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on Health Economics |
| By: | Silvia Balia |
| Abstract: | This paper investigates formation of expected longevity in an elderly population. We use Italian data from the early (2004) release of the Survey of Health, Ageing and Retirement in Europe (SHARE). The SHARE provides a numerical measure for subjective survival probability (SSP). To assess internal consistency and investigate validity of SSP as a proxy of actual mortality, we compare SSP to lifetables and look at the variation with health, smoking and socio-economic variables. In a multivariate framework, we propose a recursive model for expected longevity, self-assessed health and smoking duration, where health and smoking variables are potentially endogenous. Unobservable individual-specific heterogeneity is considered by estimating a finite mixture model via the EM algorithm, which allows division of the population according to different latent classes and estimation of class membership probabilities. Our mixture model fits the data better than the single class model and provides evidence of individual unobserved heterogeneity in the formulation of survival expectations. Expectations are shown to vary most with health status, socio-economic characteristics, parental mortality and age. Two-types of individuals in the population are identified, that differ in terms of unobservable frailty and rationality in addiction. We also find differences between current and former smokers in the way they discount future consequences of tobacco consumption on health and mortality risk. Our findings suggest caution in the use of SSP as a proxy of actual mortality. |
| Keywords: | subjective survival probability; smoking; beta regression; duration analysis;unobservable heterogeneity; mixture model; EM algorithm. |
| JEL: | I12 C0 C30 C41 |
| Date: | 2007 |
| URL: | http://d.repec.org/n?u=RePEc:cns:cnscwp:200705&r=hea |
| By: | Rudolph G. Penner; Richard W. Johnson (Urban Institute); ; |
| Abstract: | Soaring health costs are squeezing government and household budgets. Rising public costs are also likely to boost future tax burdens. This study considers how rising tax burdens and out-of-pocket health care costs will affect the timing of retirement. Conceptually, the impact of taxes depends on which particular taxes are raised. How well people anticipate future increases in taxes and health care costs, and how they react at younger ages, will crucially affect retirement impacts. If households are farseeing rational planners, higher health costs and tax burdens will likely induce more saving and harder work while young, muting effects on retirement decisions. To gauge the potential importance of rising taxes and health care costs to the retirement decision, the study compares projected retirement income for prototypical workers under two sets of assumptions about future tax and health care burdens. The results show that a moderate-income couple would have to work an additional 2.5 years under the scenario with high health care costs and tax burdens to receive as much income in the first year of retirement — net of taxes and out-of-pocket health spending — as they would receive under the low-cost scenario. The low-income couple would have to delay retirement under the high cost scenario by about 2.4 years to offset income lost from higher taxes and health costs, and the high-income couple would have to work an additional 2.8 years. |
| Keywords: | health costs, tax burdens, out-of-pocket spending, retirement, planning, households |
| Date: | 2006–11 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2006-20&r=hea |
| By: | Alicia H. Munnell; Jerilyn Libby (Center for Retirement Research, Boston College); ; |
| Abstract: | As recently as the mid-1960s, the median retirement age for men — the age at which half of all men are no longer in the labor force — was 66. Today, it is 63. But given the scheduled decline in Social Security replacement rates, increased longevity, and the relatively low balances in 401(k) accounts, Americans risk serious income shortfalls, especially at older ages, if they continue to retire at age 63. A rational response is to move the average retirement age back to 66 or even older. A key consideration is whether people will be healthy enough to work longer. This brief compares the health status of older people today with those forty years ago and explores what happens to people’s health as they age. The bottom line is that the health of older people (those 65 and older), as opposed to older workers (those 50 to 64), showed little improvement in the 1970s, mixed results in the 1980s, and marked improvement since the 1990s. The marked improvement for older workers most likely began earlier, in the 1980s. Today, the health of older workers appears to be at least as good as it was forty years ago. Thus, if half of the male population were then healthy enough to work until age 66, the same percentage should be able to do so today. Two important issues not addressed in this brief are whether the jobs will be there for older workers and the challenge presented by the 15 to 20 percent of the older population for whom work will be impossible. |
| Keywords: | working longer, median retirement age, social security replacement rates, longevity |
| Date: | 2007–03 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2007-7-3&r=hea |
| By: | Howard Gleckman; (Business Week, Washington D.C. Bureau); ; |
| Abstract: | By mid-century, the nation will be spending more on Medicaid, the joint state/federal health program for the poor, than it currently spends on national defense. Much of this projected growth will be generated by the rapidly expanding demand for long-term care due to an aging population. Therefore, both states and the federal government are exploring ways to restrain the program’s growth, but no initiatives to date have significantly slowed the trend. This brief explores trends in Medicaid spending on long-term care and the implications of its rapid growth for taxpayers and for the needs of an aging population. The first section defines long-term care. The second section describes Medicaid’s role in financing it. The third section describes the impact of Medicaid on state budgets. The final section assesses efforts to rein in Medicaid spending. |
| Keywords: | medicaid, long-term care, aging population |
| Date: | 2007–04 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2007-7-4&r=hea |
| By: | Howard Gleckman; (Business Week, Washington D.C. Bureau); ; |
