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on Health Economics |
| By: | Barry P. Bosworth; Kan Zhang |
| Abstract: | This paper uses data from the Survey of Income and Program Participation (SIPP) and the Health and Retirement Study (HRS) to explore the extent of a widening in life expectancies by socioeconomic status (SES) for older persons. We construct four alternative measures of SES, using educational attainment, average (career) earnings in the prime working ages of 41-50, wealth, and occupational classifications. The paper finds that: - There is strong statistical evidence in both the SIPP and HRS of a growing inequality of mortality risk by SES across birth cohorts from 1910 to 1961. - Growing inequality in mortality risk is evident using all four indicators of SES, but it is strongest for the measures based on career earnings and educational attainment. - The secular changes in differential mortality are very large, but their influence on the length of time for which people receive benefits has been dampened by legal restrictions on early retirement for low-SES individuals and by voluntary postponement of retirement at the top of the distribution. - Self-reported health status is a highly significant predictor of mortality risk, but its inclusion in the statistical models has only a marginal effect on the evidence of differential mortality operating through the various SES indicators. - The combination of survey measures of the various SES indicators and the administrative records covering earnings, death records, and OASDI benefits provides a particularly large and rich data set for the analysis of mortality experience and its implications for the distribution of benefits. The policy implications of the findings are: - Indexing the retirement age to increases in average life expectancy to stabilize OASDI finances may have substantial unintended distributional consequences, because most mortality gains have been concentrated among workers with relatively high SES. |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2015-13&r=hea |
| By: | Aizawa, Naoki (Federal Reserve Bank of Minneapolis); Fang, Hanming (University of Pennsylvania) |
| Abstract: | We present and empirically implement an equilibrium labor market search model where risk averse workers facing medical expenditure shocks are matched with firms making health insurance coverage decisions. Our model delivers a rich set of predictions that can account for a wide variety of phenomenon observed in the data including the correlations among firm sizes, wages, health insurance offering rates, turnover rates and workers’ health compositions. We estimate our model by Generalized Method of Moments using a combination of micro datasets including Survey of Income and Program Participation, Medical Expenditure Panel Survey and Robert Wood Johnson Foundation Employer Health Insurance Survey. We use our estimated model to evaluate the equilibrium impact of the 2010 Affordable Care Act (ACA) and find that it would reduce the uninsured rate among the workers in our estimation sample from about 22% in the pre-ACA benchmark economy to less than 4%. We also find that income-based premium subsidies for health insurance purchases from the exchange play an important role for the sustainability of the ACA; without the premium subsidies, the uninsured rate would be around 18%. In contrast, as long as premium subsidies and health insurance exchanges with community ratings stay intact, ACA without the individual mandate, or without the employer mandate, or without both mandates, could still succeed in reducing the uninsured rates to 7.34%, 4.63% and 9.22% respectively. |
| Keywords: | Health; Health insurance; Health care reform; Labor market equilibrium |
| JEL: | G22 I11 I13 J32 |
| Date: | 2015–07–02 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedmwp:727&r=hea |
| By: | Joan Costa-i-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 be the number of problems with activities of daily living) and crisis severity. The results are robust to the inclusion of 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:ehl:lserod:62606&r=hea |
| By: | Sarah Flèche; Richard Layard |
| Abstract: | Studies of deprivation usually ignore mental illness. This paper uses household panel data from the USA, Australia, Britain and Germany to broaden the analysis. We ask first how many of those in the lowest levels of life-satisfaction suffer from unemployment, poverty, physical ill health, and mental illness. The largest proportion suffer from mental illness. Multiple regression shows that mental illness is not highly correlated with poverty or unemployment, and that it contributes more to explaining the presence of misery than is explained by either poverty or unemployment. This holds both with and without fixed effects. |
| Keywords: | Mental health; life-satisfaction; wellbeing; poverty; unemployment |
| JEL: | I31 I32 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:62589&r=hea |
| By: | Ana Aizcorbe; Tina Highfill (Bureau of Economic Analysis) |
| Date: | 2015–05 |
| URL: | http://d.repec.org/n?u=RePEc:bea:wpaper:0121&r=hea |
| By: | Reichert, Arndt R.; Tauchmann, Harald; Wübker, Ansgar |
| Abstract: | Obesity may not only be linked to undesirable health outcomes but also to limitations in sexual life. The present paper aims to assess whether there is a causal relationship between weight loss and sexual activity in adult obese individuals. To address the endogeneity of weight loss that is likely to result in biased estimation results, the analysis is based on data from a randomized field experiment. In this experiment financial weight-loss rewards were offered to a random subgroup of participants and can be used as exogenous source of weight variation in an instrumental variables approach. Estimation results indicate that for obese males loosing weight increases the probability for being involved in a sexual relationship. Conditional on having already lost some weight, a further reduction in obesity also increases the frequency of sexual intercourse. |
