nep-hea New Economics Papers
on Health Economics
Issue of 2017‒10‒22
29 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Clustering surgical procedures for master surgical scheduling By Kressner, Alexander; Schimmelpfeng, Katja
  2. The Healthy Immigrant Paradox and Health Convergence By Constant, Amelie F.
  3. Organized interests and foreign-educated professionals: The case of the associations for physicians and nurses in Sweden By Jansson, Olle
  4. The ‘Healthy Worker Effect’: Do Healthy People Climb the Occupational Ladder? By Costa Font, Joan; Ljunge, Martin
  5. The Relationship between Working Hours and Mortality in the United States By Murat Anil Mercan
  6. Subjective and physiological measures of well-being: an exploratory analysis using birth-cohort data By Andrén, Daniela; Clark, Andrew E; D´Ambrosio, Conchita; Karlsson, Sune; Pettersson, Nicklas
  7. Strengthening Multipayer Collaboration: Lessons from the Comprehensive Primary Care Initiative By Grace Anglin; Ha Tu; Kristie Liao; Laura Sessums; Erin Fries Taylor
  8. Collaborative Design of a Health Care Experience Survey for Persons with Disability By Lisa I. Iezzoni; Holly Matulewicz; Sarah A. Marsella; Kimberley S. Warsett; Dennis Heaphy; Karen Donelan
  9. The Effects of a Criminal Record on Employment, Welfare Participation, and Health: A Model of Long-Run Behaviors and Outcomes when Lagged Variables are Missing Non-Randomly By Ning Fu; Donna B. Gilleskie; Shawn Kneipp; Todd Schwartz; Amanda Sheely
  10. Long-Term Care in Latin America and the Caribbean? Theory and Policy Considerations By Caruso Bloeck, Martín; Galiani, Sebastian; Ibarrarán, Pablo
  11. The impact of regional health care coverage on infant mortality and disease incidence By Liebert, Helge; Mäder, Beatrice
  12. High Cost Pool in a Health Status Based Risk Adjustment System – Some Conceptional and Empirical Considerations By Wasem, Jürgen; Buchner, Florian; Lux, Gerald; Schillo, Sonja
  13. Should the unemployed care for the elderly? The effect of subsidized occupational and further training in geriatric care By Lang, Julia; Dauth, Christine
  14. Household Finance and the Value of Life By Bommier, Antoine; Harenberg, Daniel; Le Grand, François
  15. Is it good to be too light? Birth weight thresholds in hospital reimbursement systems By Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie
  16. From measuring the past to strategically framing challenges in the healthcare sector. The role of the balance scorecard By Anna Comacchio; Maddalena Campioni; Mauro Bonin
  17. Quality of Care for Adults in Medicaid: Findings from the 2015 Adult Core Set (Chart Pack) By The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies.
  18. Quality of Care for Children in Medicaid and CHIP: Findings from the 2015 Child Core Set (Chart Pack) By The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies.
