nep-hea New Economics Papers
on Health Economics
Issue of 2017‒09‒03
twenty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets By Kate Ho; Robin S. Lee
  2. Self-Control and Demand for Preventive Health: Evidence from Hypertension in India By Liang Bai; Benjamin Handel; Edward Miguel; Gautam Rao
  3. The Lifetime Costs of Bad Health By Svetlana Pashchenko; Ponpoje (Poe) Porapakkarm; Mariacristina De Nardi
  4. Obesity Based Labour Market Discrimination in South Africa: A Dynamic Panel Analysis By Junita Henry; Umakrishnan Kollamparambil
  5. Management, Supervision, and Health Care: A Field Experiment By Dunsch, Felipe A.; Evans, David K.; Eze-Ajoku, Ezinne; Macis, Mario
  6. Infant Health, Cognitive Performance and Earnings: Evidence from Inception of the Welfare State in Sweden By Bhalotra, Sonia; Karlsson, Martin; Nilsson, Therese; Schwarz, Nina
  7. Examining the link between health measures, management practices and establishment performance By Broszeit, Sandra; Laible, Marie-Christine
  8. Smoking Behaviour in Germany: Evidence from the SOEP By Daniela Heilert; Ashok Kaul
  9. Long working days and falling asleep at work – issues in R&D work efficiency By Erve Sõõru; Aaro Hazak; Marit Rebane
  10. The Chinese Saving Rate: Long-Term Care Risks, Family Insurance, and Demographics By Ayşe İmrohoroğlu; Kai Zhao
  11. On the Motivations for the Dual-Use of Electronic and Traditional Cigarettes By David Ronayne; Daniel Sgroi
  12. Survey sponsor effects on the willingness to pay for mortality risk reductions By Marcelo Lima
  13. Ownership and Hospital Productivity By Carine Milcent; Brigitte Dormont
  14. The Joint Effects of a Health Insurance and a Public Works Scheme in Rural Ethiopia By Shigute, Zemzem; Strupat, Christoph; Burchi, Francesco; Alemu, Getnet; Bedi, Arjun S.
  15. Modeling under-5 mortality through multilevel structured additive regression with varying coefficients for Asia and Sub-Saharan Africa By Kenneth Harttgen; Stefan Lang; Judith Santer; Johannes Seiler
  16. Malaria Control and Infant Mortality in Africa By Denis Cogneau; Pauline Rossi
  17. EpiCore: Harnessing a Network of Health Professionals for Verification of Public Health Events By So O'Neil; Divya Vohra; Brenna Rabel
  18. The Medicaid Analytic eXtract MAX Chartbook By Audra T. Wenzlow; Dan Finkelstein; Ben Le Cook; Kathy Shepperson; Christine Yip; David Baugh
  19. The Affordable Care Act and Ambulance Response Times By Courtemanche, Charles; Friedson, Andrew I.; Koller, Andrew P.; Rees, Daniel I.
  20. 'Rational Overeating' in a Feast-or-Famine World: Economic Insecurity and the Obesity Epidemic By Smith, Trenton G.; Stillman, Steven; Craig, Stuart
  21. Smoking and the Business Cycle: Evidence from Germany By Kaiser, Micha; Reutter, Mirjam; Sousa-Poza, Alfonso; Strohmaier, Kristina
  22. Fiscal policy for better health outcomes in the Pacific By Sanjesh Naidu from the ESCAP Subregional Office for the Pacific.
  23. Gaining weight through retirement? Results from the SHARE survey By Mathilde Godard
  24. Is there a strategy in China’s health official development assistance to African countries? By Marlène Guillon; Jacky Mathonnat
  25. Does it pay to be a doctor in France? By Brigitte Dormont; Anne-Laure Samson
  26. Inequality of Opportunity in Health and the Principle of Natural Reward: evidence from European Countries By Damien Bricard; Florence Jusot; Alain Trannoy; Sandy Tubeuf

  1. By: Kate Ho; Robin S. Lee
    Abstract: Why do insurers choose to exclude medical providers, and when would this be socially desirable? We examine network design from the perspective of a profit-maximizing insurer and a social planner to evaluate the welfare effects of narrow networks and restrictions on their use. An insurer may engage in exclusion to steer patients to less expensive providers, cream-skim enrollees, and negotiate lower reimbursement rates. Private incentives for exclusion may diverge from social incentives: in addition to the standard quality distortion arising from market power, there is a "pecuniary" distortion introduced when insurers commit to restricted networks in order to negotiate lower rates. We introduce a new bargaining solution concept for bilateral oligopoly, Nash-in-Nash with Threat of Replacement, that captures such bargaining incentives and rationalizes observed levels of exclusion. Pairing our framework with hospital and insurance demand estimates from Ho and Lee (2017), we compare social, consumer, and insurer-optimal hospital networks for the largest non-integrated HMO carrier in California across several geographic markets. We find that both an insurer and consumers prefer narrower networks than the social planner in most markets. The insurer benefits from lower negotiated reimbursement rates (up to 30% in some markets), and consumers benefit when savings are passed along in the form of lower premiums. A social planner may prefer a broader network if it encourages the utilization of more efficient insurers or providers. We predict that, on average, network regulation prohibiting exclusion has no significant effect on social surplus but increases hospital prices and premiums and lowers consumer surplus. However, there are distributional effects, and regulation may prevent harm to consumers living close to excluded hospitals.
