nep-hea New Economics Papers
on Health Economics
Issue of 2017‒09‒24
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. The Microbiome, diet and health: Towards a science and innovation agenda By OECD
  2. An Econometric Analysis of The Impact of Telecare By Momanyi, Kevin
  3. Piling Pills? Forward-Looking Behavior and Stockpiling of Prescription Drugs By Marianne Simonsen; Lars Skipper; Niels Skipper
  4. Sanctioned to Death? The Impact of Economic Sanctions on Life Expectancy and its Gender Gap By Jerg Gutmann; Matthias Neuenkirch; Florian Neumeier
  5. Mortality and Morbidity in the 21st Century By Anne Case; Angus Deaton
  6. The drunk side of trust: Social capital generation at gathering events By Giuseppe Attanasi; Stefania Bortolotti; Simona Cicognani; Antonio Filippin
  7. The Impact of Subsidized Antimalarials on Treatment Seeking Behavior By Jacqueline Fiore
  8. Biodiversity, infectious diseases and the dilution effect By Stefano BOSI; David DESMARCHELIER; Manh Hung NGUYEN
  9. e-Health/m-Health Adoption and Lifestyle Improvements: Exploring the Roles of Technology Readiness, the Expectation-Confirmation Model, and Health-Related Information Activities By Leung, Louis; Chen, Chris Cheng
  10. An e-Ambulance Project in Kochi Prefecture, one rural area in Japan By Matsumoto,Yoshihisa; Ogawa, Masaru; Tsuji, Masatsugu
  11. Relationships among ICT, ageing, and health expenditures in Japan: An economic evaluation By Taher, Sheikh Abu; Uddin, Kamal; Tsuji, Masatsugu
  12. Integrating Behavioral and Physical Health for Medicare-Medicaid Enrollees: Lessons for States Working With Managed Care Delivery Systems By Melanie Au; Claire Postman; James Verdier
  13. Should payment for performance depend on mortality? By Philippe Loirat; Marie Ferrua; Benoît Lalloué; Aude Fourcade; Etienne Minvielle
  14. Environment, Health and Labor Market By Xavier Pautrel
  15. Child Marriage and Infant Mortality: Evidence from Ethiopia By Jorge García Hombrados
  16. Weighting Sub-Populations in Longevity Inequality Research: A Practical Approach By Adam Szulc
  17. Agricultural Fires and Infant Health By Tom Vogl; Marcos Rangel
  18. Access to Long-Term Care After a Wealth Shock: Evidence from the Housing Bubble and Burst By Joan Costa Font; Richard Frank; Katherine Swartz
  19. The Effects of Graduation Requirements on Risky Health Behaviors of High School Students By Zhuang Hao; Benjamin W. Cowan
  20. The Accident Externality from Trucking By Lucija Muehlenbachs; Stefan Staubli; Ziyan Chu
  21. Preventing the White Death: Tuberculosis Dispensaries By Casper Worm Hansen; Peter Sandholt Jensen; Peter Egedesø Madsen
  22. The Effect of the Program of All-Inclusive Care for the Elderly (PACE) on Quality By Jody Beauchamp; Valerie Cheh; Robert Schmitz; Peter Kemper; John Hall
  23. Uses and Limitations of Claims-Based Performance Feedback Reports: Lessons from the Comprehensive Primary Care Initiative By Margaret Gerteis; Deborah Peikes; Arkadipta Ghosh; Lori Timmins; Ann S. O'Malley; Michael Barna; Erin F. Taylor; Timothy J. Day; Kaylyn Swankoski; Perry W. Payne; Jr.; Randall Brown
  24. The Effect of an Increase in Lead in the Water System on Fertility and Birth Outcomes: The Case of Flint, Michigan By Daniel S. Grossman; David J.G. Slutsky
  25. Long-term care policy with nonlinear strategic bequests By Canta, Chiara; Cremer, Helmuth
  26. Examining the Intention to Use Infant Health Monitoring Devices in South Korea By Choi, Mideum; Kim, Seongcheol
  27. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care? By Marie Ferrua; Claude Sicotte; Benoît Lalloué; Etienne Minvielle

  1. By: OECD
    Abstract: There is now strong evidence that microbiomes play an important role in human health, as there are clear linkages to many of the major non-communicable diseases. This report assesses the key policy challenges for innovation in the microbiome. Evidence is accumulating that through diet, the gut microbiome can be altered to generate greater well-being, to offer better protection against non-communicable diseases, and even to cure such conditions. The report argues that if such a promising scientific field is to lead to innovative applications, policies on science and innovation must be improved in five areas: 1) science policy; 2) enabling translational science; 3) public-private collaboration; 4) regulatory frameworks; and 5) skills, communication and the public.
