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on Health Economics |
| By: | Debra J. Lipson; Jenna Libersky; Katharine Bradley; Corinne Lewis; Allison Wishon Siegwarth; Rebecca Lester |
| Abstract: | In a project for the Centers for Medicare & Medicaid Services Center for Medicaid and CHIP Services, Mathematica developed a toolkit to assist states in developing their network adequacy and service availability standards for Medicaid and CHIP managed care organizations (MCOs). |
| Keywords: | Medicaid, CHIP, Managed care, Network Adequacy, Service Availability |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7ed7da0f686044ba8aa1419bb1b51c64&r=hea |
| By: | Francis Makamu (Oklahoma State University); Mehtabul Azam (Oklahoma State University); Harounan Kazianga (Oklahoma State University) |
| Abstract: | Using the rollout of the schistosomiasis campaign in Nigeria as a quasi-experiment, we examine the impact of the disease control program on school age children education outcomes. Schistosomiasis is a parasitic disease caused by infections from a small worm. Its most severe effects hamper growth and cognitive development of children. The mass campaign targeted four states that saw large reduction in the infectious disease afterwards. Using difference-in-differences strategy, we find that the cohort exposed to the treatment in rural areas accumulated an additional 0.6 years of education compared to cohort not exposed to the treatment. Moreover, the impact of the schistosomiasis treatment is mainly on girls residing in rural areas. |
| Keywords: | Schistosomiasis; Disease Control; Child Education; Nigeria. |
| JEL: | I15 I18 |
| Date: | 2017–07 |
| URL: | http://d.repec.org/n?u=RePEc:okl:wpaper:1711&r=hea |
| By: | Leslie Foster; Robert Schmitz; Peter Kemper; Amy Zambrowski; Mei-Ling Mason; Matthew Jacobus; Jill Gurvey; Jeffrey Holt |
| Abstract: | The Centers for Medicare & Medicaid Services and state governments are increasingly interested in moving states’ long-term care systems away from reliance on institutional care and toward the development of more community-based services. |
| Keywords: | PACE , Medicare , Medicaid , Health |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:475d51ab4f72460981f94d8ba4ca95f4&r=hea |
| By: | David K. Baugh; Carol V. Irvin |
| Abstract: | This fact sheet summarizes the new Medicaid data captured under T-MSIS. |
| Keywords: | Medicaid data, T-MSIS, CHIP |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:0c9cb3f7caf243839b30430f88477306&r=hea |
| By: | Claire Postman; James Verdier |
| Abstract: | This brief describes the ongoing problem of improper billing of protected dually eligible beneficiaries for Medicare cost-sharing and describes steps states and health plans can take to address it. |
| Keywords: | balance billing , dual D-SNP , cost sharing |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:c90eabf157914073b012f480e92fce4c&r=hea |
| By: | David K. Baugh; Henry T. Ireys; Carol V. Irvin; Carey O. Appold |
| Abstract: | This issue brief examines the history of Medicaid data and identifies current opportunities to use emerging data systems to guide the program’s continued evolution. |
| Keywords: | Medicaid data, T-MSIS, CHIP |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:19b3af4d8be54352b4d3a109c309187f&r=hea |
| By: | Lawrence S. Wissow; Jonathan D. Brown; Robert J. Hilt; Barry D. Sarvet |
| Abstract: | Integrated care is widely advocated as a way of providing medical services that are better tailored to patients’ needs and as a way of addressing the undersupply or inavailability of specialists. |
| Keywords: | Integrated care, Children, Adolescents, Primary care, Mental health, Evaluation, Outcomes |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:be2708c327cc4d0f8fdab6663de9874a&r=hea |
| By: | Ann O’Malley; Rumin Sarwar; Rosalind Keith; Patrick Balke; Sai Ma; Nancy McCall |
| Abstract: | This article summarizes results from a qualitative research study of provider experience with the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. |
| Keywords: | chronic care management, providers, Medicare, payment |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7398ea35a9a44668aa841a45240c61d8&r=hea |
| By: | Jia Pu; Katherine G. Hastings; Derek Boothroyd; Powell O. Jose; Sukyung Chung; Janki B. Shah; Mark R. Cullen; Latha P. Palaniappan; David H. Rehkopf |
| Abstract: | This study aims to examine geographical differences in CVD mortality among Asian American subgroups living in the United States and whether they are consistent with geographical differences observed among non†Hispanic whites. |
| Keywords: | epidemiology, geographical disparities, mortality rate, race and ethnicity |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:ea84496772c3457eaa7f5c0bfdc0473a&r=hea |
| By: | AfDB AfDB |
| Date: | 2017–08–01 |
| URL: | http://d.repec.org/n?u=RePEc:adb:adbwps:2393&r=hea |
