nep-hea New Economics Papers
on Health Economics
Issue of 2018‒05‒14
twenty papers chosen by
Yong Yin
SUNY at Buffalo

  1. NHS Agency Staffing and the Impact of Recent Interventions By Mullin, C.
  2. Interventions that Encourage High-value Nursing Home Care: Lessons for the UK By Grabowski, D.
  3. Waiting Time Policies in the Health Sector By Siciliani, L.
  4. Delivering an Outcomes-based NHS: Creating the Right Conditions By Hicks, N.
  5. Family Ties and Children Obesity in Italy By Crudu, F.;; Neri, L.;; Tiezzi, S.;
  6. Varieties of Health Care Devolution: 'Systems or Federacies'? By Joan Costa-Font; Laurie Perdikis
  7. The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis By Madureira-Lima, Joana; Reeves, Aaron; Clair, Amy; Stuckler, David
  8. SMOKERS ARE DIFFERENT: THE HETEROGENEITY OF SMOKERS’ RESPONSES TO PRICE INCREASES By Paolo Liberati; Francesco Crespi; Massimo Paradiso; Simone Tedeschi; Antonio Scialà
  9. Utilisation, Fund Flows and Public Financial Management under the National Health Mission. By Choudhury, Mita; Mohanty, Ranjan Kumar
  10. Fair play in Indian Health Insurance. By Malhotra, Shefali; Patnaik, Ila; Roy, Shubho; Shah, Ajay
  11. What we still need to know about the impacts of medical marijuana laws in the United States? By Chu, Yu-Wei Luke
  12. Smoking Czechs: Modeling Tobacco Consumption and Taxation By Karel Janda; Martin Strobl
  13. A General Equilibrium Model of Optimal Alcohol Taxation in the Czech Republic By Karel Janda; Zuzana Lajksnerova; Jakub Mikolasek
  14. Financial incentives to work for disability insurance recipients - Sweden’s special rules for continuous deduction By Andersson, Josefine
  15. Households and heat stress: estimating the distributional consequences of climate change By Park, Jisung; Bangalore, Mook; Hallegatte, Stephane; Sandhoefner, Evan
  16. Factors Effecting the Locations of Public and Private Hospitals in Turkey By Kerem Yavuz Arslanli; Vedia Dokmeci
  17. Is Envy Harmful to a Society’s Psychological Health and Wellbeing? A Longitudinal Study of 18,000 Adults By Mujcic, Redzo; Oswald, Andrew J.
  18. Physical Disability and Labor Market Discrimination: Evidence from a Field Experiment By Charles Bellemare; Marion Gousse; Guy Lacroix; Steeve Marchand
  19. Real World Evidence for Coverage Decisions: Opportunities and Challenges By Hampson, G.; Towse, A.; Dreitlein, B.; Henshall, C.; Pearson, S.
  20. Achieving Coordination of Care to Improve Population Health: Provider Collaboration in Delivery System Reform Incentive Payment Programs By Jessica Heeringa; Carey Appold; Julia Baller; Keanan Lane; Ryan Stringer; James Woerheide

  1. By: Mullin, C.
    Abstract: This seminar focuses on the NHS staffing markets and the use of temporary staff, specifically in the NHS provider sector, i.e. foundation trusts and NHS trust. (which include hospitals). To provide background and context, the discussion begins with an overview of the NHS labour market and the role of staffing agencies in providing temporary staff. The core of the seminar is an examination of previous strong growth in expenditure on such staffing, particularly during the early part of this decade; the effects to date of government intervention to address that spending; and possible lessons for other sectors from the limited evidence now available.
    JEL: I1
    Date: 2018–01–01
  2. By: Grabowski, D.
    Abstract: This OHE Seminar Briefing summarises a seminar given by Professor David Grabowski, which provided a health economics perspective on how payment and delivery interventions can encourage high-value nursing home care. It took lessons from the U.S. effort to encourage high-value care and applied them to the UK, where we have similarly relied on regulation as the key guarantor of quality.
