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on Health Economics |
| By: | Paola Bertoli (University of Economics, Prague); Veronica Grembi (Copenhagen Business School & CEIS, University of Rome "Tor Vergata") |
| Abstract: | We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from the exogenous variation in the proximity to cities that are allowed by law to have a hospital based on their population size. Our instrumental variable results, based on Italian municipalities data from 2000 to 2012, show that an increase by a standard deviation of distance to the nearest hospital (5 km) increases the fatality rate by 13.84% on the sample average. This is equal to a 0.92 additional death per every 100 accidents. We show that OLS estimates provide a downward biased measure of the real effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity matters more when the road safety is low; the emergency service is not properly organized, and the nearest hospital has lower quality standards. |
| Keywords: | Access to care, Hospital Proximity, Road-Traffic Accidents, Instrumental Variables, Difference in Differences |
| JEL: | C26 I10 R41 |
| Date: | 2015–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:rtv:ceisrp:349&r=hea |
| By: | Liran Einav; Amy Finkelstein; Raymond Kluender; Paul Schrimpf |
| Abstract: | In recent years, the increased use of "big data" and statistical techniques to score potential transactions has transformed the operation of insurance and credit markets. In this paper, we observe that these widely-used scores are statistical objects that constitute a one-dimensional summary of a potentially much richer heterogeneity, some of which may be endogenous to the specific context in which they are applied. We demonstrate this point empirically using rich data from the Medicare Part D prescription drug insurance program. We show that the "risk scores," which are designed to predict an individual's drug spending and are used by Medicare to customize reimbursement rates to private insurers, do not distinguish between two different sources of spending: underlying health, and responsiveness of drug spending to the insurance contract. Naturally, however, these two determinants of spending have very different implications when trying to predict counterfactual spending under alternative contracts. As a result, we illustrate that once we enrich the theoretical framework to allow individuals to have heterogeneous behavioral responses to the contract, strategic incentives for cream skimming still exist, even in the presence of "perfect" risk scoring under a given contract. |
| JEL: | D12 G22 I11 I13 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21304&r=hea |
| By: | Amy Finkelstein; Nathaniel Hendren; Erzo F.P. Luttmer |
| Abstract: | We develop a set of frameworks for valuing Medicaid and apply them to welfare analysis of the Oregon Health Insurance Experiment, a Medicaid expansion for low-income, uninsured adults that occurred via random assignment. Our baseline estimates of Medicaid's welfare benefit to recipients per dollar of government spending range from about $0.2 to $0.4, depending on the framework, with at least two-fifths – and as much as four-fifths – of the value of Medicaid coming from a transfer component, as opposed to its ability to move resources across states of the world. In addition, we estimate that Medicaid generates a substantial transfer, of about $0.6 per dollar of government spending, to the providers of implicit insurance for the low-income uninsured. The economic incidence of these transfers is critical for assessing the social value of providing Medicaid to low-income adults relative to alternative redistributive policies. |
| JEL: | H51 I13 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21308&r=hea |
| By: | Benjamin Hansen; Joseph J. Sabia; Daniel I. Rees |
| Abstract: | Using data from the state and national Youth Risk Behavior Surveys for the period 1991-2005, Carpenter and Cook (2008) found a strong, negative relationship between cigarette taxes and youth smoking. We revisit this relationship using four additional waves of YRBS data (2007, 2009, 2011, and 2013). Our results suggest that youths have become much less responsive to cigarette taxes since 2005. In fact, we find little evidence of a negative relationship between cigarette taxes and youth smoking when we restrict our attention to the period 2007-2013. |
| JEL: | H71 I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21311&r=hea |
| By: | Subarna Mohanty; Kashinath Metri; Nagaratna R. and H. R. Nagendra |
