nep-hea New Economics Papers
on Health Economics
Issue of 2018‒03‒26
37 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Preventives Versus Treatments Redux: Tighter Bounds on Distortions in Innovation Incentives with an Application to the Global Demand for HIV Pharmaceuticals By Kremer, Michael; Snyder, Christopher
  2. Measuring the Demand Effects of Formal and Informal Communication : Evidence from Online Markets for Illicit Drugs By Luis Armona
  3. An Analysis of Peer Effects on Vaccination Behavior Using a Model of Privately Provided Public Goods By Itaya, Jun-ichi; Ibuka, Yoko; Miyazato, Naomi
  4. Mental health legislation in Croatia: past, current state and future challenges By Velinka Grozdani?; Marissabell ?kori?; Dalida Rittossa
  5. A SCOPING STUDY OF RESEARCH INTO THAI MEDICINAL PLANTS AND THAI TRADITIONAL DRUGS By Tipaporn Kanjanarach; Nantawan Panpech; Panaya Chouwajareon; Thanaporn Wisetgeaw
  6. Bounds Test Cointegration Approach to Examine Factors Contributing to Declining Maternal Mortality Ratio in Sudan (1969-2015) By Mohamed, Elwasila
  7. The Disability Option: Labor Market Dynamics with Macroeconomic and Health Risks By David Wiczer; Amanda Michaud
  8. R&D-Driven Medical Progress, Health Care Costs, and the Future of Human Longevity By Sebastian Böhm; Volker Grossmann; Holger Strulik
  9. The State of Tobacco Control in ASEAN: Framing the Implementation of the FCTC from a Health Systems Perspective By Gianna Gayle Herrera Amul and Tikki (Pangestu) Pang
  10. Progress in Tobacco Control in Singapore: Lessons and Challenges in the Implementation of the Framework Convention on Tobacco Control By Gianna Gayle Herrera Amul and Tikki (Pangestu) Pang
  11. Effects of Motorcycle Helmet Laws on Fatalities’ Prevention: An Impact Evaluation By Blanco, Magdalena; Cabrera, José María; Cid, Alejandro; Carozzi, Felipe
  12. Seductive Solutions, Inspiration, Easy-to-Remember Phrases, and Ambiguity: Why Is the Idea of Active Ageing so Successful? By Hasmanová Marhánková, Jaroslava
  13. Social capital as disease prevention By Stefano Bartolini
  14. How Medicaid Helps Older Americans By Steven A. Sass
  15. Worsening Workers' Health by Lowering Retirement Age: The Malign Consequences of a Benign Reform By Ann Barbara Bauer; Reiner Eichenberger
  16. Disentangling the effect of waiting times on hospital choice: Evidence from a panel data analysis By M. Lippi Bruni; C. Ugolini; R. Verzulli
  17. An Ounce of Prevention is Worth a Pound of Cure—Universal Health Coverage to Strengthen Health Security By Geoff Clark, Michael O'Dwyer, Ysanne Chapman and Benjamin Rolfe
  18. The Impact of Obesity on Wages: the Role of Personal Interactions and Job Selection By Moro, Andrea; Tello-Trillo, D. Sebastian; Tempesti, Tommaso
  19. Macro Economy and Health in India By Motkuri, Venkatanarayana; Khan, Amir Ullah
  20. The effect of a mystery shopper scheme on prescriptions in primary care By Cheo, Roland; Ge, Ge; Godager, Geir; Liu, Rugang; Wang, Qiqi; Wang, Jian
  21. Could Easier Access to University Improve Health and Reduce Health Inequalities? By Heckley, Gawain; Nordin, Martin; Gerdtham, Ulf-G.
  22. Prenatal care and socioeconomic status: effect on cesarean delivery By Carine Milcent
  23. Class-specific gender gaps in health. The role of gender and working conditions within classes. By Kjellsson, Sara
  24. Social justice, the food product consumer and non-communicable diseases: Implications of consumer protection legislation for the food industry in South Africa By Karunanidhi Reddy
  25. A Brief History of the Care of Those with Mental Disorders and Developmental Disabilities in the United States By Maureen Gibney
  26. Parental Beliefs about Returns to Child Health Investments By Biroli, Pietro; Boneva, Teodora; Raja, Akash; Rauh, Christopher
  27. Economic Conditions, Parental Employment and Health of Newborns By van den Berg, Gerard J.; Paul, Alexander; Reinhold, Steffen
  28. The Formation and Malleability of Dietary Habits: A Field Experiment with Low Income Families By Belot, Michèle; Berlin, Noemi; James, Jonathan; Skafida, Valeria
  29. Health and Skill Formation in Early Childhood By Pietro Biroli
  30. Local Market Equilibrium and the Design of Public Health Insurance System By Chao Fu; Naoki Aizawa
  31. Economic assessment and valuations of environmental and health impacts caused by Perfluorooctanoic acid (PFOA) and its salts By Silke Gabbert
  32. Prenatal Exposure to Shocks and Early-Life Health: Impact of Terrorism and Flood on Birth Outcomes in Pakistan By Muhammad Nasir
  33. Factors Affecting Participation in Health Checkups: Evidence from Japanese Survey Data By Riko Noguchi; Junyi Shen
  34. Estimating the Value of Life and Injury for Pedestrians Using a Stated Preference Framework By Glenn P. Jenkins; Naghmeh Niroomand
  35. Impact of type 2 diabetes on health expenditure: an estimation based on individual administrative data By François-Olivier Baudot; Anne-Sophie Aguadé; Thomas Barnay; Christelle Gastaldi-Ménager; Anne Fagot-Campagna
  37. Health Expenditure, GDP Growth and the Financial Crisis: A Panel Data Analysis for OECD European Countries By Joana Cima; Alvaro S Almeida

  1. By: Kremer, Michael; Snyder, Christopher
    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.
