nep-hea New Economics Papers
on Health Economics
Issue of 2018‒04‒02
23 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Determinants of depressive symptomatology in caregivers of frail older-adults: The case of ultra-orthodox Jewish community By Tova Band-Winterstein; Offer E. Edelstein; Yaacov G. Bachner
  2. Assessment of a self-administered questionnaire identifying occupational exposures among lung cancer patients By Mélanie Varin; Barbara Charbotel; Olivia Pérol; Lionel Perrier; Amélie Massardier-Pilonchéry; Sandrine Bonnand; Elodie Belladame; Emmanuel Fort; Virginie Avrillon; Paul Rebattu; Maurice Pérol; Béatrice Fervers
  3. Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda By Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H.
  4. Care coordination in a business-to-business and a business-to-consumer model for telemonitoring patients with chronic diseases By Grustam, Andrija S; Vrijhoef, Hubertus J. M.; Cordella, Antonio; Koymans, Ron; Severens, Johan L
  5. The Impact of Healthy Harlem on the Body Mass Index and Weight Status of Adolescents after Two and Three Years By Martha Bleeker; James Mabli; Mary Kay Fox; Betina Jean-Louis; Marlene Fox
  6. The Impact of Healthy Harlem on Student Fitness Outcomes after Two and Three Years By Martha Bleeker; James Mabli; Mary Kay Fox; Betina Jean-Louis; Marlene Fox
  7. Caregivers' Open Communication with Terminal Cancer Patients about Illness and Death: A Comparison between Men and Women By Yaacov G. Bachner; Nily Yosef-Sela; Sara Carmel
  8. How to Design and Enforce Tobacco Excises? By Patrick Petit; Janos Nagy
  9. Universal Health Insurance in the Republic of Macedonia and Effects from the Implementation of the Project "Health Insurance for All" By Maja Parnardzieva-Zmejkova; Vladimir Dimkovski
  10. Health Differences at Birth between Roma and Non-Roma Children in Hungary - Long-Run Trends and Decompositions By Tamas Hajdu; Gabor Kertesi; Gabor Kezdi
  11. The New Prescription Drug Paradox: Pipeline Pressure and Rising Prices By Alice M. Ellyson; Anirban Basu
  12. Medical Malpractice Reforms and the Location Decisions of New Physicians By Pinka Chatterji; Siyang Li; Gerald R. Marschke
  13. The Legacy of Colonial Medicine in Central Africa By Lowes, Sara Rachel; Montero, Eduardo
  14. Effects of Pay-For-Performance on Prescription of Hypertension Drugs among Public and Private Primary Care Providers in Sweden By Ellegård, Lina Maria
  15. Early smoking, education, and labor market performance By Palali, Ali
  16. Health cost risk : A potential solution to the annuity puzzle By Peijnenburg, J.M.J.; Nijman, Theo; Werker, Bas
  17. The role of hospitals in bridging the care continuum : A systematic review of coordination of care and follow-up for adults with chronic conditions By De Regge, Melissa; De Pourcq, Kaat; Meijboom, Bert; Trybou, Jeroen; Mortier, Eric; Eeckloo, Kristof
  18. Maternal Depression, Women’s Empowerment, and Parental Investment: Evidence from a Large Randomized Control Trial By Victoria Baranov; Sonia Bhalotra; Pietro Biroli; Joanna Maselko
  19. Gene editing in an international context: Scientific, economic and social issues across sectors By Anu Shukla-Jones; Steffi Friedrichs; David E. Winickoff
  20. Does Deforestation Increase Malaria Prevalence? Evidence from Satellite Data and Health Surveys By Sebastian Bauhoff; Jonah Busch
  21. Health insurance coverage vs self-prevention: What impact of the insurer's healthcare prevention programs ? By Jean-Yves Lesueur
  22. Economic Crisis, Mortality and Health Status. A New Perspective By Vincenzo Atella; Federico Belotti; Joanna Kopinska; Alessandro Palma; Andrea Piano Mortari
  23. High radon areas and lung cancer prevalence in Ireland By Dempsey, Seraphim; Lyons, Seán; Nolan, Anne

  1. By: Tova Band-Winterstein (University of Haifa, Department of Gerontology); Offer E. Edelstein (2. Ben-Gurion University of the Negev, The Spitzer Department of Social Work); Yaacov G. Bachner (Ben-Gurion University of the Negev, Department of Public Health)
    Abstract: Depression is the most frequent negative health outcome among informal caregivers. The aims of the current study were (i) to assess the level of depression, (ii) to explore associations between care recipients' characteristics, caregivers' characteristics, situational factors and depression among Ultra-Orthodox Jewish (UOJ) caregivers. A total of 112 (44 men and 68 women) UOJ primary caregivers of frail older-adults were interviewed face-to-face in their homes, using valid and reliable measures. Participants reported a notable depressive symptomatology. Three variables emerged as significant predictors of caregiver depression: higher external control (chance), being a spouse, and lower levels of social support. External locus of control, being a spouse, and social support are highly important factors for explaining depression among UOJ caregivers. Resources should be allocated to target spousal caregivers with lower levels of social support and a greater sense of external locus of control in order to alleviate their depressive symptomatology.
