nep-hea New Economics Papers
on Health Economics
Issue of 2017‒10‒01
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  2. Relevance of clinical judgement and risk stratification in the success of integrated care for multimorbid patients By Myriam Soto-Gordoa; Esteban de Manuel; Ane Fullaondo; Marisa Merino; Arantzazu Arrospide; Juan Ignacio Igartua; Javier Mar
  3. Habit Formation and Rational Addiction: A Field Experiment in Handwashing By Reshmaan Hussam; Atonu Rabbani; Giovanni Reggiani; Natalia Rigol
  4. Returns to Pharmaceutical Innovation in the Market for Oral Chemotherapy in Response to Insurance Coverage Expansion By Caroline S. Bennette; Anirban Basu; Scott D. Ramsey; Zachary Helms; Peter B. Bach
  5. Premium Levels and Demand Response in Health Insurance: Relative Thinking and Zero-Price Effects By Rudy Douven; Ron van der Heijden; Thomas McGuire; Frederik T. Schut
  6. The Response of Parental Time Investments to the Child's Skills and Health By Nicoletti, Cheti; Tonei, Valentina
  7. The Mitigating Role of Prescription Drug Monitoring Programs in the Abuse of Prescription Drugs By Birk, Erica G.; Waddell, Glen R.
  8. Labour Supply and Informal Care Supply: The Impacts of Financial Support for Long-Term Elderly Care By Hollingsworth, Bruce; Ohinata, Asako; Picchio, Matteo; Walker, Ian
  9. Activation against Absenteeism: Evidence from a Sickness Insurance Reform in Norway By Hernaes, Øystein
  10. The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe By Laetitia Duval; François-Charles Wolff; Martin Mckee; Bayard Roberts
  11. Multi-generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation’s Health By Chloe N. East; Sarah Miller; Marianne Page; Laura R. Wherry
  12. Water, Health and Wealth By Nava Ashraf; Edward Glaeser; Abraham Holland; Bryce Millett Steinberg
  13. March Madness: NCAA Tournament Participation and College Alcohol Use By Dustin R. White; Benjamin W. Cowan; Jadrian Wooten
  14. Smoking, Health Capital, and Longevity: Evaluation of Personalized Cessation Treatments in a Lifecycle Model with Heterogeneous Agents By Li-Shiun Chen; Ping Wang; Yao Yao
  15. Trends in SSDI Benefit Receipt: Are More Recent Birth Cohorts Entering Sooner and Receiving Benefits Longer? By Yonatan Ben-Shalom; David Stapleton; Alex Bryce
  16. The Impact of Healthy Harlem on the Prevalence of Child Overweight and Obesity and Contributing Factors: Interim Evaluation Report By James Mabli; Martha Bleeker; Mary Kay Fox
  17. The “Battle†of Managing Language Barriers in Health Care By Emma M. Steinberg; Doris Valenzuela-Araujo; Joseph S. Zickafoose; Edith Kieffer; Lisa Ross DeCamp
  18. Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015 By Patricia Pittman; Suhui Evelyn Li; Xinxin Han; Time Lowe
  19. Follow-Up After Discharge from an Inpatient Psychiatric Facility By Jonathan D. Brown; Randall Blair; Xiao Barry
  20. The Impact of State Medical Marijuana Laws on Social Security Disability Insurance and Workers' Compensation Benefit Claiming By Johanna Catherine Maclean; Keshar M. Ghimire; Lauren Hersch Nicholas

  1. By: Abdullah Afzal (UQO - Université du Québec en Outaouais - Université du Québec en Outaouais); Jacques-Bernard Gauthier (UQO - Université du Québec en Outaouais - Université du Québec en Outaouais)
    Abstract: More and more health care systems are taking the project management route. The present article sets out the results of a literature review (who was produced with the help of ABI/INFORM GLOBAL and covers the period from 1979 to May 2017 inclusively) dealing with project management in the health sector. Consequently, this paper is not a comparative analysis of Quebec’s health systems vis-à-vis the rest of the world’s. Nor is it a theoretical analysis of project management and strategic health systems management. This paper is of interest to practitioners who must manage their health services and social services on a by-project basis because their organization has turned onto the project path. So, what does the discipline of Project Management (a discipline that sees itself as being oriented to practitioners) have to offer to practitioners in the health sector? Results of the literature review indicate that the information technology project management in health sector is the favorite topic of researchers. Furthermore, very little of the research on health sector project management is published in the project management discipline’s journals and, on the other hand, a minority of the articles reviewed make reference to the works that are published in these PM Journals. Although the present article review focuses only on articles with the key words “Health” and “Project Management”, we can conclude that if project management wishes to become a discipline associated with health, it must promote the initiation of research that clearly identifies the real issues involved in a project and its management, in relation to the primary mission of health care systems: care, health services and social services. This paper presents the importance given to project management in the health sector and the theme of health in project management. It demonstrates the lack of emphasis on project management as a lever for health care, health services and social services which is the primary mission of healthcare systems and its practitioners.
