nep-hea New Economics Papers
on Health Economics
Issue of 2018‒03‒12
28 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Positive and Negative Effects of Social Status on Longevity: Evidence from Two Literary Prizes in Japan By Shusaku Sasaki; Hirofumi Kurokawa; Fumio Ohtake
  2. Mortality and the business cycle: Evidence from individual and aggregated data By van den Berg, Gerard J.; Gerdtham, Ulf G.; von Hinke, Stephanie; Lindeboom, Maarten; Sundquist, Jan; Lissdaniels, Johannes; Sundquist, Kristina
  3. Promoting Children’s Physical Activity in Low-Income Communities in Colorado: What Are the Barriers and Opportunities? By Daniel M. Finkelstein; Dana M. Petersen; Lisa S. Schottenfeld
  4. Neighborhood Air Pollution and Children’s Cognitive Development By Brandon Wagner; Louis Donnelly; Sara McLanahan; Irwin Garfinkel; Jeanne Brooks-Gunn
  5. Links between Childhood Exposure to Violent Contexts and Risky Adolescent Health Behaviors By Sarah James; Louis Donnelly; Jeanne Brooks-Gunn; Sara McLanahan
  6. Developmental Pathways Between Low Birth Weight Status and Children's Academic and Socioemotional Competence: The Role of Parenting Processes as a Moderator By Sangita Pudasainee-Kapri; Rachel Razza
  7. Which policies increase value for money in health care? By Luca Lorenzoni; Fabrice Murtin; Laura-Sofia Springare; Ane Auraaen; Frederic Daniel
  8. The marriage gap: Optimal aging and death in partnerships By Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
  9. Parental Incarceration and Child Overweight By Amelia Branigan; Christopher Wildeman
  10. Access to Long Term Care After a Wealth Shock: Evidence from The Housing Bubble and Burst By Joan Costa-i-Font; Richard G. Frank; Katherine Swartz
  11. Call the Midwife - Health Personnel and Mortality in Norway 1887-1921 By Andreas Kotsadam; Jo Thori Lind; Jørgen Modalsli
  12. Does Insurance Expansion Alter Health Inequality and Mobility? Evidence from the Mexican Seguro Popular By Joan Costa-i-Font; Frank Cowell; Belén Saénz de Miera Juárez
  13. Too Young to Die: Regression Discontinuity of a Two-Part Minimum Legal Drinking Age Policy and the Causal Effect of Alcohol on Health By Heckley, Gawain; Gerdtham, Ulf-G.; Jarl, Johan
  14. The Impact of Obesity on Adult Mortality Assessment of Estimates with Applications By Alberto Palloni; Hiram Beltran-Sanchez
  15. The Effect of the 2009 Influenza Pandemic on Absence from Work By Fabian Duarte; Srikanth Kadiyala; Samuel H. Masters; David Powell
  16. How Increasing Medical Access to Opioids Contributes to the Opioid Epidemic Evidence from Medicare Part D By David Powell; Rosalie Liccardo Pacula; Erin Audrey Taylor
  17. Prevalence and Patterns of Health Risk Behaviors of Palestinian Youth Findings from a Representative Survey By Peter Glick; Umaiyeh Kammash; Mohammed Shaheen; Ryan Andrew Brown; Prodyumna Goutam; Rita Karam; Sebastian Linnemayr; Salwa Massad
  18. Supply-Side Drug Policy in the Presence of Substitutes Evidence from the Introduction of Abuse-Deterrent Opioids By Abby Alpert; David Powell; Rosalie Liccardo Pacula
  19. Balancing Free Movement and Public Health: The Case of Minimum Unit Pricing of Alcohol in Scotch Whisky By Alemanno, Alberto
  20. How States Can Better Understand Their Medicare-Medicaid Enrollees: A Guide to Using CMS Data Resources By Danielle Chelminsky
  21. Endocan as an early biomarker of severity in patients with acute respiratory distress syndrome By Diego Orbegozo Cortes; Lokmane L. Rahmania; Marian M. Irazabal; Manuel M. Mendoza; Filippo Annoni; Daniel De Backer; Jacques Creteur; Jean Louis Vincent
  22. Rethinking Public Funding of Biomedical Science By Link, Albert; Danziger, Robert; Scott, John
  23. Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study By Antonio Maria A.M. Dell'Anna; Claudio C. Sandroni; Irene I. Lamanna; I Belloni; Katia Donadello; Jacques Creteur; Jean Louis Vincent; Fabio Taccone
  24. The Smoking Epidemic across Generations, Gender and Educational Groups: A Matter of Diffusion of Innovations By Cinzia Di Novi; Anna Marenzi
  25. Health Care Spending and Hidden Poverty in India By Michael P. Keane; Ramna Thakur
  26. Socio-economic Disparities in U.S. Healthcare Spending: The Role of Public vs. Private Insurance By Elena Capatina; Michael P. Keane; Shiko Maruyama
  27. Addressing market segmentation and incentives for risk selection: How well does risk equalisation in the Irish private health insurance market work? By Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve
  28. The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany By Kaier, K.; Reinecke, H.; Naci, Huseyin; Frankenstein, L.; Bode, M.; Vach, W.; Hehn, P.; Zirlik, A.; Zehender, M.; Reinöhl, J.