| Abstract: | Diabetes is one of the chronic medical condition with high prevalence rates. Long standing diabetes is associated with impaired cognitive functioning. Yoga is known to improve the cognitive functions in normal and chronic diseased individuals. Mind sound resonance technique (MSRT) is one of the mindfulness based yogic relaxation technique, know to enhance cognitive functions. The objective comprised to study the immediate effect of MSRT practice on cognitive function in patient with type 2 diabetes.Forty three (18 male) type 2 diabetes patientswith an age range between 30 to 65 (mean age ± SD = 56.83 ± 12.54) with minimum history of diabetes since last 5 years, were enrolled in this study. All the subjects underwent training of 15 sessions of MSRT practice in 6 days. 7th day subjects were administered DLST before and immediately after the MSRT intervention. Data was found normally distributed by Shapiro-Wilcox test. The paired sample t test was used to see the pre-post changes.There was significant improvement in total score (p = 0.001; +24.99) and net score (p = 0.001; +25.47) along with a nonsignificant decrease in wrong attempts (p- 0.855) of DLST.Present pilot study indicates that MSRT may have a potential role in enhancing psychomotor performance in patients suffering from diabetes, immediately after the practice. These findings need confirmation from studies with a larger sample size and randomized controlled design, which will be implicated in the future. Key words: Mind sound resonance technique; psychomotor performance; diabetes, mindfulness, cognitive function |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:vor:issues:2015-06-11&r=hea |
| By: | Pammi Sesha Srinivas; Sony Kumari |
| Abstract: | Information Technology industry in India resulted in increase of job stress and its management by professionals would impact their employability as well as personal lives. Yoga is an ancient science which can give comfort to body/mind complex of human being in any context of life with a disciplined practice. Present study was design toassess the effect ofyoga technique- cyclic meditation on job stress on Indian information technology professionals. A qualitative research method was used to collect data and results are worth pursuing. Key words: Yoga,Meditation, Job stress,Cyclic meditation, Stress management&IT professionals |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:vor:issues:2015-06-12&r=hea |
| By: | Chokkalingam; Sony Kumari; K.B. Akhilesh and H.R. Nagendra |
| Abstract: | The personality of employees determine the performance of employee. Agreeableness is one of the Big Five Personality traits which affects the performance of employee. An empirical study is made to assess the effect of practicing Integrated Yoga on personality traits,including agreeableness of employee. 51 employees are given Yoga Intervention for four months and another 51 employees are not given any intervention. Using Big Five Personality Inventory, data is collected before, in the middle, and at the end of the study. The analysis of data using SPSS showed that agreeableness among employees in Integrated Yoga Intervention group improved significantly (p<.01) Key words: Personality, Performance of Employee, Agreeableness, Integrated Yoga |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:vor:issues:2015-06-13&r=hea |
| By: | Osea Giuntella (University of Oxford, IZA); Catia Nicodemo (University of Oxford, CHSEO, IZA); Carlos Vargas Silva (University of Oxford, COMPAS) |
| Abstract: | This paper analyzes the effects of immigration on access to health care in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labor Force Survey, we analyze how immigrant inflows affected waiting times in the National Health Service. We find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. However, there is evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside London. These effects are concentrated in the years immediately following the 2004 EU enlargement and vanish in the medium-run (e.g., 3 to 4 years). Our findings suggest that these regional disparities are explained by both differences in the health status of immigrants moving into different local authorities and in natives’ internal mobility across local authorities. |
| Keywords: | Immigration, waiting times, access to health care, welfare |
| JEL: | I10 J61 |
| Date: | 2015–05–06 |
| URL: | http://d.repec.org/n?u=RePEc:nuf:econwp:1504&r=hea |
| By: | Stevenson, Jared |
| Abstract: | Telehealth systems – using ICT to manage health from a distance – have been developing for decades, including within the ambulance sector. The author undertook this research to better understand how telehealth could improve patient outcomes, improve effectiveness, or create efficiencies for the St John ambulance service. To achieve this, current literature was reviewed and a small group of experts were interviewed whose experience lies in either the ambulance service or the health sector. Key recommendations are described below: • It is of strategic importance to design ambulance telehealth systems with interoperability and interconnectivity – this will maximise health sector integration and governmental support. • Telehealth solutions should be based on simple, well-established, easy to use, and ubiquitous technologies. This reduces fear, limits technical challenges, enables technology adoption, and improves chances of success. Of all available technologies, video-calling provides the most opportunity at present. • Consistent with the 111 Clinical Hub model, St John should centralise specialists to provide telehealth support. This approach is cost effective as only a small number of specialists is required. It also supports effective clinical decision-making as this group routinely make complex decisions. • It is realistic for St John to integrate video-calling as a telehealth solution into the 111 Clinical Hub. As a patient-to-clinician