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on Health Economics |
| By: | Niimi, Yoko |
| Abstract: | This paper examines the impact of providing informal care to elderly parents on caregivers' subjective well-being using unique data from the "Preference Parameters Study" of Osaka University, a nationally representative survey conducted in Japan. The estimation results indicate heterogeneous effects: while informal elderly care does not have a significant impact on the happiness level of married caregivers regardless of whether they take care of their own parents or parents-in law and whether or not they reside with them, it has a negative and significant impact on the happiness level of unmarried caregivers who take care of their parents outside their home. These findings shed light on the important role that formal care services could play in reducing the burden on caregivers, particularly unmarried caregivers who presumably receive less support from family members. |
| Keywords: | Aging, Caregiving, ElderlyCare, Happiness, InformalCare, Japan, Long-term Care Insurance, ParentalCare, Subjective Well-being |
| JEL: | D10 I18 I31 J14 |
| Date: | 2015–11 |
| URL: | http://d.repec.org/n?u=RePEc:agi:wpaper:00000082&r=hea |
| By: | Pilar García Gómez; Sergi Jiménez-Martín; Judit Vall-Castello |
| Abstract: | In a world with limited PAYGO financing possibilities this paper explores whether older Spanish individuals have the health capacity to work longer. For that purpose we use Milligan-Wise and Cutler-Meara Cutler-Meara-Richards-Shubik simulation methods. Our results suggest that Spanish workers have significant additional capacities to extend their working careers. |
| Keywords: | work capacity, Retirement, Health |
| JEL: | J11 J26 I12 I18 |
| Date: | 2016–02 |
| URL: | http://d.repec.org/n?u=RePEc:bge:wpaper:876&r=hea |
| By: | Amanda Glassman and Juan Ignacio Zoloa |
| Abstract: | As Latin American countries seek to expand the coverage and benefits provided by their health systems under a global drive for universal health coverage (UHC), decisions taken today – whether by government or individuals – will have an impact tomorrow on public spending requirements. To understand the implications of these decisions and define needed policy reforms, this paper calculates long-term projections for public spending on health in three countries, analyzing different scenarios related to population, risk factors, labor market participation, and technological growth. In addition, the paper simulates the effects of different policy options and their potential knock-on effects on health expenditure. Without reforms aimed at expanding policies and programs to prevent disease and enhancing the efficiency of health systems, we find that health spending will likely grow considerably in the not-distant future. These projected increases in health spending may not be a critical situation if revenues and productivity of other areas of the economy maintain their historical trends. However, if revenues do not continue to grow, keeping the share of GDP spent on health constant despite growing demand will certainly affect the quality of and access to health services. Long-term fiscal projections are an essential component of planning for sustainable expansions of health coverage in Latin America. |
| Keywords: | health financing, Latin America, fiscal projections, fiscal policy, health policy |
| JEL: | O23 I15 I18 |
| Date: | 2014–10 |
| URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:382&r=hea |
| By: | Willa Friedman |
| Abstract: | This paper looks at the impact of corruption on the effectiveness of antiretroviral drugs in preventing AIDS deaths and the potential channels that generate this relationship. This is based on a unique panel dataset of countries in sub-Saharan Africa, which combines information on all imported antiretroviral drugs (ARVs) from the World Health Organization's Global Price Reporting Mechanism with measures of corruption and estimates of the HIV prevalence and the number of AIDS deaths in each year and in each country. Countries with higher levels of corruption experience a significantly smaller drop in AIDS deaths as a result of the same quantity of ARVs imported. This is robust to different measures of corruption and to a measure of overall death rates as well as HIV-specific death rates as the outcome. A case-study analysis of the Kenyan experience illustrates one potential mechanism for the observed effect, demonstrating that disproportionately more clinics begin distributing ARVs in areas that are predominantly represented by the new leader's ethnic group. |
| Keywords: | HIV/AIDS, antiretroviral drugs, corruption |
| JEL: | I15 D73 |
| Date: | 2015–02 |
| URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:395&r=hea |
| By: | Adriana Camacho and Daniel Mejia |