  1. By: Shusaku Sasaki; Hirofumi Kurokawa; Fumio Ohtake
    Abstract: It is widely believed that a rise in social status extends longevity. A handful number of studies examine datasets of candidates for prestigious prizes to exploit the causality. However, while some studies report positive relationships between receiving awards and recipients’ longevity, others report negative relationships. In this study, we show evidence that receiving a prize has both positive and negative causal effects on recipients’ longevity, by using a dataset covering Japan’s most prestigious and traditional literary recognitions, the Akutagawa and Naoki Prizes. The results reveal that the recipients of the Akutagawa Prize for new or emerging novelists exhibit lower mortality than their fellow nominees. The increase in longevity is estimated at 1.4 years. By contrast, the recipients of the Naoki Prize mainly for established novelists report higher mortality than their fellow nominees, and the decreased longevity is estimated at 5.2 years. We discuss with additional empirical analyses that we are likely to find a life-prolonging effect from receiving a prize when candidates belong to a lower social stratum. In so doing, our findings provide narrative explanations for why earlier studies show conflicting relationships between receiving awards and recipients’ longevity.
    Date: 2016–04
  2. By: van den Berg, Gerard J. (Department of Economics, University of Bristol; IFAU); Gerdtham, Ulf G. (Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University; Department of Economics, Lund University; Centre fo Economic Demography, Lund University); von Hinke, Stephanie (Department of Economics, University of Bristol); Lindeboom, Maarten (School of Business and Economics, Lund University); Sundquist, Jan (Faculty of Medicine, Lund University); Lissdaniels, Johannes (Health Economics Unit, Dept. of Clinical Sciences, Lund University; Swedish Agency for Health and Care Services Analysis); Sundquist, Kristina (Faculty of Medicine, Lund University)
    Abstract: There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.
    Keywords: Death; recession; Health; unemployment; income; aggregation
    JEL: E30 I10 I12
    Date: 2017–12–29
  3. By: Daniel M. Finkelstein; Dana M. Petersen; Lisa S. Schottenfeld
    Abstract: In this formative study of Colorado families, participants confirmed barriers to physical activity that previous research on low-income communities has documented, and these varied by geographic location.
    Keywords: Colorado families, children's physical activity, Low-Income
    JEL: I
  4. By: Brandon Wagner (Texas Tech University); Louis Donnelly (Princeton University); Sara McLanahan (Princeton University); Irwin Garfinkel (Columbia School of Social Work); Jeanne Brooks-Gunn (Teachers College and the College of Physicians and Surgeons at Columbia University)
    Abstract: Exposure to airborne toxins is associated with a variety of health risks. A growing body of research suggests exposure to air pollution negatively impacts neurological function, although the extent to which cumulative exposure throughout childhood matters for children’s cognitive development is unclear. To address this question, we join Census tract-level data on air pollution estimated in the National Air Toxics Assessment by the Environmental Protection Agency to individual-level data from the Fragile Families and Child Wellbeing Study, a birth cohort study following children born in large US cities between 1998 and 2000. We find that children who grow up in neighborhoods with higher levels of neurologically hazardous air pollution score lower on multiple measures of intellectual and academic ability at age 9, even after accounting for parental intelligence and the socio-economic characteristics of families and neighborhoods. We also show that cumulative exposure to air pollution during childhood is associated with declines in relative vocabulary test scores between ages 3 and 9, net of air pollution exposure at birth. Overall, our findings provide strong evidence for the deleterious effect of childhood air pollution on children’s cognitive development.
