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on Health Economics |
| By: | Hannah-Kathrin Viergutz |
| Abstract: | Starting point: Hospitals are an essential element of every health care system and have priority in the healthcare industry. Healthcare buildings are highly complex infrastructural buildings and their future-oriented planning and long-term economy is extremely relevant for the sustainability of a hospital. These facilities are open 24/7, 365 days a year and used by numerous of patients, employees, visitors and suppliers. More than 1,1 million employees work in over 1.900 hospitals in order to guarantee high quality medical care all over Germany (cf. Statistisches Bundesamt, 2015).All hospitals have to deal with individual challenges regarding the building plot, structure of hospital buildings (comb structure, linear structure), the progression of medical technologies and patient wishes (cf. McKee, M. and Healy, J., 2002, p.45).Problem definition: The big challenges for hospitals in Germany are currently the demographic development of the population, the rural exodus and the progression of the medical technologies (cf. Klauber, 2015, p.2). This paper will explore the effects of varying changes in health care developments on the flexibility of hospital design and how much the future viability and existence of an hospital depends on its location and the inherent hospital functions as well as realised planning decisions in the past and its future perspective.State of research: The regional planning of healthcare buildings is of high interest for politics, people and the economy. According to my research, there are various scientific publications which deal with this topic in Germany as well as on an international level (e.g. McKee, M. and Healy, J. (2002): Hospitals in a changing Europe).Objective: Based on an analysis of different locations and building types of hospitals as well as their underlying basic conditions in Germany, the overall objective of this research is to evaluate the future potential and risk level for hospitals.What are the primary future challenges for hospital buildings? And in which way does hospital planning react those challenges?Methodology: Literature study, structural surveys of hospitals in Germany and interviews with the CEOs, project leaders and employees, architects and the local administrative unit are conducted in order to focus on weaknesses in hospital planning in the past to avoid in future-oriented planning. |
| Keywords: | Germany; Health Care; hospital buildings; sustainable planning |
| JEL: | R3 |
| Date: | 2017–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:eres2017_155&r=hea |
| By: | Elsner, Benjamin (University College Dublin); Wozny, Florian (IZA) |
| Abstract: | This paper studies the long-term effect of radiation on cognitive skills. We use regional variation in nuclear fallout caused by the Chernobyl disaster in 1986, which led to a permanent increase in radiation levels in most of Europe. To identify a causal effect, we exploit the fact that the degree of soil contamination depended on rainfall within a critical ten-day window after the disaster. Based on unique geo-coded survey data from Germany, we show that people who lived in highly-contaminated areas in 1986 perform significantly worse in standardized cognitive tests 25 years later. This effect is driven by the older cohorts in our sample (born before 1976), whereas we find no effect for people who were first exposed during early childhood. These results are consistent with radiation accelerating cognitive decline during older ages. Moreover, they suggest that radiation has negative effects even when people are first exposed as adults, and point to significant external costs of man-made sources of radiation. |
| Keywords: | environment, human capital, radioactivity, cognitive skills |
| JEL: | J24 Q53 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11408&r=hea |
| By: | Borgschulte, Mark (University of Illinois at Urbana-Champaign); Corredor-Waldron, Adriana (University of Illinois); Marshall, Guillermo (University of Illinois) |
| Abstract: | In this paper we investigate the dual role of supply restrictions and drug treatment in combating the concurrent rise of opioid abuse and suicide in the United States over the last two decades. We find that supply-side interventions decrease suicides in places with strong addiction-help networks, implying that prescription drug abuse is associated with an inherent risk of suicide. Our findings support an important role for access to treatment services in policies designed to combat the opioid epidemic. |
| Keywords: | prescription drugs, drug abuse, drug addiction treatment, PDMP, suicide |
| JEL: | I12 I18 D11 D12 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11391&r=hea |
| By: | Misty L. Heggeness; Donna K. Ginther; Maria I. Larenas; Frances D. Carter-Johnson |
| Abstract: | The Ruth L. Kirschstein National Research Service Award (NRSA) program is a major research training program administered by the National Institutes of Health (NIH) with funds appropriated each year by Congress. This study examines the impact of NRSA postdoctoral fellowships on subsequent research-related career outcomes using NIH administrative records on applicants who applied for a fellowship between 1996 and 2008. We find that postdoctoral fellowships increased the probability of receiving subsequent NIH research awards from 6.3 to 8.2 percentage points and of achieving an NIH-funded R01 award, an indication of an independent research career, from 4.6 to 6.1 percentage points. Our findings demonstrate that the NRSA postdoctoral fellowship awards have the potential to promote retention of scientists in NIH-funded research and in the biomedical workforce pipeline. |