| Abstract: | This paper exploits the variation in aerial spraying across time and space in Colombia and employs a panel of individual health records in order to study the causal effects of aerial spraying of herbicides (Glyphosate) on short term health-related outcomes. The results show that exposure to the herbicide used in aerial spraying campaigns increases the number of medical consultations related to dermatological and respiratory related illnesses and the number of miscarriages. This finding is robust to the inclusion of individual fixed effects, which compares the prevalence of these medical conditions for the same person under different levels of exposure to the herbicide used in the aerial spraying program over a period of 5 years. Also, the results are robust to controlling for the extent of coca cultivation of illicit crops in the municipality of residence. |
| Keywords: | Aerial spraying, Eradication policies, health, Plan Colombia, Glyphosate. |
| JEL: | I15 H75 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:408&r=hea |
| By: | Giuseppe Moscelli (Centre for Health Economics, University of York, UK); Luigi Siciliani (Department of Economics and Related Studies, University of York, UK); Nils Gutacker (Centre for Health Economics, University of York, UK); Richard Cookson (Centre for Health Economics, University of York, UK) |
| Abstract: | Equity of access is a key policy objective in publicly-funded healthcare systems. Using data on patients undergoing non-emergency heart revascularization procedures in the English National Health Service, we find evidence of significant differences in waiting times within public hospitals between patients with different socioeconomic status (up to 35% difference between the most and least deprived population quintiles). We employ selection models to test whether such differences are explained by patients exercising choice over hospital or type of treatment. Selection bias due to choice has a limited effect on the gradient suggesting the presence of substantial inequities within the public system. |
| Keywords: | waiting times, inequalities, socioeconomic status, selection bias, choice. |
| JEL: | I14 I11 I18 C34 |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:112cherp&r=hea |
| By: | Pierre-Carl Michaud; Eileen Crimmins; Michael Hurd |
| Abstract: | The effect of job loss on health may play an important role in the development of the SES-health gradient. In this paper, we estimate the effect of job loss on objective measures of physiological dysregulation using longitudinal data from the Health and Retirement Study and biomarker measures collected in 2006 and 2008. We use a variety of econometric methods to account for selection and reverse causality. Distinguishing between layoffs and business closures, we find no evidence that business closures lead to worse health outcomes. We also find no evidence that biomarker health measures predict subsequent job loss becaue of business closures. We do find evidence that layoffs lead to diminished health. Although this finding appears to be robust to confounders, we find that reverse causality tends to bias downward our estimates. Matching estimates, which account for self-reported health conditions prior to the layoff and subjective job loss expectations, suggest even stronger estimates of the effect of layoffs on health as measured from biomarkers, in particular for glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP). Overall, we estimate that a layoff could increase annual mortality rates by 9.4%, which is consistent with other evidence of the effect of mass layoffs on mortality. |
| Keywords: | Job loss, Health, SES-health gradient, Biomarkers, |
| JEL: | I14 J10 J14 |
| Date: | 2015–02–05 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2015s-05&r=hea |
| By: | Francesconi, Marco; James, Jonathan |
| Abstract: | We estimate the effect of binge drinking on accident and emergency attendances, road accidents, arrests, and the number of police officers on duty using a variety of unique data from Britain and a two-sample minimum distance estimation procedure. Our estimates, which reveal sizeable effects of bingeing on all outcomes, are then used to monetize the short-term externalities of binge drinking. We find that these externalities are on average £4.9 billion per year ($7 billion), about £80 for each man, woman, and child living in the UK. The price that internalizes this externality is equivalent to an additional 9p per alcoholic unit, implying a 20% increase with respect to the current average price. |
| Keywords: | Alcohol; Arrests; Externalities; Health; Road accidents |
| JEL: | I12 I18 K42 |
| Date: | 2015–02 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:10412&r=hea |
| By: | Adrian Sayers; Yoav Ben-Shlomo; Ashley W. Blom; Fiona Steele |
