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on Health Economics |
| By: | Asongu Simplice (Yaoundé/Cameroun) |
| Abstract: | Purpose – How do economic prosperity, health expenditure, savings, price-stability, demographic change, democracy, corruption-control, press-freedom, government effectiveness, human development, foreign-aid, physical security, trade openness and financial liberalization play-out in the fight against health-worker crisis when existing emigration levels matter? Despite the acute concern of health-worker crisis in Africa owing to emigration, lack of relevant data has made the subject matter empirically void over the last decades. Design/methodology/approach – A quantile regression approach is used to assess the determinants of health-worker emigration throughout the conditional distributions of health-worker emigration. This provides an assessment of the determinants when existing emigrations levels matter. Findings – Findings provide a broad range of tools for the fight against health-worker brain-drain. As a policy implication, blanket emigration-control policies are unlikely to succeed equally across countries with different levels of emigration. Thus to be effective, immigration policies should be contingent on the prevailing levels of the crisis and tailored differently across countries with the best and worst records on fighting health worker emigration. Originality/value – This paper has examined the theoretical postulations of a WHO report on determinants of health-worker migration. |
| Keywords: | Welfare; Health; Human Capital; Migration; Africa |
| JEL: | D60 F22 I10 J24 O15 |
| Date: | 2013–09 |
| URL: | http://d.repec.org/n?u=RePEc:agd:wpaper:13/034&r=hea |
| By: | Emiliana Mangone; ErikaMarie Pace |
| Abstract: | (English) At the turn of the new millennium the European Union (EU) catapulted into a new economic era. The golden period of the welfare state, as a solution to social inequity, started to lose ground especially in countries traditionally considered as having conservative-corporatist welfare regimes. Gradually the economic burden the welfare state had transformed itself into became too conspicuous for governments to conceal from other EU member states, the global economic scenario, the sharp eyes of the media and community at large. Due to austerity measures, the guarantee of universal access to healthcare which civil society had gained in exchange of votes started to crumble and, as public debts become more grievous, citizens have started giving up hope on politicians’ promises of finding solutions. In this article we pose the question as to whether civil society can merely be acknowledged as playing a role in healthcare, or if the reform measures adopted are demanding that civil society shoulders the responsibility which states seem unable to handle any longer. In the first part of the article the healthcare system in Italy, the third largest economy in the Euro-zone and a welfare system based on solidarity, is presented as a case study of how the principle of universal healthcare has slowly been nibbled at since the 90s. In the second part we argue that Italian civil society, despite a period characterised by a long transition of administrative and healthcare reforms, plays more than a key role in guaranteeing community wellbeing. (Italiano) Nel nuovo millennio l’Unione Europea è catapultata in una nuova era economica. Il periodo d’oro del welfare state, come soluzione alla disuguaglianza sociale, inizia a perdere terreno soprattutto in paesi considerati a regimi di welfare conservatore-corporativo. A poco a poco il peso economico dello Stato sociale diviene troppo evidente tanto che i governi tendono a nasconderlo agli altri Stati membri dell’UE, agli occhi dei media e della comunità in generale. A causa di misure di austerità, la garanzia di accesso universale all’assistenza sanitaria che la società civile aveva guadagnato in cambio di voti ha iniziato a sgretolarsi e contemporaneamente il peso del debito pubblico diventa più grave, tanto che i cittadini iniziano a rinunciare alla speranza di trovare soluzioni politiche. In questo articolo si pone la questione se la società civile possa essere riconosciuta solo per il ruolo nell’ambito della sanità, o se le misure di riforma adottate inducano la società civile ad accollarsi la responsabilità che i governi sembrano non essere in grado di supportare. Nella prima parte dell’articolo si riflette sul sistema sanitario in Italia, terza potenza economia della zona euro con un sistema di welfare solidaristico, presentato come un caso di studio per spiegare come il principio dell’assistenza sanitaria universale sia stato eroso a partire dagli anni ‘90. Nella seconda parte si sostiene che la società civile italiana, nonostante un periodo caratterizzato da una lunga transizione di riforme amministrative e sanitarie, gioca molto più che un ruolo nel garantire il benessere della comunità. |
| Keywords: | (English) Civil Society; Healthcare Systems; Community Empowerment; Health Promotion; Critical Pedagogy (Italiano) Società civile; Sistema sanitaria; Empowerment comunitario; Promozione della salute; Pedagogia critica |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:cnz:wpaper:63:2014&r=hea |
| By: | Janke, Katharina; Propper, Carol; Shields, Michael |
| Abstract: | Crime has been argued to have important externalities. We investigate the relationship between violent crime and an important type of behaviour: individuals’ participation in their local area through walking and physical activity. We use a sample of nearly 1 million people residing in over 320 small areas in England between 2005 and 2011. We show that concerns about personal safety co-move with police recorded violent crime. To identify the causal effect of recorded violent crime on walking and other physical activity we control for individual-level characteristics, non-time varying local authority effects, national time effects and local authority-specific trends. In addition, we exploit a natural experiment that caused a sudden increase in crime – the 2011 England riots – to identify the causal impact of a large exogenous crime shock on physical activity in a triple difference framework. Our results show a substantive deterrent effect of local area violent crime on walking, pointing to important effects of violent crime on non-victims. The adverse effect of an increase in local area violent crime from the 25th to the 75th percentile on walking is equivalent in size to a 6 C fall in average minimum temperature. |
| Keywords: | physical activity; riots; violent crime; walking |
| JEL: | I12 I18 R23 |
| Date: | 2013–09 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9605&r=hea |
| By: | Modin, Bitte; van den Berg, Gerard J |
| Abstract: | We analyze interaction effects of birth weight and the business cycle at birth on individual cardiovascular (CV) mortality later in life. In addition, we examine to what extent these long-run effects run by way of cognitive ability and education and to what extent those mitigate the long-run effects. We use individual records of Swedish birth cohorts from 1915--1929 covering birth weight, family characteristics, school grades, sibling identifiers, and outcomes later in life including the death cause. The birth weight distribution does not vary over the business cycle. The association between birth weight (across the full range) and CV mortality rate later in life is significantly stronger if the individual is born in a recession. This is not explained by differential fertility by social class over the cycle. Ability itself, as measured at age 10, varies with birth weight and the cycle at birth. But the long-run effects of early-life conditions appear to mostly reflect direct biological mechanisms. We do not find evidence of indirect pathways through ability or education, and the long-run effects are not mitigated by education. |