| By: | Oludamilola Adeyanju (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Sandy Tubeuf (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Tim Ensor (Leeds Institute of Health Sciences, University of Leeds) |
| Abstract: | Despite the implementation of several family planning (FP) programmes, uptake and use of modern contraception in Nigeria remains constrained by a limited access and weak service delivery especially among the poorest. Between 2009 and 2014 the Nigerian Urban Reproductive Health Initiative (NURHI) was initiated among urban Nigerian women in 6 states with the aim of increasing the use of modern contraceptive. The objective of this paper is to assess the changes in modern contraceptive use within the NURHI programme participants and understand the characteristics explaining the changes. We use data collected before and after the programme and apply the Fairlie decomposition method to evaluate the contribution of socioeconomic and other individual factors to the changes in contraceptive use over time. Results show an increase in modern contraceptive use in the programme areas over time. While wealth and education are important determining factors of modern contraceptive use pre-programme, their contribution post-programme reduces substantially. Pre-programme it is mainly women with higher education who use modern contraception because of greater autonomy, financial ability, social interaction and access to FP services however the programme appears to help close the socioeconomic gaps in modern contraceptive use over time. In particular, the NURHI reduces the strength of the link between contraceptive use, and education and wealth, and increases women’s empowerment and decision-making regarding contraception. |
| Keywords: | Modern Contraceptive use, Family Planning, Fairlie Decomposition, Nigeria |
| JEL: | J13 I14 I12 |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:lee:wpaper:1704&r=hea |
| By: | Palali, Ali; van Ours, Jan C. |
| Abstract: | Our paper investigates the effect of tobacco control policies on smoking initiation in eleven European countries. We analyze longitudinal data of individuals by using information about their age of onset of smoking. We apply hazard rate models to study smoking initiation. Thus, we are able to take into account observed and unobserved personal characteristics as well as the effect of the introduction of a variety of tobacco control policies including bans on tobacco advertisements, smoke-free air regulation, health warnings on packages of cigarettes and treatment programs to help smokers quitting. We find that none of these tobacco control policies influence smoking initiation. |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12201&r=hea |
| By: | Bauernschuster, Stefan; Driva, Anastasia; Hornung, Erik |
| Abstract: | We investigate the impact on mortality of the world's first compulsory health insurance, established by Otto von Bismarck, Chancellor of the German Empire, in 1884. Employing a multi-layered empirical setup, we draw on international comparisons and difference-in-differences strategies using Prussian administrative panel data to exploit differences in eligibility for insurance across occupations. All approaches yield a consistent pattern suggesting that Bismarck's Health Insurance generated a significant mortality reduction. The results are largely driven by a decline of deaths from infectious diseases. We present prima facie evidence that diffusion of new hygiene knowledge through physicians was an important channel. |
| Keywords: | demographic transition; Health Insurance; Mortality; Prussian Economic History |
| JEL: | I13 I18 J11 N33 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12200&r=hea |
| By: | Thorhildur Ólafsdóttir; Tinna Laufey Ásgeirsdóttir; Edward C. Norton |
| Abstract: | Chronic pain clearly lowers utility, but it is empirically challenging to estimate the monetary compensation needed to offset this utility reduction. We use the subjective well-being method to estimate the value of pain relief among individuals age 50 and older. We use a sample of 64,205 observations from 4 waves (2008-2014) of the Health and Retirement Study, a nationally representative individual-level survey data, permitting us to control for individual heterogeneity. Our models, which allow for nonlinear effects in income, show the value of avoiding pain ranging between 56 to 145 USD per day. These results are lower than previously reported, suggesting that the value of pain relief varies by income levels. Thus, previous estimates of the value of pain relief assuming constant monetary compensation for pain across income levels are heavily affected by the highest income level. Furthermore, we find that the value of pain relief increases with pain severity. |
| JEL: | I10 I14 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23649&r=hea |
| By: | Molly Schnell; Janet Currie |