  19. Retirement and Informal Care-giving: Behavioral Patterns among Older Workers By Raab, Roman
  20. Elderly Care Service in an Aging Society By Masaya Yasuoka
  21. Simple vs. Complex Carbohydrate Dietary Patterns and the Global Overweight and Obesity Pandemic By Ferretti, Fabrizio; Mariani, Michele
  22. The Structure of Cigarette Excises in the EU: From Myths to Reality By Marko Primorac; Silvija Vlah Jeric
  23. Politics, Hospital Behavior, and Health Care Spending Effect Methods to Examine Treatment Effect Heterogeneity in Experiments for the Young and Privately Insured? By Zack Cooper; Amanda E. Kowalski; Eleanor Neff Powell; Jennifer Wu
  24. The Children of the Missed Pill By Tomás Rau; Miguel Sarzosa; Sergio S. Urzúa
  25. Long-Term Care Insurance: Knowledge Barriers, Risk Perception and Adverse Selection By Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
  26. Measuring the Potential Health Impact of Personalized Medicine: Evidence from MS Treatments By Kristopher J. Hult
  27. Dual Practice by Health Workers: Theory and Evidence from Indonesia By Gonzalez, Paula; Montes-Rojas, Gabriel V.; Pal, Sarmistha
  28. The effect of house prices on the long-term care market: Evidence from England By Bilotkach, Volodymyr; Braakmann, Nils; Gonzalo-Almorox, Eduardo; Wildman, John
  29. Plan Responses to Diagnosis-Based Payment: Evidence from Germany's Morbidity-Based Risk Adjustment By Sebastian Bauhoff; Lisa Fischer; Dirk Göpffarth; Amelie C. Wuppermann

  1. By: Kressner, Alexander; Schimmelpfeng, Katja
    Abstract: The sound management of operating rooms is a very important task in each hospital. To use this crucial resource efficiently, cyclic master surgery schedules are often developed. To derive sensible schedules, high-quality input data are necessary. In this paper, we focus on the (elective) surgical procedures' stochastic durations to determine reasonable, cyclically scheduled surgical clusters. Therefore, we adapt the approach of van Oostrum et al (2008), which was specifically designed for clustering surgical procedures for master surgical scheduling, and present a two-stage solution approach that consists of a new construction heuristic and an improvement heuristic. We conducted a numerical study based on real-world data from a German hospital. The results reveal clusters with considerably reduced variability compared to those of van Oostrum et al(2008).
    Keywords: master surgery scheduling (MSS),stochastic surgery duration,surgery types,clustering
    Date: 2017
  2. By: Constant, Amelie F.
    Abstract: The health status of people is a precious commodity and central to economic, socio-political, and environmental dimensions of any country. Yet it is often the missing statistic in all general statistics, demographics, and presentations about the portrait of immigrants and natives. In this paper we are concerned with international migration and health outcomes in the host countries. Through a general literature review and examination of specific immigration countries, we provide insights into the Healthy Immigrant Paradox and the health assimilation of immigrants as we also elucidate selection and measurement challenges. While health is part of human capital, health assimilation is the mirror image of earnings assimilation. Namely, immigrants arrive with better health compared to natives and their health deteriorates with longer residence in the host country, converging to the health of natives or becoming even worse. A deeper understanding of immigrant health trajectories, and disparities with natives and other immigrants is of great value to societies and policymakers, who can design appropriate policy frameworks that address public health challenges, and prevent the health deterioration of immigrants.
    Keywords: Health status,Healthy Immigrant Paradox,International migration,Assimilation,Age-Cohort-Period effects,Selection,Aging
    JEL: I00 I10 I12 I14 I18 J00 F22 J11 J14 J15 J24 J61 O15
    Date: 2017
  3. By: Jansson, Olle (Department of Economic History, Uppsala University)
    Abstract: The role and importance of employee organizations (i.e., unions) on policies concerning international migration have been studied extensively for decades. However, we know very little about the strategies of the organized interests of health care professionals. This paper will contribute to previous research, both internationally and in the Swedish context, on issues concerning the (re-)action of professional organizations towards migration reforms that might endanger the profession's control over their segment of the labor market. Through a study of the associations representing the two largest licensed health care professions in Sweden – physicians and nurses – the study investigates if, and how, they try to limit the competition in the labor market against reforms that are promoting increased mobility and international migration. The conclusions are mixed, suggesting that the long-term goals of professional associations are more important than strategies that might reduce the competition of foreign-educated practitioners in the short run.
    Keywords: international migration; regulated occupations; physicians; nurses; professionalism; migration policy; Sweden
    JEL: J44 J48 J51 J61
    Date: 2017–09–20
  4. By: Costa Font, Joan (London School of Economics); Ljunge, Martin (Research Institute of Industrial Economics (IFN))
    Abstract: The association between occupational status and health has been taken to reveal the presence of health inequalities shaped by occupational status. However, that interpretation assumes no influence of health status in explaining occupational standing. This paper documents evidence of non-negligible returns to occupation status on health (which we refer to as the ‘healthy worker effect’). We use a unique empirical strategy that addressed reverse causality, namely an instrumental variable strategy using the variation in average health in the migrant’s country of origin, a health measure plausibly not determined by the migrant’s occupational status. Our findings suggest that health status exerts significant effects on occupational status in several dimensions; having a supervising role, worker autonomy, and worker influence. The effect size of health is larger than that of an upper secondary education.
