nep-ias New Economics Papers
on Insurance Economics
Issue of 2008‒07‒30
four papers chosen by
Soumitra K Mallick
Indian Institute of Social Welfare and Bussiness Management

  1. Remittances and the household’s expenditures on health By Valero-Gil, Jorge
  2. Social Security’s Five OASI Inflation Indexing Problems By Michael C. Lovell
  3. Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies By Manca, A; Austin, P. C
  4. Nurse-To-Patient Ratios in Hospital Staffing: A Queueing Perspective By Francis de Véricourt,; Otis B. Jennings

  1. By: Valero-Gil, Jorge
    Abstract: This paper considers the effect of remittances on the share of health expenditures to total household expenditure. The main purpose of this paper is to investigate whether remittances are especially targeted towards household’s health in Mexico. We use a Tobit model with random effects and find a statistically significant effect of remittances on the proportion of health expenditures for households that do not have access to employment’s medical insurance: Our results suggest that around 10% of changes in remittances are devoted to health expenditure.
    Keywords: Health expenditure; Remittances; Tobit; Health related consumption
    JEL: D12 I12 F24
    Date: 2008–06–24
  2. By: Michael C. Lovell (Department of Economics, Wesleyan University)
    Abstract: This paper examines five problems with the inflation indexing procedures used by the Social Security Administration in taking inflation into account when calculating Old Age and Survivors Insurance (OASI) Benefits. Several of these problems have capricious and perverse distributional consequences. For example, as a result of Problems #2 and #4 your OASI check will be larger if wage inflation happens to be extra high in your 60th year or if price inflation is exceptionally low in your 61st year. And because of Problem and the start of OASI benefits depends in part on the pace of inflation. While indexing problems do not attract much attention in normal times, they can contribute to serious short-run financial instability for the OASI trust funds in periods of substantial inflation.
    JEL: H55
    Date: 2008–07
  3. By: Manca, A; Austin, P. C
    Abstract: The methodology relating to the statistical analysis of individual patient-level cost-effectiveness data collected alongside randomised controlled trials (RCTs) has evolved dramatically in the last ten years. This body of techniques has been developed and applied mainly in the context of the randomised clinical trial design. There are, however, many situations in which a trial is neither the most suitable nor the most efficient vehicle for the evaluation. This paper provides a tutorial-like discussion of the ways in which propensity score methods could be used to assist in the analysis of observational individual patient-level cost-effectiveness data. As a motivating example, we assessed the cost-effectiveness of CABG versus PTCA – one year post procedure - in a cohort of individuals who received the intervention within 365 days of their index admission for AMI. The data used for this paper were obtained from the Ontario Myocardial Infarction Database (OMID), linking these with data from the Canadian Institute for Health Information (CIHI), the Ontario Health Insurance Plan (OHIP), the Ontario Drug Benefit (ODB) program, and Ontario Registered Persons Database (RPDB). We discuss three ways in which propensity score can be used to control for confounding in the estimation of average cost-effectiveness, and provide syntax codes for both propensity score matching and cost-effectiveness modelling.
    Keywords: Cost, cost-effectiveness, propensity score, revascularisation, statistical methods
    Date: 2008–07
  4. By: Francis de Véricourt, (ESMT European School of Management and Technology); Otis B. Jennings (Duke University)
    Abstract: The immediate motivation of this paper is California Bill AB 394, legislation which mandates fixed nurse-to-patient staffing ratios as a means to address the current crisis in the quality of health care delivery. Modeling medical units as closed queueing systems, we seek to determine whether or not ratio policies are effective at managing nurse workload. Our many-server asymptotic results suggest that ratio policies cannot provide consistently high service quality across medical units of different sizes. As a remedy, we recommend policies that deviate from the restrictive linear nature of ratio policies, employing the "square root rule" commonly used to staff large service systems. Under some quality of care assumptions, our policies exhibit a type of "super" pooling effect, in which, for large systems, the requisite workforce is significantly smaller than the nominal patient load.
    Keywords: queueing system, health care, public policy, nursing, staffing, manyserver limit theorems
    Date: 2008–07–03

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