    JEL: I11 L10 L14
    Date: 2017–08
  2. By: Liang Bai; Benjamin Handel; Edward Miguel; Gautam Rao
    Abstract: Self-control problems constitute a potential explanation for the under-investment in preventive health care observed in low-income countries. A commonly proposed policy tool to solve such problems is offering consumers commitment devices. We conduct a field experiment to evaluate the effectiveness of different types of theoretically-motivated commitment contracts in increasing preventive doctor visits by hypertensive patients in rural India. We document varying levels of takeup of the different commitment contracts, but find no effects on actual doctor visits or individual health outcomes. Thus, a substantial number of individuals pay for commitments, but then fail to follow through on the specified task, losing money without experiencing any health benefit. We develop and structurally estimate a pre-specified model of consumer behavior under present bias with varying levels of naivete. The results are consistent with a large share of individuals being partially naive about their own self-control problems: in other words, they are sophisticated enough to demand some commitment, but overly optimistic about whether a given commitment is sufficiently strong to be effective. The results suggest that commitment devices may in practice be welfare diminishing, at least in some contexts, and serve as a cautionary tale about the role of these contracts in the health care sector.
    JEL: D91 I12
    Date: 2017–08
  3. By: Svetlana Pashchenko (University of Georgia); Ponpoje (Poe) Porapakkarm (National Graduate Institute for Policy Studies (GRIPS,Tokyo)); Mariacristina De Nardi (Federal Reserve Bank of Chicago)
    Abstract: How costly is bad health and what makes good health valuable over the life cycle? Answering these questions requires carefully modeling health dynamics, including in the longer run, and a rich model of how health can affect households. We estimate a health shock process that allows for both history-dependence and ex-ante heterogeneity, and we introduce it in a rich life-cycle model that we estimate and that matches three sets of important facts: (i) The dynamics of health; (ii) The quantitative impact of bad health on labor earnings, medical spending, and life expectancy; (iii) The large disparity in accumulated wealth between the healthy and the unhealthy at retirement. We find that the costs of bad health among the working age population are steeply increasing in the number of years spent unhealthy and that the largest component of these costs is the loss in labor earnings. In contrast, the effect of out-of-pocket medical spending is relatively small. To also evaluate the non-pecuniary effects of health, we evaluate the willingness to pay to be healthy and we find that the most valuable aspect of being healthy is a longer life expectancy
    Date: 2017
  4. By: Junita Henry; Umakrishnan Kollamparambil
    Abstract: There is increasing concern regarding obesity related healthcare costs in South Africa. Obesity is also seen to have far reaching effects that seep into labour market outcomes (Barnett & Kumar, 2009). Using NIDS panel data, this study aims to examine the relationship between Body Mass Index and employment status as well as wage levels. This is done using a probit and tobit model and thereafter a system GMM model to take endogeneity into account. Thereafter, the paper uses ethnicity backed obesity thresholds to measure the discrimination obese individuals face on the probability of becoming employed and their wages earned once employed. It is found that obesity is indeed, an influencing factor and a source of discrimination within the labour market in South Africa. Moreover, this discrimination is seen to be more so for females than males.
