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on Health Economics |
| By: | Nie, Peng (University of Hohenheim); Otterbach, Steffen (University of Hohenheim); Sousa-Poza, Alfonso (University of Hohenheim) |
| Abstract: | Using several waves of the China Health and Nutrition Survey (CHNS), this study analyzes the effect of long work hours on health and lifestyles in a sample of 18- to 65-year-old Chinese workers. Although working long hours does significantly increase the probabilities of high blood pressure and poorer reported health, the effects are small. Also small are the negative effects of long work hours on sleep time, fat intake, and the probabilities of sports participation or watching TV. We find no positive association between work time and different measures of obesity and no evidence of any association with calorie intake, food preparation and cooking time, or the sedentary activities of reading, writing, or drawing. In general, after controlling for a rich set of covariates and unobserved individual heterogeneity, we find little evidence that long work hours affect either the health or lifestyles of Chinese workers. |
| Keywords: | long work hours, health, lifestyle, China |
| JEL: | I10 I12 J22 J81 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8911&r=hea |
| By: | Blázquez Cuesta, Maite (Universidad Autónoma de Madrid); Budría, Santiago (University of Madeira) |
| Abstract: | This paper uses data from the 2002-2005-2008 waves of the Spanish Survey of Household Finances (EFF) to investigate whether debts burdens hamper people's health. Several measures of debt strain are constructed, including debt-to-income ratios, the existence of debt arrears and amounts of outstanding debts. The paper also differentiates between mortgage and non-mortgage debts and explores the role of social norm effects in the debt-health relationship. The results, based on a random effects model extended to include a Mundlak term, show that non-mortgage debt payments and debt arrears affect significantly people's health. Furthermore, mild social norm effects are detected, according to which being less indebted than the reference group results, ceteris paribus, in better health. |
| Keywords: | over-indebtedness, self-assessed health, random effects model, social norm effects |
| JEL: | G01 I13 I22 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp8912&r=hea |
| By: | Alvin E. Roth; Ran I. Shorrer |
| Abstract: | A collaboration of medical professionals with economists and computer scientists involved in ?market design? had led to the redesign of the clearinghouse assigning medical students to internships in Israel. The new mechanism presents significant efficiency gains relative to the previous one, and almost all students get a better chance of getting what they want. Continued monitoring of the new mechanism is required to verify that it is not abused, and explore whether it can be improved. Other organizations in Israel may also be able to profit from the experience that accumulates from market design, both in Israel and abroad. |
| URL: | http://d.repec.org/n?u=RePEc:qsh:wpaper:242036&r=hea |
| By: | Grégoire de Lagasnerie; Valérie Paris; Michael Mueller; Ankit Kumar |
| Abstract: | This study covers “tapering scale” mechanism in hospital payments, i.e. mechanisms linking unit prices to the volume of services produced. This paper begins with an overview of hospital services and hospital payment methods in OECD countries, focusing more specifically on DRG-based payment. It then reviews studies published on economies of scales in hospitals, which is the economic rationale justifying tapering payments. Thereafter, four case studies from Germany, the US State of Maryland, the Czech Republic and Israel offer a detailed insight into the practicalities of introducing this method of controlling hospital volumes and the impacts it has had.<BR>Ce rapport porte sur les politiques de dégressivité tarifaire appliquées au paiement des hôpitaux, c’est-à-dire les mécanismes liant les prix unitaires des services hospitaliers au volume de soins produits. Ce document de travail dresse tout d’abord un panorama de l’offre hospitalière et des modes de paiement des hôpitaux au sein des pays de l’OCDE en étudiant plus spécifiquement le paiement à l’activité. Il présente ensuite une revue des études portant sur les économies d’échelle dans le secteur hospitalier, justification principale de la diminution des tarifs au-delà d’un seuil de production. Enfin, quatre études de cas en Allemagne, l’État du Maryland, la République tchèque et Israël sont présentées afin d’étudier finement les modalités d’instauration et l’impact de ce mécanisme de contrôle des volumes hospitaliers. |
| JEL: | D22 D24 H51 I18 L84 L88 |
| Date: | 2015–03–27 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:78-en&r=hea |
| By: | Jesse M. Pines; Vincent Keyes; Martijn van Hasselt; Nancy McCall |
| Abstract: | Patient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED visits and hospitalizations (all-cause and ambulatory-care-sensitive conditions) between patient-centered medical homes recognized in 2009 or 2010 and practices without recognition. |
| Keywords: | Emergency Department, Inpatient Hospital Use, Medicare Beneficiaries, Patient-Centered Medical Homes |
| JEL: | I |
| Date: | 2015–03–10 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:bd8cc720cc374d9cb3054d932fe62422&r=hea |
| By: | Jonathan D. Brown; Allison Barrett; Kerianne Hourihan; Emily Caffery; Henry T. Ireys |
| Abstract: | Medicaid beneficiaries with schizophrenia and bipolar disorder require a range of services and supports. This descriptive study used 2007 Medicaid claims data from 21 states and the District of Columbia to examine the extent to which this population received guideline-concordant medications, medication monitoring, outpatient mental health care, and preventive physical health care. More than 80 % of beneficiaries in each state filled at least one prescription for a guideline-concordant medication during the year but, on average, only 57 % of those with schizophrenia and 45 % of those with bipolar disorder maintained a continuous supply of medications. Roughly 25 % did not have an outpatient mental health visit during the year (excluding case management and some other services); in some states more than half did not have such a visit. Only 11 % of beneficiaries received a physical health examination or health behavior counseling when claims codes were used to identify these services rather than all primary care physician visits. Less than 5 % of beneficiaries maintained their supply of medications, received medication monitoring and had an outpatient mental health visit, physical health examination or received health behavior counseling during the year. Although these rates of service utilization are likely conservative and the data predate recent efforts to integrate care, the findings underscore the need for quality improvement efforts targeted to this population and may provide a baseline for monitoring progress. |