    Keywords: deadweight loss; pharmaceuticals; product development
    JEL: F23 I14 L65 O31
    Date: 2018–02
  2. By: Luis Armona
    Abstract: I present evidence that communication between marketplace participants is an important influence on market demand. I find that consumer demand is approximately equally influenced by communication on both formal and informal networks- namely, product reviews and community forums. In addition, I find empirical evidence of a vendor's ability to commit to disclosure dampening the effect of communication on demand. I also find that product demand is more responsive to average customer sentiment as the number of messages grows, as may be expected in a Bayesian updating framework.
    Date: 2018–02
  3. By: Itaya, Jun-ichi; Ibuka, Yoko; Miyazato, Naomi
    Abstract: Traditional economic models of vaccination behavior simply assume that agents free-ride on the vaccination decisions of others. We provide three different models of private provision of a public good, such as a joint production model and a conjectural variation model, to explain how a positive peer effect regarding vaccination behavior arises. We conduct two empirical studies using Japanese data in these models. The first empirical analysis, using a data set on the vaccination behavior of neighbors residing in the same block of a city, finds the existence of positive peer effects on individuals' vaccination decisions. The second empirical analysis also confirms that there are peer effects on the vaccination decisions of members of the same household using a dataset from the national survey we conduct.
    Keywords: Peer effect, Public Good, Vaccination, Free-rider,
    Date: 2018–02–25
  4. By: Velinka Grozdani? (Faculty of Law University of Rijeka); Marissabell ?kori? (Faculty of Law University of Rijeka); Dalida Rittossa (Faculty of Law University of Rijeka)
    Abstract: For the first time in Croatia the mental health legislation was enacted in 1997. Before the enactment of the Law/97 legal regulations concerning the legal status and compulsory detention of persons with mental difficulties were partial, inadequate, outdated and in most cases not applied in practice. Unfortunately, the first Croatian stand-alone law for mental health didn?t resolve all the problems. Experience with the Law/97 shows that the mere existence of mental health legislation does not necessarily guarantee the protection of the human rights of people with mental disorders. In the meantime high standards for protection of people with mental disabilities have already been accepted in numerous European and international documents. The 2006 UN Convention on the Rights of Persons with Disabilities has played a leading role in setting the new standards. Developments in the area of protection of people with mental health problems and specially the entry into force of the Convention in May 2008 triggered legislative reforms in many states including Croatia. The new Law on Protection of Persons with Mental Difficulties was enacted in June 2014 and entered into force in January 2015. The main aim of the legislator has been to put forward legal solutions to improve a current legal position of persons suffering from mental disorders. One of the most important amendments is related to models of placement into psychiatric institution. An agent for healthcare decisions is a new institute introduced into Croatian legal system to directly and substantially enhance protection of persons with mental health problems. Another important improvement introduced in the Law concerns outpatient treatment of mentally incompetent persons who committed an unlawful act. Making laws is the first step in protecting the rights of people with mental disorders, but after that it is necessary to organize educational lectures and workshops to prepare mental health professionals, lawyers as well as psychiatrists for implementation of the new Law. The NGO activists were included in educational programs and organisation of a campaign to promote the new human rights package of standards for people with mental disorders. A development of international standards and application of the Law/14 have been closely monitored and evaluated under the research activities within the Croatian Science Foundation project. Education, close cooperation of practitioners from different fields and opened discussions have been recognised as an important tool for promotion the rights of people with mental health problems increasing their empowerment in society.
    Keywords: mental health legislation, persons with mental difficulties, international standards, Croatia
    Date: 2017–10
  5. By: Tipaporn Kanjanarach (Khon Kaen University); Nantawan Panpech (Khon Kaen University); Panaya Chouwajareon (Khon Kaen University); Thanaporn Wisetgeaw (Khon Kaen University)
    Abstract: Introduction: Thailand established a policy to promote the use of traditional medical knowledge in the country?s health care system in1977. Research into the safety and efficacy of Thai medicinal plants and Thai traditional drugs was a key strategy. Objective: This scoping review aimed to analyze the types of research articles specific to Thai medicinal plants and Thai traditional drugs. Methods: Research articles were extracted from three data bases: PubMed, Thai-journal citation index centre (TCI) and Thai Thesis Database. The keyword ?Thai traditional*? was used to capture all possible articles. Three reviewers independently screened the search results to exclude the articles published in languages other than Thai or English, or references to other Thai traditional medical practice. Results: Of 1830 articles possibly related to Thai traditional drugs, 408 were finally included for the review. A majority of the articles were about individual Thai herbs. Only 46 (11.3%) were about Thai traditional formulations. Seventy seven articles (18.9%) were on herbs or Thai traditional formulations listed in the national essential drug list. Most of the research reports were in vitro phase (324 articles, 79.4 %) followed by in vivo phase (61 articles, 15.0%), clinical phase I to phase III (10 articles, 2.45%), biological activity (10 articles, 2.45%) and post-marketing studies (3 articles, 0.7%). An increasing trend of the number of publications started to be noticed after 2003. During 2012-2016, the average number of publications per year was 35. Conclusion: The findings suggested that evidence to support the use of Thai medicinal plants and Thai traditional drugs is still lacking. Thailand should review the country?s strategies to support research into Thai medicinal plants and Thai traditional drugs.
