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Journal of Health Economics

Rachel Griffith, Stephanie von Hinke, Sarah Smith
There is growing policy interest in encouraging better dietary choices. We study a nationally-implemented policy - the UK Healthy Start scheme - that introduced vouchers for fruit, vegetables and milk. We show that the policy has increased spending on fruit and vegetables and has been more effective than an equivalent-value cash benefit. We also show that the policy improved the nutrient composition of households' shopping baskets, with no offsetting changes in spending on other foodstuffs.
February 24, 2018: Journal of Health Economics
J Michelle Brock, Andreas Lange, Kenneth L Leonard
We test the value of unconditional non-monetary gifts as a way to improve health worker performance in a low income country health setting. We randomly assigned health workers to different gift treatments within a program that visited health workers, measured performance and encouraged them to provide high quality care for their patients. We show that unconditional non-monetary gifts improve performance by 20 percent over a six-week period, compared to the control group. We compare the impact of the unconditional gift to one in which a gift is offered conditional on meeting a performance target and show that only the unconditional gift results in a statistically significant improvement...
February 23, 2018: Journal of Health Economics
Jason M Lindo, María Padilla-Romo
This study considers the effects of the kingpin strategy, an approach to fighting organized crime in which law-enforcement efforts focus on capturing the leaders of criminal organizations, on community violence in the context of Mexico's drug war. Newly constructed historical data on drug-trafficking organizations' areas of operation at the municipality level and monthly homicide data allow us to control for a rich set of fixed effects and to leverage variation in the timing of kingpin captures to estimate their effects...
February 21, 2018: Journal of Health Economics
Thomas Wiseman
I study the interplay among competition, contractual commitment, income risk, and saving and borrowing in insuring consumers against both short-term healthcare expenses and longer-term changes in health status. Examining different combinations of firms' ability to commit to long-term contracts, consumers' access to credit markets, and the availability of termination fees helps to highlight sources of inefficiency.
February 16, 2018: Journal of Health Economics
Eskil Heinesen, Susumu Imai, Shiko Maruyama
Previous studies find significant negative effects of cancer on employment, with stronger effects for less-educated workers. We investigate whether the effect of cancer varies by skill requirement in the pre-cancer occupation, whether such heterogeneity can explain educational gradients, and whether cancer is associated with changes in job characteristics for cancer survivors who remain employed four years after the diagnosis. We combine Danish administrative registers with detailed skill requirement data and use individuals without cancer as a control group...
February 10, 2018: Journal of Health Economics
Osea Giuntella, Catia Nicodemo, Carlos Vargas-Silva
This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas...
February 10, 2018: Journal of Health Economics
Jan-Walter De Neve, Günther Fink
While a large literature has investigated the role of parental human capital on children's well-being, relatively little is known regarding the effects of human capital investment in children on long run outcomes of parents. In this study we explore the human capital variations created by the 1974 Tanzania education reform to estimate the effect of children's primary schooling attainment on parental survival. Using 5,026,315 census records from 1988, 2002, and 2012, we show that the 1974 reform resulted in an additional 1...
February 9, 2018: Journal of Health Economics
Alec Morton, Ashwin Arulselvan, Ranjeeta Thomas
In recent years, donors such as the Bill and Melinda Gates Foundation have made an enormous contribution to the reduction of the global burden of disease. It has been argued that such donors should prioritise interventions based on their cost-effectiveness, that is to say, the ratio of costs to benefits. Against this, we argue that the donor should fund not the most cost-effective interventions, but rather interventions which are just cost-ineffective for the country, thus encouraging the country to contribute its own domestic resources to the fight against disease...
February 8, 2018: Journal of Health Economics
Gautam Gowrisankaran, Claudio Lucarelli, Philipp Schmidt-Dengler, Robert Town
This paper seeks to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which receives more generous Medicare reimbursements in return for limits on capacity and length of stay. We find that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints...
February 7, 2018: Journal of Health Economics
R Tamara Konetzka, Elizabeth A Stuart, Rachel M Werner
In this paper we examine empirically the effect of integration on Medicare payment and rehospitalization. We use 2005-2013 data on Medicare beneficiaries receiving post-acute care (PAC) in the U.S. to examine integration between hospitals and the two most common post-acute care settings: skilled nursing facilities (SNFs) and home health agencies (HHA), using two measures of integration-formal vertical integration and informal integration representing preferential relationships between providers without formal relationships...
