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on Health Economics |
| By: | Yijuan Chen; Juergen Meinecke; Peter Sivey |
| Abstract: | We develop a signalling-game theoretical model to study a policy that publicly reports hospital waiting times. We characterize two effects of such a policy: the "competition effect" that drives hospitals to compete for patients by increasing service rates and reducing waiting times, and the "signalling effect" that allows patients to distinguish a high-quality hospital from a low-quality one. While both effects help reduce the waiting time of the low-quality hospital, they act in opposite directions for the high-quality hospital.s waiting time. We show that the competition effect on the high-quality hospital will outweigh the signalling effect, and consequently both hospitals.waiting times will be reduced after the policy. Empirically we suggest how to exploit the timing in implementing the policy, and provide a set of hypothesis tests for the presence of competition effect, signalling effect, and the policy's overall effect on waiting times. |
| JEL: | I18 D82 |
| Date: | 2013–12 |
| URL: | http://d.repec.org/n?u=RePEc:acb:cbeeco:2013-614&r=hea |
| By: | Asian Development Bank (ADB); (Regional and Sustainable Development Department, ADB); ; |
| Abstract: | Reducing the burden of poor maternal, neonatal, and child health ill-health requires improvements in both the supply and use of effective maternal, newborn and child health (MNCH) services. The financial costs of treatment are known globally to be a major barrier to accessing essential care, potentially imposing considerable burdens on households. To find out what was known about the scale and impact on families of out-of-pocket expenditures in accessing MNCH care in the Asia-Pacific region, this study undertook a systematic review of the global and regional evidence. The findings show that despite significant progress in improving coverage in the region, millions of families in the region continue to face financial barriers to accessing essential MNCH care, and experience significant financial hardships as a result of out-of-pocket payments. It points to areas where the research needs to be improved both methodologically and in terms of geographical coverage, and where better policies might make a difference. |
| Keywords: | health services, maternal health, childcare, safe childbirth, neonatal care, newborn health, out-of-pocket expenditures, mnch, financial barriers, child mortality rates, illnesses, medical treatments, hospitalization, household income, health improvement asia, health care providers, medicines, medical supplies |
| Date: | 2012–12 |
| URL: | http://d.repec.org/n?u=RePEc:asd:wpaper:rpt135430-3&r=hea |
| By: | Asian Development Bank (ADB); (Regional and Sustainable Development Department, ADB); ; |
| Abstract: | The efficiency and cost of Ministry of Health and Family Welfare (MOHFW) healthcare services in Bangladesh are critical constraints on how far the Government of Bangladesh can expand healthcare coverage in the country. Regular information can assist MOHFW in improving the efficiency of service delivery. The Bangladesh Facility Efficiency Survey (FES) 2011 surveyed the services and costs in a nationally representative, stratified sample of 135 Ministry of Health and Family Welfare (MOHFW) facilities. The sample included medical college hospitals (MCHs), specialized hospitals, district hospitals, general hospitals, upazila (subdistrict) health complexes (UHCs), maternal and child welfare centers (MCWCs), and union subcenters. Service indicators and recurrent unit costs for outpatient and inpatient services were estimated for fiscal year (FY) 2010, and assessments are made of efficiency gains since 1997, when the last Bangladesh Facility Efficiency Survey was conducted. The FES 2011 shows that there are high levels of utilization in all major types of inpatient facilities, with bed occupancy averaging 80%-100% at UHCs and MCHs, and over 100% at district hospitals. Since 1997 patient throughput has substantially increased, and been accommodated by significant improvements in operating efficiency, reflected in a decline in average lengths of stay across all facilities. Quality of care seems not have been negatively impacted, as case fatality rates have substantially improved since 1997. There has been little increase in real terms in facility operating budgets since 1997, so overall unit costs have been reduced substantially to one-half to one-third of 1997 levels. The findings suggest that the MOHFW delivery system has not only expanded delivery of services in the past decade, but that much of the increase has been financed through efficiency gains. |
| Keywords: | health services, bangladesh healthcare, medical service providers, hospital equipments, hospital facilities, asian hospitals, patient delivery, inpatient services, fes 2011, child mortality, fertility, maternal health, birth giving, specialized hospitals, medical staff, medical personnels, government facilities, bangladesh clinics, district hospitals |
| Date: | 2012–12 |
| URL: | http://d.repec.org/n?u=RePEc:asd:wpaper:rpt135431-3&r=hea |
| By: | Asian Development Bank (ADB); (Regional and Sustainable Development Department, ADB); ; |