    Keywords: Economics of Health Care Systems
    JEL: I1
    Date: 2017–08–01
  3. By: Siciliani, L.
    Abstract: This OHE Seminar Briefing summarises a seminar given by Professor Luigi Siciliani on waiting time policies in the health sector from an international perspective, and highlights which policies have worked well in the last decade in OECD countries. Professor Siciliani also touches on methods for comparing waiting times internationally and where the UK stands in the international figures. Finally, the Briefing discusses waiting time inequality by socioeconomic status.
    JEL: I1
    Date: 2016–06–01
  4. By: Hicks, N.
    Abstract: This OHE Seminar Briefing summarises a seminar given by Dr Nicholas Hicks, Co-founder and Chief Executive of COBIC (Capitated Outcomes-Based Incentivised Care). Dr Hicks describes COBIC's outcomes-centred approach that has been adopted by NHS services across England and that brings together commissioners, providers, other professions, patients and carers. The COBIC approach involves six elements - (1) defined population and scope, (2) desired outcomes associated with indicators, (3) service model redesign, (4) financial analysis and defined budget, (5) agreed contract form and duration, describing incentives and risks, and (6) readied and prepared service providers. In this Briefing, Dr Hicks discusses the example of the Bedfordshire Musculoskeletal (MSK) project, where COBIC worked with Bedfordshire Clinical Commissioning Group to improve MSK care and outcomes, and to decrease per capita costs.
    Keywords: Economics of Health Care Systems
    JEL: I1
    Date: 2017–02–01
  5. By: Crudu, F.;; Neri, L.;; Tiezzi, S.;
    Abstract: This paper estimates the influence of overweight family members on weight outcomes of Italian children aged 6 to 14 years. We use a new dataset matching the 2012 cross sections of the Italian Multipurpose Household Survey and the Household Budget Survey. Endogenous peer groups within the family are accounted for using a set of instrumental variables. We find evidence of a strong, positive effect of both overweight adults and peer children in the family on children weight outcomes. The impact of overweight peer children in the household is larger than the impact of adults. These findings can help identifying the main factors driving the rise in Italian children obesity in the past few decades.
    Keywords: children obesity; family ties; IV probit; heteroskedasticity;
    JEL: I12
    Date: 2018–04
  6. By: Joan Costa-Font; Laurie Perdikis
    Abstract: Some European countries have devolved health care services to subnational units. This is especially the case in unitary states that are organised as a national health service, where choice is not 'built into' the health care system. We argue that there are different models of devolving authority to subnational jurisdictions which have repercussions for regional health care inequalities and the amount of policy interdependence across regions. We examine broad trends in two institutional models of devolution: a 'federacy model', where only a few territories obtain health care responsibilities (such as in the United Kingdom), and a 'systems model', where the whole health system is devolved to a full set of subnational units (such as in Spain). This paper briefly discusses the impact of these two models of devolution on the regional diversity of the health system. Our findings suggest that a 'systems model' of decentralisation, unlike a 'federacy model', gives rise to significant policy interdependence. Another finding indicates that geographical dispersion of health care activity is larger in the 'federacy model'.
    Keywords: regional dispersion, models of devolution, federacy, policy interdependence, systems model, Spain, UK
    Date: 2018–02
  7. By: Madureira-Lima, Joana; Reeves, Aaron; Clair, Amy; Stuckler, David
    Abstract: Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. Methods We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Results Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022–0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Conclusions Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health.
    JEL: J1
    Date: 2018–02–01
  8. By: Paolo Liberati; Francesco Crespi; Massimo Paradiso; Simone Tedeschi; Antonio Scialà
    Abstract: This paper contributes to the understanding of smokers’ responses to cigarette prices increases, with a focus on heterogeneity across individuals and over price changes. A stated preference quasi-experimental design grounded on a random utility framework is proposed, based on individual-level data drawn from a survey gathering detailed information on Italian smokers’ habits. On average, the predicted probability of reducing cigarettes consumption increases with the price variation, even though a huge heterogeneity of price responsiveness is found. In terms of potential price elasticity, a polarisation between low and high responsiveness individuals has also been identified. Finally, by comparing even and uneven price variations across price classes, it is shown that uniform across-brand price increases limit product substitutions and downtrading. Estimated heterogeneity provides information to forecast the effect on tax revenue of a tax-driven price change, and some guidance on how to design tax reforms to balance health and revenue goals.