| Abstract: | Studies involving the use of probabilistic record linkage are becoming increasingly common. However, the methods underpinning probabilistic record linkage are not widely taught or understood, and therefore these studies can appear to be a ‘black box’ research tool. In this article, we aim to describe the process of probabilistic record linkage through a simple exemplar. We first introduce the concept of deterministic linkage and contrast this with probabilistic linkage. We illustrate each step of the process using a simple exemplar and describe the data structure required to perform a probabilistic linkage. We describe the process of calculating and interpreting matched weights and how to convert matched weights into posterior probabilities of a match using Bayes theorem. We conclude this article with a brief discussion of some of the computational demands of record linkage, how you might assess the quality of your linkage algorithm, and how epidemiologists can maximize the value of their record-linked research using robust record linkage methods. |
| Keywords: | Record linkage; epidemiological methods; medical record linkage; bias; data linkage |
| JEL: | C1 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:64894&r=hea |
| By: | Noémi Kreif; Richard Grieve; Dominik Hangartner; Alex James Turner; Silviya Nikolova; Matt Sutton |
| Abstract: | This paper examines the synthetic control method in contrast to commonly used difference-in-differences (DiD) estimation, in the context of a re-evaluation of a pay-for-performance (P4P) initiative, the Advancing Quality scheme. The synthetic control method aims to estimate treatment effects by constructing a weighted combination of control units, which represents what the treated group would have experienced in the absence of receiving the treatment. While DiD estimation assumes that the effects of unobserved confounders are constant over time, the synthetic control method allows for these effects to change over time, by re-weighting the control group so that it has similar pre-intervention characteristics to the treated group. We extend the synthetic control approach to a setting of evaluation of a health policy where there are multiple treated units. We re-analyse a recent study evaluating the effects of a hospital P4P scheme on risk-adjusted hospital mortality. In contrast to the original DiD analysis, the synthetic control method reports that, for the incentivised conditions, the P4P scheme did not significantly reduce mortality and that there is a statistically significant increase in mortality for non-incentivised conditions. This result was robust to alternative specifications of the synthetic control method |
| Keywords: | synthetic control method; difference-in-differences; policy evaluation; pay-for-performance |
| JEL: | N0 |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:65074&r=hea |
| By: | Hartwig, R.; Sparrow, R.A.; Budiyati, S.; Yumna, A.; Warda, N.; Suryahadi, A.; Bedi, A.S. |
| Abstract: | We exploit variation in the design of sub-national health care financing initiatives in Indonesian districts to assess the effects of these local schemes on maternal care from 2004 to 2010. The analysis is based on a district pseudo-panel, combining data from a unique survey among District Health Offices with the Indonesian Demographic and Health Surveys, the national socioeconomic household surveys, and the village census. Our results show that these district schemes contribute to an increase in antenatal care visits and the probability of receiving basic recommended antenatal care services, and a decrease in home births, especially for households that fall outside the target group of the national health insurance programs. The variation in scheme design is a source of impact heterogeneity. Including antenatal and delivery services explicitly in benefit packages and contracting local rather than national health care providers increases the positive effects on maternal care. |
| Keywords: | health care financing, decentralization, maternal health care, Indonesia |
| JEL: | I13 I18 |
| Date: | 2015–03–30 |
| URL: | http://d.repec.org/n?u=RePEc:ems:euriss:77964&r=hea |
| By: | Panda, P.; Chakraborty, A.; Raza, W.A.; Bedi, A.S. |
| Abstract: | Low renewal rate is a key challenge facing the sustainability of Community-based Health Insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This paper uses longitudinal data to analyse what determines renewal, both one and two years after the introduction of three CBHI schemes, which have been operating in rural Bihar and Uttar Pradesh since 2011. We find that initial scheme uptake is about 23-24 % and that two years after scheme operation, only about 20 % of the initial enrolees maintain their membership. A household’s socio-economic status does not seem to play a large role in impeding renewal. In some instances, a greater understanding of the scheme boosts renewal. The link between health status and use of health care in maintaining renewal is mixed. The clearest effect is that individuals living in households that have received benefits from the scheme are substantially more likely to renew their contracts. We find that having access to a national health insurance scheme is not a substitute for the CBHI. We conclude that the low retention rates may be attributed to limited benefit packages, slow claims processing times and the gaps between the amounts claimed and amounts paid out by insurance. |