    Keywords: Obesity, unemployment, Wages, Discrimination, Labour market, South Africa
    JEL: I14 J71 J31
    Date: 2017–08
  5. By: Dunsch, Felipe A. (World Bank); Evans, David K. (World Bank); Eze-Ajoku, Ezinne (Johns Hopkins University); Macis, Mario (Johns Hopkins University)
    Abstract: If health service delivery is poorly managed, then increases in inputs or ability may not translate into gains in quality. However, little is known about how to increase managerial capital to generate persistent improvements in quality. We present results from a randomized field experiment in 80 primary health care centers (PHCs) in Nigeria to evaluate the effects of a health care management consulting intervention. One set of PHCs received a detailed improvement plan and nine months of implementation support (full intervention), another set received only a general training session, an overall assessment and a report with improvement advice (light intervention), and a third set of facilities served as a control group. In the short term, the full intervention had large and significant effects on the adoption of several practices under the direct control of the PHC staff, as well as some intermediate outcomes. Virtually no effects remained one year after the intervention concluded. The light intervention showed no consistent effects at either point. We conclude that sustained supervision is crucial for achieving persistent improvements in contexts where the lack of external competition fails to create incentives for the adoption of effective managerial practices.
    Keywords: management, health care, supervision, economic development
    JEL: I15 M10 O15
    Date: 2017–08
  6. By: Bhalotra, Sonia (University of Essex); Karlsson, Martin (University of Duisburg-Essen); Nilsson, Therese (Research Institute of Industrial Economics (IFN)); Schwarz, Nina (University of Duisburg-Essen)
    Abstract: We estimate impacts of exposure to an infant health intervention trialled in Sweden in the early 1930s using purposively digitised birth registers linked to school catalogues, census fies and tax records to generate longitudinal microdata that track individuals through fie stages of the life-course, from birth to age 71. This allows us to measure impacts on childhood health and cognitive skills at ages 7 and 10, educational and occupational choice at age 16-20, employment, earnings and occupation at age 36-40, and pension income at age 71.Leveraging quasi-random variation in eligibility by birth date and birth parish, we estimate that an additional year of exposure was associated with improved reading and writing skills in primary school, and increased enrolment in university and apprenticeship in late adolescence. These changes are larger and more robust for men, but we find increases in secondary school completion which are unique to women. In the longer run, we find very substantial increases in employment (especially in the public sector) and income among women, alongside absolutely no impacts among men. We suggest that this may be, at least in part, because these cohorts were exposed to a massive expansion of the Swedish welfare state, which created more jobs for women than for men.
    Keywords: Infant health; Early life interventions; Cognitive skills; Education; Earnings; Occupational choice; Programme evaluation; Sweden
    JEL: H41 I15 I18
    Date: 2017–08–23
  7. By: Broszeit, Sandra; Laible, Marie-Christine (Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany])
    Abstract: "We examine the relationship between establishment-level health measures, Anglo-Saxon management practices and labor productivity, as well as median wages. Based on the observation that management practices are positively associated with establishment outcomes, we test whether health measures have a distinct effect on their own, or if they are already comprised in management practices. Using representative survey data from the German Management and Organizational Practices Survey, we find a strong increase in the use of health measures from 2008 to 2013, predominantly in large establishments. Fixed effects regressions confirm that management practices significantly increase labor productivity, however, health measures do not. The reverse is true for median wages, such that health measures are positively associated with median wages, but management practices are not." (Author's abstract, IAB-Doku) ((en))
    Keywords: betriebliches Gesundheitsmanagement, Lohnhöhe, Arbeitsproduktivität, Unternehmensführung, IAB-Datensatz Management Practices
    JEL: D22 I15 J24 L2 M2
    Date: 2017–08–17
  8. By: Daniela Heilert; Ashok Kaul
    Abstract: As in most OECD countries, smoking prevalence and cigarette consumption have been decreasing in Germany since the early 2000s. This paper analyses whether smoking prevalence and cigarette consumption, as well as their development over time, differ between socio-economic subgroups. Identifying these differences provides insights into the effect of policy interventions on German smoking behaviour. Based on data from the Socio-Economic Panel (SOEP), a large longitudinal study of the German population, we find that both the decline in smoking prevalence and the decline in average cigarette consumption were probably driven by a behavioural change of younger people, as well as of those with a high educational level and those with a high income. People who quit smoking were on average more highly educated, had a higher income and had most likely a lower cigarette consumption (before quitting). In contrast, smoking prevalence increased among people who were older than 45 and had a low educational level and among those who were unemployed. Smoking prevalence among women was relatively constant over time. Indeed, the smoking prevalence of women and men converged over time, especially in older age groups. Daily cigarette consumption of smokers increased among 66-to-75-year-olds, although it decreased in all other age groups. One explanation might be that the tobacco control measures were successful only in certain socio-economic subgroups. Not only smoking prevalence, but also smoking intensity was higher among men, among those with a lower educational level and among those with a lower income. Especially for younger birth cohorts, smoking prevalence among those with a lower educational level was particularly high. Thus, based on data from 1998 through 2014, the so-called social gradient in smoking was only a distinct feature of younger birth cohorts, and not of older ones.