    Keywords: : Smoking behaviour, Preference heterogeneity, Price elasticity, Tobacco tax, Random utility models
    JEL: I12 I18 C25
    Date: 2018–05
  9. By: Choudhury, Mita (National Institute of Public Finance and Policy); Mohanty, Ranjan Kumar (National Institute of Public Finance and Policy)
    Abstract: This study provides insights on how institutional architecture for public fund flows affects budget execution. Using the case of the National Health Mission (NHM) in India, it highlights how the rules and procedures that govern release of public funds affect utilisation of budgeted resources. It analyses the utilisation of NHM funds in 29 States, and documents the processes for fund releases from State treasuries to implementing agencies in Bihar, Maharashtra and Odisha. The study finds that on average, only about 55 per cent of funds allocated for NHM were utilised in 2015-16 and 2016-17. In Bihar and Maharashtra, this was partly due to significant delays in release of funds from State treasuries to implementing agencies. The delays were a result of complex administrative procedures associated with the release of NHM funds from State treasuries. The existence of implementing agencies outside the States’ administrative setup, and the rigid fragmented financial design of NHM has contributed to the complicated architecture of release processes.
    Keywords: Public Fund Flow ; Fund Utilisation ; Public Financial Management ; Budget Execution ; National Health Mission
    Date: 2018–05
  10. By: Malhotra, Shefali (National Institute of Public Finance and Policy); Patnaik, Ila (National Institute of Public Finance and Policy); Roy, Shubho (National Institute of Public Finance and Policy); Shah, Ajay (National Institute of Public Finance and Policy)
    Abstract: In recent years there has been an increased role for health insurance in Indian health care, through government funded health insurance programs and privately purchased health insurance. Our analysis of the claims ratio and the complaints rate in the health insurance industry, suggests that there are important difficulties with the working of health insurance. The lack of fair play in this industry is derived from deficiencies in regulations, weak enforcement of regulations and faulty institutional design of consumer redress. The solutions lie in laws and regulatory processes for consumer protection. The thought process of health policy and financial policy converges in the strategy for change.
    Date: 2018–05
  11. By: Chu, Yu-Wei Luke
    Abstract: Past-month marijuana use among adolescents does not increase after the passage of medical marijuana laws in the U.S. It is crucial for future research to explore causal mechanisms affecting different types of marijuana users to bring a deeper understanding of behavioral responses to marijuana polices.
    Keywords: Marijuana, Medical marijuana law, Marijuana use,
    Date: 2018
  12. By: Karel Janda (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic; Department of Banking and Insurance, Faculty of Finance and Accounting, University of Economics, Namesti Winstona Churchilla 4, 13067 Prague, Czech Republic); Martin Strobl (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic)
    Abstract: We model the future tobacco consumption, size of smoking population and governmental tax revenues in the Czech Republic. The main assumption of our model states that smokers determine their future tobacco consumption behavior as adolescents. Further assumptions make the model applicable to the data from the Czech National Monitoring Centre for Drugs and Drug Addiction. Future teenage smoking rates and average consumption are the inputs to the model; consumption growth coeffcients for each age category are estimated using zero-inflated negative binomial regression. Several scenarios are built to model possible developments, including extreme cases. All our scenarios show that all model outcomes are going to grow until 2028 in a very similar pattern. In particular, the projected number of smokers in 2028 is by 4-8% higher than in 2013, the total daily tobacco consumption and tax revenue by 7-26%. This increase is induced by aging of large birth cohorts.