| Abstract: | As the United States searches for ways to reform its system of financing long-term care, it may learn from the experiences of other developed nations. In Japan and much of Europe, public benefits for the long-term care of the aged have become a pillar of social policy, on par with retirement and health care. Many of these nations embarked on major reforms in their long-term care programs beginning in the mid-1990s. However, they have taken quite different approaches. This brief will review the experiences of Germany, Japan, France, and the United Kingdom and highlight potential lessons for the United States. |
| Keywords: | long-term care, financing, social policy, Japan, Europe, reforms, lessons from abroad |
| Date: | 2007–06 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2007-7-8&r=hea |
| By: | Richard W. Johnson; (Urban Institute); ; |
| Abstract: | Because most workers receive health benefits from their employers, retirement often disrupts health insurance coverage. Some employers offer health insurance to retirees, but many firms are cutting retiree health benefits by passing more costs to retirees or eliminating benefits altogether. Few alternatives exist. Private nongroup coverage is generally quite expensive, and few people in their 50s and early 60s qualify for publicly financed benefits. Many workers who cannot obtain retiree benefits from their own employers or their spouses’ employers delay retirement to age 65, when Medicare coverage begins. This brief examines the availability and cost of health insurance coverage at ages 55 to 64 and changes in coverage after retirement. Today most workers with employer health benefits retain their coverage when they retire early, although their required premium contributions have increased sharply over the past ten years. In the future, however, steady declines in the share of younger workers with access to retiree health benefits may jeopardize income security for the next generations of retirees. |
| Keywords: | retirement, health benefits, disrupt, cutting benefits, health insurance coverage |
| Date: | 2007–02 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2007-7&r=hea |
| By: | Jani-Petri Laamanen (FDPE, and University of Tampere); Kaisa Kotakorpi (FDPE, and University of Tampere) |
| Abstract: | We examine the effect of publicly provided health care on welfare by combining local level data on public health care, and individual level data on life satisfaction. It is shown that relatively high expenditures in health care have a positive effect on individuals' life satisfaction in our data. We further illustrate how life satisfaction data can be used to directly test theoretical hypotheses about how the welfare effect of public provision should vary among different groups in the population. We …nd some evidence for an "ends-against-the-middle" equilibrium (Epple and Romano, 1996) in the provision of public health care, where middle-income individuals prefer higher public expenditure at the margin than low-income or high-income individuals. Further, our results indicate that valuation for health care depends on individual political orientation. |
| Keywords: | Life satisfaction; public provision; health care |
| JEL: | H44 I18 |
| Date: | 2007–07–16 |
| URL: | http://d.repec.org/n?u=RePEc:dgr:uvatin:20070053&r=hea |
| By: | Hannes Spengler; Sandra Schaffner |
| Abstract: | This paper presents a new approach to obtain unbiased estimates of the value of a statistical life (VSL) with labor market data. Investigating job changes, we combine the advantages of recent panel studies, which allow to control for unobserved heterogeneity of workers, and conventional cross-sectional estimations, which primarily exploit the variation of wage and risk between different jobs. We find a VSL of 6.1 million euros from pooled cross-sectional estimation, 1.9 million euros from the static first-differences panel model and 3.5 million euros from the job-changer specification. Thus, ignoring individual heterogeneity causes overestimates of the VSL, whereas identifying the wage-risk tradeoff not only by means of between job variation (job-changer model) but also on the basis of noisy variation on the job (panel models) may lead to underestimates of the VSL. Our results can be used to perform cost-benefit analyses of public projects aimed at reducing fatality risks, e.g., in the domains of health, environmental or traffic policy. |
| Keywords: | Value of a statistical life (VSL), compensating wage differentials, work accidents, job changes |
| JEL: | I10 J17 J28 K00 |
| Date: | 2007 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwwpp:dp713&r=hea |
| By: | Betliy Oleksandra; Kuziakiv Oksana; Onishchenko Katerina |
| Abstract: | Sound panel data analysis both on the macro and micro levels intends to define key macro and micro determinants of health of the population and quality of health services. The research will contribute to development of quality-enhancing policies in health sector on regional level and on the level of medical establishments. |
| Date: | 2007–07–26 |
| URL: | http://d.repec.org/n?u=RePEc:eer:wpalle:04-909&r=hea |
| By: | Timothy J. Halliday (Department of Economics, University of Hawaii at Manoa; John A. Burns School of Medicine, University of Hawaii at Manoa) |
| Abstract: | This paper investigates the evolution of health over the life-cycle using the Panel Study of Income Dynamics. We allow for two sources of persistence: unobserved heterogeneity and state dependence. The former is modeled by discrete “types.” Estimation indicates that there are at least four types suggesting that there is a large degree of heterogeneity governing health dynamics. We find that the degree of state dependence is near unity for over half of the population. The implications of these findings are twofold. First, health inequalities in adulthood have antecedents in childhood. Second, policies that improve health care and its delivery may be an effective means of mitigating the gradient. |
| Keywords: | Health, Dynamic Panel Data Models, Gradient |
| JEL: | I1 C5 |
| Date: | 2007–07–11 |
| URL: | http://d.repec.org/n?u=RePEc:hai:wpaper:200716&r=hea |
| By: | Böckerman, Petri (Labour Institute for Economic Research); Johansson, Edvard (Swedish School of Economics and Business Administration); Jousilahti, Pekka (National Public Health Institute); Uutela, Antti (National Public Health Institute) |
