords: demographics, seniors, social supports, health, human resources
    JEL: J11
    Date: 2017–07
  13. By: Audrey Laporte; Brian Ferguson
    Abstract: It is well known that uncertainty is a key consideration in theoretical health economics analysis. The literature has shown that uncertainty is a multifaceted concept, with the individual's optimal response depending on the formal nature of the uncertainty and the time horizon involved. This paper extends the literature by considering uncertainty with regards to the cumulative effect on health capital of on-going health behaviours. It uses techniques of stochastic optimal control to analyze uncertainty which can be represented as a Weiner process and shows how, in a Grossman health investment framework, the optimal lifetime health investment trajectory might be affected.
    JEL: I1 I12
    Date: 2017–07
  14. By: Ramani, Shyama V. (UNU-MERIT, and School of Business and Economics, Maastricht University)
    Abstract: The objective of the Swachh Bharath Mission (SBM) or Clean India Mission of the Indian Government is to eliminate open defecation in India through installation of toilets and triggering of behavioural change by 2019. The problem is most daunting in isolated communities with poor WASH infrastructure and local agencies with scarce resources. In India, tribal communities, living near forests and along mountain ranges are among the most isolated, which means that the study of the impact of WASH (water, sanitation and hygiene behaviour) and the effectiveness of local agencies responsible for public hygiene in such communities is pertinent for our research query. Thus, this working paper presents the results of a study of 20 villages located in two districts, Nilgiris and Jalpaiguri, in two distinct Indian states - Tamil Nadu and West Bengal respectively. The central research question is: What is the role of WASH infrastructure and capabilities and local agencies in containing the incidence of excreta related diseases in isolated rural Indian communities? A novel multi-level model is developed and estimated and further validated through focus research groups. It confirms that disease incidence is jointly determined by the quantity as well as the quality of WASH. The role of agency seems to matter more at village level rather than at the household level.
    Keywords: WASH, Sanitation, Health, Public Health, Health Policy, Inequality, Economic development, Social Innovation, India
    JEL: I12 I15 I18 O15 O18 O35
    Date: 2017–05–08
  15. By: Graham Beattie; Jean-William P. Laliberté; Catherine Michaud-Leclerc; Philip Oreopoulos
    Abstract: Students from 4-year colleges often arrive having already done very well in high school, but by the end of first term, a wide dispersion of performance emerges, with an especially large lower tail. Students that do well in first year (we call the top 10 percent Thrivers) tend to continue to do well throughout the rest of their time in university. Students that do poorly (we call the bottom 10 percent Divers) greatly struggle and are at risk of not completing their degree. In this paper we use a mandatory survey with open ended questions asking students about their first-year experience. This allows us to explore more closely what sets Thrivers and Divers apart, in terms of study habits, attitudes, and personal experiences. We find that poor time management and lack of study hours are most associated with poor academic performance, and that those who struggle recognize these weaknesses. Divers also report feeling more depressed and unhappy with their lives. We posit an 'academic trap', whereby initial poor performance is related to poor time management which in turn lowers expectations, which in turn leads to lower study time, and so on. Thrivers, in contrast, study significantly more and meet with course instructors.
    JEL: I20 I23 I26 J20
    Date: 2017–07
  16. By: Diane Alexander; Janet Currie; Molly Schnell
    Abstract: Retail clinics are an innovation that has the potential to improve competition in health care markets. We use the universe of emergency room (ER) visits in New Jersey from 2006-2014 to examine the impact of retail clinics on ER usage. We find significant effects of retail clinics on ER visits for both minor and preventable conditions; Residents residing close to an open clinic are 4.1-12.3 percent less likely to use an ER for these conditions. Our estimates suggest annual cost savings from reduced ER usage of over $70 million if retail clinics were made readily available across New Jersey.
    JEL: I11
    Date: 2017–07
  17. By: Nga Le Thi Quynh (UNU-MERIT, and Maastricht University); Groot, Wim (TIER, and CAPHRI School for Public Health and Primary Care, Maastricht University); Tomini, Sonila M. (UNU-MERIT, and Maastricht University); Tomini, Florian (Amsterdam School of Economics, University of Amsterdam,)
    Abstract: This study provides a systematic review of empirical evidence on the labour supply effects of health insurance. The outcomes in the 63 studies reviewed include labour supply in terms of hours worked and the probability of employment, self-employment and the level of economic formalisation. One of the key findings is that the current literature is vastly concentrated on the US. We show that spousal coverage in the US is associated with reduced labour supply of secondary earners. The effect of Medicaid in the US on labour supply of its recipients is ambiguous. However we have initial evidence of labour supply distortion caused by Children's Health Insurance Program, Affordable Care Act and other public health insurance expansions. A tentative result is that dependent young adults in the US who can access health insurance via their parents' employer have lower labour supply through fewer hours worked while keeping the same employment probability. The employment-coverage link is an important determinant of labour supply of people with health problems. The same holds for self-employment decisions. Universal coverage may create either an incentive or a disincentive to work depending on the design of the system. Finally, evidence on the relationship between health insurance and the level of economic formalisation in developing countries is fragmented and limited.
    Keywords: health insurance, labour supply, labour market
    JEL: I13 J22
    Date: 2017–03–23
  18. By: Dan A. Black; Yu-Chieh Hsu; Seth G. Sanders; Lynne Steuerle Schofield; Lowell J. Taylor
    Abstract: We examine inferences about old age mortality that arise when researchers use survey data matched to death records. We show that even small rates of failure to match respondents can lead to substantial bias in the measurement of mortality rates at older ages. This type of measurement error is consequential for three strands in the demographic literature: (1) the deceleration in mortality rates at old ages, (2) the black-white mortality crossover, and (3) the relatively low rate of old age mortality among Hispanics—often called the “Hispanic paradox.” Using the National Longitudinal Survey of Older Men (NLS-OM) matched to death records in both the U.S. Vital Statistics system and the Social Security Death Index, we demonstrate that even small rates of missing mortality matching plausibly lead to an appearance of mortality deceleration when none exists, and can generate a spurious black-white mortality crossover. We confirm these findings using data from the National Health Interview Survey (NHIS) matched to the U.S. Vital Statistics system, a dataset known as the “gold standard” (Cowper et al., 2002) for estimating age-specific mortality. Moreover, with these data we show that the Hispanic paradox is also plausibly explained by a similar undercount.
    JEL: J1
    Date: 2017–07

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