| Keywords: | obesity,sexual partnership,frequency of intercourse,randomized trial,weight-loss incentives |
| JEL: | I10 I18 J28 J65 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:iwqwdp:062015&r=hea |
| By: | Oasis Kodila-Tedika (Université de Kinshasa Département d’Eco); Simplice Asongu (Yaoundé/Cameroun) |
| Abstract: | This study complements existing literature on the relationship between HIV/AIDS and human capital by introducing previously unexplored indicators as well as more robust empirical strategies. The overarching purpose is to assess whether previous findings on the relationship withstand empirical scrutiny when alternative indicators and methodologies are employed. Four main HIV/AIDS measurements are regressed on intelligence for a maximum of 195 cross-sectional averages over the past decade. The empirical evidence is based on OLS, IWLS and 2SLS. The following findings are established. First, human capital decreases HIV prevalence with the magnitude on ‘Women’s share of population ages 15+ living with HIV’ substantially higher. This implies improving average human capital levels across communities would be more beneficial to girls above the age of 15 living with HIV. The relatively similar negative magnitudes across other dependent variables implies that increasing human capital decreases deaths from HIV/AIDS by almost the same rate as it reduces infections to the disease. Moreover, the HIV infection rate in children between the ages of 0 and 14 does not significantly change with human capital improvements. More policy implications are discussed. |
| Keywords: | Health; Human capital; Intelligence |
| JEL: | D60 I10 I20 J24 O15 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:agd:wpaper:15/027&r=hea |
| By: | Sofia Dimakou (Technological Educational Institute of Athens); Ourania Dimakou (SOAS, University of London); Henrique S. Basso (Banco de España) |
| Abstract: | Waiting time targets have been a key policy intervention in many OECD countries, aimed at reducing persistent waiting times for healthcare. What is the impact of targets on the distribution of patients' waiting time? Do they affect healthcare outcomes? We address the first question by developing a theoretical model of healthcare provision and empirically assessing the entire distribution of patients' durations at the hospital level. Our model and empirical evidence identify two distinct admission patterns. Hospitals respond by either treating all patients faster or by `substituting' among short and long waiters, indicating an asymmetric effect across patients. In order to address the impact of targets on healthcare outcomes (mortality, prolonged healthcare, delayed discharge at the patient level) we explore the identified heterogeneity of responses across hospitals. We find supportive evidence of a systematic difference in outcomes of patients treated in hospitals that exhibit asymmetric responses to targets. |
| Keywords: | Waiting time targets, Hospitals, Prioritisation, Public Health Provision, Government Policy. |
| JEL: | I18 I11 H51 |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:bbk:bbkcam:1502&r=hea |
| By: | Lars Thiel |
| Abstract: | The aim of this study is to estimate the causal effect of cultural participation on health status. Cultural activities may directly impact upon health through palliative coping or substituting health-compromising behaviors. Cultural engagement may also facilitate the development of social networks, which can improve health via social support and the dissemination of social health norms. Previous estimates on the arts-health relationship are potentially biased due to reverse causality and unobserved heterogeneity. Using individual-level data from Germany, we employ propensity-score matching methods. The treatment group is confined to individuals that visit cultural events at least once a month. The participation equation includes a rich set of personal characteristics that cover the respondents' demographic and social background, social capital and leisure-time activities, health-related lifestyle, personality and childhood environment. We explicitly consider reverse causality by including the pre-treatment trends in health outcomes among the covariates. To deal with time-fixed unobserved heterogeneity, we combine the matching model with a difference-indifference approach. We find that frequent cultural-event visits are unrelated to health once we account for unobserved persistent differences across individuals. However, examining the dose-response relationship we find positive mental-health effects of low levels of cultural participation compared to non-attendance. Our results may thus yield important insights on the effectiveness of arts participation as a means to reduce social inequalities in health. |
| Keywords: | Cultural participation; mental health; physical health; propensity-score matching; multivalued treatment |
| JEL: | I12 Z11 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:diw:diwsop:diw_sp767&r=hea |
| By: | Clemencia Cosentino |
| Keywords: | Diversify Health Professions, RWJF Summer Medical and Dental Education Program |
| JEL: | I |
| Date: | 2015–05–04 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d9a4f6a8881c4902b3a52730761cfc34&r=hea |
| By: | Alexander Ahammer, G. Thomas Horvath, Rudolf Winter-Ebmer |
