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on Health Economics |
| By: | N. Meltem Daysal; William N. Evans; Mikkel Hasse Pedersen; Mircea Trandafir |
| Abstract: | We investigate the effects of radiation therapy on the mortality and economic outcomes of breast cancer patients. We implement a 2SLS strategy within a difference-in-difference framework exploiting variation in treatment stemming from a medical guideline change in Denmark. Using administrative data, we reproduce results from an RCT showing the lifesaving benefits of radiotherapy. We then show therapy also has economic returns: ten years after diagnosis, treatment increases employment by 37% and earnings by 45%. Mortality and economic results are driven by results for more educated women, indicating that equalizing access to treatment may not be sufficient to reduce health inequalities. |
| JEL: | I10 I14 I18 J20 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32167&r=hea |
| By: | Carlos F. Gould; Sam Heft-Neal; Alexandra K. Heaney; Eran Bendavid; Christopher W. Callahan; Mathew Kiang; Joshua S. Graff Zivin; Marshall Burke |
| Abstract: | Increased temperature-related mortality is predicted to be one of the largest contributors to future economic damages from climate change globally, with declines in cold-related deaths in some regions outweighed by increases in heat-related deaths in others. Changes in temperature could also affect non-fatal health outcomes, whose aggregate societal burden is large, yet much less is known about how temperature affects the overall level and distribution of morbidity. Using georeferenced data on emergency department visits, mortality, and daily temperatures across California from 2006-2017, we show that the effect of temperature on mortality differs substantially from its effect on ED visits: mortality increases under extreme heat and cold, whereas ED visits increase under extreme heat but decline under extreme cold. These differential responses fundamentally shape the burden of future climate change: we predict that mortality in California will decrease by 0.32% due to changes in temperatures by mid-century, with declining cold deaths outweighing increasing heat deaths, but that ED visits will increase by 0.46% over the same period in the state, representing a total of 1.9 million excess visits. Our findings suggest that projected impacts of future warming on mortality, including benefits in many areas, might be a poor guide for morbidity impacts. |
| JEL: | Q51 Q54 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32195&r=hea |
| By: | Yeongmi Jeong; Nicholas W. Papageorge; Meghan Skira; Kevin Thom |
| Abstract: | Genetic factors play a major role in the development of Alzheimer’s disease and related dementias (ADRD). Observable genetic factors could impact household planning and medical care if they contain actionable information, meaning that they i) are associated with significant harms, ii) reflect risks for which individuals are not already prepared, and iii) are informative above and beyond current knowledge or expectations. We examine these properties for existing genetic measures related to ADRD in the Health and Retirement Study (HRS). We replicate existing relationships between genetic factors and cognitive health. We also show that higher genetic risk is associated with worse economic outcomes on several dimensions including work, income, and wealth. Surprisingly, individuals at higher risk are less likely to engage in planning activities that could mitigate the consequences of cognitive decline (e.g. assigning durable power of attorney). In predictive exercises, existing genetic indices provide clinically valuable and policy-relevant information on the development of severe adverse cognitive outcomes in the future. |
| JEL: | D14 G51 G52 I12 I14 J14 J22 J26 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32181&r=hea |
| By: | Aravena, José M.; Chen, Xi; Levy, Becca R. |
| Abstract: | Low healthcare quality has been found to predict the development of several illnesses in older adults, while the evidence on dementia is still lacking. This study assesses whether and to what extent experiencing low healthcare quality can be associated with developing dementia in people 60-years-old and greater. Participants in the Health and Retirement Study (HRS), without dementia and 60-years-old and greater at baseline, were followed 2006 through 2019. Experiencing low healthcare quality was assessed at baseline through healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression is used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. Experiencing low healthcare quality is associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95%CI: 1.27 - 2.21, p-value |
| Keywords: | Dementia, Patient Satisfaction, Perceived Discrimination, Social Determinants of Health, Healthcare Quality, Alzheimer's Disease |
| JEL: | I11 I18 J14 J15 J18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1402&r=hea |
| By: | Gruber, Jonathan; Lordan, Grace; Pilling, Stephen; Propper, Carol; Saunders, Rob |
