|
on Health Economics |
| By: | Ainhoa Aparicio; Libertad González |
| Abstract: | We study the effect of the business cycle on the health of newborn babies using 30 years of birth certificate data for Spain. Exploiting regional variation over time, we find that babies are born healthier when the local unemployment rate is high. Although fertility is lower during recessions, the effect on health is not the result of selection (healthier mothers being more likely to conceive when unemployment is high). We match multiple births to the same parents and find that the main result survives the inclusion of parents fixed-effects. We then explore a range of maternal behaviors as potential channels. Fertility-age women do not appear to engage in significantly healthier behaviors during recessions (in terms of exercise, nutrition, smoking and drinking). However, they are more likely to be out of work. Maternal employment during pregnancy is in turn negatively correlated with babies’ health. We conclude that maternal employment is a plausible mediating channel. |
| Keywords: | recessions, business cycles, infant health, fertility, birth weight, infant mortality, Spain |
| JEL: | I12 J13 O49 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:bge:wpaper:702&r=hea |
| By: | Martine AUDIBERT; Yong HE; Jacky MATHONNAT (Centre d'Etudes et de Recherches sur le Développement International) |
| Abstract: | We estimate the evolution of healthcare demand under the influence of income growth and population aging with two samples of patients surveyed in the same regions, but with an interval of 18 years in rural China and with mixed logit to deal with heterogeneity. In accordance with theoretical and inductive inferences, it is found that healthcare price effects decreased and became more heterogeneous. Aging impact overweighed income growth impact, resulting in increasing distance effect and patients' preference to proximity. In the face of this demand change, the adjustment of governmental supply should be to promote small and middle-sized healthcare providers. However during this period to cope with urbanization, the Chinese policy consisted of privileging large hospitals. This has led to a higher share of patients, especially the aging patients, to choose self-care and a higher share of poorer patients to suffer from catastrophic health expenditures. This finding carries broad implications for rural health policy-making on, along with income growth, population aging and urbanization, how to provide better coverage of rural areas by enough qualified and multifunctional small and middle-sized healthcare providers in the developing world. |
| Keywords: | Two-period healthcare demand comparison, mixed logit model, price and distance effects, heterogeneity, insurance, rural China |
| JEL: | I1 C5 D1 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:cdi:wpaper:1450&r=hea |
| By: | Chris Bojke (Centre for Health Economics, University of York, UK); Adriana Castelli (Centre for Health Economics, University of York, UK); Katja Grasic (Centre for Health Economics, University of York, UK); Andrew Street (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK); Padraic Ward (Centre for Health Economics and Department of Economics and Related Studies, University of York, UK) |
| Abstract: | Overview - 2010/11 was the first full financial year of a Coalition government committed to meeting the so-called “Nicholson challenge†of making £20bn efficiency savings in projected NHS expenditure by 2015. Securing improvements in NHS productivity is seen as a key element in meeting this challenge. In what follows we report year-on-year changes in productivity from 2004/5 to 2010/11. |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:87cherp&r=hea |
| By: | Rita Santos (Centre for Health Economics, University of York, UK); Hugh Gravelle (Centre for Health Economics, University of York, UK); Carol Propper (Imperial College, london, University of Bristol and CEPR, UK) |
| Abstract: | Recent and planned policy changes in the NHS, including the abolition of the Medical Practices Committee, revised tendering arrangements for new practices, readily available information on practices via NHS Choices, and letting patients register with any practice, will increase potential competition amongst general practices. Since practices cannot compete on price they may compete on the quality they offer to patients. A necessary condition for greater competition to improve quality is that patient choice of practice is affected by practice quality. |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:88cherp&r=hea |
| By: | Laura Crespo (CEMFI, Centro de Estudios Monetarios y Financieros); Borja López-Nodal (Universidad de Cantabria); Pedro Mira (CEMFI, Centro de Estudios Monetarios y Financieros) |
| Abstract: | In this paper we provide new evidence on the causal effect of education on adult depression and cognition. Using SHARE data, we use schooling reforms in several European countries as instruments for educational attainment. We find that an extra year of education has a large and significant protective effect on mental health: the probability of suffering depression decreases by 6.5 percent. We find a large and significant protective effect on cognition as measured by word recall. We also explore whether heterogeneity and selection play a part in the large discrepancy between OLS and IV (LATE) estimates of the effect of education on depression and cognition. Using the data available in SHARELIFE on early life conditions of the respondents such as the individuals’ socioeconomic status, health, and performance at school, we identify subgroups particularly affected by the reforms and with high marginal health returns to education. |
| Keywords: | Health-SES gradient, education reforms, instrumental variables treatment effects, SHARELIFE. |
| JEL: | I1 I2 C3 |
| Date: | 2013–04 |
| URL: | http://d.repec.org/n?u=RePEc:cmf:wpaper:wp2013_1304&r=hea |
| By: | R. Anton Braun; Karen A. Kopecky; Tatyana Koreshkova |