| Abstract: | We analyze the effect of income on mortality in Austria using administrative social security data. To tackle potential endogeneity concerns arising in this context, we estimate time-invariant firm-specific wage components and use them as instruments for actual wages. While we do find quantitatively small yet statistically significant effects in our naïve least squares estimations, IV regressions reveal a robust zero-effect of income on ten-year death rates for prime-age workers, both in terms of coefficient magnitude and statistical significance. These results are robust to a number of different sample specifications and both linear and non-linear estimation methods. |
| Keywords: | Income, mortality, wage decomposition. |
| JEL: | J14 J31 I10 |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:jku:econwp:2015_04&r=hea |
| By: | Palali, Ali (Tilburg University, Center For Economic Research) |
| Abstract: | This study investigates the effects of early smoking on educational attainment and<br/>labor market performance. The results show that early smoking adversely affects educational attainment and initial labor market performance, but only for males. The effect of early smoking on initial labor market performance is indirect through educational attainment. Moreover, for males only, early smoking has a negative effect on current labor market performance even after conditioning on education. For females neither education nor labor market performance is affected by early smoking. |
| Keywords: | early smoking; education; labor market performance; Mixed Proportional Hazards model; discrete factor approach |
| JEL: | C41 I19 J24 J31 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:tiu:tiucen:b51be057-cb0e-445a-a428-4ba801d3adf7&r=hea |
| By: | Dizon-Ross, Rebecca; Dupas, Pascaline; Robinson, Jonathan |
| Abstract: | Heavily subsidizing essential health products through existing health infrastructure has the potential to substantially decrease child mortality in sub-Saharan Africa. There is, however, widespread concern that poor governance and in particular limited accountability among health workers seriously undermines the effectiveness of such programs. We performed innovative audits on bed net distribution programs in three countries (Ghana, Kenya and Uganda) to investigate local agency problems and their determinants in the allocation of targeted subsidies. Overall, agency concerns appear modest. Around 80% of the eligible receive the subsidy as intended and leakage to the ineligible appears limited, even when the ineligible have a high willingness to pay. The estimated level of mistargeting only modestly affects the cost-effectiveness of free distribution. |
| Keywords: | extortion; leakage; motivation; shirking |
| JEL: | D73 H11 I15 I38 |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:10690&r=hea |
| By: | Emily Hewlett; Kierran Horner |
| Abstract: | As part of a wider project on mental health in OECD countries, a series of descriptive profiles have been prepared, intended to provide descriptive, easily comprehensible, highly informative accounts of the mental health systems of OECD countries. These profiles, entitled ‘Mental Health Analysis Profiles’ (MHAPs), will be able to inform discussion and reflection and provide an introduction to and a synthesised account of mental health in a given country. Each MHAP follows the same template, and whilst the MHAPs are stand-alone profiles, loose cross-country comparison using the MHAPs is possible and encouraged. The English mental health care system can be regarded as one of the clearest examples of a “community care” approach to mental illness, with relatively well established links and networks between mental health care providers and social care providers. Strong links between social support services, for example employment and housing services, and appropriate psychological and medical interventions, have been a priority. Recent developments in the system include the introduction of a programme of talking therapies, IAPT, rolled-out nation-wide, a commitment to introduce waiting times standards for mental health services, and early in 2014 a mental health action plan, Closing the gap: priorities for essential change, which sets out 25 areas for urgent action.<BR>Lancée dans le cadre d’un projet plus vaste consacré à la santé mentale dans les pays de l'OCDE, la série de profils « Santé mentale : profils d’analyse » (Mental Health Analysis Profiles - MHAP) vise à décrire de manière simple et détaillée les systèmes de santé mentale des pays de l'OCDE. Ces profils, qui étayeront les examens et les réflexions qui seront menés, feront le point sur la situation d’un pays donné dans le domaine de la santé mentale. Les profils MHAP sont indépendants les uns des autres mais suivent le même modèle : il est donc possible, et recommandé, de les utiliser pour procéder à des comparaisons entre pays. Le système de santé mentale anglais peut être vu comme un des exemples typiques de système ayant une approche de "soins communautaires" en ce qui concerne les maladies mentales, avec des liens et réseaux relativement bien établis entre les intervenants de soins de santé mentale et les services sociaux. La priorité a été mise sur la nécessité d'avoir des liens étroits entre les services d'aide sociale, par exemple l'emploi et le logement, et les interventions médicales et psychologiques. De récentes évolutions dans ce système sont à noter, telles que l'introduction d'un programme de thérapie parlante, l'IAPT, déployé sur tout le territoire, un engagement pour l'introduction de limites de temps d'attente pour les services de santé mentale, et, au début de 2014, un plan d'action de santé mentale appelé en anglais Closing the gap: priorities for essential change, définissant 25 domaines d'action urgente. |
