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on Health Economics |
| By: | Rihab Bedoui (IHEC Sousse - IHEC); Islem Kedidi (LAREMFIQ - Laboratory Research for Economy, Management and Quantitative Finance - Institut des Hautes Etudes Commerciales (Université de Sousse)) |
| Abstract: | Longevity Risk becomes an important challenge in the recent Year because of the decreases in the mortality rates and the rising in the life expectancy through the decades. In this article, we propose a consistent multi-factor dynamics affine mortality model to the longevity risk model-ing, we show that this model is an appropriate model to fit the historical mortality rates.To our Knowledge this is the first work that uses a consistent Mortality models to model USA Longevity risk.Indeed the multiple risk factors permitting applications not only to the hedge and price of the longevity risk but also in mortality derivatives and the general problems in the risk management .A state space presentation is used to estimate the model parameters through the kalman filter .To capture the effect of the size of the population sample we include a measurement error variance for each age. We evaluate 2-and 3-factor implementation of the model through the use of the USA mortality data, we employ Bootstrapping method to derive parameter estimated and the Consistent models prove the performance and the stability of the model. We show that the 3-factor independent model is the best model that can provide a better fit to our survivals curves and especially for the elderly persons |
| Keywords: | consistent,multi-factor,Mortality model,Longevity Risk,Affine,Kalman filter |
| Date: | 2018–01–08 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-01678050&r=hea |
| By: | Chenyuan Liu; Justin R. Sydnor |
| Abstract: | Recent studies have found that many people select into health plans with higher coverage (e.g., lower deductibles) even when those plans are financially dominated by other options. We explore whether having dominated options is common by analyzing data on plan designs from the Kaiser Family Foundation Employer Health Benefits Survey for firms that offered employees both a high-deductible (HD) health plan and a lower-deductible (LD) option. In 65% of firms the high-deductible option would result in lower maximum possible health spending for the employee for the year. We estimate that the HD plan financially dominates the LD plan at roughly half of firms across a wide range of possible health spending needs employees might anticipate. The expected savings from selecting the HD plan are typically over $500 per year, often with no increase in financial risk. We present evidence that these patterns may arise naturally from employers passing through large average-cost differences between HD and LD plans to their employees. We discuss the implications of those dynamics for the nature of transfers between employees and the efficiency of health spending. |
| JEL: | D22 G22 I13 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24392&r=hea |
| By: | Shanel Lu (EmergenceAI); Sharon L. Burton (SLBurtonConsulting) |
| Abstract: | This study investigated the need to provide a formal artificial intelligence (AI) health care education model to the 21th century AI health care learners. Health care has continuously transformed at all levels of health care administrative, operational, and practical. This vastly changing health care industry requires a synthesis of communicating multifaceted and diverse forms of thinking. AI health care professional entities within business, technology, art, biomedical, and other health care related sectors must work cross-functionally to establish roles that will meet the need toward improving health care at all levels. In order to achieve this pursuit, we researched and investigated how to create an AI health care education model fostering collaboration and innovation. There has been a significant calling for AI heath care collaboration of academicians, clinical scientist, and health care practitioners of all levels to identify a comprehensive AI health care education model due to the current void in the health care course design. To further this empirical study, the researchers focused on a qualitative study comprising of qualitative interviews and surveys inviting participants from the AI health care, business, biomedical, clinical scientist, academia, and capital investors to expound on the level of significance each professional sector have toward AI Health care education. |
| Keywords: | Health Care technology solutions, Health care Technology solutions education, Incubator Clinical Hours, Emergence AI Curriculum Design Mode |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:smo:npaper:005&r=hea |
| By: | David Gunawan (University of New South Wales); William Griffths (Department of Economics, The University of Melbourne); Duangkamon Chotikapanich (Monash University) |
| Keywords: | Dominance probabilities; ordinal data; inequality indices. |
| JEL: | C11 I14 I31 |
| Date: | 2017–06 |
| URL: | http://d.repec.org/n?u=RePEc:mlb:wpaper:2031&r=hea |
| By: | Leora Friedberg; Wenliang Hou; Wei Sun; Anthony Webb (Schwartz Center for Economic Policy Analysis (SCEPA)) |