| Keywords: | business cycle; cardiovascular disease; cause of death; cognitive ability; developmental origins; education; fetal programming; genetic determinants; health; life course; life expectancy; longevity; nature and nurture; school grades; siblings; stratified partial likelihood. |
| JEL: | C41 E32 I10 I12 I21 I31 J10 J13 N34 |
| Date: | 2013–09 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9650&r=hea |
| By: | Dinkelman, Taryn |
| Abstract: | Drought is Africa’s primary natural disaster and a pervasive source of income risk for poor households. This paper documents the long-run health effects of early life exposure to drought and investigates an important source of heterogeneity in these effects. Combining birth cohort variation in South African Census data with cross-sectional and temporal drought variation, I estimate long-run health impacts of drought exposure among Africans confined to homelands during apartheid. Drought exposure in early childhood significantly raises later life male disability rates by 4% and reduces cohort size. Among a subset of homelands – the TBVC areas – disability effects are double and negative cohort effects are significantly larger. I show that differences in spatial mobility restrictions that influence the extent of migrant networks across TBVC and non-TBVC areas contribute to this heterogeneity. Placebo checks show no differential disability impacts of drought exposure across TBVC and non-TBVC areas after the repeal of migration restrictions. The results show that although drought has significant long-run effects on health human capital, migrant networks in poor economies provide one channel through which families mitigate these negative impacts of local environmental shock |
| Keywords: | disability and early life health; drought; local shocks; migration; South Africa |
| JEL: | I15 J61 N37 O15 |
| Date: | 2014–02 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9801&r=hea |
| By: | Kelly, Elaine; Rasul, Imran |
| Abstract: | Abstract We evaluate the impact of a policing experiment that depenalized the possession of small quantities of cannabis in the London borough of Lambeth, on hospital admissions related to illicit drug use. To do so, we exploit administrative records on individual hospital admissions classified by ICD-10 diagnosis codes. These records allow the construction of a quarterly panel data set for London boroughs running from 1997 to 2009 to estimate the short and long run impacts of the depenalization policy unilaterally introduced in Lambeth between 2001 and 2002. We find the depenalization of cannabis had significant longer term impacts on hospital admissions related to the use of hard drugs, raising hospital admission rates for men by between 40 and 100% of their pre-policy baseline levels. The impacts are concentrated among men in younger age cohorts. The dynamic impacts across cohorts vary in profile with some cohorts experiencing hospitalization rates remaining above pre-intervention levels three to four years after the depenalization policy is introduced. We combine these estimated impacts on hospitalization rates with estimates on how the policy impacted the severity of hospital admissions to provide a lower bound estimate of the public health cost of the depenalization policy. |
| Keywords: | alcohol; cannabis; class-A drugs; depenalization; hospital admissions |
| JEL: | H75 I18 K42 |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9856&r=hea |
| By: | Lindeboom, Maarten; van der Klaauw, Bas; Vriend, Sandra |
| Abstract: | We provide evidence from a large-scale field experiment on the causal effects of audit rules on compliance in a market for long-term care. In this setting care should be provided quickly and, therefore, the gatekeeper introduced ex-post auditing. Our results do not show significant effects of variations in random audit rates and switching to a conditional audit regime on the quantity and quality of applications for care. We also do not find evidence for heterogeneous effects across care providers differing in size or hospital status. Our preferred explanation for the lack of audit effects is the absence of direct sanctions for noncompliance. The observed divergence of audit rates in the conditional audit regime is the consequence of sorting and thus identifies the quality of application behavior of providers. |
| Keywords: | auditing; compliance; feedback; field experiment; long-term care |
| JEL: | C93 H51 I18 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9924&r=hea |
| By: | van Ours, Jan C; Williams, Jenny |
| Abstract: | Cannabis is the most popular illegal drug. Its legal status is typically justified on the grounds that cannabis use has harmful consequences. Empirically investigating this issue has been a fertile topic for research in recent times. We provide an overview of this literature, focusing on studies which seek to establish the causal effect of cannabis use on health, education and labor market success. We conclude that there do not appear to be serious harmful health effects of moderate cannabis use. Nevertheless, there is evidence of reduced mental well-being for heavy users who are susceptible to mental health problems. While there is robust evidence that early cannabis use reduces educational attainment, there remains substantial uncertainty as to whether using cannabis has adverse labor market effects. |
| Keywords: | cannabis use; education; health; labor market |
| JEL: | I10 I20 J10 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9932&r=hea |
| By: | Bergman, Mats; Johansson, Per; Lundberg, Sofia; Spagnolo, Giancarlo |
| Abstract: | Non-contractible quality dimensions are at risk of degradation when the provision of public services is privatized. However, privatization may increase quality by fostering performance-improving innovation, particularly if combined with increased competition. We assemble a large data set on elderly care services in Sweden between 1990 and 2009 and estimate how opening to private provision affected mortality rates – an important and not easily contractible quality dimension – using a difference-in-difference-in-difference approach. The results indicate that privatization and the associated increase in competition significantly improved non-contractible quality as measured by mortality rates. It also reduced the cost per resident, although left total cost unaffected. |
| Keywords: | competition; incomplete contracts; limited enforcement; mortality; nursing homes; outsourcing; performance measurement; privatization; procurement; public services; quality |
| JEL: | H57 I18 L33 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9939&r=hea |
| By: | Cohen, Daniel; Leker, Laura |
| Abstract: | During the XXth century, life expectancy levels have converged across the world. Yet, macroeconomic studies, as Acemoglu and Johnson (2007), estimate that improvements in health have no impact on growth or any factors of growth; in particular, they find no impact of life expectancy increases on education. We argue that their pessimistic results with respect to schooling investment is due to the use of an imprecise proxy. Indeed, when life expectancy increases at time t, only the cohort born at t should increase its human capital investment. On the contrary, Acemoglu and Johnson (2007) look at the impact of life expectancy improvements on the average education of the whole population aged above 15, which evolves much slower. We have reproduced their estimations with a cohort-based measure of education and find a positive and significant impact of life expectancies on education, of a magnitude between 20% and 47%. Finally, we use both the Cohen-Soto (2007) and the Barro-Lee (2010-2013) databases on education, and explain in the text why the former delivers better results than the latter. |
| Keywords: | education; growth; life expectancy |
| JEL: | O10 |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9940&r=hea |
| By: | Bailey, Roy E; Hatton, Timothy J.; Inwood, Kris |