    Keywords: Occupational status; Self-reported health; Immigrants; Work autonomy; Supervising role
    JEL: I18 J50
    Date: 2017–10–06
  5. By: Murat Anil Mercan (Department of Economics, Gebze Technical University)
    Abstract: This study bridges a gap in the literature by examining the relationship between working hours and the probability of mortality among older workers in the United States. We have applied the Cox regression method, a frequently used approach in survival analysis, to panel data from the Health and Retirement Survey (HRS). We have found a small negative relationship exists between working hours and the probability of mortality. This study’s findings may raise questions about the need for initiatives in the European Union and other countries that regulate the length of work schedules.
    Keywords: mortality, working hours, the United States, male, female
    JEL: J01 J81
    Date: 2017–08–01
  6. By: Andrén, Daniela (Örebro University School of Business); Clark, Andrew E (Paris School of Economics (PSE)); D´Ambrosio, Conchita (University of Luxembourg); Karlsson, Sune (Örebro University School of Business); Pettersson, Nicklas (Örebro University School of Business)
    Abstract: We use a rich longitudinal data set following a cohort of Swedish women from age 10 to 49 to analyse the effects of birth and early-life conditions on adulthood outcomes. These latter include both well-being and the stress hormone cortisol. Employment and marital status are important adult determinants of well-being. Log family income and absence from school also predict adult well-being, although their importance falls when controlling for adult and birth characteristics. Among the birth characteristics, we find that high birth weight (>4.3kg) affects adult well-being. We predict the level of adult cortisol only poorly, and suggest that the relationship between life satisfaction and cortisol is non-monotonic: both high and low cortisol are negatively correlated with life satisfaction. The results from an OLS life satisfaction regression and a multinomial logit of high or low cortisol (as compared to medium) are more similar to each other.
    Keywords: life satisfaction; cortisol; birth-cohort data; adult; child and birth outcomes; multivariate imputation by chained equations
    JEL: A12 D60 I31
    Date: 2017–10–12
  7. By: Grace Anglin; Ha Tu; Kristie Liao; Laura Sessums; Erin Fries Taylor
    Abstract: With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation.
    Keywords: insurance carriers, practice transformation, primary health care, public-private sector partnerships
    JEL: I
  8. By: Lisa I. Iezzoni; Holly Matulewicz; Sarah A. Marsella; Kimberley S. Warsett; Dennis Heaphy; Karen Donelan
    Abstract: When assessing results of health care delivery system reforms targeting persons with disability, quality metrics must reflect the experiences and perspectives of this population.
    Keywords: Disability, Quality, Measurement, Survey, Medicare, Medicaid
    JEL: I J
  9. By: Ning Fu; Donna B. Gilleskie; Shawn Kneipp; Todd Schwartz; Amanda Sheely
    Abstract: The authors study the collateral consequences of women's criminal records on their future employment, welfare participation, and health outcomes.
    Keywords: Criminal behavior
  10. By: Caruso Bloeck, Martín (Universidad Nacional de la Plata); Galiani, Sebastian (University of Maryland); Ibarrarán, Pablo (Inter-American Development Bank)
    Abstract: This paper discusses theoretical and practical issues related to long-term care (LTC) services in Latin America. Demand for these services will rise as the region undergoes a swift demographic transition from its currently young population to a rapidly aging one, especially since the region's aging cohorts are more prone to experience a decline in their functional and physical abilities than elderly people elsewhere in the world. We argue that private insurance markets are ill-equipped to provide coverage to meet the need for LTC, while the amount of personal savings required to afford self-insurance is prohibitively high. We study how developed economies have dealt with the issue of LTC and pay special attention to the most salient features of their LTC programs. We then direct the discussion to Latin America, where LTC may not be an immediate priority, but governments are likely to encourage the development of LTC programs as demand for them steadily grows. In particular, policymakers are probably going to focus initially on LTC programs for the poor and the vulnerable, for whom LTC affordability is a greater problem. We therefore study how basic elements of policy design affect cost-effectiveness of LTC programs by means of a formal model. Our study shows that pro-poor programs are more cost effective when people have the option to receive cash subsidies, and the availability of in-kind and in-cash choices reduces program costs overall. We argue that our findings are natural starting points to start thinking about LTC program development in the region.
