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on Health Economics |
| By: | Anna Sanz-de-Galdeano (CSEF, University of Salerno and IZA Bonn) |
| Abstract: | This paper uses longitudinal micro-evidence from the European Community Household Panel to investigate the obesity phenomenon in nine EU countries from 1998 to 2001. The author documents cross-country prevalence, trends and cohort-age profiles of obesity among adults and analyses the socioeconomic factors contributing to the problem. The associated costs of obesity are also investigated, both in terms of health status, health care spending and absenteeism. |
| Keywords: | obesity, body mass index, demand for health care |
| JEL: | I12 I18 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp1814&r=hea |
| By: | Margaret Denton; Isik Urla Zeytinoglu; Sharon Davies; Danielle Hunter |
| Abstract: | Because of the on-going need to co-ordinate care and ensure its continuity, issues of retention and recruitment are of major concern to home care agencies. The purpose of this study was to examine the factors affecting turnover decisions among visiting home care workers. In 1996, 620 visiting nurses and personal support workers from three non-profit agencies in a mid-sized Ontario city participated in a survey on their work and health. By the fall of 2001, 320 of these respondents had left the agencies. Analysis of the turnover data showed a temporal association between the implementation of managed competition and turnover. We mailed a self-completion questionnaire asking about their reasons for leaving the agency and about their subsequent work experience. One hundred and sixty nine (53%) responded to this survey. Respondents indicated dissatisfaction with the implementation of managed competition, with pay, hours of work, lack of organizational support and work load as well as health reasons, including work-related stress, as reasons for leaving. Less than one-third remained employed in the home care field, one-third worked in other health care workplaces and one-third were no longer working in health care. Their responses to our 1996 survey were used to predict turnover. Results show that nurses were more likely to leave if they had unpredictable hours of work, if they worked shifts or weekends and had higher levels of education. They were more likely to stay with the agency if they reported working with difficult clients, had predictable hours, good benefits, had children under 12 years of age in the home, and were younger. Personal support workers were more likely to leave if they reported higher symptoms of stress, and had difficult clients. They were more likely to stay if they worked weekends and perceived their benefits to be good. |
| Keywords: | turnover, home care workers, nurses, personal support workers, managed competition, home care sector, policy, for-profit agency, non-profit agency |
| JEL: | I11 I18 |
| Date: | 2005–09 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:393&r=hea |
| By: | Isik Urla Zeytinoglu; Margaret Denton; Sharon Davies; Andrea Baumann; Jennifer Blythe; Ann Higgins |
| Abstract: | This report examines the effects of contemporary employment arrangements on the quality of nursing work life, and the implications of these employment arrangements for individual nurses, the hospitals, and also for the organization. First we look at nurse work status (full-time, part-time or casual job), contract status (permanent or temporary), and employment preference as factors affecting commitment to the hospital and profession, job satisfaction, retention in the organization, and absenteeism from work. Second, we examine stress, burnout, and physical occupational health problems (in particular, musculoskeletal disorders), as affecting nurse and hospital outcomes. This project investigated how the quality of nursing worklife and career choices differ for nurses in full-time, part-time and casual employment, and whether nurses who have the employment arrangements they prefer enjoy a standard of worklife that encourages retention. We collected data for the study from 1,396 nurses employed at three large teaching hospitals in Southern Ontario (Hamilton Health Sciences, Kingston General Hospital, and St. Michael's Hospital in Toronto) using the New Health Care Worker Questionnaire. Results indicate that although a substantial majority of the nurses were employed in the type of job that they preferred, problems of stress, burnout and physical health problems were reported. Further, these problems affected the nurses' job satisfaction, commitment, and propensity to leave the hospitals. |
| Keywords: | health care workers, employment status, nurses, job satisfaction, commitment, stress, burnout, physical health problems, MSD, propensity to leave |
| JEL: | I11 I18 |
| Date: | 2005–09 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:394&r=hea |
| By: | Doreen Wing Han Au; Thomas F. Crossley; Martin Schellhorn |
