nep-hea New Economics Papers
on Health Economics
Issue of 2015‒02‒16
twenty-six papers chosen by
Yong Yin
SUNY at Buffalo

  1. What Do Longitudinal Data on Millions of Hospital Visits Tell Us about the Value of Public Health Insurance as a Safety Net for the Young and Privately Insured? By Amanda E. Kowalski
  2. Physician Longitudinal Relationship between Participation in Physical Activity and Health By Logan McLeod; Jane E. Ruseski
  3. The Influence of Environmental Factors on Human Health: Economic Estimations for Ukraine By Kubatko Oleksandr; Kubatko Oleksandra
  4. The Cost of Binge Drinking By Marco Francesconi; Jonathan James
  5. On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter? By Novignon, Jacob
  6. The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the ACA By Michael J. Dickstein; Mark Duggan; Joseph Orsini; Pietro Tebaldi
  7. A Behavioural Approach to Health Promotion: Informing the Global NCD Agenda with Behavioural By Alemanno , Alberto
  8. Competition and the Operational Performance of Hospitals: The Role of Hospital Objectives By Andritsos , Dimitrios; Aflaki , Sam
  9. Learning-by-Doing in a High-Skill Profession when Stakes are High: Evidence from Advanced Cancer Surgery By Avdic, Daniel; Lundborg, Petter; Vikström, Johan
  10. The Effect of Early Universal Daycare on Child Weight Problems By Lauber, Verena; Thomas, Lampert
  11. The Effect of Copayments on Children's and Adolescents' Demand for Medical Care By Paul, Alexander; Nilsson, Anton
  12. Reference pricing and cost-sharing: Theory and evidence on German off-patent drugs By Herr, Annika; Stühmeier, Torben; Wenzel, Tobias
  13. Economic Evaluation of the GOAL Lifestyle Intervention to Prevent Type-2 Diabetes By Jan Häußler; Nelli Hankonen; Pilvikki Absetz
  14. Foreign aid and HIV infections: evidence of causal effects from country-level panel data By Thomas, RA
  15. Analysis of Worker's Mental Health and Working Environment By Juntarou Yamaoka; Miki Kobayashi
  16. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – ETXEAN ONDO (Spain) Case Study Report By Francisco Lupiañez-Villanueva; Alexandra Theben
  17. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – BSA (Spain) Case Study Report By Francisco Lupiañez-Villanueva; Alexandra Theben
  18. Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – BLMSE (Sweden) Case Study Report By Daniel Smedberg; Francisco Lupiañez-Villanueva
  19. The Medical Care Costs of Mood Disorders: A Coarsened Exact Matching Approach By Schurer, Stefanie; Alspach, Michael; MacRae, Jayden; Martin, Greg L.
  20. Public Health Insurance and Entry into Self-Employment By Fossen, Frank M.; König, Johannes
  21. How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget By Congressional Budget Office
  22. On the Assumption of Bivariate Normality in Selection Models: A Copula Approach Applied to Estimating HIV Prevalence By McGovern, Mark E.; Bärnighausen, Till; Giampiero Marra; Rosalba Radice
  23. Early Life Circumstance and Mental Health in Ghana By James Fenske; Achyuta Adhvaryu; Anant Nyshadham
  24. Natural resourcs and the spread of HIV/AIDS: curse or blessing? By Olivier Sterck
  25. The Capacity of Self-Reported Health Measures to Predict High-Need Medicaid Enrollees By Lindsey Leininger Kelsey Avery
  26. Youth unemployment and mental health: dominance approach. Evidence from Poland. By Martyna Kobus; Marcin Jakubek

  1. By: Amanda E. Kowalski (Cowles Foundation, Yale University)
    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.
    Keywords: Health insurance, Nonelderly, Cohort
    JEL: I13
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:cwl:cwldpp:1983&r=hea
  2. By: Logan McLeod; Jane E. Ruseski
    Abstract: Health production models include participation in physical activity as an input. We investigate the longitudinal relationship between participation in physical activity and health outcomes using a random effects probit model and a dynamic unobserved effect probit model. Estimates based on data from 8 cycles of the Canadian National Population Health Survey (NPHS) indicate lagged participation in physical activity has a modest negative effect on the incidence of high blood pressure, ulcers, arthritis, and heart disease. Lagged participation in physical activity has a relatively large negative effect on the probability of being in fair or poor health self-reported health.