| Abstract: | The Government of Bangladesh has made it a priority to expand access by the poor to maternal, neonatal, and child health (MNCH) services. Central to its strategy is the provision of healthcare services at free or nearly free prices through Ministry of Health and Family Welfare (MOHFW) facilities. However, poor families make less use of MOHFW services than the non-poor, and many patients are reported to incur significant costs at MOHFW facilities. The Patient Exit Survey (PES) 2011 carried out exit interviews of over 5,000 inpatients and outpatients at a representative sample of MOHFW facilities in order to find out why patients incur out-of-pocket expenses at MOHFW facilities, to quantify their size, and to assess the impact of demand-side financing (DSF) pilot schemes on patient out-of-pocket costs and utilization of MNCH services. Almost all outpatients and inpatients report out-of pocket expenses associated with their healthcare visits. These fall into four categories: (i) travel costs to reach the healthcare institution, (ii) official fees charged by MOHFW facilities, (iii) informal or unofficial fees paid to persons inside the facility to obtain services or other benefits, and (iv) the costs of purchasing medicines recommended by the medical staff that which are not available at the health facility. The major out-of-pocket expense reported is purchasing medicines and supplies that are recommended by medical staff but are not available at the facility. About 50% of outpatients and over 90% of inpatients rreport such costs, which average Tk301 per outpatient and Tk980 per inpatient. Travel costs to the facility average Tk27 for outpatients and Tk131 for inpatients, however, travel costs for expectant mothers are much higher and average Tk220. About 50% of outpatients and 75% of inpatients report having to pay official fees, with inpatient women who had delivered, reporting higher-than-average fees. The incidence of informal payments is much lower than anticipated, with most outpatients reporting no such expenses. There have been large increases since 2006 in facility childbirths at facilities enrolled in the DSF schemes, with the greatest impact seen in those enrolled in the universal DSF schemes. However, findings show that the DSF actual out-of-pocket costs incurred at the time of treatment are no lower at DSF enrolled facilities, and that equity of utilization does not seem to have been improved. |
| Keywords: | health services, bangladesh healthcare, medical service providers, hospital equipments, hospital facilities, asian hospitals, patient delivery, inpatient services, fes 2011, child mortality, fertility, maternal health, birth giving, specialized hospitals, medical staff, medical personnels, government facilities, bangladesh clinics, district hospitals |
| Date: | 2012–12 |
| URL: | http://d.repec.org/n?u=RePEc:asd:wpaper:rpt135432-3&r=hea |
| By: | WHO International |
| Keywords: | Medicine and Health Sciences |
| Date: | 2014–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ctcres:qt2r34j901&r=hea |
| By: | Till Seuring (Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK); Yevgeniy Goryakin (UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK); Marc Suhrcke (Centre for Health Economics, University of York, UK) |
| Abstract: | This study explores the impact of diabetes on employment in Mexico using data from the Mexican Family Life Survey (MxFLS) (2005), taking into account the possible endogeneity of diabetes via an instrumental variable estimation strategy. We find that diabetes significantly decreases employment probabilities for men by about 9.9 percent (p |
| Keywords: | diabetes, emplyment, instrumental variables, Mexico |
| JEL: | I10 J01 |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:100cherp&r=hea |
| By: | Dolores de la Mata; Mauricio G. Valencia-Amaya |
| Abstract: | This paper studies the link between severe weather shocks in Colombia and municipality-level incidence of dengue and malaria. The unexpectedly high variability of the 2010 rainfalls relative to previous periods and their regional heterogeneity are exploited as an identification strategy. A differences-indifferences DD) strategy is thereby implemented where the period 2007-2009 is defined as the pre-treatment period and 2010-2011 as the post-treatment period. The treatment group is all municipalities that experienced higher intra-year rain variability in 2010 than in 2007-2009. The results from the different specifications confirm that the relationship between climate events and vector-borne diseases is intricate. The 2010 weather shocks are associated with not only an increase in the number of dengue cases, in the case of high variability (but not extreme) yearly rain, but also a decrease in its incidence, in particular in the presence of extreme rain events. Floods seem to have decreased the number of dengue cases. |
| Keywords: | Climate Change, Human health, Climate variability, Weather shocks, Vector-borne diseases, Dengue |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:idb:brikps:85896&r=hea |
| By: | Briggs Depew; Eric Cardella |
| Abstract: | We exploit a sharp change in the likelihood that an individual is covered by health insurance when they turn 19 years of age to study how health insurance affects reported health status. We find that an individual is 6 percentage points less likely to have health insurance when they turn 19. Using a fuzzy regression discontinuity design, we find that having health coverage significantly increases the likelihood of reporting excellent health among young adults. |
