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 'Health Economics' source. Fri, 12 Mar 2010 16:00:50 +0100 http://www.medworm.com/index.php?rid=3345673&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1591 Willingness-to-pay (WTP) estimates derived from discrete-choice experiments (DCEs) generally assume that the marginal utility of income is constant. This assumption is consistent with theoretical expectations when costs are a small fraction of total income. We analyze the results of five DCEs that allow direct tests of this assumption. Tests indicate that marginal utility often violates theoretical expectations. We suggest that this result is an artifact of a cognitive heuristic that recodes cost levels from a numerical scale to qualitative categories. Instead of evaluating nominal costs in the context of a budget constraint, subjects may recode costs into categories such as 'low', 'medium', and 'high' and choose as if the differences between categories were equal. This simplifies the choi... Health Economics journals http://www.medworm.com/rss/comments.php?id=3345673 Tue, 09 Mar 2010 00:00:00 +0100 3345673 http://www.medworm.com/index.php?rid=3345672&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1590 This paper uses Johansen multivariate cointegration analysis to examine the relationship between health and GDP for 13 OECD countries over the last two centuries, for periods ranging from 1820-2001 to 1921-2001. A similar, long run, cointegrating relationship between life expectancy and both total GDP and GDP per capita was found for all the countries estimated. The relationships have a significant influence on both total GDP and GPD per capita in most of the countries estimated, with 1% increase in life expectancy resulting in an average 6% increase in total GDP in the long run, and 5% increase in GDP per capita. Total GDP and GDP per capita also have a significant influence on life expectancy for most countries. There is no evidence of changes in the relationships for any country over th... Health Economics journals http://www.medworm.com/rss/comments.php?id=3345672 Tue, 09 Mar 2010 00:00:00 +0100 3345672 http://www.medworm.com/index.php?rid=3286682&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1588 Measuring health services provided to patients can be difficult when patients see providers across multiple health systems and all visits are rarely captured in a single data source covering all systems where patients receive care. Studies that account for only one system will omit the out-of-system health-care use at the patient level. Combining data across systems and comparing utilization patterns across health systems creates complications for both aggregation and accuracy because data-generating processes (DGPs) tend to vary across systems. We develop a hybrid methodology for aggregation across systems, drawing on the strengths of the DGP in each system, and demonstrate its validity for answering research questions requiring cross-system assessments of health-care utilization. Positiv... Health Economics journals http://www.medworm.com/rss/comments.php?id=3286682 Fri, 19 Feb 2010 00:00:00 +0100 3286682 http://www.medworm.com/index.php?rid=3250287&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1587 Optimising the design of discrete choice experiments (DCE) involves maximising not only the statistical efficiency, but also how the nature and complexity of the experiment itself affects model parameters and variance. The present paper contributes by investigating the impact of the number of DCE choice sets presented to each respondent on response rate, self-reported choice certainty, perceived choice difficulty, willingness-to-pay (WTP) estimates, and response variance. A sample of 1053 respondents was exposed to 5, 9 or 17 choice sets in a DCE eliciting preferences for dental services. Our results showed no differences in response rates and no systematic differences in the respondents' self-reported perception of the uncertainty of their DCE answers. There were some differences in WTP e... Health Economics journals http://www.medworm.com/rss/comments.php?id=3250287 Mon, 08 Feb 2010 00:00:00 +0100 3250287 http://www.medworm.com/index.php?rid=3230461&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1573 We analyse the determinants of annual net income and wages (net income/hours) of general practitioners (GPs) using data for 2271 GPs in England recorded during Autumn 2008. The average GP had an annual net income of £97 500 and worked 43 h per week. The mean wage was £51 per h. Net income and wages depended on gender, experience, list size, partnership size, whether or not the GP worked in a dispensing practice, whether they were salaried of self-employed, whether they worked in a practice with a nationally or locally negotiated contract, and the characteristics of the local population (proportion from ethnic minorities, rurality, and income deprivation). The findings have implications for pay discrimination by GP gender and ethnicity, GP preferences for partnership size, incentives for ... Health Economics journals http://www.medworm.com/rss/comments.php?id=3230461 Tue, 02 Feb 2010 00:00:00 +0100 3230461 http://www.medworm.com/index.php?rid=3211172&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1555 We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany. Copyright © 2010 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3211172 Wed, 27 Jan 2010 00:00:00 +0100 3211172 http://www.medworm.com/index.php?rid=3211174&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1571 Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999... Health Economics journals http://www.medworm.com/rss/comments.php?id=3211174 Tue, 26 Jan 2010 00:00:00 +0100 3211174 http://www.medworm.com/index.php?rid=3211173&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1582 We present a model of optimal contracting between a purchaser and a provider of health services when quality has two dimensions. We assume that: (i) the provider is (at least to some extent) altruistic; (ii) one dimension of quality is verifiable (dimension 1) and one dimension is not verifiable (dimension 2); (iii) the two quality dimensions can be either substitutes or complements. Our main result is that setting the price equal to the marginal benefit of the verifiable quality dimension can be optimal even if the two quality dimensions are substitutes. Copyright © 2010 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3211173 Tue, 26 Jan 2010 00:00:00 +0100 3211173 http://www.medworm.com/index.php?rid=3196676&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1586 Institutions with the responsibility for making adoption (reimbursement) decisions in health care often lack the remit to demand or commission further research: adoption decisions are their only policy instrument. The decision to adopt a technology also influences the prospects of acquiring further evidence because the incentives to conduct research are reduced and the ethical basis of further clinical trials maybe undermined. In these circumstances the decision maker must consider whether the benefits of immediate access to a technology exceeds the value of the evidence which maybe forgone for future patients. We outline how these expected opportunity losses can be established from the perspective of a societal decision maker with and without the remit to commission research, and demonstr... Health Economics journals http://www.medworm.com/rss/comments.php?id=3196676 Fri, 22 Jan 2010 00:00:00 +0100 3196676 http://www.medworm.com/index.php?rid=3196677&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1581 This study provides new quantitative information about how to make jobs in rural areas more attractive to newly educated clinical officers (COs). A unique data set stemming from a discrete choice experiment with CO finalists in Tanzania is applied. The results show that offering continuing education after a certain period of service is one of the most powerful recruitment instruments the authorities have available. Increased salaries and hardship allowances will also substantially increase recruitment in rural areas. Offers of decent housing and good infrastructure, including the provision of equipment, will increase recruitment to rural remote areas but not as much as higher wages and offers of education. Women are less responsive to pecuniary incentives and are more concerned with factor... Health Economics journals http://www.medworm.com/rss/comments.php?id=3196677 Thu, 21 Jan 2010 00:00:00 +0100 3196677 http://www.medworm.com/index.php?rid=3184617&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1568 Cross-country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro-level data from hospitals in different health care systems. To do so, we developed a multi-level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi-level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi-level models are re... Health Economics journals http://www.medworm.com/rss/comments.php?id=3184617 Tue, 19 Jan 2010 00:00:00 +0100 3184617 http://www.medworm.com/index.php?rid=3174735&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1576 The goal of this study was to examine the impact of research activities on hospital costs and lengths of stay in French public hospitals. Our data consist of a random sample of 30 000 inpatient stays in 38 hospitals that were extracted from the French Hospital Cost Survey database. Hospital characteristics were added using data from a French national survey and performing a bibliometric study. This is a retrospective study of hospitalizations. We used multilevel modelling. We considered separate models to explain the cost per day and the length of hospital stay (LOS). Research output was defined based on the quartiles of the distribution of the number of impact-weighted scientific publications produced in our sample of hospitals over a 6-year period. Research production was associated with... Health Economics journals http://www.medworm.com/rss/comments.php?id=3174735 Thu, 14 Jan 2010 00:00:00 +0100 3174735 http://www.medworm.com/index.php?rid=3166195&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1583 The objective of this paper is to investigate the effects of state tobacco control program expenditures on individual-level tobacco use behaviors among young adults. Data come from the 1997, 1999 and 2001 waves of the Harvard School of Public Health College Alcohol Study (CAS). Our findings indicate that a higher level of state spending on tobacco control programs in the prior year is associated with a statistically significant increase in the probability that current daily smokers report at least one attempt to quit smoking in the past year. We also find evidence that higher state expenditures on tobacco control programs in the prior year are associated with reductions in the prevalence of daily smoking and 30-day cigar use among college students. We do not find any statistically signific... Health Economics journals http://www.medworm.com/rss/comments.php?id=3166195 Wed, 13 Jan 2010 00:00:00 +0100 3166195 http://www.medworm.com/index.php?rid=3141519&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1584 This paper proposes a behavioural model of inequality of opportunity in health that integrates John Roemer's framework of inequality of opportunity with the Grossman model of health capital and demand for health. The model generates a recursive system of equations for health and lifestyles, which is then jointly estimated by full information maximum likelihood with freely correlated error terms. The analysis innovates by accounting for the presence of unobserved heterogeneity, therefore addressing the partial-circumstance problem, and by extending the examination of inequality of opportunity to health outcomes other than self-assessed health, such as long-standing illness, disability and mental health. The results provide evidence for the existence of third factors that simultaneously infl... Health Economics journals http://www.medworm.com/rss/comments.php?id=3141519 Tue, 05 Jan 2010 00:00:00 +0100 3141519 http://www.medworm.com/index.php?rid=3114003&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1579 This study examines the contribution of processed foods consumption to the prevalence of overweight/obesity in Guatemala using generalized methods of moments (GMM) regression. The results show that all other things remaining constant, a 10% point increase in the share of partially processed foods from the total household food expenditure increases the BMI of family members (aged 10 years and above) by 3.95%. The impact of highly processed foods is much stronger. A 10% point increase in the share of highly processed food items increases the BMI of individuals by 4.25%, ceteris paribus. The results are robust when body weight is measured by overweight/obesity indicators. These findings suggest that increasing shares of partially and highly processed foods from the total consumption expenditu... Health Economics journals http://www.medworm.com/rss/comments.php?id=3114003 Wed, 23 Dec 2009 00:00:00 +0100 3114003 http://www.medworm.com/index.php?rid=3114006&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1572 The primary statistical challenge that must be addressed when using cross-sectional data to estimate the consequences of consuming addictive substances is the likely endogeneity of substance use. While economists are in agreement on the need to consider potential endogeneity bias and the value of instrumental variables estimation, the selection of credible instruments is a topic of heated debate in the field. Rather than attempt to resolve this debate, our paper highlights the diversity of judgments about what constitutes appropriate instruments for substance use based on a comprehensive review of the economics literature since 1990. We then offer recommendations related to the selection of reliable instruments in future studies. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Ec... Health Economics journals http://www.medworm.com/rss/comments.php?id=3114006 Tue, 22 Dec 2009 00:00:00 +0100 3114006 http://www.medworm.com/index.php?rid=3114005&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1578 We tested the influence of the growth in life expectancy over time on social time preferences for health. Growing life expectancy of future generations should raise social discount rates for health because of diminishing marginal utility of additional health gains and equity reasons reflecting the desire for a more equitable distribution of benefits over generations. This influence has, however, been largely ignored in empirical studies. We provide a first comprehensive analysis of how time preferences for health gains vary with projected growth rates, indicating the importance of subjective expectations about the growth in life expectancy in the elicitation of social time preference. Six hundred and fifty-six respondents, representative of the Dutch population, completed one of four quest... Health Economics journals http://www.medworm.com/rss/comments.php?id=3114005 Tue, 22 Dec 2009 00:00:00 +0100 3114005 http://www.medworm.com/index.php?rid=3114004&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1577 This study investigates the impact of state mental health and SA parity legislation on treatment admission flows and cost-sharing. Fixed effects specifications indicate that mandating comprehensive parity for mental health and SA disorders raises the probability that a treatment admission is privately insured, lowering costs for the individual. Despite some crowd-out of charity care for private insurance, mandates reduce the uninsured probability by a net 2.4 percentage points. States mandating comprehensive parity also see an increase in treatment admissions. Thus, increasing cost-sharing and reducing financial barriers may aid the at-risk population in obtaining adequate SA treatment. Supply constraints mute effect sizes, suggesting that demand-focused interventions need to be complement... Health Economics journals http://www.medworm.com/rss/comments.php?id=3114004 Tue, 22 Dec 2009 00:00:00 +0100 3114004 http://www.medworm.com/index.php?rid=3070191&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1559 A large literature has documented relationships between state clean indoor air laws (SCIALs) and smoking-related outcomes in the United States. These laws vary within states over time and across venues such as schools, government buildings, and bars. Few studies, however, have evaluated whether the effects of SCIALs are plausibly concentrated among workers who should have been directly affected because they worked at locations covered by the venue-specific restrictions. We fill this gap in the literature using data on private sector workers, government employees, school workers, eating and drinking place workers, and bartenders from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. Our quasi-experimental models indicate robust effects of SCIALs restricting smoking in ... Health Economics journals http://www.medworm.com/rss/comments.php?id=3070191 Wed, 09 Dec 2009 00:00:00 +0100 3070191 http://www.medworm.com/index.php?rid=3070192&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1565 We assess the impact of cardiovascular disease (CVD) mortality on economic growth, using a dynamic panel growth regression framework taking into account potential endogeneity problems. In the worldwide sample we detect a non-linear influence of working age CVD mortality rates on growth across the per capita income scale. Splitting the sample (according to the resulting income threshold) into low- and middle-income countries, and high-income countries, we find a robust negative contribution of increasing CVD mortality rates on subsequent five-year growth rates in the latter sample. Not too surprisingly, we find no significant impact in the low- and middle-income country sample. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3070192 Tue, 08 Dec 2009 00:00:00 +0100 3070192 http://www.medworm.com/index.php?rid=3055439&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1570 This research explores the impact of education on health in relation to an individual's country of birth using the US National Health and Nutrition Examination Surveys for 2001-2004. We analyze health equations that relate health to education and other variables. Health is measured in terms of self-reported overall health, an index of biological risk factors, and body mass index. The primary hypothesis tested is whether education has a greater impact on immigrants' productive and allocative efficiency, because of their need to learn about how to remain healthy and access appropriate health care in a new environment. The empirical results indicate that for US residents, who were foreign-born, education is associated with a greater beneficial effect on every health outcome compared to those ... Health Economics journals http://www.medworm.com/rss/comments.php?id=3055439 Fri, 04 Dec 2009 00:00:00 +0100 3055439 http://www.medworm.com/index.php?rid=3055440&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1564 In this study we examine the behavior of 80 practitioners from the Arusha region of Tanzania for evidence of professionalism. We show that about 20% of these practitioners behave professionally, and almost half of those who do so practice in the public sector. These professional health care workers provide high quality care even when they work in an environment that does not reward this effort, a finding that has important implications for the use of performance-based incentives. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3055440 Thu, 03 Dec 2009 00:00:00 +0100 3055440 http://www.medworm.com/index.php?rid=3035472&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1567 In previous work (Health Econ. 2004; 13: 417-427; Health Econ. 2006; 15: 319-322) has suggested that survivor consumption costs should be included in cost-utility analyses only if the corresponding utility gains are also included. Here, it is further argued that the welfare implications of survivor consumption are already known because unlike new medical treatments or interventions whose complex and uncertain outcomes and third-party purchasing make the welfare implications unclear, survivor consumption must have passed a private market welfare test. That is, the gains must have exceeded the costs in order for the survivor consumption to be purchased; therefore, survivor consumption is welfare increasing. The same would apply for survivor leisure forgone. Implications for cost-benefit anal... Health Economics journals http://www.medworm.com/rss/comments.php?id=3035472 Sat, 28 Nov 2009 00:00:00 +0100 3035472 http://www.medworm.com/index.php?rid=3035475&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1566 In this note we explore the welfare properties of access restrictions to health care based on cost effectiveness. We show that such instrument can improve the average effectiveness of health care, but it is optimal only under specific assumptions relating to the shape of the welfare function and the utility of health care. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3035475 Fri, 27 Nov 2009 00:00:00 +0100 3035475 http://www.medworm.com/index.php?rid=3035474&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1563 Over recent years there has been renewed interest in cost-benefit analysis (CBA) in health care but the 'hypothetical bias' concern (i.e. the belief that WTP values overstate real preferences) is a remaining anxiety. This paper reports new empirical data comparing hypothetical and real preferences in a health care context, using the clinical setting of patient self-management (PSM) of anticoagulation (warfarin) therapy. The data offer considerable support for the use of WTP and CBAs in a self-management health care context; the hypothetical bias hypothesis is not supported by our data. The generalisability of these results to other health care settings needs to be explored. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3035474 Fri, 27 Nov 2009 00:00:00 +0100 3035474 http://www.medworm.com/index.php?rid=3035473&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1569 Recent evidence suggests that conditional cash transfer (CCT) programs for schooling are effective in raising school enrolment and attendance. However, there is also reason to believe that such programs can affect other outcomes, such as the sexual behavior of their young beneficiaries. Zomba Cash Transfer Program is a randomized ongoing CCT intervention targeting young women in Malawi that provides incentives (in the form of school fees and cash transfers) to current schoolgirls and recent dropouts to stay in or return to school. An average offer of US$10/month conditional on satisfactory school attendance - plus direct payment of secondary school fees - led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after ju... Health Economics journals http://www.medworm.com/rss/comments.php?id=3035473 Fri, 27 Nov 2009 00:00:00 +0100 3035473 http://www.medworm.com/index.php?rid=3014637&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1561 In this study, we reconsider the relationship between heavy and persistent marijuana use and high school dropout status. Using a unique prospective panel study of over 4500 7th grade students from South Dakota who are followed through high school, we developed propensity score weights to adjust for baseline differences found to exist before marijuana initiation occurs for most students (7th grade). We then used weighted logistic regression that incorporates these propensity score weights to examine the extent to which time-varying factors, including substance use, also influence the likelihood of dropping out of school. We found a positive association between marijuana use and dropping out (OR=5.6, RR=3.8), over half of which was explained by prior differences in observational characterist... Health Economics journals http://www.medworm.com/rss/comments.php?id=3014637 Sat, 21 Nov 2009 00:00:00 +0100 3014637 http://www.medworm.com/index.php?rid=3014641&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1557 This study uses the second National Family Health Survey of India to estimate the effect of state-level public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state's gross fiscal deficit as an instrument for its health spending. Our study shows a 10% increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3014641 Fri, 20 Nov 2009 00:00:00 +0100 3014641 http://www.medworm.com/index.php?rid=3014640&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1562 A number of recent studies find that poor health is empirically associated with a safer portfolio allocation. It is difficult to say, however, whether this relationship is truly causal. Both health status and portfolio choice are influenced by unobserved characteristics such as risk attitudes, impatience, information, and motivation, and these unobserved factors, if not adequately controlled for, can induce significant bias in the estimates of asset demand equations. Using the 1992-2006 waves of the Health and Retirement Study, we investigate how much of the connection between health and portfolio choice is causal and how much is due to the effects of unobserved heterogeneity. Accounting for unobserved heterogeneity with fixed effects and correlated random effects models, we find that heal... Health Economics journals http://www.medworm.com/rss/comments.php?id=3014640 Fri, 20 Nov 2009 00:00:00 +0100 3014640 http://www.medworm.com/index.php?rid=3014639&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1556 The analyst tasked with measuring population health, with appraising healthcare investments, or allocating healthcare resources, may frame their task in one of two possible ways: either as being concerned with health assets (e.g. health expectancy or stock of QALYs), or with health deficits (a 'health gap', analogous to the poverty gap). In this paper, we discuss the consequences of taking the asset or the deficit concept as one's basic building block in developing a health measurement system when one has concerns about equitable distribution. We conclude that building metrics from a primitive health gap concept is possible and indeed may offer insights not otherwise easily accessible. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=3014639 Fri, 20 Nov 2009 00:00:00 +0100 3014639 http://www.medworm.com/index.php?rid=3014638&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1560 This paper proposes a method of deriving a quality indicator for hospitals using mortality outcome measures. The method aggregates any number of mortality outcomes into a single indicator via a two-stage procedure. In the first stage, mortality outcomes are risk-adjusted using a system of seemingly unrelated regression equations. These risk-adjusted mortality rates are then aggregated into a single quality indicator in the second stage via weighted least squares. This method addresses the dimensionality problem in measuring hospital quality, which is multifaceted in nature. In addition, our method also facilitates further analyses of determinants of hospital quality by allowing the resulting quality estimates be associated with hospital characteristics. The method is applied to a sample of... Health Economics journals http://www.medworm.com/rss/comments.php?id=3014638 Fri, 20 Nov 2009 00:00:00 +0100 3014638 http://www.medworm.com/index.php?rid=2907712&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1552 This paper investigates the long-run economic relationship between health care expenditure and income in the US at a State level. Using a panel of 49 US States over the period 1980-2004, we study the non-stationarity and co-integration between health spending and income, ultimately measuring income elasticity of health care. The tests we adopt allow us to explicitly control for cross-section dependence and unobserved heterogeneity. Specifically, in our regression equations we assume that the error has a multifactor structure, which may capture global shocks and local spill overs in health expenditure. Our results suggest that health care is a necessity rather than a luxury, with an elasticity much smaller than that estimated in other US studies. Further, we detect significant spatial conce... Health Economics journals http://www.medworm.com/rss/comments.php?id=2907712 Mon, 19 Oct 2009 23:00:00 +0100 2907712 http://www.medworm.com/index.php?rid=2893503&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1550 This paper employs the Behavioral Risk Factor Surveillance System (2001) data in conjunction with the Environmental Protection Agency's Air Quality System data to investigate how air pollution caused by motor vehicle emissions affects the likelihood of good health and the amount of health investments. Models are estimated using three different measures of overall health: a measure of self-assessed health and two health outcome indicators (asthma and blood pressure). A multivariate probit approach is used to estimate recursive systems of equations for self-assessed health, health outcomes and life-styles. The most interesting result concerns the influence of pollution on health-improving life-style choices: only if traffic pollution is in the 'satisfactory range' (AQI level at or below 100)... Health Economics journals http://www.medworm.com/rss/comments.php?id=2893503 Wed, 14 Oct 2009 23:00:00 +0100 2893503 http://www.medworm.com/index.php?rid=2874817&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1554 Little is known about the possible impact of an influenza pandemic on a nation's economy. We applied the UK macroeconomic model 'COMPACT' to epidemiological data on previous UK influenza pandemics, and extrapolated a sensitivity analysis to cover more extreme disease scenarios. Analysis suggests that the economic impact of a repeat of the 1957 or 1968 pandemics, allowing for school closures, would be short-lived, constituting a loss of 3.35 and 0.58% of GDP in the first pandemic quarter and year, respectively. A more severe scenario (with more than 1% of the population dying) could yield impacts of 21 and 4.5%, respectively. The economic shockwave would be gravest when absenteeism (through school closures) increases beyond a few weeks, creating policy repercussions for influenza pandemic p... Health Economics journals http://www.medworm.com/rss/comments.php?id=2874817 Thu, 08 Oct 2009 23:00:00 +0100 2874817 http://www.medworm.com/index.php?rid=2874820&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1551 Despite its centrality for the provision of health care, physician compensation remains understudied, and existing studies either fail to control for time trends, cover small samples from highly particular settings, or examine empirically negligible changes in reward levels. Using a four-year sample of 59 physicians and 1.1 million encounters, we study how physicians at a network of primary care clinics responded when their salaried compensation plan was replaced with a lower salary plus substantial piece rates for encounters and select procedures. Although patient characteristics remained unchanged, physicians increased encounters by 11 to 61%, both by increasing encounters per day and days worked at the network, and increased procedures to the maximum reimbursable level. Copyright © 200... Health Economics journals http://www.medworm.com/rss/comments.php?id=2874820 Wed, 07 Oct 2009 23:00:00 +0100 2874820 http://www.medworm.com/index.php?rid=2874819&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1549 Real options analysis is a promising approach to model investment under uncertainty. We employ this approach to value stockpiling of antiviral drugs as a precautionary measure against a possible influenza pandemic. Modifications of the real options approach to include risk attitude and deviations from expected utility are presented. We show that risk aversion counteracts the tendency to delay investment for this case of precautionary investment, which is in contrast to earlier applications of risk aversion to real options analysis. Moreover, we provide a numerical example using real world data and discuss the implications of real options analysis for health policy. Suggestions for further extensions of the model and a comparison with the expected value of information analysis are put forwa... Health Economics journals http://www.medworm.com/rss/comments.php?id=2874819 Wed, 07 Oct 2009 23:00:00 +0100 2874819 http://www.medworm.com/index.php?rid=2874818&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1548 In response to the widespread availability of illegal contraband, the federal and five provincial governments in Canada implemented a 40-60% reduction to cigarette excise taxes in February 1994. We exploit this unique and discrete policy shock by estimating the effects of cigarette taxes on youth smoking with data from the 1992-1996 Waterloo Smoking Prevention Program, 1991 General Social Survey, 1994 Youth Smoking Survey, 1996-1997 and 1998-1999 National population Health Surveys, and the 1999 Canadian Tobacco Use Monitoring Survey. Empirical estimates yield daily and occasional participation elasticities from -0.10 to -0.14, which is consistent with findings from recent U.S.