    Keywords: Project Management,Health,Literature Review,Practitioner
    Date: 2017–08–31
  2. By: Myriam Soto-Gordoa; Esteban de Manuel; Ane Fullaondo; Marisa Merino; Arantzazu Arrospide; Juan Ignacio Igartua; Javier Mar
    Abstract: The Department of Health of the Basque Government launched in 2010 a new strategy to tackle the challenge of chronicity which aimed to re-orient the health system towards an integrated care model. In this paper we evaluate this strategy through a retrospective observational study with a historical control group based on data from the clinical and administrative databases of the Basque Health Service
    Date: 2017–09
  3. By: Reshmaan Hussam (Harvard Business School, Business, Government and the International Economy Unit); Atonu Rabbani (Dhaka University, Dept. of Economics); Giovanni Reggiani (Massachusetts Institute of Technology); Natalia Rigol (Harvard University)
    Abstract: Regular handwashing with soap is believed to have substantial impacts on child health in the developing world. Most handwashing campaigns have failed, however, to establish and maintain a regular practice of handwashing. Motivated by scholarship that suggests handwashing is habitual, we design, implement and analyze a randomized field experiment aimed to test the main predictions of the rational addiction model. To reliably measure handwashing, we develop and produce a novel soap dispenser, within which a time-stamped sensor is embedded. We randomize distribution of these soap dispensers as well as provision of monitoring (feedback reports) or monitoring and incentives for daily handwashing. Relative to a control arm in which households receive no dispenser, we find that all treatments generate substantial improvements in child health as measured by child weight and height. Our key test of rational addiction is implemented by informing a subset of households about a future boost in monitoring or incentives. We find that (1) both monitoring and incentives increase handwashing relative to receiving only a dispenser; (2) these effects persist after monitoring or incentives are removed; and (3) the anticipation of monitoring increases handwashing rates significantly, implying that individuals internalize the habitual nature of handwashing and accumulate habit stock accordingly. Our results are consistent with the key predictions of the rational addiction model, expanding its relevance to settings beyond what are usually considered 'addictive' behaviors.
    Date: 2017–09
  4. By: Caroline S. Bennette; Anirban Basu; Scott D. Ramsey; Zachary Helms; Peter B. Bach
    Abstract: We estimated the average returns, in terms of patient survival, to the marginal innovations in oral chemotherapy market induced by Part D expansion of oral chemotherapy coverage for elderly individuals by mandating inclusion of “all or substantially all” oral anti-cancer medications on plans’ formularies. We exploited exogenous variation in the age of diagnosis for different cancer sites - and therefore the relative expansion in market size for different cancers under the Medicare’s prescription drug coverage – to isolate the effect of Part D on innovation and the health benefits that these innovative technologies provide. Using data from FDA and clinical studies from January 1994 to December 2016, we find that the approval rate for oral chemotherapies increased an additional 5.7% (95% CI: 1.7, 9.8) after implementation of Part D for every 1% increase in exposure to the Medicare market. In contrast, greater exposure to Medicare was associated with a smaller increase in the indication-specific survival gains reported in the drug’s label (3.2% [95% CI: 2.1, 4.3]) and 8.0% [95% CI: 6.1, 9.8] lower in absolute and relative gains, respectively). Similar trends were not observed for intravenously administered chemotherapy whose coverage was largely unaffected by Part D. These findings suggest that there could be diminishing returns to incentives for pharmaceutical innovation created by broad coverage mandates and that health policy tools, such as value–based pricing, may help maximize the health benefits provided by future pharmaceutical innovations.