| Abstract: | Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n=816), Diabetes (n=2813) or Cardiovascular Disease (CVD) (n=4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring common mental disorders and long-term chronic conditions. |
| Keywords: | depression; hospital utilisation; psychological interventions; chronic conditions; wellbeing |
| JEL: | I10 I00 |
| Date: | 2022–03–25 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:121885&r=hea |
| By: | Damien Echevin; Bernard Fortin; Aristide Houndetoungan |
| Abstract: | We analyze the effects of a mixed compensation (MC) scheme for specialists on the quality of their healthcare services. We exploit a reform implemented in Quebec (Canada) in 1999. The government introduced a payment mechanism combining a per diem with a reduced fee per clinical service. Using a large patient/physician panel dataset, we estimate a multi-state multi-spell hazard model analogous to a difference-in-differences approach. We compute quality indicators from our model. Our results suggest that the reform reduced the quality of MC specialist services measured by the risk of re-hospitalization and mortality after discharge. These effects vary across specialties. |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2402.04472&r=hea |
| By: | Lasse J. Jessen; Sebastian Koehne; Patrick Nüß; Jens Ruhose |
| Abstract: | Using survey experiments in the United States and Germany with 12, 000 participants, we examine perceptions of life expectancy inequality between rich and poor people. The life expectancy of the poor is underestimated more than that of the rich, leading to exaggerated perceptions of inequality in both countries. Receiving accurate information narrows concerns about this inequality. However, the impact of information on policy demand is limited because support for policies addressing life expectancy for the poor is consistently high, regardless of varying perceptions of inequality. We conclude that there is strong and unconditional public support for health equity policies. |
| Keywords: | socioeconomic inequality in life expectancy, health care, information treatment, survey experiment |
| JEL: | C90 D71 D83 I14 I18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10940&r=hea |
| By: | Shishir Shakya; Tulasiram Nepal; Edward Timmons |
| Abstract: | The Maintenance of Certification (MOC) program of the American Board of Medical Specialties (ABMS) requires physicians to pass the MOC exam every ten years to maintain board certification. Proponents argue that MOC enhances patient care and physician competencies. Critics perceive it as an expensive, burdensome, and time-consuming recertification process that may lead to the departure of elderly physicians from the workforce. Notably, some states are adopting Anti-MOC laws. Our analysis, employing a generalized difference-in-difference method and event-study frameworks, demonstrates a statistically significant 3.5-6% increase in actively practicing physicians aged 60 and above in states implementing Anti-MOC laws, with no impact on physicians aged below 60. Our findings have implications for healthcare, offering the potential to improve access to quality care and tackle physician shortages in the United States. Key Words: Scope of Practice, anti-Maintenance of certification, physicians |
| JEL: | J01 J08 J21 J44 J7 K30 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:apl:wpaper:24-06&r=hea |
| By: | Elena Capatina; Gary Hansen; Minchung Hsu |
| Abstract: | This paper compares the impact of long term care (LTC) risk on single and married households and studies the roles played by informal care (IC), consumption sharing within households, and Medicaid in insuring this risk. We develop a life-cycle model where individuals face survival and health risk, including the possibility of becoming highly disabled and needing LTC. Households are heterogeneous in various important dimensions including education, productivity, and the age difference between spouses. Health evolves stochastically. Agents make consumption-savings decisions in a framework featuring an LTC state-dependent utility function. We find that household expenditures increase significantly when LTC becomes necessary, but married individuals are well insured against LTC risk due to IC. However, they still hold considerable assets due to the concern for the spouse who might become a widow/widower and can expect much higher LTC costs. IC significantly reduces precautionary savings for middle and high income groups, but interestingly, it encourages asset accumulation among low income groups because it reduces the probability of means-tested Medicaid LTC. |
| JEL: | D16 E21 H31 J14 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32196&r=hea |
| By: | Debra L. Brucker (University of New Hampshire); Megan Henly (University of New Hampshire); Andrew Houtenville (University of New Hampshire) |