    Date: 2017–09–22
  2. By: Momanyi, Kevin
    Abstract: This paper presents some preliminary results of a study investigating the effect of telecare on the length of stay in hospital using linked administrative health and social care data in Scotland. We make various assumptions about the probability distribution of the outcome measure and formulate three Negative Binomial Models to that effect i.e. a basic Negative Binomial Model, a zero-inflated Negative Binomial Model and a zero-truncated Negative Binomial Model. We then bring the models to data and estimate them using a strategy that controls for the effects of confounding variables and unobservable factors. These models provide an alternative to the Propensity Score Matching technique used by the previous studies. The empirical results show that telecare users are expected to spend a shorter time in hospital than non-users, holding other factors constant. The results also show that older individuals, females, rural residents and individuals with comorbidities have a longer length of stay in hospital, on average, than their counterparts, all things equal. Future research will involve conducting a sub-group analysis, investigating the effectiveness of various telecare devices and determining the impact of telecare on admission to hospital.
    Keywords: Telecare,Negative Binomial Models,Length of stay in hospital
    JEL: C32 C36 D13 I12
    Date: 2017
  3. By: Marianne Simonsen (Department of Economics and Business Economics, Aarhus University, Denmark); Lars Skipper (Department of Economics and Business Economics, Aarhus University, Denmark); Niels Skipper (Department of Economics and Business Economics, Aarhus University, Denmark)
    Abstract: This paper provides evidence of forward-looking behavior in the demand for prescription drugs, while relying on registry-based, individual-level information about the universe of Danish prescription drug purchases from 1995–2014. We exploit a universal shift in policy in early 2000 from a flat-rate to a non-linear insurance plan for prescription drugs that incentivizes stockpiling at the end of the coverage year. We extend the original framework of Keeler et al. (1977) and discuss how the institutional features of most health insurance contracts, at least theoretically, incentivize intertemporal substitution in purchases across coverage years. We describe how consumers react to the introduction of the non-linear plan by increasing spending by 80% immediately before the implementation of the new regime. Next, our main analysis takes advantage of the policy experiment to formally analyze behavior immediately prior to the end-of-year reset in the non-linear plan using a difference-in-difference strategy. We provide evidence that consumers react to this reset by stockpiling toward the end of the coverage year: consumers buy what amounts to an additional 20%. We detect heterogeneity in the size of the response by individual-level characteristics, proxies for health status, and drug type. We find no evidence of any immediate adverse health utilization effects associated with the stockpiling. We round off the paper with an analysis of the importance of stockpiling for estimates of price sensitivity. We find that ignoring intertemporal substitution across coverage years inflates price sensitivity estimates by a non-negligible amount.
    Keywords: prescription drugs, non-linear pricing, intertemporal shifting
    JEL: I11 I18 D12
    Date: 2017–09–18
  4. By: Jerg Gutmann; Matthias Neuenkirch; Florian Neumeier
    Abstract: In this paper, we empirically analyze the effect of UN and US economic sanctions on life expectancy and its gender gap in target countries. Our sample covers 98 less developed and newly industrialized countries over the period 1977–2012. We employ a matching approach to account for the endogeneity of sanctions. Our results indicate that an average episode of UN sanctions reduces life expectancy by about 1.2–1.4 years. The corresponding decrease of 0.4–0.5 years under an average episode of US sanctions is significantly smaller. These average effects conceal that the damage to life expectancy is accumulating over time; with every additional year under UN (US) sanctions the size of the adverse effect on life expectancy increases by 0.3 (0.2) years. Finally, we find evidence that women are affected more severely by the imposition of sanctions. The fact that sanctions are not “gender-blind” can be interpreted as evidence that sanctions disproportionately affect (the life expectancy of) the more vulnerable members of society.