| Abstract: | Poor health, large acute and long-term care medical expenses, and spousal death are significant drivers of impoverishment among retirees. We document these facts and build a rich, overlapping generations model that reproduces them. We use the model to assess the incentive and welfare effects of Social Security and means-tested social insurance programs such as Medicaid and food stamp programs, for the aged. We find that U.S. means-tested social insurance programs for retirees provide significant welfare benefits for all newborn. Moreover, when means-tested social insurance benefits are of the scale in the United States, all individuals would prefer to be born into an economy with no Social Security. Finally, we find that the benefits of increasing means-tested social insurance are small or negative, if we hold fixed Social Security contributions and benefits at their current levels |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedawp:2013-02&r=hea |
| By: | Julie L. Hotchkiss; M. Melinda Pitts |
| Abstract: | It is well known that smoking leads to lower wages. However, the mechanism of this negative relationship is not well understood. This analysis includes a decomposition of the wage gap between smokers and nonsmokers, with a variety of definitions of smoking status designed to reflect differences in smoking intensity. This paper finds that nearly two-thirds of the 24 percent selectivity-corrected smoking/nonsmoking wage differential derives from differences in characteristics between smokers and nonsmokers. These results suggest that it is not differences in productivity that drive the smoking wage gap. Rather, it is differences in the endowments smokers bring to the market along with unmeasured factors, such as baseline employer tolerance. In addition, we also determine that even one cigarette per day is enough to trigger the smoking wage gap and that this gap does not vary by smoking intensity. |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedawp:2013-03&r=hea |
| By: | Hansen, Fredrik (Department of Economics, Lund University); Anell, Anders (Department of Business Administration, Lund University); Gerdtham, Ulf-G (Department of Economics, Lund University); Lyttkens, Carl Hampus (Department of Economics, Lund University) |
| Abstract: | The health care systems in the Nordic countries are facing key challenges. While the possibilities and willingness to expand health care resources are limited, the demand for health care are increasing due to continuous development of new medical technologies, changing demographics, increasing income level and greater expectations from patients. Consequently, health care organizations are increasingly required to take economic restrictions into account and there is an urgent need to improve the efficiency in the health care sector. A reasonable question to ask is if health economics of today is prepared and equipped to support in meeting these challenges. This article argues that behavioral and experimental economics are promising fields to consider when closing vital knowledge gaps. The aim of this paper is two-fold: introduce the fields of behavioral and experimental economics, and thereafter identify and characterize health economic issues where these two fields have a particularly promising application potential. We also address the advantages of applying a pluralistic view on health economics. Based on the analysis in this, and similar articles, on the development of health economics, we anticipate a dynamic future of health economics. |
| Keywords: | Health economics; Behavioral economics; Experimental economics; Pluralism |
| JEL: | B40 C90 D03 I10 |
| Date: | 2013–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2013_020&r=hea |
| By: | Nordström, Jonas (Department of Economics, Lund University); Thunström, Linda (Department of Economics and Finance, University of Wyoming) |
| Abstract: | Food high in energy but low in nutritional value is an important contributor to several serious illnesses, and one type of food that is particularly high in energy but low in nutrition is food consumed away from home. In this paper, we examine the demand and willingness to pay for healthy, Keyhole-labelled meals. A Keyhole-labelled meal is particularly low in calories, fat, sugar and salt, but particularly high in fibre. The results suggest that to get the majority of individuals to choose the healthy option regularly it would be necessary to alter the relative price between healthy and less healthy meals. Generally groups of individuals with a poor nutritional intake require a larger compensation (subsidy) before they choose the healthy alternative. About one third of respondents would choose the healthy option regularly if the prices for a healthy and less healthy meal were the same. In particular groups of individuals who already have a relatively good nutritional intake would select the healthy option. Groups with a generally poor nutritional intake (men and individuals with lower education and lower income) would gain health benefits from a subsidy of Keyhole-labelled meals. |
| Keywords: | subsidy; food demand; food away from home; healthy; restaurant |
| JEL: | D12 H20 H31 I18 |
| Date: | 2013–06–18 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2013_021&r=hea |
| By: | Ljungvall, Åsa (Department of Economics, Lund University) |
