nep-hea New Economics Papers
on Health Economics
Issue of 2018‒02‒05
27 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Using Simulation and Six-Sigma Tools in Improving Process Flow in Outpatient Clinics By Heidarzadeh, Elham; Sajadnia, Sahar
  2. Reasons for unmet needs for health care: the role of social capital and social support in some Western EU countries By Fiorillo, Damiano
  3. Usage-driven problem design for radical innovation in healthcare By Guillaume Lamé; Bernard Yannou; François Cluzel
  4. Direct medical costs associated with the extrahepatic manifestations of hepatitis C virus infection in France By Patrice Cacoub; Mathieu Vautier; A. C. Desbois; David Saadoun; Zobair Younossi
  5. Importance Degree of eHRM and its Impact on Various Administrative Levels in Palestinian Universities By Mazen J. Al Shobaki; Samy S. Abu Naser; Youssef M. Abu Amuna; Suliman A. El Talla
  6. Does moderate weight loss affect subjective health perception in obese individuals? Evidence from field experimental data By Hafner, Lucas; Tauchmann, Harald; Wübker, Ansgar
  7. Medical progress, demand for health care, and economic performance By Frankovic, Ivan; Kuhn, Michael; Wrzaczek, Stefan
  8. The International Epidemiological Transition and the Education Gender Gap By Klasing, Mariko J.; Milionis, Petros
  9. How does childhood obesity affect school achievement? Contributions from a qualitative analysis implemented in Mexico City. By Pierre Levasseur; Luis Ortiz-Hernandez
  10. Why Has U.S. Life Expectancy Fallen Below Other Countries? By Anqi Chen; Alicia H. Munnell; Geoffrey T. Sanzenbacher; Alice Zulkarnain
  11. Reputations count: why benchmarking performance is improving health care across the world By Bevan, Gwyn; Evans, Alice
  12. Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes By Roberts, Samantha; Barry, Eleanor; Craig, Dawn; Airoldi, Mara; Bevan, Gwyn; Greenhalgh, Trisha
  13. Decentralization and Health in the Philippines: A Systematic Review of Empirical Evidences By Ortiz, Danica Aisa P.; Abrigo, Michael R.M.; Tam, Zhandra C.
  14. Social tenants’ health: evaluating the effectiveness of landlord interventions By Cheshire, Paul; Gibbons, Stephen; Mouland, Jemma
  15. Do speed cameras save lives? By Tang, Cheng Keat
  16. Wealth Shocks and Health Outcomes: Evidence from Stock Market Fluctuations By Schwandt, Hannes
  17. Backtesting the Lee-Carter and the Cairns-Blake-Dowd Stochastic Mortality Models on Italian Death Rates By Carlo Maccheroni; Samuel Nocito
  18. Preventives Versus Treatments Redux: Tighter Bounds on Distortions in Innovation Incentives with an Application to the Global Demand for HIV Pharmaceuticals By Michael Kremer; Christopher M. Snyder
  19. Socioeconomic determinants and health care utilization among elderly people living in Europe: Evidence from the Survey of Health, Ageing and Retirement. By David Cantarero-Prieto; Marta Pascual-Sáez; Javier Lera Torres
  20. Awareness about Diabetes Risk Factors and Prevention Strategies among Women of Punjab By Kansra, Dr. Pooja
  21. Assessing Hospital Performance in Indonesia: An Application of Frontier Analysis Techniques By Firdaus Hafidz; Tim Ensor; Sandy Tubeuf
  22. Missing Twins: Fetal Origins, Institutions, and Twin-singleton Mortality Convergence By PONGOU Roland; SHAPIRO David; TENIKUE Michel
  23. Does Sick Pay Affect Workplace Absence? By Bryson, Alex; Dale-Olsen, Harald
  24. Socioemotional Skills, Education, and Health-Related Outcomes of High-Ability Individuals By Savelyev, Peter A.; Tan, Kegon T.K.