    Date: 2017
  9. By: Erve Sõõru; Aaro Hazak; Marit Rebane
    Abstract: Excessive daytime sleepiness is a major problem in the modern 24/7 society. In our study among Estonian creative R&D employees, we sought to investigate the links between work arrangements, duration of the working day and daytime sleepiness. The average duration of the working day among our sample of 153 creative R&D employees is as long as 10 hours – considerably more than the statutory eight hours. As might be expected, the more working hours and the less sleeping hours, the more serious the daytime sleepiness problem is. Moreover, we find that employees that have the flexibility to choose when they work (and where they work) experience less daytime sleepiness, and also feel that their sleep is significantly less disturbed compared to peers with more rigid work arrangements. Flexitime and distance work may therefore help considerably in reducing work-related daytime sleepiness.
    Date: 2017–08–31
  10. By: Ayşe İmrohoroğlu (University of Southern California); Kai Zhao (University of Connecticut)
    Abstract: In this paper, we show that a general equilibrium model that properly captures the risks in old age, the role of family insurance, changes in demographics, and the productivity growth rate is capable of generating changes in the national saving rate in China that mimic the data well. Our findings suggest that the combination of the risks faced by the elderly and the deterioration of family insurance due to the one-child policy may account for approximately half of the increase in the saving rate between 1980 and 2010. Changes in the productivity growth rate account for the fluctuations in the saving rate during this period.
    Date: 2017–08
  11. By: David Ronayne; Daniel Sgroi
    Abstract: Abstract We apply a classical economic categorization of preferences to identify the motivations of dual-users of electronic and traditional cigarettes. The responses of 2,406 U.S. adults (including 413 dual-users) in 2015 were collected using a novel online survey along with a follow-up in 2016 of 143 of these adults (68 dual-users). A sizeable minority of 37% of dual-users reported viewing electronic and conventional cigarettes primarily as complements. Of those who had never smoked or used electronic cigarettes, only 27% thought the complementarity motive would be primary. Dual-user motivations were associated with quit-attempt, cessation methods, gender and age. One year on, there was a positive relationship between the level of complementarity in the dual-user’s motives and their change in self-reported cigarette consumption. It is concluded that the application of a canonical economic classification of preferences may reveal important heterogeneities among the dual-user population.
    Keywords: smoking; complements; substitutes; dual-use; preferences
    JEL: I12 I18 D12
    Date: 2017–08–21
  12. By: Marcelo Lima
    Abstract: This paper considers whether the answers to stated preference surveys (of the type used to monitise non-market goods) are affected by the survey's sponsoring institution. The sponsor is indicated to respondents by the logo used in the survey instrument, an online questionnaire. Survey repondents are randomly assigned to one of eight types of sponsor and whether stated willingness-to-pay for a product that reduces mortality risk is affected by the sponsor is observed. It is also considered whether sponsorship has an effect on measures of respondent engagement with the survey (survey completion rates, item response rates, time spend on the willingness to pay question and on the survey as a whole). The analysis finds that respondents that believe the survey to be sponsored by an environmental ministry or a health ministry are willing to pay significantly less for the product than those that believe that the survey is sponsored by other types of institution. There are also apparent trade-offs between the different repondent engagement measures considered.
    Date: 2017–08
  13. By: Carine Milcent (PSE - Paris-Jourdan Sciences Economiques - ENS Paris - École normale supérieure - Paris - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique); Brigitte Dormont (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine)
    Abstract: There is ongoing debate about the effect of ownership on hospital performance as regards efficiency and care quality. This paper proposes an analysis of the differences in productivity and efficiency between French public and private hospitals. In France, public and private hospitals do not only differ in their objectives. They are also subject to different rules as regards investments and human resources management. In addition, they were financed according to different payment schemes until 2004: a global budget system was used for public hospitals, while private hospitals were paid on a fee-for-service basis. Since 2004, a prospective payment system (PPS) with fixed payment per stay in a given DRG is gradually introduced for both private and public hospitals. Payments generally differ for the same DRG, depending on whether the stay occurred in a private or public hospital. A convergence of payments between the nonprofit and for profit sectors was planned by 2018 by the previous government, but this project has been abandoned by the newly elected government. Pursuing such a convergence comes down to suppose that there are differences in efficiency between private and public hospitals, which would be reduced by the introduction of competition between these two sectors. The purpose of this paper is to compare the productivity of public and private hospitals in France. We try to assess the respective impacts, on productivity differences, of differences in efficiency, patient characteristics and production composition. We have chosen to estimate a production function. For that purpose, we have defined a variable measuring the volume of care services provided by each hospital, synthetizing the hospital multiproduct activity into one homogenous output. Our data comes from two administrative sources which record exhaustive information about French hospitals. Matching these two database provides us an original source of information, at the hospital-year level, about both the production composition (number of stays in each DRG), and production factors (number of beds, facilities, number of doctors, nurses, of administrative and support staff, etc.). We observe 1,604 hospitals over the period 1998-2003, of which 642 hospitals are public, 126 are private not-for-profit and 836 are private-for-profit. This database is relative to acute care and covers more than 95 % of French hospitals. We use a stochastic production frontier approach combined with hospitals fixed effects. We find that the lower productivity of public hospitals is not explained by inefficiency (distance to the frontier), but oversized establishments, patient characteristics and production characteristics (small proportion of surgical stays). Once patient and production characteristics are taken into account, large and medium sized public hospitals appear to be more efficient than private hospitals. As a result, payment convergence would provide incentives for public hospitals to change the composition of their supply for care.
