nep-hea New Economics Papers
on Health Economics
Issue of 2018‒01‒08
thirty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Inclusive growth and health By Chris James; Marion Devaux; Franco Sassi
  2. Measuring patient experiences (PREMS): Progress made by the OECD and its member countries between 2006 and 2016 By Nicolaas S. Klazinga; Rie Fujisawa
  3. Intergenerational Effects of Education on Risky Health Behaviours and Long-Term Health By Mathias Huebener
  4. Evaluation of Medicare Disease Management Programs: LifeMasters Final Report of Findings By Dominick Esposito; Kate A. Stewart; Randall Brown
  5. Patients motivation and health plan choice By DongWoo Ko
  6. Do Skewed Sex Ratios Among Children Promote Parental Smoking? Longitudinal Evidence from Rural China By Chen, Xi
  7. Repealing or Replacing the ACA’s Provisions: How Would Adults with Disabilities Fare? By Purvi Sevak; Jody Schimmel Hyde; Matthew Kehn
  8. Population Segmentation and Targeting of Health Care Resources: Findings from a Literature Review By Dana Jean-Baptiste; Ann O'Malley; Tanya Shah
  9. The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial By Cathy J. Bradley; David Neumark; Lauryn Saxe Walker
  10. Late 19th and Early 20th Century Native and Immigrant Body Mass Index Values By Scott A. Carson
  11. Not All Silver Lining? The Great Recession and Road Traffic Accidents By Paola Bertoli; Veronica Grembi; Judit Vall Castello
  12. Politics, Hospital Behaviour and Health Care Spending By Zack Cooper; Amanda Kowalski; Eleanor Neff Powell; Jennifer Wu
  13. Can Regional Decentralisation Shift Health Care Preferences? By Joan Costa-i-Font; Ada Ferrer-i-Carbonell
  14. Surprise! Out-of-Network Billing for Emergency Care in the United States By Zack Cooper; Fiona Scott Morton; Nathan Shekita
  15. Hospital Readmission is Highly Predictable from Deep Learning By Damien Échevin; Qing Li; Marc-André Morin
  16. Education Effects on Days Hospitalized and Days out of Work by Gender: Evidence from Turkey By Aysit Tansel; Halil Ibrahim Keskin
  17. Does moderate weight loss affect subjective health perception in obese individuals? Evidence from field experimental data By Hafner, Lucas; Tauchmann, Harald; Wübker, Ansgar
  18. Volume-outcome relationship and minimum volume regulations in the German hospital sector: Evidence from nationwide administrative hospital data for the year 2005-2007 By Hentschker, Corinna; Mennicken, Roman; Reifferscheid, Antonius; Wasem, Jürgen; Wübker, Ansgar
  19. The relationship between nurse staffing levels and objective and subjective quality of care: A panel data approach for Germany By Augurzky, Boris; Bünnings, Christian; Wübker, Ansgar
  20. Strengthening tuberculosis control overseas: Who benefits? By Hoa Thi Minh Nguyen; Roslyb I Hickson; Tom Kompas; Geoffery N. Mercer; Kamalini M. Lokuge
  21. Comparison of alternatives to passive surveillance to detect foot and mouth disease incursions in Victoria, Australia By M.G.Garner; I.J.East; P.V.Ha; S.E.Roche; H.T.M. Nguyen
  22. Check Up Before You Check Out: Retail Clinics and Emergency Room Use By Alexander, Diane; Currie, Janet; Schnell, Molly
  23. Social Protection and Access to Health Care among Children in the Philippines By Abrigo, Michael R.M.; Paqueo, Vicente B.
