nep-hea New Economics Papers
on Health Economics
Issue of 2018‒03‒19
24 papers chosen by
Yong Yin
SUNY at Buffalo

  1. A shortcut to Rome: Exploring the Social Determinants of patients' Time to Diagnosis By Setti Rais; Ali Dourgnon; Lise Rochaix
  2. Inequalities in Life Expectancy and the Global Welfare Convergence By Hippolyte D'Albis; Florian Bonnet
  3. The impact of social mobilization on health service delivery and health outcomes: Evidence from rural Pakistan By Xavier Giné; Salma Khalid; Ghazala Mansuri
  4. The effect of Hukou registration policy on rural-to-urban migrants’ health By Marta Bengoa; Christopher Rick
  5. Does an Early Primary Care Follow-up after Discharge Reduce Readmissions for Heart Failure Patients? By Damien Bricard; Zeynep Or
  6. Parametric models for biomarkers based on flexible size distributions By Davillas, Apostolos; Jones, Andrew M.
  7. The Welfare Implications of Addictive Substances: A Longitudinal Study of Life Satisfaction of Drug Users By Julie Moschion; Nattavudh Powdthavee
  8. Mortality data reliability in an internal model By Fabrice Balland; Alexandre Boumezoued; Laurent Devineau; Marine Habart; Tom Popa
  9. Prevalence and socio-demographic correlates of alcohol consumption: survey findings from five states in India By Kaushalendra Kumar; Santosh Kumar; Anil Kumar Singh
  10. Smoking Inequality across Genders and Socio-economic Classes. Evidence from Longitudinal Italian Data. By Di Novi, Cinzia; Jacobs, Rowena; Migheli, Matteo
  11. The Impact of a Health Information Technology–Focused Patient-Centered Medical Neighborhood Program Among Medicare Beneficiaries in Primary Care Practices: The Effect on Patient Outcomes and Spending By Sean Orzol; Rosalind Keith; Mynti Hossain; Michael Barna; G. Greg Peterson; Timothy Day; Boyd Gilman; Laura Blue; Keith Kranker; Kate Stewart; Sheila Hoag; Lorenzo Moreno
  12. Access to Care and Satisfaction Among Health Center Patients With Chronic Conditions By Leiyu Shi; De-Chih Lee; Geraldine Pierre Haile; Hailun Liang; Michelle Chung; Alek Sripipatana
  13. The Mediating Role of Adherence on the Relationship between Health Locus of Control and Quality of Life in Adults with Asthma By Anindita Chairina
  14. The effect of health shocks on financial risk preferences differs by personality traits By Jones, A.M.;; Rice, N.;; Robone, S.;
  15. Infant Health, Cognitive Performance and Earnings: Evidence from Inception of the Welfare State in Sweden By Bhalotra, S.;; Karlsson, M.;; Nilsson, T.;; Schwarz, N.;
  16. Sunlight and Protection Against Influenza By David Slusky; Richard J. Zeckhauser
  17. Team Formation and Performance: Evidence from Healthcare Referral Networks By Leila Agha; Keith Marzilli Ericson; Kimberley H. Geissler; James B. Rebitzer
  18. The Effect of Education on Mortality and Health: Evidence from a Schooling Expansion in Romania By Ofer Malamud; Andreea Mitrut; Cristian Pop-Eleches
  19. The Effect of Organized Breast Cancer Screening on Mammography Use: Evidence from France By Thomas C. Buchmueller; Léontine Goldzahl
  20. Bayesian factor models for probabilistic cause of death assessment with verbal autopsies By Tsuyoshi Kunihama; Zehang Richard Li; Samuel J. Clark; Tyler H. McCormick
  21. Risk predictors of out of hospital cardiac arrest. Evidence from linked trial and national administrative data By Robert Willans; Silviya Nikolova; Claire Hulme; Ranjit Lall; Tom Quinn; Gavin Perkins
  22. Are waiting times and length of stay connected? Theoretical underpinnings and empirical results By Arthur Sinko; Silviya Nikolova
  23. Fuel prices and road deaths in Australia By Paul J Burke; Ataklti Teame
  24. Effects of Expanding Health Screening on Treatment - What Should We Expect? What Can We Learn? By Rebecca Mary Myerson; Darius Lakdawalla; Lisandro D. Colantonio; Monika Safford; David Meltzer

  1. By: Setti Rais (Hospinnomics (PSE - AP-HP), PSE - Paris School of Economics); Ali Dourgnon (Institute for genetic disease); Lise Rochaix (Hospinomics - PSE - Paris School of Economics, PSE - Paris School of Economics, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)
