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on Health Economics |
| By: | Charles J. Courtemanche; Joshua C. Pinkston; Christopher J. Ruhm; George Wehby |
| Abstract: | A growing literature examines the effects of economic variables on obesity, typically focusing on only one or a few factors at a time. We build a more comprehensive economic model of body weight, combining the 1990-2010 Behavioral Risk Factor Surveillance System with 27 state-level variables related to general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. Controlling for demographic characteristics and state and year fixed effects, changes in these economic variables collectively explain 37% of the rise in BMI, 43% of the rise in obesity, and 59% of the rise in class II/III obesity. Quantile regressions also point to large effects among the heaviest individuals, with half the rise in the 90th percentile of BMI explained by economic factors. Variables related to calorie intake – particularly restaurant and supercenter/warehouse club densities – are the primary drivers of the results. |
| JEL: | I12 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20892&r=hea |
| By: | Boone, J. (Tilburg University, Center For Economic Research); Schottmuller, C. (Tilburg University, Center For Economic Research) |
| Abstract: | We provide a modeling framework to think about selective contracting in the health care sector. Two health care providers differ in quality and costs. When buying health insurance, consumers observe neither provider quality nor costs. We derive an equilibrium where health insurers signal provider quality through their choice of provider network. Selective contracting focuses on low cost providers. Contracting both providers signals high quality. Market power tends to lower quality and lead to inefficiency. In a dynamic extension of the model, providers under-invest in quality while there can be both over and under-investment in cost reductions if there is a monopoly insurer while an efficient investment equilibrium exists with insurer competition. |
| Keywords: | selective contracting; exclusive contracts; common contracts; managed care; health care quality; signaling |
| JEL: | D86 I11 L13 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:tiu:tiucen:2327d90d-af3a-49ae-8b0b-7345d84d76a5&r=hea |
| By: | Johanna Catherine Maclean (Department of Economics, Temple University); Asia Sikora Kessler (Department of Health Promotion, Social and Economic Behavioral Health, University of Nebraska Medical Center); Donald S. Kenkel (Department of Policy Analysis and Management, Cornell University) |
| Abstract: | In this study we use the Health and Retirement Study (HRS) to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a $1.00 (131.6%) tax increase leads to a 3.8% to 5.2% reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax-elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status, and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population. |
| Keywords: | smoking, cigarette taxes, older adults |
| JEL: | I1 J14 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:tem:wpaper:1502&r=hea |
| By: | Marija Trachtenberg; Michael Parsonage; Geoff Shepherd; Jed Boardman |
| Abstract: | Peer support workers - people with their own lived experience of mental illness - provide mutually supportive relationships in secondary mental health services. Increasing numbers are being employed, both in this country and elsewhere. But good quality evidence on the effectiveness of this form of service delivery is in short supply and even less is known about its cost-effectiveness. This paper makes a first attempt at assessing whether peer support provides value for money, looking specifically at whether peer support workers can reduce psychiatric inpatient bed use. Because of the very high cost of inpatient care, the savings that result from even small changes in bed use may be sufficient to outweigh the costs of employing peer workers. |
| JEL: | E6 |
| Date: | 2013–06–05 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:60793&r=hea |
| By: | Marcus, Jan (DIW Berlin); Siedler, Thomas (University of Hamburg) |
| Abstract: | Excessive alcohol consumption among young people is a major public health concern. On March 1, 2010, the German state of Baden-Württemberg banned the sale of alcoholic beverages between 10pm and 5am at off-premise outlets (e.g., gas stations, kiosks, supermarkets). We use rich monthly administrative data from a 70 percent random sample of all hospitalizations during the years 2007-2011 in Germany in order to evaluate the short-term impact of this policy on alcohol-related hospitalizations. Applying difference-in-differences methods, we find that the policy change reduces alcohol-related hospitalizations among adolescents and young adults by about seven percent. There is also evidence of a decrease in the number of hospitalizations due to violent assault as a result of the ban. |
| Keywords: | binge drinking, drinking hours, alcohol control policies, difference-in-differences, hospital diagnosis statistics, alcohol |