    Keywords: Gender Gap, Human Development, Life Expectancy, Sanctions, United Nations, United States
    JEL: F51 F52 F53 I15
    Date: 2017
  5. By: Anne Case (Princeton University); Angus Deaton (Princeton University)
    Abstract: Building on our earlier research (Case and Deaton 2015), we find that mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century continued to climb through 2015. Additional increases in drug overdoses, suicides, and alcohol-related liver mortality—particularly among those with a high school degree or less—are responsible for an overall increase in all-cause mortality among whites. We find marked differences in mortality by race and education, with mortality among white non-Hispanics (males and females) rising for those without a college degree, and falling for those with a college degree. In contrast, mortality rates among blacks and Hispanics have continued to fall, irrespective of educational attainment. Mortality rates in comparably rich countries have continued their premillennial fall at the rates that used to characterize the United States. Contemporaneous levels of resources—particularly slowly growing, stagnant, and even declining incomes—cannot provide a comprehensive explanation for poor mortality outcomes. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next—in the labor market, in marriage and child outcomes, and in health—is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies—even ones that successfully improve earnings and jobs, or redistribute income—will take many years to reverse the increase in mortality and morbidity, and that those in midlife now are likely to do worse in old age than the current elderly. This is in contrast to accounts in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this, however, implies that there are no policy levers to be pulled. For instance, reducing the overprescription of opioids should be an obvious target for policymakers.
    JEL: I12
    Date: 2017
  6. By: Giuseppe Attanasi; Stefania Bortolotti; Simona Cicognani; Antonio Filippin
    Abstract: We present a case study to assess the relation between alcohol intake and trust generation at a cultural gathering event. Over a span of six editions (2012–2017), we interviewed and elicited blood alcohol concentration (BAC) of nearly 2,000 attendees of the final concert of “La Notte della Taranta Festival”, the biggest concert in Europe dedicated to traditional music (about 200,000 participants per year). Once controlling for the BAC of respondents, and for the belief about own and others’ BAC, we find that alcohol, consumption during the event is positively correlated with trust generation towards other attendees. Furthermore, looking at the amount of trust devoted to drinkers (the drunk side of trust), we find a positive correlation with both own measured BAC and own believed BAC. Considered together, we argue that these two results are indicative of endogenous group formation in terms of alcohol consumption: drinking during event attendance positively correlates with increased trust to other drinkers in the event audience.
    Keywords: Cultural event; Instantaneous social capital; Generalized trust; Blood alcohol concentration; Tourist.
    JEL: A13 D91 Z10
    Date: 2017
  7. By: Jacqueline Fiore (Department of Economics, Tulane University)
    Abstract: I investigate the effect of the first multi-country antimalarial subsidy on the type and source of treatment taken for children under five years of age reporting a fever. I use nationally representative, cross-sectional survey data from sixteen malaria endemic African countries over a ten year period. My research design exploits the within country variation in malaria treatment subsidies. Artemisinin-based Combination Therapies (ACTs) are the recommended first line treatment for uncomplicated malaria. Overall, the ACTs subsidy achieved two of its main objectives. Among children reporting a fever, countries offering subsidized ACTs showed a statistically significant 8.1 percentage point increase in ACTs taken from private sector outlets compared to countries not participating in the subsidy. To complement these results, the ACTs subsidy was associated with a decrease of 10.7 percentage points in children taking lesser effective antimalarial monotherapies from any source for participating countries. However, the effect of the ACTs subsidy was not consistent among the four countries participating in the subsidy. Uganda showed the desired response with the greatest magnitude to the subsidy whereas no significant effect was observed in Ghana. The mixed results among countries participating in the ACTs subsidy may be due to differences in ACTs availability, price, market share, and supporting interventions.
    Keywords: Malaria, subsidy, Artemisinin-based combination therapies (ACTs), Affordable Medicines Facility-malaria, Private Sector Co-payment Mechanism
    JEL: I11 I12 I18
    Date: 2017–09
  8. By: Stefano BOSI; David DESMARCHELIER; Manh Hung NGUYEN
    Abstract: Biologists point out that biodiversity loss contributes to promote the transmission of diseases. In epidemiology, this phenomenon is known as dilution effect. Our paper aims to model this effect in an economic model where the spread of an infectious disease is considered. More precisely, we embed a SIS model into a Ramsey model (1928) where a pollution externality coming from production affects the evolution of biodiversity. Biodiversity is assimilated to a renewable resource and affects the infectivity of the disease (dilution effect). A green tax is levied on production at the firm level to finance depollution according to a balanced budget rule. In the long run, a disease-free and an endemic regime are possible. We focus only on the second case and we find that the magnitude of the dilution effect determines the number of steady states. When the dilution effect remains low, there are two steady states with high and low biodiversity respectively. Conversely, when the dilution effect becomes high, the steady state is always unique. Moreover, under a low dilution effect, a higher green-tax rate always impairs biodiversity at the low steady state, while this green paradox is over under a high dilution effect. In the short run, limit cycles can arise in both the cases even if only a low dilution effect can lead to the occurrence of Bogdanov-Takens and generalized Hopf bifurcations.
