nep-hea New Economics Papers
on Health Economics
Issue of 2023‒04‒03
eight papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Emergency Care Centers, Hospital Performance and Population Health By Bhalotra, Sonia; Nunes, Leticia; Rocha, Rudi
  2. Race and the income-achievement gap By Bacic, Ryan; Zheng, Angela
  3. Did smallpox cause stillbirths? Maternal smallpox infection, vaccination and stillbirths in Sweden, 1780-1839 By Schneider, Eric B.; Edvinsson, Sören; Ogasawara, Kota
  4. Manual versus machine: An evaluation of the performance of the Medical Text Indexer (MTI) at classifying different document types by disease area By Moore, Duncan A.Q.; Yaqub, Ohid; Sampat, Bhaven N.
  5. Perceptions Matter: Quasi-Experimental Evidence on the Effects of Minimum Income on Objective and Subjective Financial Wellbeing in Spain By Bilbao-Goyoaga, Eugenia
  6. Conditioning public pensions on health: effects on capital accumulation and welfare By Giorgio Fabbri; Marie-Louise Leroux; Paolo Melindi-Ghidi; Willem Sas
  7. Do efficiency and equity move together? Cross-dynamics of Health System performance and Universal Health Coverage By Pavitra Paul; Ulrich Nguemdjo; Armel Ngami; Natalia Kovtun; Bruno Ventelou
  8. Health System Trust and Compliance with COVID-19 Restrictions By Costa-Font, Joan; Vilaplana-Prieto, Cristina

  1. By: Bhalotra, Sonia (University of Warwick); Nunes, Leticia (Institute of Education and Research (Insper)); Rocha, Rudi (Sao Paulo School of Business Administration (FGV EAESP))
    Abstract: Hospitals are under increasing pressure as they bear a growing burden of chronic disease while also dealing with emergency cases that do not all require hospital care. Many countries have responded by introducing alternative facilities that provide 24/7 care for basic and medium-complexity cases. Using administrative data, we investigate impacts of the opening of these intermediate facilities (UPA) in the state of Rio de Janeiro in Brazil. We find that an UPA opening in the catchment area of a hospital reduces hospital outpatient procedures and admissions and that this is associated with improved hospital performance. There is a decline in inpatient mortality, particularly mortality from the more complex conditions that hospitals are best equipped to deal with. There is no discernible change in the risk profile of cases going to hospital, and no concurrent policy changes that can account for these findings. In order to capture displacement effects, we investigate city-level population outcomes. We find that two-thirds of the decline in hospital mortality is offset by deaths in UPAs. Looking at individual death causes, we see a net decline in deaths from congestive heart failure.
    Keywords: urgent care centers ; hospital performance ; displacement effects ; health outcomes JEL codes: I11 ; I15 ; I18
    Date: 2023
  2. By: Bacic, Ryan; Zheng, Angela
    Abstract: We study whether racial disparities in economic opportunity appear at an early age. Using administrative education data linked to tax records, we study the income-achievement gap across different races and find important variation. The income-achievement gap is small for East Asian children while it is close to twice as large for Indigenous children. Sorting by income into schools accounts for a large portion of the variation in the income-achievement gap across all student groups. In addition, our results suggest that the large income-achievement gap for Indigenous students may be rooted in inequality in health outcomes and poor housing conditions. Our findings on income-achievement gaps across race could partially explain the different intergenerational mobility outcomes by race documented by others.
    Keywords: test scores, income-achievement gaps, race
    JEL: I20 I24 J15
    Date: 2023
  3. By: Schneider, Eric B.; Edvinsson, Sören; Ogasawara, Kota
    Abstract: While there is strong evidence that maternal smallpox infection can cause fetal loss, it is not clear whether smallpox infections were a demographically important source of stillbirths historically. In this paper, we use parish-level data from the Swedish Tabellverket dataset from 1780 to 1839 to test the effect of smallpox on stillbirths quantitatively, analysing periods before and after the introduction of vaccination in 1802. Before 1820, we find that smallpox infection was not a major cause of stillbirths because most women contracted smallpox as children and were therefore not susceptible during pregnancy. We do find a small, statistically significant effect of smallpox on stillbirths from 1820-39 when waning immunity from vaccination put a greater share of pregnant women at risk of contracting smallpox. However, the reduced prevalence of smallpox in this period limited the demographic impact. Thus, smallpox was not an important driver in historical stillbirth trends.
    Keywords: stillbirth; fetal death; smallpox; vaccination; historical demography; T&F deal
    JEL: J13
    Date: 2023–02–22
  4. By: Moore, Duncan A.Q.; Yaqub, Ohid; Sampat, Bhaven N.
    Abstract: The Medical Subject Headings (MeSH) thesaurus, a controlled vocabulary, is increasingly being used by those who study research and innovation. While classification was once purely entirely manual, human indexers are now assisted by algorithmic suggestions in an effort to automate some of the indexing process. A version of this algorithm, the Medical Text Indexer, has been made available, allowing for classification of arbitrary text into MeSH categories. Potentially, this opens up other document classes to MeSH assignment for research and innovation studies. However, it remains unclear how well the MTI, a tool designed to categorize publications for indexing purposes, can be reliably extended to other document classes. To allow for assessment of the MTI’s performance for different classes of documents, we collected text from grant descriptions, patent claims, and drug indications; and compared the MTI’s categorisation to that of a qualified human classifier. We also tested whether MTI performance varied with text length or score thresholding. Our results suggest that researchers can proceed with confidence that the MTI reliably captures the diseases contained in a text (recall), and that its scoring can be used to guard against false diseases in its outputs (precision).
