nep-hea New Economics Papers
on Health Economics
Issue of 2018‒12‒03
twelve papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Beyond Birth Weight: The Origins of Human Capital By Gabriella Conti; Mark Hanson; Hazel Inskip; Sarah Crozier; Cyrus Cooper; Keith Godfrey
  2. The Impact of Paid Maternity Leave on Maternal Health By Bütikofer, Aline; Riise, Julie; Skira, Meghan
  3. Cesarean Sections for High-Risk Births: Health, Fertility and Labor Market Outcomes By Mühlrad, Hanna
  4. Physicians' Incentives to Adopt Personalized Medicine: Experimental Evidence By David Bardey; Samuel Kembou Nzalé; Bruno Ventelou
  5. Is incentivizing by subsidizing a better way of managing chronic health conditions? By Islam, M. Kamrul; Kjerstad, Egil
  6. Economic Evaluation of Pharmacological Treatments in Dementia Disorders - A Systematic Literature Review By Saha, Sanjib; Gerdtham, Ulf-G.; Toresson, Håkan; Minthon, Lennart; Jarl, Johan
  7. Fuel prices and road accident outcomes in New Zealand By Rohan Best; Paul J. Burke
  8. Emotions related to the process of eating behaviour change. The measurement scale. By Grazyna Wasowicz; Magdalena Poraj_Weder; Tessy Boedt; Christophe Matthys
  9. The economic and health impact of a tax on sugar sweetened beverages (SSBs) in South Africa By Gomo, Charity; Birg, Laura
  10. Health insurance and self-employment transitions in Vietnam: A multinomial analysis By Le, Nga; Groot, Wim; Tomini, Sonila; Tomini, Florian
  11. Investigating the economic benefit of better access to radiation therapy treatment to women with cervical cancer in rural KwaZulu-Natal, South Africa By Muhammad Hoque; Mpho Mbhele
  12. Health insurance and patient satisfaction: Evidence from the poorest regions of Vietnam By Le, Nga; Groot, Wim; Tomini, Sonila; Tomini, Florian

  1. By: Gabriella Conti (University College London); Mark Hanson (University of Southampton); Hazel Inskip (MRC Lifecourse Epidemiology Unit, University of Southampton); Sarah Crozier (MRC Lifecourse Epidemiology Unit, University of Southampton); Cyrus Cooper (MRC Lifecourse Epidemiology Unit, University of Southampton); Keith Godfrey (University of Southampton)
    Abstract: Birth weight is the most widely used indicator of neonatal health. It has been consistently shown to relate to a variety of outcomes throughout the life cycle. Lower birth weight babies have worse health and cognition from childhood, lower educational attainment, wages, and longevity. But what's in birth weight? What are the aspects of the prenatal environment that birth weight actually reflect? In this paper we address this fundamental, yet currently unanswered, question, using unique data with fetal ultrasound measurements from two UK sources. We show that birth weight provides a distinctly limited picture of the uterine environment, capturing both positive and negative aspects of fetal health. Other newborn measures are more informative about different dimensions of the prenatal environment and more predictive of child growth and cognitive development, beyond birth weight. Additionally, patterns of fetal growth are predictive of child physical and mental health conditions, beyond health at birth. Our results are robust to correcting for measurement error, and to accounting for child- and mother-specific unobserved heterogeneity. Our analysis rationalizes a common finding in the early origins literature, that prenatal events can influence postnatal development without affecting birth outcomes. It further clarifies the role of birth weight and height as markers of early health, and suggests caution in adopting birth weight as the main target of prenatal interventions.
    Keywords: birth weight, fetal development, prenatal investments, developmental origins of health
    JEL: I14 J13 J24
    Date: 2018–11
  2. By: Bütikofer, Aline (Norwegian School of Economics); Riise, Julie (University of Bergen, Department of Economics); Skira, Meghan (Unversity of Georgia, Athens)
    Abstract: We examine the impact of the introduction of paid maternity leave in Norway in 1977 on maternal health. Before the policy reform, mothers were eligible for 12 weeks of unpaid leave. Mothers giving birth after July 1, 1977 were entitled to 4 months of paid leave and 12 months of unpaid leave. We combine Norwegian administrative data with survey data on the health of women around age 40 and estimate the medium- and long-term impacts of the reform using regression discontinuity and difference-inregression discontinuity designs. Our results suggest paid maternity leave benefits are protective of maternal health. The reform improved a range of maternal health outcomes, including BMI, blood pressure, pain, and me mntal health, and it increased health-promoting behaviors, such as exercise and not smoking. The effects were larger for first-time and low-resource mothers and women who would have taken little unpaid leave in the absence of the reform. We also study the maternal health effects of subsequent expansions in paid maternity leave and find evidence of diminishing returns to leave length.