    Keywords: smoking, tobacco, cigarettes, consumption, taxation, forecasting
    JEL: D12 I12
    Date: 2018–01
  13. By: Karel Janda (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic; Department of Banking and Insurance, Faculty of Finance and Accounting, University of Economics, Namesti Winstona Churchilla 4, 13067 Prague, Czech Republic); Zuzana Lajksnerova (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic); Jakub Mikolasek (Institute of Economic Studies, Faculty of Social Sciences, Charles University in Prague, Smetanovo nabrezi 6, 111 01 Prague 1, Czech Republic)
    Abstract: This paper provides a general equilibrium theoretical model of alcohol taxation and empirically estimates this model. For this purpose, we use a model determined by both externality corrections and fiscal considerations as the tax increase is assumed to immediately change other governmental policies such as labour taxation or medical expenditures. The results of our analysis show that under the most of parametric scenarios the current Czech tax rate on beer and wine is below its optimal level and that the fiscal component has a significant impact on the optimal level of tax.
    Keywords: Alcohol, Beer, Wine, Czech Republic, Elasticity, Price, Social costs, Tax
    JEL: H21 Q02 Q18
    Date: 2018–03
  14. By: Andersson, Josefine (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: Evidence from around the world suggests that individuals who are awarded disability benefits in some cases still have residual working capacity, while disability insurance systems typically involve strong disincentives for benefit recipients to work. Some countries have introduced policies to incentivize disability insurance recipients to use their residual working capacities on the labor market. One such policy is the continuous deduction program in Sweden, introduced in 2009. In this study, I investigate whether the financial incentives provided by this program induce disability insurance recipients to increase their labor supply or education level. Retroactively determined eligibility to the program with respect to time of benefit award provides a setting resembling a natural experiment, which could be used to estimate the effects of the program using a regression discontinuity design. However, a simultaneous regime change of disability insurance eligibility causes covariate differences between treated and controls, which I adjust for using a matching strategy. My results suggest that the financial incentives provided by the program have not had any effect on labor supply or educational attainment.
    Keywords: disability Insurance; financial Incentives; continuous deduction; regression discontinuity design; propensity score matching; nearest neighbor matching
    JEL: H53 H55 I18 J22
    Date: 2018–05–03
  15. By: Park, Jisung; Bangalore, Mook; Hallegatte, Stephane; Sandhoefner, Evan
    Abstract: Recent research documents the adverse causal impacts on health and productivity of extreme heat, which will worsen with climate change. In this paper, we assess the current distribution of heat exposure within countries, to explore possible distributional consequences of climate change through temperature. Combining survey data from 690,745 households across 52 countries with spatial data on climate, this paper suggests that the welfare impacts of added heat stress may be regressive within countries. We find: (1) a strong negative correlation between household wealth and warmer temperature in many hot countries; (2) a strong positive correlation between household wealth and warmer temperatures in many cold countries; and (3) that poorer individuals are more likely to work in occupations with greater exposure. While our analysis is descriptive rather than causal, our results suggest a larger vulnerability of poor people to heat extremes, and potentially significant distributional and poverty implications of climate change.
    Keywords: climate change; exposure; heat stress; labor productivity; poverty
    JEL: E24 I32 Q50 Q54
    Date: 2018–04–12
  16. By: Kerem Yavuz Arslanli; Vedia Dokmeci
    Abstract: Health is the basic condition of economic growth and the investment on health facilities should be parallel to other investments.. In general, the distribution of those facilities will encourage balanced economic prosperity. After 1990’s privatization of health facilities had started but very little research done about factors affecting the outcome. In this paper the distribution of public and private health facilities are investigated with respect to, socio-demographic, economic and education levels of provinces. Distribution of Public and Private Hospital beds with respect to province population throughout time is analyzed. Public hospitals are generally distributed with balanced population except some southeast and east Anatolian provinces. Private hospitals are five times less the volume of public hospitals and 15 provinces have no private hospitals. Most of the private hospitals are located in a few higher income provinces and rest is distributed by population. Regression model the number of hospital beds are taken as dependent variable and population of provinces, income and education level are taken as independent variables. According to analysis, public hospitals are affected by population and education levels. For private hospitals only population is found to be effecting the distribution. So, in parallel to health facilities, distribution of education and job opportunities should be considered throughout Turkey.