| Date: | 2015–07–08 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:81-en&r=hea |
| By: | Pauliina Patana |
| Abstract: | Mental ill-health is a significant issue in Sweden, with both mild-to-moderate and severe disorders representing a significant burden of ill health. Mild and moderate mental health problems constitute the greatest number of cases, and such disorders have been on the rise over the past several decades. However, mental ill-health is also recognised as a vital national issue by Swedish authorities. Accordingly, Sweden has a relatively comprehensive approach to mental health as part of its universal health plan. Sweden was also at the forefront of such trends as deinstitutionalisation and official suicide prevention programs. Country-specific initiatives designed to tackle the most pressing psychological problems in Sweden are in place, including suicide, societal stigma and rising levels of mental problems amongst Swedish youth and workers.<BR>La santé mentale est un problème significatif en Suède avec à la fois des troubles légers à modérés et sévères qui représentent un fardeau considérable dans le domaine de la santé. Les problèmes de santé mentale légers à modérés constituent la majeure partie des cas, et ces troubles sont en augmentation depuis plusieurs décennies. Pour autant, les autorités suédoises reconnaissent la maladie mentale comme un sujet national primordial. C'est pourquoi la Suède adopte une approche relativement globale de la santé mentale dans le cadre de son plan universel de santé. La Suède a aussi été un pays précurseur dans la désinstitutionalisation et la mise en place de programmes officiels de prévention contre le suicide. Des initiatives nationales spécifiques existent pour lutter contre les problèmes psychologiques les plus urgents, tel que le suicide, la stigmatisation sociale et l’augmentation des problèmes mentaux chez les jeunes et les travailleurs suédois. |
| Date: | 2015–07–08 |
| URL: | http://d.repec.org/n?u=RePEc:oec:elsaad:82-en&r=hea |
| By: | Leslie Foster; Meg Booth; Colin Reusch |
| Abstract: | Young children who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) can be at risk for developing early childhood caries (ECC). ECC is a chronic bacterial infection that causes severe tooth decay and can begin to develop before baby teeth erupt. Children with ECC may experience pain, difficulty eating, developmental complications, and loss of days in day care or preschool. ECC is expensive to treat and untreated ECC can lead to other serious infections. |
| Keywords: | Oral Health, Issue Brief, CMS, Early Childhood Tooth Decay, ECC, State Policymakers, Medicaid dental services |
| JEL: | I |
| Date: | 2015–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d06c96a588fa49548579f1ab77aaea8a&r=hea |
| By: | Leslie Foster; Meg Booth; Colin Reusch |
| Abstract: | States across the nation are redesigning their health care systems to promote higher quality health care services, healthier populations, and lower per capita costs. Medicaid and the Children’s Health Insurance Program (CHIP) are playing key roles in health system redesign for the 31 million children enrolled in these programs. |
| Keywords: | Oral Health, Issue Brief, CMS, Early Childhood Tooth Decay, ECC, Overview, Medicaid dental services |
| JEL: | I |
| Date: | 2015–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:aa3f0bc337594ef09277de94e17fe982&r=hea |
| By: | Colin Reusch; Meg Booth; Leslie Foster |
| Abstract: | Young children who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) can be at risk for developing early childhood caries (ECC). ECC is a chronic bacterial infection that causes severe tooth decay and can begin to develop before baby teeth erupt. |
| Keywords: | Oral Health, Issue Brief, CMS, Early Childhood Tooth Decay, ECC, Dental Program Managers, Medicaid dental services |
| JEL: | I |
| Date: | 2015–05–30 |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:0332a36ed61a4cfbb04f448b320b5e6c&r=hea |
| By: | Reyes, Celia M. |
| Abstract: | The Aquino Health Agenda of 2010 articulates succinctly the Philippine health sector's aim for universal health coverage. The agenda has three thrusts: rapid expansion of enrollment and benefit delivery using subsidies for the poorest families, improved access to quality hospitals and health-care facilities, and attainment of health-related Millennium Development Goals through additional effort and resources targeted to the most critical areas in the country. Years after the launch of the agenda, the Department of Health collaborated with key institutions to implement the Health Systems Research Management (HSRM) Project, with the Philippine Institute for Development Studies as one of the collaborators. Through this HSRM project, several research projects were carried out, providing critical updates and new information on the progress of the health sector's Aquino Health Agenda. Several of these critical updates and new information are presented in this special volume of the Philippine Journal of Development. The volume focuses on health financing and service delivery, particularly PhilHealth coverage, household spending for health, and health infrastructure. |
| Keywords: | Philippines, PhilHealth, universal health coverage, health financing, health, Health Systems Research Management (HSRM), health service delivery |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2x&r=hea |
| By: | Racelis, Rachel H. |
