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on Health Economics |
By: | Koichi Futagami (Graduate School of Economics, Osaka University); Kunihiko Konishi (Research Fellow of the Japan Society for the Promotion of Science (JSPS)) |
Abstract: | This study constructs an overlapping-generations model with endogenous fertility, mortality, and R&D activities. We demonstrate that the model explains the observed fertility dynamics of developed countries. When the level of per capita wage income is either low or high, an increase in such income raises the fertility rate. When the level of per capita wage income is in the middle, an increase in such income decreases the fertility rate. The model also predicts the observed relationship between population growth and innovative activity. At first, both the rates of population growth and technological progress increase, that is, there is a positive relationship. Thereafter, the rate of population growth decreases but the rate of technological progress increases, showing a negative relationship. |
Keywords: | Fertility, Mortality, R&D |
JEL: | D91 J13 O10 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:osk:wpaper:1726&r=hea |
By: | Mohammad Mainul Hoque; Elizabeth King; Claudio E. Montenegro; Peter F. Orazem |
Abstract: | Data from 919 household surveys conducted between 1960 and 2012 spanning 147 economies are used to evaluate the relationship between rising life expectancy at birth and lifetime years of schooling for successive birth cohorts between 1905 and 1988. We find significant positive effects of increased life expectancy at birth on lifetime completed years of schooling in 95% of the surveys with significant negative effects found in only 2.3%. Rising life expectancy at birth for a birth cohort has intergenerational benefits in that their children’s schooling also increases. Rising life expectancy at birth since 1905 can explain 70% of the rising completed years of schooling for those birth cohorts. |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:udc:wpaper:wp450&r=hea |
By: | Bisceglia, Michele; Cellini, Roberto; Grilli, Luca |
Abstract: | In several countries, healthcare services are provided by public and/or private subjects, and they are reimbursed by the Government, on the basis of regulated prices. Thus, providers take prices as given and compete on quality to attract patients. In some countries, regulated prices differ across regions. This paper focuses on the interdependence between regional regulators within a country: it proposes a model of spatial competition to study how price-setters of different regions interact, in a simple but realistic framework. We show that the decentralisation of price regulation implies higher expenditure, but higher patients' welfare. |
Keywords: | Healthcare Services; Diagnosis Related Group; 2-Stage Non Cooperative Game; Quality Competition. |
JEL: | H42 I11 L13 R12 R38 |
Date: | 2017–07–10 |
URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:80507&r=hea |
By: | Salvatore Russo (Dept. of Management, Università Ca' Foscari Venice); Stefano Landi (Dept. of Management, Università Ca' Foscari Venice); Paolo Landa (Medical School, University of Exeter) |
Abstract: | Background. Osteoarthritis (OA) is a chronic and degenerative pathology that affects joints in particular hands, knees, hip and lower back. It is one of the main causes of disability in most of advanced economy countries. Its prevalence and incidence are increasing for the ageing of population and the presence of risk factors. OA burden of disease implies high costs of care and it has an important social impact. Although more high-quality evidence is needed, recent studies indicate that intra-articular Platelet-Rich Plasma (i.a. PRP) injections can relieve pain, improving knee function and quality of life, especially in younger patients and mild OA cases. Objectives. The aim of this work is to develop a preliminary economic evaluation of i.a. PRP therapy in the treatment of knee OA. The comparator adopted is the Hyaluronic acid (HA) which represents the standard therapy. Both therapies can reduce pain and can help the patient to delay the total knee replacement (TKR) surgical intervention. Methods. A Cost-Utility Analysis (CUA) was performed using a decision tree model. Outcomes are reported in terms of Quality Adjusted Life Year (QALY), while costs are reported in Euro (Û) currency. The adopted perspective is the National Healthcare System. Deterministic and probabilistic sensibility analyses are reported to evaluate the robustness of results under uncertainty. Results. The i.a. PRP-based therapy is cost-effective with respect to HA. Future clinical studies should provide more evidence on the major effectiveness and considering a longer patient follow-up there could be the delay of TKR, reducing consequently the eventual prosthesis revision and reducing costs of knee OA for National Healthcare System. |
Keywords: | materiality, integrated report, accounting |
JEL: | C63 D61 I1 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:vnm:wpdman:141&r=hea |
By: | Julia Goldberg Raifman (Boston University); Felix Lam (Clinton Health Access Initiative); Janeen Madan Keller (Center for Global Development); Alexander Radunsky (Harvard T.H. Chan School of Public Health); William Savedoff (Center for Global Development) |
