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on Health Economics |
| By: | Yasser Moullan (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I) |
| Abstract: | This paper analyse the impact of health foreign assistance on physicians' brain drain. We use the database from Bhargava and Docquier (2008) to explain physicians' brain drain and health foreign assistance from 1995 to 2003 using a bilateral gravity equation model. In the first time, we propose to investigate the direct and reverse impact of health assistance through simultaneous equation model with Three-Stage Least Squares (3SLS) methodology and highlight a significant negative effect of health foreign assistance on the medical brain whereas emigration rate of doctor increases the amount of health aid received by recipient countries. In a second time, we analyzed the indirect effect of health aid via epidemics prevalence through the death rate per 1000 people. We find that health aid plays a key role in the improvement of vaccination, treatment and prevention which may reduce death rate and, finally, decreases the physicians emigration rates. These findings confirm the efficiency of health foreign aid to weaken the vicious circle of physicians drain. |
| Keywords: | International migration ; physicians emigration rates ; foreign aid ; health foreign assistance ; simultaneous equation model ; Three Stage Least Squares ; gravity equation model |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:cesptp:halshs-00399306_v1&r=hea |
| By: | Ulimwengu, John M. |
| Abstract: | "The A stochastic frontier production function is used to estimate agricultural efficiency index. Then, controlling for household characteristics and other exogenous variables, the efficiency index is regressed on the probability of being sick. Estimation is performed using the treatment effect model where the probability of being sidelined by sickness is modeled as a probit. This framework allows policy simulations that underscore the impact of farmers' health status on both agricultural efficiency and poverty reduction. Overall, regression results confirm the negative impact of health impediment on farmers' agricultural efficiency. Simulation results show that improving farmers' agricultural efficiency by investing in farmers' health may not necessarily lead to poverty reduction. Additional policy instruments may be needed to achieve simultaneous increase in agricultural productivity and reduction in poverty rate." from authors' abstract |
| Keywords: | health, Agriculture, productivity, Poverty, Farmers, Efficiency, Stochastic, Production, Science and technology, Institutional change, Innovation, |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:ifprid:868&r=hea |
| By: | Smith, James P. (RAND) |
| Abstract: | This paper examines impacts of childhood health on SES outcomes observed during adulthood-levels and trajectories of education, family income, household wealth, individual earnings and labor supply. The analysis is conducted using data that collects these SES measures in a panel who were originally children and who are now well into their adult years. Since all siblings are in the panel, one can control for unmeasured family and neighborhood background effects. With the exception of education, poor childhood health has a quantitatively large effect on all these outcomes. Moreover, these estimated effects are larger when unobserved family effects are controlled. |
| Keywords: | childhood health, labor market outcomes |
| JEL: | I10 J00 |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4274&r=hea |
| By: | Herbst, Chris M. (Arizona State University); Tekin, Erdal (Georgia State University) |
| Abstract: | Child care subsidies play a critical role in facilitating the transition of disadvantaged mothers from welfare to work. However, little is known about the influence of these policies on children's health and well-being. In this paper, we study the impact of subsidy receipt on low-income children's weight outcomes in the fall and spring of kindergarten. The goals of our empirical analysis are twofold. We first utilize standard OLS and fixed effects methods to explore body mass index as well as measures of overweight and obesity. We then turn to quantile regression to address the possibility that subsidy receipt has heterogeneous effects on children's weight at different points in the BMI distribution. Results suggest that subsidy receipt is associated with increases in BMI and a greater likelihood of being overweight and obese. We also find substantial variation in subsidy effects across the BMI distribution. In particular, child care subsidies have no effect on BMI at the lower end of the distribution, inconsistent effects in the middle of the distribution, and large effects at the top of the distribution. Our results point to the use of non-parental child care, particularly center-based services, as the key mechanism through which subsidies influence children's weight outcomes. |
| Keywords: | child care, subsidy, obesity |
| JEL: | I12 I18 J13 |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp4255&r=hea |
| By: | Yu, Li; Orazem, Peter; Jolly, Robert W. |
| Abstract: | Rural firms have a higher survival rate than urban firms. Over the first 13 years after firm entry, the hazard rate for firm exits is persistently higher for urban firms. While differences in firm attributes explain some of the rural-urban gap in firm survival, rural firms retain a survival advantage 18.5% greater than observationally equivalent urban firms. We argue that in competitive markets, the remaining survival advantage for rural firms must be attributable to unobserved factors that must be known at the time of entry. A plausible candidate for such a factor is thinner markets for the capital of failed rural firms. The implied lower salvage value of rural firms suggests that firms sorting into rural markets must have a higher probability of success in order to leave their expected profits equal to what they could earn in an urban market. |
| Keywords: | Rural, urban, entry, exit, survival, sorting , salvage value |
| JEL: | R0 |
| Date: | 2009–07–03 |
| URL: | http://d.repec.org/n?u=RePEc:isu:genres:13085&r=hea |
| By: | Marie-Louise Leroux; Grégory Ponthière |
| Abstract: | Classical utilitarianism, if coupled with standard assumptions such as the expected utility hypothesis and additive lifetime welfare, has the undesirable corollary to recommend a redistribution of resources from short-lived to long-lived agents, against any intuition of compensation. This paper proposes a remedy to that undesirable property of utilitarianism. This remedy consists in imputing, when solving the social planner's problem, the consumption equivalent of a long life to the consumption of long-lived agents. Provided the consumption equivalent is positive, the modified first-best problem exhibits a compensation of short-lived agents, under the form of a higher consumption. Then, in a general framework where agents differ in survival prospects, we compare the ex ante remedy (compensating agents with a lower life expectancy) and the ex post remedy (compensating short-lived agents), and show their incompatibility. |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pse:psecon:2009-19&r=hea |
| By: | Noguchi, Haruko; Shimizutani, Satoshi |
| Abstract: | Following the introduction of the long-term care insurance scheme and deregulation of the market for at-home care services, Japan experienced a substantial increase in expenditure on care for the elderly. Using household-level survey data, we empirically examine whether the increase in care expenditure is associated with supplier density springing from the rise in the number of care providers following deregulation. We provide weak evidence that supplier density in the at-home care market is positively correlated with probability to use care or expenditure on care. Moreover, we find no link between the share of for-profit providers and the demand for at-home care services. |
| Keywords: | supplier density, at-home care, long-term care insurance |
| JEL: | I11 |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:hit:piecis:434&r=hea |
| By: | Durevall, Dick (Department of Economics, School of Business, Economics and Law, Göteborg University); Lindskog, Annika (Department of Economics, School of Business, Economics and Law, Göteborg University) |
| Abstract: | The paper analyses how communal HIV/AIDS in rural Malawi impacts on fertility. Ordered probit models are estimated using individual data on actual fertility and the ideal number of children from the 2004 Malawi Demographic and Health Survey. The survey includes tests of HIV status, making it possible to distinguish between behavioural and physiological effects. The main indicator of communal HIV/AIDS is district prime-age mortality rates, obtained from the 1998 Population Census. The paper first address the question of the overall behavioural fertility response due to the epidemic, and then tests for differences in responses due to genderspecific district mortality and HIV rates, knowledge about mother-to-child HIV transmission, and age. The main findings are: HIV/AIDS has a negative but small impact on fertility; responses differ depending on genderspecific district mortality and HIV rates, actual fertility and women’s ideal number of children are more negatively affected by HIV/AIDS among women than among men; and a woman’s knowledge about mother-tochild transmission of HIV and age are important determinants of her fertility response to the disease.<p> |