    Keywords: natural product; herb; traditional medicine; health care policy; Thai
    JEL: I18
    Date: 2017–10
  6. By: Mohamed, Elwasila
    Abstract: Abstract Unlike other studies in the field of maternal health, the objective of this study is to examine the contribution of some socioeconomic, demographic and health care factors to the declining trend of maternal mortality ratio MMR in Sudan over the period 1969-2015. The study employs econometric techniques including the OLS, Cointegration methods of Johansen and autoregressive distributed lag ARDL bounds tests and Granger causality analysis. The OLS shows that economic growth measured by GDP has significant bad affect on MRR but it has more significant good effect when measured by GDP per capita GDPP. Declining fertility rates lead to declines in MMR. Health expenditure has no effect on MMR. The ARDL bounds test shows existence of a long-run equilibrium relationship between MMR and its explanatory variables. In both the short run and long run, declines in MMR are explained by GDPP and fertility but badly affected by GDP. In contrast, health care factors have no effects on MMR. Granger causality test shows a unidirectional relationship running from economic growth measured by GDP and GDPP to MMR with no sign of feedback effect. Bidirectional relationships between MMR and fertility rate, MMR and health expenditure, as well as between MMR and the number of physicians per 100,000 people have been established. The study recommends that the government should ensure stable and inclusive economic growth. There is a need to increase resources to maternal and reproductive health with emphasis on the number of physicians per 100,000 people in order to move forward to the SDGs.
    Keywords: Key words: Maternal Mortality, GDP, Fertility, Health care, Cointegration, ARDL, Sudan
    JEL: I15 I18
    Date: 2018–03–03
  7. By: David Wiczer (FRB St. Louis); Amanda Michaud (Indiana University)
    Abstract: In recent decades, Social Security Disability Insurance (SSDI) claims have risen rapidly. We evaluate the importance of changing macroeconomic conditions in shaping this trend. Our quantitative framework considers that economic conditions interact with individuals' health status in their decisions to apply for SSDI. Crucially, these factors are correlated through the nature of work: multiple sectors differentially expose workers to health and economic risks. Decomposing factors driving SSDI growth in a calibrated model, we find the deteriorating economic conditions and concentration of health risks account for about half of the increase in SSDI claims predicted by the model, about a third overall.
    Date: 2017
  8. By: Sebastian Böhm; Volker Grossmann; Holger Strulik
    Abstract: In this paper we set up an overlapping generations model of gerontological founded human aging that takes the interaction between R&D-driven medical progress and access to health care into account. We use the model to explore potential futures of human health and longevity. For the baseline policy scenario of health care access, the calibrated model predicts substantial future increases in health and life expectancy, associated with rising shares of health expenditure in GDP. Freezing the expenditure share at the 2020 level by rationing access to health care severely reduces potential gains in health, longevity and welfare. These losses are greatest in the long run due to reduced incentives for medical R&D. For example, rationing is predicted to reduce potential gains of life-expectancy at age 65 by about 4 years in the year 2050. Generally, and perhaps surprisingly, young individuals (i.e. those who save the most health care contributions through rationing) are predicted to suffer the greatest losses in terms of life expectancy and welfare.
    Keywords: longevity, medical R&D, morbidity, health care, rationing
    JEL: H50 I10 C60 O11
    Date: 2018
  9. By: Gianna Gayle Herrera Amul and Tikki (Pangestu) Pang
    Abstract: Using a tobacco control framework that combines demand-reduction and selected supply-reduction measures according to a health system's building blocks, this article aims to assess the state of Framework Convention on Tobacco Control implementation in ASEAN countries from a health systems perspective. Results show that more ASEAN member states are showing leadership in adopting effective policies in the MPOWER suite of interventions such as raising taxes on tobacco, establishing smoke-free areas and implementing graphic health warnings. However, effective enforcement of these policies is hampered by the lack of policies to protect public health measures from tobacco industry interference. ASEAN faces three challenges to control and reduce tobacco use: tackling the increasing burden of disease from tobacco use, tobacco industry interference and the need for better governance based on stronger political will and commitment. ASEAN member states need to further invest and innovate on tobacco control and promoting healthy lifestyles in order to achieve the SDG target on tobacco control.
    Keywords: tobacco control, ASEAN, FCTC, Southeast Asia, health policy, health system
    Date: 2018–01–21
  10. By: Gianna Gayle Herrera Amul and Tikki (Pangestu) Pang
    Abstract: Singapore has implemented tobacco control policies since the 1970s, more than three decades before it became party to the World Health Organization (WHO) Framework Convention on Tobacco Control—the first evidence-based global health treaty in 2005. The country's stringent policies have resulted in a 13 per cent adult smoking prevalence rate, one of the lowest in the world. This article reviews how a mix of demand- and supply-reduction measures with extensive regulation and stringent enforcement has contributed to Singapore's reputation as the ‘most hostile environment’ for tobacco companies. Its tobacco control policies can offer lessons for more effective tobacco control among its neighbouring countries.
