nep-hea New Economics Papers
on Health Economics
Issue of 2017‒07‒30
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Going after the Addiction, Not the Addicted: The Impact of Drug Decriminalization in Portugal By Félix, Sónia; Portugal, Pedro; Tavares, Ana
  2. The Economic Burden of Chronic Diseases: Estimates and Projections for China, Japan and South Korea By Bloom, David E.; Chen, Simiao; Kuhn, Michael; McGovern, Mark E.; Oxley, Les; Prettner, Klaus
  3. What does demand heterogeneity tell us about health care provider choice in rural China? By Martine AUDIBERT; Yong HE; Jacky MATHONNAT
  4. Health Status as a Determinant for Pre-Retirement Savings By Jana Votapkova; Pavlina Zilova
  5. Income and Substitution Effects of a Disability Insurance Reform By Eugster, Beatrix; Deuchert, Eva
  6. Long-Run Changes in the Body Mass Index of Adults in Three Food-Abundant Settler Societies: Australia, Canada and New Zealand By John Cranfield; Kris Inwood; Les Oxley; Evan Roberts
  7. The Impact of the Affordable Care Act's Medicaid Expansion on Medicaid Spending by Health Care Service Category By Jacqueline Fiore
  8. The Catalan health budget rationing problem By Solís Baltodano, María José
  9. Other State Approaches to Integrating Medicare and Medicaid for Dually Eligible Beneficiaries: Implications for the New York State FIDA Demonstration By James Verdier; Ann Mary Philip
  10. Toxic roads: Unearthing hazardous waste dumping By Caterina Gennaioli; Gaia Narciso
  11. Smeed fs Law and the Role of Hospitals in Modeling Fatalities and Traffic Accidents By Yueh-Tzu Lu; Mototsugu Fukushige
  12. Learn4Health, a European project creating health and food literacy through innovative interdisciplinary teaching and learning methods By Anna Marie Fisker; Katja Seerup Clausen
  13. The Health Burden of Dust Pollution in the Textile Industry of Faisalabad, Pakistan By Muhammad Khan
  14. Exploring health outcomes by stochastic multi-objective acceptability analysis: an application to Italian regions. By Raffaele Lagravinese; Paolo Liberati; Giuliano Resce
  15. Time devoted by elderly people to physical activities: micro-econometric evidence from Spain By Campaña, Juan Carlos
  16. Community Participation on Health Management: A Case of Dengue Fever Disease Control Program By Anusorn Kunanusorn; Chanita Chotisatiankul
  17. Individual Results May Vary: Elementary Analytics of Inequality-Probability Bounds, with Applications to Health-Outcome Treatment Effects By John Mullahy
  18. Health-related quality of life in adolescents with mild scoliosis By Mei-chun Cheung; Joanne Yip; Lai-hing Fok; Garcia Kwok
  19. Surprise! Out-of-Network Billing for Emergency Care in the United States By Zack Cooper; Fiona Scott Morton; Nathan Shekita
  20. Development of Optimal Nursing Workforce Model and Its Application to Outpatients in a Tertiary Hospital By Jinhyun Kim; Eunhee Lee; Kyounga Lee; YeonHee Kim; SunHee Lee; JiHey Kim; KyeongYeon Oh; KyeongOk Heo; HyunAh Choi
  21. An Analysis of the Memphis Nurse-Family Partnership Program By James J. Heckman; Margaret L. Holland; Kevin K. Makino; Rodrigo Pinto; Maria Rosales-Rueda
  22. The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes By Mark Duggan; Gopi Shah Goda; Emilie Jackson
  23. Infant Feeding and Cohort Health: Evidence from the London Foundling Hospital By Arthi, Vellore; Schneider, Eric
  25. The Need of Educating Adolescent Females of Karachi, Pakistan regarding Reproductive Health By Rizwana Amin; Prof. Dr. Shahida Sajjad
  26. Albinism in the Black Population of South Africa: Uncovering the Health Challenges from a Legal Perspective By Mphoeng Maureen Mswela
  27. Demand for Health Insurance Marketplace Plans Was Highly Elastic in 2014-2015 By Jean Abraham; Coleman Drake; Daniel W. Sacks; Kosali I. Simon

  1. By: Félix, Sónia (Banco de Portugal); Portugal, Pedro (Banco de Portugal); Tavares, Ana (Universidade Nova de Lisboa)
    Abstract: This paper investigates the impact of drug decriminalization in Portugal using the Synthetic Control Method. The applied econometric methodology compares Portuguese drug-related variables with the ones extracted from a convex combination of similar European countries. The results suggest that a policy change implemented in Portugal contributed to a decrease in the number of heroine and cocaine seizures, a decrease in the number of offenses and drug-related deaths, and a decrease in the number of clients entering treatment. Moreover, the policy change contributed to a reduction in the incidence of drug addicts among HIV individuals.