| Abstract: | We examine the health and height of men born in England and Wales in the 1890s who enlisted in the army at the time of the First World War. We take a sample of the army service records and use this information to find the recruits as children in the 1901 census. Econometric results indicate that adult height was negatively related to the number of children in the household as well as to the share of earners, the degree of crowding, and positively to socioeconomic class. Adding the characteristics of the local registration district has little effect on the household-level effects. But local conditions were important; in particular the industrial character of the district, local housing conditions and the female illiteracy rate. We interpret these as representing the negative effect on height of the local disease environment. The results suggest that changing conditions at both household and locality levels contributed to the increase in height and health in the following decades. |
| Keywords: | Health in Britain.; Heights of recruits; Household structure |
| JEL: | I12 J13 N33 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:9959&r=hea |
| By: | Barry P. Bosworth; Kathleen Burke |
| Abstract: | This analysis uses data from the Health and Retirement Study (HRS) to examine the sources of variation in mortality for individuals of varying socioeconomic status. The use of the HRS allows a distinction between education and a measure of career earnings as primary determinants of socioeconomic status for men and women separately. We use those predictions of mortality to estimate the distribution of annual and lifetime Old Age, Survivors, and Disability Insurance benefits for different birth cohorts spanning the birth years from 1900 to 1950. We find differential rates of mortality have had substantial effects in altering the distribution of lifetime benefits in favor of higher income individuals. |
| Date: | 2014–04 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2014-4&r=hea |
| By: | Kristine M. Brown |
| Abstract: | In the United States, because access to health insurance is tied to employment, the availability of retiree health insurance interacts with post-retirement income to shape the retirement decision. This paper uses administrative data from the California Department of Education to estimate the rate at which individuals’ trade off post-retirement health insurance benefits for a longer retirement and for retirement income benefits. The sensitivity of retirement to the return to working in terms of post-retirement health insurance is estimated. This estimate is then compared to the sensitivity of retirement to pension generosity in order to determine the implied rate at which individuals substitute between health insurance and pension benefits. The two estimation methods used leverage plausibly exogenous benefit variation driven by the sharp features of the retiree benefit programs. The results imply that individuals will delay retirement to become eligible for retiree health benefits, but that the effect is small relative to the effect of pension benefits on retirement timing. |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2014-7&r=hea |
| By: | Geoffrey T. Sanzenbacher |
| Abstract: | The brief’s key findings are *Numerous studies have examined the impact of Massachusetts’ landmark 2006 health care reform, the basis for the national Affordable Care Act. *The results suggest that the Massachusetts reform has largely succeeded by: *reducing uninsurance rates; *improving health care access and health outcomes; and *inducing more firms to offer coverage, without raising unemployment. *At the same time improving access to non-employer coverage may have reduced labor force participation for men age 55- 64. *Finally, while health care cost growth has slowed in recent years, cost control remains a challenge |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2014-9&r=hea |
| By: | Mario Coccia (Ceris - Institute for Economic Research on Firms and Growth,Turin, Italy); Ugo Finardi (Ceris - Institute for Economic Research on Firms and Growth,Turin, Italy) |
| Abstract: | The paper analyzes the evolution of scientific production and patenting, main proxies of scientific and technological breakthroughs, concerning non-thermal plasma for biomedical applications in order to detect emerging technological trajectories. New scientific directions of non-thermal plasma in medicine play a critical role because they might generate important innovations that could change the clinical practice. Occurrences of scientific products and patents are retrieved with Boolean queries on SciVerse database after a meticulous procedure to delineate the most promising applications in biomedical sciences. Data are analyzed with two methodological approaches: an exponential model of growth and regression analysis. Results show high rates of scientific growth for applications of non-thermal plasma in disinfection, anticancer treatments, dermatology, whereas for surgery, although values of occurrences are similar to the other research fields, it shows a different trend that after the 2005 is decreasing due to the peculiar application to materials for implantation. Some arguments are discussed at the end of the paper. |
| Keywords: | Non Thermal Plasma, Technological Trajectories, Plasma, Cancer, Medicine |
| JEL: | O30 I31 |
| Date: | 2013–06 |
| URL: | http://d.repec.org/n?u=RePEc:csc:cerisp:201302&r=hea |
| By: | Greta Falavigna (Ceris - Institute for Economic Research on Firms and Growth,Turin, Italy); Roberto Ippoliti (S.S.A. Sviluppo e Promozione Scientifica, A.S.O. “SS. Antonio e Biagio e Cesare Arrigo” di Alessandria;); Grazia Lomolino (S.S.A. Sviluppo e Promozione Scientifica, A.S.O. “SS. Antonio e Biagio e Cesare Arrigo” di Alessandria;) |
| Abstract: | This study proposes a cost-effectiveness analysis concerning the implementation of a tool to check for ventilator-associated pneumonia (VAP) in Intensive Care. VAP is a sub-type of hospital-acquired pneumonia which occurs in people receiving mechanical ventilation. An empirical analysis is performed to estimate the effectiveness of a specific procedure to prevent VAP (i.e. Ventilator Bundle), as well as to evaluate cost savings related to not developing the infection. The relevance of the results thus obtained is not only clinical but also managerial and economic, since a reduction in costs improves the economic performance of hospitals and a lower incidence of VAP improves their reputation on the national market of healthcare services. |
| Keywords: | Ventilator-associated pneumonia; Ventilator Bundle; Analysis of cost-effectiveness; Intensive-Care Unit |
| JEL: | I11 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:csc:cerisp:201318&r=hea |
| By: | Greg Fischer (London School of Economics); Dean Karlan (Economic Growth Center, Yale University); Margaret McConnell (Harvard University); Pia Raffler (Yale University) |
| Abstract: | Pricing policy for any experience good faces a key tradeoff. On the one hand, a price reduction increases immediate demand and hence more people learn about the product. On the other hand, lower prices may serve as price anchors and, through a comparison effect, decrease subsequent demand. This tension is particularly important for the distribution of health products in low-income countries, where free or heavily subsidized distribution is a common but controversial practice. Based on a model combining the learning aspect of experience goods with reference-dependent preferences, we set up a field experiment in Northern Uganda in which three health products differing in their scope for learning were initially offered either for free or for sale at market prices. In line with prior studies, when the product has potential for positive learning, we do not find an effect of free distribution on future demand. However, for products without scope for positive learning, we find evidence of price anchors: future demand is lower after a free distribution than after a distribution at market prices. |
