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on Health Economics |
| By: | Olena Nizalova (Kyiv School of Economics and Kyiv Economics Institute); Maria Vyshnya (Kyiv Economics Institute and Kyiv Mohyla Academy) |
| Abstract: | This paper exploits a unique opportunity to evaluate the impact of improvement in the quality of prenatal care and labor and delivery services on maternal and infant mortality and morbidity. Since basic medical care has been universally available in Ukraine, implementation of the Mother and Infant Health Project allows addressing quality rather than quantity effect of medical care. Employing program evaluation methods we find that the administrative units (rayons) participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control rayons. Among the infant health characteristics, the MIHP impact is most pronounced for stillbirths, as well as infant mortality and morbidity resulted from deviations in perinatal period and congenital anomalies. As for the maternal health, the MIHP is most effective at combating such complications related blood circulation, veins, and urinary-genital systems, as well as late toxicosis and anemia. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 85 taking into account both maternal and infant lives saved as well as cost savings due to changes in labor and delivery practices. |
| Keywords: | Maternal health, maternal mortality, infant health, infant mortality; prenatal care |
| JEL: | I12 I18 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:kse:dpaper:18&r=hea |
| By: | Jennifer Roberts; Nigel Rice; Andrew M. Jones |
| Abstract: | Both health and income inequalities have been shown to be much greater in Britain than in Germany. One of the main reasons seems to be the difference in the relative position of the retired, who, in Britain, are much more concentrated in the lower income groups. Inequality analysis reveals that while the distribution of health shocks is more concentrated among those on low incomes in Britain, early retirement is more concentrated among those on high incomes. In contrast, in Germany, both health shocks and early retirement are more concentrated among those with low incomes. We use comparable longitudinal data sets from Britain and Germany to estimate hazard models of the effect of health on early retirement. The hazard models show that health is a key determinant of the retirement hazard for both men and women in Britain and Germany. The size of the health effect appears large compared to the other variables. Designing financial incentives to encourage people to work for longer may not be sufficient as a policy tool if people are leaving the labour market involuntarily due to health problems. |
| Keywords: | health, early retirement, hazard models |
| JEL: | J26 I10 C23 C41 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp188&r=hea |
| By: | Nils Braakmann |
| Abstract: | This paper considers the impact of adverse health shocks that hit an individual’s partner on subjective well-being. Using data on couples from the German Socio-Economic Panel for the years 1984 to 2006, I compare the losses in well-being caused by own and spousal disability using panel-regressions. I find that women and to a lesser extent men are harmed by spousal disability which is consistent with the existence of other-regarding preferences within couples. The magnitude of effects suggests that spousal disability is about one quarter to one half as harmful as individual disability with larger effects being found for women. |
| Keywords: | Disability, subjective well-being, other-regarding preferences |
| JEL: | D64 I10 J14 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp194&r=hea |
| By: | Sheila Mammen (Department of Resource Economics, University of Massachusetts Amherst); Jean W. Bauer (Family Social Sciences Department, University of Minnesota); Daniel Lass (Department of Resource Economics, University of Massachusetts Amherst) |
| Abstract: | The satisfaction with life (SWL) among rural low-income mothers was assessed using a sample of 163 mothers who participated in a multi-state, three-year longitudinal study. Dependent variables included those that represented various forms of capital (health, human, personal and social) as well as the mothers’ levels of life satisfaction from prior years. Nearly two-thirds of the rural mothers were satisfied with their life in all three years. Their level of satisfaction appeared to be constant, however, such persistence had a time frame of only one year. In all three years, their depression score and the adequacy of their income had a significant effect on SWL. Their confidence as a parent and home ownership affected their life satisfaction during two years. Finally, their satisfaction with social relationships, age of the youngest child, and total number of children had an impact on their life satisfaction for one year. |
| Keywords: | Satisfaction with life, rural low-income mothers, health capital, human capital, personal capital, social capital, homeostatis |
| JEL: | I30 I31 I32 I39 |
| Date: | 2009–02 |
| URL: | http://d.repec.org/n?u=RePEc:dre:wpaper:2009-2&r=hea |
| By: | Julien Hugonnier (University of Lausanne and Swiss Finance Institute); Florian Pelgrin (University of Lausanne and CIRANO); Pascal St-Amour (University of Lausanne, Swiss Finance Institute, CIRANO and CIRPEE) |
| Abstract: | The empirical literature on the asset allocation and medical expenditures of U.S. households consistently shows that risky portfolio shares are increasing in both wealth and health whereas health investment shares are decreasing in these same variables. Despite this evidence, most of the existing models treat financial and health-related choices separately. This paper bridges this gap by proposing a tractable framework for the joint determination of optimal consumption, portfolio and health investments. We solve for the optimal rules in closed form and show that the model can theoretically reproduce the empirical facts. Capitalizing on this closed-form solution, we perform a structural estimation of the model on HRS data. Our parameter estimates are reasonable and confirm the relevance of all the main characteristics of the model. |
| Keywords: | Portfolio, Health Investment, Mortality Risk. |
| JEL: | G11 I12 |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:chf:rpseri:rp0918&r=hea |
| By: | Thurlow, James; George, Gavin; Gow, Jeff |
| Abstract: | "This paper estimates the economic impact of HIV/AIDS on KwaZulu-Natal (KZN) and the rest of South Africa (RSA). We extend previous studies by employing an integrated analytical framework that combines the following: firm-level surveys of workers' HIV prevalence by sector and occupation; a demographic model that produces both population and workforce projections; and a regionalized economywide model linked to a survey-based micro-simulation module. This framework permits a full macro-microeconomic assessment. The results indicate that HIV/AIDS greatly reduces annual economic growth, mainly by lowering the long-term rate of technical change. However, the impacts on income poverty are small, and inequality is reduced by HIV/AIDS. This is because high unemployment among low-income households minimizes the economic costs of increased mortality. In contrast, slower economic growth hurts higher-income households despite the lower prevalence of HIV among these households. We conclude that the increase in economic growth achieved through addressing HIV/AIDS is sufficient to offset the population pressure this move will place on income poverty. Moreover, incentives to mitigate HIV/AIDS lie not only with poorer infected households, but also with uninfected higher-income households. Our findings reveal that HIV/AIDS will place a substantial burden on future economic development in KZN and RSA, confirming the need for policies to curb the economic costs of this pandemic." from authors' abstract |
| Keywords: | HIV/AIDS, Growth, Poverty, Development strategies, KwaZulu-Natal, |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:864&r=hea |