    Keywords: drug decriminalization policy, illicit drugs, synthetic control method
    JEL: C21 D04 K42
    Date: 2017–07
  2. By: Bloom, David E. (Harvard University); Chen, Simiao (Harvard School of Public Health); Kuhn, Michael (Vienna Institute of Demography); McGovern, Mark E. (Queen's University Belfast); Oxley, Les (University of Waikato); Prettner, Klaus (University of Hohenheim)
    Abstract: We propose a novel framework to analyse the macroeconomic impact of non-communicable diseases. We incorporate measures of disease prevalence into a human capital augmented production function, which enables us to determine the economic costs of chronic health conditions in terms of foregone gross domestic product (GDP). Unlike previously adopted frameworks, this approach allows us to account for i) variations in human capital for workers in different age groups, ii) mortality and morbidity effects of non-communicable diseases, and iii) the treatment costs of diseases. We apply our methodology to China, Japan, and South Korea, and estimate the economic burden of chronic conditions in five domains (cardiovascular diseases, cancer, respiratory diseases, diabetes, and mental health conditions). Overall, total losses associated with these non-communicable diseases over the period 2010-2030 are $16 trillion for China (measured in real USD with the base year 2010), $5.7 trillion for Japan, and $1.5 trillion for South Korea. Our results also highlight the limits of cost-effectiveness analysis by identifying some intervention strategies to reduce disease prevalence in China that are cost beneficial and therefore a rational use of resources, though they are not cost-effective as judged by conventional thresholds.
    Keywords: non-communicable diseases, human capital, health interventions, aggregate output, ageing, East Asia
    JEL: H51 I15 I18 J24 O11
    Date: 2017–07
  3. By: Martine AUDIBERT (FERDI); Yong HE (FERDI); Jacky MATHONNAT (Cerdi - University of Auvergne)
    Abstract: The objective of this paper is twofold: 1) to fill the gap in the health care literature with the estimation of the price and distance effects on health care provider choices by households in the presence of varying demand heterogeneity, 2) to contribute to estimation robustness by confronting the performance of the mixed multinomial logit (MMNL) and the multinomial logit (MNL). We built a database of two samples of patients surveyed within the same regions in rural China over a time interval of 18 years, and presumed varying demand heterogeneity due to income increase and people aging. We find that while the mean price and distance negative effects on patients choice were present in both time periods, their differences in heterogeneity, which were confirmed with the MMNL, could have crucial importance in avoiding erroneous policy making based merely on mean price and distance effects. We also find that while both the MNL and the MMNL are able to predict price and distance effects with low heterogeneity, only the MMNL appears able to detect the price effect when heterogeneity is high. This finding has policy implications and suggests using caution when interpreting estimation results with the MNL in cases of high heterogeneity.
    Keywords: price effect, distance effect, health care choice, preference heterogeneity, multinomial and mixed logit model, estimation robustness, Chinese rural households
    JEL: D1 C5 I1
    Date: 2017–07
  4. By: Jana Votapkova (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic); Pavlina Zilova (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic)
    Abstract: The paper aims to find out whether health status determines the level of liquid savings among a pre-retirement (50-60 years old) segment of the Czech population as retrieved from the SHARE (Survey of Health, Aging and Retirement in Europe) database, Wave 5 using a 2SLS methodology. Other demographic, health and economic characteristics are considered. We find a significant positive relationship between health and savings. It suggests that careful design of preventive health programs could ease the public pension system because if healthy, individuals could secure themselves for retirement.
    Keywords: Health status, savings, Czech Republic, 2SLS, SHARE Dataset
    JEL: D14 I15
    Date: 2017–05
  5. By: Eugster, Beatrix; Deuchert, Eva
    Abstract: Disability insurance (DI) systems are widely criticized for their inherent work disincentives. This paper evaluates the effects of a Swiss DI reform that aims to lower pensions for a group of existing DI bene?ciaries and introduces an additional notch to the pension schedule. The reform does not signi?cantly affect average earnings and employment, but increases the disability degree of those threatened by a pension decline. We estimate bounds on the income and substitution effects employing the principal strati?cation framework. The in-come effect is quantitatively important, while the substitution e?ect is smaller and bounds include zero.