| Abstract: | This paper explores the relationship between the physical strenuousness of work and the body mass index in Finland, using individual microdata over the period 1972-2002. The data contain self-reported information about the physical strenuousness of a respondent’s current occupation. Our estimates show that the changes in the physical strenuousness of work can explain around 8% at most of the definite increase in BMI observed over the period. The main reason for this appears to be that the quantitative magnitude of the effect of the physical strenuousness of work on BMI is rather moderate. Hence, according to the point estimates, BMI is only around 1.5% lower when one’s current occupation is physically very demanding and involves lifting and carrying heavy objects compared with sedentary job (reference group of the estimations), other things being equal. Accordingly, the changes in eating habits and the amount of physical activity during leisure time must be the most important contributors to the upward trend in BMI in industrialised countries, but not the changes in the labour market structure. |
| Keywords: | BMI; body mass index; obesity; overweight; occupational structure |
| Date: | 2007–02–08 |
| URL: | http://d.repec.org/n?u=RePEc:hhb:hanken:0523&r=hea |
| By: | Partha Deb (Hunter College, Department of Economics); Eugenia Priedane (London School of Hygiene and Tropical Medicine, Department of Public Health and Policy) |
| Abstract: | The objective of this study is to estimate the effect of parents alcohol and cigarette use on time use and educational attainment of their children. We use data from the Russia Longitudinal Monitoring Survey (RLMS), an annual panel survey from 1995-2004. We find that both maternal and paternal cigarette consumption have adverse effects on reading and educational attainment. Parents consumption of alcohol does not appear to have effects on reading or educational attainment but does have effects on the number of hours spent watching TV. We implement a bounds analysis of selection and find that these effects are plausibly causal. |
| URL: | http://d.repec.org/n?u=RePEc:htr:hcecon:420&r=hea |
| By: | Mavalankar Dileep; Shastri Priya; Ramani K.V. |
| Abstract: | Chikungunya is a virus spread by the bite of the Aedes mosquito, which recently reemerged as a massive epidemic in the Indian Ocean islands and India. Chikungunya is generally considered self-limiting and has been reported as non-fatal but, since March 2005, one-third of the 770,000 people in the Indian Ocean Island of Réunion (a French territory) have been affected by Chikungunya with 237 deaths. India reported 1.3 million cases of Chikungunya however the Government of India has not reported any deaths. However there is evidence that deaths due to Chikungunya did occur. The lack of official reports of deaths is mainly due to the poor recording of ‘Causes of Death’ in India. The London Bills of Mortality from the 17th provides a very good example of the importance of proper reporting of deaths especially during an epidemic period. This paper reflects on the London bills of mortality and modern day lessons to be drawn from it as well as the reasons behind the apparent lack of death reporting in 2006’s Chikungunya epidemic. |
| Date: | 2007–07–25 |
| URL: | http://d.repec.org/n?u=RePEc:iim:iimawp:2007-07-12&r=hea |
| By: | Matteo Cervellati (University of Bologna, IAE Barcelona and IZA); Uwe Sunde (IZA, University of Bonn and CEPR) |
| Abstract: | This paper provides a unified theory of the economic and demographic transition. Individuals make optimal decisions about fertility, education of their children and the type and intensity of the investments in their own education. These decisions are affected by different dimensions of mortality and technological progress which change endogenously during the process of development. The model generates an endogenous transition from a regime characterized by limited human capital formation, little longevity, high child mortality, large fertility and a sluggish income and productivity growth to a modern growth regime in which lower net fertility is associated with the acquisition of human capital and improved living standards. Unlike previous models, the framework emphasizes the education composition of the population in terms of the equilibrium share of educated individuals, and differential fertility related to education. The framework explores the roles of different dimensions of mortality, wages and schooling in triggering the transition. The dynamics of the model are consistent with empirical observations and stylized facts that have been difficult to reconcile so far. For illustration we simulate the model and discuss the novel predictions using historical and cross-country data. |
| Keywords: | long-term development, demographic transition, endogenous life expectancy, child mortality, heterogeneous human capital, technological change, industrial revolution |
| JEL: | E10 J10 O10 O40 O41 |
| Date: | 2007–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp2905&r=hea |
| By: | Sonia Bhalotra (University of Bristol, CMPO and IZA) |
| Abstract: | There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about -0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth-order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes). |
| Keywords: | public spending, health, poverty, infant mortality, India |
| JEL: | I18 I38 O15 O12 |
| Date: | 2007–07 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp2914&r=hea |
| By: | Valérie Paris; Elizabeth Docteur |
| Abstract: | This paper examines aspects of the policy environment and market characteristics of the Swiss pharmaceutical sector, and assesses the degree to which Switzerland has achieved certain policy goals. In Switzerland, pharmaceutical spending has not been growing faster than health expenditure as a whole, as has been the case in many other OECD countries. Swiss pharmaceutical spending per capita and as a share of GDP is modest by OECD standards. This in part reflects relatively low levels of pharmaceutical consumption, given that public prices are among the highest in Europe and the Swiss tend to be early adopters of new pharmaceutical products. Switzerland’s regulation of prices for reimbursed drugs, based on referencing across countries and within the therapeutic class for products with comparators, appears to result in prices lower than what would be obtained absent regulation. Although ex-manufacturer prices are somewhat high relative to other European countries, recent reforms have reduced the differential. While costs are under control, Switzerland has scope to improve the cost-effectiveness of its expenditures in the pharmaceutical area. Generic penetration of