    Date: 2023–02–25
  5. By: Bilbao-Goyoaga, Eugenia (The London School of Economics)
    Abstract: This paper examines how minimum income schemes (MISs) affect households’ financial wellbeing and whether this effect differs across objective material conditions and households’ perceptions. Two reasons motivate this study. First, while the Covid-19 pandemic, the ecological transition and the cost-of-living crisis have all prompted a renewed interest in MISs, no consensus exists on how effective these schemes are in improving households’ financial wellbeing. Second, when evaluating MISs, the literature focuses on objective measures of financial wellbeing, namely monetary poverty. Yet, peoples’ perceptions of their own situation can be instrumental in affecting their health, productivity and decision-making and can reveal important information about adaptation mechanisms or spillovers to non-recipients. This paper examines the case study of Spain, a country that introduced a new MIS in 2020. The study uses Eurostat survey data for the 2010-2022 period in a Synthetic Control Method analysis. The results show that, while the policy had no significant effect on objective financial wellbeing measures (i.e. the poverty rate, the poverty gap and mean income) for its first year and a half of existence, it did considerably improve subjective financial wellbeing after two years and a half, as it helped households feel less pessimistic about the evolution of their finances during the Covid-19 and cost-of-living crises. The paper discusses several mechanisms explaining this differentiated impact of the policy, such as its lagged rollout, the improvements made to the benefit from 2022 as well as anticipation, placebo and positive spillover effects of the MIS. The findings highlight the importance for practitioners to consider subjective measures when assessing income support schemes.
    Date: 2023–02–24
  6. By: Giorgio Fabbri; Marie-Louise Leroux; Paolo Melindi-Ghidi; Willem Sas
    Abstract: This paper develops an overlapping generations model which links a public health system to a pay-as-you-go (PAYG) pension system. It relies on two assumptions. First, the health system directly finances curative health spending on the elderly. Second, public pensions partially depend on health status during old age, by introducing a component which is indexed to society’s average level of disability. This way, reducing disability during old age lowers the pension benefit as the need to finance long-term care services also drops. We then study the effects of introducing such a ‘comprehensive’ social security system on individual decisions, capital accumulation, and welfare. We first show that under certain conditions, health investments can boost savings and capital accumulation in the long run. Second, we show that if individuals are sufficiently concerned with their health when old, it is optimal to introduce a health-dependant pension system, as this will raise social welfare compared to a system where pensions are not tied to the society’s average level of old-age disability. Our analysis thus highlights an important policy recommendation: making PAYG pension schemes partially health-dependent can be beneficial to society.
    Keywords: Curative Health Investments, PAYG Pension System, Disability, Overlapping Generations, Long-term Care
    JEL: H55 I15 O41
    Date: 2022–12
  7. By: Pavitra Paul (CSH - Centre de sciences humaines de New Delhi - MEAE - Ministère de l'Europe et des Affaires étrangères - CNRS - Centre National de la Recherche Scientifique, Yerevan State Medical University after Mkhitar Heratsi); Ulrich Nguemdjo (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Armel Ngami (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Natalia Kovtun (Taras Shevchenko National University of Kyiv); Bruno Ventelou (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Efficiency within the health system is well recognised as key for achieving Universal Health Coverage (UHC). However, achieving equity and efficiency simultaneously is often seen as a conflicting effort. Using 12 years of data (2003–2014) from the selection of a number of low- and lower middle-income countries (Afghanistan, Bangladesh, Burkina Faso, Ghana, Indonesia, Mongolia, Mozambique, Tajikistan, Togo, Uzbekistan and Yemen Republic), we compute an index of Universal health coverage (UHC), measure the health system's performance (HSp) and, finally, investigate the cross-dynamics of the resulting HSp and the UHC previously obtained. We find that, with the few exceptions over the statistical sample, the causality between performances of the national health system and the universal health coverage is typically bidirectional. From an empirical standpoint, our findings challenge the idea from economic orthodoxy that efficiency must precede equity in healthcare services. Rather, our findings support the view of simultaneous efforts to improve expansion of the coverage and efficiency of the health system, directing attention towards the importance of organisation of the health system in the country context.
    Date: 2022–12
  8. By: Costa-Font, Joan (London School of Economics); Vilaplana-Prieto, Cristina (Universidad de Murcia)
    Abstract: We examine the extent to which exposure to higher relative COVID-19 mortality (RM), influences health system trust (HST), and whether changes in HST influence the perceived ease of compliance with pandemic restrictions during the COVID-19 pandemic. Drawing on evidence from two representative surveys covering all regions of 28 European countries before and after the first COVID-19 wave and using a difference in differences strategy together with Coarsened Exact Matching (CEM), we document that living in a region with higher RM during the first wave of the pandemic increased HS. However, the effect is driven by individuals over 45 years of age, and the opposite is true among younger cohorts. We find that a higher HST reduces the costs of complying with COVID-19 restrictions, but only so long as excess mortality does not exceed the average by more than 20%, at which point the ease of complying with COVID-19 restrictions significantly declines, offsetting the positive effect of trust in the healthcare system. Our interpretation of the estimates is that RM is interpreted as a risk signal among those over 45, and as a signal of health-care system failure among younger age individuals.
    Keywords: healthcare system trust, mortality, lockdown, Eurobarometer, difference in differences, COVID-19
    JEL: I13 Z1
    Date: 2023–02

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