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on Health Economics |
| By: | Layte, Richard; Nolan, Anne |
| Abstract: | The presence of pronounced inequalities in mortality and life expectancy across income, education and social groups is now well established. Research across a large number of developed and wealthy countries, including Ireland, has shown that those with fewer resources, less education or a lower occupational class have higher standardised mortality rates (SMRs) than more advantaged individuals. Research for Ireland for the period 1989-1991 indicated that men in the unskilled manual social class had a mortality rate 2.8 times that of men in the higher professional social class. However, serious issues with the occupational coding of mortality data for the years since 1991 have meant that there has been no subsequent analysis of trends in socio-economic inequalities in mortality. The period since then has been characterised by an unprecedented boom and bust in economic activity which may well have influenced mortality differentials between socio-economic groups. The SMR in 2008 was 37% lower than in 1984 and 30% lower than in 1995. Using annual mortality data from the CSO over the period 1984-2008, this paper examines whether the overall downward trend in mortality observed over this period was experienced equally by all socio-economic groups (SEG) whilst adjusting the SMRs to take account of the coding issues effecting data on occupation/SEG. We use three methods to deal with the coding issues in the data across time: direct adjustment; imputation and a fully Bayesian imputation. Using these approaches we find that the differential in SMRs between professional and unskilled men aged 15+ decreased between 1984 and the early 1990s but then increased significantly thereafter as the SMR for professional men continued to decrease whilst that of unskilled men stabilised and then began to increase. |
| Date: | 2013–11 |
| URL: | http://d.repec.org/n?u=RePEc:esr:wpaper:wp470&r=hea |
| By: | Fischer, Martin (University of Duisburg-Essen); Karlsson, Martin (University of Duisburg-Essen); Nilsson, Therese (Research Institute of Industrial Economics (IFN)) |
| Abstract: | Theoretically, there are several reasons to expect education to have a positive effect on health and empirical research suggests that education can be an important health determinant. However, it has not yet been established whether education and health are indeed causally related, and the effects found in previous studies may be partially attributable to methodological weaknesses. Moreover, existing evidence on the education-health relationship using information of schooling reforms for identification, generally use information from fairly recent reforms implying that health outcomes are observed only over a limited time period. This paper examines the effect of education on mortality using information on a national roll-out of a reform leading to one extra year of compulsory schooling in Sweden. In 1936, the national government made a seventh school year compulsory; however, the implementation was decided at the school district level, and the reform was implemented over a period of 12 years. Taking advantage of the variation in the timing of the implementation across school districts, by using county-level proportions of reformed districts, census data and administrative mortality data, we find that the extra compulsory school year reduced mortality. In fact, the mortality reduction is discernible already before the age of 30 and then grows in magnitude until the age of 55–60. |
| Keywords: | Returns to schooling; Education Reform; Mortality |
| JEL: | I12 I18 I21 |
| Date: | 2013–12–03 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:iuiwop:0992&r=hea |
| By: | Sergey Shishkin (National Research University Higher School of Economics); Alexandra Burdyak (Russian Presidential Academy of National Economy and Public Administration); Elena Potapchik (National Research University Higher School of Economics,) |
| Abstract: | The opportunity for patient choice in the health care system in CIS countries was created by the partial destruction of the referral system and the development of paid medical services. The data of two population surveys conducted in Russia in 2009 and 2011 show that patient choice of medical facility and physician is taking place in the post-Semashko health care system, and it is not restricted to the area of paid medical services. However for the majority of population the choice of medical facility and physician is not a necessity. Part of reason for patient choice is caused by the failure of the patient referral system to ensure the necessary treatment. For some Russian citizens, the choice of health care provider is a means to obtain better quality care, and in this respect the enhancement of patient choice is leading to the improved efficiency of the emerging health care system. |
| Keywords: | health care, Semashko system, patient choice, Russia |
| JEL: | I10 I11 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:hig:wpaper:09/pa/2013&r=hea |
| By: | Tatiana Kossova (National Research University Higher School of Economics); Elena Kossova (National Research University Higher School of Economics); Maria Sheluntcova (National Research University Higher School of Economics) |
| Abstract: | This paper aims to reveal the relationship between rate of time preferences (RTP) and healthy lifestyles of Russians. This rate shows individual preferences for the distribution of consumption over time. We examine such healthy and unhealthy behavior as smoking, drinking alcohol, doing physical exercise and having medical check-ups. The research is based on data from a survey which was conducted by the Yuri Levada Analytical Center in 2011. Our findings suggest that the RTP along with such factors as age, gender, marital status, income, health status and employment status influence the lifestyle of Russians |