    Keywords: Singapore, tobacco control, public health, smoking, policy
    Date: 2018–01–23
  11. By: Blanco, Magdalena; Cabrera, José María; Cid, Alejandro; Carozzi, Felipe
    Abstract: Simultaneity bias complicates the estimation of the causal effect of motorcycle helmet usage on fatalities. We overcome this obstacle by exploiting an exogenous variation in the enforcement of the motorcycle helmet usage law between two municipalities in Uruguay. We show evidence of a dramatic increase in helmet usage in one municipality after the law was enforced. In just one month, usage increased from less than 10% to more than 90%. Our difference in difference estimates show that helmet usage laws are associated with a significant decrease in injuries and fatalities.
    Keywords: motorcycle accidents, helmet, natural experiment, prevention
    JEL: I1 I12 I18
    Date: 2017–11
  12. By: Hasmanová Marhánková, Jaroslava
    Abstract: The idea of active ageing has become one of the most influential perspectives in modern gerontology, social work, and social policy. This paper discusses factors that helped to establish active ageing as a successful theoretical concept that has significantly influenced contemporary social representations of ageing and has a practical impact on social work and policy. The perspective of the philosophy of social science is employed to explain what makes the idea of active ageing so attractive despite the remaining confusions concerning what “activity” and “ageing actively” means. The paper aims to answer the following question: What makes the concept of active ageing so successful? It draws upon the work of Murray Davis (1986) and her insight into the key aspects that make sociological theory “seductive.” The paper analyzes in what ways the concept of active ageing fulfills the specific features that, according to Davis, determine the success of social theories. Simultaneously, the paper critically evaluates the ways the idea of active ageing is translated into ageing policy. The case of Czech Republic is used to illustrate the problematic aspect of active ageing policies as well as the specific rhetoric that makes the idea of active ageing so attractive for a broad spectrum of disciplines as well as for social policy.
    Keywords: Active Ageing, Policy Ideas, Sociological Theory
    JEL: J14 J18
    Date: 2017
  13. By: Stefano Bartolini
    Abstract: Increasing demand for healthcare in developed countries raises concerns about the sustainability of spending on healthcare. Building on epidemiological, medical, economic, sociological and psychological research, I argue that a well-being and social capital crisis largely explains rising healthcare demand. There is compelling evidence that increasing dissatisfaction has caused an increase in morbidity and mortality rates in the US. A main policy recommendation is to tackle declining connections and the spread of social isolation in order to increase well-being and health. I review literature suggesting three domains where policies for social capital can be implemented: urban planning, schooling and regulation of advertising. Moreover, a crisis of trust between physicians and patients underlies the increasing phenomenon of defensive medicine that weighs substantially on healthcare spending. Policies aimed at tackling defensive medicine are discussed
    Keywords: health, morbidity, mortality, social capital, happiness, subjective well-being, objective well-being
    JEL: I10 I31 Z13
    Date: 2018–02
  14. By: Steven A. Sass
    Abstract: Medicaid is generally not the first program that comes to mind when discussing government health care for older Americans. Its counterpart, Medicare, is the primary health insurance program for seniors of all income levels, while MedicaidÕs beneficiaries span a broad age range and typically have low incomes. However, Medicaid does offer critical benefits to many retirees and those approaching retirement. For eligible retirees, Medicaid provides insurance directly or pays their Medicare premiums and co-pays. It is also the single largest source of long-term care support for the elderly, covering about half of total spending on these services. Finally, in states that adopted the Medicaid expansion under the Affordable Care Act, the program insures about one out of six Americans approaching retirement. This brief offers a primer on the role of Medicaid for retirees and near-retirees. The discussion proceeds as follows. The first section reviews Medicaid benefits for the elderly, ages 65 and over. The second section reviews benefits for those approaching retirement, ages 50-64. The third section discusses how these groups, particularly those 65 and over, fit within the context of the larger Medicaid program. The final section concludes that the need for Medicaid benefits by older Americans will rise as the population ages and medical costs continue to increase faster than household incomes. Whether Medicaid meets this need depends on the outcome of the ongoing policy debate over the size and scope of the program.
    Date: 2018–03
  15. By: Ann Barbara Bauer; Reiner Eichenberger
    Abstract: In 2003, the retirement age of Swiss construction workers was lowered from 65 to 60. This reform has been intended to improve their health. Our study shows the opposite outcome. The human capital theory suggests that investments in employees’ productivity by the employer and the employees themselves depend on the time remaining until their retirement. Hence, we hypothesize that pension reforms that reduce employees’ working horizon decrease investments in work-related human capital, which translates into a higher prevalence of sickness absences, a longer absence duration, and worse health. By econometrically comparing pre- and post-reform cohorts of construction workers with other blue-collar workers, we find that among 56–60-year-old construction workers, their sickness absences increase from 3.2% to 5.6%, their sickness duration increases by 33%, and their probability of having health problems increases from 9% to 12.7% due to the reform.
