nep-hea New Economics Papers
on Health Economics
Issue of 2017‒11‒19
ten papers chosen by
Yong Yin
SUNY at Buffalo

  1. Physician behavior under prospective payment schemes: Evidence from artefactual field and lab experiments By Hafner, Lucas; Reif, Simon; Seebauer, Michael
  2. Nurses in advanced roles in primary care: Policy levers for implementation By Claudia B. Maier; Linda H. Aiken; Reinhard Busse
  3. A novel health metric based on biomarkers By Qing Li; Alain A. Cohen; Linda P. Fried
  4. The role of measurement uncertainty in Health Technology Assessments (HTAs) of in-vitro tests By Alison F. Smith; Mike Messenger; Peter Hall; Claire Hulme
  5. Value-Based Payment in Nursing Facilities: Options and Lessons for States and Managed Care Plans By Jenna Libersky; Julie Stone; Leah Smith; James Verdier; Debra Lipson
  6. Response to the Commission for Evidence-Based Policymaking Final Report (Presentation) By Paul Decker
  7. Analysing the determinants of health aid allocation in sub-Saharan Africa By Abrams M E Tagem
  8. Nutritional Quality of Congregate and Home-Delivered Meals Offered in the Title III-C Nutrition Services Program: An Examination Utilizing the Healthy Eating Index Tool By Katherine Niland; Mary Kay Fox; Elizabeth Gearan
  9. The Effect of Paid Vacation on Health: Evidence from Sweden By Hofmarcher, Thomas
  10. Health Insurance Coverage and Health Care Utilization: Evidence from the Affordable Care Act's Dependent Coverage Mandate By Baris K. Yörük