    JEL: Q53 I24 J13
    Date: 2017
  5. By: Sarah James (Princeton University); Louis Donnelly (Princeton University); Jeanne Brooks-Gunn (Teachers College and the College of Physicians and Surgeons at Columbia University); Sara McLanahan (Princeton University)
    Abstract: We assess whether childhood exposure to violent contexts is prospectively associated with risky adolescent health behavior and whether these associations are specific to different contexts of violence and different types of risky behavior. Data come from 2,693 adolescents in the Fragile Families and Child Wellbeing Study, a population-based, birth cohort study of children born between 1998-2000 in 20 large American cities. Using logistic regression models, we evaluate whether exposure to 6 indicators of community violence and 7 indicators of family violence at ages 5 and 9 is associated with risky sexual behavior, substance use, and obesity risk behavior at age 15. Controlling for a range of adolescent, parent, and neighborhood covariates, each additional point on the community violence scale is associated with 8% higher odds of risky sexual behavior but not substance use or obesity risk behavior. Alternatively, each additional point on the family violence scale is associated with 20% higher odds of substance use but not risky sexual behavior or obesity risk behavior. We conclude that childhood exposure to violent contexts is associated with risky adolescent health behaviors, but the associations are context and behavior specific.
    JEL: I12 K42
    Date: 2017
  6. By: Sangita Pudasainee-Kapri (Syracuse University); Rachel Razza (Syracuse University)
    Abstract: The present study examined the longitudinal associations among moderate low birth weight (MLBW), parenting factors, and children’s developmental outcomes within an at-risk sample (N= 1,809), using secondary data from Fragile Families and Child Wellbeing (FFCW) study. Of particular interest was whether parenting factors moderate the associations between MLBW and indicators of both socioemotional and cognitive/academic competence. Birth weight and prenatal data were taken from medical records. Parenting factors were assessed during in-home assessments at ages 3 and 5. Mothers and teachers reported on externalizing behaviors and teachers reported on social skills at age 9. In addition, cognitive/academic outcomes were assessed using teacher reports and standardized assessments at age 9. Overall, findings suggest that MLBW was significantly associated with teacher reports of children's socioemotional competence as well as cognitive/academic outcomes including receptive vocabulary, reading, and math achievement at age 9. These associations remained significant after accounting for a large battery of control variables; the exception was the link between MLBW status and parent's report of externalizing behavior at age 9. Results also indicated that maternal warmth, but not parenting stress, moderated the longitudinal associations between MLBW and cognitive/academic outcomes and teacher-reported socioemotional competence. To conclude, these results highlight the significance of MLBW and positive parenting processes across diverse child outcomes. The implications of these findings are discussed for interventions targeting MLBW children within at-risk populations.
    Keywords: Academic/Cognitive outcomes, Externalizing behaviors, Low birth weight, Maternal warmth, Parenting stress, Social competence
    JEL: I12 J13 I21
    Date: 2017
  7. By: Luca Lorenzoni (OECD); Fabrice Murtin (OECD); Laura-Sofia Springare (OECD); Ane Auraaen (OECD); Frederic Daniel (OECD)
    Abstract: The incentive structures produced by different institutional arrangements in health systems are important determinants of their performance, and can explain some of the differences in cross-country performance patterns. This paper proposes an approach and quantitative method to investigate how different policies and institutions helped achieving better value for money across 26 OECD countries for the period of 2000-2015. To this aim, it uses a panel of health system characteristics indicators - derived from questionnaires sent to countries by OECD in 2008, 2012 and 2016 - that describes primarily health financing and coverage arrangements, health care delivery systems, and governance and resource allocation.