| JEL: | J24 O3 O38 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24508&r=hea |
| By: | Sarah Hamersma; Johanna Catherine Maclean |
| Abstract: | This study provides the first evidence on the effects of U.S. state-level private and public insurance expansions on specialty substance use disorder (SUD) treatment use among children ages 12 to 18. We examine both private and public expansions over the period 1996 to 2010. Public insurance expansions are measured by changes in income thresholds for Medicaid and the State Children’s Health Insurance Program (SCHIP). Private expansions are generated by state laws that compel private insurers to cover SUD treatment services at ‘parity’ with general healthcare services. We apply differences-in-differences regression models and leverage an all-payer admissions dataset. Our findings suggest that expansions, both private and public, lead to increases in admissions to treatment and increased insurance coverage among children in treatment. After public expansions, we find that treated children are more likely to be younger and to have previous experience with treatment, but less likely to be referred by the criminal justice system. We find no evidence that public expansions crowd out adult admissions, and in fact both public and private expansions increase at least some types of admissions among adults. |
| JEL: | I1 I13 I18 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24499&r=hea |
| By: | Charles Courtemanche; James Marton; Benjamin Ukert; Aaron Yelowitz; Daniela Zapata |
| Abstract: | This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by income and age. |
| JEL: | I12 I13 I18 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24511&r=hea |
| By: | East, Chloe N. (University of Colorado Denver); Friedson, Andrew I. (University of Colorado Denver) |
| Abstract: | In this study, we document the effect of Food Stamp access on adult health care utilization. While Food Stamps is one of the largest safety net programs in the U.S. today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants' eligibility for Food Stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to Food Stamps reduced the likelihood of an adult visiting a physician more than twice in one year, but had no significant effect on the likelihood of having any physician visits. This result does not appear to be due to changes in physical or mental health, or due to individuals with common chronic health conditions, leaving open the possibility that changes in nutrition or resources may reduce the need for physician visits. Additionally, we find that for single women, Food Stamps increased the affordability of specialty health care, which may have further reduced the need for physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp program, as reductions in health care utilization due to Food Stamps may offset some of the program's impact on the overall government budget due to the existence of government-provided health insurance programs such as Medicaid. |
| Keywords: | Food Stamps, immigrants, health care |
| JEL: | H51 H53 H75 I11 I18 Q18 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11445&r=hea |
| By: | van den Berg, Gerard J. (University of Bristol); Siflinger, Bettina M. (Tilburg University) |
| Abstract: | This paper studies the effects of day care exposure on behavioral disorders and mental and physical health at various ages during childhood. We draw on a unique set of merged population register data from Sweden over the period 1999-2008. This includes merged information at the individual level from the inpatient and outpatient registers, the population register and the income tax register. The outpatient register contains all ambulatory care contacts including all contacts with physicians and therapists. Visits are recorded by day, and comprehensive diagnoses are recorded for each visit. By exploiting variation in day care exposure by age generated by a major day care policy reform, we estimate cumulative and instantaneous effects on child health at different ages. We find a positive cumulative impact on behavior at primary school ages, in particular for children from low socio-economic status households, and substitution of infections from primary school ages to low ages. All this affects health care utilization and leads to a moderate reduction in health care costs. Results are confirmed by analyses based on a sibling design and on regional and household-specific components of day care fees. |
| Keywords: | child care, pre-school, infections, non-cognitive ability, behavioral disorders, illness, education, health registers, day-care fees |
| JEL: | I12 J13 J14 C23 C25 C83 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11447&r=hea |
| By: | Courtemanche, Charles (Georgia State University); Friedson, Andrew I. (University of Colorado Denver); Rees, Daniel I. (University of Colorado Denver) |
| Abstract: | Expanding insurance coverage could, by insulating patients from having to pay full cost, encourage the utilization of arguably unnecessary medical services. It could also eliminate (or at least diminish) the need for emergency services through increasing access to preventive care. Using publicly available data from New York City for the period 2013-2016, we explore the effect of the Affordable Care Act (ACA) on the volume and composition of ambulance dispatches. Consistent with the argument that expanding insurance coverage encourages the utilization of unnecessary medical services, we find that, as compared to dispatches for more severe injuries, dispatches for minor injuries rose sharply after the implementation of the ACA. By contrast, dispatches for pre-labor pregnancy complications decreased as compared to dispatches for women in labor. |