  25. Price Discrimination in the Italian Medical Device Industry: An Empirical Analysis By Alberto Cavaliere; Giovanni Crea; Angelo Cozzi
  26. Implementing Electronic Health Record Default Settings to Reduce Opioid Overprescribing: A Pilot Study By Kara Zivin; Jessica O. White; Sandra Chao; Anna L. Christensen; Luke Horner; Dana M. Petersen; Morgan R. Hobbs; Grace Capreol; Kevin A. Halbritter; Christopher M. Jones
  27. Did the ACA's Dependent Coverage Mandate Reduce Financial Distress for Young Adults? By Blascak, Nathan; Mikhed, Vyacheslav

  1. By: Heidarzadeh, Elham; Sajadnia, Sahar
    Abstract: It is apparent that outpatient clinics are becoming complex and need to be optimized and improved on a daily basis. In this project, we used several methods including discrete event simulation, quality function deployment (QFD), and failure modes and effects analysis (FMEA) to optimize and improve these clinics. We conducted this study at a major suburban outpatient clinic to propose main recommendations which most likely apply to a vast majority of such clinics. Firstly, the simulation-based modeling that we ran assisted us in recognizing optimum staff number which would result in decreasing waiting times that patients usually spend and making the process flow at the facility smoother. Secondly, QFD approach for analyzing outpatient clinic requirement is also proposed and realized through a case study. It is realized that the proposed approach can adjust service quality toward customer requirements effectively. Lastly, the health care failure modes and effects analysis (FMEA) that we implemented as a novel method to discover conditions and active failures and to prioritize these based on the potential severity of risks associated with them.
    Keywords: Outpatient clinic, discrete event simulation, quality function deployment (QFD), failure modes and effects analysis (FMEA)
    JEL: C8 C83 L8 L80
    Date: 2017–10–31
  2. By: Fiorillo, Damiano
    Abstract: The paper focus on the patient-side factors that determine access to health care and analyzes the issues of unmet needs and reasons for unmet needs for health care in Western EU countries. The paper has two main objectives: first, to study the determinants of unmet health care needs (UN) with a particular hub on social capital and social support; second, to analyze whether social capital and social support are predictors of the reasons for unmet needs (RUN). A probit model is estimated from the whole population sample accounting for the possibility of individual selection in unmet needs for health care (UN) (selection equation). Then expanded probit models (including inverse Mills ratio) are used on the reasons for unmet needs (RUN) with social capital and social support as determinants and using the European Union Statistics on Income and Living Conditions (EU-SILC) dataset carried out in 2006. In UN equation, results indicate higher unmet health care needs for younger, people with tertiary education, low economic situation, unemployed and in poor health status. Moreover, the frequency of visiting relatives and friends and the ability to ask for help are correlated with a lower likelihood of declaring unmet needs, instead volunteering and participation in formal organizations present a higher probability of not visiting a doctor when needed. In RUN equations, findings show that female, large households, people with low economic situation and financial constraints, unemployed and in poor health status have a higher probability of declaring unmet needs due to economic costs. Additionally, people with tertiary education, high income and employed have a higher probability of not visiting a doctor when needed due to time availability. Furthermore, the frequency of contact with friends and the ability to ask for help are related with a lower probability of unmet needs due to economic costs, while the frequency of contact with relatives is related with a lower probability of unmet needs due to time availability and distance. However, the ability to ask for help is also correlated with a higher probability of not having medical care due to time availability and wait and see.
    Keywords: Unmet needs for healthcare, reasons for unmet needs, social capital, social support, EU Western countries, EU-SILC data, Heckman selection model
    JEL: C35 I12 I18 Z1
    Date: 2017–11
  3. By: Guillaume Lamé (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); Bernard Yannou (Ingénierie de la conception - Design Engineering - LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec, LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec); François Cluzel (LGI - Laboratoire Génie Industriel - EA 2606 - CentraleSupélec)
    Abstract: Lamé, Guillaume, Bernard Yannou, and François Cluzel. 2017. "Usage-driven problem design for radical innovation in healthcare." BMJ Innovations (in press). ABSTRACT Whilst the diffusion and evaluation of healthcare innovations receive a lot of attention, the early design stages are less studied and potential innovators lack methods to identify where new innovations are necessary and to propose concepts relevant to users. To change this, we propose a structured methodology, Radical Innovation Design ® (RID), which supports designers who want to work on the unstated needs of potential end-users in order to create superior value. In this article, the first part of RID is introduced with its two sub-processes: Problem Design and Knowledge Design. In this first period, RID guides innovators to systematically explore users' problems and evaluate which ones are most pressing in terms of innovation, taking into account existing solutions. The result is an ambition perimeter, composed of a set of value buckets, i.e. important usage situations where major problems are experienced and the current solutions provide little or no relief. The methodology then moves on to Solution Design and Business Design (which are not detailed in this paper) to address the value buckets identified. With its emphasis on problem exploration, RID differs from methods based on early prototyping. The RID methodology has been validated in various industrial sectors, and is well-adapted for healthcare innovation. To exemplify the methodology, we present a case study in dental imagery performed by ten students in 8 weeks. This example demonstrates how RID favors efficiency in Problem Design and allows designers to explore unaddressed and sometimes undeclared user needs. KEYWORDS Innovation methodology; Problem definition; Value bucket; Front end of innovation; Need-seeker innovation. Lamé, Guillaume, Bernard Yannou, and François Cluzel. 2017. "Usage-driven problem design for radical innovation in healthcare." BMJ Innovations (in press).