  24. HIV/AIDS Knowledge and Sexual Behavior of Female Young Adults in the Philippines By Abrigo, Michael R.M.
  25. Can Community Development Improve Health? Emerging Opportunities for Collaboration between the Health and Community Development Sectors By Fazili, Sameera
  26. France: improving the efficiency of the health-care system By Antoine Goujard
  27. Trade-offs in health investments: HIV, Malaria and Malnutrition By Mikel Casares; Sandra Miñes
  28. Limits to Human Life Span Through Extreme Value Theory By Einmahl, Jesson; Einmahl, John; de Haan, L.F.M.
  29. Retirement and Unexpected Health Shocks By Bénédicte H. Apouey; Cahit Guven; Claudia Senik
  30. Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability By Kara Contreary; Jennifer Tennant; Yonatan Ben-Shalom

  1. By: Chris James (OECD); Marion Devaux (OECD); Franco Sassi (OECD)
    Abstract: In response to observed growing inequalities in income and other dimensions of well-being, including health, the OECD launched an initiative on Inclusive Growth in 2012. The objective was to help governments find ways to make economic growth more inclusive, so that it translates into meaningful gains in living standards across key dimensions of well-being and different socioeconomic groups. This paper links health to the overall inclusive growth agenda. It assesses the two-way relationship between health and socioeconomic factors. An empirical health production function is specified, using data from 35 OECD countries for the period 1990-2015. This is complemented by a review of the related empirical literature, as well as successful policies across OECD countries.
    JEL: I12 I14 I15
    Date: 2017–12–19
  2. By: Nicolaas S. Klazinga (OECD); Rie Fujisawa (OECD)
    Abstract: The OECD has been leading the work on international comparisons of patient-reported experience measures (PREMs) across its member states for over a decade. This paper synthesises national developments in relation to measuring and monitoring PREMs between 2006 and 2016 across countries participating in the OECD Health Care Quality Indicator expert group. This report shows that most OECD countries measure patient experience at a national level. It also highlights that efforts to measure and report patient-reported measures which used to be conducted in an ad hoc manner previously, have been institutionalised and standardised in an increasing number of countries. This national progress has enabled the international reporting of patient experiences with ambulatory care across 17 OECD countries in the recent edition of OECD’s flagship publication, Health at a Glance 2017. The scope of these indicators is currently limited, but recent national progress suggests that there is an opportunity to expand PREMs data collection in different domains for international reporting. The OECD plans to continue developing PREMs that would be useful for policy makers, and help drive improvements in health system performance for health care users, building on the PREMs work to date undertaken in consultation with countries.
    JEL: I12 I18
    Date: 2017–12–19
  3. By: Mathias Huebener
    Abstract: This paper estimates the causal effects of parental education on their children's risky health behaviours and health status. I study the intergenerational effects of a compulsory schooling reform in Germany after World War II. Implemented across federal states at different points in time, the reform increased the minimum number of school years from eight to nine. Instrumental variable estimates and difference-in-differences estimates reveal that increases in maternal schooling reduce children's probability to smoke and to be overweight in adolescence. The effects persist into adulthood, reducing chronic conditions that often result from unhealthy lifestyles. No such effects can be identified for paternal education. Increased investments in children's education and improvements in their peer environment early in life are important for explaining the effects. Changes in family income, family stability, fertility and parental health-related behaviours are less relevant empirically. The intergenerational effects of education on health and health-related behaviours exceed the direct effects. Studies neglecting the intergenerational perspective substantially understate the full causal effects.
    Keywords: Parental education, returns to education, smoking, overweight, compulsory schooling
    JEL: I12 I20
    Date: 2017
  4. By: Dominick Esposito; Kate A. Stewart; Randall Brown
    Abstract: From January 2005 to December 2007, the Centers for Medicare & Medicaid Services (CMS) sponsored a population-based disease management demonstration program implemented by LifeMasters Supported SelfCare (LifeMasters).
    Keywords: Medicare , Disease Management , LifeMasters
    JEL: I
  5. By: DongWoo Ko (Hankuk University of Foreign Studies, South Korea)
    Abstract: Previous studies have shown that Medicare beneficiaries tend not to switch their prescription drug plans even though they can largely save drug costs by plan switching. To explore why this so called “plan stickiness†happens, the present study focused on the concept of social exclusion, which is one of the most important characteristics of the elderly. This study compared the impact of two types of social exclusion on an association between psychological cost and plan switchingpassive social exclusion and active social exclusion. These two types are known to differently influence consumers’ motivation and decision-making process. The 2007 Prescription Drug Study supplement to the Health and Retirement Study data were used for analysis. We investigated the individual- level willingness to switch across multiple levels using a Hierarchical Linear Model. The findings suggest that passive social exclusion is associated with uncertainty cost. Study findings will help policymakers better understand the elderly’s plan decision- making process and promote their informed plan decisions.