| Abstract: | Using longitudinal data from the Canadian National Population Health Survey (NPHS), we study the relationship between health and employment among older Canadians. We focus on two issues: (1) the possible problems with self- reported health, including endogeneity and measurement error, and (2) the relative importance of health changes and long-term health in the decision to work. We contrast estimates of the impact of health on employment using self-assessed health, an objective health index contained in the NPHS - the HUI3, and a "purged" health stock measure. Our results suggest that health has an economically significant effect on employment probabilities for Canadian men and women aged 50 to 64, and that this effect is underestimated by simple estimates based on self-assessed health. We also corroborate recent U.S. and U.K. findings that changes in health are important in the work decision. |
| Keywords: | health, health changes, employment, older workers |
| JEL: | I12 J26 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:397&r=hea |
| By: | Frank T. Denton; Amiram Gafni; Byron G. Spencer |
| Abstract: | Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians. |
| Keywords: | physician shortages, physician requirements, population aging |
| JEL: | I11 J11 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:399&r=hea |
| By: | Neil J Buckley; Frank T Denton; A Leslie Robb; Byron G Spencer |
| Abstract: | It is well established that there is a positive statistical relationship between socioeconomic status (SES) and health but identifying the direction of causation is difficult. This study exploits the longitudinal nature of two Canadian surveys, the Survey of Labour and Income Dynamics and the National Population Health Survey, to study the link from SES to health (as distinguished from the health-to-SES link). For people aged 50 and older who are initially in good health we examine whether changes in health status over the next two to four years are related to prior SES, as represented by income and education. Although the two surveys were designed for different purposes and had different questions for income and health, the evidence they yield with respect to the probability of remaining in good health is similar. Both suggest that SES does play a role and that the differences across SES groups are quantitatively significant, increase with age, and are much the same for men and women. |
| Keywords: | health transitions, income, education |
| JEL: | I10 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:mcm:qseprr:402&r=hea |
| By: | Michael Perry (University of Michigan) |
| Abstract: | This paper attempts to confirm the life-cycle relationship that lower subjective survival probabilities should lead to less positively sloped consumption trajectories. I use the results of six waves of subjective survival probability questions in the HRS to construct an index of survival belief that exploits the panel nature of the data by summarizing all of a respondent’s answers to such questions. In conjunction with constructed consumption values from the financial section of the HRS, I test the life-cycle relationship using OLS and Least-Absolute Deviation regression. I find weak evidence that the life-cycle effect of subjective survival probability is significant in a high-cognitive-ability sub-sample of the HRS. Measurement error in the constructed consumption data is problematic. |
| Date: | 2005–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp103&r=hea |
| By: | Jens Ludwig; Douglas L. Miller |
| Abstract: | This paper exploits a new source of variation in Head Start funding to identify the program’s effects on health and schooling. In 1965 the Office of Economic Opportunity (OEO) provided technical assistance to the 300 poorest counties in the U.S. to develop Head Start funding proposals. The result was a large and lasting discontinuity in Head Start funding rates at the OEO cutoff for grant-writing assistance, but no discontinuity in other forms of federal social spending. We find evidence of a large negative discontinuity at the OEO cutoff in mortality rates for children ages 5-9 from causes that could be affected by Head Start, but not for other mortality causes or birth cohorts that should not be affected by the program. We also find suggestive evidence for a positive effect of Head Start on educational attainment in both the 1990 Census, concentrated among those cohorts born late enough to have been exposed to the program, and among respondents in the National Education Longitudinal Study of 1988. |
| JEL: | I18 I20 I38 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11702&r=hea |
| By: | Sujoy Chakravarty; Martin Gaynor; Steven Klepper; William B. Vogt |
| Abstract: | We examine the evolving structure of the U.S. hospital industry since 1970, focusing on how ownership form influences entry and exit behavior. We develop theoretical predictions based on the model of Lakdawalla and Philipson, in which for-profit and not-for-profit hospitals differ regarding their objectives and costs of capital. The model predicts for-profits would be quicker to enter and exit than not-for-profits in response to changing market conditions. We test this hypothesis using data for all U.S. hospitals from 1984 through 2000. Examining annual and regional entry and exit rates, for-profit hospitals consistently have higher entry and exit rates than not-for-profits. Econometric modeling of entry and exit rates yields similar patterns. Estimates of an ordered probit model of entry indicate that entry is more responsive to demand changes for for-profit than not-for-profit hospitals. Estimates of a discrete hazard model for exit similarly indicate that negative demand shifts increase the probability of exit more for for-profits than not-for-profits. Finally, membership in a hospital chain significantly decreases the probability of exit for for-profits, but not not-for-profits. |