| Keywords: | State Variation, Comprehensive Services, Medicaid Beneficiaries, Schizophrenia, Bipolar Disorder |
| JEL: | I |
| Date: | 2015–03–19 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:3849bff442674fd5b1b09c4f5dd54c35&r=hea |
| By: | Julie Seibert; Suzanne Fields; Catherine Anne Fullerton; Tami L. Mark; Sabrina Malkani; Christine Walsh; Emily Ehrlich; Melina Imshaug; Maryam Tabrizi |
| Abstract: | The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. |
| Keywords: | Quality Measures, Medicaid, Behavioral Health, State Agencies, Health Care Reform |
| JEL: | I |
| Date: | 2015–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:984a0301fff94ee7acfa5fc74dbaaf90&r=hea |
| By: | James M. Verdier |
| Keywords: | SNP, Special Needs Plan, Medicare, Medicaid, Dual Eligibles |
| JEL: | I |
| Date: | 2015–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2b19217cfe5c4749bb71f5c9e6ca75ab&r=hea |
| By: | Jesse Bump; Susan Sparkes; Mehtap Tatar; Yusuf Celik; Meltem Aran; Claudia Rokx |
| Abstract: | Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey?s health system has few ? if any ? parallels in scope and speed. Before the reforms, Turkey?s aggregate health indicators lagged behind those of OECD member states and other middle-income countries. The health financing system was fragmented, with four separate insurance schemes and a ?Green Card? program for the poor, each with distinct benefits packages and access rules. Both the Ministry of Labor and Social Security and Ministry of Health (MoH) were providers and financiers of the health system, and four different ministries were directly involved in public health care delivery. Turkey?s reform efforts have impacted virtually all aspects of the country?s health system and have resulted in the rapid expansion of the proportion of the population covered and of the services to which they are entitled. At the same time, financial protection has improved. For example, (i) insurance coverage increased from 64 to 98 percent between 2002 and 2012; (ii) the share of pregnant women having four antenatal care visits increased from 54 to 82 percent between 2003 and 2010; and (iii) citizen satisfaction with health services increased from 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic improvements there is still space for Turkey to continue to improve its citizens? health outcomes, and challenges lie ahead for improving services beyond primary care. The main criticism to reform has so far come from health sector workers; the future sustainability of reform will rely not only on continued fiscal support to the health sector but also the maintanence of service provider satisfaction. |
| Keywords: | access to health care, access to health care services, access to health services, administrative control, allocative efficiency, antenatal care, Capita Health Expenditure ... See More + child mortality, Childbirth, citizen, citizens, communicable diseases, deaths, Debt, delivery system, demand for health, demand for health services, doctors, Economic growth, economic resources, emergency vehicles, Employment, expenditures, financial protection, financing of health care, focus group discussions, fragmented financing system, General practitioners, Health Administration, Health Affairs, health care, Health Care Costs, health care delivery, health care expenditures, health care facilities, health care providers, health care sector, health care services, health care system, health centers, HEALTH COVERAGE, Health Data, health delivery, health delivery system, Health Expenditure, Health expenditure growth, Health Expenditure per capita, health expenditures, Health facilities, health finance, Health Financing, health financing system, health indicators, health infrastructure, health insurance, health insurance scheme, Health Insurance System, Health Organization, health outcomes, Health Planning, Health Policy, health posts, health professionals, Health Project, health reform, health reforms, health risks, health sector, health sector reform, health sector workers, health services, health spending, Health status, health status indicators, health supply, health system, Health System Efficiency, Health Systems, Health Systems in Transition, health workers, health workforce, Health-Care, Health-Care System, Health-Financing, Healthcare Spending, hospital autonomy, hospital beds, Hospital management, Hospital Sector, hospitals, HR, human development, human resources, illness, Immunization, income, income countries, income households, individual health, induced demand, infant, infant mortality, infant mortality rate, inservice training, insurance, insurance coverage, insurance schemes, integration, labor market, level of health spending, life =expectancy, life expectancy, life expectancy at birth, live births, local authorities, maternal health, maternal health services, medical centers, Medical Policy, medical school, medical specialties, medicines, Midwives, Ministry of Health, morbidity, mortality, National Health, National Health Insurance, National Health Policy, Newborn Health, nurses, Nutrition, old system, outpatient services, paradigm shift, paramedics, parliamentary seats, party platform, patient, patient care, Patient Cost, patient satisfaction, patients, pharmaceutical expenditures, pharmacists, pharmacy, physician, physicians, pocket payments, policy change, policy decisions, policy goals, Policy Research, political power, political turmoil, popular support, Pregnancy, pregnant women, prescription drugs, preventive health services, primary care, primary health care, primary health care facilities, private insurance, private pharmacies, private sector, private sectors, professional associations, progress, provision of health care, Public Expenditure, Public Health, public health care, public health expenditures, public health system, Public Hospital, Public Hospitals, public providers, public sector, public service, public support, purchaser-provider split, purchasing power, purchasing power parity, quality assurance, quality of care, quality of services, rural areas, scientific evidence, series of meetings, service delivery, service provider, service provision, service quality, service utilization, Social Insurance, Social Policy, Social Security, social security schemes, socioeconomic development, socioeconomic status, State Planning, supply of health care, Sustainable Development, Trade Unions, Under-five mortality, urban centers, workers |
| Date: | 2014–09 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:93172&r=hea |
| By: | Chris Bojke (Centre for Health Economics, University of York, UK); Adriana Castelli (Centre for Health Economics, University of York, UK); Katja Grasic (Centre for Health Economics, University of York, UK); Andrew Street (Centre for Health Economics, University of York, UK) |