| Abstract: | In 2012, there were about 4.5 million Filipinos attending private schools and an estimated 21.6 million employed by private establishments in the Philippines. Private schools and private establishments are thus strategically positioned to contribute toward the protection, promotion, and maintenance of the health of a very large number of Filipinos. The roles that these institutional units can play in the health care of the population have in fact been strengthened by government policies on school health, and on occupational safety and health. This paper examined the provision of student health services in private schools and employer-provided health-care services and benefits in private establishments using data from two recent surveys. |
| Keywords: | Philippines, health, employer-provided health care, private schools, student health services, health benefits |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2g&r=hea |
| By: | Banzon, Eduardo P.; Lucero, Josephine Anne C.; Ho, Beverly Lorraine C.; Puyat, Maria Elizabeth D.; Quibod, Emmae June A.; Factor, Patricia Ann A. |
| Abstract: | The World Health Organization advocates universal health coverage so that all people can obtain the needed health services without suffering financial hardships. In the Philippines, the government has included public-private partnerships (PPPs) as among its strategies in pursuit of universal health coverage, as PPPs can help fund the immediate repair, rehabilitation, and construction of selected priority health facilities. It also encourages local government units to tap PPPs in improving their service delivery. Given all these, it is important to define PPPs and distinguish them from all other forms of public-private interactions. Public-private investment partnerships (PPIPs) have been described as health-related PPPs that are potentially transformative for underperforming government-run health systems. These comprise of long-term, highly structured relationships between the public and private sectors designed to achieve significant and sustainable improvements to health-care systems at national or subnational levels. Since PPIPs are the type of PPPs that appropriately support the pursuit of universal health coverage, it is important that the country prioritizes PPIPs and consider the three PPIP options—namely, health-care delivery in the settings of primary care; hospital care; and an integrated system—as it moves ahead with implementing health PPPs. Although both PPIPs and public-private interactions are intended to improve the country's health outcomes, the former must be prioritized as it can improve the overall efficiency of the system. Ultimately, PPIPs must be integrated within the health system to demonstrate the country's commitment to the pursuit of universal health coverage. |
| Keywords: | Philippines, universal health care (UHC), health, public-private partnership (PPP), public-private investment partnerships, public-private interactions |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2f&r=hea |
| By: | Wong, John Q.; Baclay, Richelcyn M.; Duque, Richelle G.; Roque, Patricia Margarita S.; Serrano, Grace Kathleen T.; Tumlos, Jenina Olivia A.; Ronsing, Aisha-Aziza A.; Cochon, Kim |
| Abstract: | This study was designed to address the question of physicians' and drugstores' compliance with the provisions of the Generics Act of 1988. Furthermore, it aimed to explore consumer awareness of generic medicines and to explain current trends and practices in drug prescribing, dispensing, and use. The study utilized a cross-sectional design and assessed four variables: generic drug prescription, generic drug substitution/dispensing, price menu cards, and use of generic drugs. The country was divided into six zones; namely, North Luzon, South Luzon, National Capital Region, Visayas, Mindanao, and Autonomous Region in Muslim Mindanao. Stratified cluster random sampling was used to identify the provinces and cities to be included in the study. Data collection techniques used a survey among consumers coming out of a drugstore, key informant interviews with 30 physicians, and focus group discussions with 6–11 patients/watchers per zone. The survey revealed that five out of six drugs were written with generic names, with doctors in the public sector prescribing generics significantly more often than those in the private sector. Factors that positively affected generics prescribing behavior are: patient's welfare, compliance, patient’s financial situation, and fear of punishment. Because there is already high compliance among drug prescribers, government efforts should now be redirected toward drugstores and consumers. Drugstore compliance should be regularly monitored. Consumers need to be aware of their right to be informed about generic alternatives. Lastly, bioequivalence tests should be done to put an end to quality concerns over generic medicines. |
| Keywords: | Philippines, generics, drug use, prescribing, dispensing, social marketing |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2e&r=hea |
| By: | Ulep, Valerie Gilbert T.; Dela Cruz, Nina Ashley O. |
| Abstract: | Health care remains inaccessible and inequitable for all, especially for the poor in the Philippines. Among the sources of health expenditures, out-of-pocket expenses remain to be Filipinos' major source of financing for medical care. However, it is this reliance on out-of-pocket expenditures that pushes Filipino households into poverty. This paper thus presents the current state of out-of-pocket expenditures in the Philippines by analyzing and estimating the burden of health payments, catastrophic payments, and impoverishments based on the Family and Income Expenditure Surveys from 2000 to 2012. This study reveals that out-of-pocket expenditures for health-care financing continue to increase. This study also reveals the higher share of out-of-pocket payments on households' nonfood expenditures. An increasing trend of catastrophic payments has been observed until recently where there was a 1.01-percent increase from 2000 to 2012. This is also the same for impoverishments: There is a rise in the prevalence of impoverished households due to high out-of-pocket expenditures. Furthermore, the poverty gap also increases after out-of-pocket payments. |