    Date: 2017
  4. By: Patrice Cacoub (I3 - Immunologie - Immunopathologie - Immunothérapie - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique); Mathieu Vautier (I3 - Immunologie - Immunopathologie - Immunothérapie - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique); A. C. Desbois (Service de médecine interne et d'immunologie clinique [CHU Pitié-Salpêtrière] - Assistance publique - Hôpitaux de Paris (AP-HP) - CHU Pitié-Salpêtrière [APHP], I3 - Immunologie - Immunopathologie - Immunothérapie - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique); David Saadoun (I3 - Immunologie - Immunopathologie - Immunothérapie - UPMC - Université Pierre et Marie Curie - Paris 6 - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique); Zobair Younossi (Inova Fairfax Hospital - Center for Integrated Research)
    Abstract: Background: The economic impact of extrahepatic manifestations of hepatitis C virus (HCV) infection remains unknown for France. Aim: To estimate the prevalence of extrahepatic manifestations of HCV and the direct medical costs associated with them. Methods: Estimates of 13 extrahepatic manifestations prevalence were obtained from (1) a retrospective data analysis of HCV-infected patients in a specialised centre and the baseline prevalence in the general French population and (2) an international systematic review. Per-patient-per-year costs to treat these manifestations were obtained from the literature, national databases or expert opinion. The impact of achieving HCV cure after anti-viral therapy was applied to the French healthcare costs. Results: Using approach (1), increased prevalence rates in HCV patients compared to the general population were observed for most extrahepatic manifestations. The mean per-patient-per-year cost of these manifestations in the tertiary centre was 3296 € [95% CI 1829; 5540]. In France, HCV-extrahepatic manifestations amounted to a total cost of 215 million (M) € per year [144; 299]. Using approach (2), the mean per-patient-per-year cost was estimated to be 1117 €. The estimated total cost reduction in France associated with HCV cure was 13.9 M€ for diabetes, 8.6 M€ for cryoglobulinemia vasculitis, 6.7 M€ for myocardial infarction, 2.4 M€ for end-stage renal disease and 1.4 M€ for stroke. Conclusion: Extrahepatic manifestations of HCV infection substantially add to the overall economic burden of the disease in France. HCV cure after anti-viral therapy is expected to significantly reduce the total costs of managing these manifestations in France.