    Keywords: health production, physical activity, lifestyle choices, random effects probit, dynamic unobserved effects probit
    JEL: I12 I18
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:cch:wpaper:150002&r=hea
  3. By: Kubatko Oleksandr; Kubatko Oleksandra
    Abstract: This paper estimates the influence of pollution on population health outcomes throughmeasuring direct and indirect pollution health effects. It is found that air pollution increase thenumber of population morbidities, and responsible on average for 10.3% of all incidents ofcardiovascular morbidity; 11% of digestion morbidity cases, 16% of respiratory morbidity cases,30% and 10.5% of man lung cancer and women lung cancer respectively. Also air pollution isresponsible on average for 3.6% of all mortality cases in Ukraine. Total economic costs attributed toair pollution and selected morbidity indicators in 2011 were in a range 0.7%-1.3% of GDP.
    JEL: I Q
    Date: 2015–02–02
    URL: http://d.repec.org/n?u=RePEc:eer:wpalle:15/01e&r=hea
  4. By: Marco Francesconi; Jonathan James
    Abstract: We estimate the effect of binge drinking on accident and emergency attendances, road accidents, arrests and the number of police officers on duty using a variety of unique data from Britain and a two-sample minimum distance estimation procedure. Our estimates, which reveal sizeable effects of bingeing on all outcomes, are then used to monetize the short-term externalities of binge drinking. We find that these externalities are on average £4.9 billion per year ($7 billion), about £80 for each man, woman and child liing in the UK. The price that internailizes this externality is equivalent to an additional 9p per alcoholic unit, implying a 20% increase with respect to the current avarage prices.
    Date: 2015–02–05
    URL: http://d.repec.org/n?u=RePEc:esx:essedp:760&r=hea
  5. By: Novignon, Jacob
    Abstract: Health expenditure in Sub-Saharan Africa (SSA) has improved over the years with several recent efforts to improve resource commitments to the health sector. Health outcomes in the region have, however, seen little improvements over the years. Several reasons, including the efficiency of health expenditure, have been given to justify this mismatch. Studies on health expenditure efficiency have mainly focused on developed regions with little attention to SSA. The objective of the study was, therefore, to examine The effects of corruption and public institution quality on efficiency. The efficiency of health expenditure was also compared across selected SSA countries. Data for the study was sourced from the World Bank's World Development Indicators for 45 countries covering the period 2005 to 2011. The two-stage Data Envelopment Analysis (DEA) was employed for the analysis. The first stage computes efficiency scores while the second stage examines the determinants of efficiency using the Tobit model. Per capita health expenditure was used as input while infant, under-five mortality and crude death rates were used as outputs. The results show that health expenditure efficiency was low with average scores of approximately 0.5. This suggests that there exist significant potential for SSA countries to improve population health outcomes given the level of expenditure. There was significant variation across countries with Cape Verde, Eritrea and Mauritius among the efficient countries while Equatorial Guinea, Sierra Leone and Swaziland were relatively inefficient. High corruption and poor public sector institutions reduced health expenditure efficiency. The findings emphasize the fact that, while increased health spending is necessary, it is also important to ensure efficiency in resource use across SSA countries. This can be achieved by effective monitoring and evaluation programmes that ensure reduced corruption and improved public institutions.
    Keywords: Health expenditure efficiency, Tobit model, DEA, SSA, Corruption, Public institutions
    JEL: H51 I10 I18
    Date: 2015–02–04
    URL: http://d.repec.org/n?u=RePEc:pra:mprapa:39195&r=hea
  6. By: Michael J. Dickstein; Mark Duggan; Joseph Orsini; Pietro Tebaldi
    Abstract: Under the Affordable Care Act, individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see .6 to .8 more active insurers, on average, and savings in annual premiums of between $200 and $300.