February 7, 2018: Journal of Health Economics
Joan Costa-Font, Sergi Jimenez-Martin, Cristina Vilaplana
We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs...
January 30, 2018: Journal of Health Economics
David Powell, Rosalie Liccardo Pacula, Mireille Jacobson
Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths. We replicate the result for opioid overdose deaths and explore the potential mechanism. The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries. As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen...
January 30, 2018: Journal of Health Economics
Kanghyock Koh
During a recession, cost-sharing of employer-sponsored health benefits could increase to reduce labor costs in the U.S. Using a variation in the severity of recession shocks across industries, I find evidence that the enrollment rate of high deductible health plans (HDHPs) among workers covered by employer-sponsored health benefits increased more among firms in industries that experienced severe recession shocks. As potential mechanisms, I study employer-side and worker-side mechanisms. I find that employers changed health benefit offerings to force or incentivize workers to enroll in HDHPs...
January 24, 2018: Journal of Health Economics
Jeffrey Traczynski, Victoria Udalova
Many states allow nurse practitioners (NPs) to practice and prescribe drugs without physician oversight, increasing the number of autonomous primary care providers. We estimate the causal impact of NP independence on population health care utilization rates and health outcomes, exploiting variation in the timing of state law passage. We find that NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulatory care sensitive conditions...
January 17, 2018: Journal of Health Economics
Ganna Pogrebna, Andrew J Oswald, David Haig
Using ultrasound scan data from paediatric hospitals, and the exogenous 'shock' of learning the gender of an unborn baby, the paper documents the first causal evidence that offspring gender affects adult risk-aversion. On a standard Holt-Laury criterion, parents of daughters, whether unborn or recently born, become almost twice as risk-averse as parents of sons. The study demonstrates this in longitudinal and cross-sectional data, for fathers and mothers, for babies in the womb and new-born children, and in a West European nation and East European nation...
January 8, 2018: Journal of Health Economics
Martin Chalkley, Stefan Listl
This article assesses the impact of dentist remuneration on the incidence of potentially harmful dental X-rays. We use unique panel data which provide details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists we estimate a series of fixed-effects models that are informed by a theoretical model of X-ray delivery and identify the effects on dental X-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption...
December 30, 2017: Journal of Health Economics
Petter Lundborg, Kaveh Majlesi
Studies on the intergenerational transmission of human capital usually assume a one-way spillover from parents to children. However, children may also affect their parents' human capital. Using exogenous variation in education, arising from a Swedish compulsory schooling reform in the 1950s and 1960s, we address this question by studying the causal effect of children's schooling on their parents' longevity. We first replicate previous findings of a positive and significant cross-sectional relationship between children's education and their parents' longevity...
December 13, 2017: Journal of Health Economics
Nicola Branson, Tanya Byker
We use a natural experiment to estimate the causal impact of a public health intervention aimed at reducing teenage childbearing. The geographic and timing variation in the rollout of the South African National Adolescent Friendly Clinic Initiative (NAFCI) in the early 2000s provides a plausibly exogenous increase in reproductive health knowledge and clinical access for teens. We investigate the causal pathway from the intervention's initial impact on early-teen childbearing to subsequent consequences for later-life outcomes of prime policy interest - education, employment and child health...
December 12, 2017: Journal of Health Economics
John A Nyman, Cagatay Koc, Bryan E Dowd, Ellen McCreedy, Helen Markelova Trenz
This study seeks to simulate the portion of moral hazard that is due to the income transfer contained in the coinsurance price reduction. Healthcare spending of uninsured individuals from the MEPS with a priority health condition is compared with the predicted counterfactual spending of those same individuals if they were insured with either (1) a conventional policy that paid off with a coinsurance rate or (2) a contingent claims policy that paid off by a lump sum payment upon becoming ill. The lump sum payment is set to be equal to the insurer's predicted spending under the coinsurance policy...
December 11, 2017: Journal of Health Economics
Elizabeth L Munnich, Stephen T Parente
Technological changes in medicine have created new opportunities to provide surgical care in lower cost, specialized facilities. This paper examines patient outcomes in ambulatory surgery centers (ASCs), which were developed as a low-cost alternative to outpatient surgery in hospitals. Because we are concerned that selection into ASCs may bias estimates of facility quality, we use predicted changes in federally set Medicare facility payment rates as an instrument for ASC utilization to estimate the effect of location of treatment on patient outcomes...
December 9, 2017: Journal of Health Economics
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