tool, 111 Clinical Hub staff could use video connections to call back low acuity patients to perform a secondary triage. As a clinician-to-clinician tool, paramedics could video-call the 111 Clinical Hub for clinical support. This would increase the richness of communication, and enable better clinical decisions to be made. • While it is unclear the role that remote monitoring will play in improving an ambulance service, it is clear is that medical alarms will evolve to have much greater functionality, including sharing of biometric information. St John needs to make a strategic decision as to whether it wants to play the role of monitoring those with long-term conditions – and therefore being responsible for taking action when there are any signs of deterioration – or whether that should be the role of general practitioners (GPs). • When designing telehealth solutions, St John must consider whether it is creating unequal access to healthcare and, where created, take actions to mitigate these inequities. • It is important that St John clearly communicates any new telehealth interventions – resistance to change must be anticipated and therefore strong communication strategies must be part of the design process. • There is limited evidence to support telehealth solutions in terms of improved patient satisfaction, improved patient outcomes, or greater efficiencies. With the impending implementation of electronic patient report form (ePRF) there is opportunity to evaluate a telehealth solution in these terms. • It’s important to note that, regardless of the telehealth system adopted, no single solution will be effective – real improvements will require multiple integrated systems. |
| Keywords: | Ambulance, Telehealth, NZ, New Zealand, |
| Date: | 2014 |
| URL: | http://d.repec.org/n?u=RePEc:vuw:vuwmba:4466&r=hea |
| By: | Tannaz Mahtoochi; Ignacio Castillo; Logan McLeod |
| Abstract: | We study a value-based healthcare delivery system with two non-cooperative parties: a purchaser of medical services and an Integrated Practice Unit (IPU). The IPU is capable of providing all healthcare needs of patients with a specific medical condition (homogeneous patient population), is comprised of a multi-disciplinary team of providers, and is responsible for the health outcomes of the patients over the care cycle. The IPU chooses the treatment strategy, incurs the associated cost, and is paid by the healthcare purchaser. The treatment strategy critically determines the health outcomes of the patients. Assuming the existence of universal health insurance for the patient population, the healthcare purchaser’s problem is to determine a payment scheme that will induce social welfare maximizing choices to the IPU. We use a dynamic continuous-time principal-agent model to capture the relationship between the purchaser and the IPU, and determine the optimal payment scheme, referred to as dynamic outcome-adjusted payment. The model characterizes the optimal payment scheme with a single variable. Previous value-based healthcare delivery principles suggest that the IPU should be reimbursed according to a “bundled payment.†Our results suggest payment should depend on the history of health outcomes over the care cycle. The proposed payment scheme combines a bundled payment with a bonus payment for consistently producing superior outcomes. Our results suggest value could be improved by paying for health outcomes over the care cycle; thus supporting the value-based healthcare delivery objective of achieving healthier patients over time. Unlike other performance-based payment schemes, this scheme could result in a single-variable implementation. |
| Keywords: | value-based healthcare delivery, integrated healthcare delivery, universal health insurance, payment systems, coordinating contracts, dynamic incentives |
| JEL: | I12 I30 J44 C73 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:cch:wpaper:150008&r=hea |
| By: | Ana María Iregui-Bohórquez; Ligia Alba Melo-Becerra; María Teresa Ramírez-Giraldo |
| Abstract: | This paper uses the Colombian National Health Survey to analyze the relationship between education and risky health behaviors, namely smoking, heavy drinking, being obese, and unsafe sexual behavior, by estimating the education gradient using Logit models. We also provide evidence on the effect of education, socio-economic and knowledge variables on these health behaviors by gender and area of residence. Results indicate that there is a negative and significant effect of years of schooling on the probability of smoking, whereas the probability of heavy drinking and unsafe sexual behaviors increases with education, highlighting the importance of social and cultural factors. Knowledge variables not only reduce the probability of smoking, but also the probability of heavy drinking and being obese, indicating that campaigns and research on the negative effects of these behaviors have raised awareness about how harmful they are. |
| Keywords: | Education, risky health behaviors, Colombia |
| JEL: | I1 I12 I20 |
| Date: | 2015–06–18 |
| URL: | http://d.repec.org/n?u=RePEc:col:000094:013040&r=hea |
| By: | Gimenez-Nadal, J. Ignacio; Molina, Jose Alberto |