    JEL: I11 I13 I18
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:nbr:nberwo:20907&r=hea
  7. By: Alemanno , Alberto
    Abstract: At a time in which behavioural science has gained increasing attention for the design of population-wide health interventions, this chapter discusses its potential contributions to the prevention and control of Non-Communicable-Diseases (NCDs). Given the largely preventable nature of NCDs, any lifestyle intervention faces the challenge to induce behavioural change. By highlighting the role of social and physical environments in shaping our behaviour, applied behavioural science provides policymakers with a new understanding of human decision-making and, as a result, may support an innovative approach to the promotion of behaviour change leading to healthier lives. <p> While only a combination of policy instruments, such as legislation, regulation, and even financial and fiscal incentives, may induce behaviour change to the scale required to reduce the burden of chronic disease at the population level, a behavioural informed approach may valuably complement the current regulatory mix. In particular, an analysis of the WHO NCD Action Plan and its accompanying strategies suggests an increased awareness of the roles played by environmental and social factors on behaviour change. Although the language employed falls short of operationalizing the major behavioural insights into the NCD agenda, it clearly highlights that their integration into the current regulatory mix appears fundamental today for the design of any lifestyle policy intervention. <p> As behavioural change is progressively becoming the focus of health promotion efforts, the lesson learned is that there is more to behaviour change than merely empowering the targeted individuals, communities and populations with the necessary information.
    Keywords: Health law; NCD; WHO; Nudge; Libertarian Paternalism; Behavioral change; Lifestyle; Regulation
    JEL: I12 I28 J18 K00 K20 K23 K32 M00
    Date: 2014–08–04
    URL: http://d.repec.org/n?u=RePEc:ebg:heccah:1054&r=hea
  8. By: Andritsos , Dimitrios; Aflaki , Sam
    Abstract: The authors examine the effect of a hospital's objective (i.e., non-profit versus for-profit) in hospital markets for elective care. Using game-theoretic analysis and queueing models to capture the operational performance of hospitals, they compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and the total patient cost from waiting and hospital care payments. In the first setting, patients are served exclusively by a single non-profit hospital; in the second, patients are served by two competing non-profit hospitals. In the third setting, the market is served by one non-profit hospital and one for-profit hospital. A non-profit hospital provides free care to patients, although they may have to wait; for-profit hospitals charge a fee to provide care with minimal waiting. A comparison of the first two settings reveals that competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. A comparison between the second and third settings indicates that, when the public funder is not financially constrained, the presence of a for-profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. The authors' analysis suggests that the public funder should exercise caution when using policy tools that support the for-profit sector -- for example, patient subsidies -- because such tools may increase patient costs in the long run; it might be preferable to raise the level of reimbursement to the non-profit sector.
    Keywords: hospitals; for-profit healthcare; non-profit healthcare; queueing models; service provider competition
    Date: 2014–05–26
    URL: http://d.repec.org/n?u=RePEc:ebg:heccah:1047&r=hea
  9. By: Avdic, Daniel; Lundborg, Petter; Vikström, Johan
    Abstract: Although learning-by-doing is believed to be an important source of productivity growth there is limited evidence that production volume affects productivity in a causal sense. We document evidence of learning-by-doing in a high-skill profession where stakes are high; advanced cancer surgery. For this purpose, we introduce a novel instrument that exploits closures and openings of entire cancer clinics which has given rise to sharp and exogenous changes in cancer surgical volume performed at Swedish public sector hospitals. Using detailed register data on more than 100,000 episodes of advanced cancer surgery our results suggest positive effects of surgery volume on survival. In addition, we provide evidence on the mechanisms through which these improvements occur. We also show that results are not driven by changes in patient composition or by other changes at the hospital level.