| JEL: | I12 I18 D04 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8763&r=hea |
| By: | Jannah Wigle; Ernestina Coast; Deborah Watson-Jones |
| Abstract: | Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low- and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programs in low- and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasized sociocultural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared. |
| Keywords: | Human papillomavirus; vaccine; cervical cancer; sexually transmitted infection; low- and middle-income countries (LMICs) |
| JEL: | I12 I18 O19 |
| Date: | 2013–08–20 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:50582&r=hea |
| By: | Ajay Aggarwal; Richard Sullivan |
| Abstract: | Context:- In high income countries the costs of delivering high quality equitable care are outstripping present budgets. This article reviews the affordability of cancer care in these countries with particular reference to the United Kingdom (U.K.). The question remains as to whether patients should contribute to their cancer treatment through the introduction of user charges, and whether such payments can be assimilated without undermining efficiency and equity of health care access. Methods:- In our review we analyse the drivers of increased cancer care utilisation, the current policies designed to control rising costs, and the potential impact of introducing patient user charges. The article also explores whether our understanding of behavioural economics could be used to create “nudge” policies that drive rational health care consumption. Findings:- The costs of cancer care in the U.K. are increasing at an unprecedented rate, driven by demographic changes, innovation (radiotherapy, drugs and imaging) and consumerism within health care. Budgets are tightly constrained and health technology assessments designed to ensure coverage of high value interventions have come under significant public and political scrutiny. User charges potentially provide a framework to “nudge” patients from low value care of limited effectiveness towards high value cost effective treatment, thereby increasing overall efficiency. However supply side controls are equally relevant with greater focus on physician test ordering, and improving the quality of doctor–patient communication, especially when discussing treatment options towards the end of life. Conclusions:- Fiscal sustainability of health care financing remains a key public policy concern. Attempts at ensuring coverage of cost effective treatments have been continuously challenged and without new policies, sustainability trade-offs may be necessary with potential rationing of high value treatments. User charges provide a potential means of sustaining spending proportional to the projected rise in number of cancer cases, whilst embracing technological innovations which could potentially improve outcomes. |
| Keywords: | user charges; cancer care; nudge policies; affordability |
| JEL: | E6 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:55297&r=hea |
| By: | Flora Cornish; Jacqueline Priego-Hernandez; Catherine Campbell; Gitau Mburu; Susie McLean |
| Abstract: | While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers. |
| Keywords: | community mobilisation; community participation; HIV prevention; HIV/AIDS; systematic review |
| JEL: | N0 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:56364&r=hea |
| By: | David E. Wennberg; Sandra M. Sharp; Gwyn Bevan; Jonathan S. Skinner; Daniel J. Gottlieb; John E. Wennberg |
| Abstract: | Objective:- To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Setting:- Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design:- Cross sectional analysis. Participants:- 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n=5 153 877). Main outcome measures:- The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services—Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare’s administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Results:- Estimated variation in age, sex, and race adjusted mortality rates across hospital referral regions was reduced using the indices based on population health, poverty, and visit corrected HCC, but increased using the standard HCC index. Most of the residual variation in age, sex, and race adjusted mortality was explained (in terms of weighted R2) by the population health index: R2=0.65. The other indices explained less: R2=0.20 for the visit corrected HCC index; 0.19 for the poverty index, and 0.02 for the standard HCC index. The residual variation in age, sex, race, and price adjusted spending per capita across the 306 hospital referral regions explained by the indices (in terms of weighted R2) were 0.50 for the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Conclusion:- Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases. |
| JEL: | G32 |
| Date: | 2014–04–10 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:56671&r=hea |