| Abstract: | Productivity is one of the key measures against which NHS achievements can be judged and is the focus of this report. We update our previous analyses of NHS productivity growth since 2004/05, focussing on the change in NHS productivity between 2011/12 and 2012/13, the latter financial year being the latest for which data have been made available. NHS productivity growth is measured as the rate of change in outputs over the rate of change of inputs. Positive productivity growth occurs when the relative growth in outputs exceeds the relative growth in inputs. NHS output captures all activity for NHS patients using data from the Hospital Episode Statistics (HES), Reference Cost returns and primary care use survey data. Quality is captured by waiting times, 30-day survival rates, and blood pressure management in primary care. Output growth amounted to 2.34% between 2011/12 and 2012/13, this being the lowest year-on-year growth rate over the full period since 2004/05. This is the first time over the full series in which quality-adjusted output growth has been lower than cost-weighted growth, which amounted to 2.58%. This is because some aspects of quality deteriorated between 2011/12 and 2012/13, with a reduction in survival rates for non-elective patients and further increases in waiting times. NHS inputs include of NHS and agency staff, intermediates and capital. NHS staff input is measured using staff numbers as recorded in the Electronic Staff Record and also from expenditure data. All other inputs are measured by deflating expenditure data by relevant price indices to capture changes in the volume of resource use. We construct two overall measures of NHS inputs, with our preferred “mixed†index using NHS staff numbers and an “indirect†index, which uses expenditure data to calculate NHS staff input. NHS input growth between 2011/12 and 2012/13 was 1.98% if labour input is calculated using NHS staff numbers or 2.63% if using expenditure data. This rate of input growth is relatively low for the series as a whole but it is the largest year-on-year increase since 2009/10. Productivity growth between 2011/12 and 2012/13 is estimated to have been 0.36% based on the mixed input index but -0.28% if based on the indirect input index. If measured using the preferred mixed index, the NHS has delivered overall total factor productivity growth of 10.4% since 2004/05, with 2011/12-2012/13 being the third consecutive period of year-on-year productivity growth. |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:110cherp&r=hea |
| By: | Kristin Geonnotti; Erin Fries Taylor; Deborah Peikes; Lisa Schottenfeld; Hannah Burak; Robert McNellis; Janice Genevro |
| Keywords: | Primary Care Practices, Quality Improvement, Practice Facilitators, Health |
| JEL: | I |
| Date: | 2015–03–23 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:724fa51ef57742c4bc4931ef9dc33186&r=hea |
| By: | Kristin Geonnotti; Erin Fries Taylor; Deborah Peikes; Lisa Schottenfeld; Hannah Burak; Robert McNellis; Janice Genevro |
| Keywords: | Practice Facilitator, Primary Care Practices, Quality Improvement |
| JEL: | I |
| Date: | 2015–03–23 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:b72461e9b5a64046b446606404004181&r=hea |
| By: | Tricia Collins Higgins; Jesse Crosson; Deborah Peikes; Robert McNellis; Janice Genevro; David Meyers |
| Keywords: | HIT, Health Information Technology, Quality Improvement, Primary Care |
| JEL: | I |
| Date: | 2015–03–23 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:aad2d999a1ec484b873fa85d57540fc1&r=hea |
| By: | Cara Orfield Jung Y. Kim |
| Keywords: | CHIP, Congressionally Mandated Evaluation, Children's Health Insurance Program, Texas Case Study |
| JEL: | I |
| Date: | 2013–04–11 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:040a7304e4c9452db3965e6e1ab7cadb&r=hea |
| By: | Ian Hill; Brigette Courtot; Margaret Wilkinson |
| Keywords: | CHIP, Congressionally Mandated Evaluation, Children's Health Insurance Program, Case Study of Utah's CHIP Program |
| JEL: | I |
| Date: | 2013–04–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:46a75db17f7c46e1a89f8e31e193537b&r=hea |
| By: | Ian Hill; Sheila Hoag; Sarah Benatar; Cara Orfield; Embry Howell; Victoria Peebles; Brigette Courtot; Margaret Wilkinson |
| Keywords: | CHIPRA Evaluation , Children's Health Insurance Program, Cross Cutting Report on Findings from Ten State Case Studies |
| JEL: | I |
| Date: | 2013–05–31 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:9db24a7d89fa4723a25770d5d1e7a7ca&r=hea |
| By: | Michael Sinkinson; Amanda Starc |
| Abstract: | We measure the impact of direct-to-consumer television advertising (DTCA) by drug manufacturers. Our identification strategy exploits shocks to local advertising markets generated by idiosyncrasies of the political advertising cycle as well as a regulatory intervention affecting a single product. We find that a 10% increase in the number of a firm's ads leads to a 0.76% increase in revenue, while the same increase in rival advertising leads to a 0.55% decrease in firm revenue. Results also indicate that a 10% increase in category advertising produces a 0.2% revenue increase for non-advertised drugs. Both the business-stealing and spillover effects would not be detected through OLS. Decomposition using micro data confirms that the effect is due mostly to new customers as opposed to switching among current customers. Simulations show that an outright ban on DTCA would have modest effects on the sales of advertised drugs as well as on non-advertised drugs. |
| JEL: | I11 L1 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21045&r=hea |
| By: | Daniel Gottlieb; Olivia S. Mitchell |
| Abstract: | We propose a model of narrow framing in insurance and test it using data from a new module we designed and fielded in the Health and Retirement Study. We show that respondents subject to narrow framing are substantially less likely to buy long-term care insurance than average. This effect is distinct from, and much larger than, the effects of risk aversion or adverse selection, and it offers a new explanation for why people underinsure their later-life care needs. |
| JEL: | D03 G22 I13 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21048&r=hea |
| By: | Dhaval M. Dave; Robert Kaestner; George L. Wehby |
| Abstract: | Despite plausible mechanisms, little research has evaluated potential changes in health behaviors as a result of the Medicaid expansions of the 1980s and 1990s for pregnant women. Accordingly, we provide the first national study of the effects of Medicaid on health behaviors for pregnant women. We exploit exogenous variation from the Medicaid income eligibility expansions for pregnant women and children during late-1980s through mid-1990s to examine effects on several prenatal health behaviors and health outcomes using U.S. vital statistics data. We find that increases in Medicaid eligibility were associated with increases in smoking and decreases in weight gain during pregnancy. Raising Medicaid eligibility by 12 percentage-points increased rates of any prenatal smoking and smoking more than five cigarettes daily by 0.7-0.8 percentage point. Medicaid expansions were associated with a reduction in pregnancy weight-gain by about 0.6%. These effects diminish at higher levels of eligibility, which is consistent with crowd-out from private to public insurance. Importantly, our evidence is consistent with ex-ante moral hazard although income effects are also at play. The worsening of health behaviors may partly explain why Medicaid expansions have not been associated with substantial improvement in infant health. |