| By: | Diao, Xinshen |
| Abstract: | "We use a dynamic CGE model to quantitatively assess the economywide impact of HPAI in Ghana. The likely effect of an avian flu outbreak is modeled as demand or supply shocks to the poultry sector. Our analysis shows that, while chicken is a quite small sector of the Ghanaian economy, the shock in chicken demand due to consumers' anxieties is the dominant factor in causing chicken production to fall. The indirect effect on soybean and maize that are used as chicken feed is also large. Under the worst-case scenario, soybean production will fall by 37 percent and maize by 6.4 percent. However, the economywide impact on both AgGDP and GDP is very small. In the worst-case scenario, in which chicken production falls by 70 percent in 2011, AgGDP falls by only 0.4 percent and GDP is almost unchanged. However, the livelihood impacts of a HPAI outbreak could be significant for some sections of the population in Ghana particularly those involved in the poultry sector. Micro-level analysis of chicken producers' livelihood, therefore, is necessary." from authors' abstract |
| Keywords: | Avian influenza Developing countries, General equilibrium model, Computable general equilibrium (CGE) modeling, Food safety, Water quality, Water policies, |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:866&r=hea |
| By: | Nancy Devlin (Office of Health Economics, London); Aki Tsuchiya (Economics Department, University of Sheffield); Ken Buckingham (Department of Preventive Medicine, University of Otago); Carl Tilling (School of Health and Related Research, University of Sheffield, Sheffield) |
| Abstract: | The aims of this study are to investigate the feasibility of eliciting Time Trade Off (TTO) valuations using short durations; to determine the effect of contrasting durations on individuals’ responses to the TTO; to examine variations within and between respondents’ values with respect to duration; and to consider the insights provided by participants’ comments and explanations regarding their reaction to duration in the valuation task. 27 participants provided TTO values using short and long durations for three EQ-5D states. Feedback was sought using a series of open ended questions. Of the 81 opportunities to observe it, strict constant proportionality was satisfied twice. 11 participants had no systematic relationship between duration and value; 11 provided consistently lower valuations in long durations, while 5 had higher valuations in long durations. Comments provided by participants were consistent with the values they provided. Mean TTO values did not differ markedly between alternative durations. We conclude that it is feasible to elicit TTO values for short durations. There is considerable heterogeneity in individuals’ responses to the time frames used to elicit values. Further research is required to ensure that the values used in cost effectiveness analysis adequately represent preferences about quality and length of life.Keywords: EQ-5D; PROMs, health outcomes; performance indicators |
| Date: | 2009–05 |
| URL: | http://d.repec.org/n?u=RePEc:cty:dpaper:0907&r=hea |
| By: | David Parker; Donna Goodman; Yoko Akachi |
| Abstract: | This paper reviews the published evidence of pathways and impacts of global climate change on child health. The review was occasioned by the recognition that most of the work to date on climate change and health lacks clear focus on the children's dimension, while the climate change and children literature tends to be brief or imprecise on the complex health aspects. <br /> Studies were identified by searching the PubMed database for articles published before April 2009. Publications by agencies (e.g., UNICEF, WHO, IPPC) were also included based upon review. A list of references was developed that provide evidence to the linkages between climate change and health outcomes, and on specific health outcomes for children. The analysis explores the hypothesis of disproportionate vulnerability of children’s health to environmental factors, specifically those most closely related to climate change.<br /> Based upon scientific and policy research conducted to date there is found to be substantial evidence of disproportionate vulnerability of children in response to climate change. The diseases likely to be potentiated by climate change are already the primary causes of child morbidity and mortality, including vector-borne diseases, water-borne diseases and air-borne diseases. For this reason further research, assessment and monitoring of child health in respect to climate change is critical. Proposals are made for governments to integrate environmental health indicators into data collection in order to accurately assess the state of child health in relation to other age groups and its sensitivity to climate change.<br /> |
| Keywords: | child health; environmental degradation; environmental effects; malnutrition; |
| JEL: | Q25 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:ucf:indipa:indipa09/5&r=hea |
| By: | Mohammad Shafiqul Islam (Shahjalal University of Science & Technology (SUST)); Mohammad Woli Ullah (Shahjalal University of Science & Technology (SUST)) |
| Abstract: | Health is a basic requirement to improve the quality of life. A national economic and social development depends on the state of health. A large number of Bangladesh’s people, particularly in rural areas, remained with no or little access to health care facilities. The lack of participation in health service is a problem that has many dimensions and complexities. Education has a significant effect on participation in health services and administrative factors could play a significant role in increasing the people’s participation in Bangladesh’s health sector. But the present health policy is not people oriented. It mainly emphasizes the construction of Thana Health Complexes (THCs) and Union Health and Family Welfare Centers (UHFWCs) without giving much attention to their utilization and delivery services. The study reveals that financial and technical support is very helpful to ensure health service among village people. However, the Government allocates only 5 percent of the budget to the health sector, while it allocates 13 percent for defense. The paper shows that the Government’s allocation and technical support (medical equipments) are not sufficient in the rural health complex and that the people’s participation is far from being satisfactory. The paper concludes with a variety of recommendations. |
| Keywords: | Bangladesh, health, participation, rural health |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:bnr:wpaper:7&r=hea |
| By: | Fauli, Siri (The Norwegian Medical Association, The Norwegian Quality Improvement of); Thue, Geir (The Norwegian Quality Improvement of Laboratory Services in Primary Care) |
| Abstract: | The focus of this study is the effect of a laboratory analysis and socioeconomic variables on choosing medical actions in a specific situation (a clinical vignette - a young woman, Mrs Hansen, with dyspepsia - presented to GPs). We assume that the GP’s decision depends on what he or she thinks is best for the patients, based on the best clinical evidence available. Significant variables associated with the choice of medical actions are: the result of the Helicobacter pylori (HP) test, the GP’s stated importance of HPRT, the location of the general practice, the GP recommending sick leave, the GP’s stated probability that Mrs Hansen’s symptoms are due to a H.pylori infection after the HP-result is known, and how the GP follows up the patient. Our results show that the HP-analysis has a significant and major influence on the GPs choice of medical actions. Therefore the quality of the analysis is likely to affect the patients’ health and social costs. Hence institutions for quality monitoring and improvement are important elements of health care reforms. Such institutions should balance cost and benefits of quality improving measures, and will be the focus of closer studies in our future research. |