| Keywords: | community-based health insurance, renewing membership, rural India |
| Date: | 2015–04–30 |
| URL: | http://d.repec.org/n?u=RePEc:ems:euriss:77965&r=hea |
| By: | Batty, Michael M. (Board of Governors of the Federal Reserve System (U.S.)); Ippolito, Benedic N. (American Enterprise Institute) |
| Abstract: | It is often assumed that financial incentives of healthcare providers affect the care they deliver, but this issue is surprisingly difficult to study. The recent enactment of state laws that limit how much hospitals can charge uninsured patients provide a unique opportunity. Using an event study framework and panel data from the Nationwide Inpatient Sample, we examine whether these regulations lead to reductions in the amount and quality of care given to uninsured patients. We find that the introduction of a fair pricing law leads to a seven to nine percent reduction in the average length of hospital stay for uninsured patients, with no corresponding change for insured patients. These care reductions are not accompanied by worsening quality of inpatient care. Overall, our results provide strong evidence that hospitals actively alter their behavior in response to financial incentives, and are consistent with the laws promoting a shift towards more efficient care delivery. The findings also add to the growing evidence that hospitals can, and do, treat patients differently based upon insurance status. |
| Keywords: | Health care; insurance; public economics |
| Date: | 2015–12–01 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedgfe:2015-107&r=hea |
| By: | Bergman , Mats A. (Department of Economics, Södertörn University); Granlund, David (Department of Economics, Umeå University); Rudholm, Niklas (Department of Economics) |
| Abstract: | We study the effect of the degree of exclusivity for the lowest bidder on the average price of generic pharmaceuticals in the short and long terms. Our results indicate that a 1-percentage-point gain in market share of the lowest bidder reduces average costs by 0.3% in the short term and 0.8% in the long term, but also reduces the number of firms by 1%. We find that reducing the number of firms has a strong positive (and hence counteracting) effect on average prices, i.e., a 1% reduction raises prices by approximately 1%. |
| Keywords: | Pharmaceutical industry; generic competition; generic drugs; brand-name drugs |
| JEL: | D80 D83 I11 L65 |
| Date: | 2016–02–02 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:umnees:0921&r=hea |
| By: | Muhammad Nasir (Department of Economics, Clark University); Marc Rockmore (Department of Economics, Clark University); Chih Ming Tan (Department of Economics, Clark University) |
| Abstract: | Exposure to violence has been found to affect behavioral parameters, mental health and social interactions. The literature focuses on large scale political violence. The effects of high levels of criminal violence – a common phenomenon in Latin America and the Caribbean – are largely unknown. We examine drug violence in Mexico and, in particular, the effects of exposure to high municipal levels of homicides on risk aversion, mental health and pro-social behavior. Using a nonlinear difference-in-differences (DID) model and data from the 2005-06 and 2009-12 waves of the Mexican Family Life Survey, we find that the surge in violence in Mexico after 2006 significantly increased risk aversion and reduced trust in civic institutions while simultaneously strengthening kinship relationships. Although the deterioration of mental health due to violence exposure has been hypothesized to explain changes in risk aversion, we find no such effect. This suggests that the literature may be potentially missing out on other relevant channels. |
| Keywords: | violence, risk aversion, social capital, trust, mental health, depression, nonlinear difference-in-differences, Mexico |
| JEL: | A12 D03 D81 O12 |
| Date: | 2016–01 |
| URL: | http://d.repec.org/n?u=RePEc:hic:wpaper:207&r=hea |
| By: | Muhammad Nasir (Department of Economics, Clark University) |
| Abstract: | An emerging literature finds that early life exposure to conflict has important effects on subsequent physical and cognitive development. While this literature focuses on large-scale violent events and low intensity conflicts, there is a lack of studies examining high levels of criminal violence. This discrepancy is important as many areas in the world, particularly Central and South America, experience consistently high levels of organized crimes. This study examines whether these health effects also extend to criminal violence setting by focusing on the sharp increase in homicide rates in Mexico since 2007-08. Using sibling fixed effects, I study whether the levels and timing of municipality homicide rates affect children's physical health and cognitive and non-cognitive development in Mexico. The results show a strong effect of in utero exposure (depending on the trimester) on the physical health and cognitive development and no effect on socio-emotional behavior and chronic illnesses. Specifically, an average increase in the homicide rate between the pre-escalation period of 2005-06 and 2009 while in utero reduces both height-for-age Z-scores (HAZ) and cognition (measured by Raven’s scores) by 0.08 standard deviation (SD). The results further provide suggestive evidence about maternal stress and prenatal care use as potential channels. |