| Keywords: | fertility; gender; HIV prevalence; mortality; prime-age adult mortality |
| JEL: | I10 J13 O12 |
| Date: | 2009–06–25 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:gunwpe:0369&r=hea |
| By: | Barrett, Scott (Johns Hopkins University); Hoel, Michael (Department of Economics) |
| Abstract: | Using a dynamic model of the control of an infectious disease, we derive the conditions under which eradication will be optimal. When eradication is feasible, the optimal program requires either a low vaccination rate or eradication. A high vaccination rate is never optimal. Under special conditions, the results are especially stark: the optimal policy is either not to vaccinate at all or to eradicate. Our analysis yields a cost-benefit rule for eradication, which we apply to the current initiative to eradicate polio. |
| Keywords: | Eradication of infectious diseases; vaccination; control theory; cost-benefit analysis; poliomyelitis |
| JEL: | D61 H41 I18 |
| Date: | 2009–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2003_023&r=hea |
| By: | Sæther, Erik Magnus (Ragnar Frisch Centre for Economic Research) |
| Abstract: | What is the effect of increased wages on physician’s working hours and sector choice? This study applies an econometric framework that allows for non-convex budget sets, nonlinear labor supply curves and imperfect markets with institutional constraints. The physicians are assumed to make choices from a finite set of job possibilities, characterized by practice form, hours and wage rates. The individuals may combine their main position with an extra job, opening for a variety of combinations of hours in the respective jobs. I take into account the complicated payment schemes for physicians, taxes and household characteristics when estimating labor supply on Norwegian micro data. The results show a modest response in total hours to a wage increase, but a reallocation of hours in favor of the sector with increased wages. |
| Keywords: | Physicians; discrete choice; labor supply |
| JEL: | C25 I10 J22 |
| Date: | 2009–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2003_019&r=hea |
| By: | Vislie, Jon (Department of Economics) |
| Abstract: | The author will in this paper analyse the issue of payment reforms for a public health care system, where public hospitals offer treatment. Any health care system should provide treatment so as to maximise expected social welfare. The implementation of this outcome, through the way private og public health care providers or hospitals are compensated for the cost of providing services, has been a policy issue in a number of countries. Many payment reforms are now based on a (high-powered) DRG-price system, so as to induce cost consciousness. <p> The hospitals are privately informed about the diseases of each patient and offer treatment with a stochastic outcome, while cost control cannot be verified. Ex post outcome and realised cost of treatment can be verified, with cost depending on treatment intensity, cost-reducing effort and the type of disease. With a disease-contingent transfer, the hospital is able to capture a rent, which has a social cost due to tax distortions and because rent has no direct weight in the welfare function. <p> When type of treatment can be verified, treatment should be less intensive than under complete information, if marginal cost of treatment is disease-dependent. However, rent extraction is accomplished not only by a less aggressive treatment (which has a negative impact on the likelihood for recovery), but also by offering a cost-reimbursement scheme, without any recovery-contingent bonus. When treatment is unverifiable, induced treatment should again be below the first-best level. This solution is implemented through a combination of a recovery-contingent bonus (declining in severity) and cost sharing (with the fraction of cost being reimbursed by the government being increasing in severity). |
| Keywords: | Public health care; hospital expenses |
| JEL: | I18 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_006&r=hea |
| By: | Gjerde, Jon (Norwegian Computing Center); Grepperud, Sverre (Institute of Health Management and Health Economics); Kverndokk, Snorre (Ragnar Frisch Centre for Economic Research) |
| Abstract: | A good health is important for having a good life. This is supported by surveys on happiness. However, at least after a certain age, the health state deteriorates naturally over time due to ageing. Nevertheless, research reports show that old people in average are satisfied with their health conditions. This and other empirical evidence indicate that individuals adapt to poorer health conditions. But how will this adaptation influence the demand for health services? <p> Gjerde, Grepperud and Kverndokk will in this paper analyse the impacts of adaptation to a falling health state on the demand for health and medical care. This is done by integrating adaptation processes in the pure consumption model of Grossman. The authors will modify the consumption-model in another direction by introducing an uncertain lifetime. Model simulations show that adaptation affects the health variables by lowering the incentives to invest in health, as well as smoothening the optimal health stock path over the life cycle. Whether or not the risk of mortality is an object of choice has important effects on the joint development of the health variables. |
| Keywords: | Grossman; Demand for health; Adaptation; Life extension; Ageing. |
| JEL: | C61 D91 I12 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_007&r=hea |
| By: | Asheim, Geir (Department of Economics); Nilssen, Tore (Department of Economics); Emblem, Anne Wenche (Agder University) |
| Abstract: | In this paper, we view health insurance as a combined hedge against the two consequences of falling ill: treatment expenditures and loss in income. We discuss how an individual’s ability when healthy affects her decision on whether to buy health insurance with treatment to full recovery if ill or with partial treatment combined with cash compensation for the resulting loss in income. We find that a highability individual demands full recovery and is fully insured, while a low-ability individual demands partial treatment and cash compensation and is only partly insured. |
| Keywords: | Health Insurance; Treatment; Compensation |
| JEL: | D81 G22 I11 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_001&r=hea |
| By: | Kravdal, Øystein (Department of Economics) |
| Abstract: | Study objectives - Sociodemographic differentials in cancer survival have occasionally been studied by using a relative-survival approach, where all-cause mortality among persons with a cancer diagnosis is compared with that among similar persons without such a diagnosis (’normal’ mortality). One should ideally take into account that this ’normal’ mortality not only depends on age, sex and period, but also various other sociodemographic variables. However, this has very rarely been done. A method that allows such variations to be considered is presented here, as an alternative to an existing technique, and is compared with a relative-survival model where these variations are disregarded and two other methods that have often been used. Design, setting and participants – The focus is on how education and marital status affect the survival from twelve common cancer types among men and women aged 40-80. Four different types of hazard models are estimated, and differences between effects are compared. The data are from registers and censuses and cover the entire Norwegian population for the years 1960- 1991. There are more than 100 000 deaths to cancer patients in this material. Main results and conclusions - A model for registered cancer mortality among cancer patients gives results that for most, but not all, sites are very similar to those from a relative-survival approach where educational or marital variations in ’normal’ mortality are taken into account. A relative-survival approach without consideration of these sociodemographic variations in ’normal’ mortality gives more different results, the most extreme example being the doubling of the marital differentials in survival from prostate cancer. When neither sufficient data on cause of death nor on variations in ’normal’ mortality are available, one may well choose the simplest method, which is to model all-cause mortality among cancer patients. There is little reason to bother with the estimation of a relative-survival model that does not allow sociodemographic variations in ’normal’ mortality beyond those related to age, sex and period. Fortunately, both these less data demanding models perform well for the most aggressive cancers. |
| Keywords: | Cancer survival models; education; marriage |
| JEL: | J12 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_003&r=hea |
| By: | Hoel, Michael (Department of Economics); Nilssen, Tore (Department of Economics); Vislie, Jon (Department of Economics); Iversen, Tor (Institute of Health Management and Health Economics) |
| Abstract: | A central theme in the international debate on genetic testing concerns the extent to which insurance companies should be allowed to use genetic information in their design of insurance contracts. This issue is analysed within a model with the following important feature: A person's well-being depends on the perceived probability of becoming ill in the future in a way that varies among individuals. <p><p> The authors show that both tested high-risks and untested individuals are equally well off whether or not test results can be used by insurers. Individuals who test for being low-risks, on the other hand, are made worse off by not being able to verify this to insurers. This implies that verifiability dominates non-verifiability in an ex-ante sense. |