| By: | Catherine Henderson; Martin Knapp; José-Luis Fernández; Jennifer Beecham; Shashivadan P Hirani; Martin Cartwright; Lorna Rixon; Michelle Beynon; Anne Rogers; Peter Bower; Helen Doll; Ray Fitzpatrick; Adam Steventon; Martin Bardsley; Jane Hendy; Stanton P Newman |
| Abstract: | Objective: To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment. Design: Economic evaluation nested in a pragmatic, cluster randomised controlled trial. Setting: Community based telehealth intervention in three local authority areas in England. Participants: 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care. Interventions: Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care. Main outcome measure: Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. Results: We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY). Conclusions: The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment. |
| Keywords: | Health economics; Health policy; Health service research; Clinical trials (epidemiology); Drugs: cardiovascular system |
| JEL: | L91 L96 |
| Date: | 2013–03–22 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:56772&r=hea |
| By: | Paul Dolan; Matteo M. Galizzi |
| Abstract: | We conduct a controlled lab-field experiment to directly test the short-run spillover effects of one-off financial incentives in health. We consider how incentives affect effort in a physical activity task – and then how they spillover to subsequent eating behaviour. Compared to a control group, we find that low incentives increase effort and have little effect on eating behaviour. High incentives also induce more effort but lead to significantly more excess calories consumed. The key behavioural driver appears to be the level of satisfaction associated with the physical activity task, which ‘licensed’ highly paid subjects to indulge in more energy-dense food. |
| Keywords: | Incentives in health; spillover effects; licensing; hidden costs of incentives |
| JEL: | C91 C93 D0 I10 |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:60356&r=hea |
| By: | Jinkook Lee; McGovern, Mark E.; David E. Bloom; P. Arokiasamy; Arun Risbud; Jennifer O?Brien; Varsha Kale; Peifeng Hu |
| Abstract: | This paper examines health disparities in biomarkers among a representative sample of Indians aged 45 and older, using data from the pilot round of the Longitudinal Aging Study in India (LASI). Hemoglobin level, a marker for anemia, is lower for respondents with no schooling (0.7 g/dL less in the adjusted model) compared to those with some formal education. The oldest old have higher levels of C-reactive protein (CRP) (1.1 mg/L greater than those aged 45-54), an indicator of inflammation and a risk factor for cardiovascular disease, as do those with greater body-mass index (an additional 1.7 mg/L for those who are obese compared to those who are underweight). We find no evidence of educational or gender differences in CRP, but respondents living in rural areas have CRP levels that are 0.8 mg/L lower than urban areas. We also find state-level disparities, with Kerala residents exhibiting the lowest CRP levels (1.96 mg/L compared to 3.28 mg/L in Rajasthan). There are substantial state and education gradients in underweight and overweight. We use the Blinder-Oaxaca decomposition approach to explain group-level differences, and find that state-level gradients in CRP are mainly due to heterogeneity in the association of the observed characteristics of respondents with CRP, as opposed to differences in the distribution of endowments across the sampled state populations. |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:228841&r=hea |
| By: | Hüseyin Sen; Ayse Kaya; Baris Alpaslan |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:man:sespap:1502&r=hea |
| By: | Catherine M. DesRoches; Michael W. Painter; Ashish K. Jha |
| Abstract: | Adopting EHRs is the first step in a long and complex journey to an IT-enabled health care system in which technology is effectively leveraged to address ongoing cost and quality challenges. |
| Keywords: | Health Information Technology, HIT, Health |
| JEL: | I |
| Date: | 2014–08–07 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:0262ebe769b94bd99d436ae193393bfa&r=hea |
| By: | Charles Stoecker (Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine); Nicholas J. Sanders (Department of Economics, College of William and Mary); Alan Barreca (Department of Economics, Tulane University) |
| Abstract: | Using county-level Vital Statistics of the United States data from 1974-2009, we employ a differences-in-differences framework comparing influenza mortality rates in Super Bowl-participating counties to non-participants. Having a local team in the Super Bowl causes an 18% increase in influenza deaths for the population over age 65, with evidence suggesting one mechanism is increased local socialization. Effects are most pronounced in years when the dominant influenza strain is more virulent, or when the Super Bowl occurs closer to the peak of influenza season. Mitigating influenza transmission at gatherings related to large spectator events could have substantial returns for public health. |