| Keywords: | Philippines, health expenditures, out-of-pocket expenditures, health care financing, household spending |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2d&r=hea |
| By: | Caballes, Alvin B. |
| Abstract: | Patients' financial protection is considered a key component of health systems and has been a consistent policy goal of the Department of Health. Of paramount importance are catastrophic health expenditures, which can severely restrict affected patients and families' access to much-needed services, contribute to (further) impoverishment, or both. This study was undertaken to determine the institutional mechanisms for addressing these expenditures and to develop a framework to improve the existing arrangements. Focus group discussions were held separately with patients (or family members), providers (clinical and support staff), and representatives of policy or financing agencies. One of the recommendations based on the inputs from the focus group discussions was to establish a dedicated unit to further develop relevant policies and strategies for the integrated financing of catastrophic health expenditures. |
| Keywords: | Philippines, catastrophic health expenditure, universal health care (UHC), financial risk protection, health financing |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2c&r=hea |
| By: | Pantig, Ida Marie T. |
| Abstract: | The national subsidy for indigent PhilHealth members identified under the National Household Targeting System for Poverty Reduction (NHTS-PR) began in 2011, in line with the government's call for universal health coverage. The subsidy involved making all individuals identified under the NHTS-PR automatically eligible for PhilHealth benefits. In 2014, the subsidy reached PHP 35 billion, which was sourced from the sin tax revenue. According to literature, health service use is anticipated to improve along with health insurance coverage. This paper explores how this change will affect the funds coming from the sin tax revenue for premium subsidy and PhilHealth's resources for benefit payment by examining administrative data and estimating loss ratios. The study finds that resources will be available for the premium subsidies but PhilHealth's collection from premiums will be much lower than the benefit payments. |
| Keywords: | Philippines, PhilHealth, social health insurance, universal health coverage, national government subsidy, premium subsidy |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2b&r=hea |
| By: | Silfverberg, Denise Valerie |
| Abstract: | The provision of social health insurance has been an increasingly popular mechanism for addressing financial barriers to health care in developing countries. In the Philippines, the social health insurance program known as PhilHealth has been expanding its breadth of coverage since its promulgation in 1995. This study looks at the regional- and provincial-level coverage of two different PhilHealth programs: the Individually Paying Program (voluntary) and the Employed Program (government and private), and identifies the possible reasons for the variation between provinces. Coverage levels for the Individually Paying Program were found to be considerably below the government's full coverage target. The regional average was found to be at 57 percent while provincial average was at 53 percent. For the Employed Program, both the private and government sectors have not achieved full coverage but the figures observed are promising. The private sector Employed Program's regional average is at 71 percent while the provincial average is at 75 percent. For the government Employed Program, the regional average lies at 74 percent while the provincial average is at 80 percent. The findings are possible propositions on how targeting should be implemented. For the government sector, no clear pattern was found based on the model presented. |
| Keywords: | Philippines, PhilHealth, employed program, individually paying program, social health insurance, universal health coverage |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:phd:pjdevt:pjd_2013_vol__40_nos__1-2a&r=hea |
| By: | Markus Eberhardt; Zheng Wang; Zhihong Yu |
| Abstract: | This paper provides the first micro-level evidence for the existence and patterns of intra-national protectionism in China. We demonstrate that drug advertising inspections are used by provincial governments to discriminate against firms from outside the province. We further reveal how the degree of discrimination could be mitigated for nonlocal firms under certain circumstances: those from neighbouring areas, those without political ties to rival provincial governments, those from regions with more economic links to the destination province, and those from provinces with stronger presence in the market, are less likely to be targeted. Our findings highlight the unique politico-economic structure in China and confirm that giving local governments strong incentives to compete with each other may exacerbate the market distortions inherent in a partially reformed economy. |
| Keywords: | Intra-national protectionism; Drug advertising; China JEL Classification: F15, L25, P26 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:not:notgep:15/07&r=hea |