  1. By: Hafner, Lucas; Reif, Simon; Seebauer, Michael
    Abstract: Recent experimental studies analyze the behavior of physicians towards patients and find that physicians care for their own profit as well as patient benefit. In this paper, we extend the experimental analysis of the physician decision problem by adding a third party representing the health insurance which finances medical service provision. Our results show that physicians take into account the payoffs of the third party, which can lead to underprovision of medical services. We conduct a laboratory experiment in neutral as well as medical framing using students and medical doctors as subjects. Subjects in the medically framed experiments behave weakly more patient orientated in contrast to neutral framing. A sample of medical doctors exhibits comparable behavior to students with medical framing.
    Keywords: health economic experiment,framing,physician behavior,prospective payment schemes
    JEL: C91 C93 I11 I18
    Date: 2017
  2. By: Claudia B. Maier (Technical University, Berlin); Linda H. Aiken (Pennsylvania State University); Reinhard Busse (Technical University, Berlin)
    Abstract: Many OECD countries have undergone reforms over the past decade to introduce advanced roles for nurses in primary care to improve access to care, quality of care and/or to reduce costs. This working paper provides an analysis of these nurse role developments and reforms in 37 OECD and EU countries. Four main trends emerge: 1) the development in several countries of specific advanced practice nursing roles at the interface between the traditional nursing and medical professions; 2) the introduction of various new, supplementary nursing roles, often focused on the management of chronic conditions; 3) the rise in educational programmes to train nurses to the required skills and competencies; and 4) the adoption of new laws and regulations in a number of countries since 2010 to allow certain categories of nurses to prescribe pharmaceuticals (including in Estonia, Finland, France, Netherlands, Poland and Spain).
    JEL: I10 I18 J2
    Date: 2017–11–20
  3. By: Qing Li (PRIMUS, University of Sherbrooke); Alain A. Cohen (Department of Family Medicine, University of Sherbrooke); Linda P. Fried (Mailman School of Public Health, Columbia University)
    Abstract: We propose a biomarker-based, objective and continuously distributed health measure which is novel to the economics literature. Using 41 commonly available biomarkers in two leading biomarker databases, we consider the individuals as points in a 41-dimensional biomarker space and measure their objective health as the Mahalanobis distance to the centroid of a reference group. In this way the centroid of the reference group represents an "ideal state" of health, and a bigger distance from this centroid indicates worse health. We validate versions of our health measure using di¤erent number of biomarkers and through the link with a commonly used measure of general health (self-reported health); we nd that our health measure is positively but not perfectly linked to self-reported health. Additionally, we nd that the signal of health increases with the number of biomarkers included; nonetheless, it is clearly feasible to have a signal with fewer biomarkers though the signal could be weaker. Finally we illustrate our health measure in two applications: 1) the estimation of health distribution where we nd a long tail representing individuals in very bad health; 2) the concentration index where we can truly satisfy the requirement for continuously de ned general health.
    Keywords: comparative advantage, physical capital, hurricanes.
    JEL: F14 O10 Q54
    Date: 2017–11
  4. By: Alison F. Smith (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Mike Messenger (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds; National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK); Peter Hall (Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK); Claire Hulme (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)
    Abstract: Introduction: Numerous factors contribute to uncertainty in test measurement procedures, and this uncertainty can impact on the downstream clinical utility and cost-effectiveness of testing strategies. Currently however, there is no clear guidance concerning if or how such factors should be considered within Health Technology Assessments (HTAs) of tests. Aim: To provide an introduction to key concepts in measurement uncertainty and explore, via systematic review, current methods utilised within HTAs for the assessment of measurement uncertainty. Methods: HTAs of in-vitro tests including a model-based economic evaluation were identified via the Centre for Reviews and Dissemination (CRD) HTA database, HTA authority websites and citation checking. Data extraction was conducted to explore the specific components of measurement uncertainty assessed and methods utilised, and results were narratively synthesised.Results: Of 107 identified HTAs, 20 (19%) attempted to assess components of measurement uncertainty: 15 included an ‘intermediate’ assessment (e.g. literature review or laboratory survey); 4 also included components within the economic model; and 1 considered measurement uncertainty within the model only. The specific components assessed and methods adopted differed across studies. In particular, several techniques were employed within the economic models to incorporate data on test agreement, total error or biological and analytical variability. Conclusion: Various approaches have been adopted within a minority of HTAs to attempt to capture the impact of measurement uncertainty on test outcomes; uncertainty remains around when such assessments are required and appropriate methodology for conducting analyses, particular within economic evaluations.
    Keywords: Health Technology Assessment, Systematic Review, Measurement Uncertainty, Economic Evaluation, In-vitro techniques
    JEL: I10 C50
    Date: 2017
  5. By: Jenna Libersky; Julie Stone; Leah Smith; James Verdier; Debra Lipson
    Abstract: To improve the value of care provided in nursing facilities, payers are experimenting with value-based payment (VBP) approaches that link financial rewards to measures of quality. Drawing on findings from interviews with state officials and plan representatives, this brief describes the VBP approaches that select states and managed care plans currently use, presents perceived effects of VBP, and shares lessons on the design and administration of VBP programs.
    Keywords: Value-Based Purchasing, Nursing Facility, Managed Care, Value-Based Payment, quality, VBP, Medicare, Medicaid
    JEL: I
  6. By: Paul Decker
    Abstract: During a special symposium with members of the Commission on Evidence-Based Policymaking at the 2017 Association for Public Policy Analysis and Management Fall Research Conference, CEO Paul Decker discussed recommendations from the commission’s report.
    Keywords: evidence-based, policymaking, CEO, conference
  7. By: Abrams M E Tagem
    Abstract: Aid allocation studies typically find considerable heterogeneity in donors’ allocation patterns; be it for total Official Development Assistance (ODA) or sector-specific aid. This paper investigates the underlying factors influencing donors’ selection and actual allocation decisions for health aid, using health aid data from the newly-created Institute of Health Metrics and Evaluation (IHME) database; covering 9 major donors and 44 recipient countries from 1990 to 2011. This is carried out in three steps; first, we test the selection and allocation decisions of bilateral/multilateral donors. Second, we proceed to test for increased importance of the previous Millennium Development Goals (MDGs, recently replaced by the Sustainable Development Goals) after the Millennium Declaration. Third, we test the hypothesis that Public-Private Partnerships (PPPs) have different selection/allocation patterns to traditional donors. The first exercise confirms that donors differ in their selection/allocation patterns, but they all select poorer countries as recipients. The second exercise shows that donors placed more emphasis on the MDGs post the Millennium Declaration while the final exercise confirms that the PPPs are indeed different in their selection and disbursement patterns.
    Keywords: MDGs, Public-Private Partnerships, Health Aid, Disease Burden
    Date: 2017
  8. By: Katherine Niland; Mary Kay Fox; Elizabeth Gearan
    Abstract: The Nutrition Services Program (NSP), administered by the Administration on Aging within the Administration for Community Living, is designed to alleviate hunger and food insecurity among the elderly while also giving them the opportunity to enrich their social lives. The NSP aims to achieve these goals, in part, by serving congregate meals at senior centers or other community settings and providing home-delivered meals to homebound participants.
    Keywords: Healthy Eating Index-2010, nutritional quality, Dietary Guidelines, congregate meals, home-delivered meals
    JEL: I0 I1
  9. By: Hofmarcher, Thomas (Department of Economics, Lund University)
    Abstract: This study estimates the causal effect of receiving additional paid vacation days on health. Using register data on the universe of central government employees in Sweden, I exploit an age-based rule stipulated in the collective agreement covering these employees. Identification is achieved by combining a regression discontinuity with a difference-in-differences design to control for time-invariant differences between consecutive birth cohorts and isolate the true effect at two separate discontinuities at ages 30 and 40. The main results indicate no statistically significant changes in health (as proxied by specialized outpatient care visits, inpatient care admissions, and long-term sick leaves) induced by an extension of three paid vacation days at age 30 and four days at age 40. There is no evidence of significant effects by sex, being a (lone) parent, education level, or broad group of diagnoses. These findings challenge the historically grown health argument for additional paid vacation days.
    Keywords: vacation; holiday; working time; health
    JEL: I18 J22 J81 M52
    Date: 2017–11–07
  10. By: Baris K. Yörük
    Abstract: This paper investigates the impact of the Affordable Care Act’s (ACA’s) dependent coverage mandate on health insurance coverage rates and health care utilization among young adults. Using data from the Medical Panel Expenditure Survey, I exploit the discontinuity in health insurance coverage rates at age 26, the new dependent coverage age cutoff enforced by the ACA. Under alternative regression discontinuity design models, I find that 2.5% to 5.3% of young adults lose their health insurance coverage once they turn 26. This effect is mainly driven by those who lose their private health insurance plan coverage and those who lose their health insurance plan coverage, whose main holder resides outside of the household. I also find that the discrete change in health insurance coverage rates at age 26 is associated with significant changes in office-based physician and dental visits, but does not have a significant impact on the utilization of outpatient or emergency department services. Furthermore, the effects of the ACA’s dependent coverage mandate on health care spending and out-of-pocket costs are insignificant. These results are robust under alternative model specifications.
    Keywords: affordable care act, health insurance coverage, health care utilization, dependent coverage
    JEL: I12 I13 I18
    Date: 2016

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