Abstract: | Evaluations are key to learning and accountability yet the quality of those evaluations are critical to their usefulness. We assessed the methodological quality of global health program evaluations commissioned or conducted by five major funders and published between 2009 and 2014. From a universe of 299 large-scale global health program evaluations, we randomly selected 37 evaluations stratified by whether they were performance evaluations or impact evaluations and applied a systematic assessment approach with two reviewers scoring each evaluation. We found that most evaluations did not meet social science methodological standards in terms of using methods and data that would simultaneously assure relevance, validity, and reliability. Most evaluations (76 percent) asked questions relevant to the health program, but 43 percent of evaluations failed to collect relevant data. In addition, only about a fifth of the evaluations followed accepted social science methods for sampling. We also assessed whether evaluations took a systematic analytical approach and considered potential confounding variables. In this regard, only 16 percent of evaluations in our sample had high analytical validity and reliability. The study provides ten recommendations for improving the quality of evaluations, including a robust finding that early planning of evaluations is associated with better quality and noting the value of better sampling approaches in data collection and disclosure of potential conflicts of interest and data. |
Keywords: | evaluation, impact evaluation, health, foreign aid, learning, research quality |
JEL: | D04 F35 F53 H43 I18 |
URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:461&r=hea |
By: | Kokot, Johanna |
Abstract: | The purpose of this study is to investigate the effect of a spouse's health shock on own risk attitudes. A spouse's health shock (i.e., the occurrence of a severe disease) can influence own expectations about the probability of falling ill. Moreover, an indisposition of the spouse, which may disrupt the ability and efficiency in sharing the everyday responsibilities, can increase mental and financial pressure, and thus would lead to a reduction of own risk willingness. On the other hand, a health shock may act as a wake-up call to enjoy life and may increase risk willingness. Using German Socio Economic Panel data, this study reveals that a health shock suffered by the spouse decreases own risk willingness. The effect is more pronounced the more serious the health shock is. The findings have implications for health insurance decisions and policy evaluations. |
Keywords: | health shock,risk attitudes,spouses |
JEL: | C81 D01 D19 D81 I10 I12 |
Date: | 2017 |
URL: | http://d.repec.org/n?u=RePEc:zbw:rwirep:707&r=hea |
By: | Geyer, J.; Korfhage, T.; |
Abstract: | Germany introduced a new insurance for long-term care in 1995 as part of its social security system. Benefits from the long-term care insurance are not means tested and only depend on the required level of care. The new scheme improved the situation for households wanting to organize informal care at home and it changed the incentives for potential informal caregivers. We exploit this reform as a quasi-experiment and examine its effect on the labor supply of caregivers who live in the same household as the care recipient. We find strong negative labor market effects for men but not for women. |
Keywords: | labor supply; long-term care; long-term care insurance; quasi-experimental approach; |
JEL: | J22 H31 I13 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:17/20&r=hea |
By: | Toulemon, L.; |
Abstract: | This paper estimates the impact of group purchasing on medicine prices in French hospitals, taking advantage of the entry of hospitals into regional purchasing groups between 2009 and 2014. I use a new database providing the average annual prices paid for all innovative and costly medicines in public hospitals. Using a fixed effects model that controls for hospitals’ medicine-specific bargaining abilities and medicine-specific price trends, I find that group purchasing reduces prices of medicines in oligopoly markets, but has no impact on the prices of medicines with no competitors. |
Keywords: | hospital medicine prices; purchasing groups; bargaining ability; |
JEL: | C23 I11 J52 J58 L13 L14 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:17/21&r=hea |
By: | Özer, Mustafa; Fidrmuc, Jan; Eryurt, Mehmet Ali |
Abstract: | We study the causal effect of maternal education on childhood immunization rates. We use the Compulsory Education Law (CEL) of 1997, and the differentiation in its implementation across regions, as instruments for schooling of young mothers in Turkey. The CEL increased the compulsory years of schooling of those born after 1986 from 5 to 8 years. We find that education of mothers increases the probability of completing the full course of DPT and Hepatitis B vaccinations for their children. The results are robust to variation in regression specification and including various individual and community variables. |
Keywords: | DPT (diphtheria, pertussis and tetanus),Hepatitis B,Maternal Education,Vaccination,Difference-in-Difference-in-Difference,Instrumental variable |
JEL: | H51 H52 I12 |
Date: | 2017 |
URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:108&r=hea |
By: | Van Gestel, R.; Müller, T.; Bosmans, J.; |