| Keywords: | Early life shocks, Human capital formation, Violence, Mexico, Children |
| JEL: | J24 J13 D79 I20 O15 |
| Date: | 2016–01 |
| URL: | http://d.repec.org/n?u=RePEc:hic:wpaper:208&r=hea |
| By: | Diether Beuermann; Rafael Anta; Patricia J. García; Alessandro Maffioli; Jose Perez Lu; Maria Fernanda Rodrigo |
| Abstract: | We evaluate the effectiveness of sending text messages to pregnant women containing appointment reminders and suggestions for healthy behaviors during pregnancy. Receiving messages had an overall positive effect of 5 percent on the number of prenatal care visits attended. Moreover, for women who live close to their assigned health center and who have higher educational attainment, the intervention positively affected vitamin intake compliance, APGAR scores, and birth weight. Evidence suggests that reminders are more effective among those who are more able to understand the future benefits of preventive care (more educated) and who face lower transaction costs of going to prenatal care checkups (located near health centers). No evidence of geographical spillover effects was found. |
| Keywords: | e-Health, Human health, Health Care, RCT, Peru, e-Health, experimental design, prenatal controls, health center, WAWARED, Pregnancy, electronic medical records |
| Date: | 2015–05 |
| URL: | http://d.repec.org/n?u=RePEc:idb:brikps:89296&r=hea |
| By: | Sahay, Arvind; Jaikumar, Saravana |
| Abstract: | In this paper, we empirically examine whether price regulation of generic essential drugs in India results in social welfare (in terms of increase in sales volume post regulation). In 2013, the Indian government enacted the Drug Price Control (DPCO) which regulated the prices of essential medicines. Using historical monthly sales volume data, we identify the best fitting SARIMA (seasonal auto regressive integrated moving average) model for each of the 105 oral solid molecules included in DPCO 2013. Using these models and following the event study approach we statistically compare the baseline against the actual volume during event window. We find that while DPCO resulted in an increase in sales volume for few molecules, overall the regulation has resulted in a reduction in sales volume. On further analysis, we find that increasing the detailing efforts for molecules with high percentage sales in urban and semi-urban cities may likely result in positive DPCO impact. Our findings have significant policy and marketing implications. |
| URL: | http://d.repec.org/n?u=RePEc:iim:iimawp:14241&r=hea |
| By: | Stella Lartey (Policy Analyst, Ministry of Health, Ghana); Rasheda Khanam (Faculty of Business, Education, Law & Arts, University of Southern Queensland); Shingo Takahashi (Professor, International University of Japan) |
| Abstract: | This paper pools four waves of data from Demographic and Health Surveys (from 1993 to2008) to examine the impact of household wealth status on child survival in Ghana. The Weibull hazard model with gamma frailty was used to estimate the general wealth effect, as well as the trend of wealth effect on child fs survival probability. We find that household wealth status has a negative and significant effect on the hazard rate. Thus a child is more likely to survive when he/she is from a household with high wealth status. Even though wealth effect declined over the years, the risk of death for children from the poorest households was about 1.7 times higher than those from the richest households. Among other factors, birth spacing and parental education are found to be highly significant to increase a child fs survival probability. |
| Keywords: | Child survival, wealth, Weibull hazard model, Gamma frailty, Ghana |
| Date: | 2016–01 |
| URL: | http://d.repec.org/n?u=RePEc:iuj:wpaper:ems_2016_01&r=hea |
| By: | Cuellar, Alison Evans (George Mason University); Dave, Dhaval M. (Bentley University) |