    JEL: I11 I13 I18
    Date: 2017–09
  5. By: Rudy Douven; Ron van der Heijden; Thomas McGuire; Frederik T. Schut
    Abstract: In health care systems with a competitive health insurance market, governments or other sponsors (e.g. employers) often subsidize premiums to encourage enrolment. These subsidies are typically independent of plan choice leaving the absolute premium differences in place so as not to distort consumer choice of plan. Such subsidies do, however, change the relative premium differences across plans, which, according to theories from behavioral economics, can affect choice. Consumers might be sensitive to differences relative to a reference premium (“relative thinking”). Furthermore, consumers might be particularly sensitive to a reference premium of zero (“zero-price effect”), a relevant range for some subsidized health insurance markets. This paper tests these ideas with two sources of evidence. We argue that observed equilibria in Germany and the U.S. Medicare Advantage markets are consistent with a powerful zero-price effects, resulting in an equilibrium focal pricing at zero. This contrasts with the Netherlands where equilibrium premiums are well above zero. In an empirical test using hypothetical questions in a web-based survey in these three countries, we also find evidence for both a relative thinking and a zero-price effect in the demand for health insurance. Our findings imply that well-designed subsidies can leverage relative thinking to increase demand elasticity for health plans. Creation of a powerful reference price (e.g., at zero), however, risks subverting price competition.
    JEL: I13 I18
    Date: 2017–09
  6. By: Nicoletti, Cheti (University of York); Tonei, Valentina (University of York)
    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: 2017–09
  7. By: Birk, Erica G. (Analysis Group); Waddell, Glen R. (University of Oregon)
    Abstract: In response to the epidemic of prescription-drug abuse, now 49 US states have passed legislation to establish Prescription Drug Monitoring Programs (PDMPs). These programs track controlled-substance prescribing and usage behavior in an effort to improve patient outcomes and identify and preempt access by drug abusers. We exploit variation in the timing of implementation across states to identify the effectiveness of PDMPs on reducing opioid abuse. In particular, by considering the role of specific program attributes we offer the strongest evidence to date of the potential for PDMP-type policy to decrease opioid-related treatment admissions. We also consider heterogeneity across intensity and tenure of use, which reveals that the largest gains are coming from reductions in the number of less-attached users. Overall, these results have important implications for the effective re-design of PDMP policy.
    Keywords: prescription drug, drug treatment, opioid, abuse
    JEL: I12 I18 K42
    Date: 2017–09
  8. By: Hollingsworth, Bruce (Lancaster University); Ohinata, Asako (University of Leicester); Picchio, Matteo (Università Politecnica delle Marche, Ancona); Walker, Ian (Lancaster University)
    Abstract: We investigate the impact of a policy reform, which introduced free formal personal care for all those aged 65 and above, on caregiving behaviour. Using a difference-in-differences estimator, we estimate that the free formal care reduced the probability of co-residential informal caregiving by 12.9%. Conditional on giving co-residential care, the mean reduction in the number of informal care hours is estimated to be 1.2 hours per week. The effect is particularly strong among older and less educated caregivers. In contrast to co-residential informal care, we find no change in extraresidential caregiving behaviour. We also observe that the average labour market participation and the number of hours worked increased in response to the policy introduction.
    Keywords: long-term elderly care, ageing, financial support, informal caregiving, difference-in-differences
    JEL: C21 D14 I18 J14
    Date: 2017–09
  9. By: Hernaes, Øystein (Institute for Social Research, Oslo)
    Abstract: I evaluate a program aimed at strictly enforcing a requirement that people on long-term sick leave be partly back at work unless explicitly defined as an exception. Employing the synthetic control method, I find that the reform reduced work-hours lost due to absenteeism by 12 % in the reform region compared to a comparison unit created by a weighted average of similar regions. The effect is driven by both increased part-time presence of temporary disabled workers and accelerated recovery. Musculoskeletal disorders was the diagnosis group declining the most. The findings imply large savings in social security expenditures.