    Keywords: Medicare, Beneficiaries Non-Switching Behavior, Psychological Cost, Hierarchical Linear Model.
    Date: 2017
  6. By: Chen, Xi
    Abstract: China and some other Asian countries have experienced skewed sex ratios, triggering intense competition and pressure in the marriage market. Meanwhile, China has more smokers than any other country, with half of men smoke while few women smoke. Men are the major income earners in most Chinese families and thus bear much of the financial burden in preparation for children’s marriage. This paper investigates how a demographic factor – a large number of surplus men in the marriage market in China – affects their fathers’ smoking behavior. We utilize two household longitudinal surveys as well as a random subsample of the China Population Census to examine fathers’ smoking in response to skewed sex ratios. Strikingly, fathers smoke more for families with a son living in communities with higher sex ratios. In contrast, those with a daughter do not demonstrate this pattern. Coping with the marriage market pressure is a more plausible pathway linking the observed skewed sex ratios among children and intense smoking among fathers. Considering worsening sex ratios and highly competitive marriage market in the coming decade as well as lasting health impacts due to smoking, policies suppressing unbalanced sex ratios could lead to welfare gains.
    Keywords: Sex Ratios,Marriage Market,Paternal Smoking,Stress
    JEL: J13 D12 I19
    Date: 2017
  7. By: Purvi Sevak; Jody Schimmel Hyde; Matthew Kehn
    Abstract: In this brief, we focus on the effects the proposed policy changes could have on individuals with disabilities and individuals with chronic conditions that could become disabling. We begin by discussing the likely effects on coverage and access to care, and review the potential effects the coverage changes would have on employment.
    Keywords: Affordable Care Act, Medicaid expansion, disabilities, employment, health insurance
    JEL: I J
  8. By: Dana Jean-Baptiste; Ann O'Malley; Tanya Shah
    Abstract: This paper examines published and gray literature describing how health care organizations both segment their HNHC populations into subgroups and target care management and other resources to subgroups.
    Keywords: Population segmentation, high-need, high-cost, super utilizer, high-risk patients, care management program, risk stratification, chronic conditions
    JEL: I
  9. By: Cathy J. Bradley; David Neumark; Lauryn Saxe Walker
    Abstract: We conducted a randomized controlled trial, enrolling low-income uninsured adults to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and spending. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. Compared to the untreated controls, subjects in the incentive groups were more likely to have a PCP visit in the initial six months. They had fewer ED visits in the subsequent six months, but outpatient visits did not decline. We also used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in emergency department use and increased outpatient use, but no reductions in overall spending.
    JEL: I12 I14 I18
    Date: 2017–12
  10. By: Scott A. Carson
    Abstract: When traditional measures for health and economic welfare are scarce or unreliable, height and the body mass index (BMI) are now well-accepted measures that reflect net nutrition during economic development. To date, there is no study that compares 19th century BMIs of immigrants and US natives. Individuals in the New South and West had high BMIs, while those in the upper South and Northeast had lower BMIs. Immigrants from Europe had the highest BMIs, while immigrants from Asia were the lowest. African-Americans and mixed-race individuals had greater BMIs than fairer complexioned whites. After accounting for occupational selection, workers in agricultural occupations had greater BMIs. Close proximity to rural agriculture decreased the relative price of food, increased net nutrition, and was associated with higher BMIs.