Abstract: | Procedural failures of physicians or teams in interventional healthcare may positively or negatively predict subsequent patient outcomes. We identify this “learning from failure†-effect by applying (non-)linear dynamic panel methods using data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry containing information on the first 860 TAVI procedures in Belgium. Using bias-corrected fixed effects linear probability models and the split-panel jackknife estimator proposed by Dhaene and Jochmans (2015), we find that a previous death positively and significantly predicts subsequent survival of the succeeding patient. Moreover, our results also provide evidence for learning from failure for stroke. We find that these learning from failure effects are not long-living and that learning from failure is transmitted across adverse events, e.g., a stroke affects subsequent survival. |
Keywords: | Physician behavior; Learning; Failure; |
JEL: | I10 I13 I18 C93 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:17/24&r=hea |
By: | Crossley, T.F.; Zilio, F.; |
Abstract: | Each year the UK records 25,000 or more excess winter deaths, primarily among the elderly. A key policy response is the “Winter Fuel Payment†(WFP), a labelled but unconditional cash transfer to older households. The WFP has been shown to raise fuel spending among eligible households. We examine the causal effect of the WFP on health outcomes, including self-reports of chest infection, measured hypertension and biomarkers of infection and inflammation. We find a robust and statistically significant six percentage point reduction in the incidence of high levels of serum fibrinogen. Reductions in other disease markers point to health benefits, but the estimated effects are not robustly statistically significant. |
Keywords: | benefits; health; biomarkers; heating; regression discontinuity; |
JEL: | H51 I12 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:yor:hectdg:17/23&r=hea |
By: | Cheti Nicoletti; Valentina Tonei |
Abstract: | Recent empirical research in family economics has shown the importance of parental investments on child's human capital development, but it is still not clear whether parents respond to changes across time in their child's skills and health. Using the Longitudinal Study of Australian Children, we measure parental investments by considering the time parents spend with their child doing formative activities. By adopting a child fixed-effect instrumental variable estimation to address endogeneity issues, we find that parents reinforce for differences in their child's socio-emotional skills, compensate for changes in her physical health, and are neutral to variation in her cognitive skills. |
Keywords: | Time-use, family investment, quality time, skills, child development. |
JEL: | J13 D13 C23 C26 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:yor:yorken:17/08&r=hea |
By: | Geng, Xin; Ide, Vera; Janssens, Wendy; Kramer, Berber; van der List, Marijn |
Abstract: | Health insurance can protect consumption from health shocks, but it can also crowd out informal transfers. This paper examines whether health insurance improves consumption smoothing in the face of health shocks, and to what extent results depend on households’ access to informal transfers as a risk coping strategy. Using high-frequency panel data on health and finances collected in rural Kenya, we show that mobile money users have stronger access to informal transfers than nonusers. We further find that health shocks induce nonusers of mobile money to lower their nonhealth expenditures by approximately 25 percent in weeks when they are uninsured. These same households are able to smooth consumption in weeks with insurance coverage, due to lower out-of-pocket health expenditures. In contrast, mobile money users are able to smooth consumption when experiencing health shocks even in the absence of health insurance, due to an inflow of informal transfers. For this group, health insurance improves healthcare utilization and does not crowd out the inflow informal transfers during weeks with health shocks. These findings have implications for the design of health insurance and mobile health financing products. |
Keywords: | health insurance, |
Date: | 2017 |
URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:1664&r=hea |
By: | Kouni, Mohamed |
Abstract: | Purpose: In this paper we use the most recent database on medical brain drain (estimated by Bhargava, Docquier and Moullon in 2010) in order to analyze the consequences ofincreasing medical migration flowson human development, in particular on life expectancy in three developing country groups. Methodology: Our aim is to study the quantitative and qualitative effect of medical brain drain (MBD) on life expectancy in the Arab, Asian and American countries. Findings: The results showed that the MBD has an important and significant quantitative effect on life expectancy in Arab and Asian countries. Indeed, the elasticity of life expectancy with respect (1+MBD) is positive and significant at 1% level in all regressions for the two groups. Nevertheless, this relationship is not clear for central and Latin American countries where elasticity is not significant in two among three regressions. Moreover, the qualitative MBD effect is negative for all countries in the three groups. Recommendations: Therefore, there is a need for the majority of these countries to change both their labor and emigration policies. This can be achieved by a veritable incentive policy and by reinforcing networks between emigrant physicians and their origin society. |