    JEL: I11 I18 L11
    Date: 2014
    URL: http://d.repec.org/n?u=RePEc:zbw:vfsc14:100278&r=hea
  10. By: Lauber, Verena; Thomas, Lampert
    Abstract: As the number of young children in daycare increases, people start to worry about the effect of early non-parental care. This is of special relevance as investments in the early periods of life are shown to be most important for a child’s long term development. Based on the German national health survey for children, we study the impact of daycare in pre-kindergarten-age on weight problems and gross motor skills of children aged five to nine. This dataset has the advantage to provide objective child development measures. Our results are thus not prone to reporting bias. We estimate the effect of early daycare based on a non-linear instrumental variable strategy, by exploiting regional differences in subsidized centerbased care for zero to three year old children as the source of exogenous variation. Our OLS estimates reveal only very weak differences and do not hint at an increase in weight problems due to early use of daycare. The estimated local average treatment effects even indicate that early daycare leads to more desirable physical development for children ’at the margin’. Further analyses suggest that we do not estimate an effect for the most advantaged children, as the caring decision in families with low and medium income and with an overweight father seem to react most strongly to differences in daycare supply.
    Keywords: Childcare,obesity,fitness,non-linear instrumental variables
    JEL: I12 J13 I20 J18
    Date: 2014
    URL: http://d.repec.org/n?u=RePEc:zbw:vfsc14:100399&r=hea
  11. By: Paul, Alexander; Nilsson, Anton
    Abstract: We exploit a policy change in Sweden to estimate the effect of copayments on the demand for children's and adolescents' usage of medical care. To this end, we use population-wide registry data including detailed characteristics of individuals and their medical visits. We examine whether the response to prices varies by socioeconomic background or health status. When visits to doctors become free of charge, we find that individuals see a doctor more often. This effect does not represent a substitution away from inpatient care. The size of the response differs by health and income but not by educational attainment
    JEL: I10 I18 G22
    Date: 2014
    URL: http://d.repec.org/n?u=RePEc:zbw:vfsc14:100403&r=hea
  12. By: Herr, Annika; Stühmeier, Torben; Wenzel, Tobias
    Abstract: This paper evaluates the impact of reference pricing on prices and co-payments in the (German) market for off-patent pharmaceuticals. We present a theoretical model with price-sensitive and loyal consumers that shows that a decrease in the reference price affects the consumers' co-payments in a non-monotonic way: For high reference prices, a marginally lower reference price may lead to lower co-payments. However, for low reference prices a further reduction may result into higher consumer co-payments. We use quarterly data on reference priced drugs covered by the social health insurance in Germany over the period 2007 - 2010 to analyze the empirical effects of reference price reductions. We find that, while prices decrease due to the reduction, co-payments behave non-monotonically and indeed increase if the reference price is sufficiently low.
    JEL: I18 I11 L13
    Date: 2014
    URL: http://d.repec.org/n?u=RePEc:zbw:vfsc14:100556&r=hea
  13. By: Jan Häußler (Department of Economics, University of Konstanz, Germany); Nelli Hankonen (University of Helsinki, Faculty of Social Sciences, Unioninkatu 37, 00014 Helsinki, Finland); Pilvikki Absetz (National Institute for Health and Welfare (THL), P.O. Box 30, 00271 Helsinki, Finland)
    Abstract: Several RCT studies have shown that prevention of type 2 diabetes is feasible via lifestyle interventions. Nevertheless, the empirical evidence for economic effectiveness of prevention in real-world settings is scarce. We analyze costs and effectiveness of a specific type 2 diabetes prevention program in Finland, the GOAL Lifestyle Implementation Trial (GOAL LIT). We developed a Markov model with five mutually exclusive (disease) states and discrete one-year intervals to simulate the health effects of the intervention over 15 years. Based on the 3-year follow-up results from the intervention and a risk factor matched control group, we computed annual transition probabilities between BMI levels. The mortality differences between intervention and control group after 15 years are insignificant for both sexes. Projected cumulative costs of diabetes for both sexes are significantly lower in the intervention group compared to control group. From the perspective of the health care system the cost saving of the study depends on the assumed degree of complications with type 2 diabetes. For an all-male intervention group, the net benefit is positive above the threshold of 8 per cent average annual complication rate. The average overall monetary gain of the intervention then lies between €213.8 and €354.8 per person. The GOAL LIT would also be cost-effective, if the program was conducted in a representative Finnish population, with possible costs savings following the intervention between €64.8 and €155.8 per person. The results indicate that a diabetes prevention program like the GOAL LIT can be cost effective. Potential cost effects are mainly due to male participants, but nevertheless also notable in a representative population. However, our framework only focuses on one obesity related disease and thus tends to underestimate the cost savings as well as potential mortality benefits.