| Abstract: | About a quarter of people with long-term care insurance let their policies lapse before they die. This study shows that policyholders who enter nursing homes are more likely to let their insurance lapse due to cognitive impairment. For these individuals, long-term care insurance is worse than useless. They not only lose their premiums, but also spend down their wealth too rapidly, erroneously believing that their insurance policy will cover long-term care costs at older ages. |
| Keywords: | long-term care insurance, insurance lapsing, insurance companies |
| JEL: | G22 D14 |
| Date: | 2017–06 |
| URL: | http://d.repec.org/n?u=RePEc:epa:cepawp:2017-13&r=hea |
| By: | Heckley, Gawain (Department of Clinical Sciences, Lund University, Sweden); Fischer , Martin (University of Duisburg-Essen, Essen, Germany); Gerdtham, Ulf-G. (Department of Economics, Lund University); Karlsson , Martin (University of Duisburg-Essen, Essen, Germany); Kjellsson, Gustav (Department of Economics, University of Gothenburg, Sweden); Nilsson, Therese (Department of Economics, Lund University) |
| Abstract: | There is a well-documented large positive correlation between education and health and yet it remains unclear as to whether this is a causal relationship. Potential reasons for this lack of clarity include estimation using different methods, analysis of different populations and school reforms that are different in design. In this paper we assess whether the type of school reform, the instrument and therefore subgroup identified and the modelling strategy impact the estimated health returns to education. To this end we use both Regression Discontinuity and Difference in Differences applied to two Swedish school reforms that are different in design but were implemented across overlapping cohorts born between 1938 and 1954 and follow them up until 2013. We find small and insignificant impacts on overall mortality and its common causes and the results are robust to regression method, identification strategy and type of school reform. Extending the analysis to hospitalisations or self-reported health and health behaviours, we find no clear evidence of health improvements due to increased education. Based on the results we find no support for a positive causal effect of education on health. |
| Keywords: | Health returns to education; demand for medical care |
| JEL: | I12 I18 |
| Date: | 2018–03–29 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2018_008&r=hea |
| By: | Marianna Battaglia (Dpto. Fundamentos del Análisis Económico); Nina Pallarés (Dpto. Fundamentos del Análisis Económico) |
| Abstract: | Our study aims at estimating the e¿ects of the exposure to an unusual family planning program on child mortality and child health. The PNSRPF, carried out in Peru during the period 1996-2000, promoted for the ¿rst time in the country voluntary surgical contraception. Yet, many indigenous women from rural areas were sterilized using coercion. We use DHS self-reported information on sterilization among indigenous women, if and when it took place —corroborated by other o¿cial data at the aggregate level— to identify which provinces were exposed to the program and at which point in time. By exploiting the geographical and time variation in its implementation, we can compare provinces a¿ected by the program before (treated) with provinces a¿ected later (control), before and after the policy. Results suggest that children in treated provinces are less likely to die within their ¿rst year of life and are breast-fed for longer compared to children in control provinces. Women in treated areas are also more likely to use temporary contraceptive methods. Nonetheless, we observe di¿erential impacts by ethnic groups in treated provinces: while non-indigenous children bene¿t from the policy regardless of the contraceptive method adopted by their mothers, almost all its positive impacts are washed away for indigenous children whose mothers got sterilized. |
| Keywords: | family planning, child health, ethnic minority |
| JEL: | J13 J15 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:ivi:wpasad:2018-03&r=hea |
| By: | Basar, Dilek; Soytas, Mehmet A. |
| Abstract: | This paper explains the gender differences in self-assessed health status by providing a theoretical identification mechanism through a dynamic structural model which allows for heterogeneity in discount factors of individuals. Theoretical predictions are empirically tested and estimation results support the structural model implications. The authors conclude that accounting for heterogeneity in individual discount factors explains a significant portion of the gender gap in self-assessed health status. |
| Keywords: | gender,self-assessed health status,discount factor heterogeneity,dynamic structural model,ordinal generalized linear model estimation |
| JEL: | I10 I12 I14 J16 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:ifwedp:201825&r=hea |
| By: | Haruya Ishizuka; Tsukasa Ishigaki; Naoya Kobayashi; Daisuke Kudo; Atsuhiro Nakagawa |