| Abstract: | This study assesses whether mental health interventions can improve academic outcomes for justice-involved youth. Only a limited number of studies have linked justice policies to outcomes beyond crime, particularly education, which carries large monetary and non-monetary benefits. The current study relies on detailed administrative data and unique policy rules under which youth are assigned to behavioral treatment programs. The administrative data allow for a rich set of controls for observed family- and youth-specific heterogeneity. In addition, the treatment assignment rules create discontinuous thresholds among youth who are deemed eligible or not eligible for treatment, rules which the study exploits empirically to address the non-random selection bias in estimating plausibly causal effects of treatment eligibility and treatment receipt. Estimates indicate that certain types of intensive mental health intervention can lower dropout and increase high-school completion for justice-involved youth. Effects on grades are negative or not significant, possibly due to the greater retention of less academically-skilled students. We also assess heterogeneity in the treatment effects, and find that the effects on dropout tend to be greater among youth believed to be less academically engaged prior to treatment. The positive effects on education, and the earnings returns alone, are large enough to produce benefits in excess of the cost for the more intensive of the mental health interventions. |
| Keywords: | mental health, treatment, juvenile justice, crime, education, high school, grades, GED, dropout |
| JEL: | I1 I21 H75 K42 |
| Date: | 2016–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9711&r=hea |
| By: | Robalino, Juan David (Cornell University) |
| Abstract: | In this paper I analyze adolescent peer effects on cigarette consumption while considering the 'popularity' of peers. The analysis is based on AddHealth data, a four wave panel survey representative of American high-school students. The data include the social network of each school, which we use to measure peers' popularity from network centrality measures, in particular weighted-eigenvector centrality. We use lagged peers' behavior at the grade level to alleviate potential homophilic confounds, and we include school fixed effects to control for contextual confounds. We find that most of the aggregate peer effects regarding cigarette smoking come from the smoking propensity of the 20% most popular kids, suggesting a mediation from social status. This effect persists seven and thirteen years later (wave 3 and 4 of the data). Indeed, the smoking propensity of the bottom 80% seems to have a negative influence on the probability of smoking in the long run (wave 3 and 4). These results hint to the importance of knowing not only the smoking propensity within a school but also the place of the smokers within the social hierarchy of the school. |
| Keywords: | peer effects, status |
| JEL: | I1 |
| Date: | 2016–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp9714&r=hea |
| By: | Diana Weinhold |
| Abstract: | Urban residential neighbour noise is ubiquitous but its effects are relatively under-researched. Neighbour noise is difficult to measure and is often locally controlled under nuisance, rather than environmental health, regulations. We analyze the health effects of residential noise annoyance using a high quality longitudinal survey of over 5000 adults in the Netherlands between 2007 and 2013. We find surprisingly widespread health effects of residential noise annoyance, with neighbour noise relatively more damaging than street noise. To address endogeneity concerns with cross sectional analysis we then exploit the time dimension of the panel and employ conditional fixed effect logistic estimation to control for unobservable time-invariant characteristics of individuals, conditioning only on initially healthy respondents to mitigate concerns of reverse-causality. We continue to find surprisingly strong and robust effects of neighbour noise annoyance on a variety of health outcomes including cardio-vascular symptoms, joint and bone disease, and headache |
| Date: | 2015–10 |
| URL: | http://d.repec.org/n?u=RePEc:lsg:lsgwps:wp213&r=hea |
| By: | Yuanyuan Deng (Stony Brook University); Hugo Benítez-Silva (Stony Brook University) |
| Abstract: | The changes to the Social Security Old Age benefits system introduced in the last decade, which will continue later this decade, have impacted individuals' labor supply and retirement decisions, and therefore their health insurance coverage. This paper provides an empirical analysis of the effects of the changes in the OA system, resulting from the 1983 Amendments, on Medicare costs. Using data from the Medicare Current Beneficiary Survey (MCBS), we empirically analyze the Medicare expenditures of individuals around retirement age as a function of their health insurance coverage and labor market attachment. Our results show a significant effect of employment measures as well as insurance coverage types, suggesting a sizable effect of employment and insurance on Medicare expenditures as well as on total health expenditures and on out-of-pocket health expenditures. Our findings allow us to compute the total savings to the Medicare system resulting from individuals' working while receiving health insurance coverage at older ages, and we estimate savings of 2.89 billion dollars a year, as well as another 333.67 million per year resulting from the delayed in enrollment into the Medicare system, given that some individuals do not enrolled in Medicare when first available, and this is more common among those who work and have insurance coverage. These results suggest that any future reform to the social insurance system will have to account for the effect on Medicare costs of policies that likely lead to increases in employment and employer provided health insurance coverage among populations eligible for Medicare. |