| Keywords: | rate of time preferences, individual discount rate, healthy lifestyle, smoking, drinking, physical exercises, medical check-ups, Russia |
| JEL: | D9 I1 |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:hig:wpaper:45/ec/2013&r=hea |
| By: | Miraldo, M; Galizzi, M; Stavropoulou, C |
| Date: | 2013–12–17 |
| URL: | http://d.repec.org/n?u=RePEc:imp:wpaper:12579&r=hea |
| By: | Ramon Sabes-Figuera (European Commission – JRC - IPTS); Ioannis Maghiros (European Commission – JRC - IPTS) |
| Abstract: | eHealth has been on the European Commission Information Society's policy agenda for more than a decade, from the eEurope initiative(European Commission 1999) to the i2010 Strategy(European Commission 2005), and most recently the Digital Agenda for Europe (DAE)(European Commission 2010), eHealth was also one of the Lead Market Initiatives in 2007. Today it is the focus of one of the two first pilots under the EU2020 Strategy and its Innovation Union flagship initiative – the European Innovation Partnership on Active and Healthy Ageing. The key strategic orientations of the European Commission eHealth policy are defined in the eHealth Action Plan 2012-2020 where eHealth is referred to as "the application of information and communications technologies across the whole range of functions that affect the health sector and including products, systems and services that go beyond simply Internet-based applications"(European Commission 2004). |
| Keywords: | European Hospital Survey, EHS, synthesis, outcomes, eHealth, deployment, availability, use, EHR, information exchange, infrastructure, composite, indicators, policy |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85845&r=hea |
| By: | Ramon Sabes-Figuera (European Commission – JRC - IPTS); Ioannis Maghiros (European Commission – JRC - IPTS) |
| Abstract: | A widespread uptake of eHealth technologies is likely to benefit European Healthcare systems both in terms of quality of care and financial sustainability and European society at large. This is why eHealth has been on the European Commission policy agenda for more than a decade. The objectives of the latest eHealth action plan developed in 2012 are in line with those of the Europe 2020 Strategy and the Digital Agenda for Europe. This report, based on the analysis of the data from the "European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013)" project, presents policy relevant results and findings in this field. The results highlighted here are based on the analysis of the survey descriptive results as well as two composite indicators on eHealth deployment and eHealth availability and use that were developed based on the survey's data. Although they are closely interrelated, these results have been grouped in four sections and are presented in detail in this document. |
| Keywords: | European Hospital Survey, EHS, synthesis, outcomes, eHealth, deployment, availability, use, EHR, information exchange, infrastructure, composite, indicators, policy |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85854&r=hea |
| By: | Manuela Deidda (Università di Cagliari); Francisco Lupiañez (Open Evidence); Ioannis Maghiros (European Commission – JRC - IPTS) |
| Abstract: | The European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013) project is the continuation of eHealth benchmarking Phase III survey. This survey funded and managed by Unit F4 of DG CONNECT, gathered data from a statistically representative sample of European acute hospitals in order to benchmark their level of eHealth deployment. IPTS researchers were part of the steering board of this project and were given the opportunity to access and use the data as soon as they were ready. In 2011 as a result of this collaboration between IPTS and DG CONNECT/F4 "A composite index for the benchmarking of eHealth Deployment in European acute Hospitals. Distilling reality in manageable form for evidence based policy" was published. The aim of the European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013) Project is to design, gather and analyse eHealth deployment in European acute Hospitals to develop a follow up of the composite indicator carried out by IPTS and to identify the trends among the other benchmarking exercises. |
| Keywords: | European Hospital Survey, EHS, methodology, pilot, sample, universe, census, stratification, interviews |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85871&r=hea |
| By: | Ioannis Maghiros (European Commission – JRC - IPTS); Fabienne Abadie (European Commission – JRC - IPTS); Maria Lluch (European Commission – JRC - IPTS); Ramon Sabes-Figuera (European Commission – JRC - IPTS); Elena Villalba (European Commission – JRC - IPTS); Bernarda Zamora (European Commission – JRC - IPTS) |