| Keywords: | Discrete choice models; Decision-making; Primary Health Care |
| JEL: | I12 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_012&r=hea |
| By: | Hernæs, Kjersti Helene (Frischsentre) |
| Abstract: | Is an increase in the quality of health services, as perceived by the hospital, appreciated by the consumers? If so, patients should respond positively to an increase in the quality of hospital services. Using two indicators to capture the quality of hospital services I investigate the relationship between these indicators and inpatients’ experiences. The health sector has increased substantially in most OECD countries over the last few decades. In Norway, total health care expenditures as a percentage share of the GDP, has grown from 2.9 % in 1960 to 8.7 % in 2002. In 2002 the state took over ownership of the Norwegian hospital sector and organized it through five regional semiautonomous companies. The motivation behind this was more efficient use of hospital resources, equal access despite geographical differences, and a higher quality of health services. Cost efficiency, measured as total activity relative to total costs, decreased during the 1990s. Part of the decrease can be explained by increased labour costs. It is often assumed that decreasing costs lead to lower quality. If this is the case in the health sector, one would expect to see a higher level of quality when costs per patient increase. Health services are paid for by taxpayers who are also the users of these services. For this reason, and especially since costs have increased, they should be able to evaluate the quality of the services they receive. This leads to an important question: What aspects of quality are important to consumers of health services? Do quality indicators, such as readmission rates and waiting time, capture the quality that consumers demand? This thesis is an attempt to answer these questions. The method I use is standard OLS. I also investigate possible cross-effects between hospitals’ readmission rates and age and look at the effect of a one standard deviation change in four of the explanatory variables. I also consider the use of an alternative estimation method that allows for stronger correlation between patients within hospitals but assumes independence between patients at different hospitals. The estimations are done using the statistical package StataSE 8. Using a simple regression model I have investigated the relationship between patients’ experiences during a hospital admission and the readmission rate and mean waiting time at the hospital they were admitted to. The data on these two hospital specific variables iii were provided by SINTEF Health who runs the Norwegian Patient Register. The register is owned by the Directorate of Health and Social Affairs. The data on patient satisfaction with hospital services were taken from an anonymous survey among patients admitted to somatic hospitals. They received the surveys two to three weeks after discharge. The response rate was approximately 50 %. The questions in the survey concerned issues such as health personnel’s ability to convey and receive relevant information, as well as provide care, treatment, and pain relief. There were also questions on patients’ impression of hospital equipment, general standard, and facilities and sanitary conditions. The survey consisted of 50 questions that I grouped into seven category variables, according to the type of service the different questions concerned. These categories were content, info, info2, facisani, care, org, and improve. Patients were also asked about their gender, age, health status, education level, number of admissions last two years, and whether their first language was Scandinavian. I was thus able to control for these characteristics. My main empirical finding is that hospitals’ readmission rates have a negative and significant effect on inpatients’ experiences. Patients admitted to hospitals with low readmission rates are more content with the care, treatment, and information they receive from hospital personnel. They are also more content with hospital facilities and sanitary conditions and organization of hospital staff. The results for waiting time were more ambiguous. Patients’ impression of hospitals’ facilities and sanitary conditions was better at hospitals with longer waiting time. It may be that other quality aspects are better at these hospitals, and that these other aspects are more important for patient satisfaction. Patients’ age, health status, number of previous admissions, and education level significantly affected their satisfaction with hospital services. The age effect was positive but decreasing. Investigating the cross-effect between age and the readmission rate showed that younger patients respond more negatively to a given readmission rate than older patients. Patient satisfaction decreased with the number of admissions and with patients’ education level but increased with patients’ health status. Patient characteristics explained the main share of the variation in patients’ experiences. Including dummies for hospitals increased the share of variation explained indicating that there are hospital specific factors present that affect patient satisfaction. Of this increase readmissions and waiting time explained a small part. More precise measures of hospital level quality may be needed in order to capture more of this variation. |
| Keywords: | quality; heslth services; hospitals |
| JEL: | I00 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_010&r=hea |
| By: | Nævdal, Eric (Department of Economics) |
| Abstract: | Screening for genetic diseases is performed in many regions and/or ethnic groups where there is a high prevalence of possibly malign genes. The propagation of such genes can be considered dynamic externality. Given that many of these diseases are untreatable and give rise to truly tragic outcomes they are a source for societal <p> concern and the screening process should perhaps be regulated. <p> The present paper incorporates a standard model of genetic propagation into an economic model of dynamic management. The paper derives cost benefit rules for optimal screening. The highly non-linear nature of genetic dynamics gives rise to perhaps surprising results which include discontinuous controls and threshold effects. One insight is that a screening program, if at all in place at all at some point in time, should screen all individuals. |
| Keywords: | Screening programme; Genetic diseases; Dynamic management |
| JEL: | I18 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_002&r=hea |
| By: | Hagen, Terje P. (Institute of Health Management and Health Economics); Veenstrab, Marijke (Rikshospitalet University Hospital); Stavem, Knut (Akershus University Hospital) |
| Abstract: | Objective for this working paper is to analyze the effects of a reimbursement reform on somatic hospitals’ efficiency and quality, measured as patient experiences. By the reform a capitation-based block grant system was replaced by an activity-based system. Methods: Data on efficiency and patient satisfaction from 213 hospital departments before (1996) and after (1998, 2000 and 2003) the reform were analyzed using a mixed model approach. The efficiency ratings were developed at the level of the hospital using data envelopment analysis, while the patient satisfaction scores were at department level data from recent patient surveys. Results: Both technical efficiency and patient satisfaction increase after the reform. Discussion: We interpret increasing technical efficiency as a direct effect of the reimbursement reform. Higher patient satisfaction is understood as an effect of lower waiting time, which in its turn is an effect of the introduction of activity-based financing. |
| Keywords: | Public hospitals; prospective payment system; financing; data envelopment analysis; efficiency; patient satisfaction |
| JEL: | I18 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_002&r=hea |