    Keywords: Obesity, Diabetes, Prevention, Evaluation
    JEL: I19
    Date: 2015–02–02
    URL: http://d.repec.org/n?u=RePEc:knz:dpteco:1502&r=hea
  14. By: Thomas, RA
    Date: 2015–01–08
    URL: http://d.repec.org/n?u=RePEc:imp:wpaper:18673&r=hea
  15. By: Juntarou Yamaoka (Graduate School of Economics, Kobe University); Miki Kobayashi (Graduate School of Economics, Kobe University)
    Date: 2015–02
    URL: http://d.repec.org/n?u=RePEc:koe:wpaper:1505&r=hea
  16. By: Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence)
    Abstract: The ETXEAN ONDO pilot project is an integrated care approach which was implemented in the Basque Country. It aimed to provide adequate support and care for elderly people living at home or in nursing homes, for family members and care professionals. The key elements of this model were the provision of a single entry point, the adoption of a case management methodology and an individualised service plan that respected patients' dignity, rights, interests and preferences. The initiative was designed to provide highly patient-centered care to the elderly, including self-management strategies and tools for health prevention and promotion. The process started by profiling patients according to their risk factors in order to identify preventive measures adapted to their case and empower them to adopt a much more active role in managing their illness. This approach was expected to reduce patients' demands on the health service while improving their quality of life and that of their carers, contributing to the sustainability of the system.
    Keywords: SIMPHS, eHealth, Remote Monitoring, ageing, integrated care, independent living, case studies, facilitators, governance, impact, drivers, barriers, integration, organisation
    JEL: I11 I18 O33 O38
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94486&r=hea
  17. By: Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence)
    Abstract: Badalona Serveis Assistencials (BSA) is an integrated private care organisation, funded entirely by public capital. It manages the Hospital Municipal de Badalona, the Homecare Integrated Service, the Socio Health Centre El Carme, 7 Primary Care Centres and the Centre for Sexual and Reproductive Health, providing care to a total population of 419,797 inhabitants in a very populated suburban area of Barcelona (Spain). BSA has been responsible for both health and social care services in this area since 2000, when the Badalona’s City council included social care in the service provided by BSA . This has fostered a new model which puts citizens' and patients’ needs at the centre of the system.
    Keywords: SIMPHS, eHealth, Remote Monitoring, ageing, integrated care, independent living, case studies, facilitators, governance, impact, drivers, barriers, integration, organisation
    JEL: I11 I18 O33 O38
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94484&r=hea
  18. By: Daniel Smedberg (Kommunförbundet Skåne); Francisco Lupiañez-Villanueva (Open Evidence)
    Abstract: In 2012 the Swedish Association of Local Authorities and Regions made an agreement with the Swedish government to foster integrated care for elderly suffering from complex health conditions. It resulted in an initiative that aims at developing patient-centred health and social care services based on the specific needs of the elderly population. The Better Life for Most Sick Elderly (BLMSE) initiative strives to encourage, strengthen and intensify cooperation among municipalities and county councils by means of economic incentives and performance-based bonus schemes. The main target group is the sick, elderly population. However, the preventive measures applied within the framework of the initiative strive to avoid people from becoming part of this group.
