nep-hea New Economics Papers
on Health Economics
Issue of 2018‒01‒29
eighteen papers chosen by
Yong Yin
SUNY at Buffalo

  1. The expected and unexpected benefits of dispensing the exact number of pills By Carole Treibich; Sabine Lescher; Luis Sagaon-Teyssier; Bruno Ventelou
  2. Identifying Sources of Inefficiency in Health Care By Amitabh Chandra; Douglas O. Staiger
  3. Evolution of the Infant Health Production Function By Hope Corman; Dhaval M. Dave; Nancy E. Reichman
  4. Leveraging Diverse Data Sources to Identify and Describe U.S. Health Care Delivery Systems By Genna R. Cohen; David J. Jones; Jessica Heeringa; Kirsten Barrett; Michael F. Furukawa; Dan Miller; Anne Mutti; James D. Reschovsky; Rachel Machta; Stephen M. Shortell; Taressa Fraze; Eugene Rich
  5. Health Practices of Children and Women with Disabilities By Reyes, Celia M.; Reyes, Charina Cecille M.; Arboneda, Arkin A.
  6. For Better or Worse? The Effects of Physical Education on Child Development By Knaus, Michael C.; Lechner, Michael; Reimers, Anne K.
  7. Economic and Health Impacts of the 2011 Post-Electoral Crisis in Côte d?Ivoire: Evidence from Microdata By TENIKUE Michel; TEQUAME Miron
  8. Evaluating Willingness to Pay as a Measure of the Impact of Dyslexia in Adults By Daniel Herrera-Araujo; Bennett A. Shaywitz; John M. Holahan; Karen E. Marchione; Reissa Michaels; Sally E. Shaywitz; James K. Hammitt
  9. Availability Model of a PHM-Equipped Component By Michele Compare; Luca Bellani; Enrico Zio
  10. The Lasting Legacy of Seasonal Influenza: In-Utero Exposure and Labor Market Outcomes By Schwandt, Hannes
  11. Commuting and Sickness Absence By Laszlo Goerke; Olga Lorenz
  12. The Global Health Networks: A Comparative Analysis of Tuberculosis, Malaria and Pneumonia Using Social Media Data By Milena Lopreite; Michelangelo Puliga; Massimo Riccaboni
  13. Selective mortality and undernutrition in low- and middle-income countries By Kenneth Harttgen; Stefan Lang; Johannes Seiler
  14. Unmet healthcare needs in Ireland By Connolly, Sheelah; Wren, Maev-Ann
  15. Regional Purchasing Groups and Hospital Medicine Prices: Evidence from Group Creations By Léa Toulemon
  16. The Mortality Effects of Retirement: Evidence from Social Security Eligibility at Age 62 By Maria D. Fitzpatrick; Timothy J. Moore
  17. Incentivizing Better Quality of Care: The Role of Medicaid and Competition in the Nursing Home Industry By Martin B. Hackmann
  18. A Mortality Model for Multi-populations A Semi-Parametric Approach By Lei Fang; Wolfgang K. Härdle; Juhyun Park

  1. By: Carole Treibich (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique - ECM - Ecole Centrale de Marseille); Sabine Lescher (SESSTIM - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - ORS PACA - INSERM - Institut National de la Santé et de la Recherche Médicale); Luis Sagaon-Teyssier (SESSTIM - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - ORS PACA - INSERM - Institut National de la Santé et de la Recherche Médicale); Bruno Ventelou (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique - ECM - Ecole Centrale de Marseille, ORS PACA)
    Abstract: BACKGROUND: From November 2014 to November 2015, an experiment in French community pharmacies replaced traditional pre-packed boxes by per-unit dispensing of pills in the exact numbers prescribed, for 14 antibiotics. METHODS: A cluster randomised control trial was carried out in 100 pharmacies. 75 pharmacies counted out the medication by units (experimental group), the other 25 providing the treatment in the existing pharmaceutical company boxes (control group). Data on patients under the two arms were compared to assess the environmental, economic and health effects of this change in drug dispensing. In particular, adherence was measured indirectly by comparing the number of pills left at the end of the prescribed treatment. RESULTS: Out of the 1185 patients included during 3 sessions of 4 consecutive weeks each, 907 patients experimented the personalized delivery and 278 were assigned to the control group, consistent with a 1/3 randomization-rate at the pharmacy level. 80% of eligible patients approved of the per-unit dispensing of their treatment. The initial packaging of the drugs did not match with the prescription in 60% of cases and per-unit dispensing reduced by 10% the number of pills supplied. 13.1% of patients declared that they threw away pills residuals instead of recycling-no differences between groups. Finally, per-unit dispensing appeared to improve adherence to antibiotic treatment (marginal effect 0.21, IC 95, 0.14-0.28). CONCLUSIONS: Supplying antibiotics per unit is not only beneficial in terms of a reduced number of pills to reimburse or for the environment (less pills wasted and non-recycled), but also has a positive and unexpected impact on adherence to treatment, and thus on both individual and public health