    Keywords: dilution effect, pollution, SIS model, Ramsey model, local bifurcations of codimension one and two.
    JEL: C61 E32 O44
    Date: 2017
  9. By: Leung, Louis; Chen, Chris Cheng
    Abstract: This purpose of this study was to investigate (a) the prevalence and patterns of e-health/m-health usein Hong Kong;(b) the activities that people engage in via health-related information platforms/apps;and (c) the roles thattechnology readiness, the expectation-confirmation model, and e-health/m-health activities play in predicting lifestyle improvement. Data were collected from a telephone survey, with a probability sample of 1,007 respondents aged 18 or above. Our results show that 47.2% of the respondents were regular users of e-health technologies, 23.2% were m-health users, and only 10.7% used wearables for health purposes. Among the six e-health/m-health activities identified, health tutorials and health information seeking were the most frequently used, followed by recording/monitoring and medical services. The least popular activities were reminders and sharing experiences. As expected, the component variables in the expectation-confirmation model, particularly confirmation and perceived usefulness, were the strongest predictors for lifestyle improvement. External factors, such as being older and innovative, the use of e-health/m-health activities for recording/monitoring, health tutorials, medical services, and sharing experiences, also had significant impacts. Theoretical and practical implications are discussed.
    Keywords: e-health/m-health,expectation-confirmation model,technology readiness,health-related activities,lifestyle improvements
    Date: 2017
  10. By: Matsumoto,Yoshihisa; Ogawa, Masaru; Tsuji, Masatsugu
    Abstract: This study aims at evaluating the economic effect of a e-ambulance project, or emergency telemedicine in the rural areas in Kochi Prefecture in Japan. The focus is on ambulances equipped with ICT devices which transmit images of acute patients to remote hospitals. Kochi Prefecture started the e-ambulance project in Aki and Muroto Cities in 2012. From two cities, it takes approximately one hour to reach emergency hospitals located in Kochi City, the prefectural capital. One of the merits of e-ambulance with the image transmitting system is that doctors in accepting hospitals can monitor real time situation of a patient and prepare for necessary treatment prior to the time patient arrives. They thus save time and effort. In measuring benefit, this study employs different methodology; the e-ambulance project enhances wellness of residents since they perceive more secure. Thus the contingent valuation method (CVM) is applied and willingness to pay (WTP) is used as an index of benefit and estimated based on surveys to residents, which amounts to 1,747 yen per resident per year. Total cost calculated is 381,792,228 yen over three years, and accordingly, B/C ratio amounts 0.459.
    Keywords: e-ambulance,WTP,Cost-benefit analysis,CVM,B/C ratio
    Date: 2017
  11. By: Taher, Sheikh Abu; Uddin, Kamal; Tsuji, Masatsugu
    Abstract: The paper examines the relationship among Information and Communication Technology (ICT), ageing, and health expenditures in Japan. For this, primary data has been collected from an extensive mail survey that was carried in Nishiaizu Town, Fukushima prefecture, Japan from 2002 to 2010. 9 years panel data is used to empirically identify the determinants of health expenditure in relation to ageing and telehealth use. Also, the effects are analyzed by comparison of medical expenditures between users and non-users of telehealth. Their receipts from those stored in the town office are examined too. The receipts of National Health Insurance of each month are kept at the town office. The paper uses mainly the following data, as: (i) name of resident, (ii) date of birth, (iii) either regular outpatient treatment or hospitalized patient treatment, (iv) name(s) of major disease(s), (v) date of initial treatment, (vi) number of days spent for treatment, and (vii) score (amount) of medical expenditure. Besides, other variables such as the availability of chronic disease among the participants, types of chronic diseases such as heart disease, high blood pressure, diabetes, and strokes, living alone or with family and employment status have also considered for the analysis. Using these variables, a rigorous econometric model is estimated. The estimation model is panel data analysis with the one-way fixed effect model with only time effect. A user dummy variable is added as an explanatory variable, which enables to estimate whether there is difference between users and non-users in medical expenditures of each disease of ageing. Based on the data obtained, the objectives of the estimation consists of the following three questions: (i) whether there is difference in medical expenditures among users and non-users of telehealth use; and (ii) how medical expenditures related to chronic diseases were different among two groups, user and non-user. (iii) how the use of telehealth can reduce medical expenditures of ageing.