| Abstract: | Along with the economic and technological developments of the past decades, obesity has become a growing public health problem. This study empirically investigates whether the large and widespread increases in body-mass index (BMI) that have been observed around the world are related to economic freedom, as measured and defined by the Economic Freedom of the World Index. Economic freedom is part of the environment in which individuals make choices about food intake and physical activity, and may encourage unhealthy behavior and affect body weight by changing the opportunity sets. It may for example affect the quality and quantity of foods available to consumers, the access to safety nets, and the access to environments for physical activity. The empirical analysis is based on a panel of 31 high-income countries and data for the period 1983 to 2008. It finds a positive and statistically significant relationship between the level of economic freedom and both the level of, and five-year change in, BMI. Decomposing the freedom index into sub-indices measuring economic freedom in five sub-areas (government, legal structure, sound money, trade, and regulations) shows that freedom in the regulations dimension is the most consistent contributor to this result. |
| Keywords: | body-mass index; obesity; economic freedom; economic freedom of the world index; health production; panel |
| JEL: | I10 I12 I15 I18 O11 P10 |
| Date: | 2013–07–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2013_023&r=hea |
| By: | Ogura, Seiritsu |
| Abstract: | Objectives: Recent studies suggest the need to adjust the construct of the Caregiver Reaction Assessment Scale among the family caregivers according to different social norms and differential public services. The aim of this study is to examine the reliability of the original five-subscale CRA and to evaluate the four-subscale CRA proposed by Malhotra, Chan, Malhotra, and Ostbye (2012) among the Japanese family caregivers of old people. Method: I conducted confirmatory factor analysis of the original Given’s Caregiver Reaction Assessment scale among Japanese family caregivers for older persons and found its fit to be less than satisfactory. I then conducted exploratory factor analysis and modified CRA scale for a better fit. Results: The second confirmatory factor analysis of a modified four-factor CRA model, similar to the one developed by Manhotra et al., (2012), showed an acceptable fit. Furthermore, I checked group invariance between the two important groups of family caregivers in Japan-married women caring for parents-in-law and women caring for own parents-and confirmed configural and metric invariance of the modified (18-item four-factor) scale. Conclusion: Thus I believe my 18-item four-factor CRA is a good empirical instrument for evaluating both positive and negative effects of informal caregiving in Japan, and possibly in some other countries in Asia. |
| Keywords: | family caregivers, Caregiver Reaction Assessment, confirmatory factor analysis, group invariance, psychometrics |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:hit:cisdps:604&r=hea |
| By: | Hugh Gravelle (Centre for Health Economics, The University of York); Anthony Scott (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Peter Sivey (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: | Prices for consultations with General Practitioners (GPs) in Australia are unregulated, and patients pay the difference between the price set by the GP and a fixed reimbursement from the national tax-funded Medicare insurance scheme. We construct a Vickrey-Salop model of GP price and quality competition and test its predictions using a dataset with individual GP level data on prices, the proportion of patients who are charged no out-of-pocket fee, average consultation length, and characteristics of the GPs, their practices and their local areas. We measure the competition to which the GP is exposed by the distance to other GPs and allow for the endogeneity of GP location decisions with measures of area characteristics and area fixed-effects. Within areas, GPs with more distant competitors charge higher prices and a smaller proportion of their patients make no out-of-pocket payment. GPs with more distant competitors also have shorter consultations, though the effect is small and statistically insignificant. |
| Keywords: | Competition, prices, quality, doctors |
| JEL: | I11 L1 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:iae:iaewps:wp2013n23&r=hea |
| By: | Goulão, Catarina; Thibault, Emmanuel |
| Abstract: | We look at the effects of physical activity (PA) recommendation policies by considering a social multiplier model in which individuals differ in their concern for PA. The government can either observe this concern (and implement the First Best) or not (and implement a uniform policy). Whichever the type of policy implemented, while the welfare of individuals the most concerned with PA increases in the social multiplier, the welfare of those the least concerned may decrease in it. For a sufficiently high social multiplier, both government interventions improve the welfare of those most concerned with PA but worsen the welfare of the least concerned individuals if they are not too many. However, compared to the First Best, a uniform recommendation improves the welfare of those most concerned with PA more than it reduces the welfare of those least concerned. |
| Keywords: | Physical Activity, Peer Effects, Long Term Care. |
| JEL: | D62 H11 I18 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:ide:wpaper:27365&r=hea |
| By: | Ghislando, S; Manachotphong, W; Perego, VME |
| Date: | 2013–06–07 |
| URL: | http://d.repec.org/n?u=RePEc:imp:wpaper:11200&r=hea |
| By: | BONAN Jacopo; LEMAY-BOUCHER Philippe; TENIKUE Michel |
| Abstract: | In the region of Thies in Senegal community-based health insurance schemes(CBHI)have been present for years. And yet despite the benefits they offer, there remain low take-up rates. Our paper measures the willingness to pay (WTP) for CBHI premiums in such context. Our results highlight the role of income, wealth and risk preferences as determinants of WTP. We also provide an analysis of the predictive power of WTP on the actual take-up of insurance following our offering of membership to a sample of 360 households. WTP has a positive and significant impact on actual take-up. |
| Keywords: | Community-based health insurance; Willingness to pay; Africa; Senegal |
| JEL: | D10 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:irs:cepswp:2013-15&r=hea |