    Keywords: nineteenth century US health, immigrant health, BMI, malnourishment, obesity
    JEL: I12 I31 J70 N31
    Date: 2017
  11. By: Paola Bertoli; Veronica Grembi; Judit Vall Castello
    Abstract: We provide new evidence on the impact of recessions on traffic accidents, by exploiting the case of Spain, where the effects of the 2008 economic crisis have been among the strongest in the developed world. We exploit differences in the incidence of the recession across Spanish provinces due to the unequal evolution of the real estate bubble across the territory. We use a unique dataset on the universe of traffic accidents in Spain between 2004 and 2011. We first follow the literature on the topic and examine the impact of the economic crisis on the probability of having a traffic accident. However, we also go one step further, as we are able to identify any changes in the composition of both victims and driving behaviors as a result of the crisis. First, our results show that the Great Recession reduced traffic accidents in Spain. Second, for the compositional effects, we report decreased probabilities of dying or reporting a serious injury. More importantly, we also detect an increase in the probability that people involved in an accident abuse alcohol and drugs. Our results are robust to different measures of the treatment (i.e., employment in the construction sector) and the use of a spatial fixed effects model and are not biased by anticipatory effects. Finally, we show that our findings are driven by less-populated areas. Thus, we suggest that alcohol and drug control measures be reinforced during recessions and more attention should be devoted to rural areas to to strengthen the reduction of road traffic accidents.
    Keywords: recession, traffic accidents; Spain; economic crisis; spatial fixed effects model
    Date: 2017–12
  12. By: Zack Cooper; Amanda Kowalski; Eleanor Neff Powell; Jennifer Wu
    Abstract: This paper examines the link between legislative politics, hospital behaviour, 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 re-election. 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.
    Keywords: health care, US, hospital, politics
    JEL: I10 I18 H51 D72 P16
    Date: 2017–12
  13. By: Joan Costa-i-Font; Ada Ferrer-i-Carbonell
    Abstract: Uniform health care delivered by a mainstream public insurer - such as the National Health Service (NHS), seldom satisfies heterogeneous demands for care, and some unsatisfied share of the population either use private health care, or purchase private insurance (PHI). One potential mechanism to partially satisfy heterogeneous preferences for health care, and discourage the use of private health care, is regional health care decentralisation. We find robust estimates suggesting that the development of regional health services shifted both perceptions of, and preferences for, using the NHS, making it more likely individuals would use public health care and, consequently, reducing the uptake of PHI. These results are heterogeneous by income, education, and age groups; and are robust to placebo and other robustness and falsification checks.
    Keywords: National Health Service (NHS), political decentralization, use of private health care, private health insurance, health system satisfaction, demand for private health care
    JEL: H70 I18
    Date: 2017
  14. By: Zack Cooper; Fiona Scott Morton; Nathan Shekita
    Abstract: Using insurance claims data capturing 8.9 million emergency episodes, we show that in 22% of cases, patients attended in-network hospitals, but were treated by out-of-network physicians. We find that out-of-network billing is concentrated in a small group of primarily for-profit hospitals. Within 50% of hospitals in our sample, fewer than 5% of patients saw out-of-network physicians. In contrast, at 15% of hospitals, more than 80% of patients saw out-of-network physicians. Out-of-network billing allows physicians to substantially increase their payment rates relative to what they would be paid for treating in-network patients and significantly improve their outside option when bargaining over in-network payments. Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities. We illustrate in a model and confirm empirically via analysis of two leading physician-outsourcing firms that physicians offer transfers to hospitals to offset the hospitals' costs of allowing out-of-network billing to occur within their facilities. We find that a New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates.
    Keywords: health care, emergency care, US, hospital, politics
    JEL: I11 I13 I18 L14
    Date: 2017–12
  15. By: Damien Échevin; Qing Li; Marc-André Morin
    Abstract: Hospital readmission is costly and existing models are often poor or moderate in predicting readmission. We sought to develop and test a method that can be applied generally by hospitals. Such a tool can help clinicians identify patients who are more likely to be readmitted, either at early stages of hospital stay or at hospital discharge. Relying on state-of-the art machine learning algorithms, we predict probability of 30-day readmission at hospital admission and at hospital discharge using administrative data on 1,633,099 hospital stays from Quebec between 1995 and 2012. We measure performance of the predictions with the area under receiver operating characteristic curve (AUC). Deep Learning produced excellent prediction of readmission province-wide, and Random Forest reached very similar level. The AUC for these two algorithms reached above 78% at hospital admission and above 87% at hospital discharge, and the diagnostic codes are among the most predictive variables. The ease of implementation of machine learning algorithms, together with objectively validated reliability, brings new possibilities for cost reduction in the health care system.