    Abstract: In this study, we measure time to diagnosis defined as the timespan from first symptoms to final diagnostic for four chronic conditions, and analyze the role played by patients social characteristics in accounting for time to diagnosis. We use self-reported data from an online open access questionnaire administered to a large French social network of patients with chronic conditions. Duration models were used to explain variations in time to diagnosis. The results suggest that social participation and social support reduce the probability of experiencing longer periods of time to diagnosis. Higher levels of education, on the contrary, increase the probability of experiencing longer period of time to diagnosis. We further analyze this result by identifying differences in health care-seeking behavior: more educated patients tend to first consult specialists, which is correlated with a longer time to diagnostic work-up. Indeed, ambulatory care specialists are less likely than GPs to refer patients to hospitals for additional tests, when needed. The findings on social capital support WHOs recommendations to enhance individual social capital as this could reduce the time period needed to obtain a final diagnosis. In addition, our results on education suggest that public interventions aimed at optimizing healthcare pathways through a GP referral system for specialists services may reduce period of time to diagnosis.
    Keywords: Chronic disease, Diagnosis, Education, Health inequalities, Social,capital
    Date: 2018–01
  2. By: Hippolyte D'Albis (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); Florian Bonnet (UP1 UFR02 - Université Panthéon-Sorbonne - UFR d'Économie - UP1 - Université Panthéon-Sorbonne, PSE - Paris School of Economics)
    Abstract: Becker, Philipson and Soares (2005) maintain that including life expectancy gains in a welfare indicator result in a reduction of inequality between 1960 and 2000 twice as great as when measured by per capita income. We discuss their methodology and show it determines the convergence result. We use an alternative methodology, based on Fleurbaey and Gaulier (2009), which monetizes differences in life expectancy between countries at each date rather than life expectancy gains. We show that including life expectancy has no effect on the evolution of world inequality.
    Keywords: World inequality,Well-being indicators,Life expectancy
    Date: 2018–01
  3. By: Xavier Giné; Salma Khalid; Ghazala Mansuri
    Abstract: We use a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong focus on ensuring the participation of women. Women in the study villages had also identified access to primary care as a critical need for them and their children at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by Lady Health Workers, as well as increased utilization of preand post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.
    Date: 2018
  4. By: Marta Bengoa; Christopher Rick
    Abstract: Access to social services in China is connected to a system of household registration (Hukou system) determined by place of origin with difficult geographical transferability. As a consequence, a vast majority of rural-to-urban migrants do not have access to public health services in urban areas. This paper examines if restrictions on healthcare provisions—that are due to restrictions on migration and Hukou registration—are linked to poorer health for rural-to-urban migrants compared with non-migrant urban residents. We use data from two waves of the Longitudinal Survey on Rural Urban Migration in China that provide data on self-reported health and objectively measured health indicators – blood pressure and grip strength. Results indicate that even after accounting for migrant’s characteristics that have known impacts on health, such as income, education, sex, marital status, and being underweight, the effect of the Hukou restriction policy is large, significantly negative, and acts as a key predictor of why rural-to-urban migrants’ health deteriorates, especially during the early years since migration.