| By: | Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Tor Helge Holmås (Uni Rokkan Centre and Health Economics Bergen); Karin Monstad (Uni Rokkan Centre and Health Economics Bergen); Odd Rune Straume (Universidade do Minho - NIPE) |
| Abstract: | We study whether and how physicians respond to financial incentives, making use of detailed register data on the health-care services provided to patients by general practitioners (GPs) in Norway over a six-year period (2006-11). To identify GPs' treatment responses, we exploit that specialisation in general medicine entitles the GPs to a higher consultation fee, implying a change in total and relative fee payments. To control for demand and supply factors related to becoming a specialist, we estimate a GP fixed effect model focusing on a narrow time window around the date of specialist certification. Our results show a sharp response by the GPs immediately after obtaining specialist certification and thus a higher consultation fee: the number of visits increase, while the treatment intensity (prolonged consultations, lab tests, medical procedures) decline. These findings are consistent with a theory model where (partly) profit-motivated GPs face excess demand and income effects are sufficiently small. Finally, we find no evidence for adverse health effects (measured by emergency care centre visits) on patients due to the change in GPs treatment behaviour after becoming a specialist. |
| Keywords: | General Practitioners; Fee-for-service; Profit-motivation |
| JEL: | H42 H51 I11 I18 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:nip:nipewp:07/2015&r=hea |
| By: | John Cawley; Anna Choi |
| Abstract: | One of the most robust findings in health economics is that higher-educated individuals tend to be in better health. This paper tests whether health disparities across education are to some extent due to differences in reporting error across education. We test this hypothesis using data from the pooled National Health and Nutrition Examination Survey (NHANES) Continuous for 1999-2012, which include both self-reports and objective verification for an extensive set of health behaviors and conditions, including smoking, obesity, high blood pressure, high cholesterol and diabetes. We find that better educated individuals report their health more accurately. This is true for a wide range of behaviors and conditions, even socially stigmatized ones like smoking and obesity. Differential reporting error across education leads to underestimates of the true health disparities across education that average 19.3%. |
| JEL: | I1 I12 I14 I20 I24 I3 |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:21317&r=hea |
| By: | Fe, Eduardo; Hollingsworth, Bruce |
| Abstract: | We explore the existence of short and long term effects of retirement on health. Short term effects are estimated with a regression discontinuity design which is robust to weak instruments and where the underlying assumptions of continuity of potential outcomes are uncontroversial. To identify the long term effects we propose a parametric model which, under strong assumptions, can separate normal deterioration of health from the causal effects of retirement. We apply our framework to the British Household Panel Survey, and find that retirement has little effect on health. However, our estimates suggest that retirement opens the gate to a sedentary life with an impoverished social component and this is a channel through which retirement could indirectly affect health in the long run. |
| Keywords: | Regression discontinuity, retirement, instrumental variables, health, wild bootstrap. |
| JEL: | C10 C21 C30 I12 I18 J26 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:65462&r=hea |
| By: | Quoc-Anh Do (Département d'économie); Trang Van Nguyen (World Bank); Anh N. Tran (Indiana University Bloomington) |
| Abstract: | We study how the urgency of a public service affects its corruption level by analyzing thousands of reported bribes made by inpatients to doctors and nurses in Vietnam. Although it is commonly expected that citizens need to pay a higher bribe to receive a more valuable or urgent service, we find the opposite. Acute patients, despite having conceivably higher benefits of treatment, are 8 percentage points less likely than non-acute patients to pay bribes. If they do, they pay 18% less in bribes. This behavior suggests that even in a highly corrupt environment, public servants face an incentive to provide important services for citizens. To understand this incentive, we show that acute patients pay relatively lower bribes in facilities that are better monitored and audited more frequently. |
| Keywords: | Bribes; Corruption; Doctors; Acute Diseases |
| JEL: | D73 I15 O53 |
| Date: | 2013–10 |
| URL: | http://d.repec.org/n?u=RePEc:spo:wpmain:info:hdl:2441/3tk4fhvbi18ndq2n4gs2e9pp6j&r=hea |
| By: | Elena del Rey; Sergi Jiménez-Martín; Judit Vall-Castello |
| Abstract: | In this paper we explore the effects of a labor market reform that changed the statutory minimum working age in Spain in 1980. In particular, the reform raised the statutory minimum working age from 14 to 16 years old, while the minimum age for attaining compulsory education was kept at 14 until 1990. To study the effects of this change, we exploit the different incentives faced by individuals born at various times of the year before and after the reform. We show that, for individuals born at the beginning of the year, the probabilities of finishing both the compulsory and the post-compulsory education level increased after the reform. In addition, we find that the reform decreases mortality while young (16-25) for both genders while it increases mortality for middle age women (26-40). We provide evidence to proof that the latter increase is partly explained by the deterioration of the health habits of affected women. Together, these results help explain the closing age gap in life expectancy between women and men in Spain. |