    Keywords: Pension reform; natural experiment; construction worker; sickness absence; sickness duration; poor health
    JEL: I12 J14 J26 L74
    Date: 2018–03
  16. By: M. Lippi Bruni; C. Ugolini; R. Verzulli
    Abstract: This study examines the effect of waiting times on hospital choice by using patient-level data on elective Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures in the Italian NHS over the years 2008-2011. We perform a multinomial logit analysis including conditional logit and mixed logit specifications. Our findings show the importance of jointly controlling for time-invariant and time varying dimensions of hospital quality in order to disentangle the effect of waiting times on hospital choice. We provide evidence that patients are responsive to changes in waiting times and aspects of clinical quality within hospitals over time, and estimate the trade-off that patients make between different hospital attributes. The results convey important policy implications for highly regulated health care markets.
    JEL: I10
    Date: 2018–03
  17. By: Geoff Clark, Michael O'Dwyer, Ysanne Chapman and Benjamin Rolfe
    Abstract: The Sustainable Development Goal 3 targets aim to ensure that individuals achieve universal health coverage and that the capacity of countries, to identify early warnings, implement risk reduction plans and to respond and manage national and global health risks including emerging infectious diseases outbreaks is strengthened. Funding for the achievement of these outcomes can be erratic and weak healthcare systems do not cope well with the vagaries of fluctuating economies. Universal health coverage is achievable with formulated social health insurance programs that ensure consistent and predictable financial flows. This article deliberates the situation in the Asia Pacific region considering how funding the elimination of infectious diseases (specifically malaria) can facilitate a strengthening of weak health systems, which in turn will build economic potency and health security in the region.
    Keywords: universal health coverage, social health insurance, malaria, Asia Pacific, health security
  18. By: Moro, Andrea; Tello-Trillo, D. Sebastian; Tempesti, Tommaso
    Abstract: We estimate the effects of obesity on wages accounting for the workers' sorting into jobs requiring different levels of personal interactions in the workplace. Using data from the National Longitudinal Survey of Youth 1979 combined with detailed information about jobs from O*Net, we find a wage penalty for obese white women. This penalty is higher in jobs that require a high level of personal interactions. Accounting for job selection does not significantly change the estimated wage penalty.
    Keywords: obesity,wages,selection,personal interactions
    JEL: I0 I12 I14 J31
    Date: 2018–01–03
  19. By: Motkuri, Venkatanarayana; Khan, Amir Ullah
    Abstract: This paper setting the health in the macroeconomic framework discusses how health is being neglected in the Indian state policy making where it has not been drawn required policy attention and priority in resource allocation. It also focuses on where health institutions failed, where policy went wrong and how adequate care was not taken in setting goals, identifying the solutions and monitoring progress. Inadequate policy attention towards sporadic interventions in pricing, health financing issues and the all important concern over the lack of trained health sector resources are a few of the major issues that define where India went wrong in tackling the health sector.
    Keywords: Health and Economy, Health
    JEL: I00 I15 I18
    Date: 2018–02
  20. By: Cheo, Roland (1Center for Economic Research, Shandong University, China); Ge, Ge (Department of Health Management and Health Economics); Godager, Geir (Department of Health Management and Health Economics); Liu, Rugang (4Center for Health Economic Experiments and Public Policy, School of Public Health, Shandong University); Wang, Qiqi (School of Economics, Shandong University, China); Wang, Jian (Center for Health Economic Experiments and Public Policy, School of Public Health, Shandong University)
    Abstract: Health care systems in many countries are still characterized by limited availability of provider performance data which can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. Using a randomized treatment-control design, we conduct a field experiment in primary care clinics in a Chinese city. We investigate whether informing clinics in the treatment group of a forthcoming mystery shopper audit influences the physicians’ prescribing behavior. As expected, we find that antibiotic medications are prescribed to patients in the majority of cases, even though such prescribing is not in accordance with current recommendations or guidelines. While the intervention did not cause significant reduction in antibiotic prescriptions, our results show that a mystery shopper scheme reduces overall unnecessary prescribing.
    Keywords: Field Experiment; Analysis of Health Care Markets; Government Policy; Information and Product Quality; Social Responsibility.
    JEL: C93 I11 I18 L15 M14
    Date: 2018–03–16
  21. By: Heckley, Gawain (Health Economics Unit, Department of Clinical Sciences, Lund University); Nordin, Martin (Department of Economics, Lund University); Gerdtham, Ulf-G. (Department of Economics, Lund University)
    Abstract: This paper estimates the impact of university education on medical care use and its income related inequality. We do this by exploiting an arbitrary university eligibility rule in Sweden combined with regression discontinuity design for the years 2003-2013 for students who graduated 2003-2005. We find a clear jump in university attendance due to university eligibility. This jump coincides with a positive jump in prescriptions for contraceptives for females but also a positive jump in mental health related hospital admissions for males. Analysis of the inequality impact of tertiary eligibility finds no clear impact on medical care use by socioeconomic status of the parents. The results imply that easing access to university for the lower ability student will lead to an increase in contraceptive use without increasing its socioeconomic related inequality. At the same time, the results highlight that universities may need to do more to take care of the mental health of their least able students.