| Abstract: | Using data on all opioid prescriptions written by physicians from 2006 to 2014, we uncover a striking relationship between opioid prescribing and medical school rank. Even within the same specialty and county of practice, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower ranked schools. Additional evidence suggests that some of this gradient represents a causal effect of education rather than patient selection across physicians or physician selection across medical schools. Altering physician education may therefore be a useful policy tool in fighting the current epidemic. |
| JEL: | I1 I18 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23645&r=hea |
| By: | Ernst R. Berndt; Rena M. Conti; Stephen J. Murphy |
| Abstract: | Regulation can influence the structure, conduct and performance of consumer product markets and the structure of product markets can influence regulation. Since the vast majority of prescription drugs consumed by Americans are generic, the structure of the U.S. generic prescription drug market is of wide interest. The supply of prescription drugs in the U.S. is also heavily regulated by the U.S. Food and Drug Administration (FDA). We describe events leading up to the passage and implementation of the Generic Drug User Fee Amendments in 2012 (GDUFA I), and compare its FDA commitments, provisions, goals and fee structure to that of the 1992 Prescription Drug User Fee Act (PDUFA) for branded drugs. Although GDUFA I expires September 30, 2017, reauthorization for GDUFA II is currently underway and is likely to shift the user fee structure away from annual facility fees to annual program fees. We explain how the fee structure of GDUFA I, and that being considered for GDUFA II, erects barriers to entry and creates scale and scope economies for incumbent manufacturers of generic drugs. Furthermore, in order to implement fees under GDUFA I, FDA required the submission of self-reported data on generic manufacturing practices including domestic and foreign active pharmaceutical ingredient (API) and finished dosage form (FDF) facilities. These data provide an unprecedented window into the recent evolution of generic drug manufacturing markets. Our analyses of these data suggest that generic drug manufacturing in 2017 is quite concentrated: a very large portion of ANDA holders have small portfolios consisting of less than five ANDAs, while a small number of very large ANDA holders have portfolios consisting of hundreds or even thousands of ANDAs. The number of API and FDF facilities have each declined by approximately 10-11% between 2013 and 2017. Furthermore, in 2017, generic manufacturing is largely foreign and has become increasingly so since 2013. We discuss the implications of the current structure of the U.S. generic prescription drug market for GDUFA II ratification and implementation. |
| JEL: | I1 I11 I18 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23642&r=hea |
| By: | Schwärzler, Marion Cornelia; Kronenberg, Tobias |
| Abstract: | The Multiregional Health Account is a methodological enhancement of the National Health Account and adds a subnational regional dimension to the latter. Both satellite accounts aim to quantify the contribution of the German health economy in terms of gross value added, employment and trade. Moreover, since they are based on supply and use tables and thus input-output tables of the national accounting system, both models allow input-output analysis for a more thorough evaluation of the national and multiregional health economy. The challenge addressed in this paper consists in questioning the reliability of the results from multiregional input-output analysis based on the Multiregional Health Account. This is necessary due to the circumstance that no official multiregional input-output tables are available for German federal states and we elaborated a new methodology to derive multiregional tables on our own. Hence, we conduct input-output analysis to evaluate the performance of the multiregional input-output table in modelling intra- and interregional interdependencies. We find that the model succeeds in reproducing certain regional characteristics. |
| Keywords: | Input-output analysis, regionalization, satellite account, health economy, Germany, supply and use tables, SUT-RAS |
| JEL: | C67 E01 I15 R11 R15 |
| Date: | 2017–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80719&r=hea |
| By: | Schwärzler, Marion Cornelia; Kronenberg, Tobias |
| Abstract: | Lagging investments in German hospitals have become a serious challenge in recent decades. The responsibility for investment financing lies with the German federal states, the “Bundeslaender”, due to the dualistic financing framework applying for German hospitals. Yet, hospital investments experience a field of tension between the availability of financial resources and necessary investments. A possible solution could be a financial equalization scheme for the health economy incorporating an earmarked fund for hospital investments. The rationale for such a system is that health economies of federal states do not represent single closed systems, but depend on interregional trade flows to supply patient treatment. The respective calculations in this paper are based on our recently compiled Multiregional Health Account for Germany. The model represents a satellite account of the health economy based on national accounts. Consequently, we are able to calculate spillover effects from patient treatment in federal states by conducting input-output analysis. Based on the results, we derive a sketch of a financial equalization scheme in order to ensure needs-based hospital infrastructure in German federal states. |