    Keywords: SIMPHS, eHealth, Remote Monitoring, ageing, integrated care, independent living, case studies, facilitators, governance, impact, drivers, barriers, integration, organisation
    JEL: I11 I18 O33 O38
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94489&r=hea
  19. By: Schurer, Stefanie (University of Sydney); Alspach, Michael (Statistics New Zealand); MacRae, Jayden (Compass Health); Martin, Greg L. (Victoria University of Wellington)
    Abstract: This paper is the first to use the method of coarsened exact matching (CEM) to estimate the impact of mood disorders on medical care costs in order to address the endogeneity of mood disorders. Models are estimated using restricted-use, general practice patient records data from New Zealand for 2009-2012. The CEM model, which exploits a discretization of the data to identify for each patient with a mood disorder a perfect statistical twin, yields estimates of the impact of mood disorders on medical costs that are lower than the estimates obtained from random effects models or conventional matching methods. For example, mood disorders lead to NZ$366 higher annual medical costs (in 2012 dollars) when perfect balancing of covariates is achieved, while minimal and conventional balancing yield estimated costs of over NZ$465 and NZ$400, respectively. The national government expenditures on managing mood disorders is estimated to be 13.4% of total general practice funding (NZ$123 Million) based on CEM.
    Keywords: mood disorder, medical care cost, national government expenditures, coarsened exact matching, patient record data, general practice
    JEL: H51 I18
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:iza:izadps:dp8814&r=hea
  20. By: Fossen, Frank M. (Free University of Berlin); König, Johannes (Freie Universität Berlin)
    Abstract: We estimate the impact of a differential treatment of paid employees versus self-employed workers in a public health insurance system on the entry rate into entrepreneurship. In Germany, the public health insurance system is mandatory for most paid employees, but not for the self-employed, who usually buy private health insurance. Private health insurance contributions are relatively low for the young and healthy, and until 2013 also for males, but less attractive at the other ends of these dimensions and if membership in the public health insurance allows other family members to be covered by contribution-free family insurance. Therefore, the health insurance system can create incentives or disincentives to starting up a business depending on the family's situation and health. We estimate a discrete time hazard rate model of entrepreneurial entry based on representative household panel data for Germany, which include personal health information, and we account for non-random sample selection. We estimate that an increase in the health insurance cost differential between self-employed workers and paid employees by 100 euro per month decreases the annual probability of entry into self-employment by 0.38 percentage points, i.e. about a third of the average annual entry rate. The results show that the phenomenon of entrepreneurship lock, which an emerging literature describes for the system of employer provided health insurance in the USA, can also occur in a public health insurance system. Therefore, entrepreneurial activity should be taken into account when discussing potential health care reforms, not only in the USA and in Germany.
    Keywords: health insurance, entrepreneurship lock, self-employment
    JEL: L26 I13 J2
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:iza:izadps:dp8816&r=hea
  21. By: Congressional Budget Office
    Abstract: Observers often cite fraud as an important contributor to high health care spending, particularly in federal programs. This report describes how CBO estimates the budgetary effects of legislative proposals to reduce fraud in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), and how those estimates are used in the Congressional budget process. What Is Fraud? For the purposes of this report, fraud is considered to be any deliberate attempt to use deception to receive a service or payment from Medicare, Medicaid, or the Children’s Health Insurance Program when the
    JEL: H60 I13 I18 K42
    Date: 2014–10–20
    URL: http://d.repec.org/n?u=RePEc:cbo:report:49460&r=hea
  22. By: McGovern, Mark E.; Bärnighausen, Till; Giampiero Marra; Rosalba Radice
    Abstract: Heckman-type selection models have been used to control HIV prevalence estimates for selection bias when participation in HIV testing and HIV status are associated after controlling for observed variables. These models typically rely on the strong assumption that the error terms in the participation and the outcome equations that comprise the model are distributed as bivariate normal. We introduce a novel approach for relaxing the bivariate normality assumption in selection models using copula functions. We apply this method to estimating HIV prevalence and new confidence intervals (CI) in the 2007 Zambia Demographic and Health Survey (DHS) by using interviewer identity as the selection variable that predicts participation (consent to test) but not the outcome (HIV status). We show in a simulation study that selection models can generate biased results when the bivariate normality assumption is violated. In the 2007 Zambia DHS, HIV prevalence estimates are similar irrespective of the structure of the association assumed between participation and outcome. For men, we estimate a population HIV prevalence of 21% (95% CI = 16%?25%) compared with 12% (11%?13%) among those who consented to be tested; for women, the corresponding figures are 19% (13%?24%) and 16% (15%?17%). Copula approaches to Heckman-type selection models are a useful addition to the methodological toolkit of HIV epidemiology and of epidemiology in general. We develop the use of this approach to systematically evaluate the robustness of HIV prevalence estimates based on selection models, both empirically and in a simulation study.