| Keywords: | Health insurance; isurance contracts; genetic testing; genetic information |
| JEL: | D82 I11 I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_010&r=hea |
| By: | Olsen, Jan Abel (Institute of Community Medicine); Eidem, Jan Inge (Department of Economics) |
| Abstract: | This paper analyses the extents to which variations in revenues and memberships of health charities – or patient organisations – might be explained by characteristics of the diseases that the organisations represent. After a theoretical discussion it inquires into 45 Norwegian patient organisations. The findings suggest that prevalence, followed by death risk are the most important characteristics of the disease for explaining charity size. There were indications that the status of the disease influenced memberships. Still, the most significant variables to explain revenues are the organisation’s age and its memberships. Cross-sectional comparisons gave no indications that public revenues ‘crowd out’ private donations. |
| Keywords: | Health charities; disease characteristics |
| JEL: | D64 D71 I19 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_016&r=hea |
| By: | Hoel, Michael (Department of Economics) |
| Abstract: | Cost effectiveness is a criterion that is often recommended for prioritizing between different types of health care. A modified use of this criterion can be justified as the outcome of a choice that is made “behind a veil of ignorance”. Reduced health will in many cases also gives an income loss that is shared between the patient and society at large. In the special case where the marginal utilities of health status (measured by QALYs) and income are independent of the health state, an efficient allocation of health resources is characterized by net marginal costs per QALY being equalized across different types of health care. Net marginal costs are equal to gross marginal costs minus the reduction in health related income losses due to treatment. In the general case where marginal utilities depend on the health state this rule must be modified. |
| Keywords: | Health management; cost effectiveness; social security; QALY |
| JEL: | D61 D63 H42 I18 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_009&r=hea |
| By: | Hoel, Michael (Department of Economics); Sæther, Erik Magnus (Ragnar Frisch Centre for Economic Research) |
| Abstract: | In this article the authors Michael Hoel and Erik Magnus Sæther consider an economy where most of the health care is publicly provided, and where there is waiting time for several types of treatments. Private health care without waiting time is an option for the patients in the public health queue. This article shows the effects of a tax (positive or negative) on private health care, and derives the socially optimal tax/subsidy. Finally, a discussion of how the size of the tax might affect the political support for a high quality public health system is provided. |
| Keywords: | Private health care; public health care; health queues |
| JEL: | I11 I18 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2000_009&r=hea |
| By: | Strand, Jon (Department of Economics) |
| Abstract: | The paper discusses how to derive empirical estimates of the value of a statistical life (VSL) from observations of highway driving speeds, and from how such speeds are affected by speed limits and penalties for speeding. When drivers optimize with respect to driving speeds, we discuss three alternative approaches. The first two rely on constructing drivers’ utility functions, and the last on revealed government preferences similar to that used by Ashenfelter and Greenstone (2002) (A-G). The two last approaches are based on observations of changed driving speeds when speed limits and speeding penalties change. When drivers are law obedient and adhere to speed limits only the A-G approach can be used. Their approach is however unrealistic in putting overly great demand on government information about VSL, and in addition provides upwardly biased average VSL estimates. |
| Keywords: | Value of a statistical life; VSL; driving |
| JEL: | J17 |
| Date: | 2009–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2003_021&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics); Lurås, Hilde (Institute of Health Management and Health Economics) |
| Abstract: | We study the interaction between patient shortage and patients' waiting time to get an appointment. From a theoretical model we predict that physicians experiencing a shortage of patients offer their patients a shorter waiting time than their unconstrained colleagues. This happens because a shorter waiting time is expected to lower the threshold for seeking care, and hence, to increase the number of patient-initiated contacts. But it also happens because a shorter waiting time can be a mean to attract new patients. The hypotheses are supported by some preliminary results from a sample of Norwegian general practitioners participating in a capitation trial. |
| Keywords: | General practitioner; patient shortage; waiting time |
| JEL: | I11 I18 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:1999_002&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics); Lurås, Hilde (Institute of Health Management and Health Economics) |
| Abstract: | The objective of this paper is to demonstrate that micro data is fundamental for the study of income motivated behaviour among general practitioners (GPs). We argue that a GP who experiences a shortage of patients in a mixed capitation and fee for service payment system, is likely to have a more service intensive practice style than his unconstrained colleagues. If he cannot have his optimal number of patients, a second best is to increase the number of services per patient if the income per time unit of providing services is greater than the marginal valuation of leisure. An empirical test requires micro data of GPs' rationing status. Data from the Norwegian capitation experiment provide us with this opportunity. We find that the effect of patient shortage (strong rationing) on a GP's income from fees per patient is positive and statistically significant. Furthermore, we find that only the municipality with the lowest GP density has a negative and statistically significant effect. If only GP density data would have been available, we might erroneously have concluded that service provision among GPs is not income motivated. The reason is that aggregate data miss the within municipality variation in the actual number of patients relative to GPs' preferred numbers. We conclude that macro data of GP density in an area are not likely to be useful in this context because the effect of better access is often not distinguishable from the effect of physician initiated services. |
| Keywords: | General practitioners; income motivated behaviour; patient shortage; service intensive; Norwegian capitation experiment |
| JEL: | I18 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:1999_003&r=hea |
| By: | Hallsteinli, Vidar (SINTEF Unimed, Health Services Research); Kittelsen, Sverre AC (Ragnar Frisch Centre for Economic Research); Magnussen, Jon (SINTEF Unimed, Health Services Research) |
| Abstract: | In this paper, the authors examine the scale, efficiency and organization of Norwegian psychiatric outpatient clinics for children. Their question is whether there is room for improved performance in these clinics, and how much? Assuming that about 5 per cent of the Norwegian population under 18 years sometimes is in need of specialist psychiatric care, it is clear that this group will suffer when we know that psychiatric services were delivered to only 2.1 per cent of the whole Norwegian population (data from 1998). Based on a relatively low number of registered consultations per therapist (1,1 per therapist day) the ministry has stipulated that productivity can increase with as much as 50 per cent. Access to services can be improved by increasing capacity, but also by increasing the utilization of the existing capacity. <p> With an Data Envelopment Analysis (DEA) the authors estimate a best-practice production frontier. The potential for efficiency improvement is measured as the difference between actual and best-practice performance, while allowing for trade-offs between different staff groups and different mixes of service production. Based on 135 observations for the years 1997 to 1999, the DEA tests lead to a model with two inputs, two outputs and variable returns to scale. The outputs are number of hours spent on direct and indirect interventions, while neither the number of interventions nor the number of patients where found to be significant. The inputs are the number of university-educated staff and other staff, but disaggregating the latter group was not significant. The analysis show that a average of estimated clinic efficiencies is 71%. Mean estimated productivity is 64%, but many large clinics have considerably lower performance due mainly to scale inefficiency. |
| Keywords: | Health Care; Productivity; Data Envelopment Analysis |
| JEL: | C61 D24 I12 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_008&r=hea |
| By: | Lurås, Hilde (Institute of Health Management and Health Economics) |