| Abstract: | This study used data from a nationally representative survey that follows people 50 and older over time (the Health and Retirement Study) to test whether the receipt of workplace accommodations by persons with work limitations varies by race/ethnicity. Workplace accommodations can include changes to time (allowing more breaks, allowing different arrival or departure times, or shortening the workday), provision of equipment/assistance (getting someone to help, getting special equipment, arranging special transportation), and changes to work (changing the job, helping to learn new job skills). We found that 85% of persons with work limitations identified a need for workplace accommodations, but only 32% actually received accommodations. While our preliminary analyses suggested some differences by race/ethnicity in the likelihood of receiving accommodations, when we also considered other factors (age, gender, education, organizational size, and physical nature of an occupation), these differences by race did not hold. Organizational size was a critical factor, however, as persons working for organizations that employed 100 or more people were significantly more likely to receive accommodations. This finding suggests that smaller employers may benefit from training or other supports to increase the availability of workplace accommodations. Workers with disabilities might also benefit from increased education offered by vocational rehabilitation agencies, workforce development programs, and other similar organizations on how to make requests for and implement reasonable accommodations. |
| Date: | 2022–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp442&r=hea |
| By: | Kaan Celebi (Chemnitz University of Technology); Jochen Hartwig (Chemnitz University of Technology, KOF Swiss Economic Institute, ETH Zurich, Hans Böckler Stiftung, Forum for Macroeconomics and Macroeconomic Policies, Düsseldorf); Anna Pauliina Sandqvist (Deloitte GmbH Wirtschaftsprüfungsgesellschaft, Munich) |
| Abstract: | Baumol's (1967) model of ‘unbalanced growth’ yields a supply-side explanation for the ‘cost explosion’ in health care. Applying a testing strategy suggested by Hartwig (2008), a sprawling literature affirms that the ‘Baumol effect’ has both a statistically and economically significant impact on health care expenditure growth. Skeptics maintain, however, that the proliferation of hi-tech medicine in acute care is clearly at odds with the assumption underlying Baumol's model that productivity-enhancing machinery and equipment is only installed in the ‘progressive’ (i.e. manufacturing) sector of the economy. They argue that Baumol's cost disease may affect long-term care, but not acute care. Our aim in this paper is to test whether Baumol's cost disease affects long-term care and acute care differently. Our testing strategy consists in combining Extreme Bounds Analysis (EBA) with an outlier-robust MM estimator. Using panel data for 23 OECD countries, our results provide robust and statistically significant evidence that expenditures on both acute care and long-term care are driven by Baumol's cost disease, even though the effect on long-term care expenditures is more pronounced. |
| Keywords: | Health care expenditure, Baumol's cost disease, Extreme Bounds Analysis, MM estimator, OECD panel |
| JEL: | C12 C23 I10 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:tch:wpaper:cep062&r=hea |
| By: | Becquey, Elodie; Touré, Mariama; Djoufouna, Ahmed D.; Barba, Francisco; Affenou, Aldo; Diatta, Ampa D.; Affenou, Aldo; Dione, Malick; Sawadogo, Abdoulaye; Huybregts, Lieven |
| Abstract: | Wasting is a persistent public health problem affecting 45 million children under five years of age worldwide. Wasting is responsible for the deaths of 875, 000 children under the age of five every year. Children who survive often suffer from long-term cognitive and physical disabilities UNICEF, the World Health Organization, and the World Bank 2021; Black et al. 2013). Member countries of the World Health Assembly (WHA) have agreed to reduce and maintain the prevalence of wasting to less than 5 percent by 2025. Most Sahelian countries are off track to meet the WHA targets and in Chad, the prevalence of wasting is still unacceptably high at 14 percent and shows large regional disparities (UNICEF, the World Health Organization, and the World Bank 2020). While both wasting prevention and treatment programs hold the potential to reduce child wasting, substantial synergies can be expected when prevention is integrated with screening, referral, and treatment services. Such integration should happen at the community level to maximize the accessibility of services for caregivers and their children. |
| Keywords: | child wasting; public health; community involvement; malnutrition; Africa; Chad |
| Date: | 2023 |
| URL: | http://d.repec.org/n?u=RePEc:fpr:prnote:138983&r=hea |
| By: | De Donder, Philippe; Bardey, David; Zaporozhets, Vera |
