nep-hea New Economics Papers
on Health Economics
Issue of 2018‒06‒18
23 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Lifetime Medical Spending of Retirees By John Bailey Jones; Mariacristina De Nardi; Eric French; Rory McGee; Justin Kirschner
  2. How Much Does Health Insurance Cost? Comparison of Premiums in Administrative and Survey Data By Jeff Larrimore; David Splinter
  3. Social Security Programs and Retirement Around the World: Working Longer – Introduction and Summary By Courtney Coile; Kevin S. Milligan; David A. Wise
  4. Safety Net Investments in Children By Hilary W. Hoynes; Diane Whitmore Schanzenbach
  5. Does the Framing of Patient Cost-Sharing Incentives Matter? The Effects of Deductibles vs. No-Claim Refunds By Hayen, Arthur P.; Klein, Tobias J.; Salm, Martin
  6. Does sanctioning disabled claimants of unemployment insurance increase labour market inactivity? An analysis of 346 British local authorities between 2009 and 2014 By Reeves, Aaron
  7. The Geography of Poverty and Nutrition: Food Deserts and Food Choices across the United States By Allcott, Hunt; Diamond, Rebecca; Dube, Jean-Pierre
  8. The intergenerational transmission of body mass index across countries By Dolton, Peter; Xiao, Mimi
  9. Environmental Bottlenecks on Children’s Genetic Potential for Adult Socioeconomic Attainments: Evidence from a Health Shock By Jason Fletcher
  10. Tobacco spending in Georgia: Machine learning approach By Maksym Obrizan; Karine Torosyan; Norberto Pignatti
  11. Free-Riding in Pharmaceutical Price Regulation: Theory and Evidence By Paolo Pertile; Simona Gamba; Martin Forster
  12. Developing Novel Drugs By Joshua L. Krieger; Danielle Li; Dimitris Papanikolaou
  13. Measuring Physicians’ Response to Incentives: Evidence on Hours Worked and Multitasking By Bruce Shearer; Nibene Habib Somé; Bernard Fortin
  14. The Influence of Bribery and Relative Reciprocity on a Physician's Prescription Decision - An Experiment By Vanessa Hilleringmann
  15. The health-taste trade-off in consumer decision making: An experimental approach By Georgia S. Papoutsi; Stathis Klonaris; Andreas C. Drichoutis
  16. Optimal Progressive Income Taxation in a Bewley-Grossman Framework By Juergen Jung; Chung Tran
  17. Inter-brand Competition in the Convenience Store Industry, Store Accessibility and Healthcare Utilization By Hung-Hao Chang; Chad D. Meyerhoefer
  18. Pauvreté, Egalité, Mortalité: Mortality (In)Equality in France and the United States By Currie, Janet; Schwandt, Hannes; Thuilliez, Josselin
  19. Sanitary infrastructures and the decline of mortality in Germany, 1877-1913 By Gallardo Albarran, Daniel
  20. Pollution and Growth: The Role of Pension on the Efficiency of Health and Environmental Policies By Armel Ngami; Thomas Seegmuller
  21. Negotiating a Better Future: How Interpersonal Skills Facilitate Inter-Generational Investment By Ashraf, Nava; Bau, Natalie; Low, Corinne; McGinn, Kathleen
  22. Measuring the progress of the timeliness childhood immunization compliance in Vietnam between 2006-2014: A decomposition analysis By Do Thi Thuy, Thuy; Nguyen, Quang Dung; Nguyen Van, Huy; Thomas-Agnan, Christine; Trinh, Thi-Huong
  23. Clusters Of International Eq-5d Health-States Valuations By Mario Garcia-Molina; Liliana Alejandra Chicaiza; Carlos Javier Rincon; Giancarlo Romano

  1. By: John Bailey Jones; Mariacristina De Nardi; Eric French; Rory McGee; Justin Kirschner
    Abstract: Using dynamic models of health, mortality, and out-of-pocket medical spending (both inclusive and net of Medicaid payments), we estimate the distribution of lifetime medical spending that retired U.S. households face over the remainder of their lives. We find that at age 70, households will on average incur $122,000 in medical spending, including Medicaid payments, over their remaining lives. At the top tail, 5 percent of households will incur more than $300,000, and 1 percent of households will incur over $600,000 in medical spending inclusive of Medicaid. The level and the dispersion of this spending diminish only slowly with age. Although permanent income, initial health, and initial marital status have large effects on this spending, much of the dispersion in lifetime spending is due to events realized later in life. Medicaid covers the majority of the lifetime costs of the poorest households and significantly reduces their risk.