| Abstract: | In this explorative study we examine factors explaining individual choice of lifestyle. The empirical analysis of smoking, exercising and diet show that the mechanisms determining people’s lifestyle are complex. We argue that the economic models on the demand for health is a meaningful framework for analysing this issue, but that it needs some refinements. A suggestion for further analytical work is therefore to reformulate the model to incorporate own past behaviour (habits), the society individuals belongs to (traditions and norms), as well as a more immediate effect on utility of lifestyle. |
| Keywords: | Health demand models; lifestyle; ordered probit analysis |
| JEL: | C35 I12 I18 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_011&r=hea |
| By: | Pedersen, Kjeld Møller (Department of public health, health economics) |
| Abstract: | In this essay a conceptual and theoretical scheme for decentralized integrated health care systems of the northern European kind is developed. With small changes it is also applicable to other countries, e.g. Italy, Spain, and Portugal. Three ideas tie together the scheme: modified fiscal federalism, principalagent thinking and the analysis of discrete structural alternatives from new institutional economics. As a special case it encompasses the ideas of planned markets and public competition developed by von Otter and Saltman. The scheme can be used to analyse driving forces behind reforms and prediction of effects. To illustrate the thinking the recent Norwegian reform is put into context, not only geographically but also theoretically. The geographical context is that of Scandinavia and there is a summary of reforms in the Scandinavian countries over the past 20-30 years. The essay thus serves the double purpose of presenting and evaluating the Norwegian reform in a Scandinavian context and to take part in the neglected discipline of developing a theory of health care reform. The Norwegian January 2002 reform is described in some detail. It is a reversal of the Scandinavian model of decentralization and a move towards more centralism. The hospital system was transferred to the state that established five regions with independent (non-political) boards and each region has a number of daughters (hospitals) that have great autonomy with their own boards and are outside the legal restrictions of the public sector. Basically the idea is to mimic the corporate structure of large private companies. The reform is evaluated based on principal-agent thinking and the analysis of discrete structural alternatives. Overall there is no a priori reason to expect large improvements in efficiency – but on the other hand neither should one expect things to get worse. Many effects depend, however, crucially, on (a) the financing system that will be put in place late 2002 or early 2003, and (b) whether or not the political and management culture change as a result of the reform. In the concluding sections possible implications for Denmark and Sweden are discussed. |
| Keywords: | Health care reform; Norway; principal-agents; discrete structural analysis |
| JEL: | H71 H72 H73 H77 I11 I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_007&r=hea |
| By: | Botten, Grete (Institute of Health Management and Health Economics); Hagen, Terje P. (Institute of Health Management and Health Economics) |
| Abstract: | Aggregated medical spending differs widely across countries and large variations exist in the frequency and the mix of medical services provided, as well as the type of technology applied. The outcomes (mostly measured as survival rates) do not, however vary to the same extent as the spending. Policy makers in many countries compare their spending to each other, with no clear consensus about how systems are effective in treating patients. In each of these debates the issue of what medical care is buying arises: When countries spend more or less on health care, how does that affect resource allocation in the medical sector and ultimately the health outcomes? <p> The goal of the project1 was to examine how different medical care systems will affect the allocation of resources in the medical sector. As the existing available macro data at an international level does not allow for satisfactory answers to such questions, this project wanted to use a microeconomic approach. An international comparison of treatments of conditions in older populations that lead to high expenditures could help to identify treatments that might be more effective in improving outcomes at lower cost. Therefore the project focused on international comparisons of treatments for a spectrum of conditions in older populations with high aggregate medical spending, well identified episodes of care, high prevalence and high policy relevance. Norway participated in studies on myocardial infarction and breast cancer 2. The choice of focus on older patients was partly motivated by the fact that in the future the elderly will probably take an increasingly proportion of the total spending in the health care sector. <p> See documentation from the main project: http://www.oecd.org/EN/document/0,,EN-do cument-194-5-no-27-32316-0,00.html |
| Keywords: | Medical care; allocation of resources; acute myocardial infarction; breast cancer; international comparisons of treatments |
| JEL: | I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_015&r=hea |
| By: | Kittelsen, Sverre A.C. (The Ragnar Frisch Centre for Economic Research); Magnussen, Jon (SINTEF Unimed NIS Health Services Research) |
| Abstract: | While measures of output in mental health care are even harder to find than in other health care activities, some indicators are available. In modelling productive efficiency the problem is to select the output variables that best reflect the use of resources, in the sense that these variables have a significant impact on measures of efficiency. The paper analyses cross-sectional data on the psychiatric outpatient clinics of Norway using the Data Envelopment Analysis (DEA) non-parametric efficiency measurement method, and tests the variable specification using statistical tools recently introduced in the literature. In addition to outputs, the importance of different profession or educational groups on efficiency is examined, and results are compared for separate samples of clinics for children and youths (BUP) with clinics for adults (VP). |
| Keywords: | Mental health care; efficiency; psychiatric outpatient clinics; DEA; Norway |
| JEL: | I18 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:1999_004&r=hea |
| By: | Biørn, Erik (Department of Economics); Hagen, Terje P. (Institute of Health Management and Health Economics); Iversen, Tor (Institute of Health Management and Health Economics); Magnussen, Jon (SINTEF Unimed Health Services Research) |
| Abstract: | Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction (30 to 50 per cent) of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF compared with global budgets. The prediction is tested using a panel data set from the period 1992-2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. Contrary to our prediction, the result is less uniform with respect to the effect on cost-efficiency. We suggest several reasons why this prediction fails. Keywords are poor information of costs, production-oriented drive, tight factor markets and soft budget constraints. |
| Keywords: | Public hospitals; financing; efficiency; DEA-scores; panel data; Norway |
| JEL: | C23 I11 I18 L32 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_008&r=hea |
| By: | Strand, Jon (Department of Economics) |
| Abstract: | We present a stated-preference study where values of statistical lives (VSL) are derived both as public and private goods, and we distinguish between three different death causes, heart disease, environmentally related illnesses and traffic accidents. 1000 randomly chosen individuals in Norway were faced a three-part valuation procedure: 1) pairwise comparisons (conjoint analysis), 2) combined contingent-ranking and contingent-valuation of willingness to pay (WTP) for public projects to reduce overall population mortality risk, and 3) WTP for individual treatment reducing own mortality risk from heart disease. Parts 1-2 comprise all three death causes, and indicate public-good VSL in the range 3-6 million USD, with heart disease deaths in the lower part of this range, environmental causes in the upper part, and traffic accidents in-between. Part 2 also permits a splitting up of VSL into motives (selfmotivated and altruistic), and indicates that about 30 % of total public-good WTP is selfmotivated. Part 3 provides a self-motivated (private-good) VSL figure for heart disease in the range 1-1.5 million USD, close to the self-motivated share of VSL from part 2. We find high consistency between values derived, and indications that private- and public-good VSL may differ subtantially, as well as VSL by death cause. Under pairwise comparisons in part 1 we find complete insensitivity of VSL to risk magnitude (or “scope”), in contrast to existing literature. The more complex choices under part 2 by contrast imply considerable scope sensitivity. |
| Keywords: | Value of statistical lives; public goods; stated preference methods; altruism |
| JEL: | D64 H41 H42 I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_002&r=hea |
| By: | Emblem, Anne Wenche (Faculty of Economics and Social Science) |