Keywords: | Brain Drain, Human Capital, Development |
JEL: | F22 J24 O15 |
Date: | 2016 |
URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:78321&r=hea |
By: | Amanda Beatty; Nick Ingwersen; William Leith; Clair Null |
Abstract: | Mathematica Policy Research uses household survey data from Indonesia to examine the prevalence of anemia among children 6-35 months old and pregnant women and identifies risk factors for anemia in those populations. |
Keywords: | Anemia, health, nutrition, Indonesia, stunting, infant |
JEL: | F Z I0 I1 |
URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:31e1360fda4945a290ff943ad9c30990&r=hea |
By: | Gerald J. Pruckner; Thomas Schober; Katrin Zocher (JKU, Austria) |
Abstract: | There is widespread agreement that behavior crucially influences one’s health. However, little is known about what actually determines health-related behavior. We explore the impact of the place where many people spend most of their time, at work, and analyze whether an individual’s decision to participate in health screening is related to the observed behavior of peers at work. We use linked employer-employee data and exploit the transitions of workers to new jobs. We find the health behavior of co-workers highly correlated. A comparison of individuals moving into new firms shows that participation in general health checks, mammography screening, and prostate-specific antigen tests increases with the share of work peers attending these screenings. To differentiate between peer effects and common influences at the workplace, we further separate the peer groups within firms and show that workers with similar characteristics tend to have a stronger effect on individual screening participation. |
Keywords: | : Health behavior, screening, peer effects, workplace. |
JEL: | I10 I12 D83 |
Date: | 2017–07 |
URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2017_07&r=hea |
By: | Aparna Keshaviah; Editor |
Abstract: | This report synthesizes research and recommendations from Mathematica’s symposium on “The Potential of Wastewater Testing for Public Health and Safety." |
Keywords: | wastewater, testing, substance use, opioids, Arnold Foundation, Advanced analytics, Machine learning, Public health, public safety |
JEL: | I |
URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:5a867fbc382040a1af74f957b565fd98&r=hea |
By: | Amanda Beatty; Nick Ingwersen; Clair Null |
Abstract: | Mathematica Policy Research examines breastfeeding practices and knowledge in the first two years of life among caregivers of children 0-35 months old in rural areas of Central Kalimantan, West Kalimantan, and South Sumatra in Indonesia. |
Keywords: | Breastfeeding, health, nutrition, Indonesia, stunting, infant |
JEL: | F Z I0 I1 |
URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:b8bede4016a243dfbdbb25d027cecd89&r=hea |
By: | Valerie Cheh; Nancy Duda; Barbara Lepidus Carlson; Karen CyBulski; Amy Zambrowski; Andrew McGuirk |
Abstract: | The Medicare home health benefit was originally designed to meet an individual’s post-hospitalization needs. |
Keywords: | home health , disabled , Medicare |
JEL: | I |
URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:43dcae5cce174c60b1ed7c60deabc07c&r=hea |
By: | Katolik, Aleksandra (University of Warwick); Oswald, Andrew J. (University of Warwick and IZA) |
Abstract: | The antidepressant pill is an important modern commodity. Its growing role in the world has been largely ignored by researchers in economics departments and business schools. Scholars may be unaware how many citizens and employees now take these pills. Here we review some of the social-science literature on the topic. We discuss research on the impact of advertising upon antidepressant consumption, the link between antidepressants and the human ‘midlife crisis’, and evidence on how antidepressants are connected to crime, suicide, and financial hardship. We argue that antidepressants will eventually have to be modelled as a new form of consumption that lies in the currently grey area between medicines and consumer goods. This topic demands scholarly and societal attention. |
Keywords: | Well-being; depression; medications; happiness. JEL Classification: I1; I120; I3; I310 |
Date: | 2017 |
URL: | http://d.repec.org/n?u=RePEc:cge:wacage:338&r=hea |
By: | Bauernschuster, Stefan (University of Passau); Driva, Anastasia (LMU Munich); Hornung, Erik (University of Bayreuth) |
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: health insurance, mortality, demographic transition, Prussia JEL Classification: : I13, I18, N33, J11 |
Date: | 2017 |
URL: | http://d.repec.org/n?u=RePEc:cge:wacage:336&r=hea |
By: | Pinka Chatterji; Xiangshi Liu; Baris K. Yoruk |
Abstract: | We test whether the ACA dependent care provision is associated with young adults’ propensity to live with/near parents and to receive food assistance. Data come from the 2008 Survey of Income and Program Participation. Findings indicate that the provision is associated with a 3.0 percentage point increase in young adults’ living with parents during the period in which the ACA had been passed but the provision was not effective, and a 6.0 percentage point increase during the time between the provision becoming effective and the end of 2013. In some specifications, the provision is associated with reduced use of food assistance. |