| By: | Hoel, Michael (Department of Economics) |
| Abstract: | In health economics, cost-effectiveness is defined as maximized health benefits for a given health budget. When there is a private alternative to public treatments, care must be taken when using costeffectiveness analysis to decide what types of treatments should be included in the public program. The correct benefit measure is in this case the sum of health benefits to those who would not be treated without the public alternative and the cost savings to those who would otherwise choose private treatment. In the socially optimal ranking of treatments to be included in the public health program, treatments should be given higher priority the higher are costs per treatment for a given ratio of gross heath benefits to costs. |
| Keywords: | Public health; cost-effectiveness |
| JEL: | H42 H51 I18 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_013&r=hea |
| By: | Godager, Geir (Institute of Health Management and Health Economics); Iversen, Tor (Institute of Health Management and Health Economics); Ma , Ching-To Albert (Department of Economics, Boston University) |
| Abstract: | We model physicians as health care professionals who care about their services and monetary rewards. These preferences are heterogeneous. Different physicians trade off the monetary and service motives differently, and therefore respond differently to incentive schemes. Our model is set up for the Norwegian health care system. First, each private practice physician has a patient list, which may have more or less patients than he desires. The physician is paid a fee-for-service reimbursement and a capitation per listed patient. Second, a municipality may obligate the physician to perform 7.5 hours per week of community services. Our data are on an unbalanced panel of 435 physicians, with 412 physicians for the year 2002, and 400 for 2004. A physician’s amount of gross wealth and gross debt in previous periods are used as proxy for preferences for community service. First, for the current period, accumulated wealth and debt are predetermined. Second, wealth and debt capture lifestyle preferences because they correlate with the planned future income and spending. The main results show that both gross debt and gross wealth have negative effects on physicians’ supply of community health services. Gross debt and wealth have no effect on fee-for-service income per listed person in the physician’s practice, and positive effects on the total income from fee-for-service; hence, the higher income from fee-for-service is due to a longer patient list. Patient shortage has no significant effect on physicians’ supply of community services, a positive effect on the fee-for-service income per listed person, and no effect on the total income from fee-for service. These results confirm physician preference heterogeneity. |
| Keywords: | physicians; incentive schemes; patient list; fee-for-service reimbursement; capitation per listed patient |
| JEL: | I18 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_004&r=hea |
| By: | Dalen, Dag Morten (Handelshøyskolen BI); Habeth, Tonje (Handelshøyskolen BI); Strøm, Steinar (Department of Economics, University of Oslo) |
| Abstract: | In March 2003 the Norwegian government implemented yardstick based price regulation schemes on a selection of drugs experiencing generic competition. The retail price cap, termed “index price”, on a drug (chemical substance) was set equal to the average of the three lowest producer prices on that drug, plus a fixed wholesale and retail margin. This is supposed to lower barriers of entry for generic drugs and to trigger price competition. Using monthly data over the period 1998-2004 for the 6 drugs (chemical entities) included in the index price system, we estimate a structural model enabling us to examine the impact of the reform on both demand and market power. Our results suggest that the index price helped to increase the market shares of generic drugs and succeeded in triggering price competition. |
| Keywords: | Discrete choice; demand for pharmaceuticals; monopolistic competition; evaluation of yardstick based price regulation |
| JEL: | C35 D43 I18 L11 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_001&r=hea |
| By: | Aas, Eline (Institute of Health Management and Health Economics) |
| Abstract: | Typically, the participation rate is below 100 per cent. In this paper pecuniary compensation is used to increase the participation rate. In a postal questionnaire to 5,000 people invited to screening for colorectal cancer, those not participating were asked "would you participate if you were given NOK X in compensation?" <p> The results show that compensation increases participation and that the participation probability systematically varies with travel expenses, income, age, county, native country, marital status, use of health care services, genetic predisposition, expected benefit from the screening, subjective health status, and education. The estimated costs per additional screening are increasing |
| Keywords: | participation; willingness-to pay; compensation; costs; binary probit |
| JEL: | C25 H42 H43 I10 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_007&r=hea |
| By: | Fauli Munkerud, Siri (Norwegian Quality Improvement of Laboratory Services in Primary Care (NOKLUS)) |
| Abstract: | This paper examines the reaction of general practitioners (GPs) to a reform in 2004 in the remuneration system for using laboratory services in general practice. Data from Norway make it possible to distinguish between income motivation and service motivation. The purpose of this paper is to study whether income motivation exists, and if so, the degree of income motivation among general practitioners (GPs) in Norway regarding the use of laboratory services in general practices. We argue that the degree of income motivation among GPs is stronger when the physicians are uncertain about the utility of the laboratory service in question. We have panel data from actual physician-patient encounters in general practices in the years 2001-2004, and use discrete choice analysis and random effects models. Our results indicate that there may be an income motivation among GPs regarding using laboratory services as, after the reform, the GPs chose to use laboratory services less frequently where the fees had been most reduced. In addition, estimation results show that an increase in the fees will lead to a small but significant increase in use. The reform led to minor changes in the use of laboratory analyses in GPs’ offices, and we argue that financial incentives were diluted because they were in conflict with medical recommendations and existing medical practice. The patient’s age has the most influence on GPs’ choice regarding use of laboratory services. The results support the hypothesis that the impact of income increases with increasing uncertainty about diagnosis and treatment. The policy implication of our results is that financial incentives alone are not an effective tool for influencing the use of laboratory services in GPs’ offices. |
| Keywords: | Financial incentives; laboratory analyses; diagnostic uncertainty; medical practice. |
| JEL: | I10 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_013&r=hea |
| By: | Fauli, Siri (The Norwegian Medical Association); Thue, Geir (Department of Public Health and Primary Health Care, University of Bergen) |