| Keywords: | subsidies, health, pricing, learning |
| JEL: | D11 D12 D83 I11 I18 O12 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:egc:wpaper:1041&r=hea |
| By: | Lin, Ming-Jen (National Taiwan University); Liu, Elaine M. (University of Houston) |
| Abstract: | This paper uses the 1918 influenza pandemic in Taiwan as a natural experiment to test whether in utero conditions affect long-run developmental outcomes. Combining several historical and current datasets, we find that cohorts in utero during the pandemic are shorter as child/teenagers, less educated, and more likely to have serious health problems, including kidney disease, circulatory, respiratory problems, and diabetes in old age, than other birth cohorts. Despite the possible positive selection on health from high infant mortality rates during this period (18 percent), our findings suggest a strong negative effect of in utero exposure to influenza. |
| Keywords: | height, 1918 influenza, fetal origins hypothesis, education, disease, mortality |
| JEL: | I12 N35 I19 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8181&r=hea |
| By: | Vellios, Nicole (SALDRU, School of Economics, University of Cape Town); van Walbeek, Corne (School of Economics, University of Cape Town) |
| Abstract: | This paper investigates the individual and household variables that influence the decision to start smoking. The data was drawn from wave 1 of the National Income Dynamics Study (NIDS) of 2008 and the analysis was performed using survival analysis. Based on the international literature and the constraints of the NIDS survey, the following potential determinants of smoking onset were investigated: age, gender, population group, price of cigarettes, geographic location (urban/rural), socio-economic status of parents, whether the respondent's mother was alive when the respondent was aged 15 or not, literacy, parents' smoking behaviour, respondent's alcohol consumption and tobacco control legislation. Smoking initiation in South Africa typically takes place in the late teenage years and early twenties. Smoking initiation amongst males is much higher than amongst females. For both males and females, the probability of starting smoking is highest amongst the Coloured population. African females have a very low uptake of smoking. Males are more responsive to price changes than females. Depending on the specification, a R1 increase in the price of cigarettes reduces the risk of smoking onset by between 1.1% and 2.8% for males. For females the impact of price on smoking initiation is insignificant. Males and females who have a parent who smokes are more likely to initiate smoking. Females whose mother died before the respondent was aged 15 are more likely to start smoking. The same effect was not found for males. Male and female respondents who currently drink alcohol one or more times a week were more likely to start smoking. The policy impact of this study is that an increase in the price of cigarettes will decrease smoking initiation, especially amongst males. |
| Keywords: | smoking initiation; survival analysis; South Africa |
| JEL: | C41 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:ldr:wpaper:128&r=hea |
| By: | Karen Donelan; Carol Romano; Catherine DesRoches; Sandra Applebaum; Johanna R.M. Ward; Bruce A. Schoneboom; Ada Sue Hinshaw |
| Keywords: | Tricare, Military Health, Nursing, Health |
| JEL: | I |
| Date: | 2014–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:8131&r=hea |
| By: | Silvia Barbaresco; Charles J. Courtemanche; Yanling Qi |
| Abstract: | The first major insurance expansion of the Affordable Care Act – a provision requiring insurers to allow dependents to remain on parents’ health insurance until turning 26 – took effect in September 2010. We estimate this mandate’s impacts on numerous health-related outcomes using a difference-in-differences approach with 23-25 year olds as the treatment group and 27-29 year olds as the control group. For the full sample, the dependent coverage provision increased the probabilities of having insurance, a primary care doctor, and excellent self-assessed health, while decreasing unmet medical needs because of cost. However, we find no evidence of improvements in preventive care utilization or health behaviors. Subsample analyses reveal particularly striking gains for college graduates, including reduced obesity. Finally, we show that the mandate’s impacts on 19-22 year olds were generally weaker than those on 23-25 year olds, although we observe a reduction in pregnancies for unmarried 19-22 year old women. |
| JEL: | I12 I13 I18 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20148&r=hea |
| By: | Seth Freedman; Haizhen Lin; Kosali Simon |
| Abstract: | This paper explores the effects of public health insurance expansions on hospitals’ decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals’ decisions to adopt neonatal intensive care units (NICUs). While the Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. This leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital’s incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. This finding is consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by providing suggestive evidence on the health impacts of this deceleration of NICU diffusion, and by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act. |
| JEL: | I11 I13 I18 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20159&r=hea |
| By: | Feldman, Anat |
| Abstract: | The purpose of this study was to examine the linkage between Fitness, Nutrition and Mind for our Well-being, Abundance and Health. This study aimed to inspire each individual to seek health the way that suits him, while taking into consideration "all area of life" and the strong rapport between three components that determent our health: fitness- "work-out", nutrition-"eating smart" and mind- "work-in" mentally, emotionally and spiritually. The work, a product of more than ten years of practicing the GymindTM method (combining Gymnastics and Mind) learned how the right "usage" of all three components is the key for best physical and mental health of the self, according to his or her goals in life. Researches and recent fitness-nutrition-mind studies formed the grounds of this work, along with studies of the subconscious mind such as NLP, EFT, Time-line-therapy, hypnotherapy and Theta-Healing, in order to look over the body-mind connection for therapy and personal growth. The field of "discourse analysis" (mainly a la Perelman's new rhetoric) served at times as a tool to present a thesis and ease the connection of all components of this interdisciplinary study. Personal stories, presented in italic and painted in grey reveal the path of 17 individuals, (not all present in this article) varied in age (adults and children), gender and goals in life, consistently emerged throughout the study. They all agreed to reveal their own fitness-nutrition-mind experience (they have been embracing over the years as my patients), in order to convey a strong message, tips and guidelines about changing bad habits, embrace an active life-style, making healthier nutritional choices, improving self-image, getting stronger physically and mentally, heal themselves and find spiritual growth. They all mainly provide an inspiration for us to find our own finest path, know ourselves better and mainly take charge over our life and take action towards Well-being, Abundance and Health. |
| Keywords: | Fitness, Nutrition, Mind, Health, Body-Mind connection, subconscious-mind. |
| JEL: | Z00 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:54387&r=hea |
| By: | Pesko, Michael |