| Abstract: | In intensive care units (ICUs), mortality prediction using vital sign or demographics of patients yields helpful information to support the decision-making of intensivists. Clinical texts recorded by medical staff tend to be valuable for prediction. However, text data are not applicable to outcome prediction of the regression framework in a direct way. In addition, learning of prediction models of such outcomes is a class of imbalanced data problem because the number of survivors is greater than the number of dead patients in most ICUs. To address these difficulties, we present Cost-Sensitive MedLDA: a supervised topic model employing cost-sensitive learning. The model realizes a prediction model from heterogeneous data such as vital signs, demographic information, and clinical text in an imbalanced class problem. Through experimentation and discussion, we demonstrate that the model has two benefits for use in medical fields: 1) our model has high prediction performance for minority instances while maintaining good performance for majority instances even if the training set is imbalanced data; 2) our model can reveal some characteristics that are associated with bad outcomes from the use of clinical texts. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:toh:dssraa:79&r=hea |
| By: | Vikas Ramachandra |
| Abstract: | In this paper, we propose the use of causal inference techniques for survival function estimation and prediction for subgroups of the data, upto individual units. Tree ensemble methods, specifically random forests were modified for this purpose. A real world healthcare dataset was used with about 1800 patients with breast cancer, which has multiple patient covariates as well as disease free survival days (DFS) and a death event binary indicator (y). We use the type of cancer curative intervention as the treatment variable (T=0 or 1, binary treatment case in our example). The algorithm is a 2 step approach. In step 1, we estimate heterogeneous treatment effects using a causalTree with the DFS as the dependent variable. Next, in step 2, for each selected leaf of the causalTree with distinctly different average treatment effect (with respect to survival), we fit a survival forest to all the patients in that leaf, one forest each for treatment T=0 as well as T=1 to get estimated patient level survival curves for each treatment (more generally, any model can be used at this step). Then, we subtract the patient level survival curves to get the differential survival curve for a given patient, to compare the survival function as a result of the 2 treatments. The path to a selected leaf also gives us the combination of patient features and their values which are causally important for the treatment effect difference at the leaf. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:1803.08218&r=hea |
| By: | Marius Huguet (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Lionel Perrier (Centre Léon Bérard [Lyon], GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Olivia Bally (Centre Léon Bérard [Lyon]); David Benayoun (Department of Radiation Oncology, Centre Hospitalier Universitaire Lyon Sud, Pierre Benite, France - HCL - Hospices Civils de Lyon); Pierre De Saint Hilaire (Hopital universitaire de Lyon - Hôpital Universitaire de Lyon); Dominique Beal Ardisson (Hôpital privé Jean Mermoz); Magali Morelle (GATE Lyon Saint-Étienne - Groupe d'analyse et de théorie économique - ENS Lyon - École normale supérieure - Lyon - UL2 - Université Lumière - Lyon 2 - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet [Saint-Étienne] - Université de Lyon - CNRS - Centre National de la Recherche Scientifique); Nathalie Havet (ISFA - Institut des Science Financière et d'Assurances - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - Université de Lyon); Xavier Joutard (LEST - Laboratoire d'économie et de sociologie du travail - AMU - Aix Marseille Université - CNRS - Centre National de la Recherche Scientifique); Pierre Méeus (Service d'Oncologie Chirurgicale - Centre Léon Bérard [Lyon]); Philippe Gabelle (UGA UFRM - Université Grenoble Alpes - UFR Médecine - UGA - Université Grenoble Alpes); Jocelyne Provencal; Céline Chauleur (GRT (EA 3065) - Groupe de recherche sur la thrombose - UJM - Université Jean Monnet [Saint-Étienne]); Olivier Glehen (EA3738 - Ciblage thérapeutique en Oncologie - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon); Amandine Charreton; Fadila Farsi (Réseau Espace Santé Cancer, Rhône-Alpes); Isabelle Ray-Coquard (Service d'Oncologie Médicale - Centre Léon Bérard [Lyon]) |
| Abstract: | Background: To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France. |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-01670155&r=hea |
| By: | Zarko Kalamov; Marco Runkel |
| Abstract: | This paper shows that if an individual’s health costs are U-shaped in weight with a minimum at some healthy weight level and if the individual has both self control problems and rational motives for over- or underweight, the optimal paternalistic tax on unhealthy food mitigates the individual’s weight problem (intensive margin), but does not induce the individual to choose healthy weight (extensive margin). Implementing healthy weight requires a further distortion (e.g. subsidy on other goods), which may render the tax on unhealthy food inferior to the option of not taxing the individual at all. In addition, with heterogeneous individuals the optimal uniform paternalistic tax may have the negative side effect of rendering otherwise healthy individuals underweight. |
| Keywords: | sin tax, paternalism, obesity, extensive versus intensive margin |
| JEL: | D03 D11 H21 I18 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_6911&r=hea |
| By: | Fox, Jonathan; Grigoriadis, Theocharis |