    Keywords: long-term care, long-term care insurance, population aging, Latin America
    JEL: J14 N36
    Date: 2017–09
  11. By: Liebert, Helge; Mäder, Beatrice
    Abstract: This paper investigates the effect of changes in the physician coverage ratio on infant and disease mortality, utilizing historical data from Germany. The results indicate substantial health effects. One additional physician per 1,000 of population reduces infant mortality by 23%. We find similar negative effects for a variety of common diseases and stillbirths. Using a semiparametric control function approach, we demonstrate that the marginal returns to coverage are nonlinear and decreasing.
    JEL: I10 I18 N34
    Date: 2017
  12. By: Wasem, Jürgen; Buchner, Florian; Lux, Gerald; Schillo, Sonja
    Abstract: Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R2 as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases.
    Date: 2017
  13. By: Lang, Julia; Dauth, Christine
    Abstract: This study analyzes the effectiveness of subsidized training in elderly care professions for the unemployed in Germany. We find that shorter further training increases employment but hardly affects wages. Retraining, which entails a vocational degree as geriatric nurse, causes strong lock-in effects, but afterwards substantial positive wage and employment effects that exceed those of further training. Yet, large shares of the estimated employment effects are attributable to part-time employment.
    JEL: I11 J24 J68
    Date: 2017
  14. By: Bommier, Antoine; Harenberg, Daniel; Le Grand, François
    Abstract: We analyze life-cycle saving strategies with a recursive model that is designed to provide reasonable positive values for the value of a statistical life. With a positive value of life, risk aversion amplifies the impact of uncertain survival on the discount rate, and thus reduces savings. Our model also predicts that risk aversion lowers stock market participation and leads to choose more conservative portfolios.
    JEL: D91 G11 J17
    Date: 2017
  15. By: Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie
    Abstract: Birth weight manipulation is common in DRG systems. Hospitals receive more money for cases with weight below certain thresholds, which could benefit newborns. Also, some reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect medical care. Based on all hospital births in Germany from 2005-2011, we investigate whether this triggers different care. We find that this is not the case, suggesting that financial incentives do not directly impact care for newborns.
    JEL: I11 I18
    Date: 2017
  16. By: Anna Comacchio (Dept. of Management, Università Ca' Foscari Venice); Maddalena Campioni (Dept. of Management, Università Ca' Foscari Venice); Mauro Bonin (Health and Social Care, Regional Direction, Veneto Region)
    Abstract: Raising challenges and reducing resources in the healthcare sector, have put performance management center stage. Recent debate has, on the one hand, highlighted the negative effects of this increasingly diffuse management approach, on the other hand, more emphasis has been placed on the need to move from performance measurement to performance management and to better integrate it with strategic planning. From this stand point a body of studies focused on the replacement of traditional accounting system by multidimensional frameworks and more specifically by the Balance scorecard. The paper investigates the role of balance scorecard in the healthcare sector and how this multidimensional framework might help to effectively link strategy and performance management, for a more comprehensive and strategic management of healthcare organizations in a fast moving environment. The paper provides empirical evidence, through a case study, on the role that a multidimensional approach such as the one delivered by the Balance scorecard can have to help organization and managers to move from measuring the past to strategically framing challenges.