    Abstract: En France les cliniques privées jouent un rôle important dans l’offre de soins hospitaliers. En 2007,56% des séjours ont eu lieu dans des hôpitaux publics, 8% dans des hôpitaux privés à but non lucratifs, qui participent au service public hospitalier (PSPH) et 36 % dans des hôpitaux privés à but lucratif (cliniques). Plusieurs rapports administratifs ont récemment montré qu’un séjour dans unhôpital public ou PSPH était plus coûteux que dans une clinique privée, suggérant que la productivité du secteur public était relativement faible. Cet article a pour but de comprendre les différences deproductivité observées en France entre les hôpitaux publics, les hôpitaux PSPHet les cliniques privées.L’introduction de la Tarification à l’Activité (T2A) en 2004 visait à améliorer l’efficacité de la dépense pour les soins hospitaliers. La mise en œuvre du nouveau paiement est progressive, avec une application intégrale à partir de 2008. Dès le départ, les tarifsdifféraient selon que le séjour avait lieu dans un hôpital public ou un hôpital privé à but lucratif. Actuellement, les paiements par séjour dans une pathologie donnée sont en moyenne 27 % plus élevés dans le secteur public que dans le secteur privé.Une convergence des grilles tarifaires des secteurs public(et PSPH) et privé était prévue à l’horizon 2018. Cet objectif a été abandonné par le gouvernement élu en 2012. Mettre en place cette convergence reviendrait à supposer que les différences de coûts sont exclusivement dues à des différences d’efficacité, qui seraient éliminées par l’introduction d’une concurrence entre les deux secteurs.Notre objectif est d’examiner s’il existe une influence de la composition des séjours sur la productivitédes hôpitaux en matière de soins aigus. Si tel est le cas, introduire de la concurrence entre lesétablissements sur la base de la T2A crée de fortes pressions en faveur d’une réorganisation de l’offrede soins. Ces changements sont souhaitables s’ils permettent d’améliorer l’efficacité dans ladélivrance des soins hospitaliers.En revanche, il n’est pas souhaitable que le système de tarification crée des incitations à la sélection de patients ou à l’arrêt de la production de soins qui seraient importants du point de vue du bien-être collectif.Les données utilisées proviennent de deux bases administratives: les données du PMSI et celles de la SAE. La base finale contient 1 604 hôpitaux sur la période 1998-2003, dont 642 sont publics, 126 sont PSPH et 836 sont privés. Pour les soins aigus cette base est proche de l’exhaustivité : en 2003, elle représente 90% de l’ensemble des séjours de soins aigus en France métropolitaine.L’analyse couvre les six années précédant l’introduction de la T2A en France afin d’observer précisément la situationqui préexistait avant la mise en place de nouvelles incitations. Ce travail permet d’avoir un référentiel sur la situation du tissu hospitalier français et les performances comparées des établissements publics, PSPH et privés, avant la mise en place de la réforme.En synthétisant l’activité “multiproduit” de l’hôpital par un produit homogène défini selon des critères identiques, quel que soit le statut de l’hôpital, nous montrons que le diagnostic sur l’efficacité producti
    Keywords: prospective payment system (PPS),health care,Hospitals,Public hospitals,Proprietary Hospitals,Industrial productivity
    Date: 2017–05–11
  14. By: Shigute, Zemzem (ISS, Erasmus University Rotterdam); Strupat, Christoph (German Development Institute); Burchi, Francesco (German Development Institute); Alemu, Getnet (University of Addis Ababa, Ethiopia); Bedi, Arjun S. (ISS, Erasmus University Rotterdam)
    Abstract: Rural households in Ethiopia are exposed to a variety of covariate and idiosyncratic risks. In 2005, the Ethiopian government introduced the Productive Safety Net Program (PSNP) and in 2011 launched the Community Based Health Insurance Scheme (CBHI). This paper analyses the interaction between the two schemes and their joint effect on health care utilization, labor supply, asset accumulation and borrowing. The empirical analysis relies on three rounds of individual-level panel data collected in 2011, 2012 and 2013 and on several rounds of qualitative work. We find that individuals covered by both programs, as opposed to neither, are 5 percentage points more likely to use outpatient care and are 21 percentage points more likely to participate in off-farm work. Furthermore, participation in both programs is associated with a 5 percent increase in livestock, the main household asset, and a 27 percent decline in debt. These results suggest that at least in Ethiopia bundling of interventions enhances protection against multiple risks and shows the potential of linked social protection schemes.