    Date: 2017
  5. By: Mazen J. Al Shobaki (Department of Information Technology - Al-Azhar University); Samy S. Abu Naser (Department of Information Technology - Al-Azhar University); Youssef M. Abu Amuna (Department of Information Technology - Al-Azhar University); Suliman A. El Talla
    Abstract: This study aims to identify the degree of importance of human resources management electronically and its impact on the different administrative levels in the Palestinian universities. The study population consists of the different administrative levels in the universities. The number of employees reached (239). The study sample consisted of (148) individuals from the different administrative levels and (35) from IT centers. The response rate was (84.31%). The researchers used the questionnaire as a tool for study and the analytical descriptive approach to achieve the objectives of the study. The SPSS program was used to analyze the study data. The results of the study showed that the clarity of the importance of human resources management electronically and the support of senior management are available and contribute greatly to the process of transition to electronic management in general and e-HRM in particular. There is clarity in the sample of the study of the importance of human resources management electronically, fully aware of their multiple benefits, this greatly helps to adopt and develop e-HRM and the development of the members of the study from the higher administrative levels and those who influence decision-making. The University's system of human resources management varies in different ways from one university to another and has a significant impact on human resources management electronically, and researchers explain this difference due to the different priorities of universities and their development plans and their material and human resources. The concept of e-management is a broad concept, encompassing several different electronic systems, and the transition to it requires extensive changes, from organizational structure to business processes. The most important electronic management systems that universities develop according to their need are electronic human resources systems. Universities also provide different means of communication with their employees using various ICT means such as e-mail and SMS. The use of e-HR forms is still very limited and greatly reduces e-HRM benefits. Self-service systems are not interrelated with pay and pay systems and researchers explain this because e-HRM systems are not complete at universities. Universities follow a strategy of combining traditional and electronic business, a positive indicator of the transition to e-management. The study reached several recommendations with the aim of benefiting from the promotion of the electronic management approach. The most important of these recommendations is the establishment of official and practical approaches to electronic administration and its systems. To keep abreast of the rapid changes in electronic management and ICT tools and means. The development of the administrative structure of universities commensurate with the process of change to electronic management. E-HRM development in universities, as they have a key role to play in the success of the transition to e-management. Expand the use of electronic forms to manage the affairs of employees to take advantage of its multiple advantages such as reducing expenses and reduce the time of completion of transactions. The adoption of internal electronic correspondence instead of paper, which contributes significantly to reduce administrative financial expenses, and the speed of completion of work. The integration of computerized management information systems and the linking of what is currently fully established as the beginning of a gradual transition to electronic management. For example, the pay system can be linked to the attendance system, self-service, or performance appraisal with the pay system.
    Keywords: Palestinian universities,higher education institutions,administrative levels,Electronically Human resources management
    Date: 2017
  6. 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
  7. By: Frankovic, Ivan; Kuhn, Michael; Wrzaczek, Stefan
    Abstract: We study medical progress within an economy of overlapping generations subject to endogenous mortality. Individuals demand health care with a view to lowering mortality over their life-cycle. We characterise the individual optimum and the general equilibrium of the economy and study the impact of improvements in the effectiveness of health care. We find that general equilibrium effects dampen strongly the increase in health care usage following medical innovation. Moreover, an increase in savings offsets the negative impact on GDP per capita of a decline in the support ratio.
    Keywords: life-cycle model,longevity,health care,medical innovation,overlapping generations,value of life
    JEL: D91 I11 I12 J11 J17 O31 O41
    Date: 2017
  8. By: Klasing, Mariko J.; Milionis, Petros (Groningen University)
    Date: 2017
  9. By: Pierre Levasseur; Luis Ortiz-Hernandez
    Abstract: In order to better understand the negative causal relationships between childhood obesity and school achievement, we implement a qualitative analysis based on 29 adolescents interviewed in Mexico City. Our findings suggest the following. First, childhood obesity affects schooling outcomes through two interdependent channels: social stigmatization and loss of productivity. Second, three main mechanisms seem to be involved in the relationship. While the loss of productivity alone represents one of such mechanism, the social stigmatization of obesity passes through two mechanisms: (i) a direct social mechanism, including material aggressions and exclusion by peers, and (ii) an indirect social mechanism, referring to psycho-sociological troubles that stigmatized people express. Third, the risk of weight discrimination depends on different individual factors: age, gender, fat distribution and body-mass category.