    Date: 2018
  5. By: Damien Bricard (IRDES Institut de recherche et documentation en économie de la santé); Zeynep Or (IRDES Institut de recherche et documentation en économie de la santé)
    Abstract: Better monitoring of patients in primary care setting is often considered to be a solution for reducing avoidable hospitalisations and readmissions. In this paper we test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up, with a focus on consultations with a generalist (GP) after discharge by patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk measured on a weekly basis, using an instrumental variable strategy (IV). The results from IV regressions suggest that a consultation with a GP in the first weeks after discharge can reduce the readmission risk by almost 50%, and that patients with higher ambulatory care utilisation have smaller odds of readmission. Furthermore, geographical disparities in primary care affect directly primary care utilization and hence indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and improving system-wide cost efficiency. In order to encourage better care transition and to improve patient outcomes after discharge, financial incentives for hospitals should be aligned with the objective of avoiding repeated hospitalisations. However, the current hospital funding system in France, based on patient volumes, does not provide any incentive for investments to improve patient follow-up after discharge.
    Keywords: Hospital, Readmission, Heart failure, Primary care, Health care organisation, Instrumental variable, Discrete-time model.
    JEL: C22 I12 L24
    Date: 2018–03
  6. By: Davillas, Apostolos; Jones, Andrew M.
    Abstract: Recent advances in social science surveys include collection of biological samples. Although biomarkers offer a large potential for social science and economic research, they impose a number of statistical challenges, often being distributed asymmetrically with heavy tails. Using data from the UK Household Panel Survey (UKHLS), we illustrate the comparative performance of a set of flexible parametric distributions, which allow for a wide range of skewness and kurtosis: the four-parameter generalized beta of the second kind (GB2), the three-parameter generalized gamma (GG) and their three-, two- or one-parameter nested and limiting cases. Commonly used blood-based biomarkers for inflammation, diabetes, cholesterol and stress-related hormones are modelled. Although some of the three-parameter distributions nested within the GB2 outperform the latter for most of the biomarkers considered, the GB2 can be used as a guide for choosing among competing parametric distributions for biomarkers. Going “beyond the mean†to estimate tail probabilities, we find that GB2 performs fairly well with some disparities at the very high levels of HbA1c and fibrinogen. Commonly used OLS models are shown to perform worse than almost all the flexible distributions.
    Date: 2018–03–08
  7. By: Julie Moschion (Melbourne Institute: Applied Economic & Social Research, The University of Melbourne); Nattavudh Powdthavee (Warwick Business School; and Centre for Economic Performance, London School of Economics)
    Abstract: This paper provides an empirical test of the rational addiction model, used in economics to model individuals’ consumption of addictive substances, versus the utility misprediction model, used in psychology to explain the discrepancy between people’s decision and their subsequent experiences. By exploiting a unique data set of disadvantaged Australians, we provide longitudinal evidence that a drop in life satisfaction tends to precede the use of illegal/street drugs. We also find that the abuse of alcohol, the daily use of cannabis and the weekly use of illegal/street drugs in the past 6 months relate to lower current levels of life satisfaction. This provides empirical support for the utility misprediction model. Further, we find that the decrease in life satisfaction following the consumption of illegal/street drugs persists 6 months to a year after use. In contrast, the consumption of cigarettes is unrelated to life satisfaction in the close past or the near future. Our results, though only illustrative, suggest that measures of individual’s subjective wellbeing should be examined together with data on revealed preferences when testing models of rational decision-making.