| URL: | http://d.repec.org/n?u=RePEc:lsu:lsuwpp:2014-08&r=hea |
| By: | Marianne P. Bitler; Madeline Zavodny |
| Abstract: | We review the existing literature about the effects of the Medicaid program. We first describe the program’s structure and how it has changed over time. We then discuss findings on coverage, crowd out, take-up and health. Finally, we look at effects of the program on non-health outcomes such as welfare use and labor supply, marriage and fertility, and savings. |
| JEL: | I1 I13 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20169&r=hea |
| By: | H. Elizabeth Peters; Kosali Simon; Jamie Rubenstein Taber |
| Abstract: | Despite the high levels of marital disruption in the United States, and substantial reliance on family-based health insurance, little research is available on the consequences of marital disruption for insurance coverage among men, women, and children. We address this shortfall by examining patterns of coverage surrounding marital disruption. We find large differences in coverage across marital status groups in the cross-section. In longitudinal analyses that focus on within-person change, we find small overall coverage changes but large changes in type of coverage following marital disruption. Both men and women show increases in private coverage in their own names, but offsetting decreases in dependent coverage tend to be larger. Dependent coverage for children also declines after marital dissolution, even though children are still likely to be eligible for that coverage. Children and, to a lesser extent, women show increases in public coverage around the time of divorce or separation. The most vulnerable group appears to be lower-educated women with children because the increases in private, own-name, and public insurance are not large enough to offset the large decrease in dependent coverage. As the United States implements federal health reform, it is critical that we understand the ways in which life course events—specifically, marital disruption—shape the dynamic patterns of coverage. |
| JEL: | I13 J12 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20233&r=hea |
| By: | D. Mark Anderson; Benjamin Hansen; Daniel I. Rees |
| Abstract: | While at least a dozen state legislatures in the United States have recently considered bills to allow the consumption of marijuana for medicinal purposes, the federal government is intensifying its efforts to close medical marijuana dispensaries. Federal officials contend that the legalization of medical marijuana encourages teenagers to use marijuana and have targeted dispensaries operating within 1,000 feet of schools, parks and playgrounds. Using data from the national and state Youth Risk Behavior Surveys, the National Longitudinal Survey of Youth 1997 and the Treatment Episode Data Set, we estimate the relationship between medical marijuana laws and marijuana use. Our results are not consistent with the hypothesis that legalization leads to increased use of marijuana by teenagers. |
| JEL: | D78 I1 K4 |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20332&r=hea |
| By: | Melissa A. Boyle; Joanna N. Lahey |
| Abstract: | Measuring the overall impact of public health insurance receipt is important in an era of increased access to publicly-provided and subsidized insurance. Although government expansion of health insurance to older workers leads to labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While theory predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Our findings suggest that although household labor supply may decrease because of the income effect, wives’ labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth. Moreover, wives with employer-provided health insurance in the previous year remain on the job while those without increase their hours, suggesting incentives to retain or obtain health insurance. Finally, non-working wives enter the labor force, those who were working part-time increase their hours, and full-time “career” women are largely unaffected. |
| JEL: | H42 I13 J14 J22 J26 |
| Date: | 2014–08 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20371&r=hea |
| By: | Mauro Pisu |
| Abstract: | This paper investigates the vulnerabilities of health care systems in OECD and BRIICS countries to adverse secular trends and large macroeconomic shocks. It identifies policies that can ally vulnerabilities considering the institutional setting of health care systems, such as the public-private mix and the main sources of revenues, and the need to balance economic sustainability with the adequacy of services. Surmonter les vulnérabilités des systèmes de santé Ce document examine les vulnérabilités des systèmes de santé, dans les pays de l’OCDE et dans les pays BRIICS, face à des tendances séculaires négatives et à d’importants chocs macroéconomiques. Il identifie les politiques qui peuvent permettre de concilier les vulnérabilités compte tenu des caractéristiques structurelles des systèmes de santé qui dépendent notamment de l’articulation public-privé et des principales sources de financement, et la nécessité de trouver un compromis entre durabilité économique et niveau adéquat des services. |
| Keywords: | sustainability, adequacy, risk pooling, health care system, macroeconomic shock, chocs macroéconomiques, mutualisation des risques, durabilité, système de santé, niveau suffisant des services |
| JEL: | I13 I14 I15 |