    JEL: D1 D14 E02 E2 H31
    Date: 2018–05
  2. By: Jeff Larrimore; David Splinter
    Abstract: Using newly available administrative data from the Internal Revenue Service, this paper studies the distribution of employer-sponsored health insurance premiums. Previous estimates, in contrast, were almost exclusively from household surveys. After correcting for coverage limitations of the IRS data, we find that average premiums for employer-sponsored plans are roughly $1000 higher in IRS records than in the Current Population Survey. The downward bias in the CPS is largely driven by underestimating of premiums among married workers and topcoding of high premiums.
    Keywords: CPS ; Employer Sponsored Health Insurance ; IRS data ; Topcoding
    JEL: I13 D3
    Date: 2018–05–04
  3. By: Courtney Coile; Kevin S. Milligan; David A. Wise
    Abstract: This is the introduction and summary to the eighth phase of an ongoing project on Social Security Programs and Retirement Around the World. This project, which compares the experiences of a dozen developed countries, was launched in the mid 1990s following decades of decline in the labor force participation rate of older men. The first several phases of the project document that social security program provisions can create powerful incentives for retirement that are strongly correlated with the labor force behavior of older workers. Subsequent phases of the project have explored disability program provisions and their effects on retirement as well as potential obstacles to promoting work at older ages, including whether there is a link between older employment and youth unemployment and whether older individuals are healthy enough to work longer. In the two decades since the project began, the dramatic decline in men’s labor force participation has ended and been replaced by sharply rising participation rates. Older women’s participation has been rising as well. In this eighth phase of the project, we explore this phenomenon of working longer. We document trends in participation and employment and also consider factors that may help to explain these changes in behavior. We conclude that social security reforms as well as other factors such as the movement of women into the labor force have likely played an important role.
    JEL: J14 J26
    Date: 2018–05
  4. By: Hilary W. Hoynes; Diane Whitmore Schanzenbach
    Abstract: In this paper, we examine what groups of children are served by core childhood social-safety net programs—including Medicaid, EITC, CTC, SNAP, and AFDC/TANF—and how that’s changed over time. We find that virtually all gains in spending on the social safety net for children since 1990 have gone to families with earnings, and to families with income above the poverty line. This is the result of welfare reform and the expansion of in work tax credits. We review the available research and find that access to safety net programs during childhood leads to benefits for children and society over the long run. This evidence suggests that the changes to the social safety net may have lasting negative impacts on the poorest children.
    JEL: H53 I38
    Date: 2018–05
  5. By: Hayen, Arthur P. (Tilburg University); Klein, Tobias J. (Tilburg University); Salm, Martin (Tilburg University)
    Abstract: In light of increasing health care expenditures, patient cost-sharing schemes have emerged as one of the main policy tools to reduce medical spending. We show that the effect of patient cost-sharing schemes on health care expenditures is not only determined by the economic incentives they provide, but also by the way these economic incentives are framed. Patients react to changes in economic incentives almost twice as strongly under a deductible policy than under a no-claims refund policy. Our preferred explanation is that individuals are loss-averse and respond differently to both schemes because they perceive deductible payments as a loss and no-claim refunds as a gain.
    Keywords: patient cost-sharing, health insurance, framing, loss aversion
    JEL: I13 D91 H51
    Date: 2018–04
  6. By: Reeves, Aaron
    Abstract: Imposing financial penalties on claimants of unemployment insurance may incentivise labour market re-entry. However, sanctions may have differential effects depending on the work-readiness of the claimants. Here, I explore whether sanctioning disabled claimants is associated with greater labour market activity or inactivity among disabled people data on 346 British local authorities between 2009 and 2014. When the number of sanctioned disabled claimants rises (as a proportion of all claimants), the disability rate among economically inactive people becomes larger. There is no clear relationship between sanctioning disabled claimants and the employed disability rate.
    Keywords: conditionality; disability; labour market; sanctions; unemployment; unemployment insurance
    JEL: N0 R14 J01
    Date: 2017–06
  7. By: Allcott, Hunt (New York University); Diamond, Rebecca (Stanford University); Dube, Jean-Pierre (University of Chicago)
    Abstract: We study the causes of "nutritional inequality": why the wealthy tend to eat more healthfully than the poor in the U.S. Using two event study designs exploiting entry of new supermarkets and households' moves to healthier neighborhoods, we reject that neighborhood environments have economically meaningful effects on healthy eating. Using a structural demand model, we find that exposing low-income households to the same food availability and prices experienced by high-income households would reduce nutritional inequality by only 9%, while the remaining 91% is driven by differences in demand. In turn, these income-related demand differences are partially explained by education, nutrition knowledge, and regional preferences. These findings contrast with discussions of nutritional inequality that emphasize supply-side issues such as food deserts.