    JEL: C23 H51 I18
    Date: 2018–03–07
  8. By: Schünemann, Johannes; Strulik, Holger; Trimborn, Timo
    Abstract: Married people live longer than singles but how much of the longevity gap is causal and what the particular mechanisms are is not fully understood. In this paper we propose a new approach, based on counterfactual computational experiments, in order to asses how much of the marriage gap can be explained by income pooling and public-goods sharing as well as collective bargaining of partners with different preferences and biology. For that purpose we integrate cooperative decision making of a couple into a biologically founded life-cycle model of health deficit accumulation and endogenous longevity. We calibrate the model with U.S. data and perform the counterfactual experiment of preventing the partnership. We elaborate four economic channels and find that, as singles, men live 8.5 months shorter and women 6 months longer. We conclude that about 25% of the marriage gain in longevity of men can be motivated by economic calculus while the marriage gain for women observed in the data is attributed to selection or other (non-standard economic) motives.
    Keywords: health,aging,longevity,marriage-gap,gender-specific preferences,unhealthy behavior
    JEL: D91 J17 J26 I12
    Date: 2018
  9. By: Amelia Branigan (University of Illinois at Chicago); Christopher Wildeman (Cornell University)
    Abstract: While the past four decades have seen unprecedented increases in rates of both childhood obesity and parental incarceration, it remains unknown whether parental incarceration is associated with an increased risk of unhealthy weight among young children. We address this question using a sample of nine-year-olds from the Fragile Families and Child Wellbeing Study, testing for effects separately by whether the mother, father, or both parents have a history of incarceration. Diverging from findings linking paternal incarceration to negative child behavioral outcomes, here we find no effect of incarcerated fathers on child body mass, while maternal incarceration is associated with significantly lower odds of overweight. Findings are consistent with an emerging body of research suggesting that the effects of maternal incarceration may differ from those of paternal incarceration, and caution against generalizing the direction of behavioral and mental health effects of parental incarceration to child physical health conditions.
    JEL: D63 K42 I12 J13
    Date: 2017
  10. By: Joan Costa-i-Font; Richard G. Frank; Katherine Swartz
    Abstract: Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care.
    Keywords: long term care, housing equity, housing bubble, informal care, home health care, nursing home care
    JEL: I18 J14
    Date: 2017
  11. By: Andreas Kotsadam; Jo Thori Lind; Jørgen Modalsli
    Abstract: The Nordic countries have the lowest maternal and child mortality rates in the world. This has not always been the case. In 1887 the mortality rates in Norway were similar to those of developing countries today. During the next 34 years, Norwegian maternal mortality was halved and infant mortality fell by 40 percent. Investigating the relationship between health personnel and mortality at the local level during this period, we find a large and robust effect of midwives on reduced maternal mortality. No clear effect is found for other types of health personnel or on infant mortality.
    Keywords: health policy, public service provision, history, mortality
    JEL: H41 I18 N33
    Date: 2017
  12. By: Joan Costa-i-Font; Frank Cowell; Belén Saénz de Miera Juárez
    Abstract: The effect of insurance expansions on the distribution of health status is still a matter we know little about. This paper draws upon new measures of pure health inequality and mobility in health which accommodates categorical data to understand how an expansion of public insurance affects both inequality and mobility in health. These measures require a measure of health status that is either “upward-looking” or “downward looking”. We find that, the distribution of health worsens in Mexico between 2002 and 2009, although the change is only consistent for the upward looking definition of status. Together with the lack of mobility in health observed, we can thus conclude that Mexico is becoming more rigid over time insofar as the distribution of health status.
    Keywords: self-reported health, health inequality, health mobility, health insurance, Mexico
    JEL: I18
    Date: 2017
  13. By: Heckley, Gawain (Health Economics Unit, Dept of Clinical Science, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University); Jarl, Johan (Department of Economics, Lund University)
    Abstract: This study examines the impact of Sweden’s unique two-part Minimum Legal Drinking Age (MLDA) policy on alcohol consumption and health using regression discontinuity design. In Sweden on-licence purchasing of alcohol is legalised at 18 and off-licence purchasing is legalised later at 20 years of age. We find an immediate and significant 6% jump in participation and a larger increase in number of days drinking at age 18 of about 16% but no large jumps at age 20. No discernible increases in mortality at age 18 or 20 are found but hospital visits due to external causes do see an increase at both 18 and 20 years. Compared to previous findings for single MLDAs the alcohol impacts we find are smaller and the health impacts less severe. The findings suggest that a two-part MLDA can help young adults in their transition to unrestricted alcohol and help contain the negative health impacts that have been observed elsewhere.