    Keywords: Mexico; childhood obesity; school achievement; loss of productivity; social stigmatization; qualitative analysis
    JEL: I15
    Date: 2017
  10. By: Anqi Chen; Alicia H. Munnell; Geoffrey T. Sanzenbacher; Alice Zulkarnain
    Abstract: Life expectancy at age 65 in the United States and other high-income countries has increased dra­matically over the last 50 years. But progress in the United States on this key health indicator has been slower than its peers during this period, and the U.S. ranking has dropped from near the top of the group to the bottom. How long people live has significant implications not only for their well-being but also for the finances of the Social Security program. Thus, understanding the reasons for the relatively slow pace of improvement is necessary to provide some basis for future projections. This brief compares U.S. life expectancy, separately for men and women, to nine other countries in the Organization for Economic Cooperation and Devel­opment (OECD). It focuses on two factors that may have contributed to the U.S.’s relatively poor perfor­mance: smoking and obesity. This brief is the second of two on mortality; the first explored trends within the United States. The discussion proceeds as follows. The first section looks at trends in life expectancy at age 65 across countries and finds that the major source of the U.S. shortfall rests with women. The second sec­tion explores whether the shortfall could be explained by the unique aspects of the U.S. health care system and concludes that these differences probably have had little impact. The third section reports cause-of-death statistics that suggest diseases associated with smoking and obesity are the major sources of the U.S. shortfall. The fourth section compares U.S. smoking and obesity patterns to those of other countries. The fifth section isolates the impact of smoking and obe­sity on life expectancy using regression analysis. The results show that, if U.S. patterns had matched those of its peer countries, U.S. life expectancy would have exceeded the average until very recently. The final section concludes that the relative performance of U.S. life expectancy in the future depends on control­ling obesity.
    Date: 2017–12
  11. By: Bevan, Gwyn; Evans, Alice
    Abstract: This paper explores what motivates improved health care governance. Previously, many have thought that performance would either improve via choice and competition or relying on trust and altruism. But neither assumption is supported by available evidence. So instead we explore a third approach of reciprocal altruism with sanctions for unacceptably poor performance and rewards for high performance. These rewards and sanctions, however, are not monetary but in the form of reputational effects through public reporting of benchmarking of performance . Drawing on natural experiments in Italy and the UK, we illustrate how public benchmarking can improve poor performance at both the sub-national and national level through ‘naming and shaming’ and enhance good performance through ‘competitive benchmarking’ and peer learning. Ethnographic research in Zambia also showed how reputations count. Policy-makers could use these effects in different ways to improve public services.
    JEL: J50
    Date: 2018
  12. By: Roberts, Samantha; Barry, Eleanor; Craig, Dawn; Airoldi, Mara; Bevan, Gwyn; Greenhalgh, Trisha
    Abstract: Objective Explore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals. Design Systematic review of economic evaluations. Data sources and eligibility criteria Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The International Society for Pharmaco-economics and Outcomes Research’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making was used to assess study quality. Results 27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin. Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and £8428/QALY, respectively) but economic estimates varied widely between studies. Intervention-only programmes were in general more cost effective than programmes that also included a screening component. The longer the period evaluated, the more cost-effective interventions appeared. In the few studies that evaluated other economic considerations, budget impact of prevention programmes was moderate (0.13%–0.2% of total healthcare budget), financial payoffs were delayed (by 9–14 years) and impact on incident cases of diabetes was limited (0.1%–1.6% reduction). There was insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive lifestyle programmes that were tested in trials. Conclusions The economics of preventing diabetes are complex. There is some evidence that diabetes prevention programmes are cost effective, but the evidence base to date provides few clear answers regarding design of prevention programmes because of differences in denominator populations, definitions, interventions and modelling assumptions
    JEL: J50 E6
    Date: 2017–11–15
  13. By: Ortiz, Danica Aisa P.; Abrigo, Michael R.M.; Tam, Zhandra C.
    Abstract: This study provides a systematic review and summary of the extant knowledge on the impacts of decentralization on health in the Philippines. Despite the country's twenty-five years of experience in decentralization, little is known about the topic. Overall, our survey shows that the existing scholarship on the impact of decentralization on health in the country is characteristically thin and with varying degree of methodological rigor. The limited available evidences point to some indication of positive impacts of decentralization on increasing government health expenditures and on improving health outcomes.