| Abstract: | The present inception report aims to describe the process for defining indicators in line with the terms of Work Package 1 of the Technical Annex for "A Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing" (MAFEIP) agreed between DG CNECT and DG JRC. It provides initial thoughts on the shaping of the MAFEIP based on IPTS' own research and taking account of the data and knowledge gained through discussions with the Expert Groups and also provided by the EIP on AHA Action Groups since their inception in June 2012, including: • Information provided by stakeholders in the First Call for Commitment (June 2012) • Knowledge obtained through interaction with partners during the Action Group meetings held between June and November 2012 and information sent by the partners on the monitoring framework of their individual commitments. • Meetings and intensive interaction with the Expert Group on the monitoring framework (June - November 2012) • Results of and decisions made at the 6 November 2012 EIP on AHA 1st Conference of Partners, with objectives and implementation detailed in the final Action Plans. • Information provided by stakeholders in the Second Call for Commitment (February 2013). • Data gathered from Action Groups' partners through the "Survey on the monitoring of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) closed in March 2013. • Data received from the Reference sites (April 2013), more specifically data on the 71 Good Practices submitted by those Reference sites. The objective of this inception report is therefore to propose some initial considerations, both from a theoretical and operational point of view, taking into account the methodological proposal agreed towards the definition of a Monitoring Framework for the EIP on AHA. |
| Keywords: | EIP, Active and Healthy Ageing, EIP on AHA, indicators, monitoring, framework |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85879&r=hea |
| By: | Fabienne Abadie (European Commission – JRC - IPTS); Maria Lluch (European Commission – JRC - IPTS); Ramon Sabes-Figuera (European Commission – JRC - IPTS); Bernarda Zamora (European Commission – JRC - IPTS) |
| Abstract: | This report aims to provide a list of process indicators that will allow monitoring the EIP on AHA process over the period 2012-2020. It also presents main highlights from the baseline data in graphical format, based on the tables provided in Annex I. The latter show the indicators computed from the baseline, i.e. data from the 234 EIP on AHA commitments submitted to the EC in June 2012 through the First Invitation for Commitment. The analysis of the data collected through the 2013 Monitoring Survey and that submitted by participants through the Second Invitation for Commitment in April 2013 will be presented in the next updates of this report. Adding the respective data sets to the analysis will allow us to take into account the enlargement of the EIP on AHA to new regions/ countries and stakeholders and measure progress in general. Although the data presented in this report only refers to the 2012 baseline dataset, the selection of process indicators presented in section 2 has been based on the analysis of both the 2012 baseline data and the 2013 Monitoring Survey data which is why there are references to both datasets. The rationale behind this is the need for the process indicators to be as inclusive as possible so as to allow monitoring and comparing the evolution of the EIP on AHA not only for the 2012-2020 period but also between the baseline (the First Invitation for Commitment), the Monitoring Survey and the Second Invitation for Commitment. Last but not least this report also identifies first gaps related to the baseline data and issues that had to be resolved or decisions to be taken when processing the data. |
| Keywords: | EIP, Active and Healthy Ageing, EIP on AHA, indicators, monitoring, framework |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85880&r=hea |
| By: | Ramon Sabes-Figuera (European Commission – JRC - IPTS) |
| Abstract: | A widespread uptake of eHealth technologies is likely to benefit European Healthcare systems both in terms of quality of care and financial sustainability and European society at large. This is why eHealth has been on the European Commission policy agenda for more than a decade. The objectives of the latest eHealth action plan developed in 2012 are in line with those of the Europe 2020 Strategy and the Digital Agenda for Europe. This report, based on the analysis of the data from the "European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013)" project, presents policy relevant results and findings for each of the 28 EU Member States as well as Iceland and Norway. The results highlighted here are based on the analysis of the survey descriptive results as well as two composite indicators on eHealth deployment and eHealth availability and use that were developed based on the survey's data. |
| Keywords: | European Hospital Survey, EHS, synthesis, outcomes, eHealth, deployment, availability, use, EHR, information exchange, infrastructure, composite, indicators, policy |
| JEL: | I11 I18 O33 O38 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc85927&r=hea |
| By: | Byron Lutz; Louise Sheiner |
| Abstract: | A major factor weighing down the long-term finances of state and local governments is the obligation to fund retiree benefits. While state and local government pension obligations have been analyzed in great detail, much less attention has been paid to the costs of the other major retiree benefit provided by these governments: retiree health insurance. The first portion of the paper uses the information contained in the annual actuarial reports for public retiree health plans to reverse engineer the cash flows underlying the liabilities given in the report. Obtaining the cash flows allows us to construct liability estimates which are consistent across governments in terms of the discount rate, actuarial method and assumptions concerning medical cost inflation and mortality. We find that the total unfunded accrued liability of state and local governments for the provision of retiree health care exceeds $1 trillion, or about ⅓ of total state and local government revenue. Relative to pension obligations discounted at the same