the market is increasing but falls short of what has been achieved elsewhere and the prices of generic products are higher than what is found in other countries. Relatively high mark-ups over ex-factory prices suggest that the distribution chain is a source of further potential efficiencies, although high costs could also reflect characteristics of the Swiss economy... <BR>Ce document passe en revue différents aspects des politiques et des caractéristiques de marché du secteur pharmaceutique en Suisse et évalue l’atteinte des objectifs relatifs à la politique pharmaceutique suisse. En Suisse, les dépenses pharmaceutiques n’ont pas augmenté plus vite que l’ensemble des dépenses de santé, contrairement ce qui s’est passé dans de nombreux autres pays de l’OCDE. Les dépenses de médicaments par habitant, et en proportion du PIB, restent modérées par rapport à la moyenne des pays de l’OCDE. Cela tient en partie au niveau relativement faible de la consommation pharmaceutique, puisque les prix publics sont parmi les plus élevés en Europe et les Suisses enclins à adopter rapidement les nouveaux produits. La régulation des prix des prix des médicaments remboursés, basée sur des comparaisons internationales et, le cas échéant, sur les prix des comparateurs au sein d’une même classe thérapeutique, semble conduire à des niveaux de prix moins élevés que ce qu’ils seraient sans régulation. Même si les prix fabricants sont relativement élevés par rapport à ce qu’ils sont dans d’autres pays européens, les récentes réformes ont réduit l’écart. Les coûts sont certes maîtrisés mais la Suisse pourrait aller encore plus loin pour améliorer l’efficience de ses dépenses pharmaceutiques. Le taux de pénétration des génériques sur le marché s’améliore mais reste inférieur à ce qu’il est ailleurs et les prix des génériques sont plus élevés que dans d’autres pays. Les marges relativement élevées appliquées sur les prix fabricants donnent à penser que les circuits de distribution pourraient être rationalisés, même si les coûts élevés peuvent aussi refléter certaines caractéristiques de l’économie suisse... |
| Keywords: | Switzerland, Suisse, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, pharmaceutical market, marché pharmaceutique |
| JEL: | I11 I18 |
| Date: | 2007–06–27 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:27-en&r=hea |
| By: | Pierre Moïse; Elizabeth Docteur |
| Abstract: | This paper examines aspects of the policy environment and market characteristics of the Swedish pharmaceutical sector, assesses the degree to which Sweden has achieved certain policy goals, and puts forth some key findings and conclusions. Thanks to low mark-ups in the distribution chain and no VAT for prescribed medicines, Sweden's public prices for pharmaceuticals are relatively low, in contrast to average prices received by manufacturers, which are among the highest in Europe. Recent reforms have helped to restrain pharmaceutical expenditure growth, following a period of double digit growth in the 1990s. Pharmaceutical expenditure per capita in Sweden is lower than the OECD average. Only five OECD countries devote less of their national income to pharmaceuticals. What limited evidence exists tends to suggest that relatively low pharmaceutical expenditures in Sweden are due to its low public prices, rather than to low levels of consumption. Sweden introduced a new pricing and reimbursement scheme in 2002. Its main features are the use of cost-effectiveness analysis for determining the reimbursement status of new pharmaceuticals and mandatory substitution of the lowest-cost generic alternative. The use of cost-effectiveness analysis in reimbursement decisions helps to relate the reimbursement price paid to the social value of the product, but does not necessarily result in the lowest possible price.The generic substitution policy has enabled Sweden to achieve fairly high penetration of generic drugs into the market in terms of volume, with a considerably low share of the total value of the market. However, the requirement to substitute only the lowest-priced listed drug risks undermining the competitiveness of the generic drug industry... <BR>Le présent document passe en revue les différents aspects des politiques et des caractéristiques du marché du secteur pharmaceutique suédois, évalue l'atteinte des objectifs relatifs à la politique pharmaceutique suédoise et formule un certain nombre de constats et de conclusions. Grâce à la faiblesse des marges de distribution et à l'absence de TVA sur les médicaments prescrits sur ordonnance, les prix publics des produits pharmaceutiques sont relativement bas, alors que les prix moyens perçus par les fabricants se situent parmi les plus élevés d'Europe. Les récentes réformes ont contribué à freiner la croissance des dépenses pharmaceutiques, qui avait dépassé 10 % par an durant les années 1990. En Suède, les dépenses de médicaments par habitant sont inférieures à la moyenne des pays de l'OCDE. Seuls cinq pays de l'OCDE y consacrent une part plus faible de leur revenu national. Les éléments d'appréciation peu nombreux disponibles tendent à laisser penser que le niveau relativement peu élevé des dépenses de médicaments en Suède s'explique par le niveau peu élevé des prix publics, plutôt que par la faiblesse de la consommation. La Suède a institué en 2002 un nouveau système de prix et de remboursement qui se caractérise essentiellement par le recours à l'analyse coût-efficacité pour la détermination du niveau de remboursement des nouveautés pharmaceutiques et le remplacement systématique par les génériques les moins onéreux. Le recours à l'analyse coût-efficacité pour l'adoption des décisions en matière de remboursement aide à relier le prix de remboursement à la valeur sociale du produit, mais ne garantit pas que le prix soit le plus bas possible. La politique de substitution des génériques a permis à la Suède d'assurer un taux relativement élevé de pénétration en volume de ces produits sur le marché, alors qu'en valeur, ils ne représentent qu'une part extrêmement réduite du total. Toutefois, l'obligation de remplacer un médicament prescrit par le produit substituable le moins cher risque de compromettre la compétitivité de l'industrie des génériques... |
| Keywords: | Sweden, Suède, pharmaceutical policy, politique pharmaceutique, pricing and reimbursement, pharmaceutical market, marché pharmaceutique |
| JEL: | I11 I18 |
| Date: | 2007–07–26 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:28-en&r=hea |
| By: | Chu, Angus C. |