    Keywords: Life satisfaction, rational addiction, drugs, homeless, Australia, happiness
    JEL: D03 I12 I18 I30
    Date: 2017–12
  8. By: Fabrice Balland; Alexandre Boumezoued; Laurent Devineau; Marine Habart; Tom Popa
    Abstract: In this paper, we discuss the impact of some mortality data anomalies on an internal model capturing longevity risk in the Solvency 2 framework. In particular, we are concerned with abnormal cohort effects such as those for generations 1919 and 1920, for which the period tables provided by the Human Mortality Database show particularly low and high mortality rates respectively. To provide corrected tables for the three countries of interest here (France, Italy and West Germany), we use the approach developed by Boumezoued (2016) for countries for which the method applies (France and Italy), and provide an extension of the method for West Germany as monthly fertility histories are not sufficient to cover the generations of interest. These mortality tables are crucial inputs to stochastic mortality models forecasting future scenarios, from which the extreme 0,5% longevity improvement can be extracted, allowing for the calculation of the Solvency Capital Requirement (SCR). More precisely, to assess the impact of such anomalies in the Solvency II framework, we use a simplified internal model based on three usual stochastic models to project mortality rates in the future combined with a closure table methodology for older ages. Correcting this bias obviously improves the data quality of the mortality inputs, which is of paramount importance today, and slightly decreases the capital requirement. Overall, the longevity risk assessment remains stable, as well as the selection of the stochastic mortality model. As a collateral gain of this data quality improvement, the more regular estimated parameters allow for new insights and a refined assessment regarding longevity risk.
    Date: 2018–03
  9. By: Kaushalendra Kumar (International Institute for Population Sciences (IIPS)); Santosh Kumar (Department of Economics and International Business, Sam Houston State University); Anil Kumar Singh (Department of Economics, Shyam Lal College (E), University of Delhi, Delhi, India.)
    Abstract: We investigate the association between socio-demographic characteristics and alcohol consumption in India. Analytical data were derived from household surveys conducted by the study team that included 6,088 adults in five states of India (male=3,803, female=2285). Multivariate logistic regression models were fitted to investigate the socio-demographic association with both alcohol use and types of alcoholic beverages. More than one-third of the sample respondents (38.6%, 95%CI = 29.2-48.8%) reported to be current drinkers and approximately one-fifth (21.7%, 95%CI = 4.2-31.7%) were heavy drinkers and 7.4% (95%CI = 4.6-11.6%) were heavy episodic drinkers. In multivariate analyses, age greater than 50 years (OR = 0.70, 95%CI = 0.56-0.86), being female (OR = 0.08, 95%CI = 0.06-0.09), schooling greater than 12 years (OR = 0.61, 95% CI = 0.50-0.75), owing land (OR = 0.74, 95%CI = 0.65-0.86), and living in a pucca house (OR = 0.85, 95% CI = 0.74-0.98) were negatively associated with current drinking status. Higher income (OR = 1.30, 95%CI = 1.08-0.57) and living in urban areas (OR = 1.54, 95%CI = 1.33-1.78) were positively associated with current drinking. Substantial differences in the socio-demographic correlates of alcohol use and types of alcoholic beverages exist in India. Intervention and prevention strategies should include drinkers characteristic as well.
    Keywords: Alcohol use, Socio-demographic determinants, Country liquor, Home-brewed, India.
    JEL: A1 I1
    Date: 2018–03
  10. By: Di Novi, Cinzia; Jacobs, Rowena; Migheli, Matteo (University of Turin)
    Abstract: There has been a dearth of literature on smoking inequalities, in spite of its contribution to health inequalities. We exploit longitudinal Italian individual-level data to identify the main socio-demographic characteristics that determine smoking inequalities. We use the Erreygers Concentration Index to identify in which groups smoking is relatively more prevalent. We find that, among men, pro-poor prevalence is driven by members of the lower socio-economic classes, while we observe the opposite for women. We encourage policymakers to address the issue of smoking inequalities, which the current policies have largely disregarded.
    Date: 2018–02
  11. By: Sean Orzol; Rosalind Keith; Mynti Hossain; Michael Barna; G. Greg Peterson; Timothy Day; Boyd Gilman; Laura Blue; Keith Kranker; Kate Stewart; Sheila Hoag; Lorenzo Moreno
    Abstract: This paper estimates impacts of TransforMED’s HCIA-funded program on patient outcomes and Medicare parts A and B spending.
    Keywords: Health Information Technology, Patient Centered Medical Neighborhood, population heath management software, spending, service use
    JEL: I
  12. By: Leiyu Shi; De-Chih Lee; Geraldine Pierre Haile; Hailun Liang; Michelle Chung; Alek Sripipatana
    Abstract: This study examined access to care and satisfaction among health center patients with chronic conditions.