    Keywords: Ethiopia, Productive Safety Net Program, Community Based Health Insurance Scheme, joint effect
    JEL: J22 I15
    Date: 2017–08
  15. By: Kenneth Harttgen; Stefan Lang; Judith Santer; Johannes Seiler
    Abstract: Despite improvements in global child health within the last three decades, under-5 mortality remains significantly high in Sub-Saharan and Asia. Both regions did not achieve the MDG target of reducing under-5 mortality by two thirds by 2015. The underlying causes of under-5 mortality differ significantly between countries and between regions, which highlights the need to expand our understanding of the determinants of child health in developing countries. By comparing the two geographic regions of the world with the highest under-5 mortality rates, we aim to gain new insights, and bring out potential differences between these regions and the causes of under-5 mortality. In addition, we aim to identify non-linear relationships between under-5 mortality and specific explanatory variables. We analyze a large data set consisting of 35 Sub-Saharan-African countries, and 13 Asian countries, using a multilevel discrete time survival model that takes advantage of a recently developed multilevel framework with structured additive predictor in a Bayesian setting. We analyze data from 131 individual surveys from 1992 to 2015, allowing for potential non-linear effects and cluster specific heterogeneity within models. We find strong non-linear effects for the baseline hazard, the household size, the age of the mother, the BMI of the mother, and the birth order of the child. Additionally, we find considerable differences in determinants between Asian and Sub-Saharan Asian countries.
    Keywords: Child mortality, Asia, Sub-Sahara Africa, multilevel STAR models, Bayesian inference
    JEL: Z1 A13 J12 J13 J43 N33
    Date: 2017–08–22
  16. By: Denis Cogneau (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement (IRD)); Pauline Rossi (PSE - Paris School of Economics, CREST - Centre de Recherche en Économie et Statistique - INSEE - ENSAE ParisTech - École Nationale de la Statistique et de l'Administration Économique)
    Abstract: Have malaria control efforts contributed to the reduction in infant mortality in Sub-Saharan Africa over the past 15 years? Using large household surveys collected in 19 countries between 2000 and 2015, we estimate the correlation between the distribution of bednets and the progress in child survival. We find that the large increase in bednets ownership observed between 2000 and 2015 is associated with a decrease in infant mortality by 1.3pp, which amounts to one third of the total decrease in infant mortality over the period. We further discuss to which extent this correlation might be interpreted as a causal impact.
    Keywords: Child mortality,Malaria,Africa,Foreign aid
    Date: 2017–01
  17. By: So O'Neil; Divya Vohra; Brenna Rabel
    Abstract: For Skoll Global Threats Fund, Mathematica conducted an initial assessment of EpiCore, an innovative public health system designed to verify the presence of outbreaks and other public health events faster than existing mechanisms alone. The issue brief reflects on EpiCore’s progress a year and a half after its launch.
    Keywords: disease outbreak, public health surveillance, global health
    JEL: F Z
  18. By: Audra T. Wenzlow; Dan Finkelstein; Ben Le Cook; Kathy Shepperson; Christine Yip; David Baugh
    Abstract: Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experience in 2002.
    Keywords: MAX Chartbook , Medicaid Analytic Extract
    JEL: I
  19. By: Courtemanche, Charles (Georgia State University); Friedson, Andrew I. (University of Colorado Denver); Koller, Andrew P. (University of Colorado Denver); Rees, Daniel I. (University of Colorado Denver)
    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.