    Keywords: Machine learning; Logistic regression; Risk of re-hospitalisation; Healthcare costs
    JEL: I10 C52
    Date: 2017
  16. By: Aysit Tansel (Department of Economics, Middle East Technical University, IZA (Germany) and ERF (Egypt)); Halil Ibrahim Keskin (Department of Econometrics, Cukurova University)
    Abstract: The strong relationship between various health indicators and education is widely documented. However, the studies that investigate the nature of causality between these variables became available only recently and provide evidence mostly from developed countries. We add to this literature by studying the causal effect of education on days hospitalized and days out of work for health reasons. We consider two educational reforms. One is the educational expansion of the early 1960s and the other is the 1997 increase in compulsory level of schooling from five to eight years. However, due to the possibility of weak instruments we do not further pursue this avenue. We focus on individuals in two cohorts namely, 1945-1965 which is an older cohort and 1980-1980 which is a younger cohort. We estimate Tobit models as well as Double Hurdle models. The results suggest that an increase in years of education causes to reduce the number of days hospitalized for both men and women unambiguously and the number of days out of work only for men while an increase in education increases the number of days out of work for a randomly selected women.
    Keywords: Education, Days hospitalized, Days out of work, Education reform, Tobit model, Double Hurdle model, Gender, Turkey.
    JEL: I15 J16 J18 C34 C36
    Date: 2017–12
  17. By: Hafner, Lucas; Tauchmann, Harald; Wübker, Ansgar
    Abstract: This paper analyzes whether moderate weight reduction improves subjective health perception in obese individuals. To cure possible endogeneity bias in the regression analysis, we use randomized monetary weight loss incentives as instrument for weight change. In contrast to related earlier work that also employed instrumental variables estimation, identification does not rely on long-term, between-individuals weight variation, but on short-term, within-individual weight variation. This allows for identifying short-term effects of moderate reductions in body weight on subjective health. In qualitative terms, our results are in line with previous findings pointing to weight loss in obese individuals resulting in improved subjective health. Yet, in contrast to these, we establish genuine short-term effects. This finding may encourage obese individuals in their weight loss attempts, since they are likely to be immediately rewarded for their efforts by subjective health improvements.
    Keywords: Self-rated health,BMI,obesity,randomized experiment,short-term effect,instrumental variable
    JEL: I12 C26 C93
    Date: 2017
  18. By: Hentschker, Corinna; Mennicken, Roman; Reifferscheid, Antonius; Wasem, Jürgen; Wübker, Ansgar
    Abstract: This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector. We use a full sample of administrative data from the unselected, complete German hospital population for the years 2005 to 2007. We apply regression methods to analyze the association between volume and hospital quality. We measure hospital quality with a binary variable, which indicates whether the patient has died in hospital. Using simulation techniques we examine the impact of the minimum volume regulations on the accessibility of hospital services. We find a highly significant negative relationship between case volume and mortality for complex interventions at the pancreas and oesophagus as well as for knee replacement. For liver, kidney and stem cell transplantation as well as for CABG we could not find a strong association between volume and quality. Access to hospital care is only moderately affected by minimum volume regulations. The effectiveness of minimum volume regulations depends on the type of intervention. Depending on the type of intervention, quality gains can be expected at the cost of slightly decreased access to care.
    Keywords: Volume,hospital quality,mortality,access to care
    JEL: I12 I18
    Date: 2017
  19. By: Augurzky, Boris; Bünnings, Christian; Wübker, Ansgar
    Abstract: In this study we investigate the relationship between nursing staffing levels and hospital quality in Germany. We use administrative data from almost all German hospitals from 2002 to 2013 and link it to mortality rates and patient satisfaction measures. To analyze the association between nursing staffing levels and hospital quality indicators empirically, we estimate linear regression models and control for a wide range of hospital and patient characteristics that might bias the results. In addition, we exploit the longitudinal structure of the data and rule out potential bias due to time-invariant unobserved heterogeneity. The estimation results indicate a positive relationship between nurse staffing levels and hospital quality for both subjective and objective quality measures. Increasing nurse staffing levels by 10 percent reduces the mortality rate by 0.05 percent and increases patient satisfaction by around 0.7 percent, on average. Although we find some of these relationships to be statistically significant, at least marginally, the absolute magnitudes of the estimated coefficients are rather small.