    JEL: D12 I12 I14 L81 R20
    Date: 2018–01
  8. By: Dolton, Peter; Xiao, Mimi
    Abstract: There is a worldwide epidemic of obesity. We are just beginning to understand its consequences for child obesity. This paper addresses one important component of the crisis; namely the extent to which adiposity, or more specifically, BMI, is passed down from one generation to the next. We find that the intergenerational elasticity of BMI is very similar across countries and relatively constant – at 0.2 per parent. Our substantive finding is that this elasticity is very comparable across time and countries – even if these countries are at very different stages of economic development. Quantile analysis suggests that this intergenerational transmission mechanism is substantively different across the distribution of children’s BMI; more than double for the most obese children what it is for the thinnest children. These findings have important consequences for the health of the world’s children.
    Keywords: Intergenerational; Body mass index
    JEL: I1
    Date: 2017–02–01
  9. By: Jason Fletcher (University of Wisconsin–Madison)
    Abstract: This paper explores gene-environmental interactions between family environments and children’s genetic scores in determining educational attainment. The central question is whether poor childhood family environments reduce the ability for children to leverage their genetic gifts to achieve high levels of educational attainments. The multigenerational information and genetic data contained in the Health and Retirement Study is used to separate two mechanisms of intergenerational transmission of socioeconomic status – genetic endowments and family environments. Using parental in utero exposure to the 1918/1919 influenza pandemic as a source of quasi-experimental variation to family environments (but not affecting children’s genetic endowments), this paper estimates interactions between parental investments and children’s genetic potential. The main finding suggests that girls with high genetic potential whose fathers were exposed to influenza face reduced educational attainments – a gene-environment interaction – but there is no similar effect for boys.
    Keywords: in utero exposure, gene-environment interactions, polygenic scores, intergenerational effects
    JEL: J62 J10 J24
    Date: 2018–06
  10. By: Maksym Obrizan (Kyiv School of Economics); Karine Torosyan (International School of Economics at TSU); Norberto Pignatti (International School of Economics at TSU)
    Abstract: The purpose of this study is to analyze tobacco spending in Georgia using various machine learning methods applied to a sample of 10,757 households from Integrated Household Survey collected by GeoStat in 2016. Previous research has shown that smoking is the leading cause of death for 35-69 year olds. In addition, tobacco expenditures may constitute as much as 17% of the household budget. Five different algorithms (ordinary least squares, random forest, two gradient boosting methods and deep learning) were applied to 8,173 households (or 76.0%) in the train set. Out-of-sample predictions were then obtained for 2,584 remaining households in the test set. Under the default settings random forest algorithm showed the best performance with more than 10% improvement in terms of root-mean-square error (RMSE). Improved accuracy and availability of machine learning tools in R calls for active use of these methods by policy makers and scientists in health economics, public health and related fields.
    Keywords: Tobacco Spending, Household Survey, Georgia, Machine Learning
    JEL: I12 L66 D12
    Date: 2018–05
  11. By: Paolo Pertile; Simona Gamba; Martin Forster
    Abstract: We present a model of the strategic interaction among authorities regulating pharmaceutical prices in different countries and the R&D investment decisions of pharmaceutical firms. Regulators’ decisions affect consumer surplus directly, via prices, and indirectly via firms’ profits and R&D investment policies, which in turn affect patient health. The positive externality of a price increase in one country provides an incentive for other countries to free-ride, and we show how country-level characteristics affect optimal pricing decisions and equilibria. Our theoretical predictions are tested using price data for a set of 70 cancer drugs in 25 OECD countries. We find evidence of behaviour that is consistent with the free-riding hypothesis and which, in line with the theoretical predictions, differs according to country-level characteristics. Countries with comparatively large market shares tend to react to increases in other countries’ prices by lowering their own prices; in countries with comparatively small market shares, regulators’ decisions are consistent with the objective of introducing the product at as low a price as possible. We discuss the policy implications of our results for incentivising global pharmaceutical R&D and the recent proposal to move towards a joint pharmaceutical procurement process at the European level.