| Abstract: | This paper studies redistribution by means of a public supply of medical treatment. We show that the government can redistribute income towards low-ability individuals in a world of asymmetric information by offering bundles of medical treatment and redistributive payment. If self-selection is a problem, then the separating scheme offers high-ability individuals complete treatment against a high payment, and low-ability individuals partial treatment against a low payment. In particular, the level of treatment offered low-ability individuals is distorted downwards. |
| Keywords: | health; medical treatment; insurance; redistribution; self-selection |
| JEL: | D81 H42 I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_004&r=hea |
| By: | Olsen, Jan Abel (Institute of Community Medicine); Ricardson, Jeff (Centre for Health Program Evaluation); Dolan, Paul (Sheffield Health Economics Group); Mentzel, Paul (Pacific Lutheran University) |
| Abstract: | This paper discusses the moral relevance of accounting for various personal characteristics when prioritising between groups of patients. After a review of the results from empirical studies, we discuss the ethical reasons which might explain – and justify – the views expressed in these studies. The paper develops a general framework based upon the causes of ill health and the consequences of treatment. It then turns to the question of the extent to which a personal characteristic – and the eventual underlying ethical justification of its relevance – could have any relationships to these causes and consequences. We attempt to disentangle those characteristics that may reflect a potentially relevant justification from those which violate widely accepted principles of social justice. |
| Keywords: | Health care priorities; Ethics; Personal responsibilities; Consequences |
| JEL: | I18 I31 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_017&r=hea |
| By: | Iversen, Tor (Institute of Health Management and Health Economics); Kopperud, Gry Stine (Institute of Health Management and Health Economics) |
| Abstract: | What factors contribute to the utilization of specialist health care in Norway, and to what extent is the policy goal of allocating health care according to peoples medical need fulfilled? With this scope the authors analyse the impact of a person's health relative to the impact of access to specialist care. It is distinguished between services provided by public hospitals and services provided by private specialists financed by the National Insurance Scheme. The data allow to consider individual patient characteristics since Survey of Living Conditions data are merged with data on capacity and access to general practice and specialist care. <p> The estimation of logit models and negative binomial models show significant differences between the factors that influence contacts with private specialists and contacts with hospitals. While a person's self-assessed health plays a major role in the utilization of hospitals, there is no significant effect of this variable on the utilization of private specialists. The supply-side variables measured by GP density and the accessibility indices for specialist care have significant effects on the utilization of private specialists, but not on hospital visits and inpatient stays. <p> A preliminary conclusion is that the utilization of hospital services is rationed according to patients' health status, and not influenced by patients' access. Hence, the utilization of hospital services seems to be in accordance with officially stated health policy. On the other hand, private specialists seem to function as an alternative to general practice. Moreover, the significant effect of chronic conditions on the utilization of private specialists suggests that regular check-ups of chronic patients are an important part of the services provided by private specialists. The challenge to policy makers is to consider measures that bring the utilization of publicly funded private specialists in accordance with national health policy. |
| Keywords: | Specialist health care; capacity; access to general practice |
| JEL: | I18 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_009&r=hea |
| By: | Kverndokk, Snorre (Ragnar Frisch Centre for Economic Research) |
| Abstract: | This paper proposes several ways to extend the standard model for health and health services. Psychological aspects such as status seeking, identity seeking and health adaptation are modelled within the framework of the Grossman model. While the two first aspects may be important psychological mechanisms, the adaptation process seems to be the most relevant process to model within a theoretical dynamic framework. As far as we know, there are no formal analyses of this process in the economic literature. |
| Keywords: | Grossman; health adaption; health services |
| JEL: | I18 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2000_005&r=hea |
| By: | Kittelsen, Sverre A.C. (Frisch Centre); Kjæserud, Guri Galtung (Frisch Centre); Kvamme, Odd Jarle (Department of General Practice) |
| Abstract: | Efficiency analyses in the health care sector are often criticised for not incorporating quality variables. The definition of quality of primary health care has many aspects, and it is inevitably also a question of the patients’ perception of the services received. This paper uses variables derived from patient evaluation surveys as measures of the quality of the production of health care services. It uses statistical tests to judge if such measures have a significant impact on the use of resources in various Data Envelopment Analysis (DEA) models. As the use of survey data implies that the quality variables are measured with error, the assumptions underlying a DEA model are not strictly fulfilled. This paper focuses on ways of correcting for biases that might result from the violation of selected assumptions. Firstly, any selection bias in the patient mix of each physician is controlled for by regressing the patient evaluation responses on the patient characteristics. The corrected quality evaluation variables are entered as outputs in the DEA model, and model specification tests indicate that out of 25 different quality variables, only waiting time has a systematic impact on the efficiency results. Secondly, the effect on the efficiency estimates of the remaining sampling error in the patient sample for each physician is accounted for by constructing confidence intervals based on resampling. Finally, as an alternative approach to including the quality variables in the DEA model, a regression model finds different variables significant, but not always with a trade-of between quality and quantity. |
| Keywords: | DEA; Health economics; Quality; Patient evaluation; Efficiency; Errors in variables; Resampling; Bootstrap; Selection bias; Sampling error |
| JEL: | C61 D24 I12 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_012&r=hea |
| By: | Asheim, Geir B. (Department of Economics); Nilssen, Tore (Department of Economics); Emblem, Anne Wenche (School of Management) |
| Abstract: | We study a health-insurance market where individuals are offered coverage against both medical expenditures and losses in income. Individuals vary in their level of innate ability. If there is private information about the probability of illness and an individual’s innate ability is sufficiently low, we find that competitive insurance contracts yield screening partly in the form of co-payment, i.e., a deductible in pay, and partly in the form of reduced medical treatment, i.e., a deductible in pain. |
| Keywords: | Health insurance; adverse selection; deductibles |
| JEL: | D82 I11 |
| Date: | 2009–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2002_013&r=hea |
| By: | Dalen, Dag Morten (BI Norwegian School of Management); Moen, Espen R (BI Norwegian School of Management); Riis, Christian (BI Norwegian School of Management) |
| Abstract: | In this paper we propose a simple, market based mechanism to set prices in health care markets, namely a system where the patients are auctioned out to the hospitals. Our aim is to characterize principles as to how such an auction should be designed. In the case of elective treatment, health authorities thus organize a competition between hospitals. The hospital with the lowest price signs a contracts with authority (or the insurer) that commits him to treat a given number of patients within a predetermined period. However, this is not a simple mechanism that identi…es the hospital with the lowest treatment cost. Due to potentially rapid and unpredictable shifts in demand, treatment capacity may be hard to know in advance. There is always a risk that treatment must be canceled due to arrival of patients that require acute treatment. This calls for a market design that accounts for the risk of default. Our main result is that the expected cost for the government is reduced if the government chooses to ”subsidize” default. This could be thought of as a system in which the government buys treatment in the spot market in the case of default, and let the hospital pay a default fee that is lower than the spot price. The reason why this reduces expected costs for the government is that the e¤ect on the bids is asymmetric: The second lowest bid is on average reduced more than the winning bid. Hence, the winner’s profit tends to shrink. This is due to what we characterize an endogenous correlation. Since the cost of treatment increases in the default risk (as the hospital must pay a penalty if it defaults), high cost hospitals typically have larger default risks than low costs hospitals. |
