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on Health Economics |
| By: | Joan Costa-Font; César Jiménez-Martínez; Cristina Vilaplana |
| Abstract: | The expansion of long-term care (LTC) coverage may improve health system efficiency by reducing hospitalisations (bed-blocking), and pave the way for the implementation of health and social care coordination plans. We draw upon the quasi-experimental evidence from the main expansion of long term care increase subsidisation in Spain in 2007 to examine the causal effect of the expansion of LTC subsidisation and coordination on hospitalisations (both on the internal and external margin) and the hospital length of stay. In addition, we examine the 2012 austerity budget cuts that reduced the subsidy. We find robust evidence of a reduction in hospitalisations and the length of stay after the expansion of LTC subsidisation. However, the reduction in hospitalisations is heterogeneous to the existence of health and social care coordination plans and type of subsidy. Overall, we estimate savings related to hospitalisations of up to 11% of total hospital costs. Consistently, subsidy reduction is found to attenuate bed-blocking gains. |
| Keywords: | hospitalisation; long-term care reform; Spain; bed-blocking; hurdle Poisson model |
| JEL: | H53 I18 J14 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:67911&r=hea |
| By: | Björkman Nyqvist, Martina; Corno, Lucia; de Walque, Damien; Svensson, Jakob |
| Abstract: | The need for effective HIV prevention programs, especially in Sub-Saharan Africa, remains urgent. We investigate the effect of a financial lottery program in Lesotho with relatively low expected payments but a chance to win a high prize conditional on negative test results for sexually transmitted infections. The intervention resulted in a 21.4% reduction in HIV incidence over two years. Lottery incentives appear to be particularly effective in targeting individuals with ex ante risky sexual behavior, consistent with the hypothesis that lotteries are more valued by individuals willing to take risks. |
| Keywords: | Financial incentives; HIV prevention; lotteries |
| JEL: | I12 I15 O15 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:11542&r=hea |
| By: | Jean-Claude Berthelemy (FERDI - Fondation pour les Etudes et Recherches sur le Développement International - FERDI, CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique); Jean Gaudart (SESSTIM - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - ORS PACA - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale); Josselin Thuilliez (CES - Centre d'économie de la Sorbonne - UP1 - Université Panthéon-Sorbonne - CNRS - Centre National de la Recherche Scientifique) |
| Abstract: | We present a simple theoretical model of household preventive behavior in response to malaria prevalence. The novelty is to include a trade-off between prevention and treatment in an otherwise standard epidemiological model of disease transmission, which depends on the relative price of treatment with respect to prevention. A relatively low price of treatment reduces prevention. |
| Keywords: | Economic epidemiology,Malaria,Treatment,Prevention,Price |
| Date: | 2015–06 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-01157279&r=hea |
| By: | Gaviria Garcés, Carlos Felipe; De la Mata, Dolores |
| Abstract: | Abstract: Nearly 8 percent of the young adults in Colombia are “aged out" from their parents' health insurance coverage when they turn 18 years old, making them the group with the lowest health insurance coverage among all age groups. In this study we exploit a regulation in Colombia that exogenously changes health insurance coverage of young adult dependents to analyze the effects on their usage of medical services and health status. We assess this effect using a regression discontinuity design (RDD) and data from the Encuesta Nacional de Calidad de Vida Survey for Colombia from 2010 to 2013. Losing health insurance coverage implies a change in usage within the pool of different medical services, led by a change in their relative prices. As a result, some medical services are prone to be less used (i.e. preventive services), while other medical services are more consumed (i.e. private medical services and emergency department [ED] visits). Additionally, since under Colombian regulation, ED care cannot be denied to anyone if their life is at risk, regardless of health insurance status, uninsured young adults tend to use this service more instead of regular medical services (such as preventive healthcare or visits to physicians or specialists). We find, consistent with the change in relative prices, that losing health insurance when turning 18 years old increases visits to the ED, reduces preventive care visits with a physician, and increases the usage of private medical services (outof-pocket) for this age group. These results imply a substitution of cheaper medical services for more expensive ones when individuals turn 18 years old in Colombia. |
| Keywords: | Health Insurance, Young Adults, Healthcare Usage, Emergency Department Visits, Colombia's Healthcare System, Regression Discontinuity, Developing Country. |
| JEL: | G22 I13 I18 |
| Date: | 2016–09–27 |