| Abstract: | Since the 80’s, the pharmaceutical industry has benefited substantially from a series of policy changes that have strengthened the patent protection for brand-name drugs as a result of the industry’s political influence. This paper incorporates special interest politics into a quality-ladder model to analyze the policymakers’ tradeoff between the socially optimal patent length and campaign contributions. The welfare analysis suggests that the presence of a pharmaceutical lobby distorting patent protection is socially undesirable in a closed-economy setting but may improve social welfare in a multi-country setting, which features an additional efficiency tradeoff between monopolistic distortion and international free-riding on innovations. |
| Keywords: | campaign contributions; intellectual property rights; patent length; special interest politics |
| JEL: | O34 D72 O31 |
| Date: | 2007–08 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:4349&r=hea |
| By: | Vicente Royuela (Faculty of Economics, University of Barcelona.); Jordi Lopez-Tamayo (Faculty of Economics, University of Barcelona.); Jordi Suriñach (Faculty of Economics, University of Barcelona and European University Institute.) |
| Abstract: | In recent years, we have seen how the quality of work life has been focused and defined by the European Commission (EC). In our study we compare the EC definition with the academic one and try to see how close they are. We also analyse the possibility of applying the institutional definition to the Spanish case through the development of specific indicators. Our main conclusions are that QWL is increasingly important for policy makers. In addition, it is essential to have objective indicators and to conduct surveys in order to reliably measure QWL. |
| Date: | 2007–07 |
| URL: | http://d.repec.org/n?u=RePEc:ira:wpaper:200713&r=hea |
| By: | Ensar Yesilyurt (Department of Economics, Pamukkale University); Filiz Yesilyurt (Department of Economics, Ege University) |
| Abstract: | Data Envelopment Analysis is frequently used in the measurement of hospital efficiency as in several other institutions, whereas not enough emphasis has been laid on the concepts of ‘congestion’ and ‘slack’, which widen the application field of this analysis and broaden the possibility of its usage as a means of politics. In this study, besides the efficiency levels of 600 general hospitals currently active in Turkey, their congestion and slacks have also been calculated. Moreover, welfare losses due to the existence of congestion and slacks, which have been ignored up to now in relation to the costs of input, have been determined. The present study, above all, constitutes a sample case about the possibility that the slacks can occur in DEA even when in an entirely efficient state. As a result, the hospitals affiliated to the Social Security Organization (SSK in Turkish) have been found out to be the most efficient and the private hospitals have been found to take the second order while the hospitals operating under the Ministry of Health have taken the third order. Considering all the hospitals altogether, the total welfare loss has been calculated to be $94.523.320. |
| Keywords: | Data Envelopment Analysis, Hospital, Congestion, Slack |
| JEL: | I1 P3 |
| Date: | 2007–06 |
| URL: | http://d.repec.org/n?u=RePEc:ege:wpaper:0705&r=hea |
| By: | John Serieux (Assistant Professor, Dept. of Economics, University of Manitoba); Terry McKinley (International Poverty Centre) |
| Abstract: | . |
| Keywords: | ODA, HIV, AIDS |
| Date: | 2007–02 |
| URL: | http://d.repec.org/n?u=RePEc:ipc:opager:29&r=hea |
| By: | Carlos Bozzoli (Princeton University); Angus Deaton (Princeton University); Climent Quintana-Domeque (Princeton University) |
| Abstract: | We investigate the childhood determinants of adult height in populations, focusing on the respective roles of income and of disease. We develop a model of selection and scarring, in which the early life burden of nutrition and disease is not only responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height, as well as in late-life disease. Across a range of European countries and the United States, we find a strong inverse relationship between post-neonatal (one month to one year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. In pooled birth-cohort data over 30 years for the United States and eleven European countries, post-neonatal mortality in the year of birth accounts for more than 60 percent of the combined cross-country and cross-cohort variation in adult heights. The estimated effects are smaller but remain significant once we allow for country and birth-cohort effects. In the poorest and highest mortality countries of the world, there is evidence that child mortality is positively associated with adult height. That selection should dominate scarring at high mortality levels, and scarring dominate selection at low mortality levels, is consistent with the model for reasonable values of its parameters. |
| Date: | 2007–03 |
| URL: | http://d.repec.org/n?u=RePEc:pri:cheawb:230&r=hea |
| By: | Anne Case (Princeton University); Christina Paxson (Princeton University); Tom Vogl (Princeton University) |
| Abstract: | Understanding whether the gradient in children’s health becomes steeper with age is an important first step in uncovering the mechanisms that connect economic and health status, and in recommending sensible interventions to protect children’s health. To that end, this paper examines why two sets of authors, Chen et al (2006) and Case et al (2002), using data from the same source, reach markedly different conclusions about income-health gradients in childhood. We find that differences can be explained primarily by the inclusion (exclusion) of a handful of younger adults living independently. |
| Date: | 2006–05 |
| URL: | http://d.repec.org/n?u=RePEc:pri:cheawb:233&r=hea |
| By: | Anne Case (Princeton University); Angus Deaton (Princeton University) |