    Keywords: Health returns to education; demand for medical care; causes of health inequality; Regression Discontinuity Design; Concentration Index
    JEL: I12 I14
    Date: 2018–03–13
  22. By: Carine Milcent (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)
    Keywords: Pregnancy care,Health education,Socioeconomic position,Cesarean delivery
    Date: 2018–03
  23. By: Kjellsson, Sara (Swedish Institute for Social Research, Stockholm University)
    Abstract: Social scientific health research typically finds higher levels of ill health among women and among the working class, and working conditions is an important mechanism in the literature on class health inequality. Whether gender health differences are similar across classes or whether they are class-specific is less studied. The aim of this study is to explore class-specific gender gaps in self-rated health (SRH), musculoskeletal pain and psychiatric distress, and whether they can be ascribed to working conditions. The study consists of 2597 employed men and women, aged 18-65, with information on class, working conditions and health from the Swedish Level of Living Survey (LNU) in 2010. Linear Probability Models (LPM) are estimated and when including interaction terms between gender and class some class-specific gender gaps are observed. The between-class aspect of these cannot be ascribed to working conditions, but they contribute to the understanding of within-class differences. For SRH the gap is 10 percentage points larger among unskilled workers than higher non-manual employees. This can partly be ascribed to these women experiencing large psychosocial demands; while at the same time being more vulnerable than male unskilled workers to physically strenuous conditions. In skilled working class women are found to be particularly exposed to psychosocially demanding conditions, which accounts for the gender gap in musculoskeletal pain within this class. This study shows that gender differences in health differs between classes, and that taking class-specific horizontal gender segregation into account is needed in order to understand gender health differences.
    Keywords: Sweden; Health inequality; Gender; Class; Working conditions
    Date: 2018–03–09
  24. By: Karunanidhi Reddy (Durban University of Technology, South Africa)
    Abstract: Many health problems are related to food and diet patterns. Socio-economic development in South Africa has meant a change in diet patterns, with poorer communities moving away from traditional foods to convenience and processed foods. These foods have been associated with obesity and could greatly increase the risk of developing food-related non-communicable diseases, including diabetes, high blood pressure and heart disease. In addition, apartheid resulted in inequality among consumers in terms of education levels, literacy and understanding of the language used in labelling and product information, as well as in terms of access to good quality commodities that are arguably healthier. It also resulted in inequality in terms of knowledge of consumer rights and the ability to enforce them, and a lack of information and knowledge as to food related health challenges. Particular sectors in the food industry have been less concerned about the consumer health risks associated with their products or communicating such information to their consumers. Hence, recently there have been initiatives by government to protect consumers against food related non communicable diseases by proposing legislation to curb consumption of specific food products. The proposed ?sugar tax? on sugar sweetened beverages is one example. The Consumer Protection Act (CPA), passed in 2008, aims at protection of consumers by prohibiting or regulating a range of marketing and business practices and affording the consumer a range of legal rights and remedies. This paper investigates the implications of the CPA and related legislation, for the food industry and consumers of food products. The approach adopted for this paper is a descriptive critique engaging in a review of related literature, and pertinent legislation, particularly the CPA. It is envisaged that this paper will highlight the implications of the CPA in terms of the rights of consumers and the concomitant obligations of suppliers of food products, to re-examine the health risks related to their products, food labelling, disclosure of information particularly about associated health risks, and consumer education about products, in plain and understandable language. It will also identify possible gaps in the law requiring specific regulation.
    Keywords: Consumer; consumer protection; non-communicable diseases; food products; food industry ; social justice; South Africa
    JEL: K29 L66
    Date: 2017–10
  25. By: Maureen Gibney (Drexel University)
    Abstract: Over the course of more than 250 years in the United States, approaches to the treatment of those with severe mental disorders and developmental disabilities have undergone significant changes. These shifts have sometimes been driven by public will, sometimes by financial constraints, and sometimes by legal interventions; occasionally the changes have reflected clinically sound considerations. In brief overview this paper will examine the evolution of the role of asylums, the reliance on and eventual turning away from long-stay institutions as key custodial and treatment facilities, and the benefits and failures of deinstitutionalization. The documentation of abuses in many institutions, the reallocation of resources through cost shifting, and the transfer of sometimes vulnerable persons to community settings will be discussed. The impact of legislation and judicial rulings, scientific advances in the understanding of mental and developmental disorders, and the current funding uncertainties facing those with chronic conditions will be explored. Finally, examining the development of the patients? rights and recovery movements, the strategic focus on advocacy and anti-stigma campaigns, and the building of alliances in the context of inclusion will highlight the centrality of the persons affected by the many legal, economic, medical, educational, and quality of life concerns to be discussed.
    Keywords: Mental health, mental disorders, developmental disabilities, asylums, deinstitutionalization, community care
    JEL: I19
    Date: 2017–10
  26. By: Biroli, Pietro (University of Zurich); Boneva, Teodora (University College London); Raja, Akash (London School of Economics); Rauh, Christopher (University of Montreal)
    Abstract: Childhood obesity has adverse health and productivity consequences and poses negative externalities to health services. Its increase in recent decades can be traced back to unhealthy habits acquired in the household. We investigate whether parental beliefs play a role by eliciting beliefs about the returns to a recommended-calorie diet and regular exercise using hypothetical investment scenarios. We show that perceived returns are predictive of health investments and outcomes, and that less educated parents perceive the returns to health investments to be lower, thus contributing to the socioeconomic inequality in health outcomes and the intergenerational transmission of obesity.