    Keywords: access to care, chronic conditions, health center, patient satisfaction, vulnerable populations
    JEL: I
  13. By: Anindita Chairina (Faculty of Psychology, Universitas Indonesia, Kampus Baru UI, Depok, 16424, Indonesia Author-2-Name: Sali Rahadi Asih Author-2-Workplace-Name: Faculty of Psychology, Universitas Indonesia, Kampus Baru UI, Depok, 16424, Indonesia)
    Abstract: Objective – It was previously assumed that the relationship between HLOC and quality of life may be mediated by adherence. HLOC plays a role in determining a person's behavior, including adherence to medical regimens. Methodology/Technique – HLOC was measured by the Multidimensional Health Locus of Control Scale, adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), and quality of life was measured by the Quality of Life Scale. Findings – The results indicate that Internal HLOC (ß = 0,497, p
    Keywords: Asthma; Adherence; Chronic Illness; Health Locus of Control, Quality of Life
    JEL: I10 I19
    Date: 2017–12–11
  14. By: Jones, A.M.;; Rice, N.;; Robone, S.;
    Abstract: We investigate whether personality traits influence the impact of health shocks on financial risk preferences using 11 waves (1998-2008) from the US Health and Retirement Study (HRS). We model stock market participation and the share of risky assets in portfolios and stratify our sample into single person households and couples. Our results indicate that personality traits play a more important role in the portfolio choices for couples than for single people. Moreover, there are differences between women and men within couples, and between chronic and acute health shocks.
    Keywords: risk preference; health shocks; portfolio choice; personality traits; US Health and Retirement Study;
    JEL: D14 D91 I10
    Date: 2018–03
  15. By: Bhalotra, S.;; Karlsson, M.;; Nilsson, T.;; Schwarz, N.;
    Abstract: We estimate impacts of exposure to an infant health intervention trialled in Sweden in the early 1930s using purposively digitised birth registers linked to school catalogues, census files and tax records to generate longitudinal data that track individuals through four stages of the life-course, from birth to age 71. This allows us to measure impacts on childhood health and cognitive skills at ages 7 and 10, educational choice during young adulthood, employment, earnings and occupation at age 36-40, and pension income at age 71. Leveraging quasi-random variation in eligibility by birth date and birth parish, we estimate that exposure was associated with substantial increases in earnings and (public sector) employment among women, alongside no improvements for men. This appears to be related to the intervention having made it more likely that primary school test scores for girls were in the top quintile of the distribution and, related, that they attended secondary school. The greater investments of women in education are consistent with their comparative advantage in cognitive tasks, but opportunities are also likely to have played a role. Our sample cohorts were exposed to a massive expansion of the Swedish welfare state, which created unprecedented employment opportunities for women.
    Keywords: Infant health; early life interventions; cognitive skills; education; earnings; occupational choice; programme evaluation; Sweden;
    JEL: I15 I18 H41
    Date: 2018–03
  16. By: David Slusky; Richard J. Zeckhauser
    Abstract: Recent medical literature suggests that vitamin D supplementation protects against acute respiratory tract infection. Humans exposed to sunlight produce vitamin D directly. This paper investigates how differences in sunlight, as measured over several years within states and during the same calendar month, affect influenza incidence. We find that sunlight strongly protects against influenza. This relationship is driven by sunlight in late summer and early fall, when there are sufficient quantities of both sunlight and influenza activity. A 10% increase in relative sunlight decreases the influenza index in September by 3 points on a 10-point scale. This effect is far greater than the effect of vitamin D supplementation in randomized trials, a differential due to broad exposure to sunlight, hence herd immunity. We also find suggestive evidence, consistent with herd immunity theory, that the protective sunlight effect is strongest with a middle level of population density.