| Abstract: | This paper presents a descriptive account of health and economic status in India and South Africa – countries in very different positions in the international hierarchy of life expectancy and income. The paper emphasizes the lack of any simple and reliable relationship between health and wealth between and within our sites in rural Rajasthan, in a shack township outside of Cape Town, and in a rural South African site that, until 1994, was part of a Bantustan. Income levels across our sites are roughly in the ratio of 4:2:1, with urban South Africa richest and rural Rajasthan poorest, while ownership of durable goods, often used as a short-cut measure or check of living standards, are in the ratio of 3:2:1. These differences in economic status are reflected in respondents’ own reports of financial status. People know that they are poor, but appear to adapt their expectations to local conditions, at least to some extent. The South Africans are taller and heavier than the Indians—although their children are no taller at the same age. South African self-assessed physical and mental health is no better, and South Africans are more likely to report that they have to miss meals for lack of money. In spite of differences in incomes across the three sites, South Africans and Indians report a very similar list of symptoms of ill-health. Although they have much lower incomes, urban women in South Africa have fully caught up with black American women in the prevalence of obesity, and are catching up in terms of hypertension. These women have the misfortune to be experiencing many of the diseases of affluence without experiencing affluence itself. |
| Date: | 2006–01 |
| URL: | http://d.repec.org/n?u=RePEc:pri:cheawb:234&r=hea |
| By: | Maren Jiménez (UN Economic Commission for Latin America and the Caribbean); Xiuhong You (University of Texas, Austin); Yolanda C. Padilla (University of Texas, Austin); Daniel A. Powers (University of Texas, Austin) |
| Abstract: | Hispanics tend to be as healthy as non-Hispanic whites across a number of indicators, yet they consistently rate their health as worse than non-Hispanic whites. This incongruous finding has been tied both to levels of acculturation and Spanish-language use, questioning the validity of self-reported health for Spanish speakers in the United States. Furthermore, in the same way that Hispanic adults interviewed in Spanish have worse self-rated health, when asked in Spanish mothers rate their children’s health as worse than those mothers who answer in English. The exact reasons for this relationship, though, are unclear. Frequently this language effect has been taken as an indicator of acculturation; as such, the assumption is that as time progresses Hispanics become more acculturated and answer questions regarding their health more similarly to non-Hispanic whites. However, up until this point there has been no longitudinal research examining the relationship between rated health and language of interview. Using three waves of data on Hispanic mothers and their children from the Fragile Families and Child Well-being Study, this paper addresses the following questions: 1. Is Spanish language interview predictive of worse rated health for both mothers and children, and do these relationships change over time? 2. Does the effect of language on rated health persist after controlling for potential mediators? By employing two-level generalized linear models, we find that on average, those who were interviewed in Spanish are more likely to rate their and their children’s health as worse than those who answered in English. The effect of language of interview on reported health persists over time, even after controlling for measures of acculturation, physical and mental health, and access to health care. Contrary to what some have proposed, we see no discernable change over time in the way women rate their own health or that of their children. |
| Date: | 2007–05 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:895&r=hea |
| By: | Julien O. Teitler; Nancy E. Reichman |
| Abstract: | This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study. We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a five year period following a non-marital birth. Diagnosed mental illness was obtained from the survey respondents' prenatal medical records. We find that mothers with mental illness were about two thirds as likely as mothers without mental illness to marry, even after controlling for demographic characteristics, and that human capital, relationship quality, partner selection, and substance abuse explain only a small proportion of the effect of mental illness on marriage. |
| Date: | 2007–01 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:907&r=hea |
| By: | Sarah O. Meadows (Princeton University); Sara S. McLanahan (Princeton University); Jeanne Brooks-Gunn (Columbia University) |
| Abstract: | Existing research shows that marriage and marital stability are positively associated with health and well-being. Thus, recent increases in births to unmarried parents and the instability surrounding these relationships raise concerns about the possible health effects associated with changes in family formation. Using latent trajectory models and data from the Fragile Families and Child Well-Being Study (FFCWS) this paper examines trajectories of mothers’ mental and physical health, specifically focusing on transitions into and out of relationships with the child’s biological father (n = 2,649). Mothers who remain married to their child’s father are in better mental and physical health than continuously cohabiting or continuously single mothers. Among mothers living with the father at birth, exiting a coresidential relationship increases mental health problems and decreases self-rated health. These effects appear to be short-lived, as suggested by stress theory, followed by periods of resilience in the absence of other transitions. Among mothers who are not living with the father, entering a residential relationship improves both mental and physical health, but only prior to the child’s first birthday. The implications of these findings for selection and causation arguments, as well as social policies promoting stable healthy unions between non-married parents, are also discussed. |
| Keywords: | marriage, mental health, physical health, trajectories, mothers |
| Date: | 2006–11 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:915&r=hea |
| By: | Rachel Tolbert Kimbro (University of Wisconsin, Madison) |
| Abstract: | Using Fragile Families and Child Wellbeing Data (N=4,342), this paper examines why relationship status matters for maternal health behaviors. The paper argues that a mother's decisions on how much to invest in her child are partly driven by her perception of how committed the father is to their relationship. Results show that several relationship dynamics measures, including multiple partner fertility, relationship quality, and for unmarried mothers, whether she believes she will eventually marry the father, all predict prenatal health behaviors above and beyond confounding factors. In addition, these relationship dynamics explain some of the advantage in maternal health behaviors married mothers have over those who are dating or who have broken up with the father of the baby by the time of the birth. |