    Keywords: absenteeism, disability, activation, forkfare
    JEL: I18 I38 J48
    Date: 2017–09
  10. By: Laetitia Duval (Imperial College London); François-Charles Wolff (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - UN - Université de Nantes); Martin Mckee (ECOHOST - London School of Hygiene & Tropical Medicine (LSHTM)); Bayard Roberts (ECOHOST - London School of Hygiene & Tropical Medicine (LSHTM))
    Abstract: Aim: To investigate differences in vaccination coverage between Roma and otherwise comparable non-Roma children, including factors associated with the vaccination gap, health care access and discrimination faced by Roma. Methods: We analyse data from the Roma Regional Survey 2011 implemented in twelve countries of Central and SouthEast Europe. Our sample comprises 8,233 children aged up to 6 with 7,072 Roma children and 1,161 non-Roma children. Estimates of the Roma vaccination gap are estimated using Logit regressions. Results: We find that the Roma children have a lower probability of being vaccinated compared to non-Roma (odds ratio = 0.325). The odds of being vaccinated for a Roma child is 33.9% that of a non-Roma child for DPT, 34.4% for Polio, 38.6% for MMR and 45.7% for BCG. These differences do not appear to be explained entirely by their worse socioeconomic status. The ethnic gap narrows by about 50% once individual characteristics are controlled for, with odds ratios of 0.548 for DPT, 0.559 for Polio, 0.598 for MMR and 0.704 for BCG. The probability of being vaccinated increases with access to health care, especially when Roma have a doctor to approach when needed. Conclusions: Our findings point out a large difference in vaccination coverage between Roma and non-Roma and support the need for better understanding of factors influencing vaccination among Roma as well as policies that might improve services for Roma in Central and SouthEast Europe.
    Keywords: discrimination,Central and South-East Europe,Roma,ethnicity,immunization,Vaccination
    Date: 2016
  11. By: Chloe N. East; Sarah Miller; Marianne Page; Laura R. Wherry
    Abstract: We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals’ in utero Medicaid exposure to the next generation’s health outcomes at birth. We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts.
    JEL: I1 I13 I14 I18
    Date: 2017–09
  12. By: Nava Ashraf; Edward Glaeser; Abraham Holland; Bryce Millett Steinberg
    Abstract: Providing clean water requires maintenance, as well as the initial connections that are typically measured. Frequently, the water supply fails in the developing world, especially when users don’t pay the marginal cost of water. This paper uses the timing of frequent, unexpected water service outages in Lusaka, Zambia to identify the short-term impacts of piped water access on contagious disease, economic activity and time use. We use microdata from the primary water utility in the city on the timing and location of supply complaints to identify outages, matched to extensive administrative data across the city. Conditional on fixed effects for time and water service district within Lusaka, we find that increases in outages are associated with increased incidence of diarrheal disease, upper respiratory infections, typhoid fever and measles. We match outages to geolocated microdata on financial transactions from the largest mobile money provider in Zambia, and find that outages cause a reduction in financial transactions. Outages also increase the time that young girls spend at their chores, possibly at the expense of time they spend doing schoolwork. Imperfect infrastructure appears to burden the poor in ways that go far beyond obvious health consequences.
    JEL: D12 D14 G21 I12 I18 O12 O13 O16 O18 Q25
    Date: 2017–09
  13. By: Dustin R. White; Benjamin W. Cowan; Jadrian Wooten
    Abstract: We examine the impact of the NCAA Men’s Basketball Tournament on college students’ drinking behavior using a nationally representative sample of American institutions. While success in intercollegiate athletics may augment the visibility of a university to prospective students and thereby benefit the school, it may also have a negative effect on the current student body by influencing risky behavior, especially the consumption of alcohol commonly associated with game day festivities. Using the Harvard School of Public Health College Alcohol Study (CAS), we find that a school’s participation in the NCAA Tournament is associated with a 30% increase in binge drinking and a 9% increase in self-reported drunk driving by male students at that school. The results suggest that this increase is not offset by less alcohol use before or after the tournament (intertemporal substitution) but instead seems to represent a net increase in the amount of alcohol consumed by students at participating schools.