| Abstract: | This project re-investigates the hookworm eradication efforts of the Rockefeller Foundation's Sanitary Commission (RSC) in the American South during the Progressive Era. The RSC worked to eradicate hookworm across 11 southern states between 1911 and 1915, efforts that have been linked to dramatic short- and long-term increases in human capital and labor productivity. Although useful from an identification standpoint, these single-shot interventions, in the absence of cooperative efforts to improve underlying conditions, have a mixed record of long-term effectiveness across public health research. The efficacy of deworming campaigns in particular has come under extensive scrutiny. The experience of the American South had stood as example of how a single-shot hookworm eradication program has improved outcomes; however, the robustness of this result has also recently come into question. A replication of the Bleakley (2007) seminal work investigating hookworm eradication finds faults with the robustness and interpretations of the results (Roodman 2017), and an investigation into the activities of the RSC has determined them unevenly distributed across hookworm-affected areas (Elman et. al 2013). Perhaps not coincidentally, the RSC's hookworm eradication program was not the only public health intervention that occurred in the rural South during the Progressive Era. Rural public health centers spread throughout the American South during this period, partially backed by the Rockefeller Foundation. Given the use of difference-in-difference methods using decennial census data, and the participation of the Rockefeller Foundation in the funding of these rural health centers, this is a potentially critical omission in the evaluation of the RSC efforts. In this project, we investigate the connection between these rural health centers and the Rockefeller Foundation's hookworm eradication efforts, consider whether their presence explains effects attributed thereto, and examine their importance as a follow-up program to the initial hookworm intervention. |
| Keywords: | Rockefeller Sanitary Commission,hookworm eradication,Deworming,EconomicDevelopment,County Health Organizations,human capital,Progressive Era |
| JEL: | I15 I18 N32 O15 O51 P51 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:fubsbe:20185&r=hea |
| By: | Adriana Castelli (Centre for Health Economics, University of York, York, UK); Martin Chalkley (Centre for Health Economics, University of York, York, UK); Idaira Rodriguez Santana (Centre for Health Economics, University of York, York, UK) |
| Abstract: | This report updates the Centre for Health Economics’ time series of National Health Service (NHS) productivity growth for the period 2014/15 to 2015/16. It also reports trends in output, input and productivity since 2004/05. NHS productivity growth is measured by comparing growth in the outputs produced by the NHS to growth in the inputs used to produce them. NHS outputs include all the activities undertaken for NHS patients wherever they are treated in England and accounts for changes in the quality of care provided to those patients. NHS inputs include the number of doctors, nurses and support staff providing care, the equipment and clinical supplies used, and the facilities of hospitals and other premises where care is provided. |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:chy:respap:152cherp&r=hea |
| By: | William B.P. Robson (C.D. Howe Institute) |
| Abstract: | Preliminary figures show faster growth in the amounts governments are budgeting for healthcare over the past three years, according to a new report from the C.D. Howe Institute. In “Healthcare Costs in Canada: Stopping Bad News Getting Worse,” author William B.P. Robson warns that the preliminary figures likely understate the acceleration, since later figures typically reveal that provinces and territories have overshot their budget targets. |
| Keywords: | Health Care Spending |
| JEL: | I10 H51 |
| URL: | http://d.repec.org/n?u=RePEc:cdh:ebrief:275&r=hea |
| By: | Mbiti, Isaac M. (University of Virginia); Serra, Danila (Southern Methodist University) |
| Abstract: | We use a lab-in-the-field experiment to examine the effectiveness of accountability systems that rely on patient reporting in Kenyan health clinics. We recruit patients and health care providers from public and private health clinics to play a series of modified Trust Games. In the game, patients can send money to providers, who are then able to reciprocate. Patients can then file complaints if they are unhappy with the provider's level of reciprocity. We examine patient and provider behavior in a system where complaints lead to non-monetary consequences in the form of disclosing the complaints to professional peers, a system where complaints lead to monetary penalties, and a system where there are no direct consequences on providers, such as standard complaint boxes (our "control"). We focus on provider reciprocity and patient reporting (or complaining) as our primary behavioral measures in the game. Combining the experimental variation in provider consequences with non-experimental variation in provider and client characteristics such as sector of work, and the existence of personal relationships between clients and providers, we find that: 1) disclosing patients' complaints to providers' professional peers increases providers' pro-social behavior toward patients as much as imposing monetary penalties based on patients' complaints; 2) when complaints lead to tangible consequences (either monetary or non-monetary) for providers, patients are less willing to file such complaints, mainly due to the existence of personal relationships with providers. Overall, our findings support the implementation of citizen reporting systems that leverage peer pressure and reputational concerns. |