| Abstract: | Abstract Diagnostic tests and in particular laboratory tests are often important in diagnostic work-up and monitoring of patients. Therefore the economic consequences of medical actions based on test results may amount to a substantial proportion of health service costs. Thus, it is of public interest to study the consequences and costs of using laboratory tests. We develop a model for economic evaluation related to the diagnostic accuracy (sensitivity and specificity) of near patient tests. Blood sample based tests to detect the bacterium Helicobacter Pylori (HP) are useful in diagnosing peptic ulcer and suitable to illustrate the model. First, general practitioners’ initial management plans for a dyspeptic patient are elucidated using a paper vignette survey. Based on survey results, and medical literature, a decision tree is constructed to visualize expected costs and outcomes resulting from using three different HP tests in the clinical situation described in the vignette. Tests included are two rapid tests for use in general practice, and one hospital laboratory test for comparison. The tests had different sensitivities and specificities. Then a costeffectiveness analysis is undertaken from a societal perspective. Finally we use sensitivity analyses to model the decision uncertainty. Estimating for a follow-up period of 120 days, the rapid test with lower sensitivity and specificity than the hospital HP test is cost-effective because the laboratory result is available immediately. Further, in general practice, the rapid test with the highest sensitivity is significantly cost effective compared to the test with the highest specificity when the willingness to pay for each dyspepsia-free day exceeds €42.6. When deciding whether a laboratory analysis should be analysed in the office laboratory or not, it is important to consider both the diagnostic accuracy of the tests and the waiting time for the alternative, i.e. a hospital laboratory result. |
| Keywords: | cost-effectiveness; laboratory tests; general practice; probabilistic sensitivity; analysis |
| JEL: | I18 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_007&r=hea |
| By: | Brekke, Kjell Arne (Department of Economics, University of Oslo,); Kverndokk, Snorre (Ragnar Frisch Centre for Economic Research) |
| Abstract: | Several empirical papers have indicated that the health inequalities in the Nordic welfare states seem to be at least as high as health inequalities in other European countries even if the Nordic states have a more egalitarian income structure. This is in contrast to standard economic theory that predicts that income equality should lead to health equality everything else equal. We argue that there may be a straightforward explanation why Nordic countries appear to have a steeper health gradient than other countries. Health and income are related, and the correlation between income and health will be weaker the more noise there is in terms of other determinants of income. If the Nordic countries have succeeded in reducing the impacts of other determinants of income, like social class, then the correlation between income and health will be stronger in the Nordic countries. This story also holds for other measures of health inequality. However, if the causality is running from income to health, there may be a reason why health inequality is higher in more egalitarian states based on cognitive stress theory. We argue however, that even in this case the difference between Nordic states and the rest of Europe may be a result of poor measures. |
| Keywords: | Health inequality; socio-economic status; Nordic welfare states; egalitarian countries |
| JEL: | D31 I12 |
| Date: | 2009–05–19 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2009_004&r=hea |
| By: | Grepperud, Sverre (Institute of Health Management and Health Economics) |
| Abstract: | Individuals often respond with strong emotions to being penalised. Such responses suggest that informal penalties are important and play a role in creating deterrence. In this paper informal penalties are analysed in the context of medical errors. The introduction of informal penalties, if dependent upon formal ones, implies that: (i) the optimal enforcement regime becomes more lenient, and in some cases the lack of formal punishment is preferred, (ii) the first-best solution becomes unattainable, (iii) liability rates and formal penalty level are no longer perfect deterrence substitutes. In addition, powers of informal penalties provide a rationale for administrative sanctions (informal criticism, reprimands and warnings). |
| Keywords: | Iatrogenic injury; enforcement; administrative sanctions |
| JEL: | D64 I18 K32 K42 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_005&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics) |
| Abstract: | In the Norwegian capitation system each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and fee-for-service. From a model of a GP’s decisions we derive the optimal practice profile contingent on whether a GP experiences a shortage of patients or not. We also find the conditions for whether a GP, who experiences a shortage of patients, is likely to increase the number of services he provides to his patients. Data give us the opportunity to reveal patient shortage, i.e. a positive difference between a GP’s preferred and actual list size, at the individual practice level. <p> From the analysis of 2587 Norwegian GPs (out of a total 3650) the main result is that patient shortage has a positive effect on a GP’s intensity of service provision and hence, on the income per listed person. We also find that a GP’s income per listed person is influenced by the composition of the list according to indicators of need for services, and of accessibility according to the GP density in the municipality. These results are also valid when possible selection bias is accounted for, although the magnitude of the effects is then smaller. |
| Keywords: | economic motives; capitation; general practice; patient shortage; service provision |
| JEL: | H42 I11 I18 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_008&r=hea |
| By: | Fevang, Elisabeth (Ragnar Frisch Centre for Economic Research); Kverndokk, Snorre (Ragnar Frisch Centre for Economic Research); Røed, Knut (Ragnar Frisch Centre for Economic Research) |
| Abstract: | This paper presents a model of informal care to parents. We assume that the child participates in the labour market and gains in utility from consumption and leisure. In addition it has altruistic motivation to give informal care to its elderly parent. We show how the labour income, labour supply and informal caregiving are affected by exogenous factors such as the education level, wage rate, other supply of care, travel distance and inheritance. |
| Keywords: | informal care for elderly; labour market; elderly parent |
| JEL: | J22 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_012&r=hea |
| By: | Aas, Eline (Institute of Health Management and Health Economics) |
| Abstract: | This paper presents a medical cost function developed for a screening programme. The medical cost function is a function of advancement both directly and indirectly through survival. We discuss how the medical cost function is affected by screening through a shift in the distribution of cancers according to advancement. We show that screening reduces the treatment cost for cancers diagnosed at the screening, even though the medical cost function not unambiguously increases with stage of advancement. This is the first step in a cost-effectiveness analysis, and even though the results are favourable to the introduction of screening for colorectal cancer as a preventive health measure, total screening costs and health benefits must be evaluated to arrive at a recommendation. |
| Keywords: | treatment cost; stage of advancement; screening; probabilistic sensitivity analysis; bootstrap method |
| JEL: | C41 H42 I10 I12 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_005&r=hea |
| By: | Sæther, Erik Magnus (Ragnar Frisch Centre for Economic Research) |
| Abstract: | This thesis aims to explore the short-term impact of increased wages on the working hours of health personnel and their practice choice. An additional objective is to identify existing compensating differentials in the job market for health personnel. |
| Keywords: | physicians; registered nurses; discrete choice; non-convex budget sets; labor supply; sector-specific wages |
| JEL: | C25 I10 J22 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_001&r=hea |