    Keywords: parental investments, health, beliefs, inequality, equality of opportunity, obesity
    JEL: D19 I10 I12 I14
    Date: 2018–02
  27. By: van den Berg, Gerard J. (University of Bristol); Paul, Alexander (Aarhus University); Reinhold, Steffen (University of Mannheim)
    Abstract: We examine whether economic downturns are beneficial to health outcomes of newborn infants in developed countries. For this we use merged population-wide registers on health and economic and demographic variables, including the national medical birth register and intergenerational link registers from Sweden covering 1992–2004. We take a rigorous econometric approach that exploits regional variation in unemployment and compares babies born to the same parents so as to deal with possible selective fertility based on labor market conditions. We find that downturns are beneficial; for example, a one-percentage-point increase in the unemployment rate during pregnancy reduces the probability of having a birth weight less than 1,500 grams or of dying within 28 days of birth by 10–15%. Effects are larger in low socio-economic status households. Health improvements cannot be attributed to the parents' own employment status. The results suggest pathways through stress and air pollution.
    Keywords: recession, unemployment, fertility, infant health, stress
    JEL: I1 J1
    Date: 2018–02
  28. By: Belot, Michèle (European University Institute); Berlin, Noemi (University Paris Ouest-Nanterre); James, Jonathan (University of Bath); Skafida, Valeria (University of Edinburgh)
    Abstract: We conduct a field experiment to evaluate the extent to which dietary habits are malleable early on in childhood and later in life. We implement two treatments one that targets what people eat, the other that targets the timing and frequency of food intake. 285 low income families with young children were recruited and assigned either to a control group or one of the two treatments, each of them lasting for 12 consecutive weeks. In one treatment, families received food groceries at home for free for 12 weeks and were asked to prepare five specific healthy meals per week. In the other treatment, families were simply asked to reduce snacking and eat at regular times. We collected a range of measures of food preferences, dietary intake, as well as BMI and biomarkers based on blood samples. We find evidence that children's BMI distribution shifted significantly relative to the control group, i.e. they became relatively "thinner". We also find some evidence that their preferences have been affected by both treatments. On the other hand, we find little evidence of effects on parents. We conclude that exposure to a healthy diet and regularity of food intake possibly play a role in shaping dietary habits, but influencing dietary choices later on in life remains a major challenge.
    Keywords: diet, field experiments, habit formation, biomarkers
    JEL: I12 I14 I18
    Date: 2018–02
  29. By: Pietro Biroli
    Abstract: This paper analyzes the developmental origins and the evolution of health, cognitive, and socio-emotional skills during early childhood, from age 0 to 5. We explicitly model the dynamic interactions of health with the child's behavior and cognitive skills, as well as the role of parental investment. A dynamic factor model corrects for the presence of measurement error in the proxy for the latent traits. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we find that children's capabilities strongly interact and build on each other: health is an important determinant of early socio-emotional development; in turn socio-emotional skills have a positive impact on the evolution of both health and cognitive functions; on the other side, the effect of cognitive abilities on health is negligible. Furthermore, all facets of human capital display a high degree of persistence. Finally, mother's investments are an important determinant of the child's health, cognitive, and socio-emotional development early in life.
    Keywords: Human capital, health, early childhood, family investment, intergenerational transmission, ALSPAC.
    Date: 2017
  30. By: Chao Fu (University of Wisconsin - Madison); Naoki Aizawa (University of Minnesota)
    Abstract: We study the design of public health insurance system and its equilibrium impacts on the labor market and the health insurance market. We develop an equilibrium model with rich heterogeneities across local markets, workers and firms; and estimate it exploiting variations across states and policy environments before and after the Affordable Care Act. The estimated model closely matches the distribution of insurance and employment status before and after the ACA. With the estimated model, we study the impacts of programs in the form of the newly proposed Medicaid block granting, which allows for state-specific Medicaid eligibility and coverage rules.
    Date: 2017
  31. By: Silke Gabbert (Wageningen University)
    Abstract: Perfluorooctanoic acid (PFOA) is being used in fluoropolymer production, as surface treatment agents and for the manufacture of side-chain fluorinated polymers. However, there is evidence that PFOA and its salts have a number of hazardous properties that may cause harm to human health and the environment. This report evaluates existing economic assessments and valuations of impacts arising from PFOA and its salts.
    Keywords: Cost-benefit analysis, environmental health valuation, non-market valuation, PBT, PFOA, regulatory impact assessment
    JEL: D61 D62 D83 I18 L51 Q51 Q52
    Date: 2018–03–22
  32. By: Muhammad Nasir (Pakistan Institute of Development Economics, Islamabad)
    Abstract: Simultaneous exposure to natural calamities and conflict shocks is a phenomenon that has been largely understudied. The interplay between natural disasters and conflict shocks can have adverse effects extending beyond the current family members to children in utero. The current paper tries to fill this gap by investigating the impact of floods on pregnancy and birth outcomes across conflict-affected and unaffected districts in Pakistan. Using mother fixed effects strategy in a triple difference framework, the results suggest that in-utero exposure to flood in conflict-affected areas increases the probability of small birth size by 8.1 percentage points. Moreover, exposure to violence in nonflooded districts reduces the likelihood of small birth size by 5.6 percentage points but increase the probability of miscarriage by 3.7 percentage points, thereby suggesting selection into birth. Significant heterogeneities are found across place of residence, income groups, and education levels.