    Keywords: Maternity Leave; Maternal Health; Regression Discontinuity
    JEL: I12 I18 J13 J18
    Date: 2018–03–05
  3. By: Mühlrad, Hanna (Department of Economics, Lund University)
    Abstract: Despite the fact that Cesarean section (C-section) is the most commonly performed surgery in a number of industrialized countries, little is known about the long-term consequences for the mothers and children involved. In this study, I use a sample of high-risk births—namely, breech births, in which the fetus is presented with its head upward instead of downward—to study the causal effect of C-sections on child health and on the health, fertility and labor market responses for mothers. Because selection into C-section may be endogenous, I exploit an information shock to doctors in 2000, in which new scientific evidence about the benefits of planned C-sections for breech births led to a sharp 23% increase in planned C-sections. Using Swedish registry data, I find that having a C-section improves child health in both the short and long run, indicated by higher Apgar scores at birth and fewer nights hospitalized during ages 1-7. I find little evidence to suggest any significant impact on maternal health, future fertility or maternal labor market outcomes.
    Keywords: Cesarean Section; Fertility; Maternal Health; Child Health; Birth Technology; Labor Market Outcomes
    JEL: I11 I12 I38 J13 J24
    Date: 2018–10–29
  4. By: David Bardey (CEDE - Los Andes University, TSE - Toulouse School of Economics - Toulouse School of Economics); Samuel Kembou Nzalé (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - Ecole Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - Ecole Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)
    Abstract: We study physicians' incentives to use personalized medicine techniques, replicating the physician's trade-offs under the option of personalized medicine information. In a laboratory experiment where prospective physicians play a dual-agent real-effort game, we vary both the information structure (free access versus paid access to personalized medicine information) and the payment scheme (pay-for-performance (P4P), capitation (CAP) and fee-for-service (FFS)) by applying a within-subject design. Our results are threefold. i) Compared to FFS and CAP, the P4P payment scheme strongly impacts the decision to adopt personalized medicine. ii) Although expected to dominate the other schemes, P4P is not always efficient in transforming free access to personalized medicine into higher quality patient care. iii) When it has to be paid for, personalized medicine is positively associated with quality, suggesting that subjects tend to make better use of information that comes at a cost. We conclude that this last result can be considered a "commitment device". However, quantification of our results suggests that the positive impact of the commitment device observed is not strong enough to justify generalizing paid access to personalized medicine.
    Keywords: personalized medicine,fee-for-service,capitation,pay-for-performance,physician altruism,laboratory experiment
    Date: 2018–11
  5. By: Islam, M. Kamrul (University of Bergen, Department of Economics); Kjerstad, Egil (University of Bergen, Department of Economics)
    Abstract: The recognition that chronic care delivery is sub-optimal has led many health authorities around the world to its redesign. In Norway, the Department of Health implemented the Coordination Reform in January 2012 with the granting of subsidies to municipalities establishing emergency bed capacity (EBC) within their primary care facilities, with the explicit aim of reducing unnecessary admissions to hospitals. We examine the impact of this EBC policy on changes in emergency hospital admissions. Municipalities took advantage of these subsidies at different points of time, which means that there are differences in the local implementation of EBC, enabling us to use an identifying restriction to define the treatment and control groups. Using five different sources of register data and a quasi-experimental framework (the difference-in-differences regression approach), we estimate the causal effect of the changes in EBC on aggregate emergency admissions for eight ambulatory care sensitive conditions (ACSCs). We also estimate the impact on each condition separately. The results show that EBC exerted a significant and negative effect on the changes in emergency admissions. The effects are largely consistent with alternative model specifications but we find mixed results for the different ACSCs, in that EBC negatively affected emergency hospital admissions for angina and chronic obstructive pulmonary disease, but not congestive heart failure and diabetes. The main implication of the study is that EBC within primary care is a sensible way of redesigning chronic care as it leads to a meaningful reduction in hospital emergency admissions.