    Keywords: Affordable Care Act, ambulance, health insurance, health care capacity, health care workforce
    JEL: I11 I13 I18
    Date: 2017–08
  20. By: Smith, Trenton G. (University of Otago); Stillman, Steven (Free University of Bozen/Bolzano); Craig, Stuart (University of Pennsylvania)
    Abstract: Obesity rates have risen dramatically in the US since the 1980s, but well-identified studies have struggled to explain the magnitude of the observed changes. In this paper, we estimate the causal impact of economic insecurity on obesity rates. Specifically, we construct a synthetic panel of demographic groups over the period 1988 to 2012 by combining the newly developed Economic Security Index (ESI) with data from the National Health and Nutrition Examination Surveys (NHANES). According to our estimates, increased economic insecurity over this time period explains 50% of the overall population-level increase in obesity.
    Keywords: obesity, economic insecurity, economic security index
    JEL: D10 I12 I18 J60
    Date: 2017–08
  21. By: Kaiser, Micha (University of Hohenheim); Reutter, Mirjam (University of Hohenheim); Sousa-Poza, Alfonso (University of Hohenheim); Strohmaier, Kristina (Ruhr University Bochum)
    Abstract: In this paper, we use data from the German Socio-Economic Panel to investigate the effect on cigarette consumption of macro-economic conditions in the form of regional unemployment rates. The results from our panel data models, several of which control for selection bias, indicate that the propensity to become a smoker increases significantly during an economic downturn, with an approximately 0.7 percentage point increase for each one percentage point rise in the unemployment rate. Conversely, conditional on the individual being a smoker, cigarette consumption decreases during recessions, with a one percentage point increase in the regional unemployment rate leading to an up to 0.8 percent decrease in consumption.
    Keywords: business cycle, smoking, unemployment
    JEL: E32 I12 J22
    Date: 2017–08
  22. By: Sanjesh Naidu from the ESCAP Subregional Office for the Pacific. (United Nations Economic and Social Commission for Asia and the Pacific)
    Abstract: Achieving better health outcomes remains a major policy priority for Pacific island developing economies. In addition to hampering social development, poor health outcomes also undermine economic development through, among other channels, output loss due to illness and death, and forgone income for family members taking care of patients. In the context of Pacific island developing economies, healthy workers are especially needed to boost the currently low level of labour productivity. Several Pacific economies had not fully achieved the Millennium Development Goals on health issues, especially those relating to maternal health, HIV/AIDS, malaria and tuberculosis. Meeting the Sustainable Development Goals on health issues, which is arguably a more complex endeavour, would be even more challenging for these economies.
  23. By: Mathilde Godard (Université Paris-Dauphine, LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine)
    Abstract: This paper estimates the causal impact of retirement among the 50-69 year-old on Body Mass Index (BMI), the probability of being either overweight or obese and the probability of being obese. Based on the 2004, 2006 and 2010-11 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), our identification strategy exploits the European variation in Early Retirement Ages (ERAs) and the stepwise increase in ERAs in Austria and Italy between 2004 and 2011 to produce an exogeneous shock in retirement behaviour. Our results show that retirement induced by discontinuous incentives in early retirement schemes causes a 13 percentage point increase in the probability of being obese among men within a two to four-year period. Additional results show that this effect is driven by men having retired from strenuous jobs and who were already at risk of obesity. No effects are found among women.
