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Health Economics

Yan Song, Douglas Barthold
Substituting generic for brand name drugs whenever possible has been proposed to control prescription drug expenditure growth in the United States. This work investigates two types of state laws that regulate the procedures under which pharmacists substitute bioequivalent generic versions of brand name drugs. Mandatory substitution laws require pharmacists to use the generic as a default, and presumed consent laws allow them to assume that the patient agrees to the substitution. Both situations can be overruled by the patient...
July 10, 2018: Health Economics
Seiro Ito, Aurélia Lépine, Carole Treibich
Senegal is the only African country where sex work is legal and regulated by a health policy. Senegalese female sex workers (FSWs) are required to register with a health facility and to attend monthly routine health checks aimed at testing and treating sexually transmitted infections (STIs). Compliance to those routine visits is recorded on a registration card that must be carried by FSWs in order to avoid sanctions in case of police arrests. Although this policy was first introduced in 1969 to limit the spread of STIs, there is no evidence so far of its impact on FSWs' health and well-being...
July 5, 2018: Health Economics
Arthur E Attema, Han Bleichrodt, Olivier L'Haridon
In most medical decisions, probabilities are ambiguous and not objectively known. Empirical evidence suggests that people's preferences are affected by ambiguity. Health economic analyses generally ignore ambiguity preferences and assume that they are the same as preferences under risk. We show how health preferences can be measured under ambiguity, and we compare them with health preferences under risk. We assume a general ambiguity model that includes many of the ambiguity models that have been proposed in the literature...
July 3, 2018: Health Economics
Alexina J Mason, Manuel Gomes, Richard Grieve, James R Carpenter
Health economics studies with missing data are increasingly using approaches such as multiple imputation that assume that the data are "missing at random." This assumption is often questionable, as-even given the observed data-the probability that data are missing may reflect the true, unobserved outcomes, such as the patients' true health status. In these cases, methodological guidelines recommend sensitivity analyses to recognise data may be "missing not at random" (MNAR), and call for the development of practical, accessible approaches for exploring the robustness of conclusions to MNAR assumptions...
July 3, 2018: Health Economics
Kim Dalziel, Jinhu Li, Anthony Scott, Philip Clarke
In health economics, the use of patient recall of health care utilisation information is common, including in national health surveys. However, the types and magnitude of measurement error that relate to different recall periods are not well understood. This study assessed the accuracy of recalled doctor visits over 2-week, 3-month, and 12-month periods by comparing self-report with routine administrative Australian Medicare data. Approximately 5,000 patients enrolled in an Australian study were pseudo-randomised using birth dates to report visits to a doctor over three separate recall periods...
July 2, 2018: Health Economics
Sean Shenghsiu Huang, John R Bowblis
The literature on provider ownership has primarily focused broadly on for-profits compared with nonprofits and chains versus nonchains. However, the understanding of more nuanced ownership arrangements within individual facilities is limited. Utilizing the principal-agent and managerial control frameworks, we study the role of managerial ownership and its relationship to quality among for-profit nursing homes (NHs). We identify NH administrators with more than 5% ownership (owner-manager) from Ohio Medicaid Cost Reports (2005-2010) and link these data to long-stay resident records in the Minimum Data Set...
July 2, 2018: Health Economics
Takuya Hasebe
In this paper, we consider a switching regression model with count data outcomes, where the possible outcome differs across two alternate states and individuals endogenously select one of the states. We assume lognormal latent heterogeneity. Building on the switching regression model, we derive estimators of various treatment effects: the average treatment effect, the average treatment effect on the treated, the local average treatment effect, and the marginal treatment effect. We illustrate an application that examines the effects of public insurance on the number of doctor visits using the data employed by previous studies...
June 28, 2018: Health Economics
Sisira Sarma, Nirav Mehta, Rose Anne Devlin, Koffi Ahoto Kpelitse, Lihua Li
Understanding how family physicians respond to incentives from remuneration schemes is a central theme in the literature. One understudied aspect is referrals to specialists. Although the theoretical literature has suggested that capitation increases referrals to specialists, the empirical evidence is mixed. We push forward the empirical research on this question by studying family physicians who switched from blended fee-for-service to blended capitation in Ontario, Canada. Using several health administrative databases from 2005 to 2013, we rely on inverse probability weighting with fixed-effects regression models to account for observed and unobserved differences between the switchers and nonswitchers...
June 26, 2018: Health Economics
Bhagyashree Katare, Timothy K M Beatty
International students offer a unique window into the role environmental factors play in driving obesity. Naïve estimates of the relationship between environmental factors and obesity are often plagued by reverse causation, sample selection, and omitted variable bias. In this study, we survey international students at 40 public universities across the United States. We use this unique data to link the weight gain of international students to the prevalence of obesity where they live. We argue that our estimates are less likely to be biased as international students have limited control over the environment to which they are exposed upon arrival in the United States...
June 21, 2018: Health Economics
Matthew Quaife, Peter Vickerman, Shanthi Manian, Robyn Eakle, Maria A Cabrera-Escobar, Sinead Delany-Moretlwe, Fern Terris-Prestholt
Evidence suggests that economic factors play an important role in commercial sex work, in particular that condomless sex commands a price premium relative to condom-protected sex. This paper explores whether the use of a new HIV prevention product, with 100% efficacy but modeled after pre-exposure prophylaxis (PrEP), could change the price and quantity of condomless commercial sex supplied. We collected stated preference data from 122 HIV-negative female sex workers in urban South Africa, using a repeated choice experiment to simulate the impact of using PrEP on choices...