| Date: | 2015–05 |
| URL: | http://d.repec.org/n?u=RePEc:bge:wpaper:834&r=hea |
| By: | Riise, Julie (Department of Economics, University of Bergen); Hole, Arne Risa (Department of Economics, University of Sheffield); Gyrd-Hansen, Dorte (COHERE, University of Southern Denmark); Skåtun, Diane (Health Economics Research Unit, University of Aberdeen) |
| Abstract: | We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors’ experience, while. In general there is a lot of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs two conflicting agency roles and what we know about the incentive structures and cultures in the different countries. |
| Keywords: | Prioritization; discrete choice Experiments; prescription behavior; GPs |
| JEL: | D82 I11 |
| Date: | 2015–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:bergec:2015_002&r=hea |
| By: | Gutierrez, Italo A. (RAND); Michaud, Pierre-Carl (University of Québec at Montréal) |
| Abstract: | We estimate the effects of employer downsizing on older workers' health outcomes using different approaches to control for endogeneity and sample selection. With the exception of the instrumental variables approach, which provides large imprecise estimates, our results suggest that employer downsizing increases the probability that older workers rate their health as fair or poor; increases the risk of showing symptoms of clinical depression; and increases the risk of being diagnosed with stroke, arthritis, and psychiatric or emotional problems. We find weaker evidence that downsizing increases the risk of showing high levels of C-reactive protein (CRP), a measure of general inflammation. We find that downsizing affects health by increasing job insecurity and stress, but that its effects remain statistically significant after controlling for these pathways, suggesting that other mechanisms such as diminished morale and general demotivation also affect worker health. Our findings suggest that employers ought to consider actions to offset the detrimental health effects of reducing personnel on their remaining (older) workers. |
| Keywords: | older workers, employer downsizing, health outcomes |
| JEL: | I12 M51 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9140&r=hea |
| By: | Kantarevic, Jasmin (Ontario Medical Assocation); Kralj, Boris (Ontario Medical Assocation) |
| Abstract: | We develop a stylized principal-agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behavior. These features include: (1) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contract and a blended capitation contract; (2) the capitation rate is higher and the cost-reimbursement rate is lower in the blended capitation contract; (3) physicians sort selectively into the contracts based on their preferences; and (4) physicians in the blended capitation model provide fewer services than physicians in the enhanced fee-for-service model. |
| Keywords: | physician remuneration, moral hazard, adverse selection, Ontario |
| JEL: | I10 I12 I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9142&r=hea |
| By: | Geldsetzer, Pascal (Harvard School of Public Health); Bloom, David E. (Harvard University); Humair, Salal (Harvard School of Public Health); Bärnighausen, Till (Harvard School of Public Health) |
| Abstract: | HIV continues to cause the largest number of disability-adjusted life years of any disease in HIV hyperendemic countries (i.e., countries with an adult HIV prevalence >15%). We compare the benefits and costs of two proven biological interventions to reduce the health losses due to the HIV epidemic in hyperendemic countries from 2015 through 2030: 1) increasing ART coverage to 90% among HIV-infected adults with a CD4-cell count <350 cells/microliter, before expanding the HIV treatment scale-up to people with higher CD4-cell counts; and 2) increasing male medical circumcision coverage to at least 90% among HIV-uninfected adult men. We developed a mathematical model to determine the benefits and costs of increasing the coverage of both ART under different CD4-cell count thresholds and of circumcision in HIV-hyperendemic countries. The results show that scaling up ART and circumcision are both cost-beneficial. However, the benefit-to-cost ratio (BCR) for circumcision is significantly higher than for ART: 7.4 vs. 3.0 (at US$1,000 per life year and a 5% discount rate) and 56.4 vs. 16.3 (at US$5,000 per life year and a 3% discount rate). The additional cost of scaling up circumcision is approximately $US500 million while the additional cost of increasing ART coverage lies between $US17 and $US19 billion. We conclude that increasing the coverage of ART among HIV-infected adults with a CD4-cell count <350 cells/microliter and, in particular, scaling up male medical circumcision among HIV-negative men are both highly cost-beneficial interventions to reduce the health burdens resulting from the HIV epidemic in hyperendemic countries over the next 15 years. |
| Keywords: | HIV, male medical circumcision, antiretroviral therapy, cost-benefit analysis |
| JEL: | D61 I18 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9143&r=hea |
| By: | Hansen, Benjamin (University of Oregon); Sabia, Joseph J. (San Diego State University); Rees, Daniel I. (University of Colorado Denver) |
| 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. |
| Keywords: | cigarette tax, tobacco control, youth smoking |
| JEL: | I18 H71 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9144&r=hea |