    Keywords: Disability insurance, work disincentives, income and substitution effects, partial bene?t system
    JEL: C30 I13 J01
    Date: 2017–07
  6. By: John Cranfield (University of Guelph); Kris Inwood (University of Guelph); Les Oxley (University of Waikato); Evan Roberts (University of Minnesota)
    Abstract: We identify changes in body mass index (BMI) since the 19th century, for three British-origin, food abundant, settler societies: Australia, Canada and New Zealand. The onset of sustained BMI increase came later in these societies than in the US. New Zealand shows a distinctive pattern of within-country gender differences. The gap between Australian Canadian males (leading) and female BMIs remains large with some increases in the gap in the 35-39 year age group, but narrowing in the 45-49 range especially in Australia. In contrast, the BMI of both sexes in New Zealand has effectively converged for most age ranges (although it has been similar for the 45-49 age range since 1977). In terms of cross-country comparisons, the results show a remarkably similar long-term pattern for males in all three countries although the absolute differences between leading BMI countries has changed over time culminating in New Zealand being the ‘top ranked’ obese country for males in the 20-49 age group. For females the pattern and trends are quite different, with New Zealand women exceeding the BMI of same aged females in Australia and Canada from the 1980s onwards. If anything the results suggest that New Zealand female BMI continues to grow while that of Australia may be leveling off.
    Keywords: obesity; body mass index; Canada; New Zealand;Australia
    JEL: I1 J11 N3
    Date: 2017–07–24
  7. By: Jacqueline Fiore (Department of Economics, Tulane University)
    Abstract: The 2014 Medicaid expansion revised Medicaid eligibility provisions to allow for low-income, non-elderly adults to be eligible for Medicaid in those states which opt for this change. During the first two years after the expansion, there were more than 10.7 million newly eligible Medicaid enrollees nationwide. I investigate the short-term impact the 2014 Medicaid expansion had on Medicaid spending by the government. Using data from the Centers for Medicare and Medicaid Services on all Medicaid expenditures over a seventeen year period, I apply a difference-in-differences design to exploit the variation among states electing to participate in the expansion and the health care services they offer. These data allow me to study the economic impact of the expansion on all possible health care services. Among the 21 services assessed, I find that after the expansion became effective, five services utilized by the target population for the reform experienced a statistically significant increase in average Medicaid spending: dental services (211 percent), clinic services (101 percent), outpatient hospital services (77 percent), physician and surgical services (35 percent), and inpatient hospital services (17 percent). This implies that the new adult group may be healthier and seeking more routine or preventive care compared to the traditional Medicaid population. The increase in routine and preventive care has the potential to result in better health outcomes and fewer medical emergencies in the future, ultimately lowering Medicaid spending by the state and federal government over the long term.
    Keywords: Affordable Care Act; Medicaid expansion; non-elderly adults; expenditures
    JEL: H51 I13
    Date: 2017–07
  8. By: Solís Baltodano, María José
    Abstract: The financial and economic crisis in Spain during recent years has induced public budget adjustments. The crisis has caused a great social impact due to the way the austerity measures have been implemented, affecting mainly key economic sectors such as the civil service, justice, education and health. Among all of these sector, the current paper focuses on the health budget distribution, since the changes in the provision of the health services induce faster and clearer impacts in the social welfare. Spain is divided into 17 regions, and each region manages its own health system. Specifically, we analyse the Catalan health budget assignment since Catalonia is one of the most populated regions and one where the restrictions have been more evident. We study the health budget distribution for the period 1998-2014, from the point of view of the conflicting claims problem (O'Neill, 1982). Accordingly, alternative allocations of the health budget are proposed by using some of the most used solutions in the body of literature. Finally, in order to choose the most appropriate solution, we require the fulfilment of (i) some commonly accepted social constraints, (ii) some criteria of fairness and stability, and (iii) low inequality indexes. Keywords: Distribution problems; Health; Axiomatic analysis; Public budget
    Keywords: Salut pública -- Catalunya -- Aspectes econòmics, Pressupost -- Catalunya, 338 - Situació econòmica. Política econòmica. Gestió, control i planificació de l'economia. Producció. Serveis. Turisme. Preus,
    Date: 2016
  9. By: James Verdier; Ann Mary Philip
    Abstract: This presentation highlights national trends and patterns in integrating Medicare and Medicaid services for beneficiaries dually eligible for both programs.