    Keywords: Hospital quality,nurse staffing,patient satisfaction,mortality rate
    JEL: C23 I11 I18
    Date: 2017
  20. By: Hoa Thi Minh Nguyen; Roslyb I Hickson; Tom Kompas; Geoffery N. Mercer; Kamalini M. Lokuge
    Abstract: Although tuberculosis is a major cause of morbidity and mortality worldwide, available funding falls far short of that required for effective control. Economic and spillover consequences of investments in the treatment of tuberculosis are unclear, particularly when steep gradients in the disease and response are linked by population movements, such as that between Papua New Guinea (PNG) and the Australian cross-border region. Objective: This paper undertakes an economic evaluation of Australian support for the expansion of basic directly observed treatment, or short-course DOTS, in the PNG border area of the South Fly from the current level of 14 per cent coverage. Methods: Both cost-utility and cost-benefit analysis is applied to models that allow for population movement across regions with different characteristics of tuberculosis burden, transmission and access to treatment. Data sources: Cost-benefit data are drawn primarily from estimates published by the WHO, and disease transmission data from a previously published model. Results: Investing $16 million to increase basic DOTS coverage in the South Fly generates a net present value of roughly $74 million for Australia (discounted 2005 dollars). The cost per DALY averted and QALY saved for PNG is $7 and $4.6, respectively. Conclusions: Where regions with major disparities in tuberculosis burden and health system resourcing are connected through population movements, investments in tuberculosis control is of mutual benefit, resulting in net health and economic gains on both sides of the border. These findings are likely to inform the case for appropriate investment in tuberculosis control globally.
    Keywords: Australia, cost-benefit analysis, cost-utility analysis, DOTS, metapopulation model, PNG, tuberculosis control
    Date: 2017–09
  21. By: M.G.Garner; I.J.East; P.V.Ha; S.E.Roche; H.T.M. Nguyen
    Abstract: This study aimed to evaluate strategies to enhance the early detection of foot and mouth disease incursions in Australia. Two strategies were considered. First, improving the performance of the current passive surveillance system. Second, supplementing the current passive system with active surveillance strategies based on testing animals at sale yards or through bulk milk testing of dairy herds. Simulation modelling estimated the impact of producer education and awareness by either increasing the daily probability that a farmer will report the presence of diseased animals or by reducing the proportion of the herd showing clinical signs required to trigger a disease report. Both increasing the probability of reporting and reducing the proportion of animals showing clinical signs resulted in incremental decreases in the time to detection, the size and the duration of the outbreak. A gold standard system in which all producers reported the presence of disease once 10% of the herd showed clinical signs reduced the median time to detection of the outbreak from 20 to 15 days, the duration of the subsequent outbreak from 53 to 42 days and the number of infected farms from 46 to 32. Bulk milk testing reduced the median time to detection by two days and the number of infected farms by six but had no impact on the duration of the outbreak. Screening of animals at sale yards provided no improvement over the current passive surveillance system alone while having significant resource issues. It is concluded that the most effective way to achieve early detection of incursions of foot and mouth disease into Victoria, Australia is to invest in improving producer reporting.
    Keywords: Foot and mouth disease, Surveillance, Early detection, Simulation modelling
    Date: 2017–09
  22. By: Alexander, Diane (Federal Reserve Bank of Chicago); Currie, Janet (Princeton University); Schnell, Molly (Princeton University)
    Abstract: Retail clinics are an innovation that has the potential to improve competition in health care markets. We use the universe of emergency room (ER) visits in New Jersey from 2006-2014 to examine the impact of retail clinics on ER usage. We find significant effects of retail clinics on ER visits for both minor and preventable conditions; Residents residing close to an open clinic are 4.1-12.3 percent less likely to use an ER for these conditions. Our estimates suggest annual cost savings from reduced ER usage of over $70 million if retail clinics were made readily available across New Jersey.