| By: | Grossman, Michael (CUNY Graduate Center); Tekin, Erdal (Georgia State University); Wada, Roy (University of Illinois at Chicago) |
| Abstract: | In this paper, we examine the effect of food prices on clinical measures of obesity, including body mass index (BMI) and percentage body fat (PBF) measures derived from bioelectrical impedance analysis (BIA) and dual energy x-ray absorptiometry (DXA), among youths ages 12 through 18. The empirical analyses employ data from various waves of the National Health and Nutrition Examination Survey (NHANES) merged with several food prices measured by county and year. This is the first study to consider clinically measured levels of body composition rather than BMI to investigate the effects of food prices on obesity among youths. We also examine whether the effects of food prices on body composition differ by gender and race/ethnicity. Our findings suggest that increases in the real price of one calorie in food for home consumption and the real price of fast-food restaurant food lead to improvements in obesity outcomes among youths. We also find that an increase in the real price of fruits and vegetables has negative consequences for these outcomes. Finally, our results indicate that measures of PBF derived from BIA and DXA are no less sensitive and in some cases more sensitive to the prices just mentioned than BMI. |
| Keywords: | food price, obesity, body fat, BMI |
| JEL: | I1 I18 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7465&r=hea |
| By: | Mu, Ren (Texas A&M University); de Brauw, Alan (International Food Policy Research Institute) |
| Abstract: | The unprecedented large scale rural-to-urban migration in China has left many rural children living apart from their parents. In this study, we examine the impact of parental migration on the nutritional status of young children in rural areas. We use the interaction terms between wage growth in provincial capital cities and initial village migrant networks as instrumental variables to account for migration selection. Our results show that parental migration has no significant impact on the height of children, but it improves their weight. We provide suggestive evidence that the improvement in weight may be achieved through increased access to tap water in migrant households. Concerns about the sustainability of the impact on weight are raised in the conclusions. |
| Keywords: | migration, children, nutrition, rural China, child nutrition |
| JEL: | I1 J6 O1 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp7466&r=hea |
| By: | Stefano Capri |
| Abstract: | There is still an unmet need for intensified research into health economic evaluation models of orphan drugs. In the first part of the paper some main issues related to the limits of cost-effectiveness in rare diseases are developed. In order to investigate the theoretical aspect in practice, a cost-effectiveness analysis has been performed to a new drug in osteosarcomas.Osteosarcomas are rare tumors: approximately 750 to 900 new cases are diagnosed each year in the United States, of which 400 arise in children and adolescents younger than 20 years of age. In the second part of the paper the cost-effectiveness of mifamurtide as add-on treatment to standard chemotherapy for the high grade resectable non metastatic osteosarcoma, compared to standard chemotherapy alone has been evaluated by using a Markov model. The horizon was lifetime and the perspective of the Italian National Health Service has been applied. The undiscounted results show that the ICER for mifamurtide added on maintenance chemotherapy over maintenance chemotherapy alone is € 32,111per Quality Adjusted Life Year (QALY). When discounting is included, the ICER changes to € 73,151 per QALY. The primary reason that discounting (of the outcomes) has a significant effect on the ICER is that the majority of the treatment costs are incurred within the first two years of the model but the clinical outcomes are obtained throughout the whole time horizon and thus discounting the outcomes (benefits) reduces the QALY difference between the treatments which adversely affects the cost-effectiveness of mifamurtide. The Probabilistic Sensitivity show that at a WTP threshold of €£50,000 around 76.4% of the iterations were below this limit (undiscounted), but only 19.4% when discounted. 19.4% of the iterations were below this limit. However, the value of € 73.151 per QALY gained seems to be relatively low when compared to the ICER of orphan drugs already marketed and reimbursed in Europe. |
| Date: | 2013–05 |
| URL: | http://d.repec.org/n?u=RePEc:liu:liucec:265&r=hea |
| By: | Donal O'Neill (Department of Economics Finance and Accounting, National University of Ireland, Maynooth); Olive Sweetman (Department of Economics Finance and Accounting, National University of Ireland, Maynooth) |
| Abstract: | Reliable measures of obesity are essential in order to develop effective policies to tackle the costs of obesity. We examine what, if anything, we can learn about obesity rates using self-reported BMI once we allow for possible measurement error. Existing approaches that correct for self-reporting errors often require strong assumptions. In this paper we combine self-reported data on BMI with estimated misclassification rates obtained from auxiliary data to derive upper and lower bounds for the population obesity rate for ten European countries using minimal assumptions on the error process. For men it is possible to obtain meaningful comparisons across countries even after accounting for measurement error. In particular the self-reported data identifies a set of low obesity countries consisting of Denmark, Ireland, Italy, Greece and Portugal and a set of high obesity countries consisting of Spain and Finland. However, it is more difficult to rank countries by female obesity rates. Meaningful rankings only emerge when the misclassification rate is bounded at a level that is much lower than that observed in auxiliary data. A similar limit on misclassification rates is also needed before we can begin to observe meaningful gender differences in obesity rates within countries. |