    Date: 2017–09–19
  2. By: Amitabh Chandra; Douglas O. Staiger
    Abstract: In medicine, the reasons for variation in treatment rates across hospitals serving similar patients are not well understood. Some interpret this variation as unwarranted, and push standardization of care as a way of reducing allocative inefficiency. However, an alternative interpretation is that hospitals with greater expertise in a treatment use it more because of their comparative advantage, suggesting that standardization is misguided. We develop a simple economic model that provides an empirical framework to separate these explanations. Estimating this model with data on treatments for heart attack patients, we find evidence of substantial variation across hospitals in both allocative inefficiency and comparative advantage, with most hospitals overusing treatment in part because of incorrect beliefs about their comparative advantage. A stylized welfare-calculation suggests that eliminating allocative inefficiency would increase the total benefits from this treatment by about a third.
    JEL: I1 I3
    Date: 2017–11
  3. By: Hope Corman; Dhaval M. Dave; Nancy E. Reichman
    Abstract: Michael Grossman’s seminal publication on the demand for health and health production (Grossman 1972) has spawned a substantial body of research focusing on the production of infant health. This article provides a systematic review of the published literature to date on infant health production and how it has evolved over the past 3-4 decades as data have become more available, computing has improved, and econometric methods have become more sophisticated. While empirical research in most fields has expanded in corresponding ways, the infant health production research has become an important part of the broader and inherently multidisciplinary literature on intergenerational health. The strongest and most robust findings are that policies matter for infant health, particularly those affecting access to health care, and that prenatal smoking and other chemical exposures substantially compromise infant health. Promising directions for future research include elucidating relevant pathways, reconciling the largely inconsistent estimated effects of nutrition and education, and exploring the roles of pre-conceptional and lifetime health care, paternal factors, social support, housing, complementarity and substitutability of inputs, factors that modify effects of inputs, and evolving medical technologies.
    JEL: I1
    Date: 2017–12
  4. By: Genna R. Cohen; David J. Jones; Jessica Heeringa; Kirsten Barrett; Michael F. Furukawa; Dan Miller; Anne Mutti; James D. Reschovsky; Rachel Machta; Stephen M. Shortell; Taressa Fraze; Eugene Rich
    Abstract: Researchers assess available data sources to identify and describe health care delivery systems, including system members and their relationships. They summarize strengths and limitations for identifying and describing systems due to varied content, linkages across data sources, and data collection.
    Keywords: healthcare delivery systems, survey data, federal data, healthcare organizations, physicians, hospitals
    JEL: I
  5. By: Reyes, Celia M.; Reyes, Charina Cecille M.; Arboneda, Arkin A.
    Abstract: Persons with disabilities (PWDs) in the Philippines generally face several difficulties in getting hold of a much needed medical attention, including transportation and other barriers to access, and financial difficulties, among others. This study is an offshoot of the joint project of the Philippine Institute for Development Studies and the Institute of Developing Economies that focuses on the health conditions of PWDs, both adult women and children, in Mandaue City and San Remigio, Cebu, Philippines. Using primary data collected through survey and key informant interviews with various stakeholders, the study highlights the lack of access to appropriate services for PWDs and that out-of-pocket expenditures on health cover a significant portion of their income. Some recommendations include the provision of early detection and intervention, routine monitoring of programs, the expanded utilization of medical and nursing students in the communities in providing preventive care services, the expanded coverage for medications and nursing/caregiver support, and the increased training on health-care providers and personnel, particularly in the communities.