| Date: | 2014–07–03 |
| URL: | http://d.repec.org/n?u=RePEc:oec:ecoaaa:1132-en&r=hea |
| By: | Francette Koechlin; Paul Konijn; Luca Lorenzoni; Paul Schreyer |
| Abstract: | Health services account for a large and increasing share of production and expenditure in OECD and Eurostat countries but there are also noticeable differences between countries in expenditure per capita. Whether such differences are due to more services being consumed or whether they reflect differences in the price of services is a question of significant policy relevance. Yet, cross-country comparisons of health services have typically not disentangled these effects. This paper presents the results of a joint effort between OECD and Eurostat in developing price comparisons for health goods and services. The main novel feature is the collection of comparable and output-based prices for hospital services that can then be applied to matching national accounts expenditure data so as to derive consistent price and volume comparisons of health products. The data is novel in that it reflects “quasi prices” (negotiated or administrative prices or tariffs) of the output of hospital services, instead of prices of inputs such as wages of medical personnel. The new methodology moves away from the traditional input perspective, thereby relaxing the assumption that hospital productivity is the same across countries... Les services de santé représentent une part importante et croissante de la production et des dépenses dans les pays de l'OCDE et d'Eurostat, mais des différences notables apparaissent au regard des dépenses par habitant. Savoir si de telles différences sont dues aux quantités des services consommés ou si celles-ci reflètent des différences dans le prix des services est une question fondamentale pour mener des politiques pertinentes. Jusqu’à présent, les comparaisons internationales des services de santé n’ont pourtant pas permis de distinguer ces effets. Ce document présente les résultats d'un effort conjoint entre l'OCDE et Eurostat dans le développement de comparaisons de prix pour les biens et services de santé. Le caractère novateur de cette étude est la collecte de prix comparables pour les services hospitaliers, prix qui peuvent être ensuite appliqués aux dépenses de comptabilité nationale correspondantes pour obtenir des comparaisons cohérentes de prix et de volume des produits de santé. Les données sont inédites car elles reflètent les "quasi-prix" (prix négociés ou réglementés ou tarifs) de la production des services hospitaliers, au lieu des prix des facteurs de production (« input ») tels que les salaires du personnel médical. La nouvelle méthodologie s'écarte de la perspective traditionnelle basée sur les facteurs de production, s’éloignant ainsi de l'hypothèse que la productivité des hôpitaux est la même dans tous les pays... |
| JEL: | C43 I10 M41 |
| Date: | 2014–08–07 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:75-en&r=hea |
| By: | Nemati, S; Edwards, BA; Joon Lee; Pittman-Polletta, B; Butler, J. P.; Malhotra, A |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:180051&r=hea |
| By: | Terrill, PI; Edwards, BA; Wellman, A; Nemati, S; Owens, RL; Butler, J. P.; Malhotra, A; Sands, SA |
| Date: | 2013–01 |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:180056&r=hea |
| By: | Nemati, S; Orr, J; Malhotra, A |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:180136&r=hea |
| By: | Charles Sutcliffe (ICMA Centre, Henley Business School, University of Reading); |
| Abstract: | Annuities are perceived as being illiquid financial instruments, and this has limited their attractiveness to consumers and inclusion in financial models. However, short positions in annuities can be replicated using life insurance and debt, permitting long positions in annuities to be offset, or short annuity positions to be created. The implications of this result for the annuity puzzle, arbitrage between the annuity and life insurance markets, and speculation on expected longevity are investigated. It is argued that annuity replication could help solve the annuity puzzle, improve the price efficiency of annuity markets and promote the inclusion of annuities in household portfolios |
| Keywords: | Annuities, annuity puzzle, arbitrage, longevity, speculation, portfolios, life insurance |
| JEL: | G12 G22 G23 |
| Date: | 2013–07 |
| URL: | http://d.repec.org/n?u=RePEc:rdg:icmadp:icma-dp2013-06&r=hea |
| By: | Liran Einav (Stanford University); Amy Finkelstein (Stanford University); Heidi Williams (MIT Department of Economics) |
| Abstract: | We present a simple framework to illustrate the welfare consequences of a “top up” health insurance policy that allows patients to pay the incremental price for more expensive treatment options. We contrast it with common alternative policies that require essentially no incremental payments for more expensive treatments (as in the United States), or require patients to pay the full costs of more expensive treatments (as in the United Kingdom). We provide an empirical illustration of this welfare analysis in the context of treatment choices among breast cancer patients, where lumpectomy with radiation therapy is a more expensive treatment than mastectomy, with similar average health benefits. We use variation in distance to the nearest radiation facility to estimate the relative demand for lumpectomy and mastectomy. Extrapolating the resultant demand curve (grossly) out of sample, our estimates suggest that the “top-up” policy, which achieves the efficient treatment decision, increases total welfare by $700-2,500 per patient relative to the current US “full coverage” policy, and by $700-1,800 per patient relative to the UK “no top up” policy. While we caution against putting much weight on our specific estimates, the analysis illustrates the potential welfare gains from more efficient reimbursement policies for medical treatments. We also briefly discuss additional tradeoffs that arise from the top-up and UK-style policies, which both lead to additional (ex-ante) risk exposure. |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:sip:dpaper:13-034&r=hea |