| Keywords: | Obesity, Self-Reporting Errors, Bounds |
| JEL: | I18 C38 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:may:mayecw:n236-13.pdf&r=hea |
| By: | Nick Beyler |
| Keywords: | Physical Activity, NHANES; accelerometry, validation study, estimated generalized least squares |
| JEL: | C |
| Date: | 2013–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7811&r=hea |
| By: | Michaela Vine; Margaret B. Hargreaves; Ronette R. Briefel; Cara Orfield |
| Keywords: | Childhood Obesity, Primary Care, Prevention, Health |
| JEL: | I0 I1 |
| Date: | 2013–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7812&r=hea |
| By: | Margaret B. Hargreaves; Todd Honeycutt; Cara Orfield; Michaela Vine; Charlotte Cabili; Michaella Morzuch; Sylvia K. Fisher; Ronette Briefel |
| Keywords: | Healthy Weight, Evaluation, Learning Collaboratives, Obesity |
| JEL: | I I0 I1 |
| Date: | 2013–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7813&r=hea |
| By: | Laura P. D'Arcy; Sally C. Stearns; Marisa E. Domino; Laura C. Hanson; Morris Weinberger |
| Keywords: | Geriatric Care, Primary Care, Nursing Home, Emergency Department |
| JEL: | I |
| Date: | 2013–01–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7815&r=hea |
| By: | Kristin Andrews |
| Keywords: | Ticket to Work , people with disabilities, employment of people with disabilities, State Medicaid |
| JEL: | I J |
| Date: | 2013–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7818&r=hea |
| By: | Yonatan Ben-Shalom; Arif Mamun |
| Keywords: | Return to Work Outcomes, Social Security Disability Insurance, SSDI, Beneficiaries |
| JEL: | I J |
| Date: | 2013–06–21 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7820&r=hea |
| By: | Ilyana Kuziemko; Katherine Meckel; Maya Rossin-Slater |
| Abstract: | Increasingly in U.S. public insurance programs, the state finances and regulates competing, capitated private health plans but does not itself directly insure beneficiaries through a public fee-for-service (FFS) plan. We develop a simple model of risk-selection in such settings. Capitation incentivizes insurers to retain low-cost clients and thus improve their care relative to high-cost clients, who they prefer would switch to a competitor. We test this prediction using county transitions from FFS Medicaid to capitated Medicaid managed care (MMC) for pregnant women and infants. We first document the large health disparities and corresponding cost differences between blacks and Hispanics (who make up the large majority of Medicaid enrollees in our data), with black births costing nearly double that of Hispanics. Consistent with the model, black-Hispanic infant health disparities widen under MMC (e.g., the black-Hispanic mortality gap grows by 42 percent) and black mothers' pre-natal care worsens relative to that of Hispanics. Remarkably, black birth rates fall (and abortions rise) significantly after MMC—consistent with mothers reacting to poor care by reducing fertility or plans discouraging births from high-cost groups. Implications for the ACA exchanges are discussed |
| JEL: | H4 I14 J13 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19198&r=hea |
| By: | Amitabh Chandra; Amy Finkelstein; Adam Sacarny; Chad Syverson |
| Abstract: | The conventional wisdom in health economics is that large differences in average productivity across hospitals are the result of idiosyncratic, institutional features of the healthcare sector which dull the role of market forces. Strikingly, however, we find that productivity dispersion in heart attack treatment across hospitals is, if anything, smaller than in narrowly defined manufacturing industries such as ready-mixed concrete. While this fact admits multiple interpretations, we also find evidence against the conventional wisdom that the healthcare sector does not operate like an industry subject to standard market forces. In particular, we find that hospitals that are more productive at treating heart attacks have higher market shares at a point in time and are more likely to expand over time. For example, a 10 percent increase in hospital productivity today is associated with about 4 percent more patients in 5 years. Taken together, these facts suggest that the healthcare sector may have more in common with “traditional” sectors than is often assumed. |
| JEL: | D22 D24 I11 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19200&r=hea |
| By: | Craig Garthwaite; Tal Gross; Matthew J. Notowidigdo |
| Abstract: | We study the effect of public health insurance eligibility on labor supply by exploiting the largest public health insurance disenrollment in the history of the United States. In 2005, approximately 170,000 Tennessee residents abruptly lost public health insurance coverage. Using both across- and within-state variation in exposure to the disenrollment, we estimate large increases in labor supply, primarily along the extensive margin. The increased employment is concentrated among individuals working at least 20 hours per week and receiving private, employer-provided health insurance. We explore the dynamic effects of the disenrollment and find an immediate increase in job search behavior and a steady rise in both employment and health insurance coverage following the disenrollment. Our results suggest a significant degree of “employment lock” – workers employed primarily in order to secure private health insurance coverage. The results also suggest that the Affordable Care Act – which similarly affects adults not traditionally eligible for public health insurance – may cause large reductions in the labor supply of low-income adults. |
| JEL: | J20 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19220&r=hea |
| By: | Kasey Buckles; Andreas Hagemann; Ofer Malamud; Melinda S. Morrill; Abigail K. Wozniak |