| Keywords: | Affordable Care Act, ambulance, emergency medical service, health insurance, moral hazard |
| JEL: | I11 I13 I18 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11444&r=hea |
| By: | Mendolia, Silvia (University of Wollongong); McNamee, Paul (University of Aberdeen); Yerokhin, Oleg (University of Wollongong) |
| Abstract: | This paper investigates the relationship between partner's mental health and individual life satisfaction, using a sample of married and cohabitating couples from the Household, Income and Labour Dynamics of Australia Survey (HILDA). We use panel data models with fixed effects to estimate the life satisfaction impact of several different measures of partner's mental health and to calculate the Compensating Income Variation (CIV) of them. To the best of our knowledge, this is the first paper to study the effect of partner's mental health on individual's wellbeing and to measure the impact of reduced life satisfaction in monetary terms. We also provide some new insights into adaptation and coping mechanisms. Accounting for measurement error and endogeneity of income, partners' mental health has a significant and sizeable association with individual well-being. The additional income needed to compensate someone living with a partner with a long term mental condition is substantial (over USD 60,000). Further, individuals do not show significant adaptation to partners' poor mental health conditions, and coping mechanisms show little influence on life satisfaction. The results have implications for policy-makers wishing to value the wider effects of policies that aim to impact on mental health and overall levels of well-being. |
| Keywords: | partner's health, compensating income variation, fixed effects |
| JEL: | I10 I12 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11431&r=hea |
| By: | Savannah L. Bergquist; Timothy J. Layton; Thomas G. McGuire; Sherri Rose |
| Abstract: | The conventional method for developing health care plan payment systems uses existing data to study alternative algorithms with the purpose of creating incentives for an efficient and fair health care system. In this paper, we take a different approach and modify the input data rather than the algorithm, so that the data used for calibration reflect the desired levels of spending rather than the observed spending levels typically used for setting health plan payments. We refer to our proposed method as “intervening on the data.” We first present a general economic model that incorporates the previously overlooked two-way relationship between health plan payment and insurer actions. We then demonstrate our approach in two applications in Medicare: an inefficiency example focused on underprovision of care for individuals with chronic illnesses, and an unfairness example addressing health care disparities by geographic income levels. We empirically compare intervening on the data to two other methods commonly used to address inefficiencies and disparities: adding risk adjustor variables, and introducing constraints on the risk adjustment coefficients to redirect revenues. Adding risk adjustors, while the most common policy approach, is the least effective method in our applications. Intervening on the data and constrained regression are both effective. The “side effects” of these approaches, though generally positive, vary according to the empirical context. Intervening on the data is an easy-to-use, intuitive approach for addressing economic efficiency and fairness misallocations in individual health insurance markets. |
| JEL: | I13 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24491&r=hea |
| By: | Dempsey, Seraphim; Lyons, Seán; Nolan, Anne |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:esr:wpaper:rb201810&r=hea |
| By: | Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis); Katalin Katona; Erik Schut; Victoria Shestalova |
| Abstract: | In this paper we estimate health plan price elasticities and financial switching gains for consumers over a 20 years period in which managed competition was introduced in the Dutch health insurance market. The period is characterised by a major health insurance reform in 2006 to provide health insurers with more incentives and tools to compete, and to provide consumers with a more differentiated choice of products. Prior to the reform, in the period 1995-2005, we find a low number of switchers, between 2-4% a year, modest average total switching gains of 2 million euro per year and short-term health plan price elasticities ranging from -0.1 to -0.4. The major reform in 2006 resulted in an all-time high switching rate of 18%, total switching gains of 130 million euro, and a high short-term price elasticity of -5.7. During 2007-2015 switching rates returned to lower levels between 4-8% per year, with total switching gains in the order of 40 million euro per year on average. Total switching gains could have been 10 times higher if all consumers would have switched to one of the cheapest plans. We find short-term price elasticities ranging between -0.9 and -2.2. Our estimations suggest substantial consumer inertia throughout the entire period as we find degrees of choice persistence ranging from about 0.8 to 0.9. |