    Keywords: Philippines, health, person with disability, PWD, Cebu, Mandaue City, health practices, access to health care, San Remigio
    Date: 2017
  6. By: Knaus, Michael C. (University of St. Gallen); Lechner, Michael (University of St. Gallen); Reimers, Anne K. (Chemnitz University of Technology)
    Abstract: This study analyses the effects of regular physical education at school on cognitive skills, non-cognitive skills, motor skills, physical activity, and health. It is based on a very informative data set, the German Motorik-Modul, and identifies the effect by using variation in the required numbers of physical education lessons across and within German federal states. The results show improvements in cognitive skills. Boys' non-cognitive skills are adversely affected driven by increased peer relation problems. For girls, the results suggest improvements in motor skills and increased extra-curricular physical activities. Generally, we find no statistically significant effects on health parameters.
    Keywords: physical education, cognitive skills, non-cognitive skills, motor skills, physical activity, health
    JEL: I12
    Date: 2018–01
  7. By: TENIKUE Michel; TEQUAME Miron
    Abstract: Past studies have shown that income shocks can trigger women to embark on commercial sex. This paper studies some microeconomic effects of the Cote d?Ivoire?s political instability in 2011 after the presidential election. We use a unique dataset, collected right before and after the crisis, on individuals sampled in health centers, which, coupled with biomarkers on HIV, allows to evaluate the consequences of the conflict. We first use subjective measures of exposure to document the entity of the crisis. We then analyze the consequence of the crisis on income and consumption during and right after the crisis. We show that individuals engage in transactional sex to make up for income loss. In particular, women who are young, unmarried and without a stable source of income increased their number of sexual partners by 26% and received 44% higher amounts of transfers right after the crisis. In the same line, we also find that the incidence of HIV grew to around 1.2% for women and 0.8% for men in conflict-intensive regions.
    Keywords: HIV/AIDS; Sexual Behavior; Conflict; Income Shock
    JEL: D70 D74
    Date: 2018–01
  8. By: Daniel Herrera-Araujo (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); Bennett A. Shaywitz (Yale University School of Medicine - Yale School of Medicine); John M. Holahan (Yale University School of Medicine - Yale School of Medicine); Karen E. Marchione (Yale University School of Medicine - Yale School of Medicine); Reissa Michaels (Yale University School of Medicine - Yale School of Medicine); Sally E. Shaywitz (Yale University School of Medicine - Yale School of Medicine); James K. Hammitt (Harvard University [Cambridge], TSE - Toulouse School of Economics - Toulouse School of Economics)
    Abstract: While much is known about dyslexia in school-age children and adolescents, less is known about its effects on quality of life in adults. Using data from the Connecticut Longitudinal Study, we provide the first estimates of the monetary value of improving reading, speaking, and cognitive skills to dyslexic and nondyslexic adults. Using a stated-preference survey, we find that dyslexic and nondyslexic individuals value improvements in their skills in reading speed, reading aloud, pronunciation, memory, and information retrieval at about the same rate. Because dyslexics have lower self-reported levels on these skills, their total willingness to pay to achieve a high level of skill is substantially greater than for nondyslexics. However, dyslexic individuals’ willingness to pay (averaging $3000 for an improvement in all skills simultaneously) is small compared with the difference in earnings between dyslexic and nondyslexic adults. We estimate that dyslexic individuals earn 15% less per year (about $8000) than nondyslexic individuals. Although improvements in reading, speaking, and cognitive skills in adulthood are unlikely to eliminate the earnings difference that reflects differences in educational attainment and other factors, stated-preference estimates of the value of cognitive skills may substantially underestimate the value derived from effects on lifetime earnings and health.
    Date: 2017–07
  9. By: Michele Compare; Luca Bellani; Enrico Zio (Chaire Sciences des Systèmes et Défis Energétiques EDF/ECP/Supélec - LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec - SSEC - Chaire Sciences des Systèmes et Défis Energétiques EDF/ECP/Supélec - Ecole Centrale Paris - SUPELEC - EDF R&D - Electricité de France Recherche et Développement - CentraleSupélec, LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec, SSEC - Chaire Sciences des Systèmes et Défis Energétiques EDF/ECP/Supélec - Ecole Centrale Paris - SUPELEC - EDF R&D - Electricité de France Recherche et Développement - CentraleSupélec)
    Abstract: —A variety of prognostic and health management (PHM) algorithms have been developed in the last years and some metrics have been proposed to evaluate their performances. However , a general framework that allows us to quantify the benefit of PHM depending on these metrics is still lacking. We propose a general , time-variant, analytical model that conservatively evaluates the increase in system availability achievable when a component is equipped with a PHM system of known performance metrics. The availability model builds on metrics of literature and is applicable to different contexts. A simulated case study is presented concerning crack propagation in a mechanical component. A simplified cost model is used to compare the performance of predictive maintenance based on PHM with corrective and scheduled maintenance. Index Terms—Availability, cost-benefit analysis, Monte Carlo (MC) simulation, prognostics and health Management (PHM) metrics.