    Keywords: balance scorecard, organizational innovation, healthcare sector, performance management
    JEL: L25 L30
    Date: 2017–10
  17. By: The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies.
    Abstract: This chart pack is a product of the Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, sponsored by the Centers for Medicare & Medicaid Services.
    Keywords: Medicaid, Adult Core Set, Health Care Quality Measures, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Affordable Care Act, Chart Pack
    JEL: I
  18. By: The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies.
    Abstract: This chart pack is a product of the Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, sponsored by the Centers for Medicare & Medicaid Services.
    Keywords: Medicaid, Child Core Set, Centers for Medicare & Medicaid Services, Department of Health and Human Services, CHIP, CHIPRA, Health Care Quality Measures, Affordable Care Act, Chart Pack
    JEL: I
  19. By: Raab, Roman (European Commission – JRC)
    Abstract: This paper uses panel data from the Survey of Health, Aging and Retirement in Europe (SHARE) to study the effect of care-giving on retirement. The findings suggest that care- and support-giving contributes to the retirement decision, in particular for men. While the frequency of care activities is more influential in the male retirement decision, the most important factor for both genders turns out to be out-of-household care.
    Keywords: informal care-giving, retirement, economics of aging, panel data
    JEL: I19 J26 J22
    Date: 2017–10
  20. By: Masaya Yasuoka (School of Economics, Kwansei Gakuin University)
    Abstract: An increase in life expectancy brings about an aging society, necessitating increasing demand for elderly care services. This paper presents an examination of how an aging society affects the demand for elderly care services and the labor market for elderly care services. Related reports of the literature describe that an aging society raises the share of labor dedicated to elderly care services. However, considering a closed economy in which saving affects the capital stock, an aging society does not always raise the share of labor allocated for elderly care services as derived by the related literature. This paper presents an examination of how the labor share and wage inequality between the final goods sector and elderly care sector are determined. In addition, this paper presents an examination of whether the subsidy for elderly care service increases demand for elderly care services, or not.
    Keywords: Aging society, Elderly care service, Labor mobility, Two-sector model
    JEL: J21 H20
    Date: 2017–10
  21. By: Ferretti, Fabrizio; Mariani, Michele
    Abstract: Nowadays, obesity and being overweight are among the major global health concerns. Many, diet-related diseases impose high tangible and intangible costs, and threaten the sustainability of health-care systems worldwide. In this study, we model, at the macroeconomic level, the impact of energy intake from different types of carbohydrates on the population’s BMI (body mass index). We proceed in three steps. First, we develop a framework to analyse both the consumption choices between simple and complex carbohydrates and the effects of these choices on people health conditions. Second, we collect figures for 185 countries (over the period 2012–2014) regarding the shares of simple (sugar and sweetener) and complex (cereal) carbohydrates in each country’s total dietary energy supply. Third, we use regression techniques to: (1) estimate the impact of these shares on the country’s prevalence of obesity and being overweight; (2) compute for each country an indicator of dietary pattern based on the ratio between simple and complex carbohydrates, weighted by their estimated effects on the prevalence of obesity and being overweight; and (3) measure the elasticity of the prevalence of obesity and being overweight with respect to changes in both carbohydrate dietary pattern and income per capita. We find that unhealthy eating habits and the associated prevalence of excessive body fat accumulation tend to behave as a ‘normal good’ in low, medium- and high-HDI (Human Development Index) countries, but as an ‘inferior good’ in very high-HDI countries.