| By: | Aas, Eline (Institute of Health Management and Health Economics) |
| Abstract: | On the basis of a randomized controlled trial we estimate the cost per life-year gained for six different strategies for colorectal cancer screening. Individuals in the age group 50 to 64 years were randomly selected for either flexible sigmoidoscopy or a combination of flexible sigmoidoscopy and a faecal occult blood test. A comprehensive dataset was collected from the trial to estimate costs and gained life-years. There are some indications that screening for colorectal cancer can be cost-effective, but the results are not statistically significant after this short follow-up period. |
| Keywords: | Keywords – screening; cost-effectiveness analysis; colorectal cancer; multinomial logit; probabilistic sensitivity analysis |
| JEL: | C41 C52 I10 I18 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_006&r=hea |
| By: | Sorisio, Enrico (PharmaNess scarl; University of Turin); Strøm, Steinar (University of Oslo; The Frisch Centre, Oslo; University of Turin) |
| Abstract: | In this paper we study the demand and supply of erythropoietin in four Nordic countries, using an econometric model based on discrete choice and a random utility model. It measures the effect of price changes as well as the loyalty of patients and physicians to a drug. Our main aims are to estimate demand for EPO and to determine the degree of competition in this Nordic market. The main motivation for this paper is to analyze the impact of product innovation on market power and welfare, e.g. on consumer and producer surplus. The product innovation is the entry of Aranesp in the Nordic market. |
| Keywords: | Discrete choice; demand for pharmaceuticals; monopolistic competition; EPO |
| JEL: | C35 D43 I18 L11 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_003&r=hea |
| By: | Chen, Yan (Department of Economics) |
| Abstract: | The idea behind this thesis stems from the existing abundance of empirical studies suggesting the strong correlation between longevity and economic growth. In a simple two period overlappinggeneration framework, we establish a direct link between health investment and economic growth through endogenous survival rate. We find that health expenditure complements saving in equilibrium, thereby contributes to economic growth, which in turn leads to a further increase in health investment. The simulation with calibrated parameters also manifests the consistence between our results and the worldwide data as well as the fact of China. |
| Keywords: | health investment; economic growth; China |
| JEL: | I31 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_008&r=hea |
| By: | Kravdal, Øystein (Department of Economics) |
| Abstract: | Using register data for the entire Norwegian population aged 50-89 in 1980-1999, in which there are ¾ million deaths, it is estimated how the proportions who are divorced or never-married in the municipality affect all-cause mortality, net of individual marital status. The data include individual histories of changes in marital status and places of residence, and provide a rare opportunity to enter municipality fixed-effects, capturing the time-invariant unobserved factors at that level, into the models. The positive health externality of marriage that has been suggested in the literature is supported by some of the estimates for women, while other estimates, and especially those for men, point in the opposite direction. These findings may indicate that a high level of social cohesion is not as beneficial as often claimed, at least not for both sexes, that marriage perhaps undermines rather than strengthens social cohesion, or that other mechanisms are involved, for example related to people’s perceptions of their health relative to that of others. Estimates from models without such municipality fixed-effects are markedly different, but these also shed doubt on the notion that a high proportion not married generally increases individual mortality. |
| Keywords: | Census; Cohesion; Community; Divorce; Education; Family; Fixed-effects; Income; Marriage; Migration; Mortality; Multilevel; Municipality; Never-married; Register; Socio-economic Acknowledgement |
| JEL: | J12 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_011&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics); Lurås, Hilde (Helse Sør-Øst Health Services Research Centre) |
| Abstract: | We study whether the information patients have about physician quality when they choose a physician, influences their probability of switching physicians. We also study whether a physician with unfavorable characteristics, as perceived by patients (ex post), can compensate for patient switching by providing a higher quantity of services to his patients. If so, a trade-off exists between quality characteristics and quantity of services in the physician services market. From panel data covering the entire population of Norwegian general practitioners, we find that information on physician quality, as perceived by patients, has a huge effect on the volume of patients switching physicians. We also find that although physicians who experience patient shortages in general provide more services to their patients than physicians who have enough patients, the increased level of service provision only has a very small impact on the number of patients who decide to switch. We conclude that a higher level of service provision does not seem to compensate for negative characteristics (patients’ impression of competence, empathy etc) of less popular physicians. We suggest that information about the volume of patient switching at the physician practice level should be made public. |
| Keywords: | Switching; Economic motives; Capitation; General practice; Patient shortage |
| JEL: | H42 I11 I18 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_004&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics); Kopperud, Gry Stine (Institute of Health Management and Health Economics) |
| Abstract: | In Norway specialized health services are provided both by public hospitals and by privately practicing specialists who have a contract with the public sector. Patients’ co-payment is the same irrespective of the type of provider they visit. The ambition of equity in the allocation of medical care is high among all political parties. The instruments for auditing whether these goals are fulfilled are not equally ambitious. The objective of the present study is to explore whether laws and regulations that govern the allocation of specialist health care resources in fact are fulfilled. Panel data from the Survey of Living Conditions are merged with data on capacity and spatial access to primary and specialist care. We find that accessibility and socio-economic variables play a considerable role in determining both the probability of at least one visit and the number of visits to a private specialist. A person with a higher university degree living in a municipality with the highest value of the geographical accessibility index has a 46%-points higher probability of at least one visit to a private specialist compared with a person with junior high living in a municipality with the lowest value of the accessibility index. With regard to visits to a hospital outpatient department these variables are not found to have significant effects. We conclude that public ambitions and regulations are fulfilled for specialist services provided by public hospitals. With regard to the provision of services provided by publicly financed private specialists we find a discrepancy between public goals and surveyed practice. |
| Keywords: | specialist health services; utilization; equity; private/public provision; survey data |
| JEL: | H42 H51 I11 I18 |
| Date: | 2009–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2005_002&r=hea |
| By: | Kravdal, Øystein (Department of Economics) |