| Keywords: | influenza, externality, Super Bowl |
| JEL: | I18 L83 R53 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:tul:wpaper:1501&r=hea |
| By: | Mathematica Policy Research |
| Abstract: | Mathematica Policy Research has conducted influential work to improve mental health and substance abuse services and policies. We combine our deep knowledge of behavioral health care with our data collection and analytic capabilities to provide a wide array of services. |
| Keywords: | Behavioral Health, Mental Health |
| JEL: | I |
| Date: | 2014–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:1a4a734395834e60bb70d8eb4e213f4d&r=hea |
| By: | Amanda E. Kowalski |
| Abstract: | Young people with private health insurance sometimes transition to the public health insurance safety net after they get sick, but popular sources of cross-sectional data obscure how frequently these transitions occur. We use longitudinal data on almost all hospital visits in New York from 1995 to 2011. We show that young privately insured individuals with diagnoses that require more hospital visits in subsequent years are more likely to transition to public insurance. If we ignore the longitudinal transitions in our data, we obscure over 80% of the value of public health insurance to the young and privately insured. |
| JEL: | I13 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:20887&r=hea |
| By: | Arnaud Cheron; Pierre-Jean Messe; Jerome Ronchetti |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:tep:teppwp:wp14-16&r=hea |
| By: | Sara Evans-Lacko; Martin Knapp; Paul McCrone; Graham Thornicroft; Ramin Mojtabai |
| Abstract: | A period of economic recession may be particularly difficult for people with mental health problems as they may be at higher risk of losing their jobs, and more competitive labour markets can also make it more difficult to find a new job. This study assesses unemployment rates among individuals with mental health problems before and during the current economic recession. |
| JEL: | I12 |
| Date: | 2013–07–26 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:51632&r=hea |
| By: | Shirin Madon; Jackline Olanya Amaguru; Mwele Ntuli Malecela; Edwin Michael |
| Abstract: | The increasing proliferation of mobiles offers possibilities for improving health systems in developing countries. A case in point is Tanzania which has piloted a mobile phone-based Management Information System (MIS) for the control of neglected tropical diseases (NTDs) where village health workers (VHWs) were given mobile phones with web-based software to test the feasibility of using frontline health workers to capture data at point of source. Based on qualitative case study research carried out in 2011, we found that providing mobile phones to VHWs has helped to increase the efficiency of routine work boosting the motivation and self-esteem of VHWs. However, despite these advantages, the information generated from the mobile phone-based NTD MIS has yet to be used to support decentralised decision-making. Even with improved technology and political will, the biggest hindrance to local usage of information for health planning is the lack of synthesised and analysed health information from the district and national levels to the villages. Without inculcating a culture of providing health information feedback to frontline workers and community organisations, the benefits of the intervention will be limited. If not addressed, this will mean that mobiles have maintained the one-way upward flow of information for NTD control and simply made reporting more hi-tech. |
| Keywords: | decentralisation; health systems; m-health; mobiles; neglected tropical diseases (NTDs); Tanzania |
| JEL: | L91 L96 |
| Date: | 2014–02 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:56058&r=hea |
| By: | Martin Knapp; Adelina Comas-Herrera; Raphael Wittenberg; Bo Hu; Derek King; Amritpal Rehill; Bayo Adelaja |
| Abstract: | As the world population continues to age, so will the number of people with dementia continue to rise rapidly. This growing prevalence poses many challenges, including the economic challenge of how societies can ensure that treatment, care and support are provided at an affordable cost, whilst ensuring good quality of life for people with dementia and their families. The aim of this research is to examine the economic consequences of different ways to respond to this challenge. |
| JEL: | E6 |
| Date: | 2014–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:57568&r=hea |
| By: | Virginia MacNeill; Caroline Sanders; Ray Fitzpatrick; Jane Hendy; James Barlow; Martin Knapp; Anne Rogers; Martin Bardsley; Stanton P Newman |