    JEL: I10 I12 I18
    Date: 2018–02
  17. By: Leila Agha; Keith Marzilli Ericson; Kimberley H. Geissler; James B. Rebitzer
    Abstract: How does team structure affect productivity? We address this question with an application to healthcare by examining the teams that primary care physicians (PCPs) assemble when they refer patients to specialists. Our theoretical model analyzes how PCPs trade off costly coordination against beneficial specialization, predicting that coordination improves when PCPs concentrate their referrals within a smaller set of specialists. Empirically we find that patients of PCPs with concentrated referrals have lower healthcare costs. This effect exists for commercially insured and Medicare populations; is statistically and economically significant; and holds under identification strategies that account for unobserved patient and physician characteristics.
    JEL: D85 I10 I11 L2 M5
    Date: 2018–02
  18. By: Ofer Malamud; Andreea Mitrut; Cristian Pop-Eleches
    Abstract: This paper examines a schooling expansion in Romania which increased educational attainment for successive cohorts born between 1945 and 1950. We use a regression discontinuity design at the day level based on school entry cutoff dates to estimate impacts on mortality with 1994-2016 Vital Statistics data and self-reported health with 2011 Census data. We find that the schooling reform led to significant increases in years of schooling and changes in labor market outcomes but did not affect mortality or self-reported health. These estimates provide new evidence for the causal relationship between education and mortality outside of high-income countries and at lower margins of educational attainment.
    JEL: I1 I12 I15 I25
    Date: 2018–02
  19. By: Thomas C. Buchmueller; Léontine Goldzahl
    Abstract: In 2004, France introduced a national program of organized breast cancer screening. The national program built on pre-existing local programs in some, but not all, départements. Using data from multiple waves of a nationally representative biennial survey of the French population, we estimate the effect of organized screening on the percentage of women obtaining a mammogram. The analysis uses difference-in-differences methods to exploit the fact that the program was targeted at women in a specific age group: 50 to 74 years old. We find that organized screening significantly raised mammography rates among women in the target age range. Just above the lower age threshold, the percentage of women reporting that they had a mammogram in the past two years increased by over 10 percentage points after the national program went into effect. Mammography rates increased even more among women in their sixties. Estimated effects are particularly large for women with less education and lower incomes, suggesting that France's organized screening program has reduced socioeconomic disparities in access to mammography.
    JEL: I12 I14 I18
    Date: 2018–02
  20. By: Tsuyoshi Kunihama (Kwansei Gakuin University); Zehang Richard Li (University of Washington); Samuel J. Clark (Ohio State University); Tyler H. McCormick (University of Washington)
    Abstract: The distribution of deaths by cause provides crucial information for public health planning, response, and evaluation. About 60% of deaths globally are not registered or given a cause which limits our ability to understand the epidemiology of affected populations. Verbal autopsy (VA) surveys are increasingly used in such settings to collect information on the signs, symptoms, and medical history of people who have recently died. This article develops a novel Bayesian method for estimation of population distributions of deaths by cause using verbal autopsy data. The proposed approach is based on a multivariate probit model where associations among items in questionnaires are flexibly induced by latent factors. We measure strength of conditional dependence of symptoms with causes. Using the Population Health Metrics Research Consortium labeled data that include both VA and medically certified causes of death, we assess performance of the proposed method. Further, we propose a method to estimate important questionnaire items that are highly associated with causes of death. This framework provides insights that will simplify future data collection.