    Keywords: Clinics; hospital emergency services; health
    JEL: I11
    Date: 2017–09–08
  23. By: Abrigo, Michael R.M.; Paqueo, Vicente B.
    Abstract: The Philippines recently introduced two distinct but related large-scale social protection programs that, first, provides conditional cash transfers (CCT) to poor households, and, second, automatically enrolls them into the government's social health insurance program. This has resulted to dramatic increase in health insurance coverage, especially among the poor. In this paper, we empirically assess the joint impact of the two programs on the health-care demand for children. Overall, we find encouraging impacts of social protection on the demand for health-care services. While we find no direct impact on morbidity, our results suggest that the social health insurance and the CCT program jointly were able to induce greater hospital visits for both preventive and curative care, and lower out-of-pocket expenditures. However, we also document possible leakages in the government's programs, as well as potential indication of health-care service differentiation based on quality. Both these concerns may undermine the expected outcomes of the country's social protection programs.
    Keywords: Philippines, social health insurance, CCT, social protection, conditional cash transfer
    Date: 2017
  24. By: Abrigo, Michael R.M.
    Abstract: The impact of sex education on various behavioral outcomes has been well studied in the literature. However, these studies fail to account for the simultaneity between knowledge demand and sexual behavior, leading to inconsistent effect estimates using simple comparison of means from randomized control interventions. A theoretical model of sexual behavior and sexually transmitted infection (STI) information demand is proposed to motivate the discussion. We show that the effect of STI knowledge on sexual behavior depends on how information affects the expected cost from sexual activity. We provide empirical evidence using Philippine data that increasing HIV/AIDS knowledge delays sexual initiation, limits sexual activity, and increases condom use among some subpopulation of female young adults.
    Keywords: Philippines, health behavior, sex education
    Date: 2017
  25. By: Fazili, Sameera (Federal Reserve Bank of Atlanta)
    Abstract: The two sectors of community development and health have long worked in the same neighborhoods, but they have not always worked together. This is starting to change, due in part to a growing recognition among health experts of the social, economic, and environmental factors that drive health outcomes. These social determinants of health have become the basis for new collaborations between community development and health professionals. This paper introduces professionals in both sectors to this emerging area of practice through a series of case studies of innovators in the southeastern United States. Case studies look at ways to bring housing and health professionals together, opportunities to leverage community development finance tools, and efforts to use Pay for Success to improve Medicaid spending. This discussion paper reviews early lessons on how to build a successful health and community development partnership, including an examination of the incentives for community developers, health professionals, state and local governments, and philanthropy to participate in these collaborations.
    Keywords: social determinants of health; affordable housing; health and housing; community development financial institutions; Medicaid
    JEL: I11 I14 L31 P46 R51 Z18
    Date: 2017–12–01
  26. By: Antoine Goujard
    Abstract: France’s health-care system offers high-quality care. Average health outcomes are good, public satisfaction with the health-care system is high, and average household out-of-pocket expenditures are low. As in other OECD countries, technology is expanding possibilities for life extension and quality, and spending is rising steadily, while an ageing population requires substantially more and different services. The main challenges are to promote prevention and cost-efficient behaviour by care providers, tackle the high spending on pharmaceuticals, strengthen the role of health insurers as purchasing agents and secure cost containment. Good-quality information and appropriate financing schemes would ensure stronger efficiency incentives. Disparities of coverage across social groups and health services suggest paying greater attention to co-ordination between statutory and complementary insurance provision. Ongoing reforms to improve prevention and co-ordination among care providers are steps in the right direction. However, progress in the development of capitation-based payment schemes, which can reduce the incentives to increase the number of medical acts and encourage health professionals to spend more time with their patients, and performance-based payment schemes in primary care need to be stepped up to respond to the increasing prevalence of chronic diseases and curb supplier-induced demand and social disparities in access to care.