    Keywords: New York, Fuly Integrated Duals Advantage, FIDA, dual eligible, Medicare, Medicaid
    JEL: I
  10. By: Caterina Gennaioli (School of Business and Management, Queen Mary University of London.); Gaia Narciso (Department of Economics, Trinity College Dublin)
    Abstract: Illegal disposal of toxic waste has become an issue of concern in both developing and developed countries. Recycling hazardous waste entails very high costs, which might give strong incentives to dispose toxic material in an illegal way. This paper adopts an innovative strategy to identify where toxic waste might have been illicitly dumped. The strategy relies on a crucial premise: road constructions provide an ideal setting in which the burial of hazardous waste may take place. Guided by the medical literature, we investigate the health outcomes of individuals living along recently constructed roads in Ethiopia. We construct a unique dataset, which includes the extensive Demographic and Health Survey, together with georeferenced data on roads, villages and economic development, covering a 10-year period. We find that an additional road within a 5 kilometres radius is associated with an increase in infant mortality by 3 percentage points. Moreover, we provide evidence that young children living near a recently built road show a lower level of haemoglobin and are more likely to suffer from severe anaemia. A series of robustness checks confirms the above findings and excludes other potential confounding factors.
    Keywords: Hazardous Waste, Health, Infant Mortality, Ethiopia
    JEL: I15 Q51 Q53 O10
    Date: 2017–07
  11. By: Yueh-Tzu Lu (Graduate School of Management, National Cheng Kung University); Mototsugu Fukushige (Graduate School of Economics, Osaka University)
    Abstract: We applied Smeed fs Law to Japanese prefectural data from between 1988 and 2016. We found that the coefficient for the number of vehicles was stable over the estimation period, but that the constant term decreased gradually. We decomposed fatalities per capita into fatalities per accidents and accidents per capita, and applied regression equations to the data. We conclude the following from this study. First, the relationship between fatalities per capita and the number of registered vehicles per capita was stable, which is consistent with Smeed fs Law. Second, the effects of technological advances have changed the estimated coefficients for time dummies. The role of hospitals may be difficult to incorporate into Smeed fs Law because of the complicated relationship between the distance to hospital and fatalities per capita.
    Keywords: Smeed fs Law, Traffic Accidents, Fatalities, Hospitals
    JEL: R41 I18 R42
    Date: 2017–07
  12. By: Anna Marie Fisker (Department of Civil Engineering, Center for Food Science, Design and Experience, Aalborg University); Katja Seerup Clausen (Department of Civil Engineering, Center for Food Science, Design and Experience, Aalborg University)
    Abstract: Research documents what educators know: Healthy pupils and students are better prepared to learn (Kristjánsson et al., 2010; KL, 2015). This paper focuses on the thesis that innovative practical methods for learnings related to health and food issues create a rewarding educational experience for pupils and students while meeting academic standards in math, reading, science, social studies, art, music and more. For this reason and many more, we created Learn4Health, a project with interdisciplinary roots.Every day, in Universities across the globe, courses are being created to embrace blended learning approaches. Classes are now being developed with focus on more effective learning and better student outcomes (Jones, 2016). However, the concept of blended learning between higher educational institutions and public schools is relatively new. This paper outlines an exploratory study of blended learning initiated by Learn4Health, an Erasmus+ Strategic Partnership including twelve partners in total, representing 6 European countries (DK, ES, SI, NL, UK and LT). Each country is represented by one higher educational institution and one primary and/or secondary school.With point of departure in the globalized food systems consumers, especially children, being increasingly disconnected from understanding how and where their food is produced, the paper provides an overview of the development and expected implementation process of a new blended learning programme. The practical methods discussed are problem based learning, an experimental approach to learning involving hands on/learning by doing approach, and an ?open school? approach reaching out to local community enterprises and farms.Another Learn4Health key tool to be addressed in this paper is foodscapes, a multi-valenced concept centered around food environments. Finally, Learn4Health is about having fun and developing lifelong food literacy skills to understand the nature of food and our own impact as consumers and citizens on health status, environment, social and economic factors. Literacy is the cornerstone of the project, and we will thus discuss the concept?s relevance and impact on health in relation to Learn4Health.