    Keywords: Alcohol consumption; regression discontinuity; minimum legal drinking age
    JEL: I12 I18
    Date: 2018–03–05
  14. By: Alberto Palloni; Hiram Beltran-Sanchez
    Abstract: In this paper we assess properties of commonly used estimates of total effects of obesity on mortality and identify consequences of these properties for inferences. We argue that standard estimates have important shortcomings that at best limit the reach of inferences and at worst lead to misleading conclusions. Although some of these limitations are routinely acknowledged, rarely is their use accompanied by careful scrutiny of their weaknesses, let alone by a quantitative assessment of their sensitivity to violations of some stringent assumptions on which they are based. In this paper we develop an integrated framework based on a multistate hazard model to describe properties of the simpler standard estimates, identify conditions under which their performance is best, and define the nature of biases and interpretational ambiguities that emerge when empirical conditions depart more than modestly from optimal ones. In particular, we show formally that estimates from limited panel data and two-state hazard models with obesity as a covariate, the workhorse in this area, produce estimates that are difficult to interpret and compare across studies and, in some cases, biased. Finally, we propose a simple procedure that can be employed when the use of conventional two-state models is risky and illustrate its application to an a empirical case.
    Keywords: obesity, T2D, mortality, multistate hazard model, two-state hazard model
    Date: 2017–06
  15. By: Fabian Duarte; Srikanth Kadiyala; Samuel H. Masters; David Powell
    Abstract: In July 2009, the WHO declared the first flu pandemic in nearly 40 years. Although the health effects of the pandemic have been studied, there is little research examining the labor productivity consequences. Using unique sick leave data from the Chilean private health insurance system, we estimate the effect of the pandemic on missed days of work. We estimate that the pandemic increased mean flu days missed by 0.042 days per person-month during the 2009 peak winter months (June and July), representing an 800% increase in missed days relative to the sample mean. Calculations using the estimated effect imply a minimum 0.2% reduction in Chile's labor supply.
    Date: 2017–01
  16. By: David Powell; Rosalie Liccardo Pacula; Erin Audrey Taylor
    Abstract: Drug overdoses involving opioid analgesics have increased dramatically since 1999, representing one of the United States' top public health crises. Opioids have legitimate medical functions, but improving access may increase abuse rates even among those not prescribed the drugs given that opioids are frequently diverted to nonmedical use. We have little evidence about the causal relationship between increased medical access to opioids and spillovers resulting in abuse. We use the introduction of the Medicare Prescription Drug Benefit Program (Part D) as a large and differential shock to the geographic supply of opioids. Part D increased opioid utilization for the 65+ population, and we show that this increase in utilization led to significant growth in the overall supply of opioids in high elderly share states relative to low elderly share states. This relative expansion in opioid supply resulted in an escalation in opioid-related substance abuse treatment admissions and opioid-related mortality among the Medicare-ineligible population, implying meaningful spillovers to individuals who did not experience any change in prescription drug benefits. The evidence suggests that increased opioid supply is associated with economically-important levels of diversion for nonmedical purposes. Our estimates imply that a 10% increase in medical opioid distribution leads to a 7.4% increase in opioid-related deaths and a 14.1% increase in substance abuse treatment admission rates for the Medicare-ineligible population.
    JEL: I11 I12 I13
    Date: 2016–10
  17. By: Peter Glick; Umaiyeh Kammash; Mohammed Shaheen; Ryan Andrew Brown; Prodyumna Goutam; Rita Karam; Sebastian Linnemayr; Salwa Massad
    Abstract: Very little is known about youth health risk behaviors such as drug and alcohol use and sexual activity in the Middle East and North Africa, and in the Occupied Palestinian Territories specifically. This lack of information, together with a lack of open discussion of these topics, leaves public health authorities in the region unprepared to deal with emerging public health threats at a time when major social and economic changes are increasing the risks that young men and women face. The Palestinian Youth Health Risk Study was designed to address these gaps in knowledge. It is the first in the region to collect large scale, representative survey data from youth on key risk behaviors (smoking, alcohol and drug use, and sexual activity as well as interpersonal violence). The study investigates the prevalence and patterns of these risk behaviors as well as of mental health, perceptions of the risks of such behaviors, and the factors increasing vulnerability to as well as protection from engagement in them.