    Date: 2017–06
  10. By: Schwandt, Hannes
    Abstract: Pregnancy conditions have been shown to matter for later economic success, but many threats to fetal development that have been identified are difficult to prevent. In this paper I study seasonal influenza, a common and preventable illness that comes around every year and causes strong inflammatory responses in pregnant women. Using administrative data from Denmark, I identify the effects of maternal influenza on the exposed offspring via sibling comparison, exploiting both society-wide influenza spread and information on individual mothers who suffer strong infections during pregnancy. In the short term, maternal influenza leads to a doubling of prematurity and low birth weight, by triggering premature labor among women infected in the third trimester. Following exposed offspring into young adulthood, I observe a 9% earnings reduction and a 35% increase in welfare dependence. These long-term effects are strongest for influenza infections during the second trimester and they are partly explained by a decline in educational attainment, pointing to cognitive impairment. This effect pattern suggests that maternal influenza damages the fetus through multiple mechanisms, and much of the damage may not be visible at birth. Taken together, these results provide evidence that strong infections during pregnancy are an often overlooked prenatal threat with long-term consequences.
    Keywords: Fetal origins; labor market outcomes; seasonal influenza
    JEL: I10 J13 J24 J3
    Date: 2018–01
  11. By: Laszlo Goerke; Olga Lorenz
    Abstract: We investigate the causal effect of commuting on sickness absence from work using German panel data. To address reverse causation, we use changes in commuting distance for employees who stay with the same employer and who have the same residence during the period of observation. In contrast to previous papers, we do not observe that commuting distances are associated with higher sickness absence, in general. Only employees who commute long distances are absent about 20% more than employees with no commutes. We explore various explanations for the effect of long distance commutes to work and can find no evidence that it is due to working hours mismatch, lower work effort, reduced leisure time or differences in health status.
    Keywords: sickness absence, absenteeism, commuting, health, labour supply
    JEL: I10 J22 R2 R40
    Date: 2017
  12. By: Milena Lopreite (Scuola Superiore Sant’Anna); Michelangelo Puliga (IMT School for advanced studies); Massimo Riccaboni (IMT School for advanced studies)
    Abstract: Global health networks (GHNs) of organizations fighting major health threats represent a useful strategy to respond to the challenge of mobilizing and coordinating different types of health organizations across borders toward a common goal. In this paper we reconstruct the GHNs of malaria, tuberculosis and pneumonia by creating a new unique database of health organizations from the official Twitter accounts of each organization. We use a majority voter Multi Naive Bayes classifier to discover, among the Twitter users, the ones that represent organizations or groups active in each disease area. We perform a social network analysis (SNA) of the global health networks (GHNs) to evaluate the structure of the network and the role and performance of the organizations in each network. We find evidence that the GHN of malaria, TBC and pneumonia are different in terms of performance and leadership, geographical coverage as well as Twitter popularity. Our analysis validate the use of social media to analyze GHNs, their effectiveness and to mobilize the global community toward global sustainable development.