| JEL: | D1 D9 I12 I13 I18 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21049&r=hea |
| By: | Joseph Doyle; John Graves; Jonathan Gruber |
| Abstract: | There is widespread agreement that the US healthcare system wastes as much as 5% of GDP, yet little consensus on what care is actually unproductive. This partly arises because of the endogeneity of patient choice of treatment location. This paper uses the effective random assignment of patients to ambulance companies to generate comparisons across similar patients treated at different hospitals. We find that assignment to hospitals whose patients receive large amounts of care over the three months following a health emergency do not have meaningfully better survival outcomes compared to hospitals whose patients receive less. Outcomes are related to different types of treatment intensity, however: patients assigned to hospitals with high levels of inpatient spending are more likely to survive to one year, while those assigned to hospitals with high levels of outpatient spending are less likely to do so. This adverse effect of outpatient spending is predominately driven by spending at skilled nursing facilities (SNF) following hospitalization. These results offer a new type of quality measure for hospitals based on utilization of SNFs. We find that patients quasi-randomized to hospitals with high rates of SNF discharge have poorer outcomes, as well as higher downstream spending once conditioning on initial hospital spending. |
| JEL: | I10 I18 |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21050&r=hea |
| By: | Bronfman, Javier |
| Abstract: | This paper examines health insurance choice and its dynamics using panel data from Chile’s National Socio Economic Characterization Survey 1996-2001-2006. Evidence indicates that private insurance is losing customers to the public sector. Two different logistic models are used to explain the determinants of insurance choice as well as what drives the decision to move from the private to the public sector and vice versa. Income is a highly important determinant of choice, as well as age, education, geographical location and health status. Evidence of adverse selection against the public sector was found in both decision models. The results of this paper are in line with most of the previous investigations done on Chile’s health insurance system but it advance previous knowledge on the topic by including the dynamism and power for causal inference that panel data permits. |
| Keywords: | Health systems, Adverse Selection, Chile |
| JEL: | I11 I13 I18 |
| Date: | 2014–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:63262&r=hea |
| By: | Rafael Cortez; Diana Bowser; Meaghen Quinlan-Davisonson |
| Abstract: | Today?s adolescents and youth face substantial physical, social, legal, and economic barriers to meeting their SRH potential. Key factors underlying these issues are a lack of adolescent SRH (ASRH) policies and access to accessible, affordable, and appropriate health services. The impact that these factors have on adolescent health and development is clearly seen in Burkina Faso. Burkinabè adolescent girls face high adolescent fertility rates, early and forced marriage, an increased risk of maternal mortality, and a high unmet need for contraception, among others. Adding to this issue is a lack of access to education, basic health information, and SRH services, contributing to a lack of awareness and knowledge about SRH and traditional and harmful gender stereotypes. The objectives of the study were to understand the impact that structural and proximal determinants have on access to ASRH services and health outcomes; and the impact that recently implemented policies and programs have on ASRH. |
| Keywords: | abortion, abortion rates, access to education, access to health, access to health care, ADOLESCENT, adolescent boys, adolescent fertility, adolescent girls, adolescent ... See More + health, adolescent maternal mortality, adolescents, age of marriage, antenatal care, average age, Basic Education, births, cancer, care strategies, childbirth, Clandestine Abortion, community interventions, complications, contraceptive method, contraceptive use, deaths, discrimination, domestic violence, early marriage, early marriages, economic growth, educational achievement, Emergency Obstetric Care, employment opportunities, equal participation, equal rights, equitable access, families, family planning, Female, Female genital cutting, females, fertility rate, fertility rates, fewer children, FGC, financial constraints, first marriage, forced marriage, forced marriages, formal education, gender, gender approach, gender equality, gender equity, gender gap, gender gap in primary, GENDER NORMS, gender parity, Gender Policy, gender stereotypes, gender-based violence, harmful practices, health care, health care services, health facilities, health facility, health information, health insurance, health interventions, health outcomes, health policies, Health Policy, health services, HIV, HIV/AIDS, hospital, human rights, human rights violation, Illegal abortions, infant, infant mortality, intimate partner, labour force, labour force participation, lack of awareness, level of education, levels of knowledge, literacy rates, MARITAL STATUS, Married women, maternal complications, maternal health, maternal morbidity, maternal mortality, Medicine, mental health, modern contraception, National Gender Policy, National Health, National Policy, need for family planning, neonatal care, Nutrition, obstetric care, older age groups, older women, participation in decision, physical abuse, Population Knowledge, pregnancy, pregnancy prevention, primary education, primary health care, primary school, promotion of gender equality, quality of services, rape, Reproduction, REPRODUCTIVE HEALTH, Risk Behaviors, rural areas, school attendance, School Children, secondary school, SEXUAL ACTIVITY, Sexual Behavior, sexual education, sexual harassment, sexual violence, skilled birth attendance, social norms, Social Science, STIs, UNESCO, UNFPA, United Nations, United States Agency for International Development, unplanned pregnancies, USAID, use of Condoms, use of health facilities, Vocational Training, woman, women in society, Young Adolescents, young age, young people, young women, younger women, youth |
| Date: | 2015–03 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpkbs:95102&r=hea |
| By: | Andre Medici; Veronica Vargas; Fernando Lavadenz; Lais Miachon |