| Date: | 2015–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp330&r=hea |
| By: | Josselin Thuilliez (Centre d'Economie de la Sorbonne - Paris School of Economics) |
| Abstract: | This study uses aggregate panel data on 96 French départements from 1982 to 2012 to investigate the relationship between macroeconomic conditions, gender and mortality. I use previously employed panel data methods, based on mortality variation across French départements and years. The novelty is to analyze the effect of gender-specific unemployment on gender-specific mortality. Within this “area-gender approach”, I give a particular attention to gender-cause-specific mortality such as prostate cancer, maternal mortality, female breast cancer, cervical cancer and ovarian cancer in addition to other cause-specific mortality. The analysis is undertaken for several age-groups, several time windows and different geographical aggregates of unemployment. The results reveal that the relationship between unemployment and mortality in France is weak and confirm recent conclusions from U.S. state-level analysis by Rhum [Ruhm, C.J., 2015. Recessions, Healthy no more?. Journal of Health Economics 42, 17-28] |
| Keywords: | Health; Mortality; Recessions; Gender; Macroeconomic conditions |
| JEL: | E32 I12 J2 |
| Date: | 2016–01 |
| URL: | http://d.repec.org/n?u=RePEc:mse:cesdoc:16008&r=hea |
| By: | Boachie, Micheal Kofi; Ramu, K. |
| Abstract: | Health is an important component of human capital yielding economic returns to its investors. It also improves people’s welfare. Investment in health, therefore, is an important source of productivity, growth and quality of life. In this study, we examined the impact of public health spending on health status, i.e., infant mortality, in Ghana. The study employed standard OLS and Newey-west estimation to examine the impact of public health spending on health status (i.e. infant mortality rate) for the period 1990 – 2012. After controlling for real per capita income, literacy level, and female participation in the labour market, we find evidence that the declining or falling infant mortality rate in Ghana has been influenced by public health spending among other factors. Thus, public healthcare expenditure is associated with improvement in health status through reduction in infant mortality. The implications for policy are discussed. |
| Keywords: | healthcare expenditure, infant mortality, health status, Ghana |
| JEL: | H51 I10 I18 |
| Date: | 2015–07–10 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:66371&r=hea |
| By: | Deluna, Roperto; maneja, Kimbely |
| Abstract: | This study identified the effectiveness of Sin Tax and Anti-smoking media campaign in regulating cigarette smokers in Davao City. Descriptive statistics were used to present the socio demographic, awareness of anti-smoking media campaign and perception and attitude of a smoker. Logit regression analysis was used to know the responsiveness of the smokers to Sin Tax. Result revealed that current cigarette smokers are mostly male, age group of 10-24, employed, single, smaller family size, urban and smokers having 8 to 11 years in school. Based on perception of the respondents, anti-smoking media campaign did not affect the smoking behavior of the respondents. However highest fraction of cigarette smokers are aware and reduced their cigarette consumption because of anti-smoking ordinance. The result from Logit Regression Analysis revealed that occupational status, location and number of years in schooling are significant and having positive effects on their cigarette consumption in response to Sin Tax. While gender, age, marital status, family size, change in income, price of cigarette and price of rice are insignificant variables. |
| Keywords: | Sin Tax, Cigarette Regulations, Anti-Smoking Campaign, Smokers Behavior |
| JEL: | C54 D12 I18 |
| Date: | 2015–04–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:68801&r=hea |
| By: | Stacey, Brian |