| JEL: | I18 C33 |
| Date: | 2017–02 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:343&r=hea |
| By: | Paola Villois; David Grimaldi; Savino Spadaro; Claudia Righy Shinotsuka; Vito Fontana; Sabino Scolletta; Federico Franchi; Jean Louis Vincent; Jacques Creteur; Fabio Taccone |
| Abstract: | Background: A decrease in circulating lymphocytes has been described as a marker of poor prognosis after septic shock; however, scarce data are available after cardiac arrest (CA). The aim of this study was to evaluate the impact of lymphopaenia after successful cardiopulmonary resuscitation. Methods: This is a retrospective analysis of an institutional database including all adult CA patients admitted to the intensive care unit (ICU) between January 2007 and December 2014 who survived for at least 24 h. Demographic, CA-related data and ICU mortality were recorded as was lymphocyte count on admission and for the first 48 h. A cerebral performance category score of 3–5 at 3 months was considered as an unfavourable neurological outcome. Results: Data from 377 patients were analysed (median age: 62 [IQRs: 52–75] years). Median time to return of spontaneous circulation (ROSC) was 15 [8–25] min and 232 (62%) had a non-shockable initial rhythm. ICU mortality was 58% (n = 217) and 246 (65%) patients had an unfavourable outcome at 3 months. The median lymphocyte count on admission was 1208 [700–2350]/mm3 and 151 (40%) patients had lymphopaenia (lymphocyte count |
| Keywords: | Cardiac arrest; Lymphopaenia; Outcome; Prognosis |
| Date: | 2017–12 |
| URL: | http://d.repec.org/n?u=RePEc:ulb:ulbeco:2013/259619&r=hea |
| By: | Frankovic, Ivan; Kuhn, Michael |
| Abstract: | We study the impact of health insurance expansion in the US on health expenditure, longevity growth and welfare in an overlapping generations economy in which individuals purchase health care to lower mortality. We consider three sectors: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to match the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion on health expenditures, medical progress and longevity. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the moral hazard associated with subsidized health care creates excessive health care expenditure, the gains in life expectancy brought about by induced medical progress more than compensate for this. By mitigating an intergenerational externality associated with the longevity benefits from current medical innovation the expansion of health insurance constitutes a Pareto improvement. |
| Keywords: | life-cycle model,health care spending,health insurance,medical progress,moral hazard,overlapping generations |
| JEL: | I11 I12 I18 J11 J17 O31 O41 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:tuweco:012018&r=hea |
| By: | Jackson, Emerson Abraham |
| Abstract: | This article was championed in view of the notion of (perceived) economic rationalisation which seem to be the foremost of patients' care in the NHS as opposed to addressing distress to their existing well-being, while in a state of being tormented with agonising news of prolonged ill health. Serious consideration is given to addressing the need to rationalise resources in ensuring the long standing history of the NHS' free health care is critically addressed, but not in a way that destroys confidence on the ability of professionals to manifest ethical prudence in their acts of judgments about whether patients' care is to be imminent or prolonged on a waiting list. There is certainly serious impacts to be comprehended with in situations of economic rationality through services provided by the NHS, but it is believed that tangible outcomes about definitive care for patients should be addressed collaboratively. |
| Keywords: | Economics; Cost Saving; Morality; Living Dead; NHS |
| JEL: | I11 I31 |
| Date: | 2018–04–05 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:86134&r=hea |
| By: | Saha, Sanjib (Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Sweden); Gerdtham, Ulf-G. (Department of Economics, Lund University); Toresson, Håkan (Clinical Memory Research Unit, Department of Clinical Science (Malmö), Lund University); Minthon, Lennart (Clinical Memory Research Unit, Department of Clinical Science (Malmö), Lund University); Jarl, Johan (Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Sweden) |
| Abstract: | Background: The rising prevalence of dementia represents an important public health issue. There is currently no available cure for dementia disorders, only symptom-relieving therapies which can be either pharmacological or non-pharmacological. The number of non-pharmacological interventions for patients with dementia disorders and their caregivers have been increasing in recent years without much knowledge on their cost-effectiveness. The objective is to review the existing evidence on cost-effectiveness of non-pharmacological interventions targeting patients with dementia disorders, their caregivers, and the patient-caregiver dyad. Method: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, ICER) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: We included seventeen studies in this review categorised into three groups: physical exercise, occupational therapy, and psychological/psychosocial treatment. In almost all the studies (except one), economic evaluation was performed for a randomised controlled trial alongside the non-pharmacological intervention or retrospectively. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of intervention. This prevents an informative comparison between most of the studies. However, we found that physical exercise was the most-effective non-pharmacological interventions for patients with dementia. For occupational therapy and psychological/psychosocial interventions we found mixed results although the majority was not cost-effective. Conclusion: More economic evaluations studies are required in non-pharmacological interventions. However, the interventions need to have a strong study design with the intention to perform economic evaluation in parallel. |