    JEL: I12 I23
    Date: 2017–09
  14. By: Li-Shiun Chen; Ping Wang; Yao Yao
    Abstract: Cigarette smoking leads to large healthcare and morbidity costs, and mortality losses, and smoking cessation plays a key role in reducing health risk and economic costs. While medical evidence suggests that some smokers are more likely to respond to medication treatment than others depending on genetic markers, it remains unexplored whether pharmacogenetic testing is cost-effective in treating potential quitters of smoking. We address this knowledge gap by developing a lifecycle model in which individuals make smoking, health investment and consumption-savings decisions. Depending on an individual's genotype, smoking may bring enjoyment but deteriorates one's health, and the dynamic evolution of health capital determines life expectancy. In addition to heterogeneous genotypes, individuals also differ in demographics. We calibrate this model to fit key economic and medical observations in the U.S. We then propose three smoking cessation policies, two with standard treatments and one personalized depending on genetic markers, all under the same program costs. We construct two unified measures of effectiveness and subsequently compute the cost-effectiveness ratio. We find that personalized treatment is the most cost-effective: for each dollar of program cost, it generates $8.94 value in effectiveness, which is 22-45% higher than those under standard treatments.
    JEL: D91 E20 I10
    Date: 2017–09
  15. By: Yonatan Ben-Shalom; David Stapleton; Alex Bryce
    Abstract: We provide the first publicly available statistics on the extent to which recent successive birth cohorts enter Social Security Disability Insurance (SSDI), and on cross-cohort trends in the average number of years of SSDI benefit receipt among all individuals of a given birth cohort.
    Keywords: disability, mortality, immigration
    JEL: I J
  16. By: James Mabli; Martha Bleeker; Mary Kay Fox
    Abstract: The Healthy Harlem program, which is focused on improving health, nutrition, and physical fitness among children enrolled in the Harlem Children’s Zone, had positive impacts on students’ nutrition knowledge, self-efficacy, fitness, and body mass index (BMI).
    Keywords: childhood obesity, Harlem Children's Zone, body mass index, nutrition, physical fitness, afterschool program
    JEL: I0 I1 I
  17. By: Emma M. Steinberg; Doris Valenzuela-Araujo; Joseph S. Zickafoose; Edith Kieffer; Lisa Ross DeCamp
    Abstract: Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging.
    Keywords: limited English proficiency, health care disparities, interpreter, Latino, qualitative research
    JEL: I
  18. By: Patricia Pittman; Suhui Evelyn Li; Xinxin Han; Time Lowe
    Abstract: Despite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time.
    Keywords: Hospital workforce, Clinical support personnel, Unlicensed assistive personnel, Nurse staffing, Skill mix
    JEL: I
  19. By: Jonathan D. Brown; Randall Blair; Xiao Barry
    Abstract: Individuals discharged from inpatient psychiatric facilities (IPFs) require timely follow-up care to maintain their functioning and avoid or delay future hospitalizations.
    Keywords: Aftercare, Community mental health services, Emergency psychiatry, Hospitalization, Mental health systems/hospitals
    JEL: I
  20. By: Johanna Catherine Maclean; Keshar M. Ghimire; Lauren Hersch Nicholas
    Abstract: We study the effect of state medical marijuana laws (MMLs) on Social Security Disability Insurance (SSDI) and Workers' Compensation (WC) claiming. We use data on benefit claiming drawn from the 1990 to 2013 Current Population Survey coupled with a differences-in-differences design. We find that passage of an MML increases SSDI, but not WC, claiming on both the intensive and extensive margins. Post-MML the propensity to claim SSDI increases by 0.27 percentage points (9.9%) and SSDI benefits increase by 2.6%. We identify heterogeneity by age and the manner in which states regulate medical marijuana. Our findings suggest an unintended consequence of MMLs: increased reliance on costly social insurance programs among working age adults.
    JEL: I1 I12 I18 J22
    Date: 2017–09

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