    Keywords: Learn for health, food literacy, school gardening, interdisciplinary teaching and learning methods, innovative school foodscapes
    JEL: I00 I29 P36
    Date: 2017–05
  13. By: Muhammad Khan
    Abstract: The study focuses on the high incidence of occupational health hazards faced by women and men working in the textile industry of Pakistan. One of the most relevant risk factors is exposure to airborne dust generated by fibers, which causes byssinosis and other respiratory impairments. Since these illnesses affect workers' health, productivity and quality of life very seriously, we estimate the disease burden and cost through a study of workers in the textile industry of Faisalabad, Pakistan. We collected the data from a randomly selected sample of 206 workers from 11 textile spinning factories in August 2013, using a two-week Health Diary and a survey questionnaire. The survey results show a significant number of workersto experience respiratory symptoms including byssinosis, chronic cough, phlegm, blood with phlegm, bronchitis, asthma and tuberculosis. The results from health diary show that roughly 9% of workers had to visit the doctor for treatment during those two weeks. The average monetary loss to the ill workers is PKR 4096 per month which accounts for 32 percent of their income. The regression results show that the probability of respiratory diseases is significantly higher for those who smoke cigarettes or work in sections that are dusty or high in temperature. The results of the health production function show that the number of work hours lost due to respiratory diseases is significantly higher for those who work in dustysections while it is significantly lower for those who wear a mask. The research highlights the importance of promoting a safety culture in textile mills through the provision of occupational safety and health training to workers and through the implementation of appropriate dust control standards in the industry.
  14. By: Raffaele Lagravinese; Paolo Liberati; Giuliano Resce
    Abstract: This paper introduces the Stochastic Multi-Objective Acceptability Analysis (SMAA) in order to investigate the evolution of mortality rates in the Italian regions over the period 1990-2013. We propose to explore the overall outcome of health care by a Composite Index (CI) of mortality based on the combination of standardized mortality rates for seventeen different diseases. From a methodological standpoint, we propose to overcome the arbitrary of the weighting process, by using the SMAA, which is a methodology that allows to rank regions considering the whole set of possible vectors of weights. Moreover, we explore the spatial segregation in health using the multidimensional generalization of the Gini index, and introducing the multidimensional generalization of ANOGI. The unprecedented use of SMAA in health sector allows to explore regional multidimensional paths beyond the order of importance given to the single dimensions. Our analysis shows that in the 24 years considered there has been no convergence path in terms of health care outcome in Italy, neither between nor within regions.
    Keywords: Stochastic Multi-Objective Acceptability Analysis; Composite Indicators;Health; Spatial Inequality; ANOGI
    JEL: H75 I14 C44
    Date: 2017–07
  15. By: Campaña, Juan Carlos
    Abstract: In this paper, I analyse the differences in the time devoted to walking, cycling, gymnastics, and hunting by the elderly in Spain, considering own and socio-demographic characteristics. Using data from the Spanish Time-Use Survey (STUS) 2009-10, I estimate a simultaneous SUR model with data from the 4,036 individuals aged 65 years and over (inclusive), finding that men devote more time to the four physical activities than do women, that good health positively influences the time devoted to these activities, and that living in a large municipality positively influences the time devoted to walking, while living in a very large municipality negatively influences the time devoted to cycling. The work is important in terms of public policy, since inactive lifestyles are a major public health challenge, and an analysis of these activities may provide guidance toward better solutions. An increase in the frequency of physical activity in the Spanish population in this age range would lead to a significant reduction of health expenditure.
    Keywords: Elderly, Physical activities, Time use, SUR model
    JEL: J14 J22
    Date: 2017–07–26
  16. By: Anusorn Kunanusorn (Rajamangala University of Technology Lanna); Chanita Chotisatiankul (Rajamangala University of Technology Lanna)
    Abstract: Community Participation on Health Management: A Case of Dengue Fever Disease Control ProgramAnusorn Kunanusorn1 PhDChanita Chotisatiankul, ProfessorAbstract Dengue Fever disease has been one of public health problems in urban and rural areas of Thailand for many years. The Royal Thai Government has spent large amount of annual budget to controlling and combating the Dengue Fever disease nation-wide for years. Chiang Mai Province is one of areas where Dengue Fever has been a health problem for years. Number of Dengue Fever patients and dead cases in Chiang Mai were high as compared to other provinces. Public health management has been changed from centralization system to decentralization system where involvements from local and community were initiated since April 2001. McKean Hospital, a charitable hospital under The Foundation of Church of Christ in Thailand, had joined the Universal Health Coverage since May 2001. Besides other health programs, the hospital had set up a program on Dengue Fever control program incorporated with local public health center, temples, churches, schools, community leaders, and NGOs in responsible area since June 2001. In 13 villages, there are