| Abstract: | This paper analyzes the relationship between health inequality and time allocation decisions of workers in six European countries. Using the Multinational Time Use Study, we find that a better perception of own health is associated with more time devoted to market work activities in all the countries, and with less time in housework activities, for both men and women. However, the evidence for the associations between health and leisure is mixed. This study represents a first step in understanding cross-country differences in the relationship between health status and time devoted to a range of activities for workers, in contrast with other analyses that have mainly focused only on market work. A better understanding of these cross-country differences may help to identify the effects of public policies on inequalities in the uses of time. |
| Keywords: | Health, Time Allocation, Inequality, Multinational Time Use Study |
| JEL: | D13 J16 J22 |
| Date: | 2015–06–29 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:65334&r=hea |
| By: | Konstantinos Chatzimichael (Dept of Economics, University of Crete, Greece); Margarita Genius (Department of Economics, University of Crete, Greece); Vangelis Tzouvelekas (Department of Economics, University of Crete, Greece) |
| Abstract: | In many sectors technological conditions of rm production require the use of specic inputs that are at the same time hazardous for firm workers, i.e., health-damaging inputs. Safety rules on the application of these health damaging inputs are not always followed due to lack of knowledge on the adverse long-run health effects and improper firm management. This in turn implies that firms suffer from important productivity losses due to deterioration of their human capital. Along these lines, we develop a primal decomposition framework to analyze the effects of human capital on individual productivity growth rates while considering the adverse eects of health-damaging inputs. Workers' health indices are estimated using the recently developed generalized propensity score (GPS) methods with continuous treatments (Hirano and Imbens, 2004). The approach is implemented in a unique dataset of greenhouse producers in Western Crete, Greece that combines individual worker health with production data. |
| Keywords: | health-damaging inputs; workers' health index; TFP growth; greenhouse farms |
| JEL: | I12 I30 Q12 D24 |
| Date: | 2015–06–19 |
| URL: | http://d.repec.org/n?u=RePEc:crt:wpaper:1505&r=hea |
| By: | Celhay,Pablo A.; Gertler,Paul J.; Giovagnoli,Paula; Vermeersch,Christel M. J. |
| Abstract: | The adoption of new clinical practice patterns by medical care providers is often challenging, even when the patterns are believed to be efficacious and profitable. This paper uses a randomized field experiment to examine the effects of temporary financial incentives paid to medical care clinics for the initiation of prenatal care in the first trimester of pregnancy. The rate of early initiation of prenatal care was 34 percent higher in the treatment group than in the control group while the incentives were being paid, and this effect persisted at least 15 months and likely 24 months or more after the incentives ended. These results are consistent with a model where the incentives enable providers to address the fixed costs of overcoming organizational inertia in innovation, and suggest that temporary incentives may be effective at motivating improvements in long-run provider performance at a substantially lower cost than permanent incentives. |
| Keywords: | Disease Control&Prevention,Health Systems Development&Reform,Health Monitoring&Evaluation,Population Policies,Labor Policies |
| Date: | 2015–06–30 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:7348&r=hea |
| By: | Catherine M. DesRoches; Kirsten A. Barrett; Bonnie E. Harvey; Rachel Kogan; James D. Reschovsky; Bruce E. Landon; Lawrence P. Casalino; Stephen M. Shortell; Eugene C. Rich |
| Abstract: | One thousand, six hundred and fifty-five physicians (55 %) were found in all three data files. |
| Keywords: | sample, frame, physician, surveys |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d9e9df2f5dc14f3d878555d3d9255cbe&r=hea |
| By: | Lara Converse; Kirsten Barrett; Eugene Rich; James Reschovsky |
| Abstract: | To support their efforts to promote high quality and efficient care, policymakers need to better understand the key factors associated with variations in physicians’ decisions, and in particular, physician deviations from evidence-based care. |
| Keywords: | clinical vignettes, evidence-based care, clinical decisions |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:7e5e2be5ac854446aabc8eb73932d15b&r=hea |
| By: | Ann S. O'Malley; Eugene C. Rich; Alyssa Maccarone; Catherine M. DesRoches; Robert J. Reid |
| Abstract: | Primary care plays a central role in the provision of health care, and is an organizing feature for health care delivery systems in most Western industrialized democracies. |
| Keywords: | primary health care, continuity of care, coordination, comprehensiveness, access, accessibility, patient outcomes, quality |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:30f6d0ccf0354f669616836a77f7a516&r=hea |
| By: | Catherine M. DesRoches; Herbert S. Wong; Eugene C. Rich; Sumit R. Majumdar |