| Keywords: | Health care markets; health care; hospitals; competition |
| JEL: | I11 I12 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_003&r=hea |
| By: | Nordberg, Morten (The Ragnar Frisch Centre for Economic); Kverndokk, Snorre (The Ragnar Frisch Centre for Economic) |
| Abstract: | We use a dependent competing risks hazard rate model to investigate individual sickness absence behaviour in Norway, on the basis of register data covering more than 2 million absence spells. Our findings are: i) that business cycle improvements yield lower work-resumption rates for persons who are absent, and higher relapse rates for persons who have already resumed work; ii) that absence sometimes represents a health investment, in the sense that longer absence ‘now’ reduces the subsequent relapse propensity; and iii) that the work-resumption rate increases when sickness benefits are exhausted, but that work-resumptions at this point tend to be short-lived. |
| Keywords: | Absenteeism; Dependent risks |
| JEL: | C41 J22 |
| Date: | 2009–06–22 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2003_017&r=hea |
| By: | Hoel, Michael (Department of Economics); Iversen, Tor (Institute of Health Management and Health Economics) |
| Abstract: | Privacy of information is a central concern in the debate about genetic testing. Two types of social inefficiencies may occur when information about prevention and test status is private; genetic testing may not be done when it is socially efficient and genetic testing may be done although it is socially inefficient. The first type of inefficiency is shown to be likely for consumers with public insurance only, while the second type of inefficiency is likely for those with a mix of public/private insurance. This second type of inefficiency is shown to be more important the less effective prevention is. |
| Keywords: | Health insurance; genetic testing |
| JEL: | I11 |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:1999_001&r=hea |
| By: | Hoel, Michael (Department of Economics) |
| Abstract: | The criterion of cost-effectiveness in health management may be given a welfaretheoretical justification if people are risk neutral with respect to life years. With risk aversion, the optimal allocation of health expenditures change: Compared to the costeffective allocation, more resources should be allocated to health cases for which the expected outcomes even after treatment are worse than average. The consequences of medical interventions are usually not known with certainty. Given this type of uncertainty, simple application of cost-effectiveness analysis would recommend maximization of expected health benefits given the health budget. We show that when people are risk averse with respect to the number of life years they live, the uncertainty associated with different types of interventions should play a role on allocating the health budget. |
| Keywords: | Health management; risk aversion; QALY; HYE |
| JEL: | D61 D81 H43 H51 I18 |
| Date: | 2009–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2001_010&r=hea |
| By: | Hugh Gravelle (National Primary Care Research and Development Centre, Centre for Health Economics, University of York); Peter Sivey (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne) |
| Abstract: | We examine the implications of policies to improve information about the qualities of profit seeking duopoly hospitals which face the same regulated price and compete on quality. We show that if the hospital costs of quality are similar then better information increases the quality of both hospitals. However if the costs are sufficiently different improved information will reduce the quality of both hospitals. |
| Date: | 2009–03 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2009n05&r=hea |
| By: | C. L. Chua (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Alfons Palangkaraya (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Jongsay Yong (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne) |
| Abstract: | This paper studies the link between competition and technical efficiency of public hospitals in the State of Victoria, Australia by accounting both quantity and quality of hospital output using a two-stage semi-parametric model of hospital production and Data Envelopment Analysis. On the one hand, it finds a positive relationship between efficiency and competition measured by the Hirschman-Herfindahl Index (HHI). On the other, it finds that efficiency and the number of competing hospitals, in particular the number of competing private hospitals, to be negatively correlated. More importantly, it finds that whether or not quality is treated as an endogenous output variable, as opposed to as an exogenous control variable, may impact on the statistical estimates of the link between efficiency and competition. Also, how the effect of competition on efficiency is modelled empirically may matter, though the impact of the treatment of quality as described above appears to be more important. Overall, the results highlight the importance of quality consideration in assessing the effects of competition on efficiency and points to possibly undesirable resource allocation effects when public hospitals are made to compete with a large number of private hospitals. |
| Keywords: | hospital competition; technical efficiency; Hirschman-Herfindahl Index; data envelopment analysis; hospital quality |
| JEL: | I11 D24 D40 |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2009n16&r=hea |
| By: | Steve DeLoach (Department of Economics, Elon University); Erika Lamanna (Department of Economics, Elon University) |
| Abstract: | Access to credit has become a staple of modern development policy as a means to facilitate anything from gender equality to growth. In economic terms, it provides an important tool for smoothing household consumption in the wake of unexpected economic shocks, including drought and financial crises. Using data from the Indonesian Family Life Survey (1993-2000), this paper investigates whether access to microfinance institutions affects child health outcomes. Specifically, we estimate a difference-in-differences model to test whether a change in the availability of microfinance institutions at the community level affects the average weight gain of young children. |
| Keywords: | Microfinance, child health, nutrition, Indonesia |
| JEL: | G21 I1 J13 |
| Date: | 2009–06–19 |
| URL: | http://d.repec.org/n?u=RePEc:elo:wpaper:2009-02&r=hea |
| By: | Shinsuke Ikeda; Kang Myong-Il; Fumio Ohtake |
| Abstract: | In view of the finding that debtors are likely to be more obese than nondebtors, we investigate whether interpersonal differences in body mass are, as in the case of debt behavior, related to those in time discounting and time discounting anomalies. The effects of time discounting on body massindex (BMI) and the probabilities of being obese, severely obese, and underweightare detected by incorporating three properties of intertemporal preferences: (i) impatience, measured by the level of the respondentsf discountrate; (ii) hyperbolic discounting, where discount rates for the discountingof immediate future payoffs are higher than those of distant future payoffs; and (iii) the sign effect, wherein future negative payoffs are discounted ata lower rate than are future positive payoffs. We also find that body mass is non-monotonically correlated with age, income, and working hours. As a policy implication, body mass can potentially be controlled by changing the intertemporal structure of medical care costs. |
| Date: | 2009–03 |
| URL: | http://d.repec.org/n?u=RePEc:dpr:wpaper:0732&r=hea |
| By: | Gine, Xavier; Karlan, Dean; Zinman, Jonathan |
| Abstract: | The authors designed and tested a voluntary commitment product to help smokers quit smoking. The product (CARES) offered smokers a savings account in which they deposit funds for six months, after which they take a urine test for nicotine and cotinine. If they pass, their money is returned; otherwise, their money is forfeited to charity. Eleven percent of smokers offered CARES tookup, and smokers randomly offered CARES were 3 percentage points more likely to pass the 6-month test than the control group. More importantly, this effect persisted in surprise tests at 12 months, indicating that CARES produced lasting smoking cessation. |
| Keywords: | Tobacco Use and Control,Health Monitoring&Evaluation,Disease Control&Prevention,Alcohol and Substance Abuse,Adolescent Health |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:4985&r=hea |
| By: | Wang, Limin; Kanji, Shireen; Bandyopadhyay, Sushenjit |
| Abstract: | Extreme weather events are known to have serious consequences for human health and are predicted to increase in frequency as a result of climate change. Africa is one of the regions that risks being most seriously affected. This paper quantifies the impact of extreme rainfall and temperature events on the incidence of diarrhea, malnutrition and mortality in young children in Sub-Saharan Africa. The panel data set is constructed from Demographic and Health Surveys for 108 regions from 19 Sub-Saharan African countries between 1992 and 2001 and climate data from the Africa Rainfall and Temperature Evaluation System from 1980 to 2001. The results show that both excess rainfall and extreme temperatures significantly raise the incidence of diarrhea and weight-for-height malnutrition among children under the age of three, but have little impact on the long-term health indicators, including height-for-age malnutrition and the under-five mortality rate. The authors use the results to simulate the additional health cost as a proportion of gross domestic product caused by increased climate variability. The projected health cost of increased diarrhea attributable to climate change in 2020 is in the range of 0.2 to 0.5 percent of gross domestic product in Africa. |
