nep-hea New Economics Papers
on Health Economics
Issue of 2019‒04‒22
nine papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Returns to Early-life Interventions for Very Low Birth Weight Children By Eric Chyn; Samantha Gold; Justine S. Hastings
  2. Paid Parental Leave: Leaner Might Be Better By Catherine Haeck; Samuel Pare; Pierre Lefebvre; Philip Merrigan
  3. The Impact of Parental Involvement Laws on Minor Abortion By Theodore J. Joyce; Robert Kaestner; Jason Ward
  4. Do minimum wages improve self-rated health? Evidence from a natural experiment By Hafner, Lucas
  5. Why Do Americans Spend So Much More on Health Care than Europeans? (REVISED) By Hui He; Kevin x.d. Huang; Lei Ning
  6. Do Hospital Closures Improve the Efficiency and Quality of Other Hospitals? By Song, Lina; Saghafian, Soroush
  7. Who is an Efficient and Effective Physician? Evidence from Emergence Medicine By Saghafian, Soroush; Imanirad, Raha; Traub, Stephen J.
  8. Efficiency Assessment of Tunisian Public hospitals Using Data Envelopment Analysis (DEA) By Miryam Daoud Marrakchi; Hédi Essid
  9. Factors Influencing Informal Workers’ Participation in Health Insurance in Sudan: Evidence from Khartoum and Kassala States By Mohammed Elhaj Mustafa; Ebaidalla Mahjoub Ebaidalla

  1. By: Eric Chyn; Samantha Gold; Justine S. Hastings
    Abstract: We use comprehensive administrative data from Rhode Island to measure the impact of early-life interventions for low birth weight newborns on later-life outcomes. We use a regression discontinuity design based on the 1,500-gram threshold for Very Low Birth Weight (VLBW) status. We show that threshold crossing causes more intense in-hospital care, in line with prior studies. Threshold crossing also causes a 0.34 standard deviation increase in test scores in elementary and middle school, a 17.1 percentage point increase in the probability of college enrollment, and $66,997 decrease in social program expenditures by age 14. We explore potential mechanisms driving these impacts.
    JEL: H53 I1 I12 I14 I18 I21 I24 J13
    Date: 2019–04
  2. By: Catherine Haeck (Department of Economics, University of Quebec in Montreal); Samuel Pare; Pierre Lefebvre (Department of Economics, University of Quebec in Montreal); Philip Merrigan (Department of Economics, University of Quebec in Montreal)
    Abstract: This article provides an analysis of the impact of the Quebec Parental Insurance Plan (QPIP). Using a quasi-experimental design with survey data, we find that mothers spent on average 10 additional days with their newborn following the implementation of the insurance plan, and that both mothers and fathers received higher benefits. For children, using both survey data and administrative data, we find that the QPIP had limited positive effects on their health, cognitive and behavioural development. Effects are concentrated among families of mothers with a post-secondary education. These results suggest that while paid benefits increased dramatically, the impacts on maternal time investment and child well-being are modest.
    Keywords: maternity leave, parental leave, child development, family well-being, natural experiment
    JEL: J13 J22 J24
    Date: 2019–03
  3. By: Theodore J. Joyce; Robert Kaestner; Jason Ward
    Abstract: In this article, we conduct a comprehensive analysis of the effect of parental involvement (PI) laws on the incidence of abortions to minors across a span of nearly three decades. We contribute to the extant literature on this topic in several ways. First, we explore differences in estimates of the effect of PI laws across time that may result from changes in contraception, the composition of pregnant minors, access to confidential abortions in nearby states, or through judicial bypass, and the degree to which these laws are enforced. We find that, on average, PI laws enacted before the mid-1990s are associated with a 15% to 20% reduction in minor abortions. PI laws enacted after this time are not, on average, associated with declines in abortions to minors. Second, we assess the role of out-of-state travel by minors, estimating models that allow the effect of PI laws to differ by the distance to the nearest state without a PI law. We find that out-of-state travel is not a substantive moderating factor of the effect of PI laws. Third, we use a synthetic control approach to explore state-level heterogeneity in the effect of PI laws and find large differences in the impact of PI laws on minor abortions by state. These differences are unrelated to the type of law (consent versus notification) or whether contiguous states have enacted PI laws. Finally, we show that estimates of the effect of PI laws using data from either the Centers for Disease Control or the Alan Guttmacher Institute do not differ qualitatively once differences in coverage by state and year across these data are harmonized.
    JEL: I12 I18 I31
    Date: 2019–04
  4. By: Hafner, Lucas
    Abstract: In this paper I evaluate a labor market reform in Germany. In particular, I analyze whether the introduction of the general minimum wage in 2015 had an effect on self-rated health and labor market outcomes of individuals who were likely affected by the reform. I exploit the plausibly exogenous variation in hourly wages induced by the natural policy experiment and apply difference-in-difference analysis combined with propensity score matching. I use survey-data combined with administrative records which enables me to control for a vast set of possibly confounding variables. I find on average significant improvements of self-rated health for individuals who are affected by the reform. My analysis indicates, that reduced stress, due to a significant reduction of weekly working hours potentially drives this result.
    Keywords: minimum wage,self-rated health,natural experiment
    Date: 2019
  5. By: Hui He (International Monetary Fund); Kevin x.d. Huang (Vanderbilt University); Lei Ning (Shanghai University of Finance and Economics)
    Abstract: Empirical evidence shows that both leisure and medical care are important for maintaining health. And taxation may affect the allocation of these two inputs. We build a life-cycle overlapping-generations model in which taxation and relative health care price are key determinants of the composition of the two inputs in the endogenous accumulation of health capital. In the model, a lower tax wedge leads to using relatively more medical care and less leisure in maintaining health, while a higher relative health care price implies an opposite substitution in quantity (away from medical care towards leisure) that weakens the direct bearing of the higher price on overall health spending. We show that differences in taxation and in relative health care price between the US and Europe can jointly account for a bulk of their differences in health expenditure- GDP ratio and in leisure time allocated for health production, with the taxation channel playing a quantitatively more significant role.