    Date: 2016–07
  18. By: Abby Alpert; David Powell; Rosalie Liccardo Pacula
    Abstract: Overdose deaths from prescription opioid pain relievers nearly quadrupled between 1999 and 2010, making this the worst drug overdose epidemic in U.S. history. In response, numerous supply-side interventions have aimed to limit access to opioids. However, these supply disruptions may have the unintended consequence of increasing the use of substitute drugs, including heroin. We study the consequences of one of the largest supply disruptions to date to abusable opioids — the introduction of an abuse-deterrent version of OxyContin in 2010. Our analysis exploits across state variation in exposure to the OxyContin reformulation. Using data from the National Survey on Drug Use and Health (NSDUH), we show that states with higher pre-2010 rates of OxyContin misuse experienced larger reductions in OxyContin misuse, permitting us to isolate consumer substitution responses. We estimate large differential increases in heroin deaths immediately after reformulation in states with the highest initial rates of OxyContin misuse. We find less evidence of differential reductions in overall opioid-related deaths, potentially due to substitution towards other opioids, including more harmful synthetic opioids such as fentanyl. Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.
    JEL: I12 I18
    Date: 2017–01
  19. By: Alemanno, Alberto (HEC Paris - Tax & Law)
    Abstract: Scotland is the first jurisdiction in the world to introduce a minimum price per unit of alcohol to reduce consumption. The relevant industry did not hesitate to challenge this new alcohol control policy before courts. The ensuing judgment contains a wealth of insights stemming from regulatory autonomy to proportionality review. What is the role of a national court in the review of national measures restricting free movement? In particular, how should it review the proportionality of those measures when adopted on public health grounds, and on the basis of what evidence? What is the burden of proof that the relevant Member State must discharge? Those are essentially the questions referred by a Scottish court to the Court of Justice when called upon to determine the compatibility with EU law of Minimum Unit Prices for alcohol introduced by the Scottish Government. Although rather recurrent in the Court’s free movement case law, the question of the standard of review, and corresponding burden of proof epitomises the struggle currently faced by national courts in striking the right balance between the proper functioning of the market and due recognition and protection of national regulatory autonomy. As such, this preliminary reference offered an opportunity to address “the information gap on what the Court of Justice expects defendant States to establish” in order to justify their measures under the proportionality stages of free movement analysis. But there is more. This case also raises deeper epistemic and methodological questions faced by any court of law when asked to review the proportionality, and in particular the necessity, of an individual policy intervention that belongs to a wider ‘political strategy’. Indeed, those strategies – as exemplified in the present case by the Scottish policy designed to combat the devastating effects of alcohol – generally entail the enactment of a full ‘regulatory mix’ of policy interventions. In those circumstances, how can we pinpoint the effect of a given policy option when it is part of a set of measures? How can we distinguish the effect, in terms of health gains deriving from a drop in alcohol consumption, to be ascribed to the introduction of MUP when such a measure coexists with other measures (more than 40 in Scotland) that have been introduced? And what when the contested measure has never been tested before? While this judgment confirms the gradual empirical turn made by the Court in its own review of the proportionality of national restrictive measures, it also provides some pragmatic guidance on how national courts may realistically engage in that review. Given the growing number of Member States ready to experiment with new policies aimed at tackling inter alia lifestyle risk factors, such as tobacco use, harmful consumption of alcohol and unhealthy diets, this appears as welcome development. Ultimately, the ensuing number of national restrictive measures of trade enacted on public health grounds, such as the UK standardised packaging for cigarettes, its sugar tax or the Hungarian ‘fat tax’, is set to put to test the Court’s approach towards both the qualification of those measures as restrictions and their justification under EU law.
    Keywords: EU law; proportionality; tax; minimum unit pricing; alcohol; lifestyle; NCD; precautionary principle; risk regulation; judicial review
    JEL: K23 K32 K33
    Date: 2016–07–01
  20. By: Danielle Chelminsky
    Abstract: This brief guides readers through the various national and state-level data resources on Medicare-Medicaid enrollees on the CMS website and how to easily use and present the data to stakeholders.