| Keywords: | Health economy, hospital investments, financial equalization scheme, input-output analysis, multiregional, federal states, Germany |
| JEL: | C67 H51 H75 I11 R15 |
| Date: | 2017–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80720&r=hea |
| By: | Schwärzler, Marion Cornelia; Kronenberg, Tobias |
| Abstract: | The Multiregional Health Account is a satellite account focusing on the economic impact of the health economy in German federal states. It was developed as an enhancement of the existing National Health Account for Germany. In contrast to the subject of matter over here, the calculations of the National Health Account are based on available national supply and use tables. Since there are no according tables available for the German federal states, we developed a methodology, which allows to calculate supply and use tables at the subnational multiregional level. The present paper focusses on the results of the MRHA for the reason of a thorough validation procedure of the developed approach. We evaluate regional direct effects of the health economy by comparing derived characteristics with company data and evaluate the performance of the algorithm in a time series. We find that the elaborated approach shows reasonable results in both dimensions evaluated. |
| Keywords: | national accounts, satellite account, health economy, Germany, regionalization, supply and use tables, SUT-RAS |
| JEL: | C67 E01 I15 R11 R15 |
| Date: | 2017–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80717&r=hea |
| By: | Mahmud, Mir |
| Abstract: | Although Immigrant children represent approximately 3 percent of total U.S. child population, they remain the most vulnerable group in terms of access to public health insurance since the enactment of the “five-year-ban” for legal immigrants in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Children Health Insurance Reauthorization Act (CHIPRA) of 2009 provided states an option to receive federal funds to expand eligibility for immigrant children regardless of their length of residency. In this paper, we utilize the cross-state variation in policy environment before and after the adoption of CHIPRA to compare the differences in access to public health insurance among the low-income immigrant children. We find that adoption immigrant child option of CHIPRA has resulted 8 percentage points increase in health coverage for the target group, almost entirely contributed by equal increase in coverage through public health insurance. Our measure of estimated treatment effect is lower than what existing literature reports. We attribute the difference to the existing state-funded programs to support immigrant children among majority of the CHIPRA states. Increase in coverage entirely comes from the ranks of previously uninsured children; no evidence of crowding out from the private insurance was found. We also verify the lack of crowding out by estimating the labor market response among mothers of immigrant children. |
| Keywords: | Key Words: Health Insurance, Medicaid, Immigrants |
| JEL: | I1 I18 |
| Date: | 2016–11–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80602&r=hea |
| By: | Averett, Susan L. (Lafayette College); Smith, Julie K. (Lafayette College); Wang, Yang (University of Wisconsin-Madison) |
| Abstract: | States are increasingly resorting to raising the minimum wage to boost the earnings of those at the bottom of the income distribution. In this paper, we examine the effects of minimum wage increases on the health of low-educated Hispanic women, who constitute a growing part of the U.S. labor force, are disproportionately represented in minimum wage jobs and typically have less access to health care. Using a difference-in-differences identification strategy and data drawn from the Behavior Risk Factor Surveillance Survey and the Current Population Survey from the years 1994–2015, we find little evidence that low-educated Hispanic women likely affected by minimum wage increases experience any changes in health status, access to care, or use of preventive care. |
| Keywords: | minimum wage, Hispanic women, health outcomes, health insurance, preventive care |
| JEL: | J15 I12 I13 I14 |
| Date: | 2017–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp10916&r=hea |
| By: | Schwärzler, Marion Cornelia; Kronenberg, Tobias |