    Keywords: Keywords: carbohydrates; dietary patterns; human development; overweight and obesity; nutrition transition
    JEL: I15
    Date: 2017–09–03
  22. By: Marko Primorac; Silvija Vlah Jeric
    Abstract: Although it may at first seem unimportant, the structure of excise taxes on cigarettes greatly affects the price of cigarettes, the structure of the consumption, but also the amount of the tax revenue. EU Directive 2011/64/EU prescribes the combination of the specific and the proportional (ad valorem) excise tax on cigarettes. However, Member States independently determine the shares of one or another component in the overall excise tax structure, whereby the EU directive only prescribes the upper and the lower limit. The purpose of this article is to challenge several myths related to the cigarette taxation in the EU. The first one is that an increase of the specific component of the cigarette excise negatively affects the consumption of cigarettes, whereas this does not hold for the proportional component. The second assumption empirically tested in the paper is that an increase of the specific excise increases the government revenue from cigarette excises, whereby this can not be confirmed for the proportional component. Lastly, since both previous hypotheses have been confirmed, we tried to delve into reasons why certain countries – despite obvious advantages of the specific in relation to proportional excise – still predominantly rely on the latter. To this end, we tested the assumption that countries with domestic production of tobacco increasingly use proportional excises to increase the price gap between domestic (usually cheaper) and more expensive (imported/international) brands. The results of the empirical analysis were consistent with this hypothesis and confirmed that domestic tobacco production is a significant determinant of the structure of cigarette excises.
    Keywords: cigarette excises, excise taxes, tax revenue, tax harmonization, EU
    JEL: H20 H30
    Date: 2017
  23. By: Zack Cooper (School of Public Health, Yale University); Amanda E. Kowalski (Cowles Foundation, Yale University); Eleanor Neff Powell (University of Wisconsin-Madison); Jennifer Wu (Department of Political Science, Yale University)
    Abstract: This paper examines the link between legislative politics, hospital behavior, and health care spending. When trying to pass sweeping legislation, congressional leaders can attract votes by adding targeted provisions that steer money toward the districts of reluctant legislators. This targeted spending provides tangible local benefits that legislators can highlight when fundraising or running for reelection. We study a provision - Section 508 – that was added to the 2003 Medicare Modernization Act (MMA). Section 508 created a pathway for hospitals to apply to get their Medicare payment rates increased. We find that hospitals represented by members of the House of Representatives who voted ‘Yea’ on the MMA were significantly more likely to receive a 508 waiver than hospitals represented by members who voted ‘Nay.’ Following the payment increase generated by the 508 program, recipient hospitals treated more patients, increased payroll, hired nurses, added new technology, raised CEO pay, and ultimately increased their spending by over $100 million annually. Section 508 recipient hospitals formed the Section 508 Hospital Coalition, which spent millions of dollars lobbying Congress to extend the program. After the vote on the MMA and before the vote to reauthorize the 508 program, members of Congress with a 508 hospital in their district received a 22% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in the members’ home states. Our work demonstrates a pathway through which the link between politics and Medicare policy can dramatically affect US health spending.
    JEL: I10 I18 H51 D72 P16
    Date: 2017–08
  24. By: Tomás Rau; Miguel Sarzosa; Sergio S. Urzúa
    Abstract: We use sharp, massive and unexpected price increases of oral contraceptives—product of a documented case of collusion among pharmaceutical retailers in Chile—as a natural experiment to estimate the impact of access to the Pill on fertility and newborn health. Our empirical strategy combines multiple sources of information and takes into account the seasonality of conceptions and the general trends of fertility, as well as the dynamics that arise after interrupting Pill's intake. Our estimates suggest that due to the price hike, the weekly birth rate increased by 4%. We show large effects on the number of children born to unmarried mothers, from mothers in their early 20's, and to primiparae women. Moreover, we find evidence of significant deterioration of newborn health as measured by the incidence of low birthweight and infant mortality. We suggest that the “extra” conceptions faced dire conditions during gestation as a result of mothers' unhealthy behaviors. In addition, we document a disproportional increase of 27% in the weekly miscarriage and stillbirth rates, which we interpret as manifestations of active efforts of termination in a country where abortion was illegal. As the “extra” children reached school age, we find lower school enrollment rates and higher participation in programs for students with special needs. Our results suggest that access to contraceptives may prevent conceptions that will turn out to be in relatively poor health, and thereby may improve the average health of children conceived.