    Keywords: Philippines, health, decentralization
    Date: 2017
  14. By: Cheshire, Paul; Gibbons, Stephen; Mouland, Jemma
    Abstract: Objectives: To test whether a social landlord can improve health outcomes for older tenants and reduce their NHS usage by simple interventions. Design: Randomised controlled trial. Setting: Social housing in five London Boroughs. Participants: 547 individuals over 50 years of age. Intervention: Baseline and two follow-up assessments of individual’s health and use of medical services undertaken by health professionals. In the treated groups, individuals were given health care and support at two different levels. 25 individuals had to be removed from the trial because early assessments revealed critical and untreated health issues. Main outcome measures: Self-reported health and wellbeing ratings and NHS usage. Conclusions: Even simple interventions to a targeted group (older and poorer people), can produce significant reductions in NHS usage. Significant reductions were found for 1) planned hospital usage; 2) nights in hospital; and 3) for emergency GP usage. Well-being scores improved in the most strongly treated group but these were not statistically significant. Perhaps the single most important finding was that the early health evaluations revealed that 4.5% of the total sample – not in the most deprived section of the population – had such severe health problems that significant and immediate intervention was required
    Keywords: randomised control trial; social housing; health interventions
    JEL: C93 I18 R29
    Date: 2017–08–01
  15. By: Tang, Cheng Keat
    Abstract: I evaluate whether speed enforcement cameras reduce the number and severity of traffic accidents by penalizing drivers for exceeding speed limits. Relying on micro data on accidents and speed cameras across Great Britain, I find that installing these devices significantly enhance road safety. Putting another 1,000 cameras reduce around 1130 collisions, 330 serious injuries, and save 190 lives annually, generating net benefits of around £21 million. However, these effects are highly localised around the camera and dissipate over distance, and there is suggestive evidence of more collisions away from the camera, illustrating the possible limitations associated with fixed speed cameras
    Keywords: accidents; injuries; fatalities; speed camera; speeding
    JEL: H23 I18 R41
    Date: 2017–09–01
  16. By: Schwandt, Hannes
    Abstract: Do wealth shocks affect the health of elderly in developed countries? I exploit the booms and busts in the US stock market as a natural experiment that generated considerable gains and losses in the wealth of stock-holding retirees. Using data from the 1998-2011 Health and Retirement Study I construct wealth shocks as the interaction of stock holdings with stock market changes. These wealth shocks predict wealth changes and strongly affect health outcomes. A 10% wealth loss leads to an impairment of 2-3% of a standard deviation in physical health, mental health and survival rates.
    Keywords: health; Mortality; Retirees; Stock market; Wealth shocks
    JEL: G10 I10 J14
    Date: 2018–01
  17. By: Carlo Maccheroni (Bocconi University); Samuel Nocito (University of Turin)
    Abstract: The work proposes a backtesting analysis in comparison between the Lee-Carter and the Cairns-Blake-Dowd mortality models, employing Italian data. The mortality data come from the Italian National Statistics Institute (ISTAT) database and span the period 1975-2014, over which we computed back-projections evaluating the performances of the models in comparisons with real data. We propose three different backtest approaches, evaluating the goodness of short-run forecast versus long-run ones. We find that both models were not able to capture the improving shock on the mortality observed for the male population on the analyzed period. Moreover, the results suggest that CBD forecast are reliable prevalently for ages above 75, and that LC forecast are basically more accurate for this data.
    Date: 2018–01
  18. By: Michael Kremer; Christopher M. Snyder
    Abstract: Kremer and Snyder (2015) show that demand curves for a preventive and treatment may have different shapes though they target the same disease, biasing the pharmaceutical manufacturer toward developing the lucrative rather than the socially desirable product. This paper tightens the theoretical bounds on the potential deadweight loss from such biases. Using a calibration of the global demand for HIV pharmaceuticals, we demonstrate the dramatically sharper analysis achievable with the new bounds, allowing us to pinpoint potential deadweight loss at 62% of the global gain from curing HIV. We use the calibration to perform policy counterfactuals, assessing welfare effects of government policies such as a subsidy, reference pricing, and price-discrimination ban. The fit of our calibration is good: we find that a hypothetical drug monopolist would price an HIV drug so high that only 4% of the infected population worldwide would purchase, matching actual drug prices and quantities in the early 2000s before subsidies in low-income countries ramped up.
    JEL: F23 I14 L65 O31
    Date: 2018–01
  19. By: David Cantarero-Prieto; Marta Pascual-Sáez; Javier Lera Torres
    Abstract: This paper examines health care utilization among elderly people in sixteen European countries using the last wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Negative Binominal regression is conducted to study the main driving factors behind health care utilization (visits to the General Practitioners, GP; Hospital Stays, HS). The empirical results suggest that age, gender, education level, self-assessed health, health limitations and status and other socioeconomic variables are the main driving factors. We also show that socioeconomic variables do not play the same role in every country. From a policy economic approach, we propose important information to the current debates both in the health economics and social welfare literature. Our findings are relevant and have several implications for policy purposes to enhance efficiency, equity and quality of health care that it can be provided.