| Abstract: | Physicians play a key role in the American health care system. Beyond providing direct medical care, they authorize the great majority of medical services, thus making them directly or indirectly responsible for access, quality, and a significant portion of U.S. health care spending. |
| Keywords: | survey research, health policy, physician workforce |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:73a22e05b86d442eb6fa8500996eeafe&r=hea |
| By: | James D. Reschovsky; Eugene C. Rich; Timothy K. Lake |
| Abstract: | There is ample evidence that many clinical decisions made by physicians are inconsistent with current and generally accepted evidence. |
| Keywords: | evidence-based medicine, decision making, health services research, health care reform |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:a5c8137e167e421086c553af01dcf6cc&r=hea |
| By: | Christopher Fleming; Eugene Rich; Catherine DesRoches; James Reschovsky; Rachel Kogan |
| Abstract: | For the latter third of the twentieth century, researchers have estimated production and cost functions for physician practices. Today, those attempting to measure the inputs and outputs of physician practice must account for many recent changes in models of care delivery. |
| Keywords: | physician practice, input, output, scale economy, efficiency |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:ffc21d7f5da84c4db72bbd7db67abc34&r=hea |
| By: | Ann S. O'Malley; Eugene C. Rich |
| Abstract: | Comprehensiveness of primary care (the extent to which the clinician, as part of the primary care team, recognizes and meets the majority of each patient’s physical and mental health care needs) is an important element of primary care, but seems to be declining in the U.S. |
| Keywords: | primary health care, health services research, comprehensive, comprehensiveness, quality of care, patient outcomes, chronic conditions |
| JEL: | I |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:396b4b99dff5449abe549f025ab3cf9b&r=hea |
| By: | Sophie-Charlotte Meyer (Schumpeter School of Business and Economics, University of Wuppertal) |
| Abstract: | A widespread finding among studies from the US and the UK is that maternal employment is correlated with an increased risk of child overweight, even in a causal manner, whereas studies from European countries obtain less conclusive results. As evidence for Germany is still scarce, the purpose of this study is to identify the effect of maternal employment on childhood overweight in Germany using two sets of representative micro data. Moreover, we explore potential underlying mechanisms that might explain this relationship. In order to address the selection into maternal full-time employment, we use an instrumental variable strategy exploiting the number of younger siblings in the household as an instrument. While the OLS model suggests that maternal full-time employment is related to a 5 percentage point higher probability of the child to be overweight, IV estimates indicate a 25 percentage points higher overweight probability due to maternal full-time employment. Exploring various possible pathways, we find that maternal employment is associated with unhealthy dietary and activity habits which might explain the positive effect of maternal employment on child overweight to some extent. Several sensitivity analyses confirm the robustness of our findings. |
| Keywords: | aternal employment, childhood overweight, BMI, maternal labor supply |
| JEL: | I12 J22 J13 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:bwu:schdps:sdp15005&r=hea |
| By: | Joan Costa Font; Martin Karlsson; Henning Øien |
| Abstract: | Macroeconomic downturns can have both an important impact on the availability of informal care and the affordability of formal long-term care. This paper investigates how the demand for and provision of informal care changed during and after the Great Recession in Europe. We use data from the Survey of Health, Aging and Retirement in Europe (SHARE), which includes a rich set of variables covering waves before and after the Great Recession. We find evidence of an increase in the availability of informal care and a reduction in the use of formal health services (doctor visits and hospital stays) after the economic downturn when controlling for year and country fixed effects. This trend is mainly driven by changes in care provision of individuals not cohabiting with the care recipient. We also find a small negative association between old-age health (measured by the number of problems with activities of daily living) and crisis severity. The results are robust to the inclusion o f individual characteristics, individual-specific effects and region-specific time trends. |
| Keywords: | Long-term care, informal care, great recession, downturn, old age dependency |
| JEL: | I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:cep:cepdps:dp1360&r=hea |
| By: | Barry P. Bosworth; Gary Burtless; Kan Zhang |
