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on Health Economics |
| By: | Michaela Kreyenfeld; Rembrandt Scholz |
| Abstract: | In recent years, considerable progress has been made in improving the data infrastructure for fertility and morality researchers in Germany. Several large scale data sets have been made available through the research data centers: the micro-censuses of the 1970s and 1980s, the censuses of the GDR and FRG, the micro-census panel, data from the pension registers, individual level data from the vital statistics, and the central foreigner registers have become available for scientific usage. Vital statistics have been reformed, and the micro-census now includes information on number of children ever born. Despite these improvements, there are still some “weak spots” in Germany’s data infrastructure. Germany is lacking official counts of reconstituted families. We know little about the mortality risks of immigrants. In addition, the data infrastructure for studying the socio-economic differences in mortality risks could be improved, thus enabling Germany to catch up with international developments in this area. This paper concludes by making some suggestions for improving the data available. |
| Keywords: | Fertility, Mortality, Demographic Data |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:rsw:rswwps:rswwps70&r=hea |
| By: | Bertram Häussler; Elke Hempel |
| Abstract: | Politics, science, research and the public base their discussions on comprehensive, valid and systematic health care data. Data based information is needed in order to measure the results or success of a policy of procedure. In Germany, the Information System of the Federal Health Monitoring (IS-GBE) comprises of a comprehensive health system data collection. Currently, the information system contains health data and information from over a 100 different sources, for instance surveys done by the statistical offices of the federation or the Länder, as well as many other surveys done within the health care system. Apart from the IS-GBE additional official and non-official health care data sources exist in Germany. Within this expertise changes made from 2001 on to existing health data sources as well as newly established data sources are presented. Data sources dealt with in other expertise are not considered. The up until now one time insuree sample collected in 2001 was, for example, collected in the course of the reform of the risk structure adjustment within the statutory health insurance is one of the more recent samples. From our point of view we highly recommend an update of this representative sample. |
| Keywords: | Information System of the Federal Health Monitoring (IS-FHM), Microcensus, Inpatient Diagnosis Data, Hospital statistics by Diagnosis Related Groups (DRG Statistics), Cancer Registries, Kidney Replacement Therapy Statistics (QuaSi Niere), External Comparative Quality Assurance of the In-patient Sector (BQS), Structured Reports on Quality (SQB), Compulsory Health Insurance (CHI) Claims Data: Insuree Sample, GEK Claims Data |
| Date: | 2009 |
| URL: | http://d.repec.org/n?u=RePEc:rsw:rswwps:rswwps62&r=hea |
| By: | Steven F. Koch (Department of Economics, University of Pretoria) |
| Abstract: | South Africa, which allowed complete suffrage in 1994, for the first time, has committed itself to improved health outcomes through equitable economic and social development. However, South Africa fares poorly in the World Health Organization’s ranking of health system performance, while spending a large proportion of its Gross Domestic Product on health care, suggesting that inequities in health opportunities and outcomes remain. This paper reports on medical aid scheme coverage rates estimated from a series of nationally representative surveys undertaken in South Africa by Statistics South Africa between 2002 and 2007. The individual’s age group, population group and gender were all used to assess coverage to examine inequalities in health care opportunities. The estimates show that coverage rates are quite low, and differ by age group, population group and gender. Despite government efforts to improve health outcomes for the previously disadvantaged population groups, medical aid access for the most disadvantaged, under apartheid, have not improved over the analyzed time period. The study provides important information related to equitable health care financing, noting that a universal national health insurance plan would need to cover an extremely large proportion of the population, as well as the failure, heretofore, of equalizing access to medical aid schemes across population groups in South Africa. |
| Keywords: | Medical Schemes, General Household Survey |
| Date: | 2009–08 |
| URL: | http://d.repec.org/n?u=RePEc:pre:wpaper:200916&r=hea |
| By: | Brick, Aoife (ESRI); Layte, Richard (ESRI) |
| Abstract: | This paper explores levels and trends in the prevalence of caesarean section delivery in Ireland between 1999 and 2006. Over this period the caesarean section rate in Ireland increased by almost one quarter. Using data from the Irish National Perinatal Reporting System we examine the contribution of maternal, birth/infant and hospital characteristics on the rise in the caesarean section rate over the period. International evidence suggests that earlier gestational age of child, older maternal age at birth, higher socio-economic status of mother and birth within a private hospital all increase the risk of caesarean section. Controlling for changes in the prevalence of these and other risk factors between 1999 and 2006 only explains half of the increase in the caesarean section rate amongst singleton delivery first time mothers. This suggests that changes in physician behaviour over the period may well play a significant role. |
| Date: | 2009–08 |
| URL: | http://d.repec.org/n?u=RePEc:esr:wpaper:wp309&r=hea |
| By: | Padmaja Ayyagari; Jody L. Sindelar |
| Abstract: | This paper examines the impact of job-related stress on smoking behavior. We use data from the Health and Retirement Study to examine how high job stress affects the probability that smokers quit and the number of cigarettes smoked for current smokers. We include individual fixed effects, which control for time-invariant factors. Occupational fixed effects are also included to control for occupational characteristics other than stress; time dummies control for the secular decline in smoking rates. Using a sample of people who smoked in the previous wave, we find that job stress is positively related to continuing to smoke and to the number of cigarettes smoked for current smokers. The FE results are of greater magnitude and significance than the OLS results suggesting an important omitted variable bias in OLS estimates. It may be that individuals who are able to handle stress or have better self-control are more likely to have high stress jobs and less likely to smoke. We also find that the smoking/stress relationship is neither explained by heterogeneity across individuals in cognitive ability, risk taking preferences or planning horizons nor is it explained by time varying measures that we observe. |
| JEL: | I1 I10 |
| Date: | 2009–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15232&r=hea |
| By: | Pierre-Carl Michaud; Dana Goldman; Darius Lakdawalla; Yuhui Zheng; Adam Gailey |
| Abstract: | The public economic burden of shifting trends in population health remains uncertain. Sustained increases in obesity, diabetes, and other diseases could reduce life expectancy - with a concomitant decrease in the public-sector’s annuity burden - but these savings may be offset by worsening functional status, which increases health care spending, reduces labor supply, and increases public assistance. Using a microsimulation approach, we quantify the competing public-finance consequences of shifting trends in population health for medical care costs, labor supply, earnings, wealth, tax revenues, and government expenditures (including Social Security and income assistance). Together, the reduction in smoking and the rise in obesity have increased net public-sector liabilities by $430bn, or approximately 4% of the current debt burden. Larger effects are observed for specific public programs: annual spending is 10% higher in the Medicaid program, and 7% higher for Medicare. |
| JEL: | I10 I38 J26 |
| Date: | 2009–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15231&r=hea |
| By: | Pierre-Carl Michaud; Dana Goldman; Darius Lakdawalla; Adam Gailey; Yuhui Zheng |
| Abstract: | In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050. |
| JEL: | I10 I38 J26 |
| Date: | 2009–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:15235&r=hea |