| Abstract: | I find causal evidence that Hurricane Katrina increased stress, smoking, binge drinking, and health insurance coverage in the non-impacted storm surge region. In this region, Hurricane Katrina increased health insurance coverage by 440,000 young adults, the number of smokers by 930,000, and the number of binge drinkers by 510,000. Results are robust to varying the location and time of Hurricane Katrina, varying the pre-Hurricane Katrina time window, and excluding counties within 400 miles of New Orleans. Findings suggest that disasters are integral to the formation of risk perceptions and affect the demand for behavioral health and health insurance. |
| Keywords: | health insurance, substance use, stress, risk perceptions, disasters |
| JEL: | D81 I13 I19 Q54 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:56205&r=hea |
| By: | Coombs, Christopher; Newman, Robert; Cebula, Richard; White, Mary |
| Abstract: | For the first time in its history, the National Sample Survey of Registered Nurses in 2008 includes a question involving union status. This study utilizes the data from this sample to estimate the union/non-union wage premium for registered nurses and among some of the occupational, workplace, and individual characteristics. The study finds that standard union wage premium estimates for registered nurses are relatively larger than what were revealed in other recent studies. Upon inspection of various characteristics of registered nurses, the study finds a positive wage gap for union nurses only as experience increases; and with respect to characteristics of the workplace, there is no statistical evidence in the sample that suggests a wage gap for registered nurses in the public or private sector. Finally, a positive wage gap is found for union nurses working in hospitals. The lattermost finding is particularly interesting given the recent change in labor law that may have influenced the bargaining power of health care unions. |
| Keywords: | union relative wage; union wage premium; union wage gap; registered nurses; union bargaining power |
| JEL: | J31 J32 J38 J51 |
| Date: | 2013–11–09 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:56223&r=hea |
| By: | Aldy, Joseph E.; Smyth, Seamus J. |
| Abstract: | We develop a numerical life-cycle model -- with choice over consumption and leisure, stochastic mortality and labor income processes, and calibrated to U.S. data -- to characterize willingness to pay (WTP) for mortality risk reduction. Our theoretical framework can explain many empirical findings in this literature, including an inverted-U life-cycle WTP and an order of magnitude difference in prime-aged adults WTP. By endogenizing leisure and employing multiple income measures, we reconcile the literature's large variation in estimated income elasticities. By accounting for gender- and race-specic stochastic mortality and income processes, we explain the literature's black-white and female-male differences. |
| Keywords: | value of statistical life, mortality risk reduction, income elasticity |
| JEL: | J17 D91 Q51 |
| Date: | 2014–05–21 |
| URL: | http://d.repec.org/n?u=RePEc:rff:dpaper:dp-14-13&r=hea |
| By: | Antoine Bommier |
| Abstract: | The paper discusses the impact of longevity extension on aggregate wealth accumulation, accounting for changes in individual behaviors as well as changes in population age structure. It departs from the standard literature by adopting risk-sensitive preferences. Human impatience is then closely related to mortality rates and aggregate wealth accumulation appears to be much more sensitive to demographic factors than usually found. Illustrations are provided using historical mortality data from different countries. |
| Keywords: | longevity, life-cycle savings, wealth accumulation, risk-sensitive preferences, risk aversion |
| URL: | http://d.repec.org/n?u=RePEc:stz:wpaper:eth-rc-14-006&r=hea |
| By: | Goulão, Catarina |
| Abstract: | We look at the consequences of allowing public health insurance (PuHI) to be voluntary when its coverage can be supplemented in the market. PuHI redistributes with respect to risk and income, and the market is affected by adverse selection. We argue that making PuHI voluntary does not lead to its collapse since there are always individuals participating in it. Additionally, in some cases, a voluntary PuHI scheme creates an increase in market efficiency because participation in it becomes a sign of an individual's type. The welfare consequences depend on the status quo. If in the status quo there is no political support for a compulsory PuHI, making it voluntary constitutes a Pareto improvement, and in some cases all individuals are strictly better off. If, instead, the status quo implements compulsory PuHI, making it voluntary then results in less redistribution. |
| Keywords: | Public health insurance, adverse selection, majority voting |
| JEL: | D72 H23 H42 H50 |
| Date: | 2014–03–17 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:28204&r=hea |
| By: | Cremer, Helmuth; Pestieau, Pierre |
| Abstract: | One of the pervasive problems with means-tested public long term care (LTC) programs is their inability to prevent individuals who could a¤ord private long term services from taking advantage of public care. They often manage to elude the means-test net through strategic impoverishment. We show in a simple model how this problem comes about, how it a¤ects welfare and how it can be mitigated. |
| Keywords: | Long term care, means-testing, strategic impoverishment, opting out, public insurance, altruism. |
| JEL: | H2 H5 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:28219&r=hea |
| By: | Ryota Nakamura (University of East Anglia); Marc Suhrcke (University of East Anglia); Daniel John Zizzo (University of East Anglia) |
| Abstract: | We propose a triple test to evaluate the usefulness of behavioral economics models for public health policy. Test 1 is whether the model provides reasonably new insights. Test 2 is on whether these have been properly applied to policy settings. Test 3 is whether they are corroborated by evidence. Where a test is not passed, this may point to directions for needed further research. We exemplify by considering the cases of social interactions models, self-control models and, in relation to health message framing, prospect theory; out of these, only a correctly applied prospect theory fully passes the tests at present. |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:uea:wcbess:14-01&r=hea |
| By: | Coccia M.; Wang L. (UNU-MERIT) |
| Abstract: | A fundamental question is how to detect likely successful anticancer treatments based on nanotechnology. We confront this question here by analysing the trajectories of nanotechnologies applied to path-breaking cancer treatments, which endeavour to pinpoint ground-breaking and fruitful directions in nanomedicine. Results tend to show two main technological waves of cancer treatments by nanotechnology applications. The early technological wave in the early 2000s was embodied in some types of chemotherapy agents with a broad spectrum, while after 2006 the second technological wave appeared with new nanotechnological applications in both chemotherapy agents and molecular target therapy. The present study shows new directions of nanotechnology-based chemotherapy and molecular cancer therapy in new treatments for breast, lung, brain and colon cancers. A main finding of this study is the recognition that, since the late 2000s, the sharp increase of several technological trajectories of nanotechnologies and anticancer drugs seems to be driven by high rates of mortality of some types of cancers e.g. pancreatic and brain in order to find more effective anticancer therapies that increase the survival of patients. The study also shows that global research leaders specialize in nanotechnology applications for specific cancers e.g. Switzerland in prostate cancer, Japan in colon cancer, China in ovarian cancer and Greece in pancreatic cancer. These ground-breaking technological trajectories are paving new directions in biomedicine and generating a revolution in clinical practice that may lead to more effective anticancer treatments in the not-too-distant future. Keywords Nanotechnology, Nanoscience, Biomedicine, Nanomedicine, Target Therapy, Chemotherapy, Cancer, Bibliometrics, Publications, Technological Trajectories. |