    Keywords: Minorities, Ultra-Orthodox Jews, depressive symptomatology , caregiving, older adults
    Date: 2017–10
  2. By: Mélanie Varin (UMRESTTE UMR T9405 - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - IFSTTAR - Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux - Université de Lyon); Barbara Charbotel (CHLS - Centre Hospitalier Lyon Sud [CHU - HCL] - HCL - Hospices Civils de Lyon, UMRESTTE UMR T9405 - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - IFSTTAR - Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux - Université de Lyon, Centre Léon Bérard [Lyon]); Olivia Pérol (Centre Léon Bérard [Lyon]); Lionel Perrier (Centre Léon Bérard [Lyon], GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Amélie Massardier-Pilonchéry (UMRESTTE UMR T9405 - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - IFSTTAR - Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux - Université de Lyon, CHLS - Centre Hospitalier Lyon Sud [CHU - HCL] - HCL - Hospices Civils de Lyon); Sandrine Bonnand (Centre Léon Bérard [Lyon]); Elodie Belladame (Centre Léon Bérard [Lyon]); Emmanuel Fort (UMRESTTE UMR T9405 - Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - IFSTTAR - Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux - Université de Lyon); Virginie Avrillon (Centre Léon Bérard [Lyon]); Paul Rebattu (Centre Léon Bérard [Lyon]); Maurice Pérol (Centre Léon Bérard [Lyon]); Béatrice Fervers (Centre Léon Bérard [Lyon])
    Abstract: Ten to 29% of lung cancers might be linked to occupational factors but 60% of them are not compensated. The PROPOUMON project aimed to improve the identification, recognition and compensation of occupational lung cancer as occupational disease using a self-administered questionnaire (AQREP). One objective was to assess the AQREP, comparing it with the questionnaire drawn up by the French Language Pneumology Society (Q-SPLF). From March 2014 to September 2015, 90 lung cancer patients treated at the Centre Léon-Bérard responded to the AQREP and Q-SPLF. The two physicians in charge of the consultation assessed independently whether or not a consultation was indicated. A certificate for the compensation process was proposed when a suspicion of high or average imputability was identified. Analysis of the questionnaires was concordant for 73% of the patients. The AQREP has a sensitivity of 72% and a specificity of 73%. Its positive and negative predictive values were 62 and 82%. The information provided by 24 patients were discordant between questionnaires. In two patients with discordant evaluation (AQREP+/Q-SPLF-; AQREP-/Q-SPLF+), one Initial Medical Certificate (IMC) was written. This study made it possible to conclude that AQREP is relevant for the identification of potentially occupational lung cancers. Collegial discussion of complex cases might be considered. The project is currently been extended to other centers and to lymphoma.