health-volunteers who were assigned to look after 5 to 10 households in health activities. The hospital which responsible for a certain area on health worked closely with these health volunteers. The health program on Dengue Fever had been operated successfully with community participation. With the policy of The Royal Thai Government on The Universal Health Coverage, McKean hospital had done successfully in eradication of Dengue Fever identified by decreasing number of patients and dead cases down to zero in its responsible area during five - year plan. Four strategies ? organizing, public relations, campaign, and monitoring and evaluation were managed in the program targeting to eradicate the Dengue Fever. With strong supports and participations, from all in community, there had been made the Dengue Fever control program reached its target successfully. McKean hospital was awarded an outstanding performance citation on ?Strong Community Supports for Dengue Fever Prevention? from The National Health Security Office (NHSO) of Thailand. The theoretical framework of this strategic operation was drafted, constructed, and operated by participations of community parties which could be tested statistically and use as a model to other health programs. 1 Rajamangala University of Technology Lanna, Faculty of Business Administration and Liberal Arts, MBA Program, Chiang Mai ThailandE-mail:
    Keywords: Dengue Fever DiseaseUniversal Health CoverageCommunity ParticipationCentralization and Decentralization
    JEL: I18 I00 I10
    Date: 2017–07
  17. By: John Mullahy
    Abstract: While many results from the treatment-effect and related literatures are familiar and have been applied productively in health economics evaluations, other potentially useful results from those literatures have had little influence on health economics practice. With the intent of demonstrating the value and use of some such results in health economics applications, this paper focuses on one particular class of parameters that describe probabilities that one outcome is larger or smaller than other outcomes, namely inequality probabilities. While the properties of such parameters have been explored in the technical literature, they have scarcely been considered in informing practical questions in health evaluations. This paper discusses how such probabilities can be used informatively, and describes how they might be identified or bounded given standard sampling assumptions and information only on marginal distributions of outcomes. Graphical and algebraic exposition reveals the logic supporting these results, as well as their empirical implementation, to be quite straightforward. Applications to health outcome evaluations are presented and discussed throughout.
    JEL: I1
    Date: 2017–07
  18. By: Mei-chun Cheung (Department of Social Work, The Chinese University of Hong Kong); Joanne Yip (Institute of Textiles and Clothing, The Hong Kong Polytechnic University); Lai-hing Fok (Institute of Textiles and Clothing, The Hong Kong Polytechnic University); Garcia Kwok (Institute of Textiles and Clothing, The Hong Kong Polytechnic University)
    Abstract: Introduction: According to the large population-based retrospective cohort study in Hong Kong, the prevalence of adolescent idiopathic scoliosis (AIS) by the age of 19 years in Hong Kong is 1.39% for Cobb angle 20° (Luk et al., 2010). AIS are characterized by uneven shoulders, spine curvature and uneven hips. At present, adolescents with mild scoliosis, that is, Cobb angle less than 20° do not receive any intervention in Hong Kong. Some of them are generally followed up by spine surgeon through clinical monitoring and re-examined the degree of curvature every 8-12 months, though they may have high growth potential and risk of curve progression during the age of 10-16 at puberty. Their health-related quality of life is generally overlooked, as compared to AIS.Objective: To characterize the influence of mild scoliosis on health-related quality of life in the community-dwelling female adolescents in Hong KongMethods: A school pre-screening program in Hong Kong was conducted to examine the prevalence of mild scoliosis during 2012-2015. A total of 545 female adolescents were recruited from several local primary/secondary schools in Hong Kong. The adolescents were divided into two groups matched in terms of age and education: individuals with mild scoliosis (n = 128) who demonstrated positive results in the Adam?s forward bending test and an angle of trunk rotation (ATR) of 3° measured by a scoliometer and normal controls without any demonstrated signs of scoliosis (n = 417). Their health-related quality of life was evaluated by the validated Scoliosis Research Society ? 22 (SRS-22) Questionnaire, which consists of 22 items that assess five domains, including Function, Pain, General Self Image and Mental health.Results: Compared with the age-matched adolescents, female with mild scoliosis showed significantly lower self-image (p
    Keywords: adolescent idiopathic scoliosis, quality of life
    JEL: I10 J13
    Date: 2017–07
  19. By: Zack Cooper; Fiona Scott Morton; Nathan Shekita
    Abstract: Using insurance claims data, we show that in 22% of emergency episodes, patients attended in-network hospitals, but were treated by out-of-network physicians. Out-of-network billing allows physicians to significantly increase their payment rates relative to what they would be paid for treating in-network patients. Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities. We illustrate in a model and confirm empirically via analysis of two leading physician-outsourcing firms that physicians offer transfers to hospitals to offset the costs of out-of-network billing and allow the practice to continue. We find that a New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates.
