MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Forum for Health Economics and Policy' source. Thu, 09 Feb 2012 10:12:53 +0100 http://www.medworm.com/index.php?rid=5663401&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F15%2F2%2F2 The 2010 Australian government tax review suggested Australia move to a uniform excise tax rate for all alcoholic beverages. Here, a model is presented and calibrated that shows the optimal per litre of pure alcohol (LAL) tax rates for beer, wine, spirits, and ready-to-drink spirits are substantially different to both current alcohol tax rates and the uniform tax rate recommended by the tax review. Specifically, given an individual consumer utility model, the best estimate values of the welfare maximising LAL tax rates are: $37 for beer, $11 for wine, $50 for spirits, and $77 for ready-to-drink spirits. The variation in the optimal tax rate across beverage types flows from differences in the externality costs associated with the consumption of each beverage type, and differences in the pro... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5663401 Mon, 06 Feb 2012 01:13:42 +0100 5663401 http://www.medworm.com/index.php?rid=5654838&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F15%2F2%2F1 We estimate changes in sexual behavior for HIV-positive individuals enrolled in an AIDS treatment program using longitudinal household survey data collected in western Kenya. We find that sexual activity is lowest at the time that treatment is initiated and increases significantly in the subsequent six months, consistent with the health improvements that result from ART treatment. More importantly, we find large and significant increases of 10 to 30 percentage points in the reported use of condoms during last sexual intercourse. The increases in condom use appear to be driven primarily by a program effect, applying to all HIV clinic patients regardless of treatment status. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5654838 Tue, 31 Jan 2012 20:47:15 +0100 5654838 http://www.medworm.com/index.php?rid=5556187&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F11 This paper assesses the effects of household investments through child educating activities on child neurodevelopment between the ages of 3 and 24 months, and evaluates whether investments explain racial and socioeconomic developmental gaps in South America. Quantile regression is used to evaluate the heterogeneity in investment effects by unobserved developmental endowments. The study finds large positive investment effects on early child neurodevelopment, with generally larger effects among children with low developmental endowments (children at the left margin of the development distribution). Investments explain part of the observed racial gaps and the whole socioeconomic developmental gap. Investments may compensate for low endowments and policy interventions to increase investments m... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5556187 Fri, 30 Dec 2011 23:23:51 +0100 5556187 http://www.medworm.com/index.php?rid=5394737&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F10 The pricing of medical products and services in the U.S. is notoriously complex. In health care, supply prices (those received by the manufacturer) are distinct from demand prices (those paid by the patient) due to health insurance. The insurer, in designing the benefit, decides what prices patients pay out-of-pocket for drugs and other products. In this primer we characterize cost and supply conditions in markets for generic and branded drugs, and apply basic tools of microeconomics to describe how an insurer, acting on behalf of its enrollees, would set demand prices for drugs. Importantly, we show how the market structure on the supply side, characterized alternatively by monopoly (unique brands), Bertrand differentiated product markets (therapeutic competition) and competition (generic... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5394737 Mon, 07 Nov 2011 19:30:17 +0100 5394737 http://www.medworm.com/index.php?rid=5266995&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F9 Past research has shown that high deductible and consumer-directed health plans (HD/CDHPs) can significantly reduce health care costs. In this paper we investigate how these cost savings are realized. We use panel data from many large employers and difference in difference models to examine how HD/CDHPs affect the number of health care episodes and the cost per episode. Our results show that about two-thirds of the cost savings from HD/CDHP enrollment are from reductions in number of episodes and the remaining one-third of the savings are from reductions in costs per episode. The presence of a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA) does not temper the effects of high deductibles on number of episodes. However, enrollees in plans with generous employer contri... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5266995 Thu, 29 Sep 2011 16:54:29 +0100 5266995 http://www.medworm.com/index.php?rid=5075136&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F8 An extensive literature has demonstrated geographic variation in medical services and this variation has been largely attributed to the health care system and not to regional differences in patient behavior. We use empirical Bayes shrinkage models, conditional on patient, firm, and market covariates, to investigate geographic variation in adherence to prescription medications across hospital referral regions (HRRs). Models are estimated for commercially insured patients in 11 combinations of chronic diseases and drug classes. We use factor analysis to create a market-level composite measure of adherence that we relate to adjusted market-level spending on non-drug services. We find that there is a very small amount of variation in adherence to prescription drugs across HRRs supporting the w... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5075136 Fri, 29 Jul 2011 18:18:16 +0100 5075136 http://www.medworm.com/index.php?rid=5056628&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F7 This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5056628 Thu, 21 Jul 2011 23:24:48 +0100 5056628 http://www.medworm.com/index.php?rid=5016153&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F6 This paper first proposes a theoretical model of smoker behaviour that serves as a vehicle to evaluate workplace smoking bans. It is a nicotine inventory management model where smoking during one phase of the day impacts utility in other phases. Smoking intensity choice forms part of the optimization. Calibrated model simulations suggest that, with the exception of heavy smokers, workplace bans have small impacts due to substitution possibilities. Quantile regression estimates support the theory. However, restrictions on smoking in the home are an order of greater importance, even when instrumented. The policy conclusion is that workplace ban effectiveness depends heavily upon private choices. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5016153 Fri, 08 Jul 2011 16:42:12 +0100 5016153 http://www.medworm.com/index.php?rid=5016154&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F5 The literature on tobacco control funding has focused on its impact on the demand for tobacco products. This paper turns the issue around by utilizing state-level panel data to address the determinants of per capita tobacco control funding. Tobacco control funding is found to be increasing with per capita income, cigarette consumption, and cigarette taxes, but decreasing with population density and neighbor-state tobacco control funding. Political affiliation, cancer and heart attack mortalities, as well as the extent of smoke-free air laws, have little impact on tobacco control funding. Results are robust to addressing the endogeneity of cigarette consumption and cigarette taxes. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=5016154 Thu, 07 Jul 2011 23:17:29 +0100 5016154 http://www.medworm.com/index.php?rid=4740679&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F4 This study evaluates employer-level health benefit offering responses to the pay-or-play mandate in the first year of implementation using the 2008 Bay Area Employer Health Benefits Survey and a difference-in-difference estimator. Although 92% of firms subject to the mandate already offered insurance prior to enactment, we find that 76% of firms had to expand benefits to comply with the minimum hourly spending requirement for each worker. Nevertheless, most surveyed San Francisco employers (61%) were supportive of the law. There is substantial employer demand for the public option, with 18% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping or restricting existing insurance offerings in the first year after implementation. A non... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4740679 Wed, 20 Apr 2011 19:34:54 +0100 4740679 http://www.medworm.com/index.php?rid=4730950&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F12 Since 2002, the average number of questions asked per respondent in the Health and Retirement Study (HRS) has risen by 39 percent, from 413 to 581. Yet there is little or no understanding of which questions, or how many in total, should be included—and more importantly, maintained—in longitudinal surveys. In this paper, we propose a simple approach to assessing the value of survey questions: journal citation counts. A sample of journal articles and book chapters published in 2006-09 (N = 206) is used to document which questions, and categories of questions, were used most and least frequently. A disproportionate number of published articles used a relatively small number of questions regarding health, wealth, income, and employment. By contrast, several categories of questions were rar... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730950 Mon, 18 Apr 2011 16:13:26 +0100 4730950 http://www.medworm.com/index.php?rid=4730951&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F11 This part of the mid-term review of the Health and Retirement Study (HRS) provides an overall assessment of the utility of HRS data for research targeting the nature and influence of social connectedness. As one of the major dimensions of the social aspects of psychosocial influences, social connectedness is among the most complicated in terms of definition, conceptualization, and measurement. However, the century-long body of theory and findings couple with a recent resurgence of research on the critical impact of these ties for health, illness, and health care to call for an examination of the richness in and limitations of current HRS data. This assessment is comprised of three broad steps: 1) an overview of the nature of social connectedness, and of the dimensions and methodological ap... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730951 Mon, 18 Apr 2011 16:13:20 +0100 4730951 http://www.medworm.com/index.php?rid=4730952&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F10 I discuss the data in the Health and Retirement Study (HRS) that can be used to study family change and intergenerational family relationships and offer suggestions about what might be done to enhance the uses of the HRS family data going forward. A number of family demographic behaviors are altering the family context of more recent cohorts of the HRS. These family changes need to be well-captured in the data collection and and should also inform future design decisions. Changes include the higher rates of childlessness, delayed marriage and childbearing after age 30 among the Baby Boom cohorts just now being enrolled in the HRS. Cohorts coming into the study also have higher rates of (lifetime) labor force participation on the part of women and much higher rates of nonmarital childbearin... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730952 Mon, 18 Apr 2011 16:13:16 +0100 4730952 http://www.medworm.com/index.php?rid=4730953&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F9 Personality tests are being added to large panel studies with increasing regularity, such as the Health and Retirement Study (HRS). To facilitate the inclusion and interpretation of these tests, we provide some general background on personality psychology, personality assessment, and the validity of personality tests. In this review, we provide background on definitions of personality, the strengths and weaknesses of the self-report approaches to personality testing typically used in large panel studies, and the validity of personality tests for three outcomes: genetics, income, and health. We conclude with recommendations on how to improve personality assessment in future panel studies. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730953 Mon, 18 Apr 2011 16:13:08 +0100 4730953 http://www.medworm.com/index.php?rid=4730954&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F8 This paper reviews several methods for measuring how people spend their time, and how they feel during these different activities, and argues that some of these methods could be well suited for large scale longitudinal surveys. Because time use methods allow for the quantitative assessment of the dynamics of human experience, they provide opportunities to explore numerous research questions that cannot be readily answered with more traditional summary measures of well-being. In the last decade or two, techniques have become available that can capture the dynamics of time use and well-being in ways that also reduce methodological problems such as biased recall. The paper describes several such methods, with a discussion of how they are implemented, and a comparison of their relative strengt... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730954 Mon, 18 Apr 2011 16:13:00 +0100 4730954 http://www.medworm.com/index.php?rid=4730955&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F7 Subjective well-being is comprised of both evaluative (life satisfaction) and hedonic (affect) components, and there has been a call to include both aspects of well-being in large-scale surveys. This paper presents a rationale for the feasibility of including a brief measure hedonic well-being based on the measurement of yesterday’s affect and experience. It discusses issues of the distinctiveness of hedonic well-being from life satisfaction, the sensitivity of a single day’s affect, the sample sizes required for detecting group differences, and the experiential content that could also be collected to extend the value of affective reports. I conclude that a brief assessment is feasible and, in conjunction with measures of evaluative well-being, could add to our understanding of well-be... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730955 Mon, 18 Apr 2011 16:12:51 +0100 4730955 http://www.medworm.com/index.php?rid=4730956&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F6 We review a diversity of genome-wide association studies (GWAS) with particular emphasis on precision in specifying phenotypes. This implies that examination of any specific phenotype involves considering the likely genetic contributions to it from the entire genome. We consider a variety of phenotypes specifiable with data from the Health and Retirement Survey (HRS). However, evidence from other large population studies is also incorporated as part of the process of developing and refining pathway representations from the genome thru a hierarchy of intermediate endpoints to behavioral, cognitive, and economic phenotypes. Any causal modeling focused on genome-phenotype connections must, of necessity, include consideration of intermediate endpoints (endophenotypes) as mediators of such asso... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730956 Mon, 18 Apr 2011 16:12:42 +0100 4730956 http://www.medworm.com/index.php?rid=4730957&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F5 The Health and Retirement Study (HRS) is an important national resource for policy makers and investigators across a wide range of disciplines, and it is critical that the study collects the best information possible on the health status of its participants within the constraints of the survey design, and without compromising the integrity of the sample. Potential directions for the collection and analysis of biomarker data in future waves of HRS are discussed, with a primary focus on blood-based biomarkers. Advantages and disadvantages of various methods for collecting blood in the home are considered, with particular attention given to the strengths and weaknesses of dried blood spot (DBS) sampling. DBS sampling has been widely applied in recent biosocial surveys due to the low cost and ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730957 Mon, 18 Apr 2011 16:12:35 +0100 4730957 http://www.medworm.com/index.php?rid=4730958&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F4 This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS), two surveys that expend considerable resources on measuring both OOP sp... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730958 Mon, 18 Apr 2011 16:12:29 +0100 4730958 http://www.medworm.com/index.php?rid=4730959&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F3 As a nationally representative cohort of middle-aged and elderly adults with longitudinal data spanning nearly two decades, the Health and Retirement Study (HRS) is an important resource for researchers studying the dynamics of health insurance coverage in the United States and the relation of insurance coverage to the use of health services and to health outcomes. We assessed the strengths and limitations of currently available HRS data for such research, focusing on survey items in these domains and Medicare claims data that have been linked to HRS survey data. The process for researchers to obtain Medicare claims has greatly improved in recent years. The additions of biomarkers (e.g. blood pressure and serum cholesterol) and objective measures of physical functioning for HRS participant... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730959 Mon, 18 Apr 2011 16:12:23 +0100 4730959 http://www.medworm.com/index.php?rid=4730960&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F2 The Health and Retirement Study (HRS) is widely use for research on the well-being of the elderly. This paper assesses the quality of economic and financial variables in the HRS. I find the coverage is comprehensive and the quality of the data is uniformly high. Thus the HRS has earned its position as the most widely used data source for research on retirement, saving adequacy, pension policy and a host of other aging-related topics. I identify two general areas that continue to merit special attention. The first is measurement error, particularly errors arising from item non-response and from inaccurate respondent reports of the ownership and level of assets. The second is the quality of the pension data. Where appropriate, I make suggestions for improving economic measures in the HRS. (S... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730960 Mon, 18 Apr 2011 16:12:19 +0100 4730960 http://www.medworm.com/index.php?rid=4730961&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F3%2F1 (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730961 Mon, 18 Apr 2011 16:12:08 +0100 4730961 http://www.medworm.com/index.php?rid=4730962&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F3 We use health care claims data from 59 large employers to estimate how consumer-directed health plans (CDHPs)—plans that combine a high deductible with personal accounts—affect health care costs and the use of preventive services by vulnerable populations. The vulnerable populations studied are those that will have increased access to health insurance under health care reform: families with high health care needs and low income families. A difference-in-difference framework is used with costs and use available for a full year before and after enrolling in a CDHP and for controls. Our key finding is that in almost all cases, CDHP benefit designs affect lower income populations and the chronically ill to the same extent as non-vulnerable populations. These effects include significant red... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4730962 Mon, 18 Apr 2011 02:48:41 +0100 4730962 http://www.medworm.com/index.php?rid=4609602&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F2 Patients as consumers are assuming a more active role in their medical care decision-making, which has been prompted by better access to medical information. Patient use of medical information may affect physician practice incentives to provide care, which critically depends on the agency relationship between physician and patient. If patient use of medical information improves communication and understanding, physicians may need to spend less time explaining what treatments are needed and convincing patients about the appropriateness of their recommendations, increasing incentives to provide care. If patients use information to demand treatments and procedures that are at odds with what the physician would recommend, this might lead to a contentious relationship, making it more difficult ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4609602 Fri, 18 Mar 2011 05:38:10 +0100 4609602 http://www.medworm.com/index.php?rid=4609603&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F14%2F2%2F1 The idea of using ‘fat taxes’ to curb obesity rates has been raised by many. In particular, the idea of taxing sugar-sweetened beverages (SSBs) has received considerable attention in the United States and has recently been discussed by President Obama. Rather less attention has been given to the alternative of ‘thin subsidies’, that is, subsidies for the consumption of foods or beverages likely to be associated with reduced incidence of obesity. This commentary examines the case for a subsidy for artificially sweetened beverages (ASBs) or ‘diet soft drinks’. In this commentary, we outline the evidence on the relationship between health outcomes, most notably obesity, and the consumption of SSBs and ASBs. In the light of the evidence we consider the economic effects of taxing SS... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4609603 Fri, 18 Mar 2011 05:38:06 +0100 4609603 http://www.medworm.com/index.php?rid=3934333&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F13 While many believe that an individual’s health plays an important role in both their willingness and ability to obtain health insurance in the employment-based setting, relatively little agreement exists on the extent to which health status affects coverage rates, particularly for those with lower incomes. In this paper, we examine the relationship between health risk and the purchase of group health insurance and whether that relationship differs by a person’s income and whether they obtain coverage in the small, medium, or large group market. Using the panel component of the 1996-2002 Medical Expenditure Panel Survey (MEPS), we find that health risk is positively associated with private health insurance across the different markets, and that this positive relationship is strong... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3934333 Sat, 04 Sep 2010 15:25:15 +0100 3934333 http://www.medworm.com/index.php?rid=3847892&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F12 Recent U.S. studies report much smaller youth smoking participation elasticities compared to research based on 1980s and 1990s data. We exploit the considerable time-series variation available within and across Canadian provinces. In particular, we study the dramatic (50%) reduction in cigarette excise taxes that occurred in February 1994 in most eastern provinces in Canada as well as significant increases within most provinces between 1994 and 2006. OLS and logit estimates from a variety of surveys suggest participation elasticities from –0.1 to –0.3 for teens aged 15 to 19 years, which are lower than traditional estimates. However, children aged 10 to 14 are significantly more tax elastic than older peers, with participation elasticities between -1.5 and -2. Finally, employing ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3847892 Mon, 09 Aug 2010 20:50:01 +0100 3847892 http://www.medworm.com/index.php?rid=3830462&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F11 Previous investigators argued that increasing 5-year survival for cancer patients should not be taken as evidence of improved prevention, screening, or therapy, because they found little correlation between the change in 5-year survival for a specific tumor and the change in tumor-related mortality. However, they did not control for the change in incidence, which influences mortality and is correlated with 5-year survival. The purpose of this study was to reexamine the question of whether increasing 5-year survival rates constitute evidence of success against cancer. We estimate the relationship across cancer sites between long-run changes in population-based mortality rates and both (1) changes in 5-year relative survival rates, and (2) changes in incidence rates, using data from both the... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3830462 Fri, 06 Aug 2010 14:22:57 +0100 3830462 http://www.medworm.com/index.php?rid=4609604&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F10 This paper investigates the link between various risk factors, including socioeconomic status (SES), and the spread of Severe Acute Respiratory Syndrome (SARS) in Hong Kong in 2003. A comprehensive data set compiled by the author shows a negative and significant correlation between SARS incidence and various measures of income, but not years of education, unlike previous studies on other health conditions. The income-SARS gradient can be accounted for by controlling for pre-SARS housing values but not an array of measurable living conditions. Areas with more white-collar workers experienced a higher incidence rate, largely driven by the share of service and sales workers, after controlling for SES. These results have implications for the understanding of the SES-health link in the context ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=4609604 Thu, 22 Jul 2010 17:11:33 +0100 4609604 http://www.medworm.com/index.php?rid=3779485&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F10 This paper investigates the link between various risk factors, including socioeconomic status (SES), and the spread of Severe Acute Respiratory Syndrome (SARS) in Hong Kong in 2003. A comprehensive data set compiled by the author shows a negative and significant correlation between SARS incidence and various measures of income, but not years of education, unlike previous studies on other health conditions. The income-SARS gradient can be accounted for by controlling for pre-SARS housing values but not an array of measurable living conditions. Areas with more white-collar workers experienced a higher incidence rate, largely driven by the share of service and sales workers, after controlling for SES. These results have implications for the understanding of the SES-health link in the context ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3779485 Thu, 22 Jul 2010 17:11:33 +0100 3779485 http://www.medworm.com/index.php?rid=3779486&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F9 In this paper, we employ a rich data set at the individual level in order to examine which factors are most highly correlated with obesity. Our main result is that, even after controlling for income levels and other factors, high “price-sensitivity” for food products is associated with high obesity rates. We find that a woman of average height who stated that prices were “not important at all” when purchasing food products had a weight circumference 4.5 centimeters (roughly 1.8 inches) smaller than those who stated that price was “very important.” We also show that this price effect is not limited to those with low income levels. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3779486 Thu, 22 Jul 2010 17:11:30 +0100 3779486 http://www.medworm.com/index.php?rid=3779487&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F8 This study develops a macroeconometric model of the Nigerian economy to examine the potential impact of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) on key macroeconomic outcomes in Nigeria. The baseline model of the Nigerian economy is estimated using data from 1980 to 2000. The simulated values of key endogenous macroeconomic outcomes are shown to closely follow actual historical data and also future macroeconomic outcomes from 2001 to 2006. Simulations are conducted to examine (1) the potential effects of an increase in HIV/AIDS prevalence and (2) the potential effects of increased government expenditure for treatment and prevention of HIV. The simulations show increased HIV/AIDS prevalence will reduce output in the agriculture and manufacturing sectors ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3779487 Thu, 22 Jul 2010 17:11:28 +0100 3779487 http://www.medworm.com/index.php?rid=3771029&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F1%2F4 While much has been written about the distinctions between biologics and small molecules in terms of their scientific, manufacturing and regulatory experiences, relatively little has been published comparing their clinical and commercial experiences. Employing a data base encompassing all 96 biologics and 212 small molecules newly launched in the U.S. between 1998Q1 and 2008Q4, we compare their downstream clinical and commercial characteristics. Substantial heterogeneity occurs across therapeutic classes. Biologics are more concentrated than small molecules in their therapeutic class composition, but have obtained FDA indication approvals in 13 of 15 classes. While average delays between FDA approval and first observed sales revenues are similar, biologics are twice as likely as small mole... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3771029 Tue, 20 Jul 2010 18:57:45 +0100 3771029 http://www.medworm.com/index.php?rid=3760700&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F7 Government-sponsored reinsurance for individuals with high health costs is a commonly proposed strategy to improve access and affordability in the individual and small-group health insurance markets. While reinsurance may have some benefits, other schemes may be more effective at accomplishing the same goals at lower cost. Reinsurance can be seen as a crude special case of risk-adjusted insurance subsidies. This paper estimates the effect of different reinsurance schemes on insurance premiums and insurers’ disincentives to enroll potentially high-cost individuals. We find that reinsurance is relatively ineffective at reducing cream-skimming incentives and argue that more sophisticated risk-adjustment schemes are more effective, particularly under community rating with guaranteed issue... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3760700 Fri, 16 Jul 2010 22:09:28 +0100 3760700 http://www.medworm.com/index.php?rid=3698495&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F1%2F3 About 7.4 million children were covered by the State Children’s Health Insurance Program (SCHIP) at some point during fiscal year 2008. Many of these children would probably have had private coverage in the absence of SCHIP; recent estimates of the extent of “crowd-out” associated with SCHIP are about 60 percent (Gruber and Simon 2008). The high rate of crowd-out means that the program is not as effective as it could be at reducing the number of uninsured children and has been a political liability for the program. Both political concerns and policy research focusing on crowd-out in SCHIP build on more than a decade of similar attention to the crowd-out associated with the Medicaid expansions of the late 1980s and early 1990s. While there is little doubt that expanding eligi... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3698495 Fri, 25 Jun 2010 16:51:02 +0100 3698495 http://www.medworm.com/index.php?rid=3694345&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F6 This study identifies factors that predict internal medicine resident satisfaction with the quality of teaching by attendings. A key issue facing educators is whether high-quality instruction can be maintained in an environment in which attending physicians have many competing demands placed on their time. A national survey of clinical third-year internal medicine residents in 125 academically affiliated generally medical training programs was conducted. Univariate analyses describe the characteristics of the sample, and multivariate analyses evaluate the factors associated with resident satisfaction with teaching. The response rate was 64.1% (n=1354). Positive factors relating to satisfaction with teaching on inpatient ward rotations included: number of patients seen during rounds, attend... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3694345 Thu, 24 Jun 2010 19:27:04 +0100 3694345 http://www.medworm.com/index.php?rid=3694346&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F1%2F2 As per capita incomes in developed countries have grown over the past three decades, over-nutrition leading to obesity and elevated health risks for cardiovascular disease, diabetes and some forms of cancer has occurred. We use economic and econometric models to identify the impact of food prices on the aggregate demand for calories and the supply of health, as reflected in mortality rates. Our models are fitted to unique panel data for 18 developed countries over 1971-2001, a period when the relative price of food first rose and then declined steadily. Some findings, using de-trended data, are that a lower real price of food, of other purchased consumer goods and of time increase the demand for calories, one cause of energy imbalance, and the supply of mortality associated with obesity. T... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3694346 Thu, 24 Jun 2010 19:26:58 +0100 3694346 http://www.medworm.com/index.php?rid=3675467&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F5 In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008—that is, before versus after the plan—over and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3675467 Fri, 18 Jun 2010 21:24:29 +0100 3675467 http://www.medworm.com/index.php?rid=3544830&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F4 Persistent lack of health insurance might arise from two distinct sources. First, individuals who lack insurance might possess certain traits, also exhibiting persistence, that associate with lower probabilities of having insurance. Second, persistence might arise if lack of insurance in the present period directly increases the probability of lacking insurance in future periods. This second channel, called "true state dependence", implies a causal mechanism from past uninsurance. State dependence can also arise if insurance status "feeds back" to future factors that affect insurance status in subsequent periods. This paper extends standard dynamic models to incorporate feedback from uninsurance to future health and employment. Results indicate that, after incorporating feedback effects, l... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3544830 Fri, 07 May 2010 20:31:57 +0100 3544830 http://www.medworm.com/index.php?rid=3447706&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F3 We propose a model of enrollee incentives in consumer directed health plans (CDHPs) and estimate the model with data from a large employer that offered a CDHP in addition to two traditional health insurance plans. In the CDHP a portion of the enrollee's pretax compensation is placed in an account that can be used to pay for out-of-pocket medical expenses or rolled over to the next year. In a multi-period model, healthy employees should save part of the account to pay for future medical contingencies. We measured health status by the employee's predicted medical spending in the year prior to the CDHP offering. We found that healthy CDHP enrollees tended to spend less in three post-enrollment years than a comparison group of healthy employees who elected to keep their traditional health insu... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3447706 Wed, 07 Apr 2010 23:11:42 +0100 3447706 http://www.medworm.com/index.php?rid=3361740&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F2 This study finds that cognitive outcomes are adversely affected not only by low birth weight (4500 grams). Our results have policy implications in terms of provision of support for pregnant women. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3361740 Fri, 12 Mar 2010 20:20:42 +0100 3361740 http://www.medworm.com/index.php?rid=3313934&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F2%2F1 Prior literature has documented improvements in cancer survival over time. However, ambiguity remains over the relative contributions of improved treatment and earlier detection to survival gains. Using registry data, we developed a novel framework to estimate the relative contributions of advances in treatment and detection. Our approach compares changes in the probability of early detection, which we interpret as the effects of advances in detection, to improvements in stage-conditional survival, which we interpret as the effects of treatment. We applied this methodology using SEER data to estimate probabilities of early detection and stage-conditional survival curves for several cancers, by race, between 1988 and 2000. Survival increased for all of the cancers we examined, with blacks e... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3313934 Fri, 26 Feb 2010 17:17:59 +0100 3313934 http://www.medworm.com/index.php?rid=3313935&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F13%2F1%2F1 Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the health care they consume. Only a comparatively small percentage of families pays for the full cost of this insurance out of their cash incomes. As health care has claimed a growing share of consumption, the percentage of care that is financed out of household incomes has declined. Because health care consumption is more important for some groups in the population than others, the growth in spending and changes in the payment system for medical care have reduced the value of standard income measures for assessing relative incomes of the rich and poor and the young and old. More than a seventh of total p... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=3313935 Fri, 26 Feb 2010 17:17:55 +0100 3313935 http://www.medworm.com/index.php?rid=2962270&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F1%2F5 Critics of me-too innovation often argue that follow-on drugs offer little incremental clinical value over existing pioneer products, while at the same time increasing health care costs. We examine whether consumers view follow-on and pioneer drugs as close substitutes or distinct clinical therapies. For five major classes of drugs, we find that large reductions in the price of pioneer molecules after patent expiration--which would typically lead to decreased consumption of strong substitutes--have no effect on the trend in demand for follow-on drugs. Our findings are likely unaffected by health insurance, competitive pricing of me-toos, marketing, and switching costs. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2962270 Wed, 04 Nov 2009 20:28:06 +0100 2962270 http://www.medworm.com/index.php?rid=2833804&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F8 We present evidence that inattentive symptoms in early childhood have large lasting effects in reducing completed schooling. We also find little consistent evidence that adolescent overweight status influences years of schooling completed. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2833804 Fri, 25 Sep 2009 22:10:43 +0100 2833804 http://www.medworm.com/index.php?rid=2823014&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F7 Conclusions: Our results indicate that people with heart disease are in better health in Canada as measured by disability, but there is no difference for overall self-reported health or functional impairment. Further research must be done to determine the cause of outcomes differences among heart disease patients. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2823014 Wed, 23 Sep 2009 14:01:12 +0100 2823014 http://www.medworm.com/index.php?rid=2736900&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F1%2F4 Conclusions: At current levels of supply, the marginal social costs of primary care visits appear to be equal to or greater than marginal social benefits of many primary care services. In considering expansions of primary care capacity, it may be efficient to increase the use of complementary, lower-skilled practitioners. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2736900 Wed, 26 Aug 2009 14:04:14 +0100 2736900 http://www.medworm.com/index.php?rid=2613079&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F6 In the contingent valuation literature, anchoring bias poses problems when using an iterative bidding game to infer willingness to pay. This bias occurs when the willingness to pay estimate is sensitive to the initially presented starting value. More generally, whenever a survey format is used and not all of those contacted participate, selection bias raises concerns about the representativeness of the sample. In this paper, we estimate students' willingness to pay for student health care at Stanford University while accounting for both of these biases. As there is no cost sharing for students, we assess willingness to pay by having a random sample of students play an on line iterative bidding game. Our main results are that (1) demand for student health care is elastic by conventional sta... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2613079 Fri, 17 Jul 2009 22:57:56 +0100 2613079 http://www.medworm.com/index.php?rid=2590490&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F1%2F3 We use data from California to document and offer possible explanations for the sharp increase in hospital prices charged to private payers after 1999. We find a downward trend in price for private pay patients in the 1990s and a rapid upward trend beginning in 1999, amounting to an annual average increase of 10.6% per year over 1999-2005. Prices in 2006 were almost double prices in 1999. By contrast, there was little discernable trend in prices for Medicare and Medicaid patients, although these prices varied from year-to-year. Surprisingly, the increase in prices is not correlated, geographically, with the change in hospital market concentration. For example, the greatest price rises came from hospitals in monopoly and highly concentrated counties which experienced little or no change ove... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2590490 Fri, 10 Jul 2009 18:27:55 +0100 2590490 http://www.medworm.com/index.php?rid=2555182&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F5 Something about being poor makes people fat. Though there are many possible explanations for the income-body weight gradient, we investigate a promising but little-studied hypothesis: that changes in body weight can--at least in part--be explained as an optimal response to economic insecurity. We use data on working-age men from the 1979 National Longitudinal Survey of Youth (NLSY79) to identify the effects of various measures of economic insecurity on weight gain. We find in particular that over the 12-year period between 1988 and 2000, the average man gained about 21 pounds. A one percentage point (0.01) increase in the probability of becoming unemployed causes weight gain over this period to increase by about 0.6 pounds, and each realized 50% drop in annual income results in an increase... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2555182 Tue, 30 Jun 2009 14:05:09 +0100 2555182 http://www.medworm.com/index.php?rid=2467261&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F4 An important, unresolved question for health policymakers and consumers is whether cigarette smoking in young adulthood has lasting effects into later adulthood. The Vietnam era draft lottery offers an opportunity to address this question, because it randomly assigned young men to be more likely to experience conditions favoring cigarette consumption, including highly subsidized prices. Using this natural experiment, we find that military service increased the probability of smoking by 35 percentage points as of 1978-80, when men in the relevant cohorts were aged 25-30, but later in adulthood this effect was substantially attenuated and did not lead to large negative health effects. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2467261 Tue, 09 Jun 2009 22:00:30 +0100 2467261 http://www.medworm.com/index.php?rid=2467262&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F3 This paper explores a central question in health economics: How sensitive is worker demand for health insurance? After controlling for variables omitted in other analyses, such as the generosity of plan coverage and aspects of worker demand that are constant within firms over time, I estimate a price elasticity (between -0.014 and -0.017) which is smaller than previous estimates. The analysis also finds that employees are more likely to take-up policies with greater insurance protection from hospital expenses, but not for increased coverage for prescription drug or provider office visit expenses. Taken together, increases in worker-paid premiums explain about 60 percent of the fall in take-up of employer policies over time, whereas increases in insurance cost-sharing explain about 10 perce... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2467262 Tue, 09 Jun 2009 21:55:10 +0100 2467262 http://www.medworm.com/index.php?rid=2439331&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F2 Additional work hours may lead to weight gain by decreasing exercise, causing substitution from meals prepared at home to fast food and pre-prepared processed food, or reducing sleep. Substitution toward unhealthy convenience foods could also influence the weight of one's spouse and children, while longer work hours for adults may further impact child weight by reducing parental supervision. I examine the effects of adult work hours on the body mass index (BMI) and obesity status of adults as well as the overweight status of children. Longer hours increase one's own BMI and probability of being obese, but have a smaller and statistically insignificant effect on these outcomes for one's spouse. Mothers', but not mother's spouse's, work hours affect children's probability of being overweight... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2439331 Wed, 27 May 2009 00:08:05 +0100 2439331 http://www.medworm.com/index.php?rid=2385845&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F2%2F1 This study examines the changing relationship between spousal health insurance coverage and labor market outcomes for married women over time as healthcare costs have increased. In particular, I investigate how husbands' health insurance coverage offers affect wives' decisions to enter the labor force and work full-time and how this has changed over time. I endeavor to correct for potential biases of these effects by 1) using an instrumental variables model to deal with endogeneity and 2) estimating and netting out likely unobserved heterogeneity biases, such as assortative mating or income effects. Using Current Population Survey data from 1995 to 2005, I find that husbands' employer-provided health insurance coverage has a negative effect on wives' labor supply that has increased (become... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2385845 Fri, 01 May 2009 22:16:58 +0100 2385845 http://www.medworm.com/index.php?rid=2385846&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F1%2F2 This paper explores the relationship between competition and hospital charity care by analyzing changes in charity care associated with changes in a hospital's competitive environment (due to mergers and divestitures), using hospital financial and discharge data from Florida and Texas. Despite the pervasive belief that competition impedes a hospital's ability to offer services to the uninsured and under-insured, I find no statistically significant evidence that increased competition leads to reductions in charity care. In fact, I find some evidence that reduced competition leads to higher prices for uninsured patients. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2385846 Fri, 01 May 2009 22:16:54 +0100 2385846 http://www.medworm.com/index.php?rid=2385847&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F12%2F1%2F1 This paper examines the impact of public health insurance expansions through both Medicaid and SCHIP on children's educational outcomes, measured by 4th and 8th grade reading and math test scores, available from the National Assessment of Educational Progress (NAEP). We use a triple difference estimation strategy, taking advantage of the cross-state variation over time and across ages in children's health insurance eligibility. Using this approach, we find that test scores in reading, but not math, increased for those children affected at birth by increased health insurance eligibility. A 50 percentage point increase in eligibility is found to increase reading test scores by 0.09 standard deviations. We also examine whether the improvements in educational outcomes can be at least partially... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2385847 Fri, 01 May 2009 22:16:52 +0100 2385847 http://www.medworm.com/index.php?rid=2028335&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F11 The quest to reduce health care cost has led many industrialized nations to reduce hospital length of stay. This paper uses instrumental variable estimation to estimate the effect of early discharge on readmission rates of maternity patients in British Columbia, Canada and investigates how the impact varied according to hospitals' degree of specialization. Principal component analysis was used to classify the hospitals according to their degree of specialization. The results show that the early discharge policy increased readmission rates, and this increase, varied according to the degree of specialization of the hospital. The increase in readmission rate is observed to be lowest in the very highly specialized hospitals and highest in the moderately specialized hospitals. The highly specia... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=2028335 Tue, 09 Dec 2008 17:41:17 +0100 2028335 http://www.medworm.com/index.php?rid=1976241&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F10 This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimizing behavior, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals, ``premier" and ``funds-constrained," and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and ``noneconomic" professional standards shortages. We believe that the perceived existence of professional standards shortages may be a signif... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1976241 Thu, 20 Nov 2008 05:25:41 +0100 1976241 http://www.medworm.com/index.php?rid=1976242&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F9 CONCLUSION: Many medicines continue to be used far beyond their period of patent protection, somewhat countering the view that newer drugs quickly replace older ones. This extended, post-patent utilization can yield additional surplus for society that is over and above the surplus generated during the period of patent protection. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1976242 Thu, 20 Nov 2008 05:25:38 +0100 1976242 http://www.medworm.com/index.php?rid=1976243&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F8 This study examines the impact of state health insurance regulations on the price of high-deductible family and individual polices in the nongroup market. We use a unique and rich data set on actual insurance policies sold through a large Internet health insurance distributor to examine the impact of various regulations on policy prices, controlling for policy characteristics, demographic characteristics of the purchasers, and state-level demographics. We also use data from a single major insurance firm that provided offer prices for a family policy from a set of randomly selected zip codes. Both datasets suggest a strong statistical relationship between regulation and insurance prices. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1976243 Wed, 19 Nov 2008 21:47:18 +0100 1976243 http://www.medworm.com/index.php?rid=1940152&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F7 Basing drug reimbursement on cost-effectiveness provides too little incentives for R&D. The reason for this is that cost-effectiveness is concerned with immediate value for money. But since the price of a drug usually declines over time, the drug might well provide value for money as seen over its entire life cycle, even though its price during patent protection is too high to warrant reimbursement according to the cost-effectiveness decision rule. We show in a theoretical model that welfare could be improved if decision-makers took a longer perspective and initially allowed higher prices than immediate value for money can motivate. We also discuss the real world relevance of applying dynamic cost-effectiveness. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1940152 Thu, 06 Nov 2008 17:41:19 +0100 1940152 http://www.medworm.com/index.php?rid=1856695&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F6 Due to the low risk of not insuring a healthy child for a short, finite period of time, it's plausible that SCHIP mandatory wait periods, where a child must forgo private insurance for several months before enrolling in SCHIP, do not provide enough incentive for parents to keep their children enrolled in private insurance. Using data from the 1996 Survey of Income and Program Participation (SIPP), we find that children eligible for SCHIP in states with shorter mandatory wait periods are more likely to be uninsured during the six months following the implementation of SCHIP than children in states with no mandatory wait periods. These children also have lower preventative care utilization, but there is no difference in their acute care utilization or health after one year. (Source: Forum fo... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1856695 Mon, 06 Oct 2008 17:46:05 +0100 1856695 http://www.medworm.com/index.php?rid=1561608&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F1%2F5 We compare and contrast the labor market and distributional impact of three common approaches to state and federal health insurance expansion: public insurance expansions, refundable tax credits for low income people, and employer and individual mandates. We draw on existing estimates from the literature and individual-level data on the non-institutionalized population aged 64 and younger from the 2005 Current Population Survey to estimate how each approach affects (1) the number of people insured; (2) private and public health spending; (3) employment and wages; and (4) the distribution of subsidies across families based on income in relation to the federal poverty level and work status of adult family members. Employer mandates expand coverage to the largest number of previously insured ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1561608 Tue, 01 Jul 2008 22:47:51 +0100 1561608 http://www.medworm.com/index.php?rid=1378120&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F1%2F4 The U.S. is the only developed country without some form of national health insurance. Yet, public opinion polls have consistently reported solid majorities in favor of such a system. In this paper, we examine whether attitudes toward different roles of government and beliefs that may be related to those attitudes are consistent with widespread support for national health insurance. Our analysis is based on the premise that a system of national health insurance would require government redistribution and government intervention in health care markets. We find that people who have favorable attitudes toward government economic intervention are 27 percentage points more likely and those with favorable attitudes toward government economic intervention are 18 percentage points more likely to f... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1378120 Wed, 16 Apr 2008 18:31:19 +0100 1378120 http://www.medworm.com/index.php?rid=1356604&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F5 This paper analyzes the effects of state mental health parity mandates on the labor and insurance markets. In particular, I investigate the effect of parity regulations along five margins: having employer provided health insurance coverage, employer contributions to health insurance premiums, the probability of full-time employment, working hours, and wages for a sample of private workers in firms with less than 100 employees using the Annual Demographic Surveys (March CPS) for the years 1999-2004 (and also in an extended sample of CPS 1992-2004). It is hypothesized that if parity mandates are costly they will have an impact on at least one of the above margins. I find no evidence for any of the most feared impact: a reduction in the probability of having employer-provided health insurance... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1356604 Mon, 07 Apr 2008 17:28:53 +0100 1356604 http://www.medworm.com/index.php?rid=1350085&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F4 Cost has deterred many small businesses from providing health insurance to their workers. Consumer-directed health plans, which are potentially less costly than traditional health plans, may be well suited to workers in small businesses. We study the factors that are associated with CDHP offering, determine the variation in CDHP offering among large and small firms, and develop models of persistence in CDHP offering. Our analysis of the Kaiser-HRET survey shows that small firms have been no quicker in their uptake of CDHPs than larger firms, and appear to display somewhat more churning in CDHP offering than large firms. Small firms that employ between three and 49 workers are less likely to offer HRA/HSA plans conditional on offering HD plans than large firms. Furthermore, conditional on o... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1350085 Thu, 03 Apr 2008 13:28:52 +0100 1350085 http://www.medworm.com/index.php?rid=1350086&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F1%2F3 It is often alleged that Canada's publicly-funded, single payer health care system, delivers better health outcomes, and distributes health resources more fairly than the mainly private U.S. multi-payer system. Our findings contradict these allegations. Differences between the U.S. and Canada in infant mortality and life expectancy --the two indicators most commonly used as evidence of better health outcomes in Canada--cannot be attributed to differences in the effectiveness of the two health care systems because they are strongly influenced by differences in cultural and behavioral factors such as the relatively high U.S. incidence of obesity and of accidents and homicides. Moreover, direct measures of the effectiveness of medical care, show that five-year relative survival rates for indi... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1350086 Thu, 03 Apr 2008 13:28:30 +0100 1350086 http://www.medworm.com/index.php?rid=1344914&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F1%2F2 Many believe the high level of United States health care costs compared with other countries is attributable to high administrative costs inherent in our pluralistic health care financing system. Instead of the well known statistics examining the percentage of GDP that various countries spend on health care, which show the US as a large outlier, we show the percentage of Gross State Product various states spend on health care. Even adjusting for age and income, there is considerable variation across the states in spending levels, with the lowest quintile of states spending approximately the same percentage as the higher spending OECD countries other than the US. This implies that the US' pluralistic financing system may not be an important cause of the large percentage of GDP that the US d... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1344914 Tue, 01 Apr 2008 21:30:11 +0100 1344914 http://www.medworm.com/index.php?rid=1320616&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F1%2F1 This study examines the impact of pharmaceutical innovation and other factors on the survival of U.S. cancer patients during the period 1992-2003. In particular, it investigates whether cancer survival rates increased more for those cancer sites that had the largest increases in the proportion of chemotherapy treatments that were "new" treatments. We control for other types of medical innovation, i.e. other pharmaceutical innovation, and innovation in surgical procedures, diagnostic radiology procedures, and radiation oncology procedures. Data on observed survival rates, the number of people diagnosed, mean age at diagnosis, and stage distribution are obtained from the National Cancer Institute's SEER public-use data. Estimates of rates of innovation in chemotherapy and other treatment and... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1320616 Fri, 21 Mar 2008 15:25:55 +0100 1320616 http://www.medworm.com/index.php?rid=1305541&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F3 The creation of tax-free health savings accounts presents a new opportunity to reduce the distortions created by federal tax preferences for health-related expenditures that ultimately could help eliminate those distortions. This paper proposes changes to current law that would allow most workers to receive the full amount that they and their employer spend on their health benefits as a tax-free cash contribution to the worker's health savings account. Restructuring the exclusion for employer-sponsored health benefits in this way would enable more individuals to obtain health insurance that matches their preferences, would increase efficiency in the health care sector, and could reduce inequities created by the exclusion. These changes also offer a means of limiting the currently unlimited... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1305541 Fri, 14 Mar 2008 18:38:19 +0100 1305541 http://www.medworm.com/index.php?rid=1278666&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F2 Most private health insurers offer a limited network of providers to enrollees. Critics have questioned whether selective contracting benefits patients. Plans counter that they take quality into account when choosing providers. Using data on five plans' networks for kidney transplant hospitals, this study shows that in-network hospitals have better outcomes than out-of-network facilities. Conditional logit estimates using patient level data confirm this result: compared to Medicare patients, privately-insured patients are more likely to register at hospitals with higher survival rates. Restricting choice has the potential to improve patient welfare if plans steer uninformed patients to high quality hospitals and physicians. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1278666 Mon, 03 Mar 2008 19:38:13 +0100 1278666 http://www.medworm.com/index.php?rid=1186312&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F11%2F2%2F1 In this study we use administrative data from California's Medicaid program to estimate the impact of HIV antiretroviral treatments (ARVs). We use data on health care utilization to proxy for health status and exploit the rapid takeup of ARVs following their FDA approval. Our estimate of a 68 percent average mortality rate reduction is in line with the results from RACTs. We also find that the ARVs lowered short-term health care spending by reducing expenditures on other categories of medical care. Combining these two effects we estimate the cost per life year saved at $19,000. Our results suggest an alternative method for estimating the real-world effects of new treatments that is especially well-suited to those treatments that diffuse rapidly following their approval. (Source: Forum for ... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1186312 Tue, 29 Jan 2008 00:19:26 +0100 1186312 http://www.medworm.com/index.php?rid=1129592&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F2%2F8 While the fraction of obese people is not as large in Europe as in the United States, obesity is becoming an important issue in Europe as well. Using comparable data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study in the U.S. (HRS), we analyze the correlates of obesity in the population ages 50 and above, focusing on measures of energy intake and expenditure as well as socio-economic status. We find that obesity rates differ substantially on both sides of the Atlantic and across European countries, with most of the difference coming from the right tail of the weight distribution. The well-known SES gradient in the prevalence of obesity differs across countries and cannot be fully explained by the variation in food expenditure or physica... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1129592 Thu, 03 Jan 2008 15:25:42 +0100 1129592 http://www.medworm.com/index.php?rid=1109981&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F2%2F7 This study analyses the demand for antiretroviral therapy (ART) using a contingent valuation approach, by estimating the willingness to pay for ART among a sample of HIV positive individuals in India. The study finds a very high willingness to be on ART, but substantially lower willingness to pay for it. To cover 70 percent of patients would require the price to be around Rs. 500 per month. Economic status generally and of females in particular have a positive relationship with the willingness to pay for drugs, whereas being a female exerts a downward pressure on the demand for ART. (Source: Forum for Health Economics and Policy) Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=1109981 Thu, 20 Dec 2007 20:01:19 +0100 1109981 http://www.medworm.com/index.php?rid=942078&cid=s_36491_51_f&fid=36491&url=http%3A%2F%2Fwww.bepress.com%2Ffhep%2F10%2F2%2F6 This study examines past patterns and projects future prevalence rates of obesity and severe obesity among US adults. Trends in body mass index (BMI), overweight (BMI≥25), obesity (BMI≥30), class 2 obesity (BMI≥35), class 3 obesity (BMI≥40) and class 4 obesity (BMI≥45) of 20-74 year olds are obtained using data from the first National Health Examination Survey and the National Health and Nutrition Examination Surveys. Quantile regression methods are then used to forecast future prevalence rates through 2020. By that year, 77.6% of men are predicted to be overweight and 40.2% obese, with class 2, 3 and 4 obesity prevalence rates projected at 16.4%, 6.3% and 3.1%. The corresponding forecasts for women are 71.1%, 43.3%, 25.3%, 12.8% and 5.6%. The large growth predicted for severe ob... Forum for Health Economics and Policy journals http://www.medworm.com/rss/comments.php?id=942078 Thu, 13 Sep 2007 23:11:44 +0100 942078