| Keywords: | health services, bottom-up accountability, patient reporting, peer shaming |
| JEL: | C90 I15 M59 |
| Date: | 2018–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11352&r=hea |
| By: | Janke, Katharina (Lancaster University); Johnston, David W. (Monash University); Propper, Carol (Imperial College London); Shields, Michael A. (Monash University) |
| Abstract: | Studies using education policy reforms to isolate causal effects of education on health produce mixed evidence. We analyse an unusually large sample and study chronic health conditions. For identification, we use two major education reforms, one that raised the minimum school leaving age and one that affected the broader educational attainment distribution. This method generated precise estimates of the impact of education on a comprehensive range of health conditions. Our results indicate that extra education, at the lowest end or higher up the attainment distribution, has little impact on the prevalence of chronic illness. The one interesting exception is diabetes. |
| Keywords: | education reform, health conditions, causality |
| JEL: | I14 I24 |
| Date: | 2018–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11353&r=hea |
| By: | Ketel, Nadine (University of Gothenburg); Leuven, Edwin (University of Oslo); Oosterbeek, Hessel (University of Amsterdam); van der Klaauw, Bas (Vrije Universiteit Amsterdam) |
| Abstract: | We exploit admission lotteries to estimate the payoffs to the dentistry study in the Netherlands. Using data from up to 22 years after the lottery, we find that in most years after graduation dentists earn around 50,000 Euros more than they would earn in their next-best profession. The payoff is larger for men than for women but does not vary with high school GPA. The large payoffs cannot be attributed to longer working hours, larger human capital investments or sacrifices in family outcomes. The natural explanation is that Dutch dentists extract a monopoly rent, which we attribute to the limited supply of dentists in the Netherlands. We discuss policies to curtail this rent. |
| Keywords: | dentists, returns to education, monopoly rents, random assignment |
| JEL: | J44 I18 I23 C36 |
| Date: | 2018–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11351&r=hea |
| By: | He, Qichun |
| Abstract: | This study explores a novel channel---endogenous health investment---through which monetary policy impacts growth and welfare. We use a scale-invariant Schumpeterian growth model with a cash-in-advance (CIA) constraint on R&D investment. We find that the effect of an increase in the nominal interest rate on long-run growth crucially depends on the form of the CIA constraint. When the CIA constraint does not apply to medical expenditure, long-run growth does not depend on the nominal interest rate. The result remains robust when health capital does not need medical expenditure to produce (i.e., health capital only needs leisure to produce). By contrast, when the CIA constraint applies to medical expenditure, an increase in the nominal interest rate leads to a decrease in R&D and health investment, which in turn reduces the long-run growth rates of technology and output. Nevertheless, welfare is always a decreasing function of the nominal interest rate, and the welfare loss is larger under the CIA constraint on medical expenditure. The results hold up with the health-in-the-utility function (HIU). |
| Keywords: | Monetary policy; innovation; health; economic growth; welfare |
| JEL: | E41 I15 O30 O40 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:85218&r=hea |
| By: | Raymond Caraher (Hampshire College); Michael Ash (Department of Economics and School of Public Policy, University of Massachusetts, Amherst) |
| Abstract: | We replicate Ashraf and Galor (2013) and find that its conclusions concerning the association between human genetic diversity and economic development depend substantially on coding errors and sample selection. We correct the coding errors and add or update data on genetic diversity and population density from high-quality sources. We find little support for the hypothesis that variation in genetic diversity among subpopulations has a systematic relationship with economic development. |
| Keywords: | genetics, development |
| JEL: | N10 N30 N50 O10 O50 Z10 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ums:papers:2018-05&r=hea |
| By: | Thomas Aronsson; Sören Blomquist |
| Abstract: | In this paper, we consider how the hours of work and retirement age ought to respond to a change in the uncertainty of the length of life. In a first best framework, where a benevolent government exercises perfect control over the individuals’ labor supply and retirement-decisions, the results show that a decrease in the standard deviation of life-length leads to an increase in the optimal retirement age and a decrease in the hours of work per period spent working. This result is robust, and is also derived in models of decentralized decision-making where individuals decide on their own consumption, labor supply, and retirement age, and where the government attempts to affect their behavior and welfare through redistribution and pension policy. |
| Keywords: | uncertain lifetime, retirement age, work hours, pension policy |