    JEL: I11 I13 I18 L14
    Date: 2017–07
  20. By: Jinhyun Kim (College of Nursing, Seoul National University); Eunhee Lee (Division of Nursing, Hallym University); Kyounga Lee (College of Nursing, Seoul National University); YeonHee Kim (Nursing Department, Asan Medical Center); SunHee Lee (Children?s Nursing Team, Asan Medical Center); JiHey Kim (GI outpatient Department, Asan Medical Center); KyeongYeon Oh (GI outpatient Department, Asan Medical Center); KyeongOk Heo (Urology Department, Asan Medical Center); HyunAh Choi (GY inpatient Department, Asan Medical Center)
    Abstract: The purpose of this study is to develop an optimal allocation model of nursing workforce and apply it to outpatients at a tertiary hospital in Korea. A workload model that consists of average number of patients per day and nursing time per patient was used to estimate the optimal number of nursing workforce in each clinical department, considering the annual off days per nursing staff. The nursing time was classified into three stages(reception-treatment-consulting) and the data were collected by one-to-one observation for three years. It was analyzed by three scenarios: scenario 1 considered actual days spent on vacation and holiday, scenario 2 reflected all holidays and annual leaves under labor act, and scenario 3 included only mandatory holidays and off days. The average number of patients per day varied from 29 to 846 according to clinical department, and required nursing time per patient was from 5.1 to 14.2 minutes. The actual nursing staffs per clinical department were 7.6 persons. The optimal nursing workforce was 7.1, 6.4, and 6.0 persons, respectively in the scenario 1, 2, and 3. In scenario 1, it was analyzed that -3.6 to 7.9 additional nursing staffs should be employed and an average of 0.5 staffs can be reduced. In scenario 2, it was analyzed that -2.9 to 8.7 (average 1.3) additional nursing staffs need to be employed. Lastly, scenario 3 estimated that -2.5 to 9.2 (average 1.7) additional nursing staffs need to be employed. However, this study estimated an optimal nursing workforce to a decimal point, while the number of nurses employed in real world is a positive integer. With nursing manpower allocation rounded to the nearest decimal, nurse staffing condition and patient outcomes could be improved. Therefore, it is recommended to consider an integer model of nurse staffing level in the further detailed studies.* This study was supported by National Research Foundation of Korea.
    Keywords: Nursing workforce, Nurse staffing model, Workload
    Date: 2017–05
  21. By: James J. Heckman; Margaret L. Holland; Kevin K. Makino; Rodrigo Pinto; Maria Rosales-Rueda
    Abstract: This paper evaluates a randomized controlled trial of the Nurse-Family Partnership (NFP) program conducted in Memphis, TN in 1990. NFP offers home visits conducted by nurses for disadvantaged first-time mothers during pregnancy and early childhood. We test NFP treatment effects using permutation-based inference that accounts for the NFP randomization protocol. Our methodology is valid for small samples and corrects for multiple-hypothesis testing. We also analyze the underlying mechanisms generating these treatment effects. We decompose NFP treatment effects into components associated with the intervention-enhanced parenting and early childhood skills. The NFP improves home investments, parenting attitudes and mental health for mothers of infants at age 2. At age 6, the NFP boosts cognitive skills for both genders and socio-emotional skills for females. These treatment effects are explained by program-induced improvements in maternal traits and early-life family investments. At age 12, the treatment effects for males (but not for females) persist in the form of enhanced achievement test scores. Treatment effects are largely explained by enhanced cognitive skills at age 6. Our evidence of pronounced gender differences in response to early childhood interventions contributes to a growing literature on this topic.
    JEL: C5 H5 I1
    Date: 2017–07
  22. By: Mark Duggan; Gopi Shah Goda; Emilie Jackson
    Abstract: The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment
    JEL: H31 H51 J18 J20 J38
    Date: 2017–07
  23. By: Arthi, Vellore; Schneider, Eric
    Abstract: What was the relationship between breastfeeding and cohort health in the past? We examine this question using a rich new source of longitudinal data on nearly 1,000 children from London's Foundling Hospital (1892-1919). Specifically, we test the association between the feeding regime in infancy and subsequent health, as manifested in mortality risk and anthropometric growth at later points in childhood and adolescence. We find that breastfeeding was positively associated with both survival and weight-for-age in infancy, with scarring dominating culling on net. However, infant-weight gradients in catch-up growth ensured that by mid childhood, these initial feeding-related health differentials had disappeared.