| Keywords: | Forecasting and Prediction Methods; Simulation Methods ; Data Collection and Data Estimation Methodology; Computer Programs: Other; Health: General; Technological Change; Research and Development; Intellectual Property Rights: General; |
| JEL: | C89 C53 O30 I10 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:unm:unumer:2014005&r=hea |
| By: | Marcus Dillendcer (W.E. Upjohn Institute for Employment Research) |
| Keywords: | Health insurance, Dependent coverage, Wages, Education |
| JEL: | J30 I13 |
| URL: | http://d.repec.org/n?u=RePEc:upj:weupjo:mdjhe14&r=hea |
| By: | Edit V. Velenyi; Marc F. Smitz |
| Abstract: | The 2008-09 global economic crises have shown that no country is immune to external challenges. When policy controls are missing or not used efficiently, crises can reverse progress even in advanced economies. This unexpected outcome has increased concerns about the ability of governments in developing countries to manage downturns. The question is whether current and future crises will reinforce the procyclical responses or whether these governments will be able to escape the procyclical trap. In the fiscal domain, countercyclical trends in developing countries are promising. Over the last decade, about a third of the developing world has been able to escape the procyclicality trap. Yet, little is known about the evidence on the cyclical patterns of government health spending. This descriptive analysis, which covers 183 countries between 1995 and 2010, provides empirical evidence on the cyclicality of government health expenditures, using panel data from a global macro database, the fiscal health database. The objective is to propose user-friendly diagnostic approaches in this area that can be easily replicated and updated to inform technical discussions and policy making |
| Keywords: | allocation of resources, analytical capacity, Article, automatic stabilizer, automatic stabilizers, balance of payment, banking crises, Burns, BUSINESS CYCLE, business ... See More + cycles, capital flows, capital formation, capital investment, capital spending, Central Bank, central government, central government spending, checks, Country Risk, credit markets, creditworthiness, crisis countries, currency crises, data analysis, DATA AVAILABILITY, data quality, debt, debt crises, debt payments, demand for health, demand for health care, demand for services, developing countries, diagnostic tool, economic cycle, economic development, economic downturn, economic downturns, economic fluctuations, economic growth, ECONOMIC POLICIES, economic policy, ECONOMIC RISK, economic shocks, education spending, efficiency gains, exchange rate, exchange rates, expenditure growth, EXPENDITURES ON HEALTH, exporters, external borrowings, external debt, family planning, financial crises, Financial Crisis, financial flows, financial markets, financial protection, financial resources, financial risk, financial sustainability, financial variables, financing policies, fiscal adjustment, fiscal austerity, fiscal behavior, fiscal constraints, fiscal deficits, Fiscal Health, fiscal impact, fiscal institutions, fiscal policies, fiscal policy, fiscal rules, fiscal stabilization, Fiscal Statistics, fiscal targets, foreign direct investment, government budgets, government consumption, government expenditure, GOVERNMENT EXPENDITURES, government revenue, government revenues, government spending, gross domestic product, growth potential, growth rate, health budgets, health care, health care financing, health coverage, Health Database, health expenditure, HEALTH EXPENDITURES, health financing, health insurance, health insurance funds, health needs, Health Organization, health outcomes, health policies, Health Policy, health sector, health sector reform, health service, health services, health share, health spending, health status, health system, Health Systems, Health Systems Research, health targets, household income, human capital, Human Development, illness, income countries, income effects, income elasticity, income groups, income growth, interest payments, International Bank, intervention, Keynesian theories, liquidity, loan, loan repayment, local currency, local governments, low-income countries, macroeconomic environment, Monetary Fund, National Health, national income, nongovernmental organizations, Nutrition, pensions, personal income, policy formulation, policy responses, political economy, Political Risk, poverty reduction, price volatility, private sector, provision of health services, provision of water, public education, public expenditure, public expenditures, public health, public health spending, public investment, public investments, public sector, public spending, purchasing power, remittances, reserves, returns, Risk Groups, risk management, safety net, sanitation, sector budget, sector policies, sector policy, sectoral allocation, sectoral policies, SOCIAL EXPENDITURES, social insurance, social policies, social policy, social programs, social protection, social safety nets, social services, solvency, sovereign debt, tax, total spending, transparency, Trust Fund, unemployment, voluntary sector |
| Date: | 2014–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:87885&r=hea |
| By: | Robert Gillingham |
| Abstract: | This paper summarizes the basic principles that should form the basis of fiscal policy. These principles encompass decisions on the functions of government, its spending, and the financing of its spending that affect economic growth, employment, inflation, and economic welfare. Although the principles are broadly applicable, it is especially important that health policy makers understand them. Ensuring access to health care is one of society's, and therefore the government's, most important goals. In meeting this goal, policy makers must be cognizant of fiscal realities; what they can reasonably expect government to achieve in the health sector and at what cost. Resources are limited, and many valuable programs in both the private and public sectors vie for them. Allocating these resources efficiently is of paramount importance, with implications for what the government does and how it finances its activities. The absolute level and share of government resources allocated to the health sector will depend on a variety of factors, but the bottom line is that health programs must compete with other government programs for scarce resources to ensure that these resources are put to their best use. |
| Keywords: | health, fiscal policy for health, public finance, revenue mobilization, expenditure decision making ;� health, fiscal policy for health, public finance, revenue ... See More + mobilization, expenditure decision making, , accounting, accounting standards, Accumulation of Debt, addiction, adverse selection, aging, asymmetric information, beneficiaries, beneficiary, bequest, borrowing requirement, budget surplus, budgeting, capital gains, cash flows, cash transfers, commodities, consumer durable, consumer durables, consumers, CONSUMPTION TAXES, contract laws, corporate income tax, corporate income taxes, crime, debt, debt ratio, debt relief, decision making, dedicated revenue, deficits, demand curve, democratic environment, deposits, developing countries, development agencies, development assistance, discounted value, distributional equity, dividends, durable goods, economic crisis, economic development, economic efficiency, economic growth, Economic Outlook, economies of scale, elasticity, electricity, environmental issues, Equity issues, evasion, Excise Taxes, exercises, expenditure, expenditures, exports, externalities, finances, financial assets, financial risk, financial services, FISCAL POLICY, fiscal surplus, fraud, GDP, GDP per capita, good governance, government action, government asset, government budget, government