    Keywords: health expenditure,economic evaluation,panel data,Japan,telemedicine
    Date: 2017
  12. By: Melanie Au; Claire Postman; James Verdier
    Abstract: This brief explores the experience of six states that have achieved varying levels of behavioral health and physical health integration or coordination for dually eligible beneficiaries in a managed care environment.
    Keywords: behavioral, physical health, integration, dually eligible
    JEL: I J
  13. By: Philippe Loirat (EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité); Marie Ferrua (IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité); Benoît Lalloué (EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, IGR - Institut Gustave Roussy); Aude Fourcade (EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, IGR - Institut Gustave Roussy); Etienne Minvielle (EHESP - École des Hautes Études en Santé Publique [EHESP], EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, IGR - Institut Gustave Roussy)
    Abstract: The introduction of the Hospital Value Based Purchasing (HVBP) programme, as shown recently by Jose F Figueroa and colleagues, did not improve 30 day mortality of Medicare beneficiaries admitted to US hospitals for three incentivised conditions. We agree with the authors’ conclusion that an “appropriate mix of quality metrics and incentives to improve patient outcomes” has yet to be identified. The programme was designed to promote better clinical outcomes for hospital patients and to improve their experience of care during hospital stays. However, if reducing mortality was the primary objective, a specific set of indicators should have been selected from relevant practice and organisational guidelines, which was not the case when the programme was designed. The absence of HVBP’s impact on mortality is therefore not surprising. In their conclusion Figueroa and colleagues say, “Nations considering similar pay for performance programs may want to consider alternative models.” This raises a question: should payment depend on achieving a decrease in mortality rates? The primary objective of pay for performance programmes could still be the development and maintenance of continuous quality improvement (CQI) programmes based on relevant process indicators to assess critical steps in patient management, such as the effective use of checklists in surgical procedures. These process indicators are apt to detect dangerous misconduct, less susceptible to bias, and more actionable. However, a problem remains: such CQI programmes in hospitals rely on a limited number of people repeatedly trying to motivate a large number of health professionals who are insensitive to the benefits of CQI. Instead of diverting the small percentage of budget devoted to pay for performance programmes it could be more profitable, for patients, to think of a better use for this money.
    Keywords: Healthcare Organization,Pay for performance
    Date: 2016–06–22
  14. By: Xavier Pautrel (University of Angers (GRANEM)-TEPP)
    Abstract: We re-examine the impact of environmental taxation on health and output, in the presence of labor market frictions. Our main findings are that matching process and wage bargaining introduce new channels of transmission of environmental taxation on the economy such that assuming perfect labor market leads to over-estimate the positive impact of environmental taxation on health. We also demonstrate that rising abatement expenditures as a way of tightening the environmental policy would be better for health than increasing environmental tax in the presence of market labor imperfections.
    Keywords: Environmental Policy, Health, Labor Market, Search, Unemployment
    JEL: I1 J2 J64 Q58
    Date: 2017–09
  15. By: Jorge García Hombrados (Department of Economics, University of Sussex)
    Abstract: This study uses age discontinuities in the degree of exposure to a law that raised the legal age of marriage for women from 15 to 18 years in some regions of Ethiopia to provide the first evidence on (a) the beneficial effects on child marriage and infant mortality of laws that ban underage marriage and on (b) the causal effect of delaying women's age at cohabitation on infant mortality using a fuzzy regression discontinuity design. The results show that although the introduction of the law did not end child marriage among Ethiopian women, it had large effects on the incidence of child marriage and on the probability of infant mortality of the first born child. Besides, the results suggest that a one-year delay in women's age at cohabitation during teenage years decreases the incidence of infant mortality of the first born by 3.8 percentage points. The size of this effect is comparable to the joint impact on child mortality of measles, BCG, DPT, Polio and Maternal Tetanus vaccinations. This effect on infant mortality seems to be closely linked to the impact of delaying cohabitation on the age of women at first birth.