| Abstract: | Background: Telehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of frontline healthcare professionals expected to implement it. Aim: To investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional. Design and setting: A qualitative study in three sites within the UK (Kent, Cornwall, and the London Borough of Newham) and embedded in the Whole Systems Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions. Method: Semi-structured qualitative interviews with 32 front-line health professionals (13 community matrons, 10 telehealth monitoring nurses and 9 GPs) involved in the delivery of telehealth. Data were analysed using a modified grounded theory approach. Results: Mixed views were expressed by front-line professionals, which seem to reflect their levels of engagement. It was broadly welcomed by nursing staff as long as it supplemented rather than substituted their role in traditional patient care. GPs held mixed views; some gave a cautious welcome but most saw telehealth as increasing their work burden and potentially undermining their professional autonomy. Conclusion: Health care professionals will need to develop a shared understanding of patient self-management through telehealth. This may require a renegotiation of their roles and responsibilities |
| Keywords: | primary care; qualitative; telehealth; Whole System Demonstrator |
| JEL: | L91 L96 |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:57614&r=hea |
| By: | Stefan Walter; Maria Glymour; Mauricio Avendano |
| Abstract: | Objective: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31). This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD. |
| JEL: | N0 |
| Date: | 2014–07–15 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:58516&r=hea |
| By: | Dimitra Petrakaki; Ela Klecun; Tony Cornford |
| Abstract: | This article considers changes in healthcare professional work afforded by technology. It uses the sociology of professionals’ literature together with a theory of affordances to examine how and when technology allows change in healthcare professional work. The study draws from research into the introduction of a national electronic patient record in an English hospital. We argue that electronic patient record affords changes through its materiality as it interacts with healthcare professional practice. Its affordances entail some level of standardisation of healthcare professional conduct and practice, curtailment of professional autonomy, enlargement of nurses’ roles and redistribution of clinical work within and across professional boundaries. The article makes a contribution to the growing literature advocating a cultural approach to the study of technological affordances in organisations and to studies that explore healthcare professional practice in conjunction with the materiality of technology. Two main lines of argument are developed here. First, that technological affordances do not solely lie with the materiality of technology nor with individual perceptions, but are cultivated and nurtured within a broader cultural–institutional context, in our case a professional context of use. Second, that technological affordance of change is realised when healthcare professionals’ (individual and collective) perceptions of technology (and of its materiality) fit with their sense of (professional) self. In this respect, the article shows the extent to which the materiality of technology plays out with professional identity and frames the level and extent to which technology can and cannot afford restructuring of work and redistribution of power across professional groups. |
| Keywords: | affordance; change; healthcare professionals; technology; work |
| JEL: | J50 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:59475&r=hea |
| By: | Martin Knapp; Tom Snell; Andrew Healey; Sacha Guglani; Sara Evans-Lacko; José-Luis Fernández; Howard Meltzer; Tamsin Ford |
| Abstract: | Background:- Policy and practice guidelines emphasize that responses to children and young people with poor mental health should be tailored to needs, but little is known about the impact on costs. We investigated variations in service-related public sector costs for a nationally representative sample of children in Britain, focusing on the impact of mental health problems. Methods:- Analysis of service uses data and associated costs for 2461 children aged 5–15 from the British Child and Adolescent Mental Health Surveys. Multivariate statistical analyses, including two-part models, examined factors potentially associated with interindividual differences in service use related to emotional or behavioural problems and cost. We categorized service use into primary care, specialist mental health services, frontline education, special education and social care. Results:- Marked interindividual variations in utilization and costs were observed. Impairment, reading attainment, child age, gender and ethnicity, maternal age, parental anxiety and depression, social class, family size and functioning were significantly associated with utilization and/or costs. Conclusions:- Unexplained variation in costs could indicate poor targeting, inequality and inefficiency in the way that mental health, education and social care systems respond to emotional and behavioural problems. |
| Keywords: | psychiatric practice; education; social work; economic evaluation |
| JEL: | E6 |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:60131&r=hea |