    Abstract: Dix à 29 % des cancers bronchopulmonaires seraient d’origine professionnelle dont 60 % ne seraient pas indemnisés. Le projet Propoumon vise à améliorer le repérage, la reconnaissance et l’indemnisation des cancers bronchopulmonaires d’origine professionnelle en maladie professionnelle à partir d’un auto-questionnaire (AQREP). Un des objectifs était d’évaluer sa capacité à détecter les patients pouvant bénéficier d’une consultation « cancers professionnels », en le comparant avec le questionnaire de la Société de pneumologie de langue française (Q-SPLF). De mars 2014 à septembre 2015, 90 patients suivis au centre Léon-Bérard pour un cancer bronchopulmonaire ont répondu aux deux questionnaires. Les deux médecins responsables de la consultation évaluaient de façon indépendante, sur la base de l’AQREP ou du Q-SPLF, l’indication d’une consultation. Si à l’issue de la consultation des arguments en faveur d’une origine professionnelle étaient réunis, une démarche de déclaration était proposée. L’analyse des questionnaires par les médecins était concordante à 73 %. L’AQREP a une sensibilité de 72 % et une spécificité de 73 %. Ses valeurs prédictives positive et négative sont de 62 et 82 %. Les informations renseignées par 24 patients étaient discordantes entre les questionnaires. Pour deux patients ayant une évaluation discordante (AQREP+/Q-SPLF- ; AQREP-/Q-SPLF+), un « Certificat médical initial » a été rédigé. Le premier a été refusé par l’Assurance maladie, le second est en cours d’instruction. Cette étude a permis de conclure en la capacité de l’AQREP à repérer les cancers bronchopulmonaires potentiellement d’origine professionnelle. Une réunion de concertation pour discuter des cas complexes pourrait être envisagée. Le projet s’élargit actuellement à d’autres centres et aux lymphomes.
    Keywords: Self-administered questionnaire,Lung cancer, Occupational exposure,Auto-questionnaire,Maladie professionnelle,Cancer bronchopulmonaire,Exposition professionnelle, Occupational disease
    Date: 2017
  3. By: Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H.
    Abstract: Background: The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda. Method: The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. Results: At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Conclusion: Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.
    Keywords: Participatory monitoring and evaluation; Implementation research; maternal and newborn health; Decision-making; Stakeholders
    JEL: J1
    Date: 2017–12–28
  4. By: Grustam, Andrija S; Vrijhoef, Hubertus J. M.; Cordella, Antonio; Koymans, Ron; Severens, Johan L
    Abstract: For telemonitoring to support care coordination, a sound business model is conditional. The aim of this study is to explore the systemic and economic differences in care coordination via business-to-business and business-to-consumer models for telemonitoring patients with chronic diseases.
    Keywords: Case management; chronic disease; costs; telemedicine; commerce
    JEL: J1 J50
    Date: 2017–12–14
  5. By: Martha Bleeker; James Mabli; Mary Kay Fox; Betina Jean-Louis; Marlene Fox
    Abstract: This issue brief focuses on body mass index (BMI)-based outcomes of overweight and obese middle and high school students who received both the Prevention and Get Fit components of Healthy Harlem, after two and three years.
    Keywords: Healthy Harlem, BMI, body mass index, childhood obesity, nutrition, obese, overweight, afterschool program, Harlem Children’s zone, student health
    JEL: I0 I1 I
  6. By: Martha Bleeker; James Mabli; Mary Kay Fox; Betina Jean-Louis; Marlene Fox
    Abstract: This issue brief focuses on fitness outcomes of overweight and obese middle and high school students who received both the Prevention and Get Fit components of Healthy Harlem, after two and three years.