| Abstract: | Peru reduced its HIV/AIDS burden by 43 percent from 2000 to 2010 due to the introduction of free antiretroviral drug therapy in 2004, and the successful execution of the 2007-2011 HIV/AIDS Strategy and budgeting for results since 2011. The national HIV program received significant external support from bilateral and international organizations until 2010. The program?s share of domestic public funding has since increased substantially. Since 2011, the Ministry of Finance has worked to improve allocative efficiency of HIV/AIDS public funding for high-risk groups, using budgeting for results and transferring resources directly to the Regions. The HIV/AIDS prevalence in 2010 was estimated at 0.4 percent, below the Latin American and the Caribbean regional prevalence of 0.5 percent. |
| Keywords: | adolescents, allocation of resources, antenatal care, burden of disease, cases of AIDS, childbearing, Community Health, condom, condom distribution, condom use, Diagnosis ... See More + Diseases, drug therapy, educational activities, epidemic, Epidemiology, female, fetus, Gross National Income, health centers, health interventions, health system, Health Workers, high risk groups, high-risk groups, HIV, HIV testing, HIV TRANSMISSION, HIV/AIDS, hospitals, Household surveys, infection, infection rate, international organizations, laboratory services, Ministry of Health, mother, mothers, national policy, National Strategy, new cases, new infections, number of deaths, number of women, Nutrition, patients, Population Knowledge, pregnant woman, pregnant women, prevalence, progress, promotion of condom use, prophylaxis, RISK POPULATIONS, safe behaviors, screening, sex, sex with men, sex workers, social security, STIs, TB, TB control, technical capacity, treatment, UNAIDS, vertical transmission, vulnerable populations, women of childbearing age |
| Date: | 2014–10 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpkbs:94279&r=hea |
| By: | Frech, Ted E; Smith, Michael P |
| Abstract: | Adverse selection death spirals in health insurance are dramatic, and so far, exotic economic events. The possibility of death spirals has garnered recent policy and popular attention because the pricing regulations in the Affordable Care Act of 2010 make health plans more vulnerable to them (though some other aspects of the ACA limit them). Most death spirals tracked in the literature have involved selection against a group health plan that was dropped quickly by the employer. In this paper, we empirically document a death spiral in individual health insurance that was apparently triggered by a block closure in 1981 and developed slowly because the insurer partially subsidized the block. Indeed, we show that premiums rose dramatically from around the time of the block closure to at least 2009 (the last year of available data). By 2009, some, but very few policyholders remained in the block and premiums were roughly seven times that of a yardstick we developed. The history of this slow-moving event is directly relevant to current policy discussions because of both adverse selection in general and the particular problems induced by closing a block. |
| Keywords: | Social and Behavioral Sciences, Adverse Selection, Death Spiral, Health Insurance, Affordable Care Act, Asymmetric Information, Community Rating, Underwriting |
| Date: | 2015–01–01 |
| URL: | http://d.repec.org/n?u=RePEc:cdl:ucsbec:qt0w64d54d&r=hea |
| By: | Kai Barron; Luis Fernando Gamboa; Paul Rodriguez-Lesmes |
| Abstract: | Abstract This paper makes use of a short, sharp, unexpected health shock in the form of the 2010 Colombian Dengue outbreak to examine the direct and indirect impact of negative health shocks on behaviour of households in affected areas. Our analysis combines data from several sources in order to obtain a comprehensive picture of the influence of the outbreak, and furthermore to understand the underlying mechanisms driving the effects. Our initial analysis indicates that the outbreak had a substantial negative effect on the health status of adults and adversely affected their ability to function as usual in their daily lives. In our aggregated school data, in areas with high levels of haemorrhagic Dengue we observe a reduction in national exam attendance (last year of secondary school) and on enrolment rates in primary education. Further analysis aims to exploit detailed individual level data to gain a more in depth understanding of the precise channels through which this disease influenced the behaviour and outcomes of the poor in Colombia. |
| Keywords: | Education, Dengue, Colombia |
| JEL: | I12 I20 |
| Date: | 2015–03–19 |
| URL: | http://d.repec.org/n?u=RePEc:col:000092:012646&r=hea |
| By: | Kate Otto; Meera Shekar; Christopher H. Herbst; Rianna Mohammed |
| Abstract: | Information and communication technologies (ICT) for health or eHealth solutions hold great potential for generating systemic efficiencies by strengthening five critical pillars of a health system: human resources for health, supply chain management, health care financing, governance and service delivery, and infrastructure. This report describes the changing landscape of eHealth initiatives through these five pillars, with a geographic focus on Sub-Saharan Africa. This report further details seven criteria, or prerequisites, that must be considered and addressed in order to effectively establish and scale up ICT-based solutions in the health sector. These criteria include infrastructure, data and interoperability standards, local capacity, policy and regulatory environments, an appropriate business model, alignment of partnerships and priorities, and monitoring and evaluation. In order to bring specific examples of these criteria to light, this report concludes with 12 specific case studies of potentially scalable ICT-based health care solutions currently being implemented across the globe at community, national, and regional levels. This report is intended to be used by development practitioners, including task team leaders at the World Bank, to strengthen their understanding of the use of ICT to support health systems strengthening (HSS) efforts as well as to highlight critical prerequisites needed to optimize the benefits of ICT for health. |