JEL: | I0 I13 J1 J62 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23700&r=hea |
By: | Amy Finkelstein; Neale Mahoney; Matthew J. Notowidigdo |
Abstract: | Health insurance confers benefits to the previously uninsured, including improvements in health, reductions in out-of-pocket spending, and reduced medical debt. But because the nominally uninsured pay only a small share of their medical expenses, health insurance also provides substantial transfers to non-recipient parties who would otherwise bear the costs of providing uncompensated care to the uninsured. The prevalence of uncompensated care helps explain the limited take-up of heavily-subsidized public health insurance and the evidence that many recipients value formal health insurance at substantially less than the cost to insurers of providing that coverage. The distributional implications of public subsidies for health insurance depend critically on the ultimate economic incidence of the transfers they deliver to providers of uncompensated care. |
JEL: | H22 H42 H51 I11 I13 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23718&r=hea |
By: | Adam I. Biener; John Cawley; Chad Meyerhoefer |
Abstract: | This paper is the first to use the method of instrumental variables to estimate the causal impact of youth obesity on U.S. medical care costs. We examine data from the Medical Expenditure Panel Survey for 2001-2013 and instrument for child BMI using the BMI of the child’s biological mother. IV estimates indicate that obesity raises annual medical care costs by $1,354 (in 2013 dollars) or 159%, which is considerably higher than previous estimates of the association of youth obesity with medical costs; thus, the cost-effectiveness of anti-obesity interventions have likely been underestimated. The costs of youth obesity are borne almost entirely by third party-payers, which is consistent with substantial externalities of youth obesity, which in turn represents an economic rationale for government intervention. |
JEL: | D62 I1 I14 I18 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23682&r=hea |
By: | Sara Markowitz; Kelli A. Komro; Melvin D. Livingston; Otto Lenhart; Alexander C. Wagenaar |
Abstract: | The purpose of this paper is to investigate the effects of state-level Earned Income Tax Credit (EITC) laws in the U.S. on maternal health behaviors and infant health outcomes. Using multi-state, multi-year difference-in-differences analyses, we estimated effects of state EITC generosity on maternal health behaviors, birth weight and gestation weeks. We find little difference in maternal health behaviors associated with state-level EITC. In contrast, results for key infant health outcomes of birth weight and gestation weeks show small improvements in states with EITCs, with larger effects seen among states with more generous EITCs. Our results provide evidence for important health benefits of state-level EITC policies. |
JEL: | H0 I0 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23714&r=hea |
By: | Charles Courtemanche; Andrew Friedson; Andrew P. Koller; Daniel I. Rees |
Abstract: | This study contributes to the literature on supply-side adjustments to insurance expansions by examining the effect of the Affordable Care Act (ACA) on ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 19%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems. |
JEL: | I11 I13 I18 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23722&r=hea |
By: | Marcella Alsan |
Abstract: | Recent policy debates on closing the education gender gap in developing countries have focused on cash transfers, but standard models of intrahousehold allocation imply that reducing the opportunity cost of girls' schooling might also be effective. I test this prediction using quasi-experimental variation from a national vaccination campaign targeting under-five children in Turkey. I find gains in health and human capital among age-eligible children of both sexes. However, educational spillover effects accrue exclusively to their adolescent, ineligible sisters. These spillover effects are increasing if the mother works outside the home and in the number of young children in the household, and are absent if an elder sister is present. My results suggest reducing morbidity among preschool children may have the added benefit of improving educational outcomes for their adolescent sisters in the developing world |
JEL: | I25 J16 O15 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23702&r=hea |
By: | Donald S. Kenkel; Sida Peng; Michael F. Pesko; Hua Wang |
Abstract: | Electronic cigarettes are a less harmful alternative to combustible cigarettes. We analyze data on e-cigarette choices in an online experimental market. Our data and mixed logit model capture two sources of consumer optimization errors: over-estimates of the relative risks of e-cigarettes; and present bias. Our novel data and policy analysis make three contributions. First, our predictions about e-cigarette use under counter-factual policy scenarios provide new information about current regulatory tradeoffs. Second, we provide empirical evidence about the role consumer optimization errors play in tobacco product choices. Third, we contribute to behavioral welfare analysis of policies that address individual optimization errors. |
JEL: | I12 |
Date: | 2017–08 |
URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23710&r=hea |