| Abstract: | We exploit exogenous variation in college completion induced by draft-avoidance behavior during the Vietnam War to examine the impact of college completion on adult mortality. Our preferred estimates imply that increasing college completion rates from the level of the state with the lowest induced rate to the highest would decrease cumulative mortality by 28 percent relative to the mean. Most of the reduction in mortality is from deaths due to cancer and heart disease. We also explore potential mechanisms, including differential earnings, health insurance, and health behaviors, using data from the Census, ACS, and NHIS. |
| JEL: | I12 I23 J24 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19222&r=hea |
| By: | Jason Fletcher; Sanjeev Kumar |
| Abstract: | Recent studies analyzing the effects of religion on various economic, social, health and political outcomes have been largely associational. Although some attempts have been made to establish causation using instrument variable (IV) or difference-in-difference (DID) methods, the instruments and the spatial and temporal variations used in these studies suffer from the usual issues that threaten the use of these identification techniques—validity of exclusion restrictions, quality of counterfactuals in the presence of spatial assortative sorting of people, and concern about omitted variable bias in the absence of information on family level unobservables and child-specific investment by families. During the adolescent years, religious participation might be a matter of limited choice for many individuals, as it is often heavily reliant on parents and family background more generally. Moreover, the focus of most of the studies has been on religious rites and rituals i.e., religious participation or on the intensity of participation. Using the National Longitudinal Study of Adolescent Health, this paper analyzes the effects of a broad set of measures of religiosity on substance use at different stages of the life course. In contrast to previous studies, we find positive effects of religion on reducing all addictive substance use during adolescence, but not in a consistent fashion during the later years for any other illicit drugs except for crystal meth and marijuana. |
| JEL: | Z12 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19225&r=hea |
| By: | Christine de la Maisonneuve; Joaquim Oliveira Martins |
| Abstract: | This paper proposes a new set of public health and long-term care expenditure projections until 2060, seven years after a first set of projections was published by the OECD. It disentangles health from longterm care expenditure, as well as the demographic from the non-demographic drivers, and refines the previous methodology, in particular by extending the country coverage. Regarding health care, nondemographic drivers are identified, with an attempt to better understand the residual expenditure growth by determining which share can be explained by the evolution of health prices and technology effects. Concerning LTC, an estimation of the determinants of the number of dependants (people needing help in their daily life activities) is provided. A cost-containment and a cost-pressure scenario are provided, together with sensitivity analysis. On average across OECD countries, total health and long-term care expenditure is projected to increase by 3.3 and 7.7 percentage points of GDP between 2010 and 2060 in the cost-containment and the cost-pressure scenarios respectively. For the BRIICS over the same period, it is projected to increase by 2.8 and 7.3 percentage points of GDP in the cost-containment and the costpressure scenarios respectively.<P>Une méthode de prévisions des dépenses publiques de santé et de soins de longue durée<BR>Ce papier présente une nouvelle série de projections des dépenses publiques de santé et de soins de longue durée jusqu’en 2060, sept ans après la publication d’une première série de projections par l’OCDE. Le papier étudie la santé et les soins de longue durée séparément ainsi que les déterminants démographiques et non-démographiques et il affine la méthodologie adoptée précédemment, en particulier, en augmentant le nombre de pays couverts. En ce qui concerne la santé, les déterminants non-démographiques sont identifiés, l’analyse effectuée dans ce papier tentant de mieux comprendre la croissance résiduelle des dépenses en déterminant quelle part peut être attribuée à l’évolution des prix de la santé et de la technologie. En ce qui concerne les soins de longue durée, une estimation des déterminants du nombre de dépendants (personnes nécessitant de l’aide dans les activités de la vie quotidienne) est utilisée. Un scénario de maîtrise des coûts et un scénario de tension sur les coûts sont élaborés ainsi qu’une analyse de sensibilité. En moyenne sur l’ensemble des pays de l’OCDE, entre 2010 et 2060, le total des dépenses de santé et de soins de longue durée devrait augmenter de 3.3 points de pourcentage de PIB dans le scénario de maîtrise des coûts et de 7.7 points de pourcentage de PIB dans le scénario de tension sur les coûts. Pour les BRIICS sur la même période, il devrait augmenter de 2.8 points de pourcentage du PIB dans le scenario de maîtrise des coûts et de 7.3 points de pourcentage dans le scenario de tension sur les coûts. |
| Keywords: | ageing populations, longevity, public health expenditures, long-term care expenditures, demographic and non-demographic effects, projection methods, vieillissement de la population, longévité, dépenses publiques de santé, dépenses publiques de soins à long terme, effets démographiques et non démographiques, méthodes de projection |
| JEL: | H51 I12 J11 J14 |
| Date: | 2013–06–14 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaaa:1048-en&r=hea |
| By: | Stéphane Sorbe |