| Abstract: | There is still much uncertainty about the impact of income inequality on health and mortality. Some studies have supported the original hypothesis about adverse effects, while others have shown no effects, and a few even indicated beneficial effects. In this investigation, register data covering the entire Norwegian population were used to estimate how income inequality in the municipality of residence, measured by the Gini coefficient, affected mortality in men and women aged 30-89 in the years 1980- 2002, net of their individual incomes. The total exposure time was about 55 million person years, and there were about 850000 deaths. Adverse effects were estimated when individual and average income and some other commonly used control variables were included in the models. However, because there are annual measurements in each municipality, the data provide a rare opportunity to include also municipality fixed-effects, to pick up time-invariant unobserved factors at that level. When this was done, there was actually more evidence for beneficial than for adverse effects. In addition to illustrating the potential importance of the fixed-effects approach, these findings should add to the scepticism about the existence of harmful health effects of income inequality, and especially in a Nordic context. |
| Keywords: | Fixed-effects; Gini; Income; Inequality; Mortality; Municipality; Norway; Register |
| JEL: | J01 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_005&r=hea |
| By: | Kittelsen, Sverre A.C. (Ragnar Frisch Centre for Economic Research); Magnussen, Jon (Department of Public Health and Community Medicine); Sarheim Anthun, Kjartan (SINTEF Health Research); Häkkinen, Unto (Centre for Health Economics); Linna, Miika (Centre for Health Economics); Medin, Emma (Medical Management Centre); Olsen, Kim Rose (Danish Institute for Health Services Research); Rehnberg, Clas (Medical Management Centre) |
| Abstract: | In a period where decentralisation seemed to be the prominent trend, Norway in 2002 chose to re-centralise the hospital sector. The reform had three main aims; cost control, efficiency and reduced waiting times. This study investigates whether the hospital reform has improved hospital productivity using the other four major Nordic countries as controls. Hospital productivity measures are obtained using data envelopment analysis (DEA) on a comparable dataset of 728 Nordic hospitals in the period 1999 to 2004. First a common reference frontier is established for the four countries, enveloping the technologies of each of the countries and years. Bootstrapping techniques are applied to the obtained productivity estimates to assess uncertainty and correct for bias. Second, these are regressed on a set of explanatory variables in order to separate the effect of the hospital reform from the effects of other structural, financial and organizational variables. A fixed hospital effect model is used, as random effects and OLS specifications are rejected. Robustness is examined through alternate model specifications, including stochastic frontier analysis (SFA). The SFA approach in performed using the Battese & Coelli (1995) one stage procedure where the inefficiency term is estimated as a function of the set of explanatory variables used in the second stage in the DEA approach. Results indicate that the hospital reform in Norway seems to have improved the level of productivity in the magnitude of approximately 4 % or more. While there are small or contradictory estimates of the effects of case mix and activity based financing, the length of stay is clearly negatively associated with estimated productivity. Results are robust to choice of efficiency estimation technique and various definition of when the reform effect takes place. |
| Keywords: | Efficiency; productivity; DEA; SFA; hospitals |
| JEL: | C14 D24 I12 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_010&r=hea |
| By: | Shogren, Jason F. (Department of Economics and Finance); Nævdal, Eric (Department of Economics and HERO) |
| Abstract: | This paper explores how collective social norms can have individual-level genetic foundation. Our study is the first we know to report a plausible link between genetically founded individual preferences in a fraction of a population and social norms governing behavior of all individuals. As our motivating example, we focus on patterns of Excessive Drinking in Social Situations (EDSS) across Europe that are possibly triggered by genetically caused variations in personality. The genetic trait is shyness, which correlates with eye color. We present empirical results indicating that alcohol consumption in social situations correlate with eye color and a model which suggests that conditions exist in which EDSS can emerge as a strategy in a larger fraction of the population than is genetically predisposed to EDSS. In addition, our model shows that alcohol taxes may be counter-productive in controlling the emergence of EDSS as a social norm. |
| Keywords: | Excessive Drinking in Social Situations (EDSS); drinking behavior; genetically founded individual preferences; sosial norms |
| JEL: | I12 I18 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_007&r=hea |
| By: | Fevang, Elisabeth (Ragnar Frisch Centre for Economic Research); Kvrendokk, Snorre (Ragnar Frisch Centre for Economic Research); Røed, Knut (Ragnar Frisch Centre for Economic Research) |
| Abstract: | Based on Norwegian register data we show that having a lone parent in the terminal phase of life significantly affects the offspring’s labor market activity. The employment propen-sity declines by around 1 percentage point among sons and 2 percentage points among daughters during the years just prior to the parent’s death, ceteris paribus. Long-term sickness absence increases sharply. The probability of being a long-term social security claimant (defined as being a claimant for at least three months during a year) rises with as much as 4 percentage points for sons and 2 percentage points for daughters. After the par-ent’s demise, earnings tend to rise for those still in employment while the employment propensity continues to decline. The higher rate of social security dependency persists for several years. |
| Keywords: | Elderly care; labor supply; ageing; inheritance |
| JEL: | J14 J22 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_008&r=hea |
| By: | Nævdal, Eric (Department of Economics and HERO) |
| Abstract: | Throughout history, epidemics have been a recurring terror to humanity. In vulnerable societies prior to the development of modern medicine an epidemic could wipe out 50-60% of a population. With the possible exception of AIDS, modern epidemics are less devastating to affected communities, but still impose large costs on society. Even more mundane diseases such as influenza impose large costs. A bad outbreak of the flu that causes, say, 10% of the population to loose on average 5 working days, represents a severe economic cost to society no matter how trivial the disease is. On the other hand, viruses such as the Ebola virus with a fatality rate close to 90% cause considerable harm to small contained areas even if the extreme mortality in itself prevents the disease from spreading to affect large populations. Recent diseases such as SARS and the possibility of a bird flu epidemic have underscored the importance of transient epidemics to human welfare. One common feature of many epidemics is that they tend to move through a population and then disappear. The epidemic may reappear later, possibly in a mutated form, but still represents disjoint events. To my knowledge this class of epidemic has not yet been analysed in the economic literature. Often outbreaks these epidemics are predicted, leading to the additional question of how to implement preparatory health policies anticipating the outbreak. The present paper thus fills two important gaps in the literature. First we analyse optimal vaccination policy for an epidemic that eradicates itself. Second, we analyse optimal preparatory vaccination schedules. Optimal preventive policies are likely to depend on parametersthat are intrinsically uncertain. Here we first analyse the deterministic case and use this analysis as a stepping stone for the case where there is uncertainty about if and when the epidemic starts as well as about the parameters in the model. |