    Keywords: quality;
    Date: 2018–06
  12. By: Joshua L. Krieger; Danielle Li; Dimitris Papanikolaou
    Abstract: We analyze the economic tradeoffs associated with firms' decisions to invest in incremental and radical innovation, in the context of pharmaceutical research and development. We develop a new, ex ante, measure of a drug candidate's innovativeness by comparing its chemical structure to that of previously developed drug candidates: this allows us to better distinguish between novel and so-called “me-too” drugs. We show that, on average, novel drug candidates 1) generate higher private and social returns conditional on approval (as measured by revenues, stock market returns, clinical value added, and patent citations) but 2) are riskier in that they are less likely to be approved by the FDA. Using variation in the expansion of Medicare prescription drug coverage, we show that firms respond to a plausibly exogenous positive shock to their net worth by developing more chemically novel drug candidates, as opposed to more “me-too” drugs. This pattern suggests that, on the margin, firms perceive novel drugs to be more valuable ex-ante investments, but that financial frictions may hinder their willingness to invest in these riskier candidates.
    JEL: G31 I10 O3
    Date: 2018–05
  13. By: Bruce Shearer; Nibene Habib Somé; Bernard Fortin
    Abstract: We measure the response of physicians to monetary incentives using matched administrative and time-use data on specialists from Québec (Canada). These physicians were paid fee-for-service contracts and supplied a number of different services. Our sample covers a period during which the Québec government changed the prices paid for clinical services. We apply these data to a multitasking model of physician labour supply, measuring two distinct responses. The first is the labour-supply response of physicians to broad-based fee increases. The second is the response to changes in the relative prices of individual services. Our results confirm that physicians respond to incentives in predictable ways. The own-price substitution effects of a relative price change are both economically and statistically significant. Income effects are present, but are overridden when prices are increased for individual services. They are more prominent in the presence of broad-based fee increases. In such cases, the income effect empirically dominates the substitution effet, which leads physicians to reduce their supply of clinical services.
    Keywords: Physician labour supply, multitasking, incentive pay
    JEL: I10 J22 J33 J44
    Date: 2018
  14. By: Vanessa Hilleringmann (Paderborn University)
    Abstract: Focusing on a physician's relationship to a briber and a patient, this experiment analyzes the influence of a bribe on a physician's treatment decision. We conduct a partner treatment, in which briber and physician play together for the whole experiment and a stranger treament, where briber and physician are re-matched every period. With the help of the two treatments, we vary the relative reciprocity between the physician and the two other actors, briber and patient. Additionally we use a follow up questionnaire to measure the behavioral motivation of the participants. We find that reciprocity leads to bribery relationships: In the partner treatment physicians act corruptly more often. Just the variation of the relative reciprocity between the treatments shows differences in the behavior of the subjects. Differences in the participants' preferences deliver no explanation for their behavior in our experiment.
    Keywords: Corruption, Reciprocity, Physician-Patient Relationship
    JEL: I12 I18 D73
    Date: 2018–05
  15. By: Georgia S. Papoutsi (Agricultural Economics Research Institute, Hellenic Agricultural Organization “Demeter”); Stathis Klonaris (Department of Agricultural Economics & Rural Development, Agricultural University of Athens); Andreas C. Drichoutis (Department of Agricultural Economics & Rural Development, Agricultural University of Athens)
    Abstract: Understanding human eating behaviour can highlight avenues for intervention by policy makers and industry. With this goal in mind, we evaluate the claim that consumers are willing to trade-off taste for health benefits, by performing a controlled laboratory experiment where we simultaneously auctioned two different functional snack products: an energy bar and a novel carob-based snack. We varied on a between-subjects basis the order of taste and product information which was communicated to participants through informational labeling. We also investigated in a within-subjects design the effect of expectations for the snacks, blind tasting and product information on sensory evaluations and on willingness to pay. Results indicate that tasting and information have economically and statistically significant effects on overall food assessment with respect to prior product expectations. Provision of information shortly before consumption, makes consumers less strict on their taste evaluation and increases their purchasing intent in order to improve the healthfulness of their diet. When information is provided after taste, it only exerts influence with respect to the carob-based snack. Furthermore, blind tasting has a negative effect on liking, irrespective of the product being evaluated. Finally, the econometric results reveal that older respondents tend to bid higher for functional snacks.