| Abstract: | Belgium has a good record in delivering accessible care, but adaptation to population ageing will be complicated by the fragmentation of responsibilities in the healthcare system and a strong reliance on government regulations. The organisation of the system could be rationalised by giving sickness funds a more active role as promoters of cost-efficiency, better aligning the incentives of the different levels of government and focussing on medium-term budgeting. At the level of care providers, better information flows and incentive structures could facilitate addressing practice and efficiency variations and supplier-induced demand. This notably involves completing the shift to pathology-based budgets in hospitals, more capitation in the remuneration of doctors and measures to tackle the high spending on drugs. Once incentives for cost-efficiency are in place, a shift towards a more demand-driven system could be encouraged by phasing out over-prescriptive hospital regulations. In addition, relative remunerations of doctors should be revised regularly to ensure an adequate supply per specialty. In long-term care, home care, which is generally cost-efficient, could be further encouraged by giving more autonomy to patients to organise their care. This Working Paper relates to the 2013 OECD Economic Survey of Belgium (www.oecd.org/eco/surveys/belgium).<P>Belgique : améliorer l'efficience et la flexibilité du secteur de la santé pour s'adapter au vieillissement de la population<BR>La Belgique a su se doter de services de santé accessibles, mais le morcellement des responsabilités au sein du système et le poids de la réglementation risquent de rendre l’adaptation au vieillissement de la population difficile. Le système pourrait être organisé plus simplement en donnant aux caisses d’assurance maladie (mutualités) un rôle plus actif dans l’amélioration de l’efficience, en alignant mieux les incitations des différents niveaux d’administration et en mettant l’accent sur la budgétisation à moyen terme. Au niveau des prestataires de santé, une meilleure circulation de l’information et de meilleures structures incitatives pourraient contribuer à atténuer les variations en termes de pratiques et d’efficience, ainsi qu’à lutter contre la demande induite par les prestataires eux-mêmes. Pour ce faire, il s’agit notamment d’achever la transition vers des budgets hospitaliers fondés sur les pathologies, d’augmenter la part de la rémunération forfaitaire des médecins et de mettre en place des mesures visant à diminuer le niveau élevé des dépenses en médicaments. Une fois que des mesures destinées à améliorer l’efficience seront en place, l’adoption d’un système davantage axé sur la demande pourrait être encouragée en supprimant progressivement les règles hospitalières excessivement normatives. En outre, les rémunérations relatives des médecins devraient être révisées régulièrement afin d’obtenir une offre adaptée dans chaque domaine de spécialité. S’agissant des soins de longue durée, la prise en charge à domicile, qui est globalement efficace au regard de son coût, pourrait être encore plus encouragée en laissant les patients organiser plus librement les soins dont ils bénéficient. Ce Document de travail se rapporte à l’Étude économique de l’OCDE de la Belgique, 2013 (www.oecd.org/eco/etudes/belgique). |
| Keywords: | health, Belgium, population ageing, long-term care, hospital, pharmaceuticals, sickness funds, santé, vieillissement de la population, soins de longue durée, Belgique, médicaments, caisses d’assurance maladie (mutualités) |
| JEL: | H51 I11 I18 |
| Date: | 2013–06–25 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaaa:1066-en&r=hea |
| By: | Christine de la Maisonneuve; Joaquim Oliveira Martins |
| Abstract: | This paper proposes a new set of public health and long-term care expenditure projections till 2060, following up on the previous set of projections published in 2006. It disentangles health from longterm care expenditure as well as the demographic from the non-demographic drivers, and refines the previous methodology, in particular by better identifying the underlying determinants of health and long-term care spending and by extending the country coverage to include BRIICS countries. A costcontainment and a cost-pressure scenario are provided together with sensitivity analysis. On average across OECD countries, total health and long-term care expenditure is projected to increase by 3.3 and 7.7 percentage points of GDP between 2010 and 2060 in the cost-containment and the cost-pressure scenarios respectively. For the BRIICS over the same period, it is projected to increase by 2.8 and 7.3 percentage points of GDP in the cost-containment and the cost-pressure scenarios respectively. |
| Keywords: | ageing populations, longevity, public health expenditures, long-term care expenditures, demographic and non-demographic effects, projection methods |
| JEL: | H51 I12 J11 J14 |
| Date: | 2013–06–26 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaab:6-en&r=hea |
| By: | Tabuga, Aubrey D. |
| Abstract: | The Philippines is at par with developed economies in terms of creating and passing laws that protect and uphold the rights of, and mainstream persons with disability (PWDs) into the society. However, pioneering surveys on the condition of PWDs reveal that they rarely take advantage of the privileges provided for by the law because of various constraints they face, and the lack of implementation and enforcement of these laws, among others. An empirical analysis of the participation of PWDs in discount privileges shows that lack of awareness is a major problem and that many PWDs have not been issued proof of identification for them to be eligible to avail of these privileges. These aspects are more problematic in relatively poorer localities than in more affluent ones. Moreover, despite awareness and possession of identification, many PWDs are not able to participate given their special circumstances; many of them have low self-esteem, are unemployed and immobile. |
| Keywords: | Philippines, disability, participation, persons with disability (PWDs), Bivariate Probit, biprobit, discount privileges |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2013-07&r=hea |
| By: | Llanto, Gilberto M.; Kelekar, Uma |