rate, we find that unfunded retiree health care liabilities are ½ the size of unfunded pension obligations. We also find that using assumptions concerning the growth in health care costs that are arguably more realistic than those employed by most states actually reduces the size of the liability in most cases. Pushing in the opposite direction, we find that using plausibly more realistic mortality assumptions increases the size of liability. The second portion of the paper places retiree health care obligations into context by examining the budget pressures associated with retiree health on a continuing, largely pay-as-you go basis. We find that much of the projected increase in retiree health obligations as a share of revenue is the result of health care cost growth. On average, states could put their retiree health obligations into long-run fiscal balance by contributing an additional ¾ percent of total revenue toward the benefit each year. There is, however, wide variation across the states, with the majority of states requiring little in the way of additional financing, but some states requiring a significantly larger increase. |
| JEL: | H0 H53 H72 H75 |
| Date: | 2014–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19779&r=hea |
| By: | Marika Cabral; Neale Mahoney |
| Abstract: | Most health insurance policies use cost-sharing to reduce excess utilization. The purchase of supplemental insurance can blunt the impact of this cost-sharing, potentially increasing utilization and exerting a negative externality on the primary insurance provider. This paper estimates the effect of private Medigap supplemental insurance on public Medicare spending using Medigap premium discontinuities in local medical markets that span state boundaries. Using administrative data on the universe of Medicare beneficiaries, we estimate that Medigap increases an individual’s Medicare spending by 22.2%. We find that the take-up of Medigap is price sensitive with an estimated demand elasticity of -1.8. Using these estimates, we calculate that a 15% tax on Medigap premiums would generate combined tax revenue and cost savings of $12.9 billion annually. A Pigouvian tax would generate combined annual savings of $31.6 billion. |
| JEL: | H2 I13 |
| Date: | 2014–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:19787&r=hea |
| By: | Franco Sassi; Annalisa Belloni; Chiara Capobianco |
| Abstract: | Taxes and other fiscal measures on health-related commodities are in widespread use. Alcoholic beverages and tobacco products have been subjected to taxation for a long time in most countries. Several OECD governments have passed legislation to increase existing taxes or to introduce new taxes on foods high in salt, sugar or fat in the past few years. Traditionally, commodity taxes have been primarily seen as a source of fiscal revenues and a way to address consumption externalities. More recently, an increased emphasis has been placed on the potential health benefits of commodity taxation, as evidence emerged of the adverse public health, social and economic consequences of the consumption of a range of commodities. This paper provides a review of the theoretical arguments and empirical evidence on the key factors that governments must address when considering the adoption of fiscal measures for health promotion, highlighting the strengths, as well as the limitations and pitfalls, of specific measures. The main focus of this paper is on taxes on health-related commodities, although a range of other fiscal measures may potentially be used in health promotion. Existing evidence of effects on consumption and health outcomes points to the conclusion that taxes on healthrelated commodities can be a powerful tool for health promotion, although the variety and complexity of the effects they generate require careful consideration by policy makers who intend to adopt new taxes or reform existing ones. The arguments in support of taxes being used to attain public health objectives are strong for tobacco products and alcoholic beverages, but less clear-cut for foods, in which case the value of using taxes is highly dependent on their design and on the context in which they would be applied. |
| JEL: | H2 I18 I31 Q18 |
| Date: | 2013–12–11 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:66-en&r=hea |
| By: | Luigi Siciliani; Valerie Moran; Michael Borowitz |
| Abstract: | Waiting times for elective (non-emergency) treatments are a key health policy concern in several OECD countries. This study describes common measures on waiting times across OECD countries from administrative data. It focuses on common elective procedures, like hip and knee replacement, and cataract surgery, where waiting times are notoriously long. It provides comparative data on waiting times across twelve OECD countries and presents trends in waiting times in the last decade. Waiting times appear to be low in the Netherlands and Denmark. In the last decade the United Kingdom (in particular England), Finland and the Netherlands have witnessed large reductions in waiting times which can be attributed to a range of policy initiatives, including higher spending, waiting-times target schemes, and incentive mechanisms which reward higher levels of activity. The negative trend in these countries has however halted in recent years and in some cases reverted. The analysis also emphasizes systematic differences across different waiting-time measures, in particular between the distribution of waiting times of patients treated versus the one of patients on the list. For example, the mean waiting time of patients on the list is generally higher than the mean waiting time of patients