    Keywords: Medicare, Medicaid, enrollment, data, dual eligibles, data visualization, characteristics
    JEL: I
  21. By: Diego Orbegozo Cortes; Lokmane L. Rahmania; Marian M. Irazabal; Manuel M. Mendoza; Filippo Annoni; Daniel De Backer; Jacques Creteur; Jean Louis Vincent
    Abstract: Background: Plasma concentrations of endocan, a proteoglycan preferentially expressed in the pulmonary vasculature, may represent a biomarker of lung (dys)function. We sought to determine whether the measurement of plasma endocan levels early in the course of acute respiratory distress syndrome (ARDS) could help predict risk of death or of prolonged ventilation. Methods: All patients present in the department of intensive care during a 150-day period were screened for ARDS (using the Berlin definition). Endocan concentrations were measured at the moment of ARDS diagnosis (T0) and the following morning (T1). We compared data from survivors and non-survivors and data from survivors with less than 10 days of ventilator support (good evolution) and those who died or needed more than 10 days of mechanical ventilation (poor evolution). Results are presented as numbers (percentages), mean ± standard deviation or medians (percentile 25–75). Results: Ninety-six consecutive patients were included [median APACHE II score of 21 (17–27) and SOFA score of 9 (6–12), PaO2/FiO2 ratio 155 (113–206)]; 64 (67%) had sepsis and 51 (53%) were receiving norepinephrine. Non-survivors were older (66 ± 15 vs. 59 ± 18 years, p = 0.045) and had higher APACHE II scores [27 (22–30) vs. 20 (15–24), p
    Keywords: Acute respiratory failure; Glycocalyx; Multiple organ failure; Proteoglycan; Pulmonary vasculature; Risk stratification
    Date: 2017–12
  22. By: Link, Albert (University of North Carolina at Greensboro, Department of Economics); Danziger, Robert (University of Illinois at Chicago); Scott, John (Dartmouth College, Department of Economics)
    Abstract: This paper offers the perspective that public policy should provide incentives to make university ideas freely available and widely disseminated. Then, industrial R&D, in some cases with university partners, could develop patentable, commercializable biomedical products, and the industrial R&D would provide feedback to stimulate new directions for university research and ideas.
    Keywords: R&D; innovation; Bayh-Dole Act; industry-university partnerships
    JEL: H41 O31 O34
    Date: 2018–01–04
  23. By: Antonio Maria A.M. Dell'Anna; Claudio C. Sandroni; Irene I. Lamanna; I Belloni; Katia Donadello; Jacques Creteur; Jean Louis Vincent; Fabio Taccone
    Abstract: Background: Elevated lactate concentration has been associated with increased mortality after out-of-hospital cardiac arrest (CA). We investigated the variables associated with high blood lactate concentrations and explored the relationship between blood lactate and neurological outcome in this setting. Methods: This was a retrospective analysis of an institutional database that included all adult (> 18 years) patients admitted to a multidisciplinary Department of Intensive Care between January 2009 and January 2013 after resuscitation from CA. Blood lactate concentrations were collected at hospital admission and 6, 12, 24 and 48 h thereafter. Neurological outcome was evaluated 3 months post-CA using the Cerebral Performance Category (CPC) score: a CPC of 3–5 was used to define a poor outcome. Results: Of the 236 patients included, 162 (69%) had a poor outcome. On admission, median lactate concentrations (5.3[2.9–9.0] vs. 2.5[1.5–5.5], p
    Keywords: Cardiopulmonary resuscitation; Hyperlactataemia; In-hospital cardiac arrest; Neurological outcome
    Date: 2017–12
  24. By: Cinzia Di Novi (Department of Economics and Management, University of Pavia); Anna Marenzi (Department of Economics, University Of Venice Cà Foscari)
    Abstract: This study examines whether the temporal variations in smoking habits across generations and gender and among groups with differing levels of education fit the pattern proposed by the theory of the diffusion of innovations (TDI) (Rogers, 2003). We focus on the Italian case and employ a pseudo-panel derived from repeated cross-sections of the annual household survey, “Aspects of Daily Life,” that is part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) for the period 1997 to 2012. The results confirm Rogers’ TDI and show that smoking prevalence has declined over time and across age cohorts: younger men of all educational levels and women with higher education are less likely to smoke than are those in other cohorts. On the other side, less-educated women, who entered the smoking-diffusion process later that others are more likely to smoke. Hence, socio-economic differences in smoking continue to persist, especially for women. According to Rogers’ TDI, smoking prevalence is expected to decline further, particularly among little-educated women.