June 21, 2018: Health Economics
Lea Toulemon
I estimate the impact of group purchasing on medicine prices in French hospitals, taking advantage of the entry of hospitals into regional purchasing groups between 2009 and 2014. Based on a new database providing the average annual prices paid for all innovative and high-priced medicines in public hospitals, I use a two-way fixed effects model that controls for hospitals' medicine-specific bargaining power and medicine-specific price trends. I find that group purchasing slightly reduces the overall prices of medicines but has no impact on the prices of medicines that have no alternative on the market...
June 19, 2018: Health Economics
Dajung Jun
With the push to repeal the Affordable Care Act, there is renewed interest in using tax credits to increase health insurance coverage. Another tax credit-driven policy, the Health Insurance Tax Credit (HITC), was implemented during 1991-1993. To date, only one paper has analyzed the effectiveness of the HITC on coverage rates. In this paper, I reexamine the effectiveness of the HITC by using the Survey of Income Program Participation and provide the first estimates of its effects on utilization and self-reported health status...
June 19, 2018: Health Economics
M Ruth Lavergne, Lindsay Hedden, Michael R Law, Kim McGrail, Megan Ahuja, Morris Barer
Fee-for-service physicians are responsible for planning for their retirements, and there is no mandated retirement age. Changes in financial markets may influence how long they remain in practice and how much they choose to work. The 2008 crisis provides a natural experiment to analyze elasticity in physician service supply in response to dramatic financial market changes. We examined quarterly fee-for-service data for specialist physicians over the period from 1999/2000 to 2013/2014 in Canada. We used segmented regression to estimate changes in the number of physicians receiving payments, per-physician service counts, and per-physician payments following the 2008 financial crisis and explored whether patterns differed by physician age...
June 19, 2018: Health Economics
Megha Swami, Hugh Gravelle, Anthony Scott, Jenny Williams
The decline in the working hours of general practitioners (GPs) is a key factor influencing access to health care in many countries. We investigate the effect of changes in hours worked by GPs on waiting times in primary care using the Medicine in Australia: Balancing Employment and Life longitudinal survey of Australian doctors. We estimate GP fixed effects models for waiting time and use family circumstances to instrument for GP's hours worked. We find that a 10% reduction in hours worked increases average patient waiting time by 12%...
June 19, 2018: Health Economics
Apostolos Davillas, Andrew M Jones
Recent advances in social science surveys include collection of biological samples. Although biomarkers offer a large potential for social science and economic research, they impose a number of statistical challenges, often being distributed asymmetrically with heavy tails. Using data from the UK Household Panel Survey, we illustrate the comparative performance of a set of flexible parametric distributions, which allow for a wide range of skewness and kurtosis: the four-parameter generalized beta of the second kind (GB2), the three-parameter generalized gamma, and their three-, two-, or one-parameter nested and limiting cases...
June 14, 2018: Health Economics
Hsiu-Han Shih, Ming-Jen Lin
This paper utilizes the eradication campaign in Taiwan in the 1950s to estimate the long-term impacts of early-life (in utero and postnatal) exposure to malaria. Matching adults in the 1992-2012 Taiwan Social Change Survey to the malaria intensity in their individual place and year of birth, difference-in-difference estimation shows strong evidence that the eradication increased men's own educational attainment as well as their family income in adulthood. We also use the 1980 census data to show there was a sharp education increase after the eradication...
June 12, 2018: Health Economics
Jason M Fletcher, Stephen L Ross
This paper estimates the effects of friends' smoking and drinking on own behavior while controlling for correlated unobservables between friends. The effect of friends' behaviors is identified by comparing similar individuals who have similar friendship opportunities and make similar friendship choices, exploiting the idea that friendship choice reveals information about unobservables. We combine this identification strategy with an across-cohort within school design so that identification arises in our reduced form estimates from across-grade differences in the clustering of health behaviors...
June 6, 2018: Health Economics
Fabrizio Mazzonna, Paola Salari
This paper evaluates the causal effect of environmental tobacco exposure on health by exploiting the time and geographical variation in public-place smoking bans implemented in Switzerland between 2007 and 2011. We use administrative data on hospitalizations for acute myocardial infarction, which allow to measure the short-run effects of the policy on an objective metric of health. We show that the incidence of acute myocardial infarction decreases by approximately 8% immediately after implementation of the law with large heterogeneity across regions...
June 4, 2018: Health Economics
Gerald J Pruckner, Thomas Schober
Health care payers try to reduce costs by promoting the use of cheaper generic drugs. We show strong interrelations in drug prescriptions between the inpatient and outpatient sectors by using a large administrative dataset from Austria. Patients with prior hospital visits have a significantly lower probability of receiving a generic drug in the outpatient sector. The size of the effect depends on both the patient and doctor characteristics, which could be related to the differences in hospital treatment and heterogeneity in the physicians' adherence to hospital choices...
May 22, 2018: Health Economics
Thomas Longden, Jane Hall, Kees van Gool
Australia is one of nine Organisation for Economic Co-operation and Development (OECD) countries that utilise deputising services to provide after-hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly advertising their services to consumers emphasising patient convenience and no copayments. The introduction of corporate entities has changed the way that deputising services operate...
May 21, 2018: Health Economics
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