| Keywords: | access to information, access to the Internet, action plan, action plans, advertising, analog, authentication, bandwidth, barcodes, basic, best practices, Birth Attendant ... See More + birth attendants, blog, business model, business models, businesses, capabilities, capacity building, Child Health, clinics, coding, commodities, COMMUNICATION TECHNOLOGIES, communication technology, communications technologies, communications technology, communities, COMMUNITY HEALTH, Community Portal, components, computer systems, computers, connectivity, customization, data analysis, data entry, data transmission, data transmissions, day-to-day operations, decision making, decision support tools, delivery system, delivery systems, devices, digital, digital assistant, digital content, Digital Development, digital infrastructure, Distribution channel, e-learning, e-mail, electricity, end users, end-user, enterprise resource planning, equipment, family planning, financial management, financial management systems, Financial Services, financial systems, financial transactions, functionality, Global Positioning System, government offices, GPS, growth strategy, hardware, harmonization, health care, health care access, health care expenditures, health care financing, health centers, health education, Health Extension, health information, Health Information System, health interventions, Health Management, Health Organization, health outcomes, Health Policy, Health promotion, health sector, health services, Health Specialist, health system, HEALTH SYSTEMS, HEALTH SYSTEMS STRENGTHENING, hospitals, human capacity, Human Development, human resource, human resource development, human resources, ICT, implementation plans, implementations, income, Informatics, information flows, information Service, Information System, information system standards, Information Systems, Information Technology, Innovation, innovations, installation, institution, Institutional Support, Intellectual Property, Intellectual Property Rights, Interactive Voice Response, interconnectivity, interoperability, intervention, inventory, inventory management, IVR, JAVA, know-how, knowledge management, knowledge sharing, legal framework, licenses, listservs, localization, Logistics Systems, management software, Management System, market demand, market opportunities, Marketing, material, medicines, menus, messaging, midwifery, Mobile Network, mobile networks, mobile phone, mobile phones, mobile telephony, Network Organization, networks, new market, new technologies, nurses, Nutrition, online network, open source software, open standards, operating system, paradigm shift, patient, patients, payment systems, pdf, penetration rate, personal digital assistant, PHYSICAL INFRASTRUCTURE, physicians, pilot project, pilot projects, policy frameworks, posters, power supplies, pregnancy, pregnant women, private partnership, private partnerships, private sector, private sectors, procurement, product availability, programming, protocol, public health, public health care, publishing, Radio, regulatory environment, regulatory environments, regulatory framework, reliability, REPRODUCTIVE HEALTH, result, results, Satellite, Satellite connections, satellites, searchable database, servers, service providers, sexual health, simulation, sites, smart cards, social development, software development, Source code, supervision, supply chain, supply chain management, systems management, taxonomy, technical expertise, technical support, technological infrastructure, Technology Park, telecom, telecommunications, telecommunications infrastructure, Telephone, telephone service, terminals, user, user community, user IDs, users, Uses, vaccination, verification, videos, waste, web, website, websites, wellness, Workers, workstations |
| Date: | 2015–01 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:hnpdps:94943&r=hea |
| By: | Hanna Kociemska (University of Economics) |
| Abstract: | This paper constitutes a contribution to a new discussion on the adequacy of existing company valuation methods with regard to the specific nature of medical entities in Poland. The author points out the shortcomings of existing theories. She calls for taking into account the quality of the activities performed by medical companies in the methodology used for their valuation. She also points to human capital at hospital as to one of the key indicators of quality of their activity, translating into the value the entity has for its owner. The author uses the method of analysis of the extensive research literature, expert interview method in the formula brain storm and prognostic method. |
| Keywords: | human capital, value of medical entity, medical market, hospital's owners |
| JEL: | A10 |
| Date: | 2014–12 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0902673&r=hea |
| By: | Fatima Boussalem (University of Jijel); Zina Boussalem (university of jijel); Abdelaziz Taiba (university of chlef) |
| Abstract: | This paper investigated the causality and co-integration relationships between public health expenditure and economic growth in Algeria during 1974-2014 using annual data. This paper concentrated on time series co-integration and causality in VECM framework. The findings revealed that there is a long-run causality from public health expenditure to economic growth, while it is not observed any short-run causality from expenditure health to economic growth. The lack of strong link from health to economic growth is not necessarily a reason to reallocate health investment away from the health sector. The improvements in health status will be worth the effort even if they turn out to have little effect on growth. |
| Keywords: | public Health Expenditure, Economic Growth, Co-integration, Causality |
| JEL: | I18 I15 C10 |
| Date: | 2014–05 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0101004&r=hea |
| By: | rahima Houalef (Faculty of economy & management - university of Tlemcen - ALGERIA); |
| Abstract: | The last decades has witnessed a revolutionary array in health care dimensions. Terms like 'Total Quality Management', 'ISO-9000', 'Continuous Quality Management', 'Reengineering', 'Benchmarking' and ‘Accreditation' have embraced and got incorporated in the delivery of health care services.Health Care Systems throughout the world are undergoing significant changes. These changes are due to acknowledgment of either medical errors or system errors. Other factors responsible for these changes include: Legal obligation for quality management in some countries, assessment of service quality provision, the sophistication of medical care and increasing costs of health care.This study attempted to examine the extent to which MUSTAPHA DAMERJI Hospital in Algeria, as a case study, implemented TQM constructs. The study also aimed at investigating if there were significant differences in the respondents` perception on TQM implementation due to demographic variables (gender, age, education, and years of experience). For this purpose, a questionnaire was developed and distributed to (280) employees. Number of (250) questionnaires were returned which comprises 89.28% of the target sample.The study made some recommendations regarding TQM implementation that would assist management of hospitals to increase their organizational performance and effectiveness. |
| Keywords: | Total Quality Management (TQM); TQM Factors. Government Hospitals. Factor Analysis. |
| JEL: | I00 |
| Date: | 2014–10 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0702009&r=hea |
| By: | Vaibhav Khandelwal (Indian Institute of Management, Indore, India) |