    Keywords: Incentives; Emergency bed capacity; Emergency admissions; Subsidies; Difference-in-differences
    JEL: C21 I10 I18
    Date: 2017–09–29
  6. By: Saha, Sanjib (Health Economics Unit, Department of Clinical Science, Lund University, Sweden); Gerdtham, Ulf-G. (Department of Economics, Lund University); Toresson, Håkan (Clinical Memory Research Unit, Department of Clinical Science, Lund University, Sweden); Minthon, Lennart (Clinical Memory Research Unit, Department of Clinical Science, Lund University, Sweden); Jarl, Johan (Health Economics Unit, Department of Clinical Science, Lund University, Sweden)
    Abstract: The objective is to systematically review the literature on economic evaluations of pharmacological treatments of dementia disorders. A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Fourteen studies were included in this review. There was a considerable heterogeneity in methodological approaches, use of simulation models, target populations, study time frames, and perspectives as well as comparators used. Keeping these issues in mind, we find that Cholinesterase Inhibitors (ChEIs), and especially donepezil, are dominating no treatment (i.e. less costly and more effective) for mild to moderate AD patients. For moderate to severe AD patients memantine is cost-effective compared to memantine or ChEIs alone. However, the effect of these drugs on survival is yet not established, which could have a major impact on the cost-effectiveness of these drugs. Conclusion: Pharmaceutical treatments are cost-effective comparing to no treatment for dementia patients. However, more research is required on the long-term effectiveness of these drugs, especially on the effects of drugs on survival.
    Keywords: Dementia; pharmaceuticals; economic evaluation; Cholinesterase Inhibitors
    JEL: H43 I10 I18
    Date: 2018–11–24
  7. By: Rohan Best; Paul J. Burke
    Abstract: Recent years have seen a spike in New Zealand’s road death toll, a phenomenon also seen in some other countries such as Australia. This paper analyses the short-run impact of fuel prices on road accident outcomes in New Zealand, including the numbers of road deaths, accidents, and injuries. Using data for the period 1989–2017, we find a negative relationship between fuel prices and key road-risk outcome variables, including the number of road deaths. There are similar results for models in levels and first differences. The number of serious injuries to cyclists tends to increase when fuel prices are high, however. Lower fuel prices appear to have contributed to New Zealand’s recent uptick in road accidents, pushing against the long-term trend of improved road safety.
    Keywords: fuel price, road accident death, road accident injury
    JEL: Q41 Q48 R41
    Date: 2018–11
  8. By: Grazyna Wasowicz (University of Warsaw); Magdalena Poraj_Weder (University of Warsaw); Tessy Boedt (Catholic University Leuven); Christophe Matthys (Catholic University Leuven)
    Abstract: World Health Organization (2018) provides statistics showing that obesity has tripled across the world between 1975 and 2016. The global prevalence of obesity stimulates research on the causes and consequences of overweight and obesity, as well as on the determinants of effective behaviour change. The process of behaviour change is difficult, as it requires ? among others - coping with emotions accompanying the process. Many previous studies have shown that most people who try to change their eating habits fail to achieve their objective. Medical and social scientists try to understand the underlying reasons in order to optimise treatment (both time and cost efficient), both for the patient and for the health care system.To achieve this objective a new scale to measure emotions experienced in the process of behaviour change (Scale on Emotions Related to the Behaviour Change, SEBeCh) has been developed. The psychological theory of emotions by Mehrabian and Russell (1974; Bakker et al., 2014) has been selected as the theoretical background of the scale. The new scale consisted of subscales that referred to various aspects of: 1) cooperation with a health professional (satisfaction with dietary advice, quality of the relationship and the level of freedom in making choices), and 2) diet-related emotions (attributes of a new diet, difficulty to manage the new diet, effectiveness of a new diet, attitude toward a new diet, and satisfaction with a progress and with herself/himself).The aim of this study was to test and validate the newly developed SEBeCh scale. An online study, with 300 participants (50% women and men), who declared passing through the process of eating habits change (40% with support of a health professional) was conducted. Positive and negative emotions related to the cooperation with a health professional reflect two-factor structure (75% of explained variance), elicited in the principal component analysis. The internal consistency of the scales is very high (Cronbach alpha equals respectively 0.98 and 0.97). The scales correlate with Health Care Climate Questionnaire used for validation purposes. Also for the diet change related emotions two factors were found (67% of explained variance), Cronbach alpha for positive and negative emotions subscales equals respectively 0.94 and 0.98. The subscales correlate highly with goal directed emotions (listed by Bagozzi, et al., 1998), which confirms validity of the scales.
    Keywords: emotions, health, obesity, weight
    JEL: I10 I19 C83
    Date: 2018–11
  9. By: Gomo, Charity; Birg, Laura
    Abstract: Background/Objectives: The increased consumption of sugar sweetened beverages (SSBs) has been associated with risks of obesity, and corresponding risks of type 2-diabetes, cancer, and cardiovascular disease. In order to reduce the intake of these beverages, the South African government has recently introduced a tax on SSBs. Methods: This paper evaluates the economic and health impact of the recently introduced tax on sugar sweetened beverages in South Africa, by constructing a microsimulation model using the South African Income and Household Survey (IES 2010/11) as the main data set. Results and conclusion: The overall results indicate that a 10% SSB tax will lead to a substantial reduction in consumption of carbonated soft drinks by about 27% and minor reductions in other SSB categories. Results also indicate that the 10% SSB tax can generate about ZAR 14.5 billion (USD 1.08 bn) in government tax revenue annually. In addition, simulation results show that the SSB tax would result in an average reduction in energy intake by 16.97 kj/person/day.