| Abstract: | The Multiregional Health Account is a methodological enhancement of the National Health Account for Germany. The latter represents an established and annually updated satellite account quantifying the economic contribution of the health economy in terms of gross value added, employment and interna-tional trade. Its methodological enhancement to a multiregional framework for the 16 federal states of Germany is represented by multiregional supply and use tables. This setting allows to compile a multire-gional health input-output table and subsequently to carry out input-output analysis. Hence, we are able to quantify the direct and indirect economic impacts of the health economy to analyze interdependencies between industries and federal states. For the purpose of compiling the Multiregional Health Account, we elaborate a new approach based on the SUT-RAS algorithm (Temurshoev & Timmer, 2011), which we adapt for the multiregional framework. We call it the MR-SUT-RAS algorithm. The methodology and its application in the context of the health economy is the subject of this contribution. |
| Keywords: | Input-Output analysis, regionalization, multi-regional supply and use tables, SUT-RAS, health economy, Germany |
| JEL: | C67 E01 I11 I18 R15 |
| Date: | 2017–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80712&r=hea |
| By: | Averett, Susan L. (Lafayette College); Terrizzi, Sabrina (Moravian College); Wang, Yang (University of Wisconsin-Madison) |
| Abstract: | Policymakers and the general public have expressed increasing concern over rising health care costs. The Certificate-of-Need (CON) programs began at the federal level in 1974 to stem the increase in costs by limiting hospital expansion and acquisition of equipment. The federal requirement for CON programs ended in 1987; however, 37 states and DC still maintain various forms of CON programs. We examine the effect of the expiration of Pennsylvania's CON law on indicators of quality and cost of health care for patients undergoing hip and knee replacement surgery. We use the standard difference-in-differences method and the Synthetic Control method. Our preferred method indicates that the expiration had no statistically significant effect on our various measures of quality and cost. |
| Keywords: | certificate of need, knee and hip replacement, health care, cost, quality |
| JEL: | I18 I10 |
| Date: | 2017–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp10917&r=hea |
| By: | FAKHRI, ISSAOUI; HASSEN, TOUMI; WASSIM, TOUILI; BILEL, AMMOURI |
| Abstract: | In This paper we try to investigate the impact of CO2 emissions on a set of socioeconomic variables (GDP, health expectancy, life expectancy, urbanization, time, and a composite variable showing the effects post the earth summit of johansburg) in eight countries covering all world economic groups (Tunisia, Saudi Arabia, France, Norway, Bresil, USA, China and Australia). The empirical results have showed that the GDP continue to be the principal variable which is inciting to the CO2 emission. Also we have demonstrated that it exists actually a voluntary act at the world scale to substitute pollutant energy sources by other sources more clean and pure. |
| Keywords: | Environmental Kuznets Curve, CO2, energy consumption, growth |
| JEL: | I1 I15 I3 I31 |
| Date: | 2016–02–08 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80702&r=hea |
| By: | Balat, Jorge (Johns Hopkins University); Papageorge, Nicholas W. (Johns Hopkins University); Qayyum, Shaiza (Johns Hopkins University) |
| Abstract: | We study the impact of expert reviews on the demand for HIV treatments. A novel feature of our study is that we observe two reviews for each HIV drug and focus attention on consumer responses when experts disagree. Reviews are provided by both a doctor and an activist in the HIV lifestyle magazine Positively Aware, which we merge with detailed panel data on HIV-positive men's treatment consumption and health outcomes. To establish a causal relationship between reviews and demand, we exploit the arrival of new drugs over time, which provides arguably random variation in reviews of existing drugs. We find that when doctors and activists agree, more positive reviews increase demand for HIV drugs. However, doctors and activists frequently disagree, most often over treatments that are effective, but have harsh side effects, in which case they are given low ratings by the activist, but not by the doctor. In such cases, relatively healthy consumers favor drugs with higher activist reviews, thus defying the doctor, which is consistent with a distaste for side effects. This pattern reverses for individuals who are in worse health and thus face stronger incentives to choose more effective medication despite side effects. Findings suggest that consumers demand information from experts according to the trade-offs they face when making health investments in the presence of adverse treatment side effects. |
| Keywords: | health, information, product reviews, pharmaceutical demand, HIV/AIDS |
| JEL: | I12 L15 M3 D12 D83 |
| Date: | 2017–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp10919&r=hea |