    Keywords: Healthy Harlem, physical fitness, childhood obesity, nutrition, afterschool program, Harlem Children's Zone, student health
    JEL: I0 I1 I
  7. By: Yaacov G. Bachner (Ben Gurion University of the Negev); Nily Yosef-Sela (Ben Gurion University of the Negev); Sara Carmel (Ben Gurion University of the Negev)
    Abstract: Aim: Numerous studies document that caregivers face severe difficulties in communicating openly with their loved ones about both illness and death. This study compares the communication level of male and female caregivers, and examines the contribution of different caregiver characteristics and situational variables to the explanation of communication level within both male and female groups. Methods: 77 spouses--who were primary caregivers of terminal cancer patients-comprised of 29 males and 48 females, participated in the study. The questionnaire included measures of caregiver communication, caregiver characteristics (i.e. age, ethnic origin, gender, education level, and self-efficacy), and situational variables (i.e. duration and intensity of care). Results: Female spouses communicated more with their loved ones about the illness and death compared to their male counterparts. Among males, ethnic origin (?=0.50, p
    Keywords: men, women, caregivers, communication difficulties, terminal patients, cancer
    Date: 2017–10
  8. By: Patrick Petit; Janos Nagy
    Abstract: Taxing tobacco can help raise much needed revenue and save lives, but it needs to be done well. This “How-to” note provides guidance on the basics of tobacco taxation. How high should tobacco taxes be? Should we use ad valorem or specific taxes? What are the key elements of an efficient tax administration that will secure the tax base and prevent illegal trade? These are important questions that need to be addressed and this note provide a sound first step towards solid policy decisions.
    Keywords: Fraud;Health;Western Hemisphere;Ad valorem taxes;Excise taxes;Canada;Tax administration;tobacco, revenue, revenue raising, taxation levels, earmarks, collection, illegal trade, enforcement, externalities, internalities
    Date: 2016–11–04
  9. By: Maja Parnardzieva-Zmejkova; Vladimir Dimkovski
    Date: 2017–10
  10. By: Tamas Hajdu (Institute of Economics, Center for Economic and Regional Studies of the Hungarian Academy of Sciences); Gabor Kertesi (Institute of Economics, Center for Economic and Regional Studies of the Hungarian Academy of Sciences); Gabor Kezdi (Survey Research Center, University of Michigan and senior research fellow Institute of Economics, Center for Economic and Regional Studies of the Hungarian Academy of Sciences)
    Abstract: This paper uses birth records linked to census data to document health differences at birth between Roma and non-Roma children in Hungary between 1981 and 2010. It focuses on differences in average birth weight and average gestational age, as well as the likelihood of low birth weight and the likelihood of preterm birth. The paper shows large gaps in all indicators over the 30 years, with a small narrowing of the gap in absolute terms but not in relative terms. Roma mothers are twice as likely to give birth to babies with low birth weight and before the 37th week. Standard decompositions show that around 80% of the gap is explained by socioeconomic factors, and education alone explains more than half. Despite significant changes in society, the explanatory power of education and other factors remains constant. Narrowing the gap in educational attainment, especially at higher levels, may have the highest potential to improve the relative health of Roma births.
    Keywords: health at birth, birth weight, preterm birth, minorities
    JEL: I14 J15
    Date: 2017–11
  11. By: Alice M. Ellyson; Anirban Basu
    Abstract: Economic literature has extensively studied how prices for incumbent pharmaceutical drugs respond to generic competition after entry. However, less attention has been paid to pricing behavior in anticipation of brand-to-brand competition. We contribute to this gap in the literature by both developing a model of pricing strategies for incumbent drug manufacturers under tiered-insurance anticipating branded competition. Our model predicts rising prices for incumbent drugs for a range of elasticities as the likelihood of entry increases from competitors with horizontally-differentiated products. Using the insulin market as a natural experiment, we exploit exogenous variation in a potential entrant's completion of clinical trials to identify the effect of drug pipeline pressure on the prices of incumbent drugs. Results suggest that pipeline pressure significantly increases the prices of incumbent drugs. We expect that similar pricing effects will be prevalent with potential biosimilar entry.