    Keywords: child marriage, infant mortality, family economics
    JEL: K0
    Date: 2017–09
  16. By: Adam Szulc
    Abstract: The weights allowing calculation of life expectancy for a whole population as a weighted average of group-specific life expectancies are proposed. They are characterized by a minimum distance from the actual population shares that are different from those assumed in life tables. It is demonstrated how they may be obtained by means of constrained regression, using popular statistical/econometric software. The problem of negative solutions is also addressed. The empirical examples include longevity inequality calculations under various weighting systems. The data come from the Human Mortality Database and from Russia's regional statistics.
    Keywords: life expectancy, inequality, weighted indices
    JEL: I14 I18
    Date: 2017–09
  17. By: Tom Vogl (Princeton University, BREAD, and NBER); Marcos Rangel (Duke University and BREAD)
    Abstract: Fire has long served as a tool in agriculture, but this practice's human capital consequences have proved difficult to study. Drawing on data from satellites, air monitors, and vital records, we study how smoke from sugarcane harvest fires affects infant health in the Brazilian state that produces one-fifth of the world's sugarcane. Because fires track economic activity, we exploit wind for identification, finding that late-pregnancy exposure to upwind fires decreases birth weight, gestational length, and in utero survival, but not early neonatal survival. Other fires positively predict health, highlighting the importance of disentangling pollution from economic activities that drive it.
    Keywords: Brazil
    JEL: H23 I15 O13 Q53
    Date: 2016–12
  18. By: Joan Costa Font; Richard Frank; Katherine Swartz
    Abstract: Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care.
    JEL: I18 J14
    Date: 2017–09
  19. By: Zhuang Hao; Benjamin W. Cowan
    Abstract: Previous studies have shown that years of formal schooling attained affects health behaviors, but little is known about how the stringency of academic programs affects such behaviors, especially among youth. Using national survey data from the Youth Risk Behavior Surveillance System (YRBS), we study the effects of mathematics and science high-school graduation requirements (HSGR) on high school students’ risky health behaviors--specifically on drinking, smoking, and marijuana use. We find that an increase in mathematics and science HSGR has significant negative impacts on alcohol consumption among high-school students, especially males and non-white students. The effects of math and science HSGR on smoking and marijuana use are also negative but generally less precisely estimated. Our results suggest that curriculum design may have potential as a policy tool to curb youth drinking.
    JEL: I12 I24
    Date: 2017–09
  20. By: Lucija Muehlenbachs; Stefan Staubli; Ziyan Chu
    Abstract: How much risk does a heavy truck impose on highway safety? To answer this question, we look at the rapid influx of trucks during the shale gas boom in Pennsylvania. Using quasi-experimental variation in truck traffic, we isolate the effect of adding a truck to the road. We find an additional truck raises the risk of a truck accident—and, at an even higher rate, the risk of nontruck accidents. These accidents pose an external cost in cases in which the truck is not found liable, not fully insured, or not directly involved. We show this external cost is capitalized in the insurance market: car insurance premiums of other road users increase when trucks are added to the road.
    JEL: G22 H23 I18 Q58 R41
    Date: 2017–09
  21. By: Casper Worm Hansen (Department of Economics, University of Copenhagen); Peter Sandholt Jensen (University of Southern Denmark); Peter Egedesø Madsen (University of Southern Denmark)
    Abstract: Tuberculosis (TB) is a leading cause of death worldwide and, while treatable by antibiotics since the 1940s, drug resistant strains have emerged. This paper estimates the effects of the establishment of a pre-antibiotic era public health institution, known as a TB dispensary, designed to prevent the spread of the disease. Our annual difference-in-differences estimation reveals that the rollout of the dispensaries across Danish cities led to a 19 percent decline in the TB mortality rate, but exhibits no significant impacts on other diseases in placebo regressions. We next take advantage of the dispensaries' explicit targeting on TB to set up a triple-differences model which exploits other diseases as controls and obtain a similar magnitude of the effect. Using monthly mortality data in a similar strategy leads to the same conclusion. In addition, we find small positive spillover effects of the dispensaries on productivity as measured by annual income per taxpayer at the city level, digitized from historical tax-assessment records. Overall, the evidence highlights the provision of personalized information on infectious diseases as a cost-effective cause of the historical mortality decline.