| Date: | 2006–11 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:916&r=hea |
| By: | Emily Moiduddin (Princeton University); Douglas S. Massey (Princeton University) |
| Abstract: | In this analysis we connect neighborhood conditions to birth outcomes through their intermediate effects on allostatic load. We hypothesize that neighborhood poverty and racial isolation combine to produce unsafe environments which raise allostatic load and thereby increase the likelihood of negative coping behaviors (substance abuse) while lowering the odds of health-promoting behaviors (prenatal visits to a health professional). We expect these behaviors, in turn, to produce lower birth weights. Using data from the Fragile Families Study we find substantial support for this hypothesized sequence of events. The two greatest direct effects on birth weight are risky behavior and racial isolation. Neighborhood poverty and prenatal care have small but significant direct effects. Though neighborhood safety—our hypothesized indicator for allostatic load—has no significant direct effect on birth weight, it has small, significant indirect effects by raising the likelihood of risky behavior and by lowering the odds of prenatal care. |
| Date: | 2006–11 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:917&r=hea |
| By: | Jean Knab (Princeton University); Sara McLanahan (Princeton University); Irv Garfinkel (Columbia University) |
| Abstract: | In 1996 the U.S. Congress passed the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), substantially reducing a family’s rights to income support. PRWORA removed the entitlement to government-provided cash assistance and increased states’ incentives to reduce welfare caseloads. At the same time it increased private responsibilities by encouraging greater work effort from mothers and more child support payments from non-resident fathers. The PRWORA provisions raised concerns within the medical community and among other advocates interested in the health and wellbeing of at-risk families. The changes to cash welfare and child support policies had potential direct and indirect consequences for women’s health. Most directly, by removing the entitlement to welfare, many feared that poor women would lose their health insurance coverage. While PRWORA included a provision to hold Medicaid eligibility constant, the administrative barriers to implementation by program staff and the confusing new rules suggested that many eligible women might lose coverage. |
| Date: | 2007–03 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:931&r=hea |
| By: | Cynthia Osborne (University of Texas, Austin); Sara McLanahan (Princeton University) |
| Abstract: | We use data from three waves of the Fragile Families Study (N = 2,111) to examine the prevalence and effects of mothers’ partnership changes between birth and age 3 on children’s behavior. We find that children born to unmarried and minority parents experience significantly more partnership changes than children born to parents who are married or White. Each transition is associated with a modest increase in behavioral problems, but a significant number of children experience three or more transitions. The effects of instability do not depend on the mothers’ relationship status or race/ethnicity with one exception: instability has a stronger effect on aggression among Hispanic children. The association between instability and behavior is mediated by maternal stress and lower quality mothering. |
| Date: | 2007–03 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:946&r=hea |
| By: | Cynthia Osborne (University of Texas, Austin); Lawrence M. Berger (University of Wisconsin, Madison) |
| Abstract: | Parental substance abuse is associated with adverse health and developmental outcomes for children. Existing research, however, has not fully explored the relative magnitude of the associations between maternal, paternal, and both parents’ substance abuse and child outcomes, nor has it examined these associations in regard to substance abuse among nonresident fathers. We use data from the Fragile Families Study (N = 3,031) to explore these issues among a cohort of 3-year-old children. We find that children living with a substance abusing parent are at considerable risk for poor health and behavior outcomes; that such risk is not moderated by parent gender; and that it is substantially larger when both parents have substance abuse problems. Moreover, children with substance abusing fathers are at considerably higher risk of health and behavior problems when their fathers live with them, although this risk is still substantial when they do not. This research has important implications for policies aimed at impacting family formation. |
| Keywords: | Family Policy, Child Well-being, Family Formation, Substance Abuse |
| Date: | 2006–09 |
| URL: | http://d.repec.org/n?u=RePEc:pri:crcwel:947&r=hea |
| By: | Hendrik Jürges (Mannheim Research Institute for the Economics of Aging (MEA)) |
| Abstract: | This paper uses data from SHARE 2004 to analyze one possible causal pathway of the health-wealth gradient, namely differences in the marginal propensity to save and spend across different health states. Conditional on age and current wealth, I find weak relationships between health and the intended use of a hypothetical windfall gift as well bequest expectations. The overall effect of health on wealth through this link is positive but very small. |
| Date: | 2007–07–16 |
| URL: | http://d.repec.org/n?u=RePEc:mea:meawpa:07139&r=hea |
| By: | Hendrik Jürges (Mannheim Research Institute for the Economics of Aging (MEA)) |
| Abstract: | I compare education-, income-, and wealth-related health inequality using data from 11 European countries and the US. The health distributions in the US, England and France are relatively unequal independent of the stratifying variable, while Switzerland or Austria always have relatively equal distributions. Some countries such as Italy dramatically change ranks depending on the stratifying variable. |
| Date: | 2007–07–16 |
| URL: | http://d.repec.org/n?u=RePEc:mea:meawpa:07140&r=hea |
| By: | Hendrik Jürges (Mannheim Research Institute for the Economics of Aging (MEA)) |