    Keywords: Bayesian latent model; Cause of death; Conditional dependence; Multivariate data; Verbal autopsies; Survey data
    Date: 2018–03
  21. By: Robert Willans (Bradford Teaching Hospitals NHS Foundation Trust); Silviya Nikolova (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Claire Hulme (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds); Ranjit Lall (Warwick Clinical Trials Unit, University of Warwick); Tom Quinn (Faculty of Health, Social Care and Education, Kingston University London and St.George’s University of London); Gavin Perkins (Warwick Clinical Trials Unit, University of Warwick; Heart of England, NHS Foundation Trust)
    Abstract: Objective To understand the demographic, health and healthcare (HC) use profile of patients who experience an out-of-hospital cardiac arrest (OHCA) in England and Wales between April 2010 and June 2013. The association with 24-hour survival was studied as a secondary objective. Methods The Paramedic study is a trial which collected information on 4471 patients with out-of-hospital cardiac arrest (OHCA). Trial data was linked to Hospital Episode Statistics (HES), administrative data covering the trial period. Multivariate survival analysis was used to quantify the impact of identified risk predictors. Results Healthcare use increases in the years leading up to a cardiac arrest with the profile of this increase differing depending on age and overall healthcare resource utilisation of the patient. Patients who are older than 60 were found to have 2.35 fold increase in the probability of not surviving OHCA. However, older patients with medium and high healthcare resource use have higher chances of surviving OHCA event (decrease in mortality risk of 67% and 70% respectively). A diagnosis of dementia carries a 3.1 fold increase in mortality risk. Conclusions Routinely collected administrative hospital data may be used to identify patients at risk of OHCA and thus may help decrease cardiovascular mortality
    Keywords: OHCA, survival, predictors, healthcare use, health
    JEL: I1
    Date: 2018
  22. By: Arthur Sinko (University of Manchester); Silviya Nikolova (Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds)
    Abstract: The English Government implemented and stringently enforced maximum waiting time (MWT) targets to tackle long waiting times for elective surgery. We consider their impact on patient prioritisation for treatment based on expected hospital length of stay. We demonstrate that prioritisation based on expected length of stay can significantly decrease average waiting times. We test whether hospitals have adopted such behaviour using data for four large volume elective procedures and 1998 – 2011 period which saw the progressive tightening of targets and their subsequent relaxing after 2010. Our analysis suggests that, following the introduction of the MWT regulatory framework, patients with longer expected hospital stay waited longer for treatment. As coronary procedures were subject to explicit shorter waits from the start we uncover positive and statistically significant relationship for CABG and PCI patients in almost all years. For orthopaedic patients we find a positive and statistically significant association after 2004 when the 18-week referral to treatment (RTT) target was introduced. We find predominantly statistically insignificant results for the period prior. These findings raise safety and fairness concerns in the treatment of clinically complex and potentially urgent patients when the healthcare system is strapped with MWT targets.
    Keywords: maximum waiting times, length of stay, prioritisation
    JEL: H4 I1
    Date: 2018
  23. By: Paul J Burke; Ataklti Teame
    Abstract: After years of general progress in reducing Australia’s road death toll, road deaths increased in 2015 and 2016, reaching 1,293 per annum. These were also years of relatively cheap fuel following the dramatic decline in the world oil price in late 2014. This study uses monthly data to model the number of road deaths in Australia. Our estimates suggest that low fuel prices have contributed to knocking Australia off track for meeting its 2020 road safety target. The paper also provides a discussion of other factors that may have contributed to the rise in Australia’s road death toll.
    Keywords: road safety, road deaths, gasoline price, fuel price, Australia
    JEL: R41 Q41 Q43
    Date: 2018–03
  24. By: Rebecca Mary Myerson; Darius Lakdawalla; Lisandro D. Colantonio; Monika Safford; David Meltzer
    Abstract: Screening interventions can produce very different treatment and health outcomes, depending on the reasons why patients went unscreened in the first place. Economists have paid scant attention to these complexities and their implications for evaluating screening programs. In this paper, we propose a simple economic framework to guide policy-makers and analysts in designing and evaluating the impact of screening on treatment uptake. We apply these insights to several salient empirical examples that illustrate the different kinds of effects screening programs might produce. Our empirical examples focus on contexts relevant to the top two causes of death in the United States, heart disease and cancer, and match three predictions from the framework. First, currently unscreened patients differ from currently screened patients in important ways, leading to lower predicted uptake of recommended treatment if these patients were diagnosed. Second, there are diminishing clinical returns to screening, which can be reversed if patients with low access to care are targeted with a bundled intervention. Third, changes in the composition of diagnosed patients can produce misleading conclusions during policy analysis, such as spurious reductions in measured health system performance as screening expands.
    JEL: D0 D8 I1
    Date: 2018–02

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