    Keywords: Tuberculosis, mortality, disease prevention, information, rollout, productivity
    JEL: D62 H23 I15 I18 N34
    Date: 2017–09–14
  22. By: Jody Beauchamp; Valerie Cheh; Robert Schmitz; Peter Kemper; John Hall
    Abstract: PACE is a Medicare managed care benefit intended to prolong the independence and enhance the quality of life of frail beneficiaries by providing solutions to the service delivery problems encountered by those who remain living in the community.
    Keywords: PACE , Care for the Elderly , Quality of Care
    JEL: I
  23. By: Margaret Gerteis; Deborah Peikes; Arkadipta Ghosh; Lori Timmins; Ann S. O'Malley; Michael Barna; Erin F. Taylor; Timothy J. Day; Kaylyn Swankoski; Perry W. Payne; Jr.; Randall Brown
    Abstract: Performance feedback is central to data-driven models of quality improvement, but the use of claims-based data for feedback has received little attention.
    Keywords: performance feedback, primary care practice, data-driven quality improvement, Medicare innovation initiatives
    JEL: I
  24. By: Daniel S. Grossman (West Virginia University, Department of Economics); David J.G. Slutsky (University of Kansas, Department of Economics)
    Abstract: Flint changed its public water source in April 2014, increasing lead exposure. The effects of lead in water on fertility and birth outcomes are not well established. Exploiting variation in the timing of births we find fertility rates decreased by 12%, fetal death rates increased by 58% (a selection effect from a culling of the least healthy fetuses), and overall health at birth decreased (from scarring), compared to other cities in Michigan. Given recent efforts to establish a registry of residents exposed, these results suggests women who miscarried, had a stillbirth or had a newborn with health complications should register.
    Keywords: Women’s Health, Birth Rate, Fertility Rate, Birth Outcomes, Lead, Environmental Regulation, Michigan
    JEL: H75 I12 I18 J13 Q53 Q58
    Date: 2017–09
  25. By: Canta, Chiara; Cremer, Helmuth
    Abstract: We study the design of long-term care (LTC) policy when children differ in their cost of providing informal care. Parents do not observe this cost, but they can commit to a "bequests rule" specifying a transfer conditional on the level of informal care. Care provided by high-cost children is distorted downwards in order to minimize the rent of low-cost ones. Social LTC insurance is designed to maximize a weighted sum of parents' and children's utility. The optimal uniform public LTC provision strikes a balance between insurance and children's utility. Under decreasing absolute risk aversion less than full insurance is provided to mitigate the distortion on informal care which reduces children's rents. A nonuniform policy conditioning LTC benefits on bequests provides full insurance even against the risk of having children with a high cost of providing care. Quite surprisingly the level of informal care induced by the optimal (uniform or nonuniform) policy always increases in the children's' welfare weight.
    Keywords: Long-term care; informal care; strategic bequests; asymmetric information
    JEL: H2 H5 I13 J14
    Date: 2017–09
  26. By: Choi, Mideum; Kim, Seongcheol
    Abstract: The era of ‘Internet of Things’ (IoT), in which all objects and the internet are connected and information is shared without human involvement, has arrived. According to published by SRI Consulting Business Intelligence in 2013, representative areas of IoT which will lead the market in 2017, include indoor positioning system applied to smart home and healthcare sector (SRI Consulting Business Intelligence, 2013). Gartner (2013) argued that global IoT market will produce economic value of 1.9 trillion dollar by 2020, and healthcare provider industry (15%) and manufacturing (15%) will account for the largest portion of the global IoT market. Healthcare industry is specifically expected to generate 285 billion dollar in added value, respectively (Gartner, 2013; KISDI, 2014). A number of specialists are considering healthcare industry as one of the areas where IoT technology will be most actively applied, and it is expected to form 'Mass Market; mass production and consumption' for consumers in the near future (Lee, 2014; BI Intelligence, 2013).
    Date: 2017
  27. By: Marie Ferrua (EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, IGR - Institut Gustave Roussy); Claude Sicotte (EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, Département d'administration de la santé - Université de Montréal); Benoît Lalloué (IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité); Etienne Minvielle (IGR - Institut Gustave Roussy, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP])
    Abstract: Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners' (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs' perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients' hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms , including as a means to improve quality of care.
    Keywords: Healthcare System,Healthcare Organization,General practice,Quality Indicators,Hospital rankings
    Date: 2016–02–03

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