    Keywords: global health network; social network analysis; machine learning classifier; tuberculosis; malaria; pneumonia; policy evaluation
    JEL: I15 I18 C8
    Date: 2018–01
  13. By: Kenneth Harttgen; Stefan Lang; Johannes Seiler
    Abstract: Anthropometric indicators, in particular the height for a particular age, are found to be lowest in South Asia compared to other geopolitical regions. However, despite the close relationship between undernutrition and mortality rates, the highest mortality rates are concentrated in sub-Saharan Africa. By accounting for this survival bias, i.e. selective mortality, this discrepancy between the undernutrition rates between South Asia and sub-Saharan Africa should be expected to decrease. In addition, one can also ask whether undernutrition rates would differ without selective mortality. Using data stemming from six waves of Demographic and Health Surveys (DHS), we assess the impact of selective mortality on the anthropometric indicators for the children's height-for-age (stunting), weight-for-age (underweight), and weight-for-height (wasting) for a global sample of low and middle income countries between 1991 and 2015. Taking advantage of a matching approach, the effect of selective mortality for a cross-section of 35 developing countries is analysed. This approach allows values, originally stemming from non-deceased children, to be assigned for the otherwise non-observed anthropometric indicators of deceased children. These values are imputed under the counterfactual scenario that these deceased children would still be alive. The results are twofold: First, this approach reveals that the imputed values for deceased children for stunting, underweight, and wasting are significantly lower compared to the observed anthropometric indicators. Second, the difference between the observed anthropometric indicators, and the constructed overall anthropometric indicators are found to be only of negligible magnitude. Only assuming high mortality rates, or imputing the lower bound considered by the WHO as cutoffs for outliers, would alter the second finding.
    Keywords: Child mortality, Undernutrition, Selective Mortality, Asia, Latin America, SSA.
    JEL: I15 I32 J13
    Date: 2017–12
  14. By: Connolly, Sheelah; Wren, Maev-Ann
    Date: 2017
  15. By: Léa Toulemon (Hospinnomics (PSE - AP-HP), PSE - Paris School of Economics, Assistance Publique - Hôpitaux de Paris - Assistance publique - Hôpitaux de Paris (AP-HP))
    Abstract: This paper estimates the impact of group purchasing on medicine prices in French hospitals, taking advantage of the entry of hospitals into regional purchasing groups between 2009 and 2014. This paper uses a new database providing the average annual prices paid for all innovative and costly medicines in public hospitals. Using a fixed effects model that controls for hospitals' medicine-specific bargaining abilities and medicine-specific price trends, I find that group purchasing reduces prices of medicines in oligopoly markets, but has no impact on the prices of medicines with no competitors.
    Keywords: hospital medicine prices,purchasing groups,bargaining ability
    Date: 2017–12–08
  16. By: Maria D. Fitzpatrick; Timothy J. Moore
    Abstract: Social Security eligibility begins at age 62, and approximately one third of Americans immediately claim at that age. We examine whether age 62 is associated with a discontinuous change in aggregate mortality, a key measure of population health. Using mortality data that covers the entire U.S. population and includes exact dates of birth and death, we document a robust two percent increase in male mortality immediately after age 62. The change in female mortality is smaller and imprecisely estimated. Additional analysis suggests that the increase in male mortality is connected to retirement from the labor force and associated lifestyle changes.
    JEL: H55 J14 J26
    Date: 2017–12
  17. By: Martin B. Hackmann
    Abstract: This paper develops a model of the nursing home industry to investigate the quality effects of policies that either raise regulated reimbursement rates or increase local competition. Using data from Pennsylvania, I estimate the parameters of the model. The findings indicate that nursing homes increase the quality of care, measured by the number of skilled nurses per resident, by 8.8% following a universal 10% increase in Medicaid reimbursement rates. In contrast, I find that pro-competitive policies lead to only small increases in skilled nurse staffing ratios, suggesting that Medicaid increases are more cost effective in raising the quality of care.
    JEL: I11 I18 L13
    Date: 2017–12
  18. By: Lei Fang; Wolfgang K. Härdle; Juhyun Park
    Abstract: Mortality is different across countries, states and regions. Several empirical research works however reveal that mortality trends exhibit a common pattern and show similar structures across populations. The key element in analyzing mortality rate is a time-varying indicator curve. Our main interest lies in validating the existence of the common trends among these curves, the similar gender differences and their variability in location among the curves at the national level. Motivated by the empirical findings, we make the study of estimating and forecasting mortality rates based on a semi-parametric approach, which is applied to multiple curves with the shape-related nonlinear variation. This approach allows us to capture the common features contained in the curve functions and meanwhile provides the possibility to characterize the nonlinear variation via a few deviation parameters. These parameters carry an instructive summary of the time-varying curve functions and can be further used to make a suggestive forecast analysis for countries with barren data sets. In this research the model is illustrated with mortality rates of Japan and China, and extended to incorporate more countries. All numerical procedures are transparent and reproduced on
    Keywords: Nonparametric smoothing, Parametric modeling, Common trend, Mortality,; Lee-Carter method, Multi-populations
    JEL: C14 C32 C38 J11 J13
    Date: 2016–03

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