| By: | Roxana Oana Darabont; Paul Suceveanu; Mihaela Suceveanu; Clara Volintiru |
| Abstract: | Romania has one of the highest mortality rates in Europe for ischemic heart disease and, especially, for cerebrovascular disease. Taking into account the actual prevalence of cardiovascular diseases, an augmentation of the demand for specialized medical services is expected. As this paper argues, this situation can have an important impact on medical tourism. We analyze original data on the case study of a hospital, specialized in cardiovascular treatment, in the Romanian county of Covasna, which is offering specific balneal procedures, such as CO2 .hydrotherapy, alongside regular rehabilitation programs. The aim of our study is to evaluate the demographic characteristics, and the pathology of the hospitalized patients, as well as the specific rehabilitation procedures. Our findings suggest that the interest of patients, with cardiovascular diseases, for medical tourism can be influenced by accessibility, by some particularities of the location, but also by the holistic nature of the rehabilitation procedures. |
| Keywords: | medical tourism; cardiovascular diseases; CO2 hydrotherapy |
| JEL: | C46 I11 L83 |
| Date: | 2014–11 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:60487&r=hea |
| By: | Runu Bhakta (Indira Gandhi Institute of Development Research; `) |
| Abstract: | The basic objective of the study is to examine the impact of public expenditure on health and education after incorporating the linkages between health status of children and their educational achievements in India. This study has developed a simultaneous equation model among health and education of children, and public expenditure on these sectors. Three stage least squares technique is applied to get consistent and efficient estimates of the system. The results show that bad health status among children, captured by high IMR, is responsible to have lower enrolment rates and high dropout rates in primary level. In addition, public expenditure on Supplementary Nutritional Program has indirect positive impact on education through the improvements in health status of children whereas additional expenditure on elementary education has positive impact on enrolment rates, but at diminishing rate. Moreover, public expenditure on elementary education has greater impact on enrolment as compared to dropout rates. |
| Keywords: | Public Expenditure, Education, Health, SEM, 3SLS, IMR, GER, NER, Dropout Rates |
| JEL: | H51 H52 I18 I28 C33 |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:ind:igiwpp:2014-049&r=hea |
| By: | Raut, Nirmal Kumar; Shrestha, Devendra Prasad |
| Abstract: | We attempt to analyze the reasons to low adult immunization from the willingness to pay perspective in the peri-urban setting of Kathmandu Valley where some private health facilities had organized Hepatitis B Vaccine Health camps in the recent past. We reason the existence of regulated Hepatitis B Vaccine market in Nepal and thereby utilize an open ended question to assess the willingness to pay of an unimmunized adult. We justify the application of the two-part model in the study and further show that the socio-economic and demographic variables do not play significant role in explaining the low adult immunization except for age and employment. The result further reveals that people do not care to pay more for vaccination at present unless they apprehend the risk of suffering from disease with the disease specific symptoms or some history of chronic diseases. We argue that people exhibit time inconsistent - present biased preferences in immunization practices. The small preventive costs incurred to them on immunization today appear very large relative to the economic benefits realized tomorrow. There still exists asymmetric information so far as understanding the importance of the vaccine and its right/proper usage are concerned; a strong case of informing people to perceive vaccination as a preventive lifesaving shot thus becomes essential. |
| Keywords: | Hepatitis B Vaccine, Adult Immunization |
| JEL: | I12 I15 I18 |
| Date: | 2011–09 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:61711&r=hea |
| By: | Ann S. O'Malley; Kevin Draper; Rebecca Gourevitch; Dori A. Cross; Sarah Hudson Scholle |
| Keywords: | primary health care, team, qualitative research, electronic health record, health services research, teamwork |
| JEL: | I |
| Date: | 2015–01–27 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:e5c2b5d8b9e2424dab904eb647aedb3a&r=hea |
| By: | Duflo, Esther; Dupas, Pascaline; Kremer, Michael |
| Abstract: | A seven-year randomized evaluation suggests education subsidies reduce adolescent girls’ dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government’s HIV curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor (unprotected sex), but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes. |
| Keywords: | education; fertility; HIV; Kenya; pregnancy |
| JEL: | I12 I25 I38 O12 |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:10338&r=hea |