    JEL: I14 I15 K42 L13 L4 L41
    Date: 2017–10
  25. By: Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud
    Abstract: We conduct a stated-choice experiment where respondents are asked to rate various insurance products aimed to protect against financial risks associated with long-term care needs. Using exogenous variation in prices from the survey design, and objective risks computed from a dynamic microsimulation model, these stated-choice probabilities are used to predict market equilibrium for long-term care insurance using the framework developed by Einav et al. (2010). We investigate in turn causes for the low observed take-up of long-term care insurance in Canada despite substantial residual out-of-pocket financial risk. We first find that awareness and knowledge of the product is low in the population: 44% of respondents who do not have long-term care insurance were never offered this type of insurance while overall 31% report no knowledge of the product. Although we find evidence of adverse selection, results suggest it plays a minimal role in limiting take-up. On the demand side, once respondents have been made aware of the risks, we find that demand remains low, in part because of misperceptions of risk, lack of bequest motive and home ownership which may act as a substitute.
    JEL: D14 I13
    Date: 2017–10
  26. By: Kristopher J. Hult
    Abstract: Individuals respond to pharmaceutical treatments differently due to the heterogeneity of patient populations. This heterogeneity can make it difficult to determine how efficacious or burdensome a treatment is for an individual patient. Personalized medicine involves using patient characteristics, therapeutics, or diagnostic testing to understand how individual patients respond to a given treatment. Personalized medicine increases the health impact of existing treatments by improving the matching process between patients and treatments and by improving a patient's understanding of the risk of serious side effects. In this paper, I compare the health impact of new treatment innovations with the potential health impact of personalized medicine. I find that the impact of personalized medicine depends on the number of treatments, the correlation between treatment effects, and the amount of noise in a patient's individual treatment effect signal. For multiple sclerosis treatments, I find that personalized medicine has the potential to increase the health impact of existing treatments by roughly 50 percent by informing patients of their individual treatment effect and risk of serious side effects.
    JEL: I1 I10 I11 O3 O31
    Date: 2017–10
  27. By: Gonzalez, Paula (Universidad Pablo de Olavide); Montes-Rojas, Gabriel V. (City University London); Pal, Sarmistha (University of Surrey)
    Abstract: Using a simple theoretical model we conjecture that dual practice may increase the number of patients seen but reduce hours spent at public facilities, if public physicians lack motivation and/or if their opportunity costs are very large. Using data from Indonesia, we then test these theoretical conjectures. Our identification strategy relies on a 1997 legislation necessitating health professionals to apply for license for private practice only after three years of graduation. Results using a difference-in-difference regression discontinuity design provides support to our conjectures, identifying the role of weak work discipline, lack of motivation and opportunity costs of public service provision.
    Keywords: dual practice of health professionals, Ministry of Health Regulation, weak monitoring, motivation, opportunity costs of public service, Indonesia
    JEL: I18 J2 J44 J45 O1
    Date: 2017–09
  28. By: Bilotkach, Volodymyr; Braakmann, Nils; Gonzalo-Almorox, Eduardo; Wildman, John
    Abstract: High house prices are often considered to be beneficial for the elderly due to the accumulation of wealth. However, as land is an input in the provision of public services, the elderly might be harmed by them, for example, due to a shortage of local care homes. Alternatively, care home providers might be attracted by asset-rich potential clients, which could lead to a positive effect of house prices on the provision of care. Applying an instrumental variables approach on English data, we show that higher house prices lead to fewer care homes, fewer entries into the market as well as fewer available beds.
    Keywords: Care homes, house prices, long-term care, England
    JEL: I11 R31
    Date: 2017–10–16
  29. By: Sebastian Bauhoff; Lisa Fischer; Dirk Göpffarth; Amelie C. Wuppermann
    Abstract: Many competitive health insurance markets adjust payments to participating health plans according to their enrollees’ risk – including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on “validated†diagnoses by providers. Using the regulator’s data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3-4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians’ coding practices in a way that could lead to higher payments.
    Keywords: health plan payment, risk adjustment, managed competition, diagnostic coding, German Statutory Health Insurance
    JEL: H51 I10 I13 I18
    Date: 2017

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