    Keywords: ageing, fee-for-services, France, generics, health care system, health disparities, health insurance, health policy, health practitioners, healthcare coordination, hospital, medical demography, pharmaceutical expenditures, prevention, primary healthcare
    JEL: I11 I12 I13 I15 I18
    Date: 2018–01–10
  27. By: Mikel Casares (Departamento de Economía-UPNA); Sandra Miñes (UPNA)
    Abstract: While life expectancy has increased worldwide during the last decades, the developing world is still losing millions of lives each year due to three pervasive illnesses: Malaria, HIV and Chronic Malnutrition. This work analyzes the observed trade-offs between health investments on these three conditions and their incidence in Ghana and Nigeria during the period 2005-2015. We use data from the OCDE credit report system database together with data on incidence from the World Health Organization, World Bank, Global Fund and the Bill and Melinda Gates Foundation. Results of the cross-data analysis show that: (i) the largest investments go to HIV in both countries, (ii) both malaria and HIV receive investments much larger than those directed to malnutrition, even when the incidence of chronic malnutrition is larger (Ghana), (iii) investments in malaria are larger in Ghana than in Nigeria despite that malaria incidence is higher in Nigeria, and (iv) the Southern states of both countries receive larger health investments in detriment of the poorest Northern areas. We identify and discuss several factors that may explain the mismatch between health funds and incidence for these conditions as well as the apparently low investments in chronic malnutrition in comparison to HIV and Malaria.
    Keywords: HIV/AIDS, Malaria, Malnutrition, health investments, trade-offs
    Date: 2017
  28. By: Einmahl, Jesson; Einmahl, John (Tilburg University, Center For Economic Research); de Haan, L.F.M. (Tilburg University, Center For Economic Research)
    Abstract: There is no scientific consensus on the fundamental question whether the probability distribution of the human life span has a finite endpoint or not and, if so, whether this upper limit changes over time. Our study uses a unique dataset of the ages at death - in days - of all (about 285,000) Dutch residents, born in the Netherlands, who died in the years 1986-2015 at a minimum age of 92 years and is based on extreme value theory, the coherent approach to research problems of this type. Unlike some other studies we base our analysis on the conguration of thousands of mortality data of old people, not just the few oldest old. We find compelling statistical evidence that there is indeed an upper limit to the life span of men and to that of women for all the 30 years we consider and, moreover, that there are no indications of trends in these upper limits over the last 30 years, despite the fact that the number of people reaching high age (say 95 years) was almost tripling. We also present estimates for the endpoints, for the force of mortality at very high age, and for the so-called perseverance parameter.
    Keywords: aging; endpoint; extreme value indez; oldest; statistics of extremes
    JEL: C12 C13 C14
    Date: 2017
  29. By: Bénédicte H. Apouey (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics); Cahit Guven (Deakin University - Minister for Innovation, Industry, Science and Research); Claudia Senik (PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, UP4 - Université Paris-Sorbonne)
    Abstract: Do people form correct expectations about the impact of retirement on their health? This paper looks at unexpected health shocks that hit people after they retire. Using data from the Household, Income and Labour Dynamics in Australia survey (waves 2001-2014), we construct measures of unexpected health shocks for each year, using information on respondents’ views about the expected and past evolution of their health status. By definition, unexpected health shocks are immune to the problem of reverse causality (running from health condition to retirement). Our findings indicate that retirement increases the likelihood of positive health shocks and decreases the probability of negative shocks for men, with no clear results for women. These shocks are mirrored by variations in life satisfaction of the same nature (e.g. increased life satisfaction in case of unexpected positive health shocks). Other indicators of mental and physical health taken from the SF-36 vary in the same way, i.e. improve unexpectedly after retirement for men. These findings suggest that, at least in the case of men, people’s desire to retire may not be based on perfectly correct expectations about the impact of this move, but is aligned with its actual consequence: retirement exerts a positive causal impact on health.
    Keywords: Australia,HILDA,Health,Retirement,Health Shocks,Life Satisfaction
    Date: 2017–12
  30. By: Kara Contreary; Jennifer Tennant; Yonatan Ben-Shalom
    Abstract: In this article, we use data from the Current Population Survey (CPS) Veterans Supplement to estimate the impacts of the change in the VA PTSD rule on DC benefit receipt and self-reported cognitive disability.
    Keywords: mental health, policy, veterans, disability
    JEL: I J

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