    Keywords: Aging; Discrete choice methods; Count Data Methods; Health; Health Care Utilization; SHARE; Europe.
    JEL: I10 I18
    Date: 2018–01
  20. By: Kansra, Dr. Pooja
    Abstract: Objective: Diabetes is a huge challenge to country’s health and economy. It has been widely debated that in order to reduce the incidence and consequences of diabetes, its awareness among the masses is pre-requisite. Thereby, in the present paper an attempt has been made to examine the awareness of the risk factors and preventive strategies of diabetes among women. Materials and Methods: The study was based on primary data collected from 200 women from Jalandhar. The analysis of the data has been made with the help of frequencies, percentages and weighted average score. Results: It has been found that 96 percent of the women were aware of diabetes. However, only 42 percent, 30 percent, 22 percent, 13 percent and 29 percent were aware of prevention of diabetes, vaccine for diabetes, complete cure for diabetes and susceptibility of diabetes. Conclusion: These figures are compelling enough to stimulate government to decide to take corrective actions to address the awareness of diabetes among women. It was also found the awareness of the risk factors and preventive measures was low among the sampled respondents. Need of the hour is to create awareness of diabetes, risk factors and lifestyle changes which can prevent or delay diabetes.
    Keywords: Awareness, Diabetes, Preventive measures, Risk Factors
    JEL: I19
    Date: 2017–08
  21. By: Firdaus Hafidz (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Tim Ensor (Leeds Institute of Health Sciences, University of Leeds); Sandy Tubeuf (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)
    Abstract: Despite increased national health expenditure in health facilities in Indonesia, health outcomes remain poor. The aim of our study is to examine the factors determining the relative efficiency of hospitals. Using linked national data sources from facility, households, and village-based surveys, we measure the efficiency of 200 hospitals across fifteen provinces in Indonesia with output oriented data envelopment analysis (DEA) and stochastic frontier analysis (SFA). Inputs include the number of doctors, nurses and midwives, other staff, and beds while outputs are the number of outpatient visits and bed-days. We run truncated regression in second stage DEA and one stage SFA analysis to assess contextual characteristics influencing health facilities performance. Our results indicate a wide variation in efficiency between health facilities. High-performing hospitals are in deprived areas. Hospitals located in less concentrated health facilities, in Java and Bali Island, high coverage of insurance scheme for the poor perform better than in other geographical location. We find an inconclusive impact of quality of care, and ownership on efficiency. This paper concludes by highlighting the characteristics of hospitals that have the potential to increase efficiency.
    Keywords: Efficiency, hospitals, frontier analysis, data envelopment analysis, stochastic frontier analysis, Indonesia
    JEL: C50 I10
    Date: 2018
  22. By: PONGOU Roland; SHAPIRO David; TENIKUE Michel
    Abstract: An important number of twins are missing because of their substantially greater mortality risk in early ages relative to singletons. This paper has a twofold goal. First, it investigates whether, as children age, the twin-singleton inequality in mortality rates vanishes, and if yes, when. Second, it analyzes how the timing of mortality convergence is affected by the quality of political institutions. We use a sample of more than 3 million births from numerous countries in sub-Saharan Africa. Twins represent 3.2% of the sample, and children are followed up to the age of 25. We find that mortality is substantially higher for twins, but the difference persists only to around the age of 5. Importantly, the timing of mortality convergence is shortened by better quality political institutions. The findings yield two major conclusions. First, biology-induced disadvantages can be partially remedied through appropriate policy interventions. Second, the fetal origins hypothesis, which holds that the risk of adult morbidity and mortality is positively affected by intrauterine growth retardation, is not universally valid. In particular, better institutions are likely to offset the short-and long-term consequences of poor intrauterine conditions, attenuating the ?missing twins? problem.