    Keywords: Natural Calamity, Violence, Birth Outcomes, Child Health,Pakistan
    Date: 2018
  33. By: Riko Noguchi (Graduate School of Economics, Kobe University, Japan); Junyi Shen (Research Institute for Economics and Business Administration (RIEB), Kobe University, Japan, and School of Economics, Shanghai University, China)
    Abstract: Multiple factors influence individuals to get health checkups. This study uses Japanese survey data to investigate key determinants of the health checkup decision. Relevant personal attributes and lifestyles are identified. The results indicate that the influence of these factors varies according to the type of health checkup. We also examine the impact of an individual’s time preference on his/her health checkup behavior. The results suggest that hyperbolic discounters are more likely than non-hyperbolic discounters to seek health checkups, which indicates that the effect of time preference on health checkup behavior differs among the different types of time discount structures.
    Keywords: Health checkup; Health behavior; Time preference; Hyperbolic discounting; Japan
    Date: 2018–01
  34. By: Glenn P. Jenkins (Queen's University, Canada and Eastern Mediterranean University, North Cyprus); Naghmeh Niroomand (Cambridge Resources International)
    Abstract: Introduction: The incidence of pedestrian death over the period 2010 to 2014 per 1000,000 in North Cyprus is about 2.5 times that of the EU, with 10.5 times more pedestrian road injuries than deaths. With the prospect of North Cyprus entering the EU, many investments need to be undertaken to improve road safety in order to reach EU benchmarks. Method: We conducted a stated choice experiment to identify the preferences and tradeoffs of pedestrians in North Cyprus for improved walking times, pedestrian costs, and safety. The choice of route was examined using mixed logit models to obtain the marginal utilities associated with each attribute of the routes that consumers chose. These were used to estimate the individuals’ willingness to pay (WTP) to save walking time and to avoid pedestrian fatalities and injuries. We then used the results to obtain community-wide estimates of the value of a statistical life (VSL) saved, the value of an injury (VI) prevented, and the value per hour of walking time saved.Results: The estimate of the VSL was €699,434 and the estimate of VI was €20,077. These values are consistent, after adjusting for differences in incomes, with the median results of similar studies done for EU countries. Conclusions: The ratio of deaths to injuries is much higher for pedestrians than for road accidents, and this is completely consistent with the higher WTP to avoid a pedestrian accident than that to avoid a car accident. Moreover, the value of risk reduction (VRR) is perfectly rational for a given reduction in the probability of a fatality and an injury, which means it is an increasing function of the initial risk level. Practical Applications: Findings provide a set of information on the VRR that is useful in the ex ante appraisal of road projects for specific policy measures.
    Keywords: Willingness to pay; choice experiment; value of a statistical life; value of an injury; road safety; pedestrians
    JEL: D12 C25 Q50 J17 R41
    Date: 2017–11
  35. By: François-Olivier Baudot; Anne-Sophie Aguadé; Thomas Barnay; Christelle Gastaldi-Ménager; Anne Fagot-Campagna
    Date: 2018
  36. By: Álvaro S Almeida (CEF.UP and Faculdade de Economia, Universidade do Porto); Joana Vales (Centro Hospitalar do Tâmega e Sousa, EPE)
    Abstract: Overcrowding in hospitals’ emergency department (ED) has often been attributed to lack of appropriate response in other parts of the health system, namely primary healthcare (PHC) institutions, but there is no definitive evidence supporting this assertion. We use patient-level data of 117,391 ED visits from two non-urban hospitals in Portugal to assess the effect that the model of PHC organization may have on ED utilization. PHC organization for the patients in our sample differed in two dimensions: patients may be enrolled in three different types of functional units - Personalized Healthcare Unit, Family Health Unit (FHU) Type A and B; and patients may have (or not) a specific family physician assigned. We estimate three different models using three dependent variables that describe the use of EDs: inappropriate use, rate of utilization and severity of patients. We conclude that the model of primary care organization exerts a significant influence on the use of EDs. FHUs have a significant positive effect on reducing the rate of utilization and inappropriate attendance of EDs. FHUs also have patients with lower severity conditions. We also conclude that patients with an assigned family physician make more appropriate use of the ED.
    Keywords: Overcrowding, Emergency Department, Primary care, family physician
    JEL: I18 I11
    Date: 2017–12
  37. By: Joana Cima (CEF.UP and Faculdade de Economia, Universidade do Porto); Alvaro S Almeida (CEF.UP and Faculdade de Economia, Universidade do Porto)
    Abstract: This study analyses the dynamics of Gross Domestic Product and health expenditure for 25 OECD European countries from 1993 to 2015. The novelty of this work is in the joint evaluation of the impact of the Great Recession of the XXI century and the post-crisis period on the growth dynamics of both variables. We estimate a Vector Error Correction model with countries’ fixed effects, and amongst other findings, we conclude that the growth dynamics of health expenditure did not change significantly during the crisis. We perform additional assessments with a third variable related to the population’s health status that show there was a higher rate of people reporting poor health during the crisis and in the following periods, and the health status is caused by GDP rather than health spending. Moreover, we decompose the analysis by health financing scheme, and we observe that countries mostly financed by compulsory health insurance scheme had a worsened health status even though there was no decrease in the growth of health expenditure. These findings are a relevant contribution to the comprehensive and recent literature about the impact of the financial crisis on health. We show there was no direct impact of the Great Recession on the process that determines health expenditure growth, and that a possible deterioration in health during the recession goes beyond the effect on health spending of economic growth.
    Keywords: health expenditure, income, health status
    JEL: I10 I13
    Date: 2018–01

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