| URL: | http://d.repec.org/n?u=RePEc:col:000504:015113&r=hea |
| By: | Joan Costa-Font; Sergi Jiménez-Martín; Cristina Vilaplana Prieto |
| Abstract: | We still know little about what motivates the informal care arrangements provided in old age. The introduction of demand-side subsidies such as unconditional caregiving allowances (cash benefits designed either to incentivize the provision of informal care, or compensate for the loss of employment of informal caregivers) provide us with an opportunity to gain a further understanding of the matter. In this paper we exploit a quasi-natural experiment to identify the effects of the inception in 2007 (and its reduction in 2012) of a universal caregiving allowance on both the supply of informal care, and subsequent intergenerational transfer flows. We find evidence of a 30% rise in informal caregiving after the subsidy, and an increase (reduction) in downstream (upstream) intergenerational transfers of 29% (and 15%). Estimates were heterogeneous by income and wealth quantiles. Consistently, the effects were attenuated by a subsequent policy intervention; the reduction of the subsidy amidst austerity cuts in 2012. |
| Keywords: | caregiving, Intergenerational Transfers, difference-in-differences, long-term care, family transfers, exchange motivation, caregiving allowances, demand-side subsidies |
| JEL: | I18 D14 G22 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:bge:wpaper:929&r=hea |
| By: | Chicoine, Luke E. (DePaul University); Guzman, Juan Carlos (University of Notre Dame) |
| Abstract: | This paper examines an alternative to monitoring staff at a public health clinic in rural Uganda. The program sent SMS updates regarding confirmed attendance of clinic staff and activities to randomly selected cell phone-owning households in the local community. A difference-in-difference approach is used to evaluate the impact of the SMS program, and finds the messages led to an increase in clinic attendance, the receipt of medicine, and reduced duration of illness for young children aged six and under. However, these benefits are only seen for children who are the same sex as the cell phone owner, suggesting favoritism towards the health of these children. These benefits are found to be similar for both boys and girls. |
| Keywords: | mobile technology, parental favoritism, children's healthcare, Uganda |
| JEL: | I15 J13 O22 |
| Date: | 2016–09 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp10228&r=hea |
| By: | Díaz Serrano, Lluís; Sackey, Frank G. |
| Abstract: | Africa’s quest to achieving improved health status and meeting the Millennium Development Goals targets cannot be effectively achieved without examining the quality of leadership, transitions and regimes and how they impact on the decisions and the policy effectiveness that bring about improved health and living standards of the citizenry. In this paper, we study the importance of regime transitions on government’s expenditure in health and on infant mortality, as a development indicator. A unique panel dataset comprising 44 sub-Saharan African countries spanning from 1970 t0 2010 containing information on political regime and leaders was used for the study. To account for the relevance of leader characteristics in regime transitions in our study we control for leader fixed-effects. The overall results are suggestive of a democratic advantage in the process of achieving effective health policy outcomes for promoting health, and hence the wellbeing of the citizens in contemporary sub-Saharan Africa in the long run. Keywords: Africa, health policy, public health, private health, child mortality, democracy, autocracy, political leaders. JEL Codes: I15, H51, O55 |
| Keywords: | Àfrica -- Política sanitària, 338 - Situació econòmica. Política econòmica. Gestió, control i planificació de l'economia. Producció. Serveis. Turisme. Preus, |
| Date: | 2016 |
| URL: | http://d.repec.org/n?u=RePEc:urv:wpaper:2072/267086&r=hea |
| By: | Amanda Lechner; Michael Cavanaugh; Crystal Blyler |
| Abstract: | Mathematica conducted an environmental scan of practices and programs for addressing trauma and related behavioral health needs in AI/AN youth. This report highlights examples of trauma-informed interventions intended to improve behavioral health for Native youth, as well as recommendations from the literature for improving the evidence base. |
| Keywords: | Native American, American Indian, Alaska Native, Trauma |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:ed815a4a1c7946609f2fe6ededb8c747&r=hea |
| By: | Jorge M. Agüero (University of Connecticut) |
| Abstract: | Non-experimental studies evaluate the robustness of their treatment effects by exploring the sensitivity of their estimates to the inclusion of additional variables. However, recent papers have shown that such heuristic approaches are insufficient. Instead, partial identification methods have been proposed to bound non-experimental estimates. I use proportional selection relationships to estimate the relative size of the unobservables needed to eliminate the estimated effects. I apply this method to test the effects that violence against women has on the health outcomes of their children, a research area that lacks credible identification strategies. Also, to expand the external validity of my analysis, I use data from five standardized nationally representative household surveys in Latin America. Consistent with previous studies, OLS estimates show large negative associations between violence against women and an array of child health outcomes. However, when accounting for omitted variable bias, at best, two-thirds of the estimates remain robust and they are concentrated on the outcomes with the largest cross-sectional estimated impacts. |