    Keywords: laboratory experiments, sensory evaluations, functional snack, labeling, willingness to pay
    JEL: C91 D12 D44 M31
    Date: 2018
  16. By: Juergen Jung; Chung Tran
    Abstract: We study optimal income tax progressivity in an environment where individuals are exposed to idiosyncratic income and health risks over the lifecycle. Our results, based on a calibration for the US economy, indicate that the presence of health risk combined with incomplete insurance markets amplies the social insurance role of progressive income taxes. The government is required to set higher optimal levels of tax progressivity in order to provide more social insurance for unhealthy low income individuals who have limited access to health insurance. The optimal progressive income tax system includes a tax break for income below $36; 400 and high marginal tax rates of over 50 percent for income above $200; 000: The tax progressivity (Suits) indexa Gini coecient for income tax contributions by incomeof the optimal tax system is around 0:53, compared to 0:17 in the benchmark tax system. Yet, the optimal tax system in our model is more progressive than the optimal tax systems in models abstracting from health risk (e.g., Conesa and Krueger (2006) and Heathcote, Storesletten and Violante (2017)). Importantly, the optimal level of tax progressivity is strongly aected by the design of the health insurance system. When health expenditure risk is reduced or removed from the model, the optimal tax system becomes less progressive and thus more similar to the optimal progressivity levels reported in the previous literature.
    Keywords: Health and income risks, Inequality, Social insurance, Tax progressivity, Suits index, Optimal taxation, General equilibrium.
    JEL: E62 H24 I13 D52
    Date: 2018–06
  17. By: Hung-Hao Chang; Chad D. Meyerhoefer
    Abstract: We investigate the impact of access to convenience stores and competition between convenience store chains on medical care use and expenditures in Taiwan; the country with the highest density of convenience stores in the world. Our study makes use of insurance claims from 0.85 million individuals enrolled in Taiwan’s national health insurance program from 2002-2012 and administrative data on convenience store chain sales. While we find that both greater store accessibility and higher levels of inter-brand competition reduce the use and cost of outpatient medical services and prescription drugs, healthcare utilization is more responsive to changes in competition. Since convenience stores in Taiwan are typically the healthier option for ready-to-eat food, we postulate that the decline in medical care utilization is driven by a reduction in convenience store prices and increase in service quality relative to other food outlets. This is supported by findings from survey data indicating that convenience store competition is associated with greater consumption of more healthy foods, lower consumption of less healthy foods, and decreases in obesity rates. While the effects we find are precisely estimated, they are small in magnitude, with the increase in convenience store competition experienced by Taiwan over a 10-year period reducing medical expenditures on outpatient services and on prescription drugs by around one half of one percent.
    JEL: H51 I12 L81
    Date: 2018–05
  18. By: Currie, Janet; Schwandt, Hannes; Thuilliez, Josselin
    Abstract: We develop a method to compare levels and trends in inequality in mortality in the United States and France in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality.
    Date: 2018–05
  19. By: Gallardo Albarran, Daniel (Groningen University)
    Abstract: Clean water provision is considered crucial towards eradicating water-borne diseases. However, the benefits of piped water are limited in the absence of efficient systems of waste disposal due to recontamination or the exposure of citizens to excrement. In this article, I analyse the historical experience of German cities and estimate the impact of water supply and sewerage systems on mortality. The results show that waterworks lowered mortality, although to a lower extent than suggested previously. I observe a much stronger effect of sanitary interventions in cities that also established sewerage systems. Together they explain 19 percent of the overall mortality decline during this period. Three pieces of evidence show that the limited effects of waterworks is related to illnesses spread via faecal-oral transmission mechanisms. First, sanitary infrastructures account for a quarter of the decline in infant mortality, which is largely affected by water-borne ailments. Second, I find a large effect for enteric-related illnesses, while deaths from etiologies with a different pathological basis are not affected. Finally, the estimated effect is related exclusively to the sanitary interventions because mortality only declines significantly after their completion, and not before.
    Date: 2018
  20. By: Armel Ngami (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - ECM - Ecole Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université - EHESS - École des hautes études en sciences sociales); Thomas Seegmuller (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - ECM - Ecole Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université - EHESS - École des hautes études en sciences sociales)
    Abstract: This paper analyses the effect of a pay-as-you-go pension system on the evolution of capital and pollution, and on the efficiency of an environmental versus health policy. In an overlapping generations model (OLG), we introduce endogenous longevity that depends on pollution and health expenditures. Global dynamics may display multiple balanced growth paths (BGP). We show that by discouraging savings, a policy that promotes the pension system enlarges the environmental poverty trap. More surprisingly, the environmental policy has contrasted effects according to the significance of the pension system. If it has a low size, a raise of the environmental policy enlarges the environmental poverty trap and leads to a rise in capital over pollution at the highest stationary equilibrium. In contrast, in economies where intergenerational solidarity is well developed, capital over pollution decreases at the highest BGP. In such a case, the environmental policy does not necessarily lead to a better longevity and growth.