| Keywords: | Health Monitoring&Evaluation,Population Policies,Climate Change,Disease Control&Prevention,Global Environment Facility |
| Date: | 2009–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:4979&r=hea |
| By: | Moreno-Serra, Rodrigo; Wagstaff, Adam |
| Abstract: | Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on"amenable mortality,"but there were significant impacts for only a couple of causes of death, and not in all model specifications. |
| Keywords: | Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Health Law,Population Policies |
| Date: | 2009–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:4987&r=hea |
| By: | Kazianga, Harounan; de Walque, Damien; Alderman, Harold |
| Abstract: | This paper uses a prospective randomized trial to assess the impact of two school feeding schemes on health and education outcomes for children from low-income households in northern rural Burkina Faso. The two school feeding programs under consideration are, on the one hand, school meals where students are provided with lunch each school day, and, on the other hand, take-home rations that provide girls with 10 kg of cereal flour each month, conditional on 90 percent attendance rate. After running for one academic year, both programs increased girls’ enrollment by 5 to 6 percentage points. While there was no observable significant impact on raw scores in mathematics, the time-adjusted scores in mathematics improved slightly for girls. The interventions caused absenteeism to increase in households that were low in child labor supply while absenteeism decreased for households that had a relatively large child labor supply, consistent with the labor constraints. Finally, for younger siblings of beneficiaries, aged between 12 and 60 months, take-home rations have increased weight-for-age by .38 standard deviations and weight-for-height by .33 standard deviations. In contrast, school meals did not have any significant impact on the nutrition of younger children. |
| Keywords: | Youth and Governance,Primary Education,Education For All,Street Children,Adolescent Health |
| Date: | 2009–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:4976&r=hea |
| By: | Pudney S (Institute for Social and Economic Research) |
| Abstract: | We investigate the processes underlying payment of Attendance Allowance (AA) in the older UK population, using a partial identification approach. Receipt of AA requires that (i) a claim is made and (ii) programme administrators assess the claim as warranting an award. These processes cannot be analysed directly because we observe neither potentially successful unpursued claims, nor rejected claims. Combining survey data with weak prior restrictions and aggregate information on claim success rates, we are able to distinguish clearly the behaviour of potential claimants and assessors. Results suggest that there are many potentially successful AA claims which are not pursued. |
| Date: | 2009–06–25 |
| URL: | http://d.repec.org/n?u=RePEc:ese:iserwp:2009-19&r=hea |
| By: | Seher Nur Sulku; Asena Caner |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:tob:wpaper:0903&r=hea |
| By: | Manoj K. Pandey |
| Abstract: | In this paper, the effect of maternal health on the under-five mortality has been examined. Third wave of micro-level National Family Health Survey 2005-06 data for rural India is used. Using various alternative measures of maternal health, the paper finds strong association between maternal health and child mortality. In particular, the effects of maternal height, weight, presence of any disease and anemia are found significant. Based on our findings, we argue that if the possible generational transfer of poor health from a mother to her child has to avoid, policies aimed at attaining the millennium development goal of reduced child mortality should be directed on improving the health of existing and future mothers. |
| Keywords: | under-five mortality, maternal height, maternal weight, body mass index, anemia |
| JEL: | D6 I12 J13 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-12&r=hea |
| By: | Manoj K. Pandey |
| Abstract: | The paper examines the association between marital status and self-reported health status of Indian adults. A nationally representative cross-sectional data surveyed by National Sample Survey Organisation (NSSO) in 2004 is used. Results confirm linkages between marital status and health and show that this relationship is sensitive to the age and gender. Based on findings, the paper argues that the implication of marital status on health could be different for adults of different age group and gender. |
| Keywords: | Self-reported Health Status, Marital Status, Ordered Probit Regression |
| JEL: | I12 J12 J14 J16 C31 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-10&r=hea |
| By: | Manoj K. Pandey |
| Abstract: | In this paper, the trend and determinants of health and poverty among the elderly in rural India is analysed. Two rounds of National Sample Survey (NSS) data for the year 1995-96 and 2004 are employed. The analysis has been done with independent and pooled datasets. Our analysis shows that levels of consumption poverty have declined marginally between 1995-96 and 2004 while increased proportion of elderly with poor health status is continued. Results suggest that poverty is one of the key determinants of health among elderly in rural India. |
| Keywords: | health, poverty, elderly |
| JEL: | I32 J14 I12 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-14&r=hea |
| By: | Manoj K. Pandey; Prakash Singh; Ram Ashish Yadav |
| Abstract: | This paper examines the effect of domestic violence on the health of ever-married women of reproductive age group in India. Micro-level National Family Health Survey (NFHS-III) data for the year 2005-06 has been used in the study. We employ disease, body mass index, under nutrition level and anemia as the measures of health and physical, emotional and sexual forms of domestic violence are used as indicators of domestic violence at both national and state levels. We find that domestic violence has negative impact on the overall women’s health and nutritional status. However, national level results are not consistent with that of the states level. Based on the findings, we argue that the issue of domestic violence should be addressed in national and state level health policies and programmes. |
| Keywords: | Domestic violence, health, prevalence rate |
| JEL: | I00 I12 J12 J16 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-13&r=hea |
| By: | Manoj K. Pandey; Charanjit Kaur |
| Abstract: | This paper examines the trend and economic determinants of the suicidal deaths in India. Time-series data over the period 1967-2006 is used from various sources. The paper analyzes the suicidal trend and exploratory relationships between suicide rate and some of the demographic and other economic variates. Further, we use ARDL model to find out the association between suicide and some economic variables. We find that inflation, per capita real GDP and industrial growth encourages the incidences of suicides whereas increased per capita household income helps in reducing suicidal deaths in India. |
| Keywords: | Suicide, Economic factors, Trends, Time series, ARDL model |
| JEL: | C22 I12 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-08&r=hea |
| By: | Manoj K. Pandey |
| Abstract: | The paper analyzes the effect of health status on labour force participation for aged Indians. The potential endogeneity in health and labour force participation has been taken care of by using full information maximum likelihood (FIML) and estimation results are compared with alternative two-stage methods. Results show that health has a significant and positive effect on labour force participation of the aged. In order to keep enough supply of elderly in the labour market, sufficient health care is necessary and hence more investment in this sector is imperative. |
| Keywords: | self-reported health status, labour force participation, elderly, endogeneity, exogeneity, simultaneous equation model |
| JEL: | J21 J14 I18 C35 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:pas:asarcc:2009-11&r=hea |
| By: | Zhang, Sidi; Kerr, William A. |
| Abstract: | This paper examins the question of revisiting the imposition of existing trade barriers in one case of an evolving marketplace â when a traditional food product is altered to provide, or discovered to have, human health benefits that increases their value to consumers. In other words, the food becomes a functional food. A functional food has the potential provide direct benefits to consumers as well as indirect benefits to society in the form of health care cost savings. If the trade barrier was put in place prior to these direct and indirect benefits of the food becoming apparent, then they would not have been considered when the decision to impose the trade barrier was taken. In these circumstances, policy makers may wish to revisit a decision to impose a trade barrier. |
| Keywords: | trade health, Agricultural and Food Policy, Health Economics and Policy, International Relations/Trade, |
| Date: | 2009–04 |
| URL: | http://d.repec.org/n?u=RePEc:ags:catpwp:51092&r=hea |