    Keywords: Anthropometric growth; Breastfeeding; Early-life health; Mortality
    JEL: I14 I15 J13 N33
    Date: 2017–07
    Abstract: Background: There is little evidence published on prevalence of vitamin d deficiency among Saudi women, in spite of the widespread food fortification and the excellent opportunity of available sun light all over the year. The present cross-sectionalstudy aims to determine the prevalence and risk factors of vitamin D deficiency among premenopausal women visiting commercial centers in Riyadh City. Materials and Methods: A quasi-random technique was employed in the recruitment of subjects from various commercial Malls in Riyadh last May-November, 2012. A total of 256 subjects filled a general questionnaire, height and weight were measured and blood extracted ascertaining total 25-hydroxyvitamin D, calcium, phosphorous and alkaline phophatase from a vitamin D External Quality Assessment (DEQAS)-certified laboratory. Results: Vitamin D deficiency (
    Keywords: Vitamin D, vitamin D deficiency, milk consumption, ages
    Date: 2017–07
  25. By: Rizwana Amin (Greenwich University); Prof. Dr. Shahida Sajjad (Greenwich University)
    Abstract: Reproductive Health Awareness is not only neglected but also a taboo issue in Pakistan. The growing age women in Pakistan are hardly aware of reproductive health complications because of reasons linked to socio-cultural and religious factors which are the determinants of inadequate reproductive trends. Menstruation and menstrual practices, hygiene, reproductive tract infection, early pregnancies, infant death, mortality rate, women?s health security, child upbringing by inexperienced young mothers are the fundamental issues faced by Pakistani females and it is directly attached with ignorance of reproductive health know how. This study aimed to discover the need of educating adolescent females of city Karachi regarding reproductive health. The objective of this study was to acquire evidence on current awareness and insights on puberty and reproductive health needs. The research followed a quantitative and pragmatic approach enabling empirical analysis along with shedding light on the facts and figures. The data was collected through convenient sampling from four schools in the urban and rural areas of the city, Karachi and analyzed through descriptive statistic, linear regression and Kruskal Wallis Test. The analysis of the data indicated that awareness regarding reproductive health amongst adolescents is very minimal along with guidance and counseling provided to them at home and in school. The study highlighted the fact that education and medical facility available in schools have a significant impact on reproductive health awareness but the schools in Pakistan of both the rural and urban areas lack in mass awareness on reproductive health. The conclusion and observation leads to creating channels for imparting knowledge and awareness regarding reproductive health and its needs to the adolescents. It is recommended to create awareness amongst youth especially females by integrating it into school curriculum from grades 5 onwards or by conducting reproductive health awareness seminars in schools at different intervals.
    Keywords: Reproductive health education, reproductive health awareness, reproductive health problems
    JEL: I00
    Date: 2017–05
  26. By: Mphoeng Maureen Mswela (niveristy of South Africa)
    Abstract: The Cancer Association of South Africa (CANSA) has acknowledged that persons with albinism face the highest risk of developing skin cancer. While information concerning their susceptibility to cancer is very important, CANSA observed that such information is communicated to persons with albinism at a very late stage, especially those living in rural areas of South Africa. As well, interviews with and campaigns led by the Chairperson of the Albinism Society of South Africa have revealed that the national health system has failed to adequately consider and take into account the health care needs of persons living with albinism. Very few persons with albinism have access to sunglasses with a high UV protection screen to relieve light sensitivity, or to preventative services such as dermatological skin checks, eye checks and eye corrections. This paper argues that the recognition of the right of access to health care in the South African Constitution affords persons living with albinism the right to challenge the government?s failure to provide them with such essential health care needs. This paper also discusses the pertinent clinical aspects of albinism, with the aim of contextualising the legal discussion in the rest of the paper.
    Keywords: Albinism, genetics, skin cancer, Oculocutaneous albinism, X-linked ocular albinism, the right to health care,
    JEL: I14
    Date: 2017–07
  27. By: Jean Abraham; Coleman Drake; Daniel W. Sacks; Kosali I. Simon
    Abstract: A major provision of the Affordable Care Act was the creation of Health Insurance Marketplaces, which began operating for the 2014 plan year. Although enrollment initially grew in these markets, enrollment has fallen recently amid insurer exits and rising premiums. To better understand these markets, we estimate premium elasticity of demand for Marketplace plans, using within-plan premium changes from 2014 to 2015, accounting for state-specific trends and simultaneous changes in generosity. Our preferred estimate implies that a one percent premium increase reduces plan-specific enrollment by 1.7 percent. We argue that this high elasticity reflects the rapid growth and high churn in this market, as well as the high degree of standardization and the availability of many close substitutes.
    JEL: I11
    Date: 2017–07

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