budgets, government finance, government finances, Government financing, government funds, GOVERNMENT INTERVENTION, Government investment, government involvement, government revenues, government securities, government spending, growth rate, health care, health outcomes, HEALTH POLICY, health services, health spending, horizontal equity, housing, human capital, Human Development, immunization, implicit tax, income elasticity of demand, income groups, income level, income support, income tax, INCOME TAXES, incomes, indebtedness, inefficiency, inflation, inflation taxes, inheritance, insurance, insurance premium, interest rate, interest rates, Intergovernmental fiscal relations, International Bank, international standards, INTERVENTION, investment projects, isolation, issuance, labor market, laws, less developed countries, level of debt, levies, levy, licenses, life expectancy, loan, local government, local governments, local taxes, long-term interests, low-income countries, low-income country, marginal cost, Market failures, Market mechanisms, market prices, middle-income countries, Monetary Fund, moral hazard, mortgage, mortgage interest, national income, natural resources, negative externalities, negative externality, net debt, NONTAX REVENUE, normal good, Nutrition, old-age income, open economy, output, outputs, PARETO EFFICIENCY, payroll taxes, pension, pension contributions, pension system, pension systems, PENSIONS, personal income, personal property, POLITICAL ECONOMY, political economy of reform, pollution, positive externalities, prepayment, price rationing, Price subsidies, private market, private markets, private sector, privatization, progressive taxes, property rights, property taxes, provisions, public, public asset, public good, public goods, public health, Public pension, PUBLIC PENSIONS, public sector, public-private partnerships, Purchasing power, rapid growth, rate of return, rates of return, real income, real property, rent seeking, reserves, returns, REVENUE SOURCES, roads, sales taxes, savings, savings accounts, securities, small enterprises, social cost, social costs, stocks, structure of government, supply curve, surgery, sustainable reforms, tax, tax collections, tax policy, tax rate, tax rates, tax revenues, tax subsidies, tax subsidy, tax system, tax systems, TAXATION, technological change, trade liberalization, trade tax, Trade Taxes, trades, transparency, Treasury, Trust Fund, trust funds, turnover, unemployment, urbanization, user charges, value added, value of assets, vertical equity, voters, wages, waste, WEALTH, wealth tax, WEALTH TAXES, workers, world economy, world trade |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:87981&r=hea |
| By: | Lisa Fleisher; Adam Leive; George Schieber |
| Abstract: | This note analyzes levels and trends of health expenditures by country, income group, and region in the context of overall government revenue, expenditure, and GDP trends between 1995 and 2010. The study uses available data from the World Health Organization's (WHO) National Health Accounts, the International Monetary Fund's (IMF) fiscal data bases, and the World Bank's World Development Indicators. The paper provides snapshots of health financing patterns, both public and private, at different points in time, as well as analyzing the stability of these relationships and tracing their evolution during this period. In general, there is little variation in the average income elasticity's of total, government, and out-of pocket (OOP) health spending by income level or region. The elasticity's of government health spending to total government expenditures and revenues exhibit more variation across both income groups and region than the income elasticity. Controlling for demographics moderately reduces the magnitude of these estimates. Many elasticity estimates are close to one, indicating the importance of income as a driving force behind health spending. Some countries exhibit fluctuations in the income elasticity of government health spending but many have increasing elasticity's over the 1995 to 2010 period. These trends highlight the simple macro-fiscal context for health spending, and flag situations that require more in-depth analyses as countries struggle with the fiscal sustainability of their health systems, particularly as they pursue universal insurance coverage and significant supply side expansions. |
| Keywords: | absolute difference, analysis of variance, average income, average share, base year, benchmarks, capita health spending, clean water, Country Level, crowding, debt, demand ... See More + for health, DESCRIPTIVE STATISTICS, determinants of health, developing countries, economic factors, exchange rates, exogenous shocks, families, financial crisis, fiscal policy, GDP, GDP per capita, government expenditures, health care, Health Care Spending, Health Economics, health expenditure, health expenditures, Health Financing, HEALTH INDICATORS, health insurance, health interventions, Health Organization, health outcomes, health policies, health policy, health programs, health share, health spending, health status, health systems, high correlation, human capital, Human Development, illness, income countries, income elasticities, income elasticity, income groups, income level, income levels, incomes, infant mortality, insurance, insurance coverage, life expectancy, life expectancy at birth, linear regression, low income, Macroeconomic Context, Mean Income, medical care, middle income countries, middle income country, mortality, mortality rates, National Health, nominal income, non-governmental organizations, Nutrition, obesity, physician, policy perspective, Political Economy, population share, positive coefficient, private spending, public health, public health interventions, public health programs, real GDP, regression analysis, significant differences, taxation, trough |
| Date: | 2013–11 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:87994&r=hea |
| By: | Li-Lin Liang; Andrew J Mirelman |
| Abstract: | A consensus exists that rising income levels and technological development are among the key drivers of total health spending. However, determinants of public sector health expenditure are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impact of national income and fiscal capacity on health spending. The author apply a two-way fixed effects and two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of spending are higher when the government is more stable. Corruption is associated with less spending in developing countries, but with more spending in high-income countries. Furthermore, the author find that development assistance for health (DAH) substitutes for domestically financed government health expenditure (DGHE). For an average country, a 1 percent increase in total DAH or DAH to government is associated with a 0.02 percent decrease in DGHE. Our work highlights that policy reforms that aim to eliminate corruption are fundamental to improving the capacity of developing countries to scale up GHE, and to increasing the efficiency of health care systems in developed countries in containing health care costs. To minimize fungibility, donors may impose stronger monitoring mechanisms for corruption. Delivering aid through NGOs may be an option in countries with high ethnic tensions; however, the ability to do so depends on institutional arrangements and the capacity of NGOs in individual countries. |