treated though we can find examples of the opposite. Mean waiting times are systematically higher than median waiting times and the difference can be quantitatively large. Les délais d'attente pour les traitements électifs (non urgents) constituent un problème majeur de la politique de santé dans plusieurs pays de l'OCDE. Cette étude fondée sur des données administratives décrit les mesures courantes pour réduire les temps d'attente dans les pays de l'OCDE. Elle se concentre sur les interventions non urgentes pratiquées dans les pays, comme le remplacement de la hanche et du genou ainsi que la chirurgie de la cataracte, pour lesquels les délais d'attente sont connus pour être longs. Elle fournit des données comparatives sur les délais d’attente dans douze pays de l'OCDE et montre comment ils ont évolué ces dix dernières années. Ainsi, ils paraissent être courts aux Pays-Bas et au Danemark. Ces dix dernières années, le Royaume-Uni (en particulier l’Angleterre), la Finlande et les Pays-Bas ont vu leurs délais d’attente se réduire considérablement, ceci pouvant être attribué à une série d'initiatives stratégiques, comme une hausse des dépenses, la mise en place de systèmes d’objectif des délais d’attente et des mécanismes d'incitation récompensant des niveaux d'activité plus élevés. La réduction des délais d’attente dans ces pays s’est toutefois interrompue depuis quelques années et, dans certains cas, ils sont même revenus à la hausse. L'analyse souligne également des différences systématiques entre les différentes mesures relatives aux délais d'attente, en particulier entre la répartition des délais d’attente des patients traités et celle des personnes inscrites sur des listes d'attente. Par exemple, le délai d’attente moyen des patients sur une liste est généralement plus élevé que celui des patients traités, bien qu’il existe des contreexemples. Les délais d’attente moyens sont systématiquement plus élevés que les délais d’attente médians et la différence peut être quantitativement importante. |
| JEL: | I10 I18 |
| Date: | 2013–11–18 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:67-en&r=hea |
| By: | Kaushal, Kaushalendra Kumar; Abhishek, Abhishek Singh; F Ram, Faujdar Ram; Subu, S V Subramanian |
| Abstract: | Background: To investigate the association between public health spending and probability of infant and child death in India. Methods: We used data from the three rounds of National Family Health Survey (NFHS) conducted in India during 1992-93, 1998-99 and 2005-06 to investigate the association between public health spending and probability of infant and child death. We used data from the birth history of three NFHS rounds to create state-year panels of births, infant and child deaths, state-level public finance variables, food grain production, household and individual variables for the period 1980-2005. Two-stage probit regression model is used to investigate the association. State-level per capita gross fiscal deficit is used as an instrument for estimating two-stage probit model. Findings: Findings suggest association between public health spending and infant and child mortality in India. A 10% increase in per capita public health spending is likely to reduce the probability of infant and child deaths by 0•005 (95% CI: 0•003, 0•007) and 0•003 (95% CI: 0•002, 0•004) respectively. The second and third lags of public health spending were also statistically significant. Other factors affecting infant and child death were sex of the child, birth order, mother’s age at birth of the index child, mother’s schooling and urban-rural residence. Interpretation: Public health spending was associated with probability of infant and child death in India. Our findings lend support to the government’s initiative to increase public health spending in India. |
| Keywords: | India, Public Spending on Health, infant and child mortality, Endogeneity, two-stage probit regression, instrument |
| JEL: | I18 I3 I38 |
| Date: | 2013–09–06 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:52425&r=hea |
| By: | Viviane Sergi (ESG UQAM MontrŽal, Canada); Maria Lusiani (Dept. of Management, Università Ca' Foscari Venice); Ann Langley (HEC MontrŽal MontrŽal, Canada); Jean-Louis Denis (ENAP MontrŽal, Canada) |
| Abstract: | Why are certain theories able to impose themselves and influence organizational practices in a significant way? Rooted at the intersection of inquiries into management fashions and into performativity, we investigate the case of the QuŽbec public health care system, where a managerial theory Ð that of Òlean managementÓ Ð has recently emerged, gained saliency and become dominant in organizational practice. Adopting a longitudinal and multi-level research approach, we focus more precisely on the conditions that allow performativity to occur and increase, considering how this process unfolds over time. We therefore study the processes and the conditions through which lean management theory imposed itself, both in the global health care system and in two distinct health care organizations and the processes and the conditions through which this theory, while imposing itself, constructs a reality for these organizations, eventually reinforcing the theory itself. By unveiling the action of three performative dynamics in this particular case, our study provides a reflection on the catalysts and inhibitors of performativity, that goes beyond the specific case and that could be relevant to researchers interested by performativity. |
| Keywords: | performativity, lean management, health care, organizational dynamics. |
| JEL: | M10 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:vnm:wpdman:71&r=hea |