| Abstract: | Education is arguably the most important correlate of health We study education-related inequality in the physical of older adults across 11 European countries and the US. Combining data from HRS 2002, ELSA 2002 and SHARE 2004, our results suggest that education is strongly correlated with health both across and within countries. Education-related inequality in health is larger in Mediterranean and Anglo-Saxon countries than in western European countries. We find no evidence of a trade-off between health levels and equity in health. Education-related inequality in health hardly driven by income or wealth effects (except in the US), and differences in health behaviors (smoking) by education level contribute surprisingly little health differences across education groups. |
| Date: | 2007–07–17 |
| URL: | http://d.repec.org/n?u=RePEc:mea:meawpa:07141&r=hea |
| By: | Jürgen Maurer (Mannheim Research Institute for the Economics of Aging (MEA)) |
| Abstract: | This paper investigates the interplay of socioeconomic and medical determinants of health care utilization among elderly Europeans from ten countries. Using novel strictly comparable cross-national data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study exploits recent semi- and nonparametric estimation methods to illustrate how individual socioeconomic status and health determine health care utilization in different institutional settings. Our flexible estimation method allows for the use of multiple health measures to adjust for individual differences in health care need without sacrificing cross-national comparability of the resulting estimates. Within countries, we find only a small, if any, socioeconomic gradient. Moreover, all health systems appear to be reasonably responsive to differences in care need. At the same time, we find considerable variation in treatment intensity across countries, which we cannot fully explain by differences in health care need. |
| Date: | 2007–07–17 |
| URL: | http://d.repec.org/n?u=RePEc:mea:meawpa:07144&r=hea |
| By: | Jürgen Maurer (Mannheim Research Institute for the Economics of Aging (MEA)) |
| Abstract: | This paper suggests bivariate semiparametric index models as a tool for modelling the interplay of socioeconomic and health characteristics in determining health care utilisation. These models allow for a fully nonparametric relationship between socioeconomic status, health care need and care utilisation. The only parametric restriction imposed is that multiple socioeconomic and health indicators can be aggregated into two distinct indices that measure the broader concepts of socioeconomic status and health care need, respectively. We demonstrate the usefulness of this class of models based on an illustrative empirical example. The estimations highlight complex interactions of socioeconomic status and health care need in determining care use, which may be difficult to grasp via standard parametric modelling approaches. |
| Date: | 2007–07–17 |
| URL: | http://d.repec.org/n?u=RePEc:mea:meawpa:07145&r=hea |
| By: | Rosalie Viney (CHERE, University of Technology, Sydney); Elizabeth Savage (CHERE, University of Technology, Sydney) |
| Abstract: | This paper investigates the nature of the utility function for health care, defined over the probability of survival, survival duration, health state and cost of treatment. A discrete choice experiment, involving treatment choice for a hypothetical health condition is used to test restrictions on preferences in the QALY model. We find that preferences do not conform to expected utility, and there are significant interactions between health state and survival duration. Individual characteristics are significant, implying substantial differences in valuations of health states across the population. The results suggest the QALY approach distorts valuations of health outcomes. |
| Keywords: | Discrete choice experiment, Qalys, preferences, health state valuation |
| JEL: | I19 |
| URL: | http://d.repec.org/n?u=RePEc:her:chewps:2006/10&r=hea |
| By: | Mark Haran; Madeleine King (CHERE, University of Technology, Sydney); Martin Stockler; Obad Marial; Bonne Lee |
| Abstract: | The SF-36 was interviewer-administered to 305 subjects at recruitment. Feasibility, content validity and internal consistency were assessed. We tested a priori hypotheses about discriminative, convergent and divergent validity. Interviewer-assisted administration was feasible. The content validity of several domains (Physical Function, Role Physical, Social Function and Role Emotional) was compromised by the irrelevance of some items and response options. Resultant ceiling and floor effects may limit the SF-36?s ability to detect changes over time. The SF-36 was able to discriminate differences between people with: tetraplegia versus paraplegia (in the Physical Function and Physical Composite scores); injuries that were recent (<4 years) versus remote (>4 years) (in the Vitality, Social Function and Mental Health domain and Mental Composite scores), and who were employed versus unemployed (in the Physical Function, Social Function, Mental Health and Mental Composite scores). It was not able to discriminate between groups dichotomised by age, injury completeness or gender. The convergent and divergent validity of all SF-36 domains was as in other populations, except for correlations involving the Physical Function scale which were poor. Internal consistency was similar to that in other populations (Cronbach?s alpha from 0.75 to 0.92); the SF-36 has sufficient precision for population-based and clinical research in spinal cord injury. The SF-36 is useful for comparing the health status of people with spinal cord injury to that of other populations, but supplementation with a disease-specific health status measure may be necessary for trials of interventions in people with spinal cord injuries. |
| Keywords: | Quality of life, outcome measures, sf-36 |
| JEL: | I10 |
| URL: | http://d.repec.org/n?u=RePEc:her:chewps:2007/4&r=hea |
| By: | Davide Aristei; Federico Pierali; Luca Pieroni |
| Abstract: | This paper describes the life-cycle alcohol consumption patterns of Italian households by decomposing gender, cohort, age and time effects and estimates the importance of demographic characteristics using a double-hurdle model. The application is based on ISTAT households expenditure survey for the period 1997-2002 organized in cohorts. As expected, cohort and age effects are significant in both participation and consumptions. The significance of gender and geographic differences suggests important policy implications. |
| Keywords: | Alcohol consumption, double-hurdle models, cohorts effects, ageing, gender effects. |
| JEL: | D12 I12 J10 |
| Date: | 2007–04 |
| URL: | http://d.repec.org/n?u=RePEc:pia:wpaper:2007041&r=hea |