| JEL: | I11 L11 L2 L3 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11705&r=hea |
| By: | David C. Grabowski; Jonathan Gruber |
| Abstract: | Nursing home expenditures are a rapidly growing share of national health care spending with the government functioning as the dominant payer of services. Public insurance for nursing home care is tightly targeted on income and assets, which imposes a major tax on savings; moreover, low state reimbursement for Medicaid patients has been shown to lower treatment quality, and bed supply constraints may deny access to needy individuals. However, expanding eligibility, increasing Medicaid reimbursement, or allowing more nursing home bed slots has the potential to induce more nursing home use, increasing the social costs of long term care. A problem in evaluating this tradeoff is that we know remarkably little about the effects of government policy on nursing home utilization. We attempt to address this shortcoming using multiple waves of the National Long-Term Care Survey, matched to changing state Medicaid rules for nursing home care. We find consistent evidence of no effect of Medicaid policies on nursing home utilization, suggesting that demand for nursing home care is relatively inelastic. From a policy perspective, this finding indicates that changes in overall Medicaid generosity will not have large effects on utilization. |
| JEL: | I11 I18 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11723&r=hea |
| By: | Tomas J. Philipson; Ernst R. Berndt; Adrian H. B. Gottschalk; Matthew W. Strobeck |
| Abstract: | The US Food and drug Administration (FDA) is estimated to regulate markets accounting for about 20% of consumer spending in the US. This paper proposes a general methodology to evaluate FDA policies, in general, and the central speed-safety tradeoff it faces, in particular. We apply this methodology to estimate the welfare effects of a major piece of legislation affecting this tradeoff, the Prescription Drug User Fee Acts (PDUFA). We find that PDUFA raised the private surplus of producers, and thus innovative returns, by about $11 to $13 billion. Dependent on the market power assumed of producers while having patent protection, we find that PDUFA raised consumer welfare between $5 to$19 billion; thus the combined social surplus was raised between $18 to $31 billions. Converting these economic gains into equivalent health benefits, we find that the more rapid access of drugs on the market enabled by PDUFA saved the equivalent of 180 to 310 thousand life-years. Additionally, we estimate an upper bound on the adverse effects of PDUFA based on drugs submitted during PDUFA I/II and subsequently withdrawn for safety reasons, and find that an extreme upper bound of about 56 thousand life-years were lost. We discuss how our general methodology could be used to perform a quantitative and evidence-based evaluation of the desirability of other FDA policies in the future, particularly those affecting the speed-safety tradeoff. |
| JEL: | I1 H0 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11724&r=hea |
| By: | Jason R. Barro; Robert S. Huckman; Daniel P. Kessler |
| Abstract: | The recent rise of specialty hospitals -- typically for-profit firms that are at least partially owned by physicians -- has led to substantial debate about their effects on the cost and quality of care. Advocates of specialty hospitals claim they improve quality and lower cost; critics contend they concentrate on providing profitable procedures and attracting relatively healthy patients, leaving (predominantly nonprofit) general hospitals with a less-remunerative, sicker patient population. We find support for both sides of this debate. Markets experiencing entry by a cardiac specialty hospital have lower spending for cardiac care without significantly worse clinical outcomes. In markets with a specialty hospital, however, specialty hospitals tend to attract healthier patients and provide higher levels of intensive procedures than general hospitals. |
| JEL: | I1 |
| Date: | 2005–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:11707&r=hea |
| By: | Anna Christina d'Addio; Marco Mira d'Ercole |
| Abstract: | This report tries to explain observed changes in fertility rates across OECD countries, with an emphasis on socio-economic considerations. It aims to extend the understanding of fertility-related behaviours in different ways: first, by explaining recent developments in fertility rates and their relationships to other social drivers; second, by developing and testing new and expanded models to explain the cross-country variation in fertility rates due to labour markets, social and fiscal policies, and individual characteristics; third, by exploring which polices, through their effects on particular variables at micro and macro levels, have the biggest effect on fertility rates. Ce rapport essaye d’expliquer les évolutions observées dans les taux de fécondité dans les pays de l’OCDE, l’accent étant mis sur un angle socio-économique. Il tend à faire comprendre les comportements liés à la fécondité de plusieurs manières : premièrement, en expliquant les évolutions récentes des taux de fécondité et leur relation avec les autres facteurs sociaux ; deuxièmement, en développant et en testant des modèles nouveaux et élargis afin d’expliquer les différences des taux de fécondité observées dans les pays en fonction des caractéristiques du marché du travail, des politiques sociales et fiscales et des caractéristiques individuelles ; troisièmement, en essayant d’identifier les politiques qui ont la plus grande incidence sur les taux de fécondité de par l’effet qu’elles ont sur des variables particulières aux niveaux micro et macro. |