    JEL: I11 I13 I18 K23 L11 L13
    Date: 2018–03
  12. By: Pinka Chatterji; Siyang Li; Gerald R. Marschke
    Abstract: Spatial inequalities in access to physicians is a long-standing problem in the US, and it may be an important underlying cause of SES-related and racial/ethnic disparities in health outcomes. One important factor underlying spatial inequalities may be the enactment of state-level malpractice reforms, which could affect physician supply to a state, and/or lead to sorting among physicians across states along characteristics such as physician quality. In this study, we test whether state-level malpractice laws affect new physicians’ location decisions and sorting of physicians by quality measures across states. We use data from the New York State (NYS) Residents’ Exit Survey, which includes all exiting medical residents from hospitals in NYS, and includes the practice locations these new physicians have chosen. We focus on two malpractice reforms – caps on noneconomic damages and caps on punitive damages. Our findings suggest that both types of reforms are associated with an increased probability of new physicians locating in the state that passed the reform, but only the caps on noneconomic damages are statistically significant at conventional levels. Effects of the laws are stronger for physicians in specialties which tend to face the highest risk of malpractice awards, while the opposite is true for physicians in specialties with the lowest risk of malpractice awards, as well as for osteopathic physicians. Physicians entering solo practice and partnerships respond more to damage cap laws than physicians entering group practices, hospital-based practices and other practice settings. While we do not find that median MCAT scores in the medical schools attended (among physicians from medical schools in New York State (NYS)) interact with the effects of the laws, we do find that US citizens attending foreign medical schools, as well as international medical graduates more generally, respond more to damage caps laws compared to physicians trained only in the US. If we consider the degree of selectivity of the medical school to be a measure of physician ability, this finding may suggest that damage cap laws influence location choices more among lower-ability physicians.
    JEL: I1
    Date: 2018–03
  13. By: Lowes, Sara Rachel; Montero, Eduardo
    Abstract: Between 1921 and 1956, French colonial governments organized medical campaigns to treat and prevent sleeping sickness. Villagers were forcibly examined and injected with medications with severe, sometimes fatal, side effects. We digitized thirty years of archival records to document the locations of campaign visits at a granular geographic level for five central African countries. We find that greater historical exposure to the campaigns reduces trust in medicine - measured by willingness to consent to a free, non-invasive blood test. The resulting mistrust is specific to the medical sector. We examine relevance for present day health initiatives; we find that World Bank projects in the health sector are less successful in areas with greater exposure to the campaigns.
    Keywords: Colonialism; Culture; health; medicine; Trust
    JEL: I15 I18 N37 O55 Z13
    Date: 2018–03
  14. By: Ellegård, Lina Maria (Department of Economics, Lund University)
    Abstract: This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Providers in regions with P4P are compared to providers in other regions in a difference-in-differences analysis using data from the Swedish Prescription Register for the period 2005-2013. The results indicate that P4P improved guideline compliance regarding prescription of Angiotensin Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARB). The effect is mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers.
    Keywords: Pay-for-performance; Hypertension treatment; Ownership; Primary health care
    JEL: D23 H73 I11 I18 J33
    Date: 2018–03–26
  15. By: Palali, Ali (Tilburg University, School of Economics and Management)
    Abstract: This study investigates the effects of early smoking on educational attainment and labor market performance by using mixed ordered and mixed proportional hazard models. The results show that early smoking adversely affects educational attainment and initial labor market performance, but only for males. The probability to finish a scientific degree is 4%-point lower for an early smoker. The effect of early smoking on initial labor market performance is indirect through educational attainment. Once the indirect effect is controlled for there is no direct effect. Moreover, for males only, early smoking has a negative effect on current labor market performance even after conditioning on educational attainment. The probability to have an academic job is 4%-point lower for an early smoker. For females neither education nor labor market performance is affected by early smoking.
    Date: 2017
  16. By: Peijnenburg, J.M.J. (Tilburg University, School of Economics and Management); Nijman, Theo (Tilburg University, School of Economics and Management); Werker, Bas (Tilburg University, School of Economics and Management)
    Abstract: We find that health cost risk lowers optimal annuity demand at retirement. If medical expenses can be sizeable early in retirement, full annuitisation at retirement is no longer optimal because agents do not have enough time to build a liquid wealth buffer. Furthermore, large deviations from optimal annuitisation levels lead to small utility differences. Our results suggest that health cost risk can explain a large proportion of empirically observed annuity choices. Finally, allowing additional annuitisation after retirement results in welfare gains of at most 2.5% when facing health cost risk, and negligible gains without this risk.