    Keywords: Hospitals; Privatization; Spatial Distribution; Turkey
    JEL: R3
    Date: 2017–07–01
  17. By: Mujcic, Redzo (Wirtschaftsuniversität Wien, Vienna); Oswald, Andrew J. (University of Warwick, CAGE, and IZA)
    Abstract: Nearly 100 years ago, the philosopher and mathematician Bertrand Russell warned of the social dangers of widespread envy. One view of modern society is that it is systematically developing a set of institutions - such as social media and new forms of advertising - that make people feel inadequate and envious of others. If so, how might that be influencing the psychological health of our citizens? This paper reports the first large-scale longitudinal research into envy and its possible repercussions. The paper studies 18,000 randomly selected individuals over the years 2005, 2009, and 2013. Using measures of SF-36 mental health and psychological well-being, four main conclusions emerge. First, the young are especially susceptible. Levels of envy fall as people grow older. This longitudinal finding is consistent with a cross-sectional pattern noted recently by Nicole E. Henniger and Christine R. Harris, and with the theory of socioemotional regulation suggested by scholars such as Laura L.Carstensen. Second, using fixed-effects equations and prospective analysis, the analysis reveals that envy today is a powerful predictor of worse SF-36 mental health and well-being in the future. A change from the lowest to the highest level of envy, for example, is associated with a worsening of SF-36 mental health by approximately half a standard deviation (p
    Date: 2018
  18. By: Charles Bellemare; Marion Gousse; Guy Lacroix; Steeve Marchand
    Abstract: We investigate the determinants and extent of labor market discrimination toward people with physical disabilities using a large scale field experiment. Applications were randomly sent to 1477 private firms advertising open positions. We find that average callback rates of disabled and non-disabled applicants are respectively 14.4% and 7.2%. We find this differential does not result from accessibility constraints related to firm infrastructures. We also find that mentioning eligibility to a government subsidy to cover the cost of workplace adaptation does not increase callback rates. Finally, we estimate that a lower bound of the proportion of discriminating firms is 49.7%.
    Keywords: discrimination, disabilities, partial identification
    JEL: J71 J68
    Date: 2018
  19. By: Hampson, G.; Towse, A.; Dreitlein, B.; Henshall, C.; Pearson, S.
    Abstract: This paper sets out the potential opportunities and important challenges and limitations that must be addressed in considering options for using RWE to inform insurer coverage decisions. The primary purpose of developing the paper was to stimulate discussion at the 2017 ICER Policy Summit meeting. A [separate paper]( available that summarises the authors reflections and proposed ways forwards based on the discussions that were had at the meeting. RWE is already utilised for multiple purposes in the US and globally. The focus of the 2017 ICER Policy Summit was on RWE for HTA assessments and payer coverage decisions - both initial decisions and reassessments – and the majority of the paper focuses on this. Acceptance of an expanded future role for RWE is not universal, particularly if it is seen as reducing the amount of RCT evidence available. Among the challenges associated with RWE explored in this paper are - bias and confounding; incomplete data; data mining; access to data; and the lack of universally accepted methodological standards. Current uses of RWE can be strengthened by increasing the quality and credibility of RWE (via national registries, data repositories and strict protocols) and establishment of appropriate governance arrangements. Key opportunities for the future include use of innovative study designs that combine benefits of collecting data from real world settings while incorporating best practice methods (i.e. randomisation methods from traditional RCTs); real time monitoring of patients; and the development of adaptive regulatory pathways linked to coverage with evidence development.
    Keywords: Economics of Health Technology Assessment
    JEL: I1
    Date: 2018–03–01
  20. By: Jessica Heeringa; Carey Appold; Julia Baller; Keanan Lane; Ryan Stringer; James Woerheide
    Abstract: This brief describes the variation in eligibility requirements for provider participation, as defined by CMS and the states; how providers collaborate to meet the goals of DSRIP; the factors that influence collaboration; and implications for the national evaluation of DSRIP.
    Keywords: 1115 demonstrations, Medicaid, implementation, evaluation, delivery system reform incentive payments , DSRIP, premium assistance, healthy behaviors
    JEL: I

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