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Health Economics

Chad Cotti, Erik Nesson, Nathan Tefft
A motivation for increasing health insurance coverage is to improve health outcomes for impacted populations. However, health insurance coverage may alternatively increase risky health behaviors due to ex ante moral hazard, and past research on this issue has led to mixed conclusions. This paper uses a panel of household purchases to estimate the effects of the recent state-level Medicaid expansions resulting from the Affordable Care Act (ACA) on consumption goods that present adverse health risks. We utilize within-household variation to identify whether increases in Medicaid availability impacted household purchase patterns of alcohol, nicotine-related, snack food, and carbonated beverage products...
November 15, 2018: Health Economics
Eunhae Shin
Under the prospective payment system (PPS), hospitals receive a bundled payment for an entire episode of treatment based on diagnosis-related groups (DRG). Although there is ample evidence regarding the impact of the introduction of the PPS, there is little research on the effects of the ensuing changes in payment levels under the PPS. In 2005, the Medicare PPS changed its definition of payment areas from the Metropolitan Statistical Areas to the Core-Based Statistical Areas, generating substantial area-specific price shocks...
November 15, 2018: Health Economics
Eliana Barrenho, Marisa Miraldo, Peter C Smith
Although it is commonly argued that there is a mismatch between drug innovation and disease burden, there is little evidence on the magnitude and direction of such disparities. In this paper, we measure inequality in innovation, by comparing research and development activity with population health and gross domestic product data across 493 therapeutic indications to globally measure: (a) drug innovation, (b) disease burden, and (c) market size. We use concentration curves and indices to assess inequality at two levels: (a) broad disease groups and (b) disease subcategories for both 1990 and 2010...
November 12, 2018: Health Economics
Timothy Simcoe, Maryaline Catillon, Paul Gertler
Disease management programs aim to reduce cost by improving the quality of care for chronic diseases. Evidence of their effectiveness is mixed. Reducing health care spending sufficiently to cover program costs has proved particularly challenging. This study uses a difference in differences design to examine the impact of a diabetes disease management program for high risk patients on preventive tests, health outcomes, and cost of care. Heterogeneity is examined along the dimensions of severity (measured using the proxy of poor glycemic control) and preventive testing received in the baseline year...
October 21, 2018: Health Economics
Declan French, Jonathan Brink, Till Bärnighausen
This study examines whether labour outcomes of HIV-infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4+ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time...
October 21, 2018: Health Economics
Krystal Lau, Katharina Hauck, Marisa Miraldo
Influenza pandemics considerably burden affected health systems due to surges in inpatient admissions and associated costs. Previous studies underestimate or overestimate 2009/2010 influenza A/H1N1 pandemic hospital admissions and costs. We robustly estimate overall and age-specific weekly H1N1 admissions and costs between June 2009 and March 2011 across 170 English hospitals. We calculate H1N1 admissions and costs as the difference between our administrative data of all influenza-like-illness patients (seasonal and pandemic alike) and a counterfactual of expected weekly seasonal influenza admissions and costs established using time-series models on prepandemic (2004-2008) data...
October 18, 2018: Health Economics
Carole Treibich, Aurélia Lépine
Social desirability bias, which is the tendency to underreport socially undesirable health behaviours, significantly distorts information on sensitive behaviours gained from self-reports. We applied the list randomisation method to indirectly elicit condom use among female sex workers and tested it among 651 female sex workers in Senegal, a country where sex workers face high social stigma and where the AIDS epidemic is mainly concentrated among this population. On the basis of our list randomisation, we found that the condom use rate in the last sexual intercourse with a client was 78%, which is significantly lower than the 97% obtained when asked directly in the survey...
October 15, 2018: Health Economics
Christopher S Carpenter, Tim A Bruckner, Thurston Domina, Julie Gerlinger, Sara Wakefield
We provide the first evidence on the effects of state laws requiring students to receive education about alcohol, tobacco, and other drugs using data on over a million youths from the 1976-2010 Monitoring the Future study. In difference-in-differences and event-study models, we find robust evidence that these laws significantly reduced recent alcohol and marijuana use among high school seniors by 1.6-2.8 percentage points, or about 8-10% of the overall decline over this period. Our results suggest that information interventions can reduce youth substance use...
October 15, 2018: Health Economics
Mujaheed Shaikh, Afschin Gandjour
This paper estimates the income elasticity of government pharmaceutical spending and assesses the simultaneous effect of such spending on gross domestic product (GDP). Using a panel dataset for 136 countries from 1995 to 2006, we employ a two-step instrumental variable procedure where we first estimate the effect of GDP on public pharmaceutical expenditure using tourist receipts as an instrument for GDP. In the second step, we construct an adjusted pharmaceutical expenditure series where the response of public pharmaceutical expenditure to GDP is partialled out and use this endogeneity adjusted series as an instrument for pharmaceutical expenditure...
October 10, 2018: Health Economics
Pieter van Baal, Meg Perry-Duxbury, Pieter Bakx, Matthijs Versteegh, Eddy van Doorslaer, Werner Brouwer
Traditionally, threshold levels of cost-effectiveness have been derived from willingness-to-pay studies, indicating the consumption value of health (v-thresholds). However, it has been argued that v-thresholds need to be supplemented by so-called k-thresholds, which are based on the marginal returns to health care. The objective of this research is to estimate a k-threshold based on the marginal returns to cardiovascular disease (CVD) hospital care in the Netherlands. To estimate a k-threshold for hospital care on CVD, we proceed in two steps: First, we estimate the impact of hospital spending on mortality using a Bayesian regression modelling framework, using data on CVD mortality and CVD hospital spending by age and gender for the period 1994-2010...