| JEL: | D61 D80 H21 H55 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_6940&r=hea |
| By: | Bardey, David; Martimort, David; Pouyet, Jérôme |
| Abstract: | This paper examines the evolution of drug use in Colombia over the past years. Our analysis, based on surveys from the Dirección Nacional de Estupefacientes, shows that drug consumption grew substantially between 1996 and 2013. The growth occurred for both genders, all ages, socioeconomic strata and types of occupation. The results also suggest that men of high socioeconomic strata who regularly consume alcohol and cigarettes and who are between 18 and 24 years of age are more likely to use drugs. Finally, the paper presents some indirect evidence that contradicts the alleged effects of the judgment of the Constitutional Court (Sentencia C-221 of May 1994) that decriminalized the personal dose on the consumption of drugs in Colombia. |
| Keywords: | Drugs; decriminalization |
| JEL: | D12 I18 |
| Date: | 2016–11–01 |
| URL: | http://d.repec.org/n?u=RePEc:ebg:heccah:1184&r=hea |
| By: | Sherri Rose; Thomas G. McGuire |
| Abstract: | While risk adjustment is pervasive in the health care system, relatively little attention has been devoted to studying the fairness of these formulas for individuals who may be harmed by them. In practice, risk adjustment algorithms are often built with respect to statistical fit, as measured by p-values or R2 statistics. The main goal of a health plan payment risk adjustment system is to convey incentives to health plans such that they provide health care services efficiently, a component of which is not to discriminate in access or care for persons or groups likely to be expensive. In an attempt to accomplish this, risk adjustment formulas include indicators for the presence of health conditions associated with higher costs. The salient issue is that incentives mainly operate at a group level, not an individual level; plans can discriminate at the group level in ways they cannot at the person level. Because health plans providing sparse care for certain illnesses is a key policy concern, group-level fit is arguably one of the most important metrics for formula evaluation. Giving primacy on the basis of individual fit when group fit may be the larger concern can lead to harmful decision making. We therefore discuss the role of p-values and statistical fit for this policy problem while considering the fairness of the risk adjustment algorithm for vulnerable groups. Enrollees with mental health and substance use disorders have been found to be subject to the adverse incentives noted above. We apply our ideas to this vulnerable group with a group-level net compensation metric of the incentives to health plans to underprovide services. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:1803.05513&r=hea |
| By: | Miguel Portela; Paul Schweinzer |
| Abstract: | We document the relationship of a set of individual choices - including parenthood, marital state, and income - with an individual’s cause of death. Using the data set of the Office for National Statistics Longitudinal Study (ONS-LS) which follows one percent of the population of England and Wales along five census waves 1971, 1981, 1991, 2001, and 2011, our competing risks analysis yields several striking results. 1) Females have only a 28% chance to die of cancer when they have children (compared to childless females); 2) males have a 71% increased chance of dying from cancer when they are married (compared to unmarried males); 3) females with children have only a 34% risk to die of heart disease and 4) a 53% chance of dying from infections (compared to females without children); 5) married men have an increased expectation of 23% to die of heart disease (compared to unmarried men); 6) high income and house ownership always is associated with higher survival but less so than having children. |
| Keywords: | children, mortality. longevity |
| JEL: | I10 J10 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_6935&r=hea |
| By: | Bütikofer, Aline (Dept. of Economics, Norwegian School of Economics and Business Administration); Riise, Julie (University of Bergen); Skira, Meghan (University of Georgia) |
| Abstract: | We examine the impact of the introduction of paid maternity leave in Norway in 1977 on maternal health. Before the policy reform, mothers were eligible for 12 weeks of unpaid leave. Mothers giving birth after July 1, 1977 were entitled to 4 months of paid leave and 12 months of unpaid leave. We combine Norwegian administrative data with survey data on the health of women around age 40 and estimate the mediumand long-term impacts of the reform using regression discontinuity and difference-inregression discontinuity designs. Our results suggest paid maternity leave benefits are protective of maternal health. The reform improved a range of maternal Health outcomes, including BMI, blood pressure, pain, and mental health, and it increased health-promoting behaviors, such as exercise and not smoking. The effects were larger for first-time and low-resource mothers and women who would have taken little unpaid leave in the absence of the reform. We also study the maternal health effects of subsequent expansions in paid maternity leave and find evidence of diminishing returns to leave length. |
| Keywords: | Maternity leave; Maternity health; |
| JEL: | I12 I18 J13 J18 |
| Date: | 2018–03–05 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:nhheco:2018_004&r=hea |