| By: | Samia Laokri; Koiné Maxime Drabo; Olivier Weil; Benoît Kafando; S Mathurin Dembelé; Bruno Dujardin |
| Abstract: | Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access. |
| Keywords: | Adult; Burkina Faso; Cost of Illness; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Tuberculosis -- diagnosis -- drug therapy -- economics; Tuberculosis, Pulmonary -- diagnosis -- drug therapy -- economics |
| Date: | 2013 |
| URL: | http://d.repec.org/n?u=RePEc:ulb:ulbeco:2013/153198&r=hea |
| By: | Cash, Richard A.; Potter, James R. |
| Abstract: | The reduction in deaths from diarrheal diseases is one of the significant public health successes of the twentieth century. That said, the disease still accounts for a significant burden of childhood morbidity and mortality in low- and middle-income count |
| Keywords: | diarrheal disease, aid effectiveness, oral rehydration therapy, child mortality |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:unu:wpaper:wp2014-016&r=hea |
| By: | Maria Eugenia Bonilla-Chacin; Luis T Marcano Vazquez; Ricardo Sierra; Ursula Aldana |
| Abstract: | To raise awareness among policymakers and health practitioners about unhealthy diets, this document examines dietary patterns in selected Latin American countries using household surveys. The analysis shows that a large percentage of households in the countries examined have inadequate diets. Not only are calorie intakes higher than recommended to maintain a healthy weight, but the diets are also rich in fats, particularly saturated fats, sugars and sodium, and poor in fruits and vegetables. These unhealthy diets are present in both rural and urban areas and in households at different income levels. These dietary patterns are likely to increase the risks for developing non-communicable diseases such as cardiovascular diseases, certain types of cancer, and diabetes mellitus. These diseases are increasingly representing the main causes of death and disability in Latin America, and thus there is an urgent need to increase efforts to promote healthy diets. There are cost-effective interventions that have proven to improve diets, particularly to reduce sodium and trans fat intake, and there are promising examples in the region of the implementation of some of these cost-effective interventions. In addition, given the harmful effects of these dietary patterns, it is important to monitor the prevalence of unhealthy diets across different population groups as well as the intermediate risks factors linked to these diets, such as overweight and obesity, high blood pressure, and high fasting glucose in the blood. This will require better information than what is currently available and information that is comparable across time. |
| Keywords: | adolescents, Aging, Agriculture, animal fats, animal protein, ascorbic acid, baked goods, beef, beverages, bottles, bran, bread, breakfast cereals, breastfeeding, butter Ca, caffeine, Calcium, caloric intake, Calorie Intake, canned foods, Carbohydrate, carbohydrates, cardiovascular diseases, cheese, child malnutrition, chronic malnutrition, COMMUNICABLE DISEASES, complex carbohydrates, Consumption Quintiles, consumption threshold, cost-effectiveness, cream, daily calories, daily expenditure on food, dairies, dairy, demand for food, diabetes, diet, dietary changes, Dietary Fiber, dietary habits, DIETARY PATTERNS, dietary Sugars, diets, disability adjusted life years, eggs, fats, Folic acid, food availability, food components, food composition, food consumption, food expenditures, food industry, food intake, food preparation, food service, Food supply, foods, Fruit, fruits, grains, health care, health status, high blood pressure, Household Budget, household income, Human Development, Hypertension, ice, income distribution, Income growth, income inequality, income quintile, injuries, intervention, iron, iron deficiency, labeling, leisure time, lipids, liquor, living conditions, Living Standards, low birth weight, maize, margarine, marketing, meal, meat, meats, micronutrients, milk, Minerals, Non-Alcoholic Beverages, nutrient, Nutrition, nutrition surveys, nuts, obesity, pasta, per capita consumption, physical activity, poorer households, Potassium, potatoes, poverty incidence, Pregnant Women, prepared foods, processed foods, Protein, proteins, regional study, restaurants, Rice, Risk Factors, Rural Areas, school health, snacks, sodium, soft drinks, starches, sub-region, Sucrose, Sugar, sugars, supermarkets, sweeteners, tubers, vegetable oils, vegetable proteins, vegetables, violence, Vitamin, Vitamin A, Vitamin B, Vitamin C, Vitamin D, Vitamin E, Vitamin K, vitamins, weight gain |
| Date: | 2014–03 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:80559&r=hea |