| JEL: | C23 C33 J1 |
| Date: | 2005–09–02 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaab:27-en&r=hea |
| By: | Dale Andrew; Karim Dahou; Ronald Steenblik |
| Abstract: | This report represents the stock-taking of the lessons learned from a series of twenty OECD case studies which examined specific market access problems arising from evironmental and health requirements faced by developing country exporters. Together with a series of UNCTAD case studies and the experiences exchanged at an OECD Gobal Forum on Trade workshop, held in New Delhi in November 2002, the focus is on the approaches that contributed to addressing the market access difficulties. These are divided into two sections: first, those addressing information flows and capacity building needs of developing-country exporters, undertaken both by governments and non-governmental organisations; and then the procedures in developing, implementing and reviewing regulations and standards. While covering a range of natural resource-based exports and manufactures and one traded service in key OECD import markets, no generalisation can be drawn regarding the scale of the market-access problems created by environmental and health requirements. |
| Keywords: | environment, regulations, market access, standards, developing countries, capacity building |
| Date: | 2004–09–24 |
| URL: | http://d.repec.org/n?u=RePEc:oec:traaaa:5-en&r=hea |
| By: | James Smith (RAND Corporation) |
| Abstract: | This paper uses some unique data derived from the Panel Survey of Income Dynamics that has followed groups of siblings and their parents for as long as thirty years. Throughout that period, information on education, income, wealth, and health were collected mostly prospectively on all parties. Most important, following siblings from the same family offers a very unique opportunity to control for unmeasured family and other background effects common to children raised in the same family. Using this data, I present estimates that indicate that health conditions during childhood have quantitatively large impacts on virtually all the key adult indicators of socioeconomic status that are used by economists. |
| JEL: | J |
| Date: | 2005–11–03 |
| URL: | http://d.repec.org/n?u=RePEc:wpa:wuwpla:0511001&r=hea |
| By: | James P. Smith |
| Abstract: | In this paper I evaluated the new health information that has recently become available in the PSID to assess whether or not it can serve a constructive role in the ongoing SES-health debate. There are two types of information that appear to be promising—the self-reports of general health status that were first introduced in 1984, and the prevalence and incidence of new chronic conditions that were first added in 1999. In this evaluation, I place particular emphasis on the possibility of using the retrospective information on incidence of chronic conditions. The paper also offers several substantive conclusions. First, across the life course SES impacts future health outcomes although the primary culprit appears to be education and not an individual’s financial resources in whatever form they might be received. That conclusion appears to be robust to whether the financial resources are income or wealth or to whether the financial resources represent new information such as the largely unanticipated wealth that was a consequence of the recent stock market boom. Finally, this conclusion appears to be robust across new health outcomes that take place across the short and intermediate time frames of up to fifteen years in the future |
| JEL: | J |
| Date: | 2005–11–03 |
| URL: | http://d.repec.org/n?u=RePEc:wpa:wuwpla:0511002&r=hea |
| By: | Sourafel Girma (Nottingham University Business School); David Paton (Nottingham University Business School) |
| Abstract: | In this paper we demonstrate how matching estimators can be used to evaluate policy interventions which are implemented in relatively few regions at different times. Our technique is based on translating calendar time into 'experimental time' to provide a common starting point for entry by different areas into the scheme. Such an approach is likely to have many applications, in particular to cases of state- or country- level interventions for which only aggregate data are available. We illustrate the technique using the case of free over-the-counter access to emergency birth control (EBC) for teenagers in England. We construct matching estimates of the impact of this scheme on the under-18 conception rate in local authorities. Irrespective of either the matching or the adjustment procedure, we do not find evidence that pharmacy EBC schemes led to significantly lower teenage pregnancy rates. |
| Keywords: | matching estimators; family planning; teenage pregnancy; emergency birth control |
| JEL: | C21 I18 J13 |
| Date: | 2005–10–22 |
| URL: | http://d.repec.org/n?u=RePEc:nub:occpap:15&r=hea |