| By: | Pablo Alonso González (Departamento de Estadística, Estructura y O.E.I. Universidad de Alcalá.); Irene Albarrán Lozano (Departamento de Estadística, Universidad Carlos III de Madrid.) |
| Abstract: | The passing of the Law 39/2006 has given to Spanish insurance companies the chance of offering products that cover the expenses associated to the risk of dependence. However, due to the lack of reliable statistic information about dependent population, it is extremely difficult to evaluate not only the frequency but also the cost. These two items make the pricing process with a big cloud of uncertainty. This paper proposes a methodology for premium calculation taking into account not only the availability of the data but also the current legal framework in Spain. Together to the theoretical approach, premium calculations for two possible versions are included. Finally, it is introduced a simulation model that pretends to evaluate the impact that a portfolio with these kind of contracts would have on the solvency of an insurance company. |
| Keywords: | Long term care insurance, Pricing, Multi-state model, Simulation, Solvency. |
| JEL: | G22 C39 C15 C63 |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:alc:alcamo:0902&r=hea |
| By: | Fletcher, Jason M.; Lehrer, Steven F. |
| Abstract: | There has been growing interest in using specific genetic markers as instrumental variables in attempts to assess causal relationships between health status and socioeconomic outcomes, including human capital accumulation. In this paper we use a combination of family fixed effects and genetic marker instruments to show strong evidence that inattentive symptoms of ADHD in childhood and depressive symptoms as an adolescent are linked with years of completed schooling. Our estimates suggest that controlling for family fixed effects is important but these strategies cannot fully account for the endogeneity of poor mental heath. Finally, our results demonstrate that the presence of comorbid conditions present immense challenges for empirical studies that aim to estimate the impact of specific health conditions. |
| Keywords: | Education Outcomes, Depression, Genetic Markers, ADHD, Obesity, Family Fixed Effects, and Instrumental Variables |
| JEL: | I20 I12 C31 |
| Date: | 2009–06–26 |
| URL: | http://d.repec.org/n?u=RePEc:ubc:clssrn:clsrn_admin-2009-40&r=hea |
| By: | Cavalieri, Marina |
| Abstract: | In recent years, health care reforms and restrained budgets have risen concerns about accessibility to health services, even in countries with universal coverage health systems. Previous studies have explored the issue by using objective event-oriented measures such as those related to utilization of health care. Analyzing access through subjective process-oriented indicators allows to better disentangle the process of seeking care, to investigate self-perceived barriers to health services and to account for differences in individual health care preferences. In this paper, data from the 2006 Italian component of the European Survey on Income and Living Conditions (EU-SILC) are used to explore reasons and predictors of self-reported unmet needs for specialist and/or dental care among adult Italians aged 18 and over. Results reveal different patterns across socio-economic groups and geographical macro-areas. Evidence of income-related inequalities and violations of the horizontal equity principle are also found both at a national and regional level. Policies to address unmet health care needs should adopt a multidimensional approach and be tailored so as to consider such heterogeneities. |
| Keywords: | Unmet health care needs; access to health care; inequality; inequity; Italy |
| JEL: | I11 I18 C31 |
| Date: | 2009–06 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:16097&r=hea |
| By: | Jason M. Fletcher; Steven F. Lehrer |
| Abstract: | While there is a well-established, large positive correlation between mental and physical health and education outcomes, establishing a causal link remains a substantial challenge. Building on findings from the biomedical literature, we exploit specific differences in the genetic code between siblings within the same family to estimate the causal impact of several poor health conditions on academic outcomes. We present evidence of large impacts of poor mental health on academic achievement. Further, our estimates suggest that family fixed effects estimators by themselves cannot fully account for the endogeneity of poor health. Finally, our sensitivity analysis suggests that these differences in specific portions of the genetic code have good statistical properties and that our results are robust to reasonable violations of the exclusion restriction assumption. |
| JEL: | C33 I12 I21 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15148&r=hea |
| By: | Partha Deb; William T. Gallo; Padmaja Ayyagari; Jason M. Fletcher; Jody L. Sindelar |
| Abstract: | This paper examines the impact of job loss from business closings on body mass index (BMI) and alcohol consumption. We improve upon extant literature by using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data (Health and Retirement Study). For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. Thus health effects of job loss could be concentrated among “at risk†individuals. |
| JEL: | C13 I1 J69 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15122&r=hea |
| By: | Jason M. Fletcher; Partha Deb; Jody L. Sindelar |
| Abstract: | Recent literature has suggested that higher taxes on addictive goods could increase welfare by assisting individuals with self control problems and trouble resisting ‘temptation’. In contrast, if individuals continue to use despite increased prices, taxation may serve to reduce the welfare of these individuals while providing no benefits in managing self control nor mitigating externalities. We use data on adolescents from the National Longitudinal Study of Adolescent Health (Add Health) to examine the impact of tobacco taxes on smoking. To account for unobserved heterogeneity in response to taxes we estimate finite mixture models, positing two types of individuals with differential responses to taxes. We find evidence of differential price elasticity for tobacco use across the adolescents groups, and show that individuals with low self control or high discount rates are largely unresponsive to cigarette price. Those who have the least willpower may need the most help in quitting but are unresponsive to taxes, suggesting that policies other than taxation may be needed to reduce adolescent tobacco use. |
| JEL: | H75 I0 I1 I18 I3 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15130&r=hea |
| By: | Marc T. Law; Zeynep K. Hansen |
| Abstract: | This paper investigates the relationship between the characteristics of medical licensing boards and the frequency with which boards discipline physicians. Specifically, we take advantage of variation in the structure of medical licensing boards between 1993 and 2003 to determine the effect of organizational and budgetary independence, public oversight, and resource constraints on rates of physician discipline. We find that larger licensing boards, boards with more staff, and boards that are organizationally independent from state government discipline doctors more frequently. Public oversight and political control over board budgets do not appear to influence the extent to which medical licensing boards discipline doctors. These findings are broadly consistent with theories of regulatory behavior that emphasize the importance of bureaucratic autonomy for effective regulatory enforcement. |
| JEL: | I1 I18 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15140&r=hea |
| By: | David E. Bloom; David Canning; Günther Fink |
| Abstract: | In a recent paper, Acemoglu and Johnson (2007) argue that the large increases in population health witnessed in the 20th century may have lowered income levels. We argue that this result depends crucially on their assumption that initial health and income do not affect subsequent economic growth. Using their data we reject this assumption in favor of a model of conditional convergence, with income adjusting to its steady state over time. We show that, allowing for conditional convergence, exogenous improvements in health due to technical advances associated with the epidemiological transition appear to have increased income levels. |
| JEL: | I10 J11 O40 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15137&r=hea |
| By: | Mariacristina De Nardi; Eric French; John Bailey Jones |
| Abstract: | This paper constructs a rich model of saving for retired single people. Our framework allows for bequest motives and heterogeneity in medical expenses and life expectancies. We estimate the model using AHEAD data and the method of simulated moments. The data show that out-of-pocket medical expenses rise quickly with both age and permanent income. For many elderly people the risk of living long and requiring expensive medical care is a more important driver of old age saving than the desire to leave bequests. Social insurance programs such as Medicaid rationalize the low asset holdings of the poorest. These government programs, however, also benefit the rich because they insure them against their worst nightmares about their very old age: either not being able to afford the medical care that they need, or being left destitute by huge medical bills. |
| JEL: | D91 E21 H31 |
| Date: | 2009–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15149&r=hea |