    Keywords: Mortality; twins; singletons; convergence; institutions; sub-Saharan Africa
    JEL: I10 I18
    Date: 2018–01
  23. By: Bryson, Alex (University College London); Dale-Olsen, Harald (Institute for Social Research, Oslo)
    Abstract: Higher replacement rates often imply higher levels of absenteeism, yet even in generous welfare economies, private sick pay is provided in addition to the public sick pay. Why? Using comparative workplace data for the UK and Norway we show that the higher level of absenteeism in Norway compared to UK is related to the threshold in the Norwegian public sick pay legislation. This threshold's importance is confirmed in a Regression Kinked Design (RKD) analysis on the Norwegian micro-data. Private sick pay is provided as an employer-provided non-wage benefit and when training costs are high.
    Keywords: absenteeism, public sick pay, private sick pay, comparative
    JEL: H31 J22 J28 J32
    Date: 2017–12
  24. By: Savelyev, Peter A. (College of William and Mary); Tan, Kegon T.K. (University of Rochester)
    Abstract: We use the high IQ Terman sample to estimate relationships between education, socioemotional skills, and health-related outcomes that include health behaviors, lifestyles, and health measures across the lifecycle. By both focusing on a high IQ sample and controlling for IQ in regression models, we mitigate ability bias due to cognitive skill. In addition, we control for detailed personality measures to account for socioemotional skills. We model skills using factor analysis to address measurement error and adopt a powerful stepdown procedure to account for multiple hypothesis testing. We find that among high IQ subjects, education is linked to better health-related outcomes, in contrast to previous evidence. Conscientiousness, Openness, Extraversion, and Neuroticism are linked to various health-related outcomes across the lifecycle. Furthermore, we find that accounting for a comprehensive set of skills, measurement error, and multiple hypothesis testing not only provides greater confidence in several established relationships but also generates novel results.
    Keywords: college education, Big Five personality taxonomy, health behavior, lifestyle, health
    JEL: I12 J24
    Date: 2017–12
  25. By: Alberto Cavaliere (Department of Economics and Management, University of Pavia); Giovanni Crea (Department of Economics and Management, University of Pavia); Angelo Cozzi (Department of Economics and Management, University of Pavia)
    Abstract: In this paper we carry out an empirical analysis to show that the significant price dispersion in the Italian market for medical devices may also be due to price discrimination strategies. We find that ASL (Aziende Sanitarie Locali) incur higher costs than AO (Aziende Ospedaliere) that purchase larger quantities. Centralized purchasing agencies pay lower prices than single purchasers. Therefore second-degree price discrimination seems to be one cause of price differences. Product age has a negative effect on prices due to the impact of innovation on suppliers’ costs. Concerning geographical price discrimination, public procurers located in the south pay significantly higher prices than those located in Northern or Central Italy. However we show that this result may be due to the higher probability that southern public procurers purchase from independent retailers rather than from producers of medical devices, implying a potential double marginalization effect due to the market power of retailers at a local level.
    Keywords: Price Dispersion, Bayesian Networks, Double Marginalization.
    JEL: I11 H51 L11
    Date: 2018–01
  26. By: Kara Zivin; Jessica O. White; Sandra Chao; Anna L. Christensen; Luke Horner; Dana M. Petersen; Morgan R. Hobbs; Grace Capreol; Kevin A. Halbritter; Christopher M. Jones
    Abstract: The authors implemented a 15-pill electronic health record default for new Schedule II opioids and assessed opioid quantity before and after implementation using electronic health record data on 6,390 opioid prescriptions from 448 prescribers.
    Keywords: Acute Pain, Analgesic, Narcotics, Opioids, Prescriptions
    JEL: I
  27. By: Blascak, Nathan (Federal Reserve Bank of Philadelphia); Mikhed, Vyacheslav (Federal Reserve Bank of Philadelphia)
    Abstract: We analyze whether the passage of the Affordable Care Act's dependent coverage mandate in 2010 reduced financial distress for young adults. U sing nationally representative, anonymized consumer credit report information, we find that young adults covered by the mandate lowered their past due debt, had fewer delinquencies, and had a reduced probability of filing for bankruptcy. These effects are stronger in geographic areas that experienced higher uninsured rates for young adults prior to the mandate's implementation. Our estimates also show that some improvements are transitory because they diminish after an individual ages out of the mandate at age 26.
    Keywords: Affordable Care Act; health insurance; consumer credit; financial distress
    JEL: D14 I13 I18
    Date: 2018–01–29

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