| Keywords: | Dementia; Non-pharmacological interventions; Caregivers |
| JEL: | H43 I10 I18 |
| Date: | 2018–04–19 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:lunewp:2018_010&r=hea |
| By: | Vit Hradil |
| Abstract: | Empirical evidence on the employment effects of minimum wage legislation suggests the possibility that firms react to increases in low-skilled labor costs driven by minimum wages by reducing investments in non-wage job aspects, which can mitigate the need for layoffs. Such adjustments may involve the worsening of workplace safety. To evaluate the hypothesis that increases in minimum wages result in a higher incidence of occupational injuries and illnesses, I use employer-level data from the United States and variation in state minimum wages during 1996-2013. The results suggest that states which increase their minimum wage experience an increase in the incidence of occupational injuries and illnesses. The effect appears stronger in industries that employ large numbers of low-wage workers, and those where the workforce is intensively exposed to health risks.Creation-Date: 2018-03 |
| Keywords: | minimum wage; job safety; occupational injuries and illnesses; |
| JEL: | I10 J32 J81 |
| URL: | http://d.repec.org/n?u=RePEc:cer:papers:wp615&r=hea |
| By: | S Anukriti (Boston College; IZA); Sonia Bhalotra (University of Essex); Hiu Tam (University of Oxford) |
| Abstract: | The introduction of prenatal sex-detection technologies in India has led to a phenomenal increase in abortion of female fetuses. We examine fertility and investment responses to these technologies. We find a moderation of son-biased fertility stopping, erosion of gender gaps in parental investments in breastfeeding and immunization, and convergence in the under-5 mor- tality rates of boys and girls. For every three aborted girls, roughly one additional girl survives to age five. We also find a shift in the distribution of girls in favor of low-socioeconomic status families. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls conditioned by greater early life investments in them. |
| Keywords: | abortion, child mortality, fertility, gender, health, India, missing girls, parental investments, prenatal sex detection, sex-selection, ultrasound |
| JEL: | I15 J13 J16 |
| Date: | 2018–01–15 |
| URL: | http://d.repec.org/n?u=RePEc:boc:bocoec:950&r=hea |
| By: | Naoko Ueada |
| Abstract: | This paper argues that the work of the Japan Overseas Cooperation Volunteers (JOCV) brought about sustained developments in social capital in the host communities and contributed to motivating people to change their individual behavior. A mixed-methods approach using semi-structured interviews and surveys was used to examine how Volunteers worked to instill “norms”, “trust,” and affect changes of “sentiment” among people in two developing countries, Bangladesh and Honduras. Specifically, the paper is concerned with the activities undertaken by the JOCV within the Polio Control/EPI (Expanded Program on Immunization) programs in Bangladesh from 1999 to 2015, and the Chagas Disease Vector Control program carried out in Honduras from 2003 to 2011. The key findings of the study include: In Bangladesh, the JOCV contributed to improving the motivation of field workers, demonstrating that their “trust” for enlarging the acceptance of vaccinations has increased as a result of their work; this then resulted in vaccinations becoming the new “norm” for the community. In this respect, the increased “trust” and changing “norms” contributed to the 2004 polio free declaration in the country by altering social capital. In Honduras, the JOCV promoted the creation of an “exchange of responses” between health administrations and communities by stimulating the intrinsic motivation of the people concerned and generating positive sentiment among them. As a result, three common “sentiments” were identified among local Community Health Volunteers: happiness, a sense of achievement, and pride. This indicates that the JOCV created and altered social capital that supported self-sustained vector control.In both Bangladesh and Honduras, the Volunteers accompanied their local colleagues during fieldwork, spoke the same language, and shared common successes and failures. Cooperation between JOCV and local colleagues was an important factor in altering the hearts, minds, and sentiments of the local partners and communities, and contributed to the achievement of the important goal of disease control. This paper argues that more attention should be focused on the heart, mind, and sentimental aspects of the individual aid workers. |
| Keywords: | Japan Overseas Cooperation Volunteers (JOCV), social capital, sentiment, Polio/Expanded Program on Immunization, Chagas Disease Control |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:jic:wpaper:162&r=hea |
| By: | George J. Borjas; David J.G. Slusky |