    Keywords: Macro-health, Taxation, Relative health care price, Health care expenditure, Time allocation, Life cycle, Overlapping generations
    JEL: E6 H2
    Date: 2019–04–09
  6. By: Song, Lina (Harvard University); Saghafian, Soroush (Harvard Kennedy School)
    Abstract: The recent trend in the U.S. hospital closures can have important impacts on the healthcare sector by changing the operational efficiency and quality of care of the remaining hospitals. We investigate the impact of hospital closures on the surrounding hospitals' efficiency and quality and shed light on mechanisms through which they can be affected. Using and combining various data sources, we find that when a hospital closes, its nearby hospitals improve their operational efficiency without expanding their resources. However, they do so via a speed-up behavior (i.e., by reducing their service durations) instead of an effort to lower their average bed idle time. Importantly, we find that this speed-up response to the increased demand by nearby hospitals negatively affects some (but not all) aspect of the care, including the 30-day patient mortality. Furthermore, hospital closures induce changes in directions that widen social disparity, as their adverse consequences fall disproportionately among hospitals or patients with limited resources. Our results have implications for both hospital administrators and policymakers who strive to improve the efficiency and quality of the healthcare system.
    Date: 2019–01
  7. By: Saghafian, Soroush (Harvard Kennedy School); Imanirad, Raha (Harvard Business School); Traub, Stephen J. (Mayo Clinic Arizona)
    Abstract: Improving the performance of the healthcare sector requires an understanding of the efficiency and effectiveness of care delivered by providers. Although this topic is of great interest to policymakers, researchers, and hospital managers, fair and scientific methods of measuring efficiency and effectiveness of care delivery have proven elusive. Through Data Envelopment Analysis (DEA), we make use of evidence from care delivered by emergency physicians, and shed light on scientific metrics that can gauge performance in terms of efficiency and effectiveness. We use these metrics along with Machine Learning techniques and Tobit analyses to identify the distinguishing behaviors of physicians who perform highly on these metrics. Our findings indicate a statistically significant positive relationship between a physician's effectiveness and efficiency scores suggesting that, contrary to conventional wisdom, high levels of effectiveness are not necessarily associated with low efficiency levels. In addition, we find that a physician's effectiveness is positively associated with his/her average contact-to-disposition time and negatively associated with his/her years of experience. We also find a statistically significant negative relationship between a physician's efficiency and his/her average MRI orders per patient visit. Furthermore, we find evidence of a peer effect of one physician upon another, which suggests an opportunity to improve system performance by taking physician characteristics into account when determining the set of physicians that should be scheduled during same shifts.
    Date: 2018–09
  8. By: Miryam Daoud Marrakchi (Université de Tunis); Hédi Essid
    Abstract: In the recent past years, Tunisia pursued a national policy on health which was directed towards the performance. Although the lack of adequate resources presents the most important constraint, efficiency in the utilization of available resources is another challenge that cannot be overlooked. The objective of this study aims to assess the technical efficiency (TE) of a sample of Tunisian public hospital using the non-parametric approach of Data Envelopment Analysis (DEA). In this perspective, we started with measuring, comparing and analyzing the TE of the three categories of the Tunisian public hospitals, then to investigate the difference in the level of efficiency by district and finally to Guide the decision and the policy makers in their decision making process through the developed decision making tools. The data were gathered from a sample of 134 public hospitals throughout Tunisia. These would cover about 80% of the total number of Tunisian public hospitals. The model estimates the technical efficiency for the whole sample as well as for each hospital. The entire sample was operating on average at 0, 78 level of technical efficiency. Only 28% of the total hospitals were found to be technically efficient in relative term while the remaining were inefficient. The Public Health Establishment (PHE), the regional hospital (RH) and the District Hospital (DH) were operating on average at 0,9; 0,74 and 0,76 level of technical efficiency respectively. Only 45% of the PHE, 23% of the RH and 25% of the DH were technically efficient while the remaining were inefficient. The study identifies the inefficient hospitals and provides the magnitudes by which specific input per inefficient hospital ought to be more managed or to be reduced. It emphasizes also the disparity by districts in term of percentage of efficient and inefficient hospitals. Therefore, the highest percentage of efficient hospitals is also in the districts of North East (NE) and Center East (CE).
    Date: 2019
  9. By: Mohammed Elhaj Mustafa (University of Kassala); Ebaidalla Mahjoub Ebaidalla
    Abstract: This study investigates the factors that influence the participation of the informal workers in health insurance program in two Sudanese states, namely, Kassala and Khartoum. To this end, the study relies on primary data collected from 742 informal workers in these two states. Both qualitative and quantitative techniques have beenadopted to carry out the intended investigation. The analysis indicates that factors such as respondent’ age, wealth status, chronic disease status, morbidity, health insurance awareness, health-seeking behavior and proximity to health care facilities arethe most significant factors affecting informal workers’ engagement in health insurance system. The result also reveals that being residing in urban areas lowers the probability of joining health insurance membership in the full, Kassala and Khartoum samples. Both monetary income and average years of schooling are found to contribute positively in raising the likelihood of voluntary enrollment in health insurance. These findings still hold under different robustness checks, confirming the existence of barriers that prevent a huge portion of the informal workers from voluntary enrollment in health insurance. Finally, the paper ends with some recommendations aimedat enhancing the role of NHIF in accommodating the informal workers and achieving universal health coverage.
    Date: 2019

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