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:qsh:wpaper:199101&r=hea
  23. By: James Fenske; Achyuta Adhvaryu; Anant Nyshadham
    Abstract: We study the origins of adult mental health using early life income fluctuations.  Combining a time series of real producer prices of cocoa with a nationally representative household survey in Ghana, we show that a one standard deviation rise in the cocoa price in early life decreases the likelihood of severe mental distress in adulthood by 3 percentage points (or half the mean prevalence) for cohorts born in cocoa-producing regions relative to other regions.  Impacts on related personality traits are consistent with this result.  Maternal nutrition, reinforcing childhood investments, and adult circumstance are operative channels of impact.
    Keywords: early life, mental health, endowments, commodioty prices, ghana
    JEL: I12 I15 O12
    Date: 2014–01–11
    URL: http://d.repec.org/n?u=RePEc:oxf:wpaper:wps/2014-03&r=hea
  24. By: Olivier Sterck
    Abstract: This paper answers two questions: "What impact have natural resources had on the spread of the HIV/AIDS epidemic so far?" and "What role can natural resource rents play in order to finance the long-run response to HIV/AIDS?"  Using a panel dataset, de Soysa and Gizelis (2013) provided evidence that oil-rich countries are more deeply affected by the HIV epidemic.  They concluded that government of resource-rich countries failed to implement effective public policies for dealing with the HIV/AIDS epidemic.  In this paper, I show that their results are not robust and are spurious because the dependent variables and explanatory variables considered in their analysis are non-stationary.  After correcting for these issuse, I find no specific relationship between resource rents and the spread of HIV/AIDS.  I conclude by discussing the potential of resources rents for financing the long-term liability brought about by the HIV/AIDS epidemic in sub-Saharan Africa.
    Keywords: HIV/AIDS, natural resources, resource curse, epidemics, spurious regression, non-stationarity
    JEL: I1 I18 E6 Q32
    Date: 2014–03–01
    URL: http://d.repec.org/n?u=RePEc:oxf:wpaper:wps/2014-12&r=hea
  25. By: Lindsey Leininger Kelsey Avery
    Abstract: This issue brief, from the SHARE-funded research project, presents findings from an evaluation of the usefulness of Health Needs Assessment (HNA) in predicting need for medical care among new enrollees in a Medicaid waiver program for previously-ineligible childless adults in Wisconsin.
    Keywords: Self-reported health measures, high-need Medicaid enrollees
    JEL: I
    Date: 2015–02–01
    URL: http://d.repec.org/n?u=RePEc:mpr:mprres:3c0c70f10ae64a90b51cb8aba0125c87&r=hea
  26. By: Martyna Kobus; Marcin Jakubek
    Abstract: In this paper we present evidence on the relationship between mental health and unemployment among Polish youth. The literature establishes links between mental health and unemployment, but the evidence concerning youths is scarce. We utilize 2010/2011 World Mental Health Survey that contains detailed information on the prevalence of psychiatric diseases and mental disorders in Poland. We compare health distributions in terms of both inequality and welfare relying on methods for ordinal data developed recently. We find that youth employed generally have better health status than youth unemployed, but the differences are very small when it comes to more detailed questions concerning mood (i.e. sadness, anxiety, anger). To observe substantial differences between two populations, one needs to ask even more detailed questions concerning personal feelings. Clear differences, however, emerge for social interactions and undertaking own initiative. Here employed present unambiguously better than unemployed.
    Keywords: youth unemployment, mental health, Poland
    JEL: J20 J22 I10
    Date: 2015–01
    URL: http://d.repec.org/n?u=RePEc:ibt:wpaper:wp042015&r=hea

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