| Abstract: | Disability benefit recipients in the United States have nearly doubled in the past two decades, growing substantially faster than the population. It is difficult to estimate how much of this increase is explained by changes in population health, as we often lack a valid counterfactual. We propose using undocumented immigrants as the counterfactual, as they cannot currently claim benefits. Using NHIS microdata, we estimate models of disability as a function of medical conditions for both the legal and undocumented populations. The relationship between health and disability is far stronger for those with legal status than it is for those who are undocumented. We find that almost all of the difference in disability trends between the two populations can be explained by different responses to underlying health impairments. |
| JEL: | I12 I18 J61 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24504&r=hea |
| By: | Julia Shu-Huah Wang; Neeraj Kaushal |
| Abstract: | We study the effect of two local immigration enforcement policies – Section 287(g) of the Illegal Immigration Reform and Immigrant Responsibility Act and the Secure Communities Program (SC) – that have escalated fear and risk of deportation among the undocumented on the health and mental health outcomes of Latino immigrants living in the United States. We use the restricted-use National Health Interview Survey for 2000-2012 and adopt a difference-in-difference research design. Estimates suggest that SC increased the proportion of Latino immigrants with mental health distress by 2.2 percentage points (14.7 percent); Task Force Enforcement under Section 287(g) worsened their mental health distress scores by 15 percent (0.08 standard deviation); Jail Enforcement under Section 287(g) increased the proportion of Latino immigrants reporting fair or poor health by 1 percentage point (11.1 percent) and lowered the proportion reporting very good or excellent health by 4.8 to 7.0 percentage points (7.8 to 10.9 percent). These findings are robust across various sensitivity checks. |
| JEL: | I1 I14 I3 J15 J18 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24487&r=hea |
| By: | David Card; Alessandra Fenizia; David Silver |
| Abstract: | Cesarean delivery for low-risk pregnancies is generally associated with worse health outcomes for infants and mothers. The interpretation of this correlation, however, is confounded by potential selectivity in the choice of birth mode. We use birth records from California, merged with hospital and emergency department (ED) visits for infants and mothers in the year after birth, to study the causal health effects of cesarean delivery for low-risk first births. Building on McClellan, McNeil, and Newhouse (1994), we use the relative distance from a mother’s home to hospitals with high and low c-section rates as an instrument for c-section. We show that relative distance is a strong predictor of c-section but is orthogonal to many observed risk factors, including birth weight and indicators of prenatal care. Our IV estimates imply that cesarean delivery causes a relatively large increase in ED visits of the infant, mainly due to acute respiratory conditions. We find no significant effects on mothers’ hospitalizations or ED use after birth, or on subsequent fertility, but we find a ripple effect on second birth outcomes arising from the high likelihood of repeat c-section. Offsetting these morbidity effects, we find that delivery at a high c-section hospital leads to a significant reduction in infant mortality, driven by lower death rates for newborns with high rates of pre-determined risk factors. |
| JEL: | I11 J13 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24493&r=hea |
| By: | Lauri Luoma-Halkola; Antti Peltokorpi; Riikka Kyrö |
| Abstract: | The healthcare industry is facing various challenges due to global megatrends, such as increasing average life expectancy, ageing population, technological advancements, urbanization and globalization. Currently, outdated hospital facilities are being thoroughly renovated in large and costly projects to meet contemporary operational requirements. Renovation work in hospital environments is particularly challenging, as the facility should remain operational during the renovation. Traditional ways of retrofitting tend to create a lot of disturbance, such as isolating sections for long periods, noise, and pollution. This study explores alternative ways to maintain a healthcare facility, without the need for major retrofits. The research approach is qualitative, utilizing stakeholder (owner - user - service provider) interviews as the main data. Based on the findings, the lifecycle sustainability of a hospital building would be improved if large, intrusive renovation projects could be replaced with multiple minor projects. Modular thinking could offer one solution to the problem. Modularity allows for more frequent minor maintenance procedures of hospital facilities, instead of major renovation cycles of decades. Modular solutions also reduce the operational downtime and costs, and create less onsite disturbance. On the other hand, modular solutions may be difficult to implement in existing buildings, which have not been originally designed to allow for such adaptability. Building on the interviews and review of existing literature, the study offers several potential solutions to improve the future adaptability and flexibility of hospital buildings. The benefits and challenges related to each solution are also discussed. The findings will benefit facility owners, managers and users, struggling with the requirements of contemporary healthcare facilities. |
| Keywords: | Adaptability; Flexibility; Healthcare; Modularity; retrofitting |
| JEL: | R3 |
| Date: | 2017–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:eres2017_213&r=hea |