| Abstract: | This survey deals with the economic academic literature on diagnostic tests, with a focus first on the determinants of the use of these tests by healthcare providers, and then on the incentives to develop new diagnostic tests. It is structured in four parts. The first part provides general results in this literature regarding how healthcare providers (mostly, physicians) react to the (explicit or implicit) incentives embedded in existing health institutions, and especially to payment schemes and reimbursement rules. The second part deals more specifically with the incentives to use diagnostic tests including, among them, biomarker tests. Both sections follow a positive approach, describing individual reactions to various incentives. The third section rather takes a normative approach and tries to ascertain which incentives should be given to providers to better use existing diagnostic tests. Finally, the fourth section studies the development of new diagnostic tests, both from the viewpoint of the health authorities (when should they be developed?) and of the industry (how to incentivize them to develop the right kind of test?). |
| Keywords: | Diagnostic tests; Healthcare systems; Incentives |
| JEL: | D86 H51 I11 |
| Date: | 2024–02–21 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:129120&r=hea |
| By: | Antonio Filippin; Marco Mantovani |
| Abstract: | Using a choice experiment we analyze moral preferences over fatalities and jobs losses due to the pandemic in Italy, the UK and the US. A structural estimation displays, surprisingly, aversion to diversification among these two bads. We also find that about 95% of the weight in the participants’ utility function goes to health, and that respondents’ stable traits (such as political orientation or risk aversion) influence attitudes more than their personal experiences with the consequences of the pandemic. Moreover, policy responses look misaligned with estimated preferences. Italy adopted more stringent containment measures, while Italian respondents display a relatively weaker pro-health attitude. |
| Keywords: | Covid-19, Structural estimation, Health-wealth trade-off, Moral preferences. |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:mib:wpaper:531&r=hea |
| By: | Laura Carella (IIE-FCE-UNLP); Cecilia Velázquez (CEDLAS-IIE-FCE-UNLP & CENEP & CINVE); Natalia Porto (IIE-FCE-UNLP); Ana Clara Rucci (IIT-FCE-UNLP) |
| Abstract: | A child’s disability increases childcare demands causing two opposing effects on the mother's labor supply: while some types of disability require additional time spent reducing labor supply, othersrequire additional expenses increasing labor supply. This paper studies the effect of a child's disability on mothers' labor supply using data from the 2019-20 IPUMS MICS of Argentina. Four measures of disability are used: children with a functional disability (based on Washington Group criteria); children with functional difficulties for seeing, hearing, or walking; children with difficulties in the remaining functional domains; and children with a disability certificate or pension. The results suggest that having a child with disability certificate or pension reduces a mother's probability of participating in the labor force. No significant effect is found for mothers of a child with a functional disability. However, this arises from two opposing effects: a negative effect on mother’s labor supply of children with difficulties for seeing, hearing, or walking and a positive effect on mothers of children with difficulties in the remaining functional domains. The evidence also shows heterogeneous effects depending on the mother’s education. The (dis)incentive to participate is present for non-graduated mothers, while the effect is not statistically significant for graduated ones. |
| JEL: | I14 J16 J22 |
| Date: | 2024–03 |
| URL: | http://d.repec.org/n?u=RePEc:dls:wpaper:0327&r=hea |
| By: | De Donder, Philippe; Bardey, David; Zaporozhets, Vera |
| Abstract: | We review the medico-economic literature assessing the economic value of diagnostic tests. We first present the health technology assessment methods, as applied to generic health interventions. We then define our object of study, diagnostic and prognostic tests, and relate them to various definitions of personalized medicine. We then review the empirical assessments of diagnostic tests related to personalized medicine andof companion tests. We summarize systematic reviews which are not performing quantitative meta-analyses, but rather provide a descriptive synthesis of the results reviewed. We find no evidence that such tests perform better than more traditional approaches, such as pharmaceutical interventions. At the same time, there is a lot of heterogeneity in the cost per QALY (Quality-Adjusted Life Year) gained, so that some genetic testing procedures may perform better than non-genetic ones. Finally, we focus on imperfect tests and show how to optimize, from an economic perspective, their accuracy levels, and how to take accuracy levels into considerations when assessing their economic value. |
| JEL: | H51 I18 J17 |
| Date: | 2024–02–21 |
| URL: | http://d.repec.org/n?u=RePEc:tse:wpaper:129121&r=hea |