| Abstract: | This paper uses data from the Health and Retirement Study (HRS) to explore the extent and causes of widening differences in life expectancy by socioeconomic status (SES) for older persons. We construct alternative measures of SES using educational attainment and average (career) earnings in the prime working ages of 41-50. We also use information on causes of death, health status and various behavioral indicators (smoking, drinking, and obesity) that are believed to be predictors of premature death in an effort to explain the causes of the growing disparities in life expectancy between people of high and low SES. The paper finds that: - There is strong statistical evidence in the HRS of a growing inequality of mortality risk by SES among more recent birth cohorts compared with cohorts born before 1930. - Both educational attainment and career earnings as constructed from Social Security records are equally useful indicators of SES, although the distinction in mortality risk by education is greatest for those with and without a college degree. - There has been a significant decline in the risk of dying from cancer or heart conditions for older Americans in the top half of the income distribution, but we find no such reduction of mortality risk in the bottom half of the distribution. - The inclusion of the behavioral variables and health status result in substantial improvement in the predictions of mortality, but they do not identify the sources of the increase in differential mortality. The policy implications of the findings are: - Indexing the retirement age to increases in average life expectancy to stabilize OASDI finances may have unintended distributional consequences, because most mortality gains have been concentrated among workers in the top half of the earnings distribution. - The fact that we cannot identify the sources of the increase in differential mortality contributes to uncertainty about the distributional effects of increases in the retirement age in future years. |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2015-10&r=hea |
| By: | Dormont, Brigitte; Péron, Mathilde |
| Abstract: | In this paper, we estimate the causal impact of a positive shock on supplementary health insurance coverage on the use of specialists who balance bill. For that purpose, we evaluate the impact on patients' behavior of a shock consisting of better coverage of balance billing, while controlling for supply side drivers, i.e. proportions of physicians who balance bill and physicians who do not. We use a panel dataset of 58,336 individuals observed between January 2010 and December 2012, which provides information, at the individual level, on health care claims and reimbursements provided by basic and supplementary insurance. Our data makes it possible to observe enrollees that are heterogeneous in their propensity to use physicians who balance bill. We observe them when they are all covered by the same supplementary insurer, with no coverage for balance billing, and after 5,134 of them switched to other supplementary insurers which offer better coverage. Our estimations show that better coverage contributes to a rise in medical prices by increasing the demand for specialists who balance bill. On the whole sample, we find that better coverage leads individuals to raise their proportion of consultations of specialists who balance bill by 9 %, which results in a 34 % increase in the amount of balance billing per consultation. However, the effect of supplementary health insurance clearly depends on the local supply side organization. The inflationary impact arises when specialists who balance bill are numerous and specialists who do not are relatively scarce. When people have a real choice between physicians, a coverage shock has no impact on the use of specialists who balance bill. When the number of specialists who charge the regulated fee is sufficiently high, there is no evidence of limits in access to health care, nor of an inflationary effect of supplementary coverage. |
| Keywords: | Health insurance; Balance billing; Health care access; |
| JEL: | I13 I18 C23 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:dau:papers:123456789/15235&r=hea |
| By: | Luc SOETE; AZOMAHOU; Bity DIENE (Université d'Auvergne(UdA)); Mbaye DIENE |
| Abstract: | This paper develops a general equilibrium framework to study the role of preferences structure (additive, multiplicative and convex combination of both) in connecting consumption, health investment, stock of health and capital, and their effects on the wage rate and on productivity. We show that the elasticities of health production, health investment and health cost determine jointly how health influences the wage rate. We examine the steady state and the equilibrium dynamics of the model. In the case of additive preferences, the existence of equilibrium and the stability of the dynamic system require that the ratio of the elasticities of the cost of health and health investment is greater than the elasticity of the production function of health. Health stock can have either positive or negative effects on wage rate. The reverse holds for multiplicative preferences and the effect of health stock on wage rate is always positive. L ongevity is a decreasing convex-concave function of the elasticity of inter-temporal substitution of health. We also compare the relative behavior of opportunity costs of health under preferences structure. |
| Keywords: | Consumption, health investment, preferences structure, wage rates, longevity, opportunity costs |