    Date: 2018
  10. By: Le, Nga (UNU-MERIT); Groot, Wim (UNU-MERIT and CAPHRI, Maastricht University,); Tomini, Sonila (UNU-MERIT); Tomini, Florian (Institute of Epidemiology and Health Care, UCL Medical School)
    Abstract: Health insurance can have important effects on self-employment and self- employment transitions. However, there is a literature gap on the relationship between health insurance and self-employment in low and middle income countries, especially in the context of the rapid expansion of health insurance in these countries. This paper examines this relationship in Vietnam with a focus on the comparison between the voluntary scheme for the informal sector (mostly self-employed workers) and the compulsory insurance for the formal sector (mostly wage workers). We employ a Multinomial Logit Model on a panel from the Vietnamese Household Living Standards Surveys 2010-2014 to investigate the association between health insurance and self-employment entry and exit over time. We show that those with compulsory health insurance in Vietnam, the formal workers, do not have the incentive to start a business compared to those having voluntary insurance. This effect holds true over time in 2012 and 2014. The effect is partly explained by the better enforcement of the compulsory health insurance scheme in Vietnam, making staying out of self-employment (often informal self-employment) a preferred choice. Regarding the effect of health insurance on self- employment exit, we do not find any conclusive evidence on this matter. The rigidity of the economy is highlighted, suggesting important policy implications in the areas of health and labour policies in Vietnam.
    Keywords: health insurance, self-employment, Vietnam, self-employment entry, self-employment exit
    JEL: I13 J22 O15
    Date: 2018–11–05
  11. By: Muhammad Hoque (University of KwaZulu-Natal); Mpho Mbhele (University of KwaZulu-Natal)
    Abstract: Cancer is the disease that touches a larger proportion of the KwaZulu-Natal population most of which are from rural setting with little or no educational background. In view of that, many of the cases that present to Greys Hospital Oncology are a majority of late stage cancers. Among the various types of cancers seen, cancer of the cervix is the highest common cancer type treated at Greys Hospital Oncology Unit. The most common challenge especially from women who received radiation treatment for cervical cancer was the length of their treatment which takes up to 8 weeks. This study aimed to describe how the cervical cancer patients would benefit socio-economically should they be granted better access to Radiotherapy for their cancer treatment. To achieve this, a descriptive quantitative study was conducted among 74 cervical cancer patients who received radiation therapy at Greys Hospital Oncology unit. Results found that 43% of the participants were single, 39% married, 43% had more than three (03) children and 82% had no nanny at home to take care of the children. It was found that 22% had no education and only 8% completed matric while 58% were found to be pensioners. The study also found that of those who spend >R1000 on groceries, 42% spend >R60 on transport. Given those statistical findings, it is evident that the participants in the study were of a low socio-economic status which meant that they were likely to suffer financial toxicity as well as other social challenges in order to receive their full cause of radiation treatment for their cancer.
    Keywords: Cancer patient, treatment, cost, benefit, challenges
    Date: 2018–11
  12. By: Le, Nga (UNU-MERIT); Groot, Wim (UNU-MERIT and CAPHRI, Maastricht University,); Tomini, Sonila (UNU-MERIT); Tomini, Florian (Institute of Epidemiology and Health Care, UCL Medical School)
    Abstract: Even though health insurance is expanding rapidly in Vietnam, its coverage is not effective. There remain inefficiencies in the healthcare system with quality concerns, especially at primary care and in remote areas. However, very little is known about how health insurance is valued by people and whether health insurance coverage can translate into quality healthcare. This paper investigates the relationship between health insurance and patient satisfaction with medical care in the poorest regions of Vietnam. We use multi-level models for ordinal responses on a cross-sectional dataset of the poorest regions of Vietnam in 2012. We find that it is not health insurance coverage per se but the financial coverage that matters to improve patient satisfaction with medical care. Patient satisfaction depends on the breadth and depth of insurance coverage (i.e. services and medicines covered, co-payment rate for each service) and the ability to use health insurance to reduce medical costs via the co-payment mechanism.
    Keywords: Health insurance, patient satisfaction, Vietnam
    JEL: I13
    Date: 2018–11–05

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