| By: | Torben M. Andersen; Cecilie Marie Løchte Jørgensen |
| Abstract: | Socio-economic differences in longevity have fuelled a debate whether pension systems have a regressive bias favouring groups with a high life expectancy. We show that the distributional implications of such pooling depend critically on the benefit profile across age/time, which in turn is determined by how benefits are indexed to prices and wages. Choosing indexation scheme involves a choice between a low initial benefit with an increasing profile and a high initial benefit with a flat/decreasing profile, where the former benefits groups with a high life expectancy, and vice versa. We analyse how indexation affects the trade-off between insurance and distribution when groups with different mortality are separated or pooled, and the optimal benefit profile under both standard preferences and temporal risk aversion wrt. the length of life. |
| Keywords: | annuities, differential mortality, distribution, indexation |
| JEL: | D14 G22 H55 J18 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_10943&r=hea |
| By: | Alison Andrew; Orazio Attanasio; Britta Augsburg; Lina Cardona-Sosa; Monimalika Day; Michele Giannola; Sally Grantham-McGregor; Pamela Jervis; Costas Meghir; Marta Rubio-Codina |
| Abstract: | Early childhood interventions aim to promote skill acquisition and poverty reduction. While their short-term success is well established, research on longer-term effectiveness is scarce, particularly in LDCs. We present results of a randomized scalable intervention in India, that affected developmental outcomes in the short-term, including cognition (0.36 SD p=0.005), receptive language (0.26 SD p=0.03) and expressive language (0.21 SD p=0.03). After 4.5 years, when the children were on average 7.5 years old, IQ was no longer affected, but impacts persisted relative to the control group in numeracy (0.330 SD, p=0.007) and literacy (0.272 SD, p=0.064) driven by the most disadvantaged. |
| JEL: | I25 I30 I38 J13 O15 |
| Date: | 2024–02 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:32165&r=hea |
| By: | Sabat, Iryna; Neumann-Böhme, Sebastian; Stargardt, Tom; Schreyögg, Jonas |
| Abstract: | European COvid Survey (ECOS), a longitudinal study spanning eight European countries, was initiated early in the COVID-19 pandemic. Its purpose was to comprehend public perceptions, trust, knowledge, and behaviors related to COVID-19, including vaccination. The study aimed to enable timely monitoring and assess relationships between these variables, producing evidence for policy and research in Europe. ECOS pursued a dual objective: first, conducting quick descriptive analyses at the end of fieldwork to produce policy-relevant evidence and share timely findings on sentiments toward containment policies, vaccinations, and vaccine types through press releases and events. These findings were valuable as they were both prompt and representative of national populations. Second, ECOS aimed to address health-economic research questions for an academic audience, utilizing advanced analytic methodologies. The resulting data-based research from ECOS provided an empirical foundation to understand longitudinal phenomena and relationships, contributing to a deeper comprehension of socioeconomic processes and behaviors during the COVID-19 pandemic. Importantly, it offered informed findings for policymakers to shape effective responses and policies. This technical report provides an account of the design, development, and methodology of 11 data collections henceforth referred to as waves of the survey, which were fielded between April 2020 and December 2022. |
| Keywords: | Covid-19, longitudinal survey, health economics, trust, vaccination, policy support |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:hcherp:284369&r=hea |
| By: | Hou, Xiaolong; Jiao, Yang; Shen, Leilei; Chen, Zhuo |
| Abstract: | It is widely recognized that African Americans have a higher level of mistrust towards the medical and health care sector, which results in insufficient utilization of public health services, low participation in clinical research, and vaccination hesitancy. While the Tuskegee Syphilis Study has been identified as a key factor in this mistrust, its specific influence on COVID-19 vaccination uptake among African Americans remains unexplored. Our paper fills this research gap. Our results suggest that the difference in COVID-19 vaccination rates between communities with low and high proportions of Black residents decreases during the study period, but the gap persists. Notably, counties closer to Tuskegee exhibit a slower rate of progress in reducing the racial disparity in COVID-19 vaccination, indicating that the lingering mistrust stemming from the Tuskegee Study has contributed to unequal vaccination rates between African Americans and the rest of America. |
| Keywords: | Vaccination, COVID-19, Racial Disparity, Tuskegee |
| JEL: | I1 N9 |
| Date: | 2024 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:glodps:1397&r=hea |