| Keywords: | optimal vaccination; epidemics; |
| JEL: | I18 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_006&r=hea |
| By: | Romoen, Maria (Faculty of Medicine); Sundby, Johanne (Faculty of Medicine); Hjortdahl, Per (Faculty of Medicine); Hussein, Fatrima (Ministry of Health); Steen, Tore W. (Ministry of Health); Velauthapillai, Manonmany (Ministry of Health); Kristiansen, Ivar Sønbø (Institute of Health Management and Health Economics) |
| Abstract: | Objectives: Chlamydia is the most common bacterial sexually transmitted infection worldwide and a major cause of morbidity – particularly among women and neonates. We compared costs and health consequences of using point-of-care (POC) tests with current syndromic management among antenatal care attendees in sub-Saharan Africa. We also compared erythromycin with azithromycin treatment and universal with age-based chlamydia management. Methods: A decision analytic model was developed to compare diagnostic and treatment strategies, using Botswana as a case. Model input was based upon 1) a study of pregnant women in Botswana, 2) literature reviews and 3) expert opinion. We expressed the study outcome in terms of costs (US$), cases cured, magnitude of overtreatment and successful partner treatment. Results: Azithromycin was less costly and more effective than was erythromycin. Compared to syndromic management, testing all attendees on their first visit with a 75% sensitive POC test increased the number of cases cured from 1 500 to 3 500 in a population of 100 000 women, at a cost of US$38 per additional case cured. This cost was lower in high-prevalence populations or if testing was restricted to teenagers. The specific POC tests provided the advantage of substantial reductions in overtreatment with antibiotics and improved partner management. Conclusions: Using POC tests to diagnose chlamydia during antenatal care in sub-Saharan Africa entails greater health benefits than syndromic management does – and at acceptable costs – especially when restricted to younger women. Changes in diagnostic strategy and treatment regimens may improve people’s health and even reduce health care budgets. |
| Keywords: | Chlamydia trachomatis (MeSH); Cost-effectiveness analysis (non-MeSH); Cost Analysis (MeSH); Developing countries (MeSH); Africa (MeSH); Sub-Saharan Africa (MeSH) Maternal health (non-MeSH); Maternal Health Services (MeSH); Women’s Health (MeSH); Point-of-care tests (non-MeSH); Diagnostic tests (non-MeSH); Diagnosis (MeSH); Syndromic approach (non-MeSH); STI management (non-MeSH) |
| JEL: | I18 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_010&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics) |
| Abstract: | The objective of this study is to estimate associations between social capital and health when other factors are controlled for. Data from the survey of level-of-living conditions by Statistics Norway are merged with data from several other sources. The merged files combine data at the individual level with data that describe indicators of community-level social capital related to each person’s county of residence. Both cross-sectional and panel data are used. We find that one indicator of community-level social capital — voting participation in local elections — was positively associated with self-assessed health in the cross-sectional study and in the panel data study. While we find that religious activity at the community-level has a positive effect in the cross-sectional survey and a non-significant effect in the panel survey, we find that sports organizations have a negative effect on health in the cross-sectional survey and a non-significant effect in the panel study. This result indicates that sports organizations represent bonding social capital. |
| Keywords: | social capital; health; Norway |
| JEL: | I19 |
| Date: | 2009–06–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2007_009&r=hea |
| By: | Melberg, Hans Olav (Institute of Health Management and Health Economics) |
| Abstract: | This paper reports briefly on some of the results from a survey of academics who have written about the theory of rational addiction. The topic is important in itself because if the literature is viewed by its participants as an intellectual game, then policy makers should be aware of this so as not to derive actual policy from toy models. More generally, the answers shed light on the nature of economics and how many economists think about model building, evidence requirements and the policy relevance of their work. A majority of the respondents believe the literature is a success story that demonstrates the power of economic reasoning. At the same time they also believe the empirical evidence to be weak, and they disagree both on the type of evidence that would validate the theory and the policy implications. Taken together this points to an interesting gap. On the one hand most of the respondents claim that the theory has valuable real-world implications. On the other hand they do not believe the theory has received empirical support. |
| Keywords: | Rational addiction theory; survey of opinions of economists; disagreement on evidence criteria and interpretation of evidence |
| JEL: | I10 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_007&r=hea |
| By: | Biørn, Erik (Department of Economics); Godager, Geir (Institute of Health Management and Health Economics) |
| Abstract: | The impact of quality on the demand facing health care providers has important implications for the industrial organization of health care markets. In this paper we study the consumers' choice of general practitioner (GP) assuming they are unable to observe the true quality of GP services. A panel data set for 484 Norwegian GPs, with summary information on their patient stocks, renders the opportunity to identify and measure the impact of GP quality on the demand, accounting for patient health heterogeneity in several ways. We apply modeling and estimation procedures involving latent structural variables, inter alia, a LISREL type of model,is used. The patient excess mortality rate at the GP level is one indicator of the quality. We estimate the effect of this quality variable on the demand for each GP's services. Our results, obtained from two different econometric model versions, indicate that GP quality has a clear positive effect on demand. |
| Keywords: | GP services; Health care quality; Health care demand; Latent variables; LISREL; Panel data; Norway |
| JEL: | C23 C33 D83 H51 H75 I11 I18 |
| Date: | 2009–06–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2008_003&r=hea |
| By: | Eric, Biørn (Department of Economics, University of Oslo); Hagen, Terje P. (Institute of Health Management and Health Economics); Iversen, Tor (Institute of Health Management and Health Economics); Magnussen, Jon (Department of Public Health and General Practice) |
| Abstract: | The paper examines the heterogeneity with respect to the impact of a financial reform - Activity Based Financing (ABF) - on hospital efficiency in Norway. Measures of technical efficiency and of cost-efficiency are considered. The data set is from a contiguous ten-year panel of 47 hospitals covering both pre-ABF years and years after its imposition. Substantial heterogeneity in the responses, as measured by both estimated and predicted coefficients, is found. Rank correlations between the estimated/predicted coefficients of the ABF dummy and the pre-ABF/post-ABF efficiencies are examined. Overall, improvement seems to be more pronounced in technical efficiency than in cost-efficiency. |
| Keywords: | Health econometrics; Panel data; Hospital efficiency; Activity-based financing; Random coefficients; Heterogeneity; Rank Correlation |
| JEL: | C23 C33 H51 I12 I18 |
| Date: | 2009–06–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2006_009&r=hea |