    Keywords: longevity,environment,health,pension system,growth,pollution
    Date: 2018–05
  21. By: Ashraf, Nava; Bau, Natalie; Low, Corinne; McGinn, Kathleen
    Abstract: Using a randomized control trial, we examine whether offering adolescent girls non-material resources - specifically, negotiation skills -can improve educational outcomes in a low-income country. In so doing, we provide the first evidence on the effects of an intervention that increased non-cognitive, interpersonal skills during adolescence. Long-run administrative data shows that negotiation training significantly improved educational outcomes over the next three years. The training had greater effects than two alternative treatments (offering girls a safe physical space with female mentors and offering girls information about the returns to education), suggesting that negotiation skills themselves drive the effect. Further evidence from a lab-in-the-field experiment, which simulates parents' educational investment decisions, and a midline survey suggests that negotiation skills improved girls' outcomes by moving households' human capital investments closer to the efficient frontier. This is consistent with an incomplete contracting model, where negotiation allows daughters to strategically cooperate with parents.
    Keywords: Gender; Human Capital; Intrahousehold Allocation; non-cognitive skills; strategic cooperation
    JEL: D13 I24 J16 O15
    Date: 2018–05
  22. By: Do Thi Thuy, Thuy; Nguyen, Quang Dung; Nguyen Van, Huy; Thomas-Agnan, Christine; Trinh, Thi-Huong
    Abstract: Vietnam launched the national Expanded Program on Immunization in 1981. Since then, this program has contributed signi cantly to the improvement of child health and to the reduction of child mortality rate. Despite of the fact that the coverage of the national EPI keeps expanding, the number of children who complied with the recommended immunization schedule remains low. This article studies the progress of the timeliness childhood immunization compliance among children between 0-5 years of age in Vietnam from 2006 to 2014 and analyzes the socio-economic factors that account for the changes of the compliance rate during this period. The dataset is extracted from the Multiple Indicator Cluster Survey in 2006 and 2014. We rst identify the socio-economic factors that impact on the vaccination compliance rate using a logistic regression model. Next, we apply the decomposition method to determine the contribution of each factor on the evolution of the timeliness childhood immunization compliance. The progress of the timeliness childhood immunization has been positive and the major contribution comes from the structure e ect (unmeasured e ect). Rural areas show a stronger improvement as of 2014. Among the socio-economic factors, mother education and birth order are the ones that have the larger in uence on the childhood immunization compliance rate. However, these factors have di erent implications in urban and rural areas. These ndings are critical to the current context of Vietnam where the government is designing a strategy focusing on the e ectiveness rather than the traditional coverage indicator.
    Keywords: Vaccination; timeliness childhood immunisation compliance; decomposition; logistic model; MICS data; Vietnam
    JEL: C02 C21 C51 P46
    Date: 2018–05
  23. By: Mario Garcia-Molina; Liliana Alejandra Chicaiza; Carlos Javier Rincon; Giancarlo Romano
    Abstract: PURPOSE: Countries without EQ-5D general-population surveys might use valuations from another country with similar health valuations. This study aimed to identify whether there are groups of countries with similar health-state valuations. METHODS: A cluster analysis was performed for the 242 states of the EQ-5D valuations for 23 studies in 18 countries, excluding the perfect-health state. Clusters were identified by means of the Ward algorithm with the Euclidean measure and hierarchical clustering. RESULTS: 5 clusters were identified. Valuations are sensitive to the preference elicitation methodology. Some countries in the same cluster have cultural similarities but a particular cluster included otherwise dissimilar countries and methodologies. Using the states associated to diabetes and breast cancer, the choice of cluster is shown to be relevant for cost-utility analysis. CONCLUSIONS: Health-state valuations tend to be clustered in a few groups of countries. The clusters found might be useful for performing cost-utility analysis in countries without such valuations.
    Keywords: Quality-adjusted life years; Utility assessment; EQ5D; Health-state utility; Outcomes research
    JEL: D10 D61 H51 I10
    Date: 2018–06–06

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