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on All new papers |
| By: | Logan McLeod, Jeffrey A. Johnson (Wilfrid Laurier University) |
| Abstract: | We exploit a quasi-experiment in the province of Alberta, Canada, to identify how changes in the schedule of medical benefits affected the provision of primary care services to patients with multiple co-morbidities. Specically, Alberta introduced a new fee code to compensate physicians for completing a comprehensive annual care plan (CACP) for qualifying patients. During the period of study, primary care physicians could practice in two settings: (i) solo practice; or (ii) primary care networks (i.e., team based care). This paper asks how the policy change affected physician-billing patterns and whether delivery structure affected physician- billing. Data come from Alberta's administrative physician claims data, covering the full population of Alberta and all services provided by primary care physicians, for one year before and two years after the policy change. We employ a difference-in-differences methodology and implement a set of robustness checks to control for confounding from other contemporaneous changes that may have occurred in Alberta as well as unobserved physician heterogeneity. Our results suggest the new fee code became the sixth most billed code in its first year (totalling $17.9 million), but was billed by only a small proportion of physicians (roughly 2% of physicians accounted for 20% of total billings). The fee code was disproportionately billed by physicians in team-based care (PCNs), and increased the billing of other complementary fee codes by 5%-10% (or roughly $80 million). The results suggest the unintended consequences of a well-intentioned policy can be costly. |
| Keywords: | physician payment; physician behaviour; difference-in-differences |
| JEL: | I10 I13 I18 |
| Date: | 2014–08–28 |
| URL: | http://d.repec.org/n?u=RePEc:wlu:lcerpa:0077&r=hea |
| By: | Andrew Dillon (Michigan State University); Jed Friedman (World Bank); Pieter Serneels (University of East Anglia) |
| Abstract: | Agricultural and other physically demanding sectors are important sources of growth in developing countries but prevalent diseases such as malaria adversely impact the productivity, labor supply, and occupational choice of workers in these sectors by reducing physical capacity. This study identifies the impact of malaria on worker earnings, labor supply, and daily productivity by randomizing the temporal order at which piece-rate workers at a large sugarcane plantation in Nigeria are offered malaria testing and treatment. The results indicate a significant and substantial intent to treat effect of the intervention – the offer of a workplace based malaria testing and treatment program increases worker earnings by approximately 10% over the weeks following the mobile clinic visit. The study further investigates the effect of health information by contrasting program effects by workers revealed health status. For workers who test positive for malaria, the treatment of illness increases labor supply, leading to higher earnings. For workers who test negative, and especially for those workers most likely to be surprised by the healthy diagnosis, the health information also leads to increased earnings via increased productivity. Possible mechanisms for this response include selection into higher return occupations as a result of changes in the perceived cost of effort. A model of the worker labor decision that includes health perceptions in the decision to supply effort suggests that, in endemic settings with poor quality health services, inaccurate health perceptions may lead workers to misallocate labor thus resulting in sub-optimal production and occupational choice. The results underline the importance of medical treatment but also of access to improved information about one’s health status, as the absence of either may lead workers to deliver lower than optimal effort levels in lower return occupations. |
| Keywords: | malaria, labor supply, labor productivity, randomized experiment |
| JEL: | I21 J22 J24 O12 |
| URL: | http://d.repec.org/n?u=RePEc:uea:wcbess:14-05&r=hea |
| By: | Jorge Aguero |
| Abstract: | This paper uses year-to-year variation in temperature to estimate the long-term effects of climate change on health outcomes in Mexico. Combining temperature data at the district level and three rounds of nationally representative household surveys, an individual’s health as an adult is matched with the history of heat waves from birth to adulthood. A flexible econometric model is used to identify critical health periods with respect to temperature. It is shown that exposure to higher temperatures early in life has negative consequences on adult height. Most importantly, the effects are concentrated at the times where children experience growth spurts: infancy and adolescence. The robustness of these findings is confirmed when using health outcomes derived from accidents, which are uncorrelated with early exposure to high temperatures. |
| JEL: | I12 Q41 Q54 |
| Date: | 2014–01 |
| URL: | http://d.repec.org/n?u=RePEc:idb:wpaper:idb-wp-481&r=hea |
| By: | Mendolia, Silvia (University of Wollongong) |
| Abstract: | This study investigates how maternal working hours are related to various outcomes in children aged 11 to 15 using a sample of mothers and adolescents in the British Household Panel Survey. Research that examines the effects of maternal employment on children has been motivated by the rapid increase of female participation rates in the labour market and increased shares of children living in female-headed or single-mother households. The existing literature on this issue is very limited, mostly based on American data, and provides conflicting results. Fixed effects have been used in the present analysis to control for characteristics of children and families that do not vary over time. The results suggest that full-time maternal employment (as opposed to part-time) has little or no effect on the propensity of adolescents to smoke, their life satisfaction, self-esteem, or intention to leave school at 16. These results are stable and consistent across various specifications of the model and different socio-economic status. |
| Keywords: | maternal working hours, adolescent well-being, children smoking |
| JEL: | I10 J13 J22 |
| Date: | 2014–08 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8391&r=hea |
| By: | Gabriele Camera (Economic Science Institute, Chapman University); Bryan Engelhardt (Department of Economics and Accounting, College of the Holy Cross) |
| Abstract: | The illicit nonmedical use of prescription drugs is studied in a model where individuals with imperfectly observable health conditions seek prescription drugs for either medical or nonmedical reasons. The equilibrium number of medical and nonmedical users is endogenous and depends on economic and non-economic barriers to drugs consumption, such as pricing, health care costs, refill policies, monitoring programs, and the medical community’s prescription standards. The results show policies centered around raising economic barriers reduces nonmedical use but inhibits medical use due to imperfect screening. Alternatively, the results suggest a national drug registry may be more effective at preventing nonmedical use. |
| Keywords: | abuse, doctors, drugs, illegal drug use, health, medication, pain, search |
| JEL: | D83 I1 I11 I18 |
| Date: | 2014–08 |
| URL: | http://d.repec.org/n?u=RePEc:hcx:wpaper:1402&r=hea |