| Keywords: | Partial identification, domestic violence, children’s health, Latin America |
| JEL: | I10 I12 J16 |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:uct:uconnp:2016-23&r=hea |
| By: | Jorge M. Agüero (University of Connecticut); Trinidad Beleche (RAND Corporation) |
| Abstract: | Worldwide, the leading causes of death could be avoided with health behaviors that are low-cost but also difficult to adopt. We show that exogenous health shocks could facilitate the adoption of these behaviors and provide long-lasting effects on health outcomes. Specifically, we exploit the spatial and temporal variation of the 2009 H1N1 influenza outbreak in Mexico and show that areas with a higher incidence of H1N1 experienced larger reductions in diarrhea-related cases. These reductions continue even three years after the shock ended. Changes in hand washing behaviors are behind these health improvements. Several robustness checks validate our findings and mechanism. |
| Keywords: | health shocks; health behaviors; hand washing; children; diarrhea |
| JEL: | I12 I15 |
| Date: | 2016–10 |
| URL: | http://d.repec.org/n?u=RePEc:uct:uconnp:2016-26&r=hea |
| By: | Bastani, Hamsa (?); Goh, Joel (?); Bayati, Mohsen (Stanford University) |
| Abstract: | Recent Medicare legislation has been directed at improving patient care quality by stopping reimbursement of hospital-acquired conditions (HACs). However, this policy may be undermined if some providers respond by upcoding, a practice where HACs are reported as present-on-admission (POA) to continue receiving full reimbursement. Identifying upcoding behavior from claims data is challenging due to unobservable confounders. Our approach leverages state-level variations in adverse event reporting regulations and instrumental variable techniques to discover contradictions between HAC and POA reporting rates that are strongly suggestive of upcoding. We find over 11,000 upcoded infections a year, resulting in an added cost burden of $200 million. Our findings suggest that, contrary to widely-held beliefs, increasing financial penalties alone may not reduce HAC incidence and may even exacerbate the problem. We make several policy recommendations based on our results, including a new measure for targeted HAC auditing and suggestions for effective adverse event reporting systems. |
| Date: | 2015 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:stabus:3328&r=hea |
| By: | Bastani, Hamsa (Stanford University); Goh, Joel (Harvard University); Bayati, Mohsen (Stanford University) |
| Abstract: | Recent Medicare legislation has been directed at improving patient care quality by penalizing providers for hospital-acquired infections (HAIs). However, asymmetric information prevents Medicare from directly monitoring HAI rates. Thus, these policies assume that providers correctly distinguish HAIs from present-on-admission (POA) infections in claims data despite opposing financial incentives. In particular, these policies may be undermined if providers engage in upcoding, a practice where HAIs are mis-reported (possibly unintentionally) to increase reimbursement or avoid financial penalties. Identifying upcoding behavior from claims data is challenging due to unobservable confounders. Our approach leverages state-level variations in adverse event reporting regulations and instrumental variable techniques to discover contradictions between HAI and POA reporting rates that are strongly suggestive of upcoding. We estimate that there are over 10,000 upcoded infections a year, resulting in an added cost burden of $200 million. Our findings suggest that, contrary to widely-held beliefs, increasing financial penalties alone may not reduce HAI incidence and may even exacerbate the problem. We make several policy recommendations based on our results, including a new measure for targeted HAI auditing and suggestions for effective adverse event reporting systems. |
| Date: | 2015–07 |
| URL: | http://d.repec.org/n?u=RePEc:ecl:stabus:3396&r=hea |
| By: | Dang, Trang; Nguyen, Cuong |
| Abstract: | This paper examines whether interethnic marriage of parents is associated with educational performance of children in Vietnam using data from the 2009 Population and Housing Census. It finds that interethnic marriage of parents is associated with educational attainment of children in Vietnam. Children with parents from different ethnic groups tend to have better education and lower disability incidence than children with parents from one ethnic minority group. |
| Keywords: | Health, education, disability, children, interethnic marriage |
| JEL: | I1 I2 |
| Date: | 2015–09–01 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:74144&r=hea |