| Keywords: | accountability, aggregate health expenditure, aggregate income, anticorruption, anticorruption reforms, bribes, cabinet, coalition government, corrupt, Corruption, corruption ... See More + in government, debt, delivery system, democracies, democracy, democratic accountability, democratic systems, determinants of health, Econometric Analysis of Health Care Expenditure, Economic Review, election, External Debt, financial resources, Fiscal Policy, fraud, Health Affairs, health care, health care costs, Health Care Expenditure, Health Care Finance, Health Care Reform, Health Care Spending, health care systems, health coverage, Health Economics, health expenditure, health expenditure growth, Health Expenditures, health financing, health insurance, health insurance coverage, Health Organization, Health Outcomes, Health Policy, health programs, health resources, health sector, Health Services, health spending, health systems, hospital systems, Human Development, Human Resources, incentive structures, income countries, Income Elasticity, Income Elasticity of Health Care, income groups, informal sector, insurance premiums, International Health Care, investigation, kickbacks, leadership, low-income countries, medical resources, medical technology, monitoring mechanisms, National Health, nepotism, Nutrition, older people, patronage, pocket payment, political interests, political opponents, political party, political system, political systems, Politicians, Private Health Services, private sector, Provision of Health Care, Public Health, Public Health Care, Public Health Spending, Public Policy, public sector, public spending, social health insurance, social welfare, transparency, Tuberculosis |
| Date: | 2014–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:88182&r=hea |
| By: | Alan Fairbank |
| Abstract: | The main purpose of this work is to develop a case study assessing the recent patterns and impacts of ODA (official development assistance) and DAH (development assistance for health) to Liberia on overall government spending and domestic revenue generation as well as domestic government health spending. Specifically, the study will examine the recent flows of ODA and DAH resources into the country and test whether it is possible to determine the degree of fungibility in domestic budgetary expenditures and revenues, overall, as well as in domestic health budgetary spending and receipts (from internal and external sources) as a result of (or due to) ODA and DAH. The study will distinguish between targeted/earmarked aid and general budget support, and will attempt to distinguish commitments from actual disbursements (both for DAH and for government). |
| Keywords: | Aid, aid effectiveness, ANALYTICAL APPROACH, arrears, budget constraint, capital expenditures, capital investment, Creditor, Currency, debt, debt forgiveness, debt relief ... See More + debt service, debt service payments, decentralization, decision making, deconcentration, developing countries, developing country, development assistance, disbursement, disbursements, discount rate, diseases, domestic borrowing, donor funding, donor funds, donor investments, economic crisis, economic development, Economic growth, economic policy, employer, equal amount, equal amounts, expatriate, expenditure, expenditures, external financing, external funds, finances, financial assistance, financial flows, Financial Management, financial management capacity, fiscal efforts, fiscal policies, fiscal policy, foreign direct investment, funding sources, fungible, government budget, government budgets, government expenditure, government expenditures, government financing, government policy, government revenue, Government revenues, government spending, health care, health expenditures, health policies, Health Policy, health services, HIV/AIDS, Human Development, income level, income tax, International Bank, International Development, investment spending, judicial system, key challenge, local governments, macroeconomic data, matching funds, ministries of finance, nominal prices, Nutrition, outstanding debt, public expenditures, Public health, public investment, public spending, receipts, regional development banks, resource allocation, revenue mobilization, rule of law, social services, Social Welfare, source of funds, statistical analyses, tax, tax efforts, tax relief, tax system, technical assistance, tranche, transaction, Trust Fund, Union |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:88183&r=hea |
| By: | Bergkvist, Sofi; Wagstaff, Adam; Katyal, Anuradha; Singh, Prabal V.; Samarth, Amit; Rao, Mala |
| Abstract: | In the mid-2000s, India began rolling out large-scale, publicly-financed health insurance schemes mostly targeting the poor. This paper describes and analyzes Andhra Pradesh's Aarogyasri scheme, which covers against the costs of around 900 high-cost procedures delivered in secondary and tertiary hospitals. Using a new household survey, the authors find that 80 percent of families are eligible, equal to about 68 million people, and 85 percent of these families know they are covered; only one-quarter, however, know that the benefit package is limited. The study finds that, contrary to the rules of the program, patients incur quite large out-of-pocket payments during inpatient episodes thought to be covered by Aarogyasri. In the absence of data and program design features that would allow for a rigorous impact evaluation, a comparison is made between Andhra Pradesh and neighboring Maharashtra over an eight-year period spanning the scheme's introduction. During this period, Maharashtra did not introduce any at-scale health initiative that was not also introduced in Andhra Pradesh. Andhra Pradesh other health initiatives were considerably less ambitious and costly than Aarogyasri. The paper finds that Andhra Pradesh recorded faster growth than Maharashtra (even after adjusting for confounders) in inpatient admissions per capita (for all income groups) and in surgery admissions (among the poor only), slower growth in out-of-pocket payments for inpatient care (in total and per admission, but only among the better off), and slower growth in transport and outpatient out-of-pocket costs. The paper argues that these results are consistent with Aarogyasri having the intended effects, but also with minor health initiatives in Andhra Pradesh (especially the ambulance program) playing a role. |
| Keywords: | Health Monitoring&Evaluation,Health Systems Development&Reform,Transport Economics Policy&Planning,Health Law,Disease Control&Prevention |
| Date: | 2014–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6883&r=hea |
| By: | Gertler, Paul; Giovagnoli, Paula; Martinez, Sebastian |
| Abstract: | Argentina's Plan Nacer provides insurance for maternal and child health care to uninsured families. The program allocates funding to provinces based on enrollment of beneficiaries and adds performance incentives based on indicators of the use and quality of maternal and child health care services and health outcomes. The provinces use these resources to pay health facilities to provide maternal and child health care services to beneficiaries. This paper analyzes the impact of Plan Nacer Healton birth outcomes. The analysis uses data from the universe of birth records in seven Argentine provinces for 2004 to 2008 and exploits the geographic phasing in of Plan Nacer over time. The paper finds that the program increases the use and quality of prenatal care as measured by the number of visits and the probability of receiving a tetanus vaccine. Beneficiaries'probability of low birth-weight is estimated to be reduced by 19 percent. Beneficiaries have a 74 percent lower chance of in-hospital neonatal mortality in larger facilities and approximately half this reduction comes from preventing low birth weight and half from better postnatal care. The analysis finds that the cost of saving a disability-adjusted life year through the program was $814, which is highly cost-effective compared with Argentina's $6,075 gross domestic product per capita over this period. Although there are small negative spillover effects on prenatal care utilization of non-beneficiary populations in clinics covered by Plan Nacer, no spillover is found onto their birth outcomes. |
| Keywords: | Health Monitoring&Evaluation,Population Policies,Disease Control&Prevention,Health Systems Development&Reform,Adolescent Health |
| Date: | 2014–05–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:6884&r=hea |