| JEL: | E21 I15 C62 C61 |
| Date: | 2015–04 |
| URL: | http://d.repec.org/n?u=RePEc:cdi:wpaper:1668&r=hea |
| By: | Martin Binder (Bard College Berlin and Annandale-on-Hudson) |
| Abstract: | This short note seeks to replicate the quantile regression analysis in Binder and Coad (2011), but taking into account individual-specific fixed effects (using the BHPS data set). It finds declining effects of the four main variables of interest (health, social life, income, education) over the quantiles of the subjective well-being distribution, with attenuated effect sizes for the fixed-effects model. Equivalized log income has a negative impact on subjective well-being throughout the distribution. Apart from a number of robustness checks, existing research is extended by looking into the quantile effects of the above variables on a set of domain satisfactions. |
| Keywords: | subjective well-being, quantile regressions, heterogeneity, BHPS, life satisfaction |
| JEL: | I12 I31 R15 |
| Date: | 2015–06–24 |
| URL: | http://d.repec.org/n?u=RePEc:esi:evopap:2015-01&r=hea |
| By: | Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence) |
| Abstract: | The Telecare Development Programme (TDP) case in Scotland (UK) is a patient-centred Integrated Care management process targeting the 65+ population in the country. It particularly addresses vulnerable subgroups of patients and patients with complex illnesses within the 32 communities across Scotland. The TDP case is a funding initiative developed between 2006 and 2011 by the Scottish Government in order to encourage the adoption of the telecare by health and social care services. It sought to demonstrate how telecare could contribute to support the safety and quality of life of older people and enable them to live at home longer, while significantly reducing the cost of health and social care services provisioning. During the period of 2006-2011, no less than 51 telecare projects were operating within all 32 Communities, covering the whole population of Scotland. The starting point of the TDP case was a change in the policy context that required a shift from a healthcare system oriented towards hospital-based treatment to a system based on preventive care to manage long-term conditions. TDP enables vertical integration within the Communities of Health Partnerships (CHPs), but should also promote full integration in a short to medium-term perspective, especially as the new legislative framework coming into force in March-April 2015 aims to integrate health and social care units, as a consequence of a recent health care spending review. |
| 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: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94496&r=hea |
| By: | Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence) |
| Abstract: | The SAM:BO case rests on an agreement that sets out guidelines concerning cooperation and communication among health care actors, together with principles on how to monitor the quality of the service provided and to support health care management processes by electronic communications. It represents a joint strategy applied by 4 hospital units, 22 municipalities and about 800 practitioners operating in the Region of Southern Denmark. SAM:BO is a formal framework of cooperation which aims to support treatment and intersectoral cooperation. It facilitates the exchange of experiences and guideline development, supports national coordination and the development of new national projects (e.g. the shared medical record, the Shared Care System), and promotes standards of IT communication. |
| 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: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94488&r=hea |
| By: | Francisco Lupiañez-Villanueva (Open Evidence); Alexandra Theben (Open Evidence) |
| Abstract: | Percorsi Diagnostico e Terapeutici Assistenziali (PDTA, in English “Assisted Diagnostic and Therapeutic Pathways”) is a patient-centric Integrated Care service organised by the Brescia Health Care Unit in Brescia Province (Italy). Brescia is the largest province of the Lombardy region and is second in terms of number of inhabitants after the province of Milan with 1.25 million inhabitants in 2013. The PDTA case started about 15 years ago as an initiative of a local health unit, which developed the PDTA approach with the support of the local GPs’ Unions and the local Associations of Health Care Specialists. The PDTA case addresses patients with complex illnesses, as well as vulnerable subgroups (e.g. persons that suffer for dementia/Alzheimer's). In order to exemplify and deepen the analysis of the case study, we have specifically studied the PDTA case applied to dementia/Alzheimer patients who represent 5% of the Brescia province population of the age group 64 and older (about 15,000 individuals). Currently, the PDTA case is providing services to 50% of the people suffering from dementia. |
| 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: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94498&r=hea |
| By: | Francisco Lupiañez-Villanueva (Open Evidence); Anna Sachinopoulou; Alexandra Theben (Open Evidence) |