October 1, 2018: Health Economics
Will Cook
Using a regression-discontinuity approach on a U.K. longitudinal dataset, this research analyses whether personalised weight feedback resulted in individuals losing weight over a period of between 2 and 7 years. The analysis presented here finds that being told one was "overweight" had, on average, no effect on subsequent weight loss; however, being told one was "very overweight" resulted in individuals losing, on average, approximately 1% of their bodyweight. The effect of feedback was found to be strongly moderated by household income, with those in higher income households accounting for seemingly all of the estimated effect due, in part, to increased physical activity...
September 27, 2018: Health Economics
Petri Böckerman, John Cawley, Jutta Viinikainen, Terho Lehtimäki, Suvi Rovio, Ilkka Seppälä, Jaakko Pehkonen, Olli Raitakari
This paper contributes to the literature on the labor market consequences of obesity by using a novel instrument: genetic risk score, which reflects the predisposition to higher body mass index (BMI) across many genetic loci. We estimate instrumental variable models of the effect of BMI on labor market outcomes using Finnish data that have many strengths, for example, BMI that is measured rather than self-reported, and data on earnings and social income transfers that are from administrative tax records and are thus free of the problems associated with nonresponse, reporting error or top coding...
September 21, 2018: Health Economics
Mark E McGovern
About 200 million children globally are not meeting their growth potential, and as a result will suffer the consequences in terms of future outcomes. I examine the effects of birth weight on child health and growth using information from 66 countries. I account for missing data and measurement error using instrumental variables and adopt an identification strategy based on siblings and twins. I find a consistent effect of birth weight on mortality risk, stunting, wasting, and coughing, with some evidence for fever, diarrhoea, and anaemia...
September 21, 2018: Health Economics
Matthew Lang, T Clay McManus, Georg Schaur
We provide evidence that average mental, physical, and general health worsens for employed workers in local U.S. labor markets exposed to greater import competition from China. The effects are greatest for mental health. Moving a region from the 25th to 75th percentiles of import exposure corresponds to a 7.8% increase in the morbidity of poor mental health, adding about 3 days of poor mental health per year for the average adult. Concurrently, the ability to afford health care decreases. Our results complement documented consequences of import competition on labor markets and temporary business cycle shocks on health outcomes...
September 19, 2018: Health Economics
Holger Strulik
This paper proposes a new framework to discuss self-control problems in the context of life-cycle health and longevity. Individual decisions are conceptualized as the partial control of impulsive desires of a short-run self by a rationally forward-looking long-run self. The short-run self strives for immediate gratification through consumption of health-neutral and unhealthy goods. The long-run self reflects the long-term consequences of unhealthy behavior on health outcomes and longevity and invests time and money to improve current and future health...
September 14, 2018: Health Economics
Terence C Cheng, Jing Li, Rhema Vaithianathan
We use novel longitudinal data from 19 monthly waves of the Singapore Life Panel to examine the short-term dynamics of the effects health shocks have on household health and nonhealth spending and income by the elderly. The health shocks we study are the occurrence of new major conditions such as cancer, heart problems, and minor conditions (e.g., diabetes and hypertension). Our empirical strategy is based on an event study approach that exploits unanticipated changes in health status through the diagnosis of new health conditions...
September 10, 2018: Health Economics
Gil Shapira, Ina Kalisa, Jeanine Condo, James Humuza, Cathy Mugeni, Denis Nkunda, Jeanette Walldorf
Pay-for-performance programs are introduced in an increasing number of low- and middle-income countries with the goal of reducing maternal and child mortality and morbidity through increased health service utilization and quality. Although most programs incentivize formal health providers, some constraints to utilization might be better alleviated by incentivizing other actors in the health care system. This paper presents results from a randomized controlled trial set to evaluate the effects of two incentive schemes that were introduced on top of Rwanda's national Performance-Based Financing program at the health facility level...
August 29, 2018: Health Economics
Aspen Gorry, Devon Gorry, Sita Nataraj Slavov
We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer-sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves reported health, mental health, and life satisfaction. In addition, we find evidence of improvements in functional limitations in the long run...
August 23, 2018: Health Economics
Claudio Lucifora, Daria Vigani
We investigate the causal impact of retirement on health care utilization using SHARE data for 10 European countries. We show that the number of doctor's visits and the probability of visiting a doctor more than four times a year (our measures of health care utilization) increase after retirement. The increase in health care utilization is found to depend mainly on the years spent in retirement, suggesting that adjustment may take time. We find evidence of heterogeneous effects by gender and across different patterns of time use prior to retirement (i...
August 21, 2018: Health Economics
Guy David, Philip Saynisch, Spencer Luster, Aaron Smith-McLallen, Ravi Chawla
Accreditation of providers helps resolve the pervasive information asymmetries in health care markets. However, meeting accreditation standards typically involves flexibility in implementation, leading to heterogeneity in performance. For example, the patient-centered medical home (PCMH) is a leading model for recognizing high-performing primary care practices. Flexibility in PCMH implementation allows for varying degrees of emphasis on processes designed to enhance medication adherence. To assess the impact of the PCMH on adherence, we combine 6 years of detailed patient claims data with a novel dataset containing detailed practice-level PCMH attributes...
November 2018: Health Economics
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