    Keywords: Body Mass Index, Obesity, Retirement, Instrumental Variables
    Date: 2017–05–19
  24. By: Marlène Guillon (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique); Jacky Mathonnat (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Chinese health official development assistance (ODA) to Africa has largely increased since the beginning of the 2000’s. Even if China now ranks among the top ten bilateral donors for health aid in Africa very little is known about the determinants of Chinese health ODA to African countries. Our objective is to study the factors associated with Chinese health ODA to sub-Saharan Africa in the 2000-2013 period. We investigate the role of three types of factors that might influence the allocation of Chinese health aid: the needs of recipient countries, their merits and the self-interest of China. Chinese health ODA is measured using the 1.2 version of the AidData database constructed by the William & Mary University, the Brigham Young University and the non-governmental organization Development Gateway. In total, 389 health aid projects were financed by China in Africa between 2000 and 2013, accounting for a total amount of 2011 US$789 million. On these 389 projects, 194 (59%) correspond to the dispatch of medical teams, 109 (24%) to the sending of medical equipment or drugs and 77 (16%) to health infrastructure construction or rehabilitation. The annual number of health projects financed by China in Africa has increased sharply after the 3rd Forum on China-Africa Cooperation (FOCAC) in 2006. We study the factors associated with the number of health projects and the amount of ODA received each year by African countries between 2000 and 2013. We stratify the analysis by types of projects (medical team dispatches/infrastructure and medical equipment or drugs projects) and by sub-periods (2000-2006/2007-2013). We use Poisson regressions to estimate both the number of projects and the amount of ODA received as Poisson regressions were shown to outperform OLS and Tobit models in the presence of heteroskedasticity and many zero observations. Pooled regressions, rather than fixed effect regressions, are used in order to exploit both inter and intra-country heterogeneity for the identification of factors associated with the allocation of Chinese health aid. We replicate the analysis using the shares of health projects and health ODA amount received by African countries each year using the fractional probit method relevant for the case of proportions as dependent variables Our results show that the motives of Chinese health aid have changed over the 2000-2013 period. In particular, Chinese political and economic interests, as measured by recipient countries’ UNGA voting alignment with China and openness rate to China, were less important in Chinese health aid allocation decisions over the 2007-2013 period that followed the 3rd FOCAC compared to the 2000-2006 period. On the contrary, taking into consideration health needs of recipient countries became more visible in Chinese health aid allocation decisions after 2006. Then, Chinese health diplomacy seems to have evolved from a rather “selfish” aid focused on political and economic self-interests to a more altruistic aid focused on health needs of recipient countries. The empirical analysis also highlights the complementarity of Chinese health ODA with its ODA in other sectors and that the allocation of Chinese health aid in African countries does not appear to be heavily related to health aid provided by traditional bilateral donors, suggesting that health aid cannot be seen as a way for China to promote its international visibility.
    Keywords: Health aid,Aid allocation,China,Africa.
    Date: 2017–05–09
  25. By: Brigitte Dormont (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine); Anne-Laure Samson (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine)
    Abstract: This paper examines whether general practitionersí(GPsí) earnings are high enough to keep this profession attractive. We set up two samples, with longitudinaldata relative to GPs and executives. Those two professions have similar abilities but GPs have chosen a longer education. To measure if they get returns that compensate for their higher investment, we study their career proÖles and construct a measure of wealth for each individual that takes into account all earnings accumulated from the age of 24 (including zero income years when they start their career after 24). The stochastic dominance analysis shows that wealth distributions do not differ significantly between male GPs and executives but that GP wealth distribution dominates executive wealth distribution at the first order for women.Hence, while there is no monetary advantage or disadvantage to be a GP for men, it is more profitable for women to be a self-employed GP than a salaried executive.
    Keywords: GPs,longitudinal data,earning profile,self-employed,executive,stochastic dominance
    Date: 2017–05–04
  26. By: Damien Bricard (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine); Florence Jusot (LEDa - Laboratoire d'Economie de Dauphine - Université Paris-Dauphine); Alain Trannoy (EHESS - L'Ecole des Hautes Etudes en Sciences Sociales - EHESS - École des hautes études en sciences sociales - School of Economics - CNRS - Centre National de la Recherche Scientifique); Sandy Tubeuf (Autres - AUTRE)
    Abstract: This paper aims to quantify and compare inequalities of opportunity in health across European countries considering two alternative normative ways of treating the correlation between effort, as measured by lifestyles, and circumstances, as measured by parental and childhood characteristics, championed by Brian Barry and John Roemer. This study relies on regression analysis and proposed several measures of inequality of opportunities. Data from the Retrospective Survey of SHARELIFE, which focuses on life histories of European people aged 50 and over, are used. In Europe at the whole, inequalities in opportunities stand for almost 50% of the health inequality due to circumstances and efforts in Barry scenario and 57.5% in Roemer scenario. The comparison of the magnitude of inequalities of opportunity in health across European countries shows considerable inequalities in Austria, France, Spain, Germany, whereas Sweden, Poland, Belgium, the Netherlands and Switzerland present the lowest inequalities of opportunities. The normative principle on the way to treat the correlation between circumstances and effort makes little difference in Spain, Austria, Greece, France, Czech Republic, Sweden and Switzerland whereas it would matter the most in Belgium, the Netherlands, Italy, Germany, Poland and Denmark. In most countries, inequalities of opportunity in health are mainly driven by social background affecting adult health directly, and so would require policies compensating for poorer initial conditions. On the other hand, our results suggest a strong social and family determinism of lifestyles in Belgium, the Netherlands, Italy, Germany, Poland and Denmark, which emphasises the importance of inequalities of opportunities in health within those countries and calls for targeted prevention policies.
    Keywords: Equality of opportunity,Principle of reward,Europe,health,inequality decomposition,efforts,circumstances
    Date: 2017–05–17

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