| Abstract: | Efforts to accurately predict health outcomes with a focus on informing policy makers of where to best spend limited resources have been made in the past. This paper builds on the efforts of those studies in an attempt to build an accurate predictor of health from readily available data. The American Time Use Survey (2010, 2012, and 2013) provides the majority of the data from which this model is built, and it is then tested via several methods. The analysis finds that the existing freely available data is significant in its predictive power, however is missing too many predictors to reduce the confidence interval about each individual prediction to a point of bearing meaningful fruit. That does not eliminate the usefulness of the study however, as by reducing the confidence required and accepting that the data is used for predicting societal means, the model is able to accurately predict average outcomes. This paper further attempts to analyze state level date to provide a geographic target for public funds expenditures, and accomplishes this through the analysis of various risk factors by region. Notable in this analysis is an attempt to correct for self-reporting errors. The literature review did not reveal any previous attempts to do so using a similar methodology (beyond recognizing that such errors exist and using robust methods to account for them), making this attempt possibly unique. The correction did not result in significantly different estimates, however that may be a result of the minimal resources applied to this small aspect of the analysis. |
| Keywords: | Health Outcomes, Health Econometrics, Health Prediction, Self-reporting Bias Correction |
| JEL: | C89 I14 I18 |
| Date: | 2015–11–25 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:68915&r=hea |
| By: | Sharma, Utsav |
| Abstract: | New Zealand has undergone a period of previously unprecedented change to the community pharmacy sector. A new funding model was implemented in 2012 with the goal of rewarding pharmacists for patient contact and clinical input, rather than solely for the number of medicines dispensed. The change has been immensely challenging for pharmacy, as they have coped with funding and service model changes. The new funding model saw the introduction of the Long Term Conditions (LTC) pharmacy service. The LTC service is designed for people with complex health and medicines management needs and medicine adherence issues. Patients in the LTC service receive more frequent dispensing, along with adherence reminders and increased pharmacist support. The pharmacy receives a monthly fee for this additional work, and is required to complete ongoing and time consuming paperwork. There is a lack of awareness about the actual cost to pharmacy of providing the LTC service as there is an absence of any studies that have attempted to define the resources needed to deliver the service and the activities that drive these costs. The aim of this report is to define the actual cost to pharmacy of delivering the LTC service through the lens of Activity Based Management (ABM), and define cost drivers using a time driven activity based costing system (TDABC). Research Method: Primary data was collected through a semi-structured survey and 18 responses were elicited from participating pharmacies. TDABC was employed to estimate the cost of providing the LTC service. Findings: Results indicate that the monthly payment of $20.80 per LTC patient registered is insufficient to cover ongoing costs. In addition to ongoing monthly costs, pharmacies incur one-off costs to initiate a new patient into the LTC service. One off costs show a positive relationship with ongoing costs and wide variation is observed for costs between pharmacies. The major cost driver was identified as pharmacist time. Recommendations: Future studies should examine the processual variations in pharmacies with low-cost and high cost profiles with the aim of providing pharmacists with more efficient options for delivering the service. Greater utilisation of software through automation of patient eligibility and administrative tasks could help free up pharmacist time. |
| Keywords: | Cost accounting, Activity based management, Time-driven activity based costing, |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:vuw:vuwmba:4960&r=hea |
| By: | Augurzky,Boris; Bauer,Thomas K.; Reichert,Arndt Rudiger; Schmidt,Christoph M.; Tauchmann,Harald |
| Abstract: | This paper examines the sustainability of weight loss achieved through cash rewards and, for the first time, the potential of monetary incentives to prevent weight cycling. In a three period randomized controlled trial, about 700 obese persons were assigned to two treatment groups, which were promised different cash rewards contingent on the achievement of an individually assigned target weight, and to a control group. Successful participants were subsequently allocated to two treatment groups offered different monetary incentives for maintaining the previously achieved target weight and to a control group. This is the first experiment of this kind that finds sustainable effects of weight loss rewards on the body weight of the obese even 18 months after the rewards were removed. Additional incentives to maintain an achieved body weight improve the sustainability of weight loss only while are in place. |
| Keywords: | Science Education,Disease Control&Prevention,Health Monitoring&Evaluation,Engineering,Scientific Research&Science Parks |
| Date: | 2015–06–26 |
| URL: | http://d.repec.org/n?u=RePEc:wbk:wbrwps:7339&r=hea |