| Abstract: | There has been a paradigm shift in the manner in which the Health of the population is being currently viewed by health professionals & researchers. There is a realisation that the health of an individual is not just a function of his medical status but is also determined by the environment in which he work and lives. This idea of going beyond a pure bio-medical explanation for health status of individuals and looking at social determinants has provided researchers with tools for explaining the puzzle related to difference in health of individuals and societies who although living in the same country, state or municipal limits have different burden of disease. Research has identified various factors which influence the health status of the population. Analogously, there have been some studies to recognise the determinants of HIV. Variables that have been identified include Education (Alvarez-Uria, Midde, Pakam, & Naik, 2012; Bärnighausen, Hosegood, Timaeus, & Newell, 2010; Pais, 1996; Sarna et al., 2008; Vyas et al., 2009; Alvarez-Uria, Midde, & Naik, 2012), Socioeconomic status (Alvarez-Uria, Midde, Pakam, et al., 2012; Vyas et al., 2009), Alcohol (WHO, 2005), Employment (Alvarez-Uria, Midde, & Naik, 2012; Sarna et al., 2008), Wealth (Bärnighausen et al., 2010) & Rural v/s Urban Residence (Bärnighausen et al., 2010). However, the studies in India that looks at the pathway through which these social determinants act on HIV are scarce. This paper is an attempt to fill this gap. This study attempts to identify the pathway through which social determinants act on HIV morbidity in Women in the state of Kerala, India. Six independent variables that have been considered for this study include Health Service Delivery, Education, Employment, Wealth, Rural Residence and Alcohol. The sample size for the study is 677 women and the data has been drawn from the latest round of National Family Health Survey i.e. NFHS-3 which was conducted in the year 2005-06. Since there is presence of latent variable and multiple dependent and independent relationships in the conceptualised model, Structural Equation Modeling (SEM) has been employed. Both the direct as well as the indirect effect of each of the independent variables on HIV morbidity have been evaluated. The results reveal that Health Service delivery has the strongest determining influence on HIV morbidity. Also, there is almost no presence of any indirect effects of any of the variables in the model. |
| Keywords: | Social Determinants; Health Service Delivery; Education; Employment; Wealth; Rural Residence; Alcohol; Pathway |
| JEL: | I18 |
| Date: | 2014–10 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0802077&r=hea |
| By: | Daniel Pelletier (Université du Québec en Outaouais) |
| Abstract: | Pooling resources, knowledge and technologies is a necessity in the health sector, both private and public. Many hospitals do so through alliances with compatible establishments, which have been studied from the organizational perspective for many years. However, many alliances are reported to fail, and the conditions which could foster their success are still not well known. The aim of this exploratory study was to identify the administrative and governance structures of hospital alliances associated with reported positive outcomes. A questionnaire was mailed to a list of hospital administrators and directors from Germany, Switzerland, Austria and Canada. Respondents were required to fill out a series of fixed alternative questions as well as some open-ended items which dealt with their perception of and experiences with, inter-hospital alliances. Administrative and governance practices were ascertained and correlated with reported outcomes. Descriptive analysis and correlations were computed using IBM SPSS statistics software. Management practices pertaining to initiation, formalization, steering and operations of alliances were correlated with financial, treatment and corporate outcomes of the alliances. Characteristics significantly linked to perceived positive alliance outcomes include: clearly defined targets and their monitoring, governance by executive management and involving the board of directors, rather formal coordination mechanisms, a project champion and a written contract including conflict resolution mechanisms. Selected structures, processes and governance practices of hospital alliances are correlated with success and therefore worth taking into account when crafting an alliance. These conclusions are derived from a multinational study and therefore could be applicable across different systems of health care. |
| Keywords: | Alliance; Network; Hospital; Governance; Structure; Management. |
| JEL: | M10 D73 I18 |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0300005&r=hea |
| By: | Daniel Simonet (American University of Sharjah) |
| Abstract: | France adopted its own version of New Public Management (NPM), embracing some of its elements (quasi-markets) and rejecting others (French administrative reforms pursued a re-centralization agenda rather than NPM-endorsed disaggregation). Clear trends emerge such as the added complexity of the public management exercise. Outcomes were below expectations in core areas including accountability, physician and citizen participation. Moreover, NPM revived bureaucratic inadequacies. The paper subsequently examines health care reforms. Rather than pointing to a post-NPM paradigm, these indicate convergence toward a hybrid system. |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0300152&r=hea |
| By: | Lara Spiteri Cornish (Coventry Business School) |
| Abstract: | This paper investigates the impact of flawed or limited nutrition knowledge on the perception of healthy eating, healthy foods and subsequent dietary behavior. Nutrition can be seen as the end result of many pushes and pulls, and a response to multiple forces that create an overall nutrition environment (Blaylock et al. 1999). One such pull is the rise of healthy-eating communications and social marketing campaigns devised by policy makers, who seek to encourage healthier dietary habits among consumers. Indeed, the dramatic rise in obesity in recent years (Finkelstein et al 2012; Stevens et al 2012) has prompted academic discourse to assist the development of interventional public policies (Andreasen 2012), along with a number of healthy-eating campaigns (e.g. "Eat4Life" and “5-a-day Campaign†in the UK). This pull, in turn, has resulted in a push response by the food industry in the form of creating brand new foods marketed as healthier or healthy (Wansink 2007; Menrad 2003; Kleinschmidt 2003; Diplock et al. 1999; Lahteenmaki 2003), to convey a better fit with the new healthier eating paradigm without necessarily being healthier than their alternatives. Such push has also meant new ideas and concepts about healthy eating and healthy foods (Nestle 2007; Pollan 2009; Block et al. 2011).This push-pull dynamics has caused increased consumer awareness of the importance of eating healthily (Zaninotto et al. 2009; COI/Department of Health 