    Keywords: Smoking habit, theory of diffusion, generations
    JEL: J1 I1
    Date: 2018
  25. By: Michael P. Keane (UNSW Sydney); Ramna Thakur (Indian Institute of Technology Mandi)
    Abstract: India has a high level of out-of-pocket (OOP) health care spending, and lacks well developed health insurance markets. As a result, official measures of poverty and inequality that treat medical spending symmetrically with consumption goods can be misleading. We argue that OOP medical costs should be treated as necessary expenses for the treatment of illness, not as part of consumption. Adopting this perspective, we construct poverty and inequality measures for India that account for impoverishment induced by OOP medical costs. For 2011/12 we estimate that 4.1% of the population, or 50 million people, are in a state of “hidden poverty” due to medical expenses. Furthermore, while poverty in India fell substantially from 1999/00 to 2011/12, the fraction of the remaining poverty that is due to medical costs has risen substantially. Economic growth appears less “pro-poor” if one accounts for OOP medical costs, especially since 2004/05, and especially in rural areas.
    Keywords: Poverty, Consumption, Healthcare, Medical Costs, Inequality, Growth
    JEL: I14 I32 O15 O53 N35
    Date: 2018–01
  26. By: Elena Capatina (UNSW Sydney); Michael P. Keane (UNSW Sydney); Shiko Maruyama (University of Technology Sydney)
    Abstract: In the US healthcare system, patients of different socio-economic status (SES) often receive disparate treatment for similar conditions. Prior work documents this phenomenon for particular treatments/conditions, but we take a system-wide view and examine socioeconomic disparities in spending for all medical conditions at the 3-digit ICD-9 level. We also compare SES spending gradients for those covered by private vs. public insurance (Medicare). Using data on adult respondents from the Medical Expenditure Panel Survey 2000-14, we estimate multivariate regressions for individual medical spending (total and out-of-pocket) controlling for medical conditions, demographics, health, and insurance, separately by sex, education, and age. Within age-sex categories, we assess how spending on each condition varies with education (a proxy for SES). In the predominantly privately insured population aged 24-64, system spending for several of the most socially costly conditions is strongly increasing in education (e.g., breast cancer for women and chest symptoms for men). These disparities are not explained by differences in health, insurance status, or ability-to-pay, suggesting they arise due to discrimination. However, we find no positive SES gradients for individuals over 64 covered by the public Medicare program, suggesting that Medicare plays an important role in improving equity.
    Keywords: Education gradient, Health insurance systems, Healthcare equity, Private and Public health insurance, Socio-economic disparities
    JEL: I13 I14 I18
    Date: 2018–02
  27. By: Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve
    Date: 2017
  28. By: Kaier, K.; Reinecke, H.; Naci, Huseyin; Frankenstein, L.; Bode, M.; Vach, W.; Hehn, P.; Zirlik, A.; Zehender, M.; Reinöhl, J.
    Abstract: BACKGROUND: The impact of various post-procedural complications after transcatheter aortic valve implantation (TAVI) on resource use and their consequences in the German reimbursement system has still not been properly quantified. METHODS: In a retrospective observational study, we use data from the German DRG statistic on patient characteristics and in-hospital outcomes of all isolated TAVI procedures in 2013 (N = 9147). The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation was analyzed using both unadjusted and risk-adjusted linear and logistic regression analyses. RESULTS: A total of 235 (2.57%) strokes, 583 (6.37%) bleeding events, 474 (5.18%) cases of acute kidney injury and 1428 (15.61%) pacemaker implantations were documented. The predicted reimbursement of an uncomplicated TAVI procedure was €33,272, and bleeding events were associated with highest additional reimbursement (€12,839, p 48 h: OR 6.93, p 48 h: OR 5.73, p
    Keywords: post-procedural complications; TAVR; transcatheter aortic valve replacement; excess costs; reimbursement; resource use
    JEL: C01 I10
    Date: 2017–02–22

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