    Date: 2017
  17. By: De Regge, Melissa; De Pourcq, Kaat; Meijboom, Bert (Tilburg University, School of Economics and Management); Trybou, Jeroen; Mortier, Eric; Eeckloo, Kristof
    Abstract: Background: Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. Method: Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. Results: Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital's side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. Conclusion: Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.
    Date: 2017
  18. By: Victoria Baranov; Sonia Bhalotra; Pietro Biroli; Joanna Maselko
    Abstract: We evaluate the long-term impact of treating maternal depression on women’s financial empowerment and parenting decisions. We leverage experimental variation induced by a cluster-randomized control trial that provided psychotherapy to perinatally depressed mothers in rural Pakistan. It was one the largest psychotherapy interventions in the world, and the treatment was highly successful at reducing depression. We locate mothers seven years after the end of the intervention to evaluate its long-run effects. We find that the intervention increased women’s financial empowerment, increasing their control over household spending. Additionally, the intervention increased both time- and monetary-intensive parental investments, with increases in investments tending to favor girls.
    Keywords: mental health, maternal depression, women’s labor supply, empowerment, early life, parenting, child development, randomized controlled trial, Pakistan
    Date: 2017
  19. By: Anu Shukla-Jones (OECD); Steffi Friedrichs (OECD); David E. Winickoff (OECD)
    Abstract: Gene editing techniques represent a major advance in the field of biotechnological research and application, promising significant benefits across the domains of human health, sustainability and the economy. There is broad agreement that gene editing techniques go beyond incremental advances of past biotechnologies. However, harnessing the potential of gene editing techniques will require meeting significant policy challenges in arenas of governance, ethics, and public engagement. This report summarises the discussions of a group of international experts of science, technology and policy, as well as policymakers at a dedicated workshop entitled “Gene editing in an international context: scientific, economic and social issues across sectors” in Ottawa, Canada on 29-30 October 2016.
    Date: 2018–03–23
  20. By: Sebastian Bauhoff (Center for Global Development); Jonah Busch (Center for Global Development)
    Abstract: Deforestation has been found to increase malaria risk in some settings, while a growing number of studies have found that deforestation increases malaria prevalence in humans, suggesting that in some cases forest conservation might belong in a portfolio of anti-malarial interventions. However, previous studies of deforestation and malaria prevalence were based on a small number of countries and observations, commonly using cross-sectional analyses of less-than-ideal forest data at the aggregate jurisdictional level. In this paper we combine fourteen years of high-resolution satellite data on forest loss with individual-level survey data on malaria in more than 60,000 rural children in 17 countries in Africa, and fever in more than 470,000 rural children in 41 countries in Latin America, Africa, and Asia. Adhering to methods that we pre-specified in a pre-analysis plan, we tested ex-ante hypotheses derived from previous literature. We did not find that deforestation increases malaria prevalence nor that intermediate levels of forest cover have higher malaria prevalence. Our findings differ from most previous empirical studies, which found that deforestation is associated with greater malaria prevalence in other contexts. We speculate that this difference may be because deforestation in Africa is largely driven by the slow expansion of subsistence or smallholder agriculture for domestic use by long-time residents in stable socio-economic settings rather than by rapid clearing for market-driven agricultural exports by new frontier migrants as in Latin America and Asia. Our results imply that at least in Africa anti-malarial efforts should focus on other proven interventions such as bed nets, spraying, and housing improvements. Forest conservation efforts should focus on securing other benefits of forests, including carbon storage, biodiversity habitat, clean water provision, and other goods and services.