| Abstract: | It has only been in the recent years that developing countries are increasingly decentralizing the provision of health care to their local governments. This paper explores some key issues related to health decentralization in the Philippines identified in literature and in course of interviews with country officials working in the health care area. Issues of planning and budgeting of health plans, revenue and expenditure assignments in a decentralized health system are discussed. In addition, issues specific to the determinants of local government health spending are closely examined. One of the key questions closely examined is whether there are any incentives for local governments to compete through spending on health in a decentralized system. The question of spatial competition is addressed through an empirical analysis that attempts to test the presence of horizontal and vertical fiscal interactions among local governments in the Philippines using local government health expenditures data. While there is a consistent positive interaction among municipalities in health spending, the interaction of municipalities with provinces is positive but weakly significant. The positive fiscal interaction among local governments is explained as a result of potential competition for health care inputs. |
| Keywords: | Philippines, local health care, health decentralization, fiscal competition, horizontal fiscal interaction, vertical fiscal interaction, Local Government Code of 1991 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2013-20&r=hea |
| By: | Davutyan, Nurhan (Kadir Has University and Fellow, Economic Research Forum); Bilsel, Murat (Marmara University); Tarcan, Menderes (Osmangazi University) |
| Abstract: | We analyze the operational performance of 330 Turkish provincial general hospitals. To help improve performance on both input and output space, we adopt a directional distance approach. We treat a mortality based variable as bad output. Congested hospitals are those for whom the switch from strong to weak disposability of mortality is costly. Thus we are able to address the “quality or adequacy of care” issue. We identify congested hospitals using 3 different direction vectors and derive the associated congestion inefficiency scores. For each case, we show these scores are negatively related to patient satisfaction. We separate congested hospitals into two groups: (i) efficient ones requiring uniform sacrifice of good outputs and/or extra inputs in order to reduce mortality, and (ii) inefficient hospitals that do not. The latter ones free up some inputs in addition to requiring extra amounts of other inputs and/or produce more of some outputs but less of others as the price of reducing mortality. The first group can be said to operate at “capacity” whereas the latter can be said to display “negative marginal productivity”. Patient dissatisfaction is demonstrably higher in the latter group of hospitals, whereas mortality reduction is positively related to patient satisfaction in “capacity constrained” hospitals. The efficient group is more likely to be located in emigrating whereas the inefficient one in immigrating regions. |
| Keywords: | Directional distance; bad outputs; hospital quality |
| JEL: | D21 I11 |
| Date: | 2013–07–09 |
| URL: | http://d.repec.org/n?u=RePEc:ris:giamwp:2013_007&r=hea |
| By: | Arthur E. Attema (iBMG/iMTA, Erasmus University, Rotterdam, Netherlands); Werner B.F. Brouwer (iBMG/iMTA, Erasmus University, Rotterdam, Netherlands); Olivier l'Haridon (CREM CNRS UMR 6211, University of Rennes 1, France) |
| Abstract: | It is well-known that expected utility (EU) has empirical deficiencies. Prospect theory (PT) has developed as an alternative with more descriptive validity. However, PT’s full function had not yet been quantified in the health domain. This paper is therefore the first to simultaneously measure utility of life duration, probability weighting, and loss aversion in the health domain. We observe loss aversion and risk aversion for gains and losses, which for gains can be explained by probabilistic pessimism. Utility for gains is almost linear. For losses, we find less weighting of probability 1/2 and concave utility. This contrasts with the common finding of convex utility for monetary losses. However, PT was proposed to explain choices among lotteries involving small outcomes. Life years are arguably not ‘small’ and need not generate convex utility for losses. Moreover, utility of life duration reflects discounting, causing concave utility. These results are a first step in fitting non-EU models for health-related decisions. |
| Keywords: | prospect theory, life duration, QALY |
| JEL: | D90 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:tut:cremwp:201321&r=hea |
| By: | John Gibson (University of Waikato); Riccardo Scarpa (University of Waikato); Halahingano Rohorua (University of Waikato) |
| Abstract: | Indoor air quality affects respiratory diseases, such as asthma, and can be altered by devices that lower dwelling humidity and raise temperature. Several countries have initiated schemes that subsidize devices such as heat pumps based on putative health benefits but the valuations of these devices by the affected populations remains unknown. We investigate preferences for devices that affect indoor air quality, dampness, and warmth, using a choice experiment with a sample of Pacific Islander immigrants in New Zealand. This is a high risk group for respiratory disease, who typically rent crowded and inadequately heated dwellings. Using both conditional logit and panel mixed logit models we find reasonably precise estimates of the willingness to pay for four improved heating and humidity control devices, which would cover the capital costs of two of the devices, and add up to about three-quarters of the cost of the other two devices. |
| Keywords: | respiratory health; indoor air-quality devices; choice experiments |
| Date: | 2013–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:wai:econwp:13/09&r=hea |