| Abstract: | In 2003 Oulu was already a technology city and had set a target of becoming a pioneer in the development of technological well-being products and services. One of the most successful services is the Oulu Self-Care, which was planned, implemented and piloted in the Kasio Project (2007-2009). The aims of the project were to develop self-care services along with an environment for new product and service testing with the participation of citizens and professionals. The Self-Care platform was opened to all citizens in 2010 as an internet-based portal. It focuses on life style and disease prevention. It also includes self-care services for chronically ill patients, which implement the Chronic Care Model developed in another project called PISARA with the cooperation of other municipalities in Finland. |
| 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: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94492&r=hea |
| By: | Ramon Sabes-Figuera (European Commission – JRC - IPTS) |
| Abstract: | ACTION (Assisting Carers using Telematics Interventions to meet Older Person’s Needs) is a self-care and family care support service provided through ICT installed at patients' homes. The main target of the service are older carers living with aged spouses who require help with the activities of daily living as a consequence of chronic illness. The ACTION service consists of 4 integrated components: multimedia educational programmes, a call centre with video-telephony, a computer with videophone placed in the older person’s home and training and supervision programmes. ACTION is currently running as a mainstream service in the Borås municipality in Western Sweden, where it was first piloted and implemented in 1997, with around 100 users (status July 2014). Back in 2011, around 350 people were using the service as there were pilot projects in twenty municipalities across Sweden. |
| 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: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94500&r=hea |
| By: | Stephanie Carretero (European Commission – JRC - IPTS); Csaba Kucsera (European Commission – JRC - IPTS) |
| Abstract: | This report elaborates five case studies of good practices of technology-enabled services for independent living of older adults at home from the 14 obtained in the deliverable 1 of the ICT-AGE project. The aim is to obtain policy lessons studying a group of variables related with the creation and implementation of these services by public long-term care systems, such as business case and models, training actions, scaling and market creation, evaluation process and organisation change, among others. A case study is provided per each good practice on the basis of the variables analysed. |
| Keywords: | long-term care, social investment, social return, information and communication technologies, active and healthy ageing, quality of care, productivity, carers, financial sustainability, care, savings, ageing in place, social innovation |
| JEL: | I00 I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc94633&r=hea |
| By: | Stephanie Carretero (European Commission – JRC - IPTS) |
| Abstract: | This report collects six policy lessons to support public authorities at all levels of the EU Member States for the adequate implementation and use of new technologies in the field of long-term care service provision for older people. These policy lessons have been obtained through the ICT-AGE research project carried out by the JRC-IPTS and funded by DG EMPL, based on the cross-analysis of good practices of technology-enabled services to help older people live independently at home. These lessons are aimed to benefit the public long-term care authorities, to modernise their social protection systems in the field of long-term care, ensuring effectiveness, adequacy and sustainability. They can enable the Member States to carry out the actions and recommendations set out in the 2013 European Commission policy on Social Investment for Growth and Cohesion (SIP) and to implement the country-specific recommendations of the European Semester. The report also provides to the targeted public authorities with different existing instruments with those the European Union could help them to implement these policy lessons. |
| Keywords: | long-term care, social investment, social return, information and communication technologies, active and healthy ageing, quality of care, productivity, carers, financial sustainability, care, savings, ageing in place, social innovation, silver economy, digital single market, ecare, ehealth, ICTs, technology, digital, ageing |
| JEL: | I00 I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ipt:iptwpa:jrc96022&r=hea |
| By: | Margaret Colby; Brenda Natzke |
| Abstract: | We compared health care utilization among children enrolled via ELE and nondisabled children who enrolled through standard pathways in each state. We used a two-step estimation approach, examining the likelihood of utilization and then the volume and cost of services among users. Regression adjustment corrected for demographic differences. |
| Keywords: | Medicaid, health care utilization, express lane eligibility, enrollment simplification |
| JEL: | I |
| Date: | 2015–06–01 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2c63ccdbf8a84d42894dc26333cfcec7&r=hea |