    Keywords: Africa, pre-analysis plan, public health, Sustainable Development Goals
    JEL: C21 C23 I18 Q23
    Date: 2018–03–22
  21. By: Jean-Yves Lesueur (Université de Lyon)
    Abstract: The yardstick competition between European health care system is not calling for the french system. Disability-free life expectancy at 65 is, for example, at a better level in few North European countries for a same level of public health expenditures than the french system. As the health french system is original because of its mixed private and public health insurance coverage system, some recent institutional reforms introduced incentives to develop individual preventive care attitudes and a new health insurance market design where private insurers invests in preventive action. In that way, the National Interprofessional Agreement that was established since 2016 between insurance companies and private firms, generated new forms of health insurance contrats that includes a free offer of preventive care. The purpose of the paper is to evaluate the impact of this free health preventive service on the optimal decision between self insurance (vs self protection) and private market demand insurance by policyholders. We demonstrated that the standard properties of insurance model in the line of Ehrlich and Becker (1972) call into question. Our results raised the debate on the optimal design market between the health profile of the insurant and its choice of health coverage.
    Abstract: La concurrence par comparaison des systèmes de santé Européen ne plaide pas en faveur du cas français. A dépenses de santé identiques voire plus faibles, plusieurs partenaires européens manifestent de meilleurs résultats en espérance de vie sans incapacité à 65 ans comme en taux de décès prématurés évitables par prévention primaire avant 65 ans. Face à ce paradoxe, les réformes institutionnelles mises en oeuvre ces dernières années, ont eu pour objectif de déplacer le curseur de la médecine curative vers la médecine préventive. Dans un contexte de déficit public, les incitations visent à favoriser le développement d'un marché de la prévention lié au marché de l'assurance complémentaire santé. Avec l'Accord National Interprofessionnel (ANI) mis en place depuis 2016, les entreprises du secteur privé ont obligation de proposer une complémentaire-santé à leurs salariés. Par cet accord, les contrats d'assurance collectifs, mais par contamination aussi les contrats individuels, sont accompagnés d'une offre, souvent incluse et gratuite, de programmes de prévention assurant un accompagnement personnalisé des assurés dans leur hygiène de vie et leur santé. On étudie dans cet article les conséquences du point de vue de l'assuré de l'adhésion à de tels programmes de prévention. Il s'agit notamment d'analyser l'impact de cette offre gratuite de prévention, sur l'arbitrage entre effort de prévention et couverture assurantielle. Nous montrons que la gestion du risque d'aléa moral est dans ce contexte fortement affectée par rapport aux prédictions des modèles d'assurance s'inscrivant dans la lignée de l'article précurseur d'Ehrlich et Becker (1972). Nos résultats mettent en évidence des comportements de sous-assurance en prévention primaire et de sur-assurance en prévention secondaire.
    Date: 2018–02–26
  22. By: Vincenzo Atella (DEF and CEIS,University of Rome "Tor Vergata"); Federico Belotti (CEIS,University of Rome "Tor Vergata"); Joanna Kopinska (CEIS, University of Rome "Tor Vergata"); Alessandro Palma (CEIS, University of Rome Tor Vergata); Andrea Piano Mortari (CEIS, University of Rome "Tor Vergata")
    Abstract: Since the seminal paper by Ruhm (2000), a large body of literature agrees on the existence of pro-cyclical fluctuation between economy’s performance and mortality, and this evidence has been confirmed also during the Great Recession (GR). In this study we identify a series of important limitations that may have severely affected previous results. For the first time in this literature we use patient level data collected by GPs in Italy, reporting mortality and objectively measured health information on a large representative population sample. We find a clear positive effect of a rise in unemployment on three important morbidity outcomes. The lag-lead analysis confirms the validity of our results, with changes in prevalences following the same dynamics of the unemployment rise since the starting of the economic slowdown. Our study shows also that the effect of unemployment on the total mortality is no longer significant when controlling for the existence of poor health conditions and suggests that the impact of severe economic downturns on population mortality should be reconsidered.
    Keywords: health status, unemployment, mortality, economic crisis, Great Recession
    JEL: I10 E32 J20 Q53
    Date: 2018–02–20
  23. By: Dempsey, Seraphim; Lyons, Seán; Nolan, Anne
    Date: 2018

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