2009). However, it has also created much scope for consumer confusion. In fact, despite increased consumer awareness of the need to eat healthily, dietary patterns have not improved (Produce for Better Health Foundation 2009; European Food Information Council 2012). Concerns about unhealthy dietary patterns have led to a growing literature in consumer behavior relating to the impact of food communication on food consumption (Verbeke 2008; Hornik 2007; Fitzgibbon et al. 2007; Randolph and Viswanath 2004; Jebb et al. 2003; Snyder 2007). A number of negative psychological consequences of healthy-eating communications which might lead to resistance to comply with desirable nutrition behavior were identified (e.g. denial, excess fear), and recommendations were made with regard to how campaigns can be modified to result in increased uptake of the desired behavior (e.g. Peattie and Peattie 2009; Evan and Hastings 2009). The implicit assumption in this literature is that the high level of consumer awareness regarding healthy-eating communications, combined with the lack of positive change in healthy eating, means that these messages are failing to persuade consumers to implement the compliant dietary behavior (Guttman and Salmon 2004; Hornik 2002; Evan and Hastings 2009; Girandola 2000). This paper moves away from this assumption and seeks to answer the following question: is consumer confusion regarding nutrition information affecting nutrition knowledge and literacy, and what are the impacts of poor nutrition literacy on consumer perceptions of healthy eating, healthy foods, and consequent dietary behaviors? In order to address this research question, the paper draws on consumer confusion theory (Mitchell et al. 2005; Mitchell and Papavassiliou 1999), and argues, as do Block et al. (2011), that having nutrition knowledge is not sufficient to change consumers’ food consumption. Consumers need appropriate nutrition literacy and it goes beyond having healthy-eating knowledge; it encompasses having the ‘right information’ (i.e. legitimate knowledge), the ability to understand such information (i.e. nutrition self-efficacy), as well as the opportunity and motivation to use such nutrition knowledge in order to make healthy food choices that lead to overall healthier diets (Block et al. 2011). This research presents an alternative explanation as to why consumers are failing to implement healthy dietary behaviors. The authors discuss how often consumers do respond to healthy-eating communications, but they do so from their level of nutrition understanding. Many consumers are confused due to limited or flawed nutrition knowledge, resulting in poor nutrition literacy and the implementation of dietary changes that contravene the intentions of health messages. This paper offers a new perspective on the impact of healthy-eating communications and food consumption, and leads to relevant implications for nutrition researchers, policy makers, and marketing managers, at a time when healthy eating is high on the policy-making agenda (Scammon et al. 2011). |
| Keywords: | Nutrition literacy; nutrition knowledge; source credibility; confusion |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0300808&r=hea |
| By: | YAN WANG (MACAO POLYTECHNIC INSTITUTE); |
| Abstract: | Objectives: To describe and analysis the life-and-death attitude of nursing bachelor students from Macao and Mainland China. Method: Using the Scale of Life Attitude, a census was carried out in 461 students. 455 effective scales were collected. 209 and 246 papers were collected from Macao and Mainland China respectively. The scale was made up of six dimensions: ideal, life autonomy, existence, love-and-care, life experience and death attitude. The Cronbach’sαis .946. Results: â–‹1Mainland China students have higher scores(365.2±43.9) than Macao students(341.8±42.3) in life-and-death attitude, and they gain higher score in dimensions of ideal, life autonomy, existence, love-and-care, and life experienceÄĽ P>0.05ÄĽ‰, â–‹2Females have higher scores(357.4±44.5) than males(342.8±43.7) in life-and-death attitude, and they gain higher score in dimensions of ideal, existence, and love-and-careÄĽ P>0.05ÄĽ‰, â–‹3Students with religion have higher scores(367.9±44.5) than students without religion(352.9±44.5) in life-and-death attitude, and they gain higher score in dimensions of ideal, and love-and-careÄĽ P>0.05ÄĽ‰, â–‹4Students coming from the families who discuss death frankly have higher scores(366.6±43.8) in life-and-death attitude, and they gain higher score in all dimensionsÄĽ P>0.05ÄĽ‰, â–‹5Students with suicide idea have lower score in life-and-death attitude, and students with more-than-once suicide idea have lower score(340.2±45.6) in dimensions of ideal, existence and life experienceÄĽ P>0.05ÄĽ‰. â–‹6Students with excellent interpersonal relationship have higher scores(383.6±42.7) in life-and-death attitude. â–‹7Scores of life-and-death attitude show no difference between students from the higher income families and the lower income families. Conclusion: â–‹1Female, having religion, discussing death frankly in family, and good interpersonal relationship are positive factors to life-and-death attitude. Suicide ideal is negative factor to life-and-death attitude. â–‹2Family incomes show no effects on the life-and-death-attitude of students. â–‹3Although all belongs to China, Macao and Mainland China have different social system. The culture background and economic development have big differences. The reasons that cause the differences in the life-and-death attitude of bachelor nursing students from the two areas need further research. |
| Keywords: | Life-and-death Attitude , Nursing Bachelor Students ,Macao |
| Date: | 2014–07 |
| URL: | http://d.repec.org/n?u=RePEc:sek:iacpro:0300247&r=hea |
| By: | BARONE, Adriana (CELPE - Centre of Labour Economics and Economic Policy, University of Salerno - Italy); NESE, Annamaria (CELPE - Centre of Labour Economics and Economic Policy, University of Salerno - Italy) |
| Abstract: | Taking into account the economic consequences of obesity highlighted in literature (Cawley, 2004), this study investigates the association between overweight and skill attainment at the university of Salerno in Italy, with particular focus on gender differences. Our findings indicate a significant negative relationship between body mass index and academic achievement only for female students thus suggesting that, during late adolescence, physicality plays different roles according to gender. We also investigated gender differences in relation to psychological factors and we find that i)only females consider "being attractive" as an important factor for their well-being and ii) peers' behavior matters on individual eating habits only when female students are considered |
| Keywords: | Human Capital; Body weight; Educational Economics; Microeconometrics |
| JEL: | C25 D01 I12 I21 J24 |
| Date: | 2014–12–30 |
| URL: | http://d.repec.org/n?u=RePEc:sal:celpdp:0129&r=hea |