-based research. A key contribution of this research is in the analysis of lower taxes on a panel of 591 youths fro... Health Economics journals http://www.medworm.com/rss/comments.php?id=2874818 Wed, 07 Oct 2009 23:00:00 +0100 2874818 http://www.medworm.com/index.php?rid=2831070&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1547 We present a model of contracting between a purchaser of health services and a provider (a hospital). We assume that hospitals provide two alternative treatments for a given diagnosis: a less intensive one (for example, a medical treatment) and a more intensive one (a surgical treatment). We assume that prices are set equal to the average cost reported by the providers, as observed in many OECD countries (yardstick competition). The purchaser has two options: (1) to set one tariff based on the diagnosis only and (2) to differentiate the tariff between the surgical and the medical treatment (i.e. to refine the tariff). We show that when tariffs are refined, the provider has always an incentive to overprovide the surgical treatment. If the tariff is not refined, the hospital underprovides th... Health Economics journals http://www.medworm.com/rss/comments.php?id=2831070 Thu, 24 Sep 2009 23:00:00 +0100 2831070 http://www.medworm.com/index.php?rid=2806581&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1546 Conclusion: Under our base line assumptions a cellular phone ban is likely to be cost saving from a societal perspective. The results are sensitive to parameters for which there is very little information or for which the available information is contradictory. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2806581 Thu, 17 Sep 2009 23:00:00 +0100 2806581 http://www.medworm.com/index.php?rid=2756156&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1545 Conclusions: WTP values to avoid the time and discomfort associated with the screening colonoscopy process were substantially lower than most of the human capital values for elapsed time alone. The human capital method may overestimate the value of time in situations that involve an irregular, episodic series of time intervals, such as preparation for or recovery after colonoscopy. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2756156 Tue, 01 Sep 2009 23:00:00 +0100 2756156 http://www.medworm.com/index.php?rid=2756157&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1542 The HIV-epidemic is one of the greatest public health crises to face South Africa. A health care response to the treatment needs of HIV-positive people is a prime example of the desirability of an economic, rational approach to resource allocation in the face of scarcity. Despite this, almost no input based on economic analysis is currently used in national strategic planning.While cost-utility analysis is theoretically able to establish technical efficiency, in practice this is accomplished by comparing an intervention's ICER to a threshold level representing society's maximum willingness to pay to avoid death and improve health-related quality of life. Such an approach has been criticised for a number of reasons, including that it is inconsistent with a fixed budget for health care and t... Health Economics journals http://www.medworm.com/rss/comments.php?id=2756157 Mon, 31 Aug 2009 23:00:00 +0100 2756157 http://www.medworm.com/index.php?rid=2711201&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1541 This paper estimates the impact of income on the body weight and clinical weight classification of elderly Americans using a natural experiment that led otherwise identical retirees to receive significantly different Social Security payments based on their year of birth. We estimate models of instrumental variables using data from the National Health Interview Surveys and find no significant effect of income on weight. The confidence intervals rule out even moderate effects of income on weight and on the probability of being underweight or obese, especially for men. For example, they indicate that the income elasticity of body mass index is not greater in absolute value than 0.06 for men or 0.14 for women. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2711201 Tue, 18 Aug 2009 23:00:00 +0100 2711201 http://www.medworm.com/index.php?rid=2711202&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1544 The 1918 Influenza Pandemic is used as a natural experiment to test the Fetal Origins Hypothesis. This hypothesis states that individual health as well as socioeconomic outcomes, such as educational attainment, employment status, and wages, are affected by the health of that individual while in utero. Repeated cross sections from the Pesquisa Mensal de Emprego (PME), a labor market survey from Brazil, are used to test this hypothesis. I find evidence to support the Fetal Origins Hypothesis. In particular, compared to individuals born in the few years surrounding the Influenza Pandemic, those who were in utero during the pandemic are less likely to be college educated, be employed, have formal employment, or know how to read and have fewer years of schooling and a lower hourly wage. These r... Health Economics journals http://www.medworm.com/rss/comments.php?id=2711202 Mon, 17 Aug 2009 23:00:00 +0100 2711202 http://www.medworm.com/index.php?rid=2708025&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1534 Cost-effectiveness acceptability curves (CEACs) have become widely used in applied health technology assessment and at the same time are criticized as unreliable decision-making tool. In this paper we show how using CEACs differs from maximizing expected net benefit (NB) and when it can lead to inconsistent decisions. In the case of comparing two alternatives we show the limits of the discrepancy between CEAC and expected NB approach and link it with expected value of perfect information. We also show how the shape of CEAC is influenced by the skewness of estimate of expected NB distribution, the correlation between cost and effect estimates and their variance. In the case of more than two options we show when using CEACs can lead to non-transitive choices in pair-wise comparisons and when... Health Economics journals http://www.medworm.com/rss/comments.php?id=2708025 Mon, 17 Aug 2009 23:00:00 +0100 2708025 http://www.medworm.com/index.php?rid=2708026&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1531 Economic evaluations must use appropriate costing methods. However, in multicentre cost-effectiveness analyses (CEA) a fundamental issue of how best to measure and analyse unit costs has been neglected. Multicentre CEA commonly take the mean unit cost from a national database, such as NHS reference costs. This approach does not recognise that unit costs vary across centres and are unavailable in some centres. This paper proposes the use of multiple imputation (MI) to predict those centre-specific unit costs that are not available, while recognising the statistical uncertainty surrounding this imputation.We illustrate MI with a CEA of a multicentre randomised trial (1014 patients, 60 centres), implemented using multilevel modelling. We use MI to derive centre-specific unit costs, based on c... Health Economics journals http://www.medworm.com/rss/comments.php?id=2708026 Sun, 16 Aug 2009 23:00:00 +0100 2708026 http://www.medworm.com/index.php?rid=2681013&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1540 Recent cross-country studies have questioned the existence of a systematic relationship between per capita health-care expenditure (HCE) and explanatory variables such as income, population ageing and total public expenditure. We reexamine this issue mainly focussing at a flexible semiparametric estimation method that allows the parameters of the model to depend on a state variable. Using the age structure of the population as the state variable, we find that the income elasticity increases with population ageing, while other explanatory variables are not significantly influenced by it. Additionally we find that the HCE relationship becomes more and more unstable in ageing economies. These results explain the difficulty to identify both the influence of population ageing and income on HCE ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2681013 Fri, 07 Aug 2009 23:00:00 +0100 2681013 http://www.medworm.com/index.php?rid=2681014&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1543 This essay discusses research on incentive-based interventions to promote healthy behavior change, contingency management (CM) and conditional cash transfers (CCT). The overarching point of the essay is that CM and CCT are often treated as distinct areas of inquiry when at their core they represent a common approach. Some potential bi-directional benefits of recognizing this commonality are discussed. Distinct intellectual traditions probably account for the separate paths of CM and CCT to date, with the former being rooted in behavioral psychology and the latter in microeconomics. It is concluded that the emerging field of behavioral economics, which is informed by and integrates principles of each of those disciplines, may provide the proper conceptual framework for integrating CM and CC... Health Economics journals http://www.medworm.com/rss/comments.php?id=2681014 Thu, 06 Aug 2009 23:00:00 +0100 2681014 http://www.medworm.com/index.php?rid=2669993&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1538 In a widely cited article, DiMasi, Hansen, and Grabowski (2003) estimate the average pre-tax cost of bringing a new molecular entity to market. Their base case estimate, excluding post-marketing studies, was $802 million (in $US 2000). Strikingly, almost half of this cost (or $399 million) is the cost of capital (COC) used to fund clinical development expenses to the point of FDA marketing approval. The authors used an 11% real COC computed using the capital asset pricing model (CAPM). But the CAPM is a single factor risk model, and multi-factor risk models are the current state of the art in finance. Using the Fama-French three factor model we find that the cost of drug development to be higher than the earlier estimate. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2669993 Tue, 04 Aug 2009 23:00:00 +0100 2669993 http://www.medworm.com/index.php?rid=2666454&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1489 The National Health Service (NHS) in England distributes substantial funds to health-care providers in different geographical areas to pay for the health care required by the populations they serve. The formulae that determine this distribution reflect populations' health needs and local differences in the prices of inputs. Labour is the most important input and area differences in the price of labour are measured by the Staff Market Forces Factor (MFF). This Staff MFF has been the subject of much debate. Though the Staff MFF has operated for almost 30 years this is the first academic paper to evaluate and test the theory and method that underpin the MFF. The theory underpinning the Staff MFF is the General Labour Market method. The analysis reported here reveals empirical support for this... Health Economics journals http://www.medworm.com/rss/comments.php?id=2666454 Mon, 03 Aug 2009 23:00:00 +0100 2666454 http://www.medworm.com/index.php?rid=2666453&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1539 There is increasing evidence suggesting that Medicare beneficiaries do not make fully informed decisions when choosing among alternative Medicare health plans. To the extent that deciphering the intricacies of alternative plans consumes time and money; the Medicare health plan market is one in which search costs may play an important role. To account for this, we split beneficiaries into two groups - those who are informed and those who are uninformed. If uninformed, beneficiaries only use a subset of covariates to compute their maximum utilities, and if informed, they use the full set of variables considered. In a Bayesian framework with Markov Chain Monte Carlo (MCMC) methods, we estimate search cost coefficients based on the minimum and maximum statistics of the search cost distribution... Health Economics journals http://www.medworm.com/rss/comments.php?id=2666453 Mon, 03 Aug 2009 23:00:00 +0100 2666453 http://www.medworm.com/index.php?rid=2656435&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1536 An incentive program for general practitioners to encourage systematic and igh-quality care in chronic disease management was introduced in Australia in 1999. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect. This paper evaluates the impact of the incentive program on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a bivariate probit model to control for the self-selection process of practices into the program. The study finds that the incentive program increased the probability of an HbA1c test being ordered by 20 percentage points and that participation in the program is facilitated by the support of Divisions of General Practice. Copyright... Health Economics journals http://www.medworm.com/rss/comments.php?id=2656435 Thu, 30 Jul 2009 23:00:00 +0100 2656435 http://www.medworm.com/index.php?rid=2656436&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1535 This paper proposes an empirical implementation of the concept of inequality of opportunity in health and applies this to data from the UK National Child Development Study. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socio-economic status and childhood health; effort is proxied by health-related lifestyles and educational attainment. Stochastic dominance tests are used to detect inequality of opportunity in the conditional distributions of self-assessed health in adulthood. Two alternative approaches are used to measure inequality of opportunity. Econometric models are estimated to illuminate and quantify the triangular relationship between circumstances, effort and health. The ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2656436 Wed, 29 Jul 2009 23:00:00 +0100 2656436 http://www.medworm.com/index.php?rid=2637098&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1537 This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers' business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2637098 Fri, 24 Jul 2009 23:00:00 +0100 2637098 http://www.medworm.com/index.php?rid=2637099&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1533 This article is focused on children providing and financing long-term care for their elderly parent. The aim of this work is to highlight the interactions that may take place among siblings when deciding whether or not to become a caregiver. We look at families with two children using data from the Survey of Health, Ageing and Retirement in Europe; our sample contains 314 dependent elderly and their 628 adult children. In order to identify the interactions between siblings, we have specified a two-person discrete game model. To estimate this model, without invoking the 'coherency' condition, we have added an endogenous selection rule to solve the incompleteness problem arising from multiplicity or absence of equilibrium. Our empirical results suggest that the three classical effects identi... Health Economics journals http://www.medworm.com/rss/comments.php?id=2637099 Thu, 23 Jul 2009 23:00:00 +0100 2637099 http://www.medworm.com/index.php?rid=2619859&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1532 No Abstract (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2619859 Mon, 20 Jul 2009 23:00:00 +0100 2619859 http://www.medworm.com/index.php?rid=2615189&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1530 Using German census data, we estimate the causal effect of education on smoking and overweight/obesity using the abolition of secondary school fees as instrumental variable. The West German federal states enacted this reform at different dates after World War II, generating exogenous variation in the access to secondary education. While we find a strong association between schooling and health behaviors using OLS, we do not find support for the notion that education causes better health behavior. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2615189 Sat, 18 Jul 2009 23:00:00 +0100 2615189 http://www.medworm.com/index.php?rid=2600525&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1529 This paper investigates whether higher education (HE) produces non-pecuniary returns via a reduction in the intensity of consumption of health-damaging substances. In particular, it focuses on current smoking intensity of the British individuals sampled in the 29-year follow-up survey of the 1970 British Cohort Study. We estimate endogenous dummy ordinal response models for cigarette consumption and show that HE is endogenous with respect to smoking intensity and that even when endogeneity is accounted for, HE is found to have a strong negative effect on smoking intensity. Moreover, pecuniary channels, such as occupation and income, mediate only a minor part of the effect of HE. Our results are robust to modelling individual self-selection into current smoking participation (at age 29) and... Health Economics journals http://www.medworm.com/rss/comments.php?id=2600525 Tue, 14 Jul 2009 23:00:00 +0100 2600525 http://www.medworm.com/index.php?rid=2583236&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1528 This article analyses the role played by childhood circumstances, especially social and family background in explaining health status among older adults. We explore the hypothesis of an intergenerational transmission of health inequalities using the French part of SHARE. As the impact of both social background and parents' health on health status in adulthood represents circumstances independent of individual responsibility, this study allows us testing the existence in France of inequalities of opportunity in health related to family and social background. Empirically, our study relies on tests of stochastic dominance at first order and multivariate regressions, supplemented by a counterfactual analysis to evaluate the long-lasting impact of childhood conditions on inequality in health. A... Health Economics journals http://www.medworm.com/rss/comments.php?id=2583236 Wed, 08 Jul 2009 23:00:00 +0100 2583236 http://www.medworm.com/index.php?rid=2572596&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1512 We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, using the death of the care recipient and sibling characteristics. We also carefully control for baseline health and work status of the adult child. We explore flexible specifications, such as Arellano-Bond estimation techniques. Continued caregiving over time increases depressive symptoms and decreases self-rated health for married women and married men. In addition, the increase in depressive symptoms is persistent for married women. While depressive symptoms for single men and women are not affected by continued caregiving, there is evidence of increased inciden... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572596 Sun, 05 Jul 2009 23:00:00 +0100 2572596 http://www.medworm.com/index.php?rid=2572595&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1503 High costs and deficits in the care of patients with chronic diseases have triggered numerous programs to improve the quality and efficiency of treatment of chronic diseases. Decision makers need to estimate the impact of a disease management program (DMP) on long-term costs and cost-effectiveness in order to decide which programs to introduce. This prediction, however, requires formalizing the relations between a variety of variables. The purpose of this paper is to formalize these relations and develop a model that enhances the quality of predictions of the costs and cost-effectiveness of a DMP. The model's cost function is able to portray a reduction both of treatment overuse and underuse by improving both physician and patient compliance. The model's applicability is demonstrated by a ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572595 Sun, 05 Jul 2009 23:00:00 +0100 2572595 http://www.medworm.com/index.php?rid=2572594&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1514 Faced with state budget troubles, policymakers may introduce or increase State Children's Health Insurance Program (SCHIP) premiums for children in the highest program income eligibility categories. In this paper we compare the responses of SCHIP recipients in a state (Kentucky) that introduced SCHIP premiums for the first time at the end of 2003 with the responses of recipients in a state (Georgia) that increased existing SCHIP premiums in mid-2004. We start with a theoretical examination of how these different policies create different changes to family budget constraints and produce somewhat different financial incentives for recipients. Next we empirically model the impact of these policies using a competing risk approach to differentiate exits due to transfers to other eligibility cat... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572594 Sun, 05 Jul 2009 23:00:00 +0100 2572594 http://www.medworm.com/index.php?rid=2572593&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1526 This paper contributes to the literature on the relationship between adolescent depression and educational attainment in several ways. First, while cross-sectional data are normally used, this paper uses longitudinal data in order to defend against the potential of reverse causality. Second, this is the first paper in the literature to control for sibling-fixed effects in examining the relationship between adolescent depressive symptoms and human capital accumulation. Importantly, this eliminates omitted factors such as family and neighborhood characteristics common to siblings that affect both depressive symptoms and educational attainments (e.g. neighborhood crime, and family resources). Third, this paper examines the effects of both an indicator and scale of depressive symptoms and find... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572593 Sun, 05 Jul 2009 23:00:00 +0100 2572593 http://www.medworm.com/index.php?rid=2572592&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1523 We reassess the impact of health on retirement plans of older workers using a unique survey-register match-up which allows comparing the retirement effects of potentially biased survey self-reports of health to those of unbiased register-based diagnostic measures. The aim is to investigate whether even for narrowly defined health measures a divergence exists in the impacts of health on retirement between self-reported health and objective physician-reported health. Our sample consists of older workers and retirees drawn from a Danish panel survey from 1997 and 2002, merged to longitudinal register data. Estimation of measurement error-reduced and selection-corrected pooled OLS and fixed effects models of retirement show that receiving a medical diagnosis is an important determinant of reti... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572592 Sun, 05 Jul 2009 23:00:00 +0100 2572592 http://www.medworm.com/index.php?rid=2572591&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1524 In this paper we employ a theoretical framework - a simple macro model augmented with health - that draws guidance from the Keynesian view of business cycles to examine the relative importance of permanent and transitory shocks in explaining variations in health expenditure and output at business cycle horizons for the USA. The variance decomposition analysis of shocks reveals that at business cycle horizons permanent shocks explain the bulk of the variations in output, while transitory shocks explain the bulk of the variations in health expenditures. We undertake a shock decomposition analysis for private health expenditures versus public health expenditures and interestingly find that while transitory shocks are more important for private sector expenditures, permanent shocks dominate pu... Health Economics journals http://www.medworm.com/rss/comments.php?id=2572591 Sun, 05 Jul 2009 23:00:00 +0100 2572591 http://www.medworm.com/index.php?rid=2555190&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1527 No Abstract (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2555190 Mon, 29 Jun 2009 23:00:00 +0100 2555190 http://www.medworm.com/index.php?rid=2501020&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1520 This paper is one of only a few studies to examine potential labor market consequences of heavy or abusive drinking in Latin America and the first to focus on Uruguay. We analyzed data from a Uruguayan household survey conducted in 2006 using propensity score matching methods and controlling for a number of socio-demographic, family, regional, behavioral health, and labor market characteristics. As expected, we found a positive association between heavy drinking and absenteeism, particularly for female employees. Counter to the findings for developed countries, our results revealed a positive relationship between heavy drinking and labor force participation or employment. This result was mostly driven by men and weakened when considering more severe measures of abusive drinking. Possible e... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501020 Wed, 24 Jun 2009 23:00:00 +0100 2501020 http://www.medworm.com/index.php?rid=2501036&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1507 With a total population of more than 1.3 billion people where more than 31% of adults smoke, China has become the world's largest producer and consumer of cigarettes. We adopt a life-course perspective to study the economics of smoking behavior in China. We use data from the China Health and Nutrition Survey (CHNS) to follow individuals over their whole lives and to analyze their decisions to both start and stop smoking. We extend the small but growing body of economic research on smoking in China. Our life-course approach emphasizes that current smoking participation reflects a decision to start and a series of past decisions to not quit. We explore how the determinants of smoking initiation differ from the determinants of smoking cessation. We find results, consistent with some previous ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501036 Mon, 22 Jun 2009 23:00:00 +0100 2501036 http://www.medworm.com/index.php?rid=2501035&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1511 This paper has two parts. The first part examines the regional health expenditure inequality in China by testing two hypotheses on health expenditure convergence. Cross-section regressions and cluster analysis are used to study the health expenditure convergence and to identify convergence clusters. We find no single nationwide convergence, only convergence by cluster. In the second part of the paper, we investigate the long-run relationship between health expenditure inequality, income inequality, and provincial government budget deficits (BD) by using new panel cointegration tests with health expenditure data in China's urban and rural areas. We find that the income inequality and real provincial government BD are useful in explaining the disparity in health expenditure prevailing betwee... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501035 Mon, 22 Jun 2009 23:00:00 +0100 2501035 http://www.medworm.com/index.php?rid=2501034&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1519 To solve the problem of 'Kan bing nan, kan bing gui' (medical treatment is difficult to access and expensive), a Harvard-led research team implemented a community-based health insurance scheme known as Rural Mutual Health Care (RMHC) in Chinese rural areas from 2004 to 2006. Two major policies adopted by RMHC included insurance coverage of outpatient services (demand-side policy) and drug policy (supply-side policy). This paper focuses on the effects of these two policies on outpatient service utilization in Chinese village clinics. The data used in this study are from 3-year household follow-up surveys. A generalized negative binomial regression model and a Heckman selection model were constructed using panel data from 2005 to 2007. The results indicate that the price elasticities of dema... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501034 Mon, 22 Jun 2009 23:00:00 +0100 2501034 http://www.medworm.com/index.php?rid=2501033&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1510 The overall goal of the paper is to understand the progress of the design and implementation of China's New Cooperative Medical System (NCMS) program between 2004 (the second year of the program) and 2007. In the paper we seek to assess some of the strengths and weaknesses of the program using a panel of national-representative, household survey data that were collected in 2005 and early 2008. According to our data, we confirm the recent reports by the Ministry of Health that there have been substantial improvements to the NCMS program in terms of coverage and participation. We also show that rural individuals also perceive an improvement in service by 2007. While the progress of the NCMS program is clear, there are still weaknesses. Most importantly, the program clearly does not meet one ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501033 Mon, 22 Jun 2009 23:00:00 +0100 2501033 http://www.medworm.com/index.php?rid=2501032&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1517 China has introduced a system of community health centers (CHCs) to provide primary care. To test whether services provided by such centers are more cost-effective than treatment at local higher-level hospitals, the study compared health outcomes and expenditures for patients with hypertension and diabetes mellitus in three cities. We hypothesized that treating patients in stable condition at CHCs is less costly than providing treatment in higher-level hospitals with no differences in health outcomes. Results indicate that daily drug and other medical expenditures were consistently equal or lower for patients seeking treatment in CHCs than for those treated in hospitals. Patients also saved time by visiting CHCs. Health outcomes, measured as mean arterial pressure for hypertension and plas... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501032 Mon, 22 Jun 2009 23:00:00 +0100 2501032 http://www.medworm.com/index.php?rid=2501031&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1522 Payment methods can affect providers' behaviour and in turn influence the outcome of medical services. The per-diem reimbursement method is predicted to increase length of stay (LOS) and reduce daily expenditure. Using a Difference in Differences design, this study empirically examines the impact of changing from fee-for-service to per-diem reimbursement in a large psychiatric hospital in Beijing. Results show that the LOS did not increase but daily expenditure in fact increased. We provide several potential explanations for these puzzling findings, including the internal contracts between the hospitals and their physician staff among public hospitals in China. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2501031 Mon, 22 Jun 2009 23:00:00 +0100 2501031 http://www.medworm.com/index.php?rid=2501030&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1500 This study presents the first economic analysis of URBMI, following a national household survey in nine representative Chinese cities. The survey aimed to answer three questions: Who is covered by the plan? Who gains from the plan? Who is most satisfied with the plan? We have found that there is a U-shaped relationship between URBMI participation rate and income. That is, the extremely rich or poor are the most likely to participate. Those with any inpatient treatment last year or with any chronic disease are also more likely to enroll in URBMI, indicating adverse selection into participation. We have also found that in reducing financial barriers to care, URBMI most significantly benefits the poor and those with previous inpatient care. Finally, those participants in the bottom 20% of fam... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501030 Mon, 22 Jun 2009 23:00:00 +0100 2501030 http://www.medworm.com/index.php?rid=2501029&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1508 Since the dissolution of the Rural Cooperative Medical System at the end of the commune period, illness has emerged as a leading cause of poverty in rural China. To address the poor state of health care, the Chinese government unveiled the New Cooperative Medical System in 2002. Because local governments have been given significant control over program design, fundamental characteristics of the program vary from one county to the next. These differences may influence the decision to seek health care as well as the choice of hospital conditional on that initial decision. In this paper, we use a nested logit model to analyze household survey data from 25 counties to analyze the determinants of such health-seeking behavior. We find that age, the share of household expenditures allocated to fo... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501029 Mon, 22 Jun 2009 23:00:00 +0100 2501029 http://www.medworm.com/index.php?rid=2501028&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1501 This paper explores the impact of the New Cooperative Medical Scheme (NCMS), a newly adopted public health insurance program in rural China. Using a longitudinal sample drawn from the China Health and Nutrition Survey (CHNS), we employed multiple estimation strategies (individual fixed-effect models, instrumental variable estimation, and difference-in-differences estimation with propensity score matching) to correct the potential selection bias. We find that participating in the NCMS significantly decreases the use of traditional Chinese folk doctors and increases the utilization of preventive care, particularly general physical examinations. However, we do not find that the NCMS decreases out-of-pocket expenditure nor do we find that it increases utilization of formal medical service or i... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501028 Mon, 22 Jun 2009 23:00:00 +0100 2501028 http://www.medworm.com/index.php?rid=2501027&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1518 This paper provides a survey of the recent empirical research on China's 'old' health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g. the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, th... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501027 Mon, 22 Jun 2009 23:00:00 +0100 2501027 http://www.medworm.com/index.php?rid=2501026&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1525 No Abstract (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2501026 Mon, 22 Jun 2009 23:00:00 +0100 2501026 http://www.medworm.com/index.php?rid=2501025&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1516 No Abstract (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2501025 Mon, 22 Jun 2009 23:00:00 +0100 2501025 http://www.medworm.com/index.php?rid=2501021&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1513 Including informal care in economic evaluations is increasingly advocated but problematic. We investigated three well-known concerns regarding contingent valuation (CV): (1) the item non-response of CV values, (2) the sensitivity of CV values to the individual circumstances of caring, and (3) the choice of valuation method by comparing willingness-to-pay (WTP) and willingness-to-accept (WTA) values for a hypothetical marginal change in hours of informal care currently provided.The study sample consisted of 1453 caregivers and 787 care recipients. Of the caregivers, 603 caregivers (41.5%) provided both WTP and WTA values, 983 (67.7%) provided at least one. Determinants of non-response were dependent on the valuation method; primary determinants were education and satisfaction with amount of... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501021 Mon, 22 Jun 2009 23:00:00 +0100 2501021 http://www.medworm.com/index.php?rid=2501022&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1521 The number of Americans who are overweight or obese has reached epidemic proportions. Elevated weight is associated with health problems and increased medical expenditures. This paper analyzes Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions to investigate the role of alcohol consumption in weight gain. Alcohol is not only an addictive substance but also a high-calorie beverage that can interfere with metabolic function and cognitive processes. Because men and women differ in the type and amount of alcohol they consume, in the biological effects they experience as a result of alcohol consumption, and in the consequences they face as a result of obesity, we expect our results to differ by gender. We use first-difference models of body mass index (BMI) a... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501022 Sun, 21 Jun 2009 23:00:00 +0100 2501022 http://www.medworm.com/index.php?rid=2501024&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1509 The role of regional primary-care organizations (PCOs) in health-care systems is not well understood. This is the first study to attempt to isolate the effect of regional PCOs on primary-care performance. We examine Divisions of General Practice in Australia, which were established in 1992. A unique Division-level panel data set is used to examine the effect of Divisions, and their activities, on various aspects of primary-care performance. Dynamic panel estimation is used to account for state dependence and the endogeneity of Divisions' activities. The results show that Divisions were more likely to have influenced general practice infrastructure than clinical performance in diabetes, asthma and cervical screening. The effect of specific Division activities, such as providing support for ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501024 Wed, 17 Jun 2009 23:00:00 +0100 2501024 http://www.medworm.com/index.php?rid=2501023&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1506 We develop a principal-agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non-gatekeeping approaches to health care when patient self-health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non-gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self-health information is neither highly inaccurate (in which case the patient's self-referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly). Copyright © 2009 John Wiley & Sons, Ltd. (Sourc... Health Economics journals http://www.medworm.com/rss/comments.php?id=2501023 Wed, 17 Jun 2009 23:00:00 +0100 2501023 http://www.medworm.com/index.php?rid=2462455&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1502 This paper examines the impact of self-reported work limitations on the labour force participation of the Australian working age population. Five consecutive waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey are used to investigate this relationship. A two-equation dynamic panel data model demonstrates that persistence and unobserved heterogeneity play an important role in work limitation reporting and its effect on labour force participation. Unobserved factors that jointly drive work limitation and participation are also shown to be crucial, especially for women. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2462455 Mon, 08 Jun 2009 04:00:00 +0100 2462455 http://www.medworm.com/index.php?rid=2462457&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1505 An important issue in the measurement of health status concerns the extent to which an instrument displays lack of sensitivity to changes in health status at the extremes of the distribution, known as floor and ceiling effects. Previous studies use relatively simple methods that focus on the mean of the distribution to examine these effects. The aim of this paper is to determine whether quantile regression using longitudinal data improves our understanding of the relationship between quality of life instruments. The study uses EQ-5D and SF-36 (converted to SF-6D values) instruments with both baseline and follow-up data. Relative to ordinary least least-squares (OLS), a first difference model shows much lower association between the measures, suggesting that OLS methods may lead to biased e... Health Economics journals http://www.medworm.com/rss/comments.php?id=2462457 Fri, 05 Jun 2009 04:00:00 +0100 2462457 http://www.medworm.com/index.php?rid=2462456&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1504 This study concerns the choice of primary dental service provider by consumers. If the health service delivery system allows individuals to choose between public-care providers or if complementary private services are available, it is typically assumed that utilisation is a three-stage decision process. The patient first makes a decision to seek care, and then chooses the service provider. The final stage, involving decisions over the amount and form of treatment, is not considered here. The paper reports a discrete choice experiment (DCE) designed to evaluate attributes affecting individuals' choice of dental-care provider. The feasibility of the DCE approach in modelling consumers' choice in the context of non-acute need for dental care is assessed. The aim is to test whether a separate ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2462456 Fri, 05 Jun 2009 04:00:00 +0100 2462456 http://www.medworm.com/index.php?rid=2426534&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1497 In societal priority setting between health programs for different patient groups, many people are reluctant to discriminate too strongly between those who can benefit much from treatment and those who can benefit moderately. We suggest that this view of distributive fairness has a counterpart in personal valuations of gains in health. Such valuations may be influenced by psychological reference points and diminishing marginal utility such that the individual utility of care in patient groups with different potentials may be more similar than what conventional QALY estimates suggest. In interviews in three convenience samples, there is some support for the hypothesis. Most respondents do not think that desire for treatment is significantly less in those who stand to gain only moderately co... Health Economics journals http://www.medworm.com/rss/comments.php?id=2426534 Thu, 21 May 2009 04:00:00 +0100 2426534 http://www.medworm.com/index.php?rid=2411805&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1498 Health-care expenditure regressions are used in a wide variety of economic analyses including risk adjustment and program and treatment evaluations. Recent articles demonstrated that generalized gamma models (GGMs) and extended estimating equations (EEE) models provide flexible approaches to deal with a variety of data problems encountered in expenditure estimation. To date there have been few empirical applications of these models to expenditures. We use data from the US Medical Expenditure Panel Survey to compare the bias, predictive accuracy, and marginal effects of GGM and EEE models with other commonly used regression models in a cross-validation study design. Health-care expenditure distributions vary in the degree of heteroskedasticity, skewness, and kurtosis by type of service and ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2411805 Mon, 11 May 2009 04:00:00 +0100 2411805 http://www.medworm.com/index.php?rid=2401992&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1496 In a probabilistic sensitivity analysis (PSA) of a cost-effectiveness (CE) study, the unknown parameters are considered as random variables. A crucial question is what probabilistic distribution is suitable for synthesizing the available information (mainly data from clinical trials) about these parameters. In this context, the important role of Bayesian methodology has been recognized, where the parameters are of a random nature. We explore, in the context of CE analyses, how formal objective Bayesian methods can be implemented. We fully illustrate the methodology using two CE problems that frequently appear in the CE literature. The results are compared with those obtained with other popular approaches to PSA. We find that the discrepancies can be quite marked, specially when the number ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2401992 Sun, 10 May 2009 04:00:00 +0100 2401992 http://www.medworm.com/index.php?rid=2401993&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1499 The assumption of risk neutrality over discounted life years underlies the standard QALY model of individual preferences over health outcomes, and is thus implicitly assumed by NICE and other health technology advisory bodies worldwide. The primary objective of this article is to report a study to test the assumption in a convenience sample of 30 respondents with use of the probability equivalence version of the standard gamble. The results indicate considerable risk aversion over life years, and therefore call into question the standard assumption of risk neutrality in practical cost-utility analyses (CUA). A secondary objective is to observe whether risk aversion can be reduced through the use of the lottery equivalents method, under the hypothesis that the gambling effect can be lessene... Health Economics journals http://www.medworm.com/rss/comments.php?id=2401993 Thu, 07 May 2009 04:00:00 +0100 2401993 http://www.medworm.com/index.php?rid=2379547&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1471 Several papers in the leading health economics journals modeled the determinants of healthcare expenditure using household survey or family budgets data of developed countries. Past work largely used self-reported current income as the core determinant, whereas the theoretically correct concept of household resource constraint is permanent or long-run income (á lá Milton Friedman). This paper strives to rectify the theoretical oversight of using current income by augmenting the model with household asset. Using longitudinal data, we constructed 'wealth index' as a distinct covariate to capture the households' tendency to liquidate assets when defraying necessary healthcare liabilities after exhausting cash incomes. (Current income and assets together capture the household expanded resour... Health Economics journals http://www.medworm.com/rss/comments.php?id=2379547 Thu, 30 Apr 2009 04:00:00 +0100 2379547 http://www.medworm.com/index.php?rid=2379548&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1494 We analyze the influence of technological progress on pharmaceuticals on rising health expenditures using US State level panel data. Improvements in medical technology are believed to be partly responsible for rapidly rising health expenditures. Even if the technological progress in medicine improves health outcomes and life quality, it can also increase the expenditure on health care. Our findings suggest that newer drugs increase the spending on prescription drugs since they are usually more expensive than their predecessors. However, they lower the demand for other types of medical services, which causes the total spending to decline. We estimate that a 1-year decrease in the average age of prescribed drugs causes per capita health expenditures to decrease by $45.43. The biggest decline... Health Economics journals http://www.medworm.com/rss/comments.php?id=2379548 Wed, 29 Apr 2009 04:00:00 +0100 2379548 http://www.medworm.com/index.php?rid=2373544&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1492 Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health-care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly becau... Health Economics journals http://www.medworm.com/rss/comments.php?id=2373544 Wed, 29 Apr 2009 04:00:00 +0100 2373544 http://www.medworm.com/index.php?rid=2373547&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1436 This paper examines the relationship of medical malpractice litigation and medical costs in the United States. We relate medical malpractice settlements to medical costs for 190 metro and non-metro areas in the United States over a 5-year period and find that litigation is positively and significantly related to medical costs. Using a panel data set and a fixed-effects specification, the estimates indicate that malpractice litigation accounts for roughly 2-10% of medical expenditures, with the impact exceeding the dollar amount of settlements. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2373547 Mon, 27 Apr 2009 04:00:00 +0100 2373547 http://www.medworm.com/index.php?rid=2373546&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1495 This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2373546 Mon, 27 Apr 2009 04:00:00 +0100 2373546 http://www.medworm.com/index.php?rid=2373545&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1493 Traditional sample size calculations for randomized clinical trials are based on the tests of hypotheses and depend on somewhat arbitrarily chosen factors, such as type I and II errors rates and the smallest clinically important difference. In response to this, many authors have proposed the use of methods based on the value of information as an alternative. Previous attempts have assumed perfect implementation, i.e. if current evidence favors the new intervention and no new information is sought or expected, all future patients will receive it. A framework is proposed to allow for this assumption to be relaxed. The profound effect that this can have on the optimal sample size and expected net gain is illustrated on two recent examples. In addition, a model for assessing the value of imple... Health Economics journals http://www.medworm.com/rss/comments.php?id=2373545 Mon, 27 Apr 2009 04:00:00 +0100 2373545 http://www.medworm.com/index.php?rid=2352599&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1485 This study aims to examine the differences between one dynamic and one static model, estimating the effects of therapeutic treatment with antiviral (AV) drugs during an influenza pandemic in the Netherlands. Specifically, we focus on the sensitivity of the cost-effectiveness ratios to model choice, to the assumed drug coverage, and to the value of several epidemiological factors. Therapeutic use of AV-drugs is cost-effective compared with non-intervention, irrespective of which model approach is chosen. The findings further show that: (1) the cost-effectiveness ratio according to the static model is insensitive to the size of a pandemic, whereas the ratio according to the dynamic model increases with the size of a pandemic; (2) according to the dynamic model, the cost per infection and the... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352599 Tue, 21 Apr 2009 04:00:00 +0100 2352599 http://www.medworm.com/index.php?rid=2352609&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1470 This paper analyzes the decision to start smoking using data from the German Socio-Economic Panel (GSOEP). Our focus is on the role that parental smoking behavior plays for children's smoking initiation. The data used are a combination of retrospective information on the age individuals started smoking and, by tracing back these individuals within the panel structure up to that point, information on characteristics at the age of smoking initiation. In contrast to the previous literature it is possible to control for the environment at the time of smoking onset that might have influenced the decision to start. Our preferred specification of a discrete time hazard model indicates that parental smoking significantly increases the offspring's hazard to start smoking. While this effect is most ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352609 Mon, 20 Apr 2009 04:00:00 +0100 2352609 http://www.medworm.com/index.php?rid=2352607&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1477 Cost-effectiveness analyses (CEA) alongside randomised controlled trials commonly estimate incremental net benefits (INB), with 95% confidence intervals, and compute cost-effectiveness acceptability curves and confidence ellipses. Two alternative non-parametric methods for estimating INB are to apply the central limit theorem (CLT) or to use the non-parametric bootstrap method, although it is unclear which method is preferable. This paper describes the statistical rationale underlying each of these methods and illustrates their application with a trial-based CEA. It compares the sampling uncertainty from using either technique in a Monte Carlo simulation. The experiments are repeated varying the sample size and the skewness of costs in the population. The results showed that, even when dat... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352607 Mon, 20 Apr 2009 04:00:00 +0100 2352607 http://www.medworm.com/index.php?rid=2352605&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1486 Systematic reviews of studies of effectiveness are the centrepiece of evidence-based medicine and policy making. Increasingly, systematic reviews of economic evaluations are also an expected input into much evidence-based policy making, with some health economists even calling for 'an economics approach to systematic review'.This paper questions the value of conducting systematic reviews of economic evaluations to inform decision making in health care. It argues that the value of systematic reviews of economic evaluations is usually undermined by three things. Firstly, compared with effectiveness studies, there is a much wider range of factors that limit the generalisability of cost-effectiveness results, over time and between health systems and service settings, including the context-depe... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352605 Mon, 20 Apr 2009 04:00:00 +0100 2352605 http://www.medworm.com/index.php?rid=2352603&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1483 Given resource scarcity, not all potentially beneficial health services can be funded. Choices are made, if not explicitly, implicitly as some health services are funded and others are not. But what are the primary influences on those choices? We sought to test whether funding decisions are linked to cost effectiveness and to quantify the influence of funding arrangements and community values arguments. We tested this via empirical analysis of 245 Australian health-care interventions for which cost-effectiveness estimates had been published. The likelihood of government funding was modelled as a function of cost effectiveness, patient/target group characteristics, intervention characteristics and publication characteristics, using multiple regression analysis. We found that higher cost eff... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352603 Mon, 20 Apr 2009 04:00:00 +0100 2352603 http://www.medworm.com/index.php?rid=2352602&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1481 Although the threshold of cost effectiveness of medical interventions is thought to be £20 000-£30 000 in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23 000 (U... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352602 Mon, 20 Apr 2009 04:00:00 +0100 2352602 http://www.medworm.com/index.php?rid=2352600&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1488 In this paper, I use a social interactions framework to detect whether individual smoking decisions are influenced by classmate smoking decisions. There are several large challenges in addressing this question, including the endogeneity of school (and thus classmates) through residential location choices, 'third factors' such as school-level unobservables that influence individual and classmate choices simultaneously, and the difficulty of the identification of parameters in empirical models of social interactions. In order to address these issues, I use an instrumental variables/fixed effects methodology that compares students in different grades within the same high school who face a different set of classmates and classmates' decisions. Preferred specifications suggest that increasing t... Health Economics journals http://www.medworm.com/rss/comments.php?id=2352600 Mon, 20 Apr 2009 04:00:00 +0100 2352600 http://www.medworm.com/index.php?rid=2338531&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1487 Conclusions: The employment status of HIV-positive individuals is directly related to their health status and other personal characteristics. Policies to improve the well-being of HIV-positive individuals should not be limited to any one sector as their needs require strategies with a multidisciplinary approach. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2338531 Sat, 18 Apr 2009 04:00:00 +0100 2338531 http://www.medworm.com/index.php?rid=2338533&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1480 We analyzed the impacts of nativity and mental health (MH) on work by gender for non-elderly adults using the 2002 National Survey on Drug Use and Health. We employed two indicators of MH - the K6 scale of Mental Illness (MI) and an indicator for symptoms of Mania or Delusions (M/D). Instrumental variable (IV) models used measures of social support as instruments for MI. Unadjusted work rates were higher for immigrants (vs US-born adults). Regressions show that MI is associated with lower rates of work among US-born males but not immigrant males and females; M/D is associated lower rates of work among US-born males and females, and among immigrant males. Results did not change using IV models for MI. Most persons with MI work, yet symptom severity reduces labor supply among natives especia... Health Economics journals http://www.medworm.com/rss/comments.php?id=2338533 Wed, 15 Apr 2009 04:00:00 +0100 2338533 http://www.medworm.com/index.php?rid=2338532&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1479 This paper explains and empirically assesses the channels through which population aging may impact on income-related health inequality. Long panel data of Swedish individuals is used to estimate the observed trend in income-related health inequality, measured by the concentration index (CI). A decomposition procedure based on a fixed effects model is used to clarify the channels by which population aging affects health inequality. Based on current income rankings, we find that conventional unstandardized and age-gender-standardized CIs increase over time. This trend in CIs is, however, found to remain stable when people are instead ranked according to lifetime (mean) income. Decomposition analyses show that two channels are responsible for the upward trend in unstandardized CIs - retired ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2338532 Wed, 15 Apr 2009 04:00:00 +0100 2338532 http://www.medworm.com/index.php?rid=2321113&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1484 Many preventive healthcare procedures are widely recognized as cost-effective but have relatively low utilization rates in the US. Because preventive care is a present-period investment with a future-period expected financial return, enrollee turnover among private insurers lowers the expected return of this investment. In this paper, I present a simple theoretical model to illustrate the suboptimal provision of preventive healthcare that results from insurers 'free riding' off of the provision from others. I also provide an empirical test of this hypothesis using data from the Community Tracking Study's Household Survey. I use lagged market-level measures of employment-induced insurer turnover to identify variation in insurers' expectations and test for the effect of turnover on several d... Health Economics journals http://www.medworm.com/rss/comments.php?id=2321113 Fri, 10 Apr 2009 04:00:00 +0100 2321113 http://www.medworm.com/index.php?rid=2321121&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1476 Consumers' price responsiveness is central to US health-care reform proposals, but the best available estimates are now more than 25 years old. We estimate health-care demands by calculating expected end-of-year prices and incorporating them into a zero-inflated ordered probit model applied to several overlapping panels of data from 1996 to 2003. Results from our correlated random effects specification indicate that the price responsiveness of ambulatory mental health treatment has decreased substantially and is now slightly lower than physical health treatment. This suggests that concerns over moral hazard alone do not warrant less generous coverage for mental health. However, prescription drug demand is more price elastic. Published in 2009 by John Wiley & Sons, Ltd. (Source: Health Econ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2321121 Tue, 07 Apr 2009 04:00:00 +0100 2321121 http://www.medworm.com/index.php?rid=2321119&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1482 Using an expected utility approach, we show that within a population that differs with respect to the probability of developing a disease, the allocation of preventive care resources should be prioritized based on the efficiency of prevention and not on whether individuals are at high or low risk of developing the disease. Should the efficiency of prevention be the same within the population, we show that the gravity of the disease, the presence of co-morbidities and the existence of uncertainty on health status can alternatively be considered so as to prioritize among preventive care resources. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2321119 Tue, 07 Apr 2009 04:00:00 +0100 2321119 http://www.medworm.com/index.php?rid=2321117&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1475 The current air quality limit values for airborne pollutants in the UK are low by historical standards and are at levels that are believed not to harm health. We assess whether this view is correct. We examine the relationship between common sources of airborne pollution and population mortality for England. We use data at local authority level for 1998-2005 to examine whether current levels of airborne pollution, as measured by annual mean concentrations of carbon monoxide, nitrogen dioxide, particulate matter less than 10 µm in diameter (PM10) and ozone, are associated with excess deaths. We examine all-cause mortality and deaths from specific cardiovascular and respiratory causes that are known to be exacerbated by air pollution. The panel nature of our data allows us to control for an... Health Economics journals http://www.medworm.com/rss/comments.php?id=2321117 Tue, 07 Apr 2009 04:00:00 +0100 2321117 http://www.medworm.com/index.php?rid=2321115&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1478 The effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. Within this institutional background, we find only weak evidence of adverse selection in the coverage of supplemental health insurance. We find much stronger effects of socio-economic background. We estimate a bivariate probit model and cannot reject the assumption of exogeneity of insurance availability for the explanation of health-care use. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spel... Health Economics journals http://www.medworm.com/rss/comments.php?id=2321115 Tue, 07 Apr 2009 04:00:00 +0100 2321115 http://www.medworm.com/index.php?rid=2294153&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1469 There is a debate about the extent to which the effect of prenatal smoking on infant health outcomes is causal. Poor outcomes could be attributable to mother characteristics, which are correlated with smoking. I examine the importance of selection on the effect of prenatal smoking by using three British cohorts where the mothers' knowledge about the harms of prenatal smoking varied substantially. I find that the effect of smoking on the probability of a low birth weight birth conditional on gestation is slightly more than twice as large in 2000 compared with 1958, implying that selection could explain as much as 50% of the current association between smoking and birth outcomes. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2294153 Fri, 27 Mar 2009 04:00:00 +0100 2294153 http://www.medworm.com/index.php?rid=2281672&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1474 After criticizing existing systems of health measurement for their unargued commitment to evaluating health states in terms of preferences or well-being, this essay argues that public rather than private values of health states should help guide the allocation of health-related resources. Private evaluation of health states is relative to a prior individual choice of specific activities and goals, while public evaluation is relative to the whole range of important activities and goals. Public evaluation is concerned with securing a wide range of choices as well as with success given one's choice. A reasonable simplification from the public perspective is to focus on just two features of health states: the subjective feelings attached to health states and the limitations that health states ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2281672 Sun, 22 Mar 2009 04:00:00 +0100 2281672 http://www.medworm.com/index.php?rid=2281678&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1445 There is growing interest in the role of social relationships in explaining patterns of health. We contribute to this debate by investigating the impact of social capital on self-reported health for eight countries from the Commonwealth of Independent States. We rely on three indicators of social capital at the individual level (trust, participation in local organisations, social isolation) and employ alternative procedures to estimate consistently the impact of social capital on health. The three social capital indicators are choice variables and are hence, by definition, endogenously determined. We attempt to circumvent the endogeneity problems by using instrumental variable estimates. Our results show that the individual degree of trust is positively and significantly correlated with he... Health Economics journals http://www.medworm.com/rss/comments.php?id=2281678 Thu, 19 Mar 2009 04:00:00 +0100 2281678 http://www.medworm.com/index.php?rid=2281676&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1472 When measuring health inequality using ordinal data, analysts typically must choose between indices specifically based upon ordinal data and more standard indices using ordinal data, which has been transformed into cardinal data. This paper compares inequality rankings across a number of different approaches and finds considerable sensitivity to the choice between ordinal- and cardinal-based indices. There is relatively little sensitivity to the ethical choices made by the analyst in terms of the weight attached to different parts of the distribution. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2281676 Thu, 19 Mar 2009 04:00:00 +0100 2281676 http://www.medworm.com/index.php?rid=2281674&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1473 This study begins to address this gap through an analysis of the consumer market for malaria treatment in rural areas of three districts in Tanzania. We developed methods for investigating market definition, sales volumes and concentration, and used these to explore the relationship between antimalarial retail prices and competition.The market was strongly geographically segmented and highly concentrated in terms of antimalarial sales. Antimalarial prices were positively associated with market concentration. High antimalarial prices were likely to be an important factor in the low proportion of care-seekers obtaining appropriate treatment.Retail sector distribution of subsidised antimalarials has been proposed to increase the coverage of effective treatment, but this analysis indicates tha... Health Economics journals http://www.medworm.com/rss/comments.php?id=2281674 Thu, 19 Mar 2009 04:00:00 +0100 2281674 http://www.medworm.com/index.php?rid=2272177&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1464 This article first summarizes the time patterns in economic research on diseases and health in developing countries for 1990-2005. It then compares those time patterns with the distribution of disability-adjusted life years (DALYs) for diseases and health conditions in developing countries estimated for 2005 and for 2030. These comparisons suggest relatively overemphasis on HIV/AIDS and underemphasis on noncommunicable diseases (NCDs). This opens the possibility for individuals or organizations initiating, re-evaluating, or increasing their economic research on health and development to make a significant contribution by focusing particularly on the analysis of behaviour and policy choices related to NCDs. Careful consideration must, of course, be given to other demands, but on the basis o... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272177 Tue, 17 Mar 2009 04:00:00 +0100 2272177 http://www.medworm.com/index.php?rid=2272174&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1463 How did rapid growth in per capita income and rising income inequality during 1991-2000 in China affect the health status of Chinese children, given that the disappearance in the 1990s of subsidized food coupons simultaneously increased the importance of money income in enabling consumption of basic foods by poor families? Using the China Health and Nutrition Survey data for 1991, 1993, 1997, and 2000 on 4400 households in nine provinces, we examine the height-for-age of Chinese children aged 2-13, with particular emphasis on the growth of children living in poor households. We use mean regression and quantile regression models to isolate the dynamic impact of poverty status and food coupon use on child height-for-age. Our principal findings are: (i) controlling for standard variables (e.g... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272174 Tue, 17 Mar 2009 04:00:00 +0100 2272174 http://www.medworm.com/index.php?rid=2272173&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1462 This paper argues that indicators of anthropometric shortfall - especially low height and low weight-for-age - are uniquely suited for assessing absolute deprivation in developing countries. Anthropometric indicators are relatively precise, readily available for most countries, reflect the preferences and concerns of many poor people, consistent with reckoning the phenomenon directly in the space of functionings, intuitive, easy to use for advocacy, and consistent over time and across subgroups. Anthropometric indicators can therefore complement (but not replace) standard indicators of income/consumption poverty, especially for comparisons across subgroups, within households, across countries, and in the long run. In addition, the paper analyses spells of change in malnutrition over time, ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272173 Tue, 17 Mar 2009 04:00:00 +0100 2272173 http://www.medworm.com/index.php?rid=2272172&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1461 This paper proposes a new method to measure health inequalities that are caused by conditions amenable to policy intervention. The method is built on a technique that can separate avoidable and unavoidable mortality risks, using world mortality data compiled by the World Health Organization for the year 2000. The new method is applied to data from 191 countries. It is found that controlling for unavoidable mortality risks leads to a lower estimate of health inequality than otherwise, especially for developed countries. Furthermore, although countries with a higher life expectancy at birth tend to have lower health inequality, there are significant variations in health inequalities across countries with the same life expectancy. The results therefore support the WHO's plea for using health ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272172 Tue, 17 Mar 2009 04:00:00 +0100 2272172 http://www.medworm.com/index.php?rid=2272171&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1460 This paper analyses the recent evolution of life expectancy in Latin American and Caribbean countries, and evaluates how much it has contributed to the overall improvements in welfare. We argue that increases in life expectancy between 1960 and 2000, which were largely independent of income, represented gains in welfare comparable to the ones derived from income growth. For countries in the region, estimates of welfare improvements accounting for health increase the numbers obtained from income alone by 40% on average. The available evidence suggests that improvements in public health infrastructure - such as provision of treated water and sewerage services - and large-scale immunization programs may have been the key factors behind the mortality reductions observed in the period. Copyrigh... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272171 Tue, 17 Mar 2009 04:00:00 +0100 2272171 http://www.medworm.com/index.php?rid=2272169&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1459 This paper examines the relationship between level of well-being and inequality at inter-country and intra-household levels, using individuals' body mass index (BMI) rather than income as the indicator of well-being. BMI is useful for these purposes because (1) it is measured at the individual rather than household level; (2) it reflects command over food, but also non-food resources that affect health status like sanitary conditions and labour-saving technologies; (3) it accounts for caloric consumption relative to needs; (4) it is easily measured; and (5) any measurement error is likely to be random. We do not find any evidence to support the idea of an intra-household or inter-country Kuznets curve. We study the correlations between average household well-being, still measured by BMI, a... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272169 Tue, 17 Mar 2009 04:00:00 +0100 2272169 http://www.medworm.com/index.php?rid=2272166&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1456 This paper looks at health inequality and deprivation, with a particular focus on developing countries. It is specifically concerned with relationships between health and income, especially the extent to which inequality and deprivation in the former is driven by changes in the latter. The paper reports increasing disparity in child mortality among country groups since the mid-1970s. It also reports decreased inequality in life expectancy among countries from the early 1960s until the late 1980s and increased inequality thereafter. Similar patterns in life expectancy deprivation are reported. The paper finds that this is partly due to a changing behavioural relationship between life expectancy and income per capita among countries with low achievement in the former variable. The paper also... Health Economics journals http://www.medworm.com/rss/comments.php?id=2272166 Tue, 17 Mar 2009 04:00:00 +0100 2272166 http://www.medworm.com/index.php?rid=2238471&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1455 The influence of current medical technology adoption decisions on the use of future potential interventions is often overlooked. Some health interventions, once exercised, restrict future potential interventions for both related and unrelated medical conditions. For example, treatment of a patient with an antibiotic may lead to resistance in that patient that precludes future treatment with the same or related compounds. This irreversibility raises the value of treatment modalities that preserve future treatment options. Surprisingly, partial reversibility with or without learning can either increase or decrease this value, depending on the distribution of patient types within the treated population. Evaluations that ignore these option values miss an important part of the welfare equation... Health Economics journals http://www.medworm.com/rss/comments.php?id=2238471 Fri, 06 Mar 2009 05:00:00 +0100 2238471 http://www.medworm.com/index.php?rid=2238470&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1465 This study used panel data collected in 2002, 1 year prior to the intervention, and followed up in 2005, 2 years after the intervention, both in the intervention and control sites. We measured health status using both a 5-point Categorical Rating Scale and the EQ-5D instruments. The estimation method used here is difference-in-difference combined propensity score matching. The results show that RMHC has a positive effect on the health status of participants. Among the five dimensions of EQ-5D, RMHC significantly reduces pain/discomfort and anxiety/depression for the general population, and has a positive impact on mobility and usual activity for those over 55-years old. Our study provides useful policy information on the development of health insurance in developing countries, and also ide... Health Economics journals http://www.medworm.com/rss/comments.php?id=2238470 Fri, 06 Mar 2009 05:00:00 +0100 2238470 http://www.medworm.com/index.php?rid=2238469&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1441 This paper focuses on the switching behaviour of enrolees in the Swiss basic health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there is limited evidence of premium convergence within cantons. This indicates that competition has not been effective so far, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of supplementary insurance. We use survey data on health plan choice (a sample of 1943 individuals whose switching behaviours were observed between 1997 and 2000) as well as administrative data relative to all insurance companies that ope... Health Economics journals http://www.medworm.com/rss/comments.php?id=2238469 Fri, 06 Mar 2009 05:00:00 +0100 2238469 http://www.medworm.com/index.php?rid=2238468&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1468 The 'missing women' dilemma in India has sparked great interest in investigating gender discrimination in the provision of health care in the country. No studies, however, have directly examined discrimination in health-care financing strategies in the case of severe illness of sons versus daughters. In this paper, we hypothesize that households who face tight budget constraints are more likely to spend their meager resources on hospitalization of boys rather than girls. We use the 60th round of the Indian National Sample Survey (2004) and a multinomial logit model to test this hypothesis and to throw some light on this important but overlooked issue. The results reveal that boys are much more likely to be hospitalized than girls. When it comes to financing, the gap in the usage of househo... Health Economics journals http://www.medworm.com/rss/comments.php?id=2238468 Fri, 06 Mar 2009 05:00:00 +0100 2238468 http://www.medworm.com/index.php?rid=2238467&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1452 Responses of inattentive or inconsistent subjects in stated-choice (SC) surveys can lead to imprecise or biased estimates. Several SC studies have investigated inconsistency and most of these studies dropped subjects who were inconsistent. However, none of these studies reported who is more likely to fail consistency tests. We investigated the effect of the personal characteristics and task complexity on preference inconsistency in eight different SC surveys. We found that white, higher-income and better-educated female subjects were less likely to fail consistency tests. Understanding the characteristics of subjects who are inattentive to the choice task may help in designing and pre-testing instruments that work effectively for a wider range of subjects. Copyright © 2009 John Wiley & So... Health Economics journals http://www.medworm.com/rss/comments.php?id=2238467 Fri, 06 Mar 2009 05:00:00 +0100 2238467 http://www.medworm.com/index.php?rid=2238466&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1457 Conclusions: We find separate testing in existing VCT programs to be only marginally worthwhile. However, in scaled-up programs the benefit-cost ratio is over three. Dual testing is always more beneficial than separate testing. However, this advantage is reduced in scaled-up programs. VCT should be greatly expanded throughout Tanzania as future returns would be even higher for both separate and joint counseling and HIV testing. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2238466 Fri, 06 Mar 2009 05:00:00 +0100 2238466 http://www.medworm.com/index.php?rid=2220786&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1458 Depression is a common condition among patients with HIV. This paper uses panel data for 1234 participants from the Women's Interagency HIV Study to estimate the effect of antidepressant use on the likelihood of being employed among women receiving highly active antiretroviral therapy (HAART) in the United States from 1996 to 2004. We show that naive regressions of antidepressant use on employment generally result in negative or non-significant coefficients, whereas the instrumental variables (IVs) approach shows a positive and significant effect of antidepressant use on the employment probability of women living with HIV. We use IVs to predict antidepressant use independently of outcomes, thus addressing potential biases (e.g. more depressed women are more likely to receive antidepressant... Health Economics journals http://www.medworm.com/rss/comments.php?id=2220786 Sat, 28 Feb 2009 05:00:00 +0100 2220786 http://www.medworm.com/index.php?rid=2220789&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1454 This paper replicates DiMasi et al. (J. Health Econ. 2003; 22: 151-185; Drug Inf. J. 2004; 38: 211-223) estimates of expenditure on new drug development using publicly available data. The paper estimates that average expenditure on drugs in human clinical trials is around $27m per year, with $17m per year on drugs in Phase I, $34m on drugs in Phase II and $27m per year on drugs in Phase III of the human clinical trials. The paper's estimated expenditure on new drug development is somewhat greater than suggested by the survey results presented in DiMasi et al. (J. Health Econ. 2003; 22: 151-185; Drug Inf. J. 2004; 38: 211-223). The paper combines a 12-year panel of research and development expenditure for 183 publicly traded firms in the pharmaceutical industry with panel of drugs in human ... Health Economics journals http://www.medworm.com/rss/comments.php?id=2220789 Thu, 26 Feb 2009 05:00:00 +0100 2220789 http://www.medworm.com/index.php?rid=2220788&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1467 The utility-based approach to health measurement, exemplified by EQ-5D and Health Utilities Index (HUI), has been challenged on a theoretical basis, but the statistical implications of such an approach have received little attention. To empirically investigate this issue, psychometric properties and statistical efficiency of the EQ-5D and HUI Mark 3 (HUI3) classifiers were compared when scored using preference weighted (WPS) and equally weighted summary scores using two longitudinal datasets (nstroke=124; nrehabilitation=264). Test-retest reliability, construct validity, responsiveness, and relative efficiency (RE) ratios (with bootstrapped 95% confidence intervals) were examined. WPS had slightly lower test-retest reliability, particularly for EQ-5D (intraclass correlation coefficient=0.6... Health Economics journals http://www.medworm.com/rss/comments.php?id=2220788 Thu, 26 Feb 2009 05:00:00 +0100 2220788 http://www.medworm.com/index.php?rid=2220787&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1466 Vietnam's health care fund for the poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces, and all households living in communes officially designated as highly disadvantaged. As of 2006, the program, which started in 2003, covered around 60% of those eligible. Those who were covered (about 20% of the population) were disproportionately poor, and around 80% of those covered were eligible. Estimates of the program's impact were obtained using a method that takes into account unobserved heterogeneity - including unobserved idiosyncratic returns - but requires minimal assumptions. The downside is that it provides an estimate only of the program's impact on those covered by it; it cannot therefore answer the question... Health Economics journals http://www.medworm.com/rss/comments.php?id=2220787 Thu, 26 Feb 2009 05:00:00 +0100 2220787 http://www.medworm.com/index.php?rid=2181104&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1439 This paper examines the economics of pricing practices at artificial reproductive clinics, which have introduced money-back guarantees (MBGs) for in vitro fertilization. We identify incentives for clinics to offer MBGs and evaluate the impact on couples' choices and on social welfare. Introducing MBGs allows a clinic to (i) segment couples simultaneously on their relative fertility and on risk preferences; (ii) offer quantity discounts to relatively infertile couples; and (iii) offer some risk-sharing to couples for this costly procedure, whose outcome is uncertain. Our results also show how the addition of MBGs can affect the overall social welfare. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2181104 Fri, 13 Feb 2009 05:00:00 +0100 2181104 http://www.medworm.com/index.php?rid=2181105&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1449 Today, one of the most pressing concerns of health-care policymakers in industrialized countries are deficits in the quality of health care. This paper presents a decision program that addresses the question in which disease areas and at what intensity to invest in quality improvement (QI) in order to maximize population health. The decision program considers both a budget constraint as well as time constraints of educators and health professionals to participate in educational activities. The calculations of the model are based on a single assumption which is that more intense quality efforts lead to larger QIs, but with diminishing returns. This assumption has been validated by previous studies. All other relationships described by the model are deduced from this assumption. The model us... Health Economics journals http://www.medworm.com/rss/comments.php?id=2181105 Wed, 11 Feb 2009 05:00:00 +0100 2181105 http://www.medworm.com/index.php?rid=2171798&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1440 Financial incentives may increase performance on targeted activities and have unintended consequences for untargeted activities. An innovative pay-for-performance scheme was introduced for UK general practices in 2004. It incentivised particular quality indicators for targeted groups of patients. We estimate the intended and unintended consequences of this Quality and Outcomes Framework (QOF) using dynamic panel probit models estimated on individual patient records from 315 general practices over the period 2000/1-2005/6. We focus on annual rates of recording of blood pressure, smoking status, cholesterol, body mass index and alcohol consumption. The recording of each risk factor is designated as incentivised or unincentivised for each individual based on whether they have one of the disea... Health Economics journals http://www.medworm.com/rss/comments.php?id=2171798 Tue, 10 Feb 2009 05:00:00 +0100 2171798 http://www.medworm.com/index.php?rid=2171797&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1438 Older people are intensive users of hospital and long-term care services. This paper explores the extent to which these services are substitutes. A small area analysis was used with both care home and (tariff cost-weighted) hospital utilisation for older people aggregated to electoral wards in England.Health and social-care structural equations were specified using a theoretical model. The estimation accounted for the skewed and censored nature of the data. For health utilisation, both a fixed effects instrumental variables GMM model and a generalised estimating equations (GEE) model were fitted, the later on a log dependent variable with predicted values of social care utilisation used to account for endogeneity (bootstrapping was used to derive standard errors). In addition to a GMM mode... Health Economics journals http://www.medworm.com/rss/comments.php?id=2171797 Tue, 10 Feb 2009 05:00:00 +0100 2171797 http://www.medworm.com/index.php?rid=2171796&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1444 Health economic decision models are based on specific assumptions relating to model structure and parameter estimation. Validation of these models is recommended as an indicator of reliability, but is not commonly reported. Furthermore, models derived from different data and employing different assumptions may produce a variety of results.A Markov model for evaluating the long-term cost-effectiveness of screening for abdominal aortic aneurysm is described. Internal, prospective and external validations are carried out using individual participant data from two randomised trials. Validation is assessed in terms of total numbers and timings of key events, and total costs and life-years. Since the initial model validates well only internally, two further models are developed that better fit t... Health Economics journals http://www.medworm.com/rss/comments.php?id=2171796 Tue, 10 Feb 2009 05:00:00 +0100 2171796 http://www.medworm.com/index.php?rid=2159511&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1447 This paper examines the factors affecting the number of patient visits per week reported by family physicians in Ontario. The way that a physician is paid is potentially endogenous to the number of patients seen per week, thus an instrumental variable method of estimation is employed to account for the endogeneity bias. Once account is taken of the endogeneity of remuneration as well as relevant physician and practice characteristics, the estimated elasticity of output with respect to hours worked is 0.74; 0.68 in group practices and 0.82 in solo practices. Physicians paid on a non-fee-for-service (NFFS) conduct 15-31% fewer patient visits per week in comparison to those paid under an FFS scheme. Certain patient populations in practices affect patient visits in important ways, as do a numb... Health Economics journals http://www.medworm.com/rss/comments.php?id=2159511 Thu, 05 Feb 2009 05:00:00 +0100 2159511 http://www.medworm.com/index.php?rid=2159516&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1437 Conclusion: Physicians' perception of patients' preferences are quite different from those of the general population. However, among general population and physicians, Canadian and US preferences were similar. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2159516 Tue, 03 Feb 2009 05:00:00 +0100 2159516 http://www.medworm.com/index.php?rid=2159515&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1429 This study tests empirically this claim using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). The sample includes nine European countries: Austria, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain and Sweden. For specialist consultation, we find that individuals with high education experience a reduction in waiting times of 68% in Spain, 67% in Italy and 34% in France (compared with individuals with low education). Individuals with intermediate education report a waiting-time reduction of 74% in Greece (compared with individuals with low education). There is also evidence of a negative and significant association between education and waiting times for non-emergency surgery in Denmark, the Netherlands and Sweden. High education reduces waits by 66, 3... Health Economics journals http://www.medworm.com/rss/comments.php?id=2159515 Tue, 03 Feb 2009 05:00:00 +0100 2159515 http://www.medworm.com/index.php?rid=2159514&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1448 The bidding game (BG) method of contingent valuation is one way to increase the precision of willingness to pay (WTP) estimates relative to the single dichotomous choice approach. However, there is evidence that the method may lead to incentive incompatible responses and be associated with starting point bias. While previous studies in health using BGs test for starting point bias, none have also investigated incentive incompatibility. Using a sample of respondents resident in Burkina Faso, West Africa, this paper examines whether the BG method is associated with both incentive incompatibility and starting point bias. We find evidence for both effects. However, average WTP values remained largely unaffected after accounting for both factors in multivariate analyses. The results suggest tha... Health Economics journals http://www.medworm.com/rss/comments.php?id=2159514 Tue, 03 Feb 2009 05:00:00 +0100 2159514 http://www.medworm.com/index.php?rid=2159513&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1435 This paper investigates whether there are differences in patient outcomes across different types of hospitals using patient-level data on readmission and mortality associated with acute myocardial infarction (AMI). Hospitals are grouped according to their ownership type (private, public teaching, public non-teaching) and their location (metropolitan, country and remote country). Using data collected from 130 Victorian hospitals on 19 000 patients admitted to a hospital with their first AMI between January 2001 and December 2003, we consider how the likelihood of unplanned re-admission and mortality varies across hospital type. We find that there are significant differences across hospital types in the observed patient outcomes - private hospitals persistently outperform public hospitals. C... Health Economics journals http://www.medworm.com/rss/comments.php?id=2159513 Tue, 03 Feb 2009 05:00:00 +0100 2159513 http://www.medworm.com/index.php?rid=2159512&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1451 The Medicare stand-alone prescription drug plan (PDP) came into existence in 2006 as part of the Medicare prescription drug benefit. It is the most popular plan type among Medicare drug plans and large numbers of plans are available to all beneficiaries. In this article we present the first analysis of beneficiary price sensitivity in the PDP market. Our estimate of elasticity of enrollment with respect to premium, -1.45, is larger in magnitude than has been found in the Medicare HMO market. This high degree of beneficiary price sensitivity for PDPs is consistent with relatively low product differentiation, low fixed costs of entry in the PDP market, and the fact that, in contrast to changing HMOs, beneficiaries can select a PDP without disrupting doctor-patient relationships. Published in... Health Economics journals http://www.medworm.com/rss/comments.php?id=2159512 Tue, 03 Feb 2009 05:00:00 +0100 2159512 http://www.medworm.com/index.php?rid=2103725&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1434 Understanding the costs associated with early detection of disease is important for determining the fiscal implications of government-funded screening programs. We estimate the lifetime medical costs for patients with screen-detected versus undetected polyps and early-stage colorectal cancer. Typically, cost-effectiveness studies of screening account only for the direct costs of screening and cancer care. Our estimates include costs for unrelated conditions. We applied the Kaplan-Meier Smoothing Estimator to estimate lifetime costs for beneficiaries with screen-detected polyps and cancer. Phase-specific costs and survival probabilities were calculated from the Surveillance, Epidemiology, and End Results-Medicare database for Medicare beneficiaries aged [ge]65. We estimate costs from the po... Health Economics journals http://www.medworm.com/rss/comments.php?id=2103725 Wed, 14 Jan 2009 05:00:00 +0100 2103725 http://www.medworm.com/index.php?rid=2103729&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1430 The rising rate of obesity has reached epidemic proportions and is now one of the most serious public health challenges facing the US. However, the underlying causes for this increase are unclear. This paper examines the effect of family income changes on body mass index (BMI) and obesity using data from the National Longitudinal Survey of Youth 1979 cohort. It does so by using exogenous variation in family income in a sample of low-income women and men. This exogenous variation is obtained from the correlation of their family income with the generosity of state and federal Earned Income Tax Credit (EITC) program benefits. Income is found to significantly raise the BMI and probability of being obese for women with EITC-eligible earnings, and have no appreciable effect for men with EITC-eli... Health Economics journals http://www.medworm.com/rss/comments.php?id=2103729 Tue, 13 Jan 2009 05:00:00 +0100 2103729 http://www.medworm.com/index.php?rid=2103728&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1431 The effects of prenatal care utilization on birth weight (BW) may vary by unobserved fetal health endowments. This heterogeneity will be masked by estimating the effects at BW mean but can be evaluated by estimating the effects at BW quantiles as fetal health endowment is a strong correlate with the BW quantile order. We estimated the effects of prenatal care visits and delay before prenatal care initiation, on BW mean and quantiles using a sample of infants from Argentina. Self-selection into prenatal care was modeled using 2SLS and instrumental variable quantile regression. Results suggest that the 'mean' effect of prenatal care utilization largely underestimates the effects at lower BW quantiles. About 35 and 77 g increase in BW mean and 0.1 quantile respectively, per visit and about 30... Health Economics journals http://www.medworm.com/rss/comments.php?id=2103728 Tue, 13 Jan 2009 05:00:00 +0100 2103728 http://www.medworm.com/index.php?rid=2103727&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1426 This study raises some important issues about the use of ordinal data to produce cardinal health state valuations. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2103727 Tue, 13 Jan 2009 05:00:00 +0100 2103727 http://www.medworm.com/index.php?rid=2103726&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1427 This study is a first attempt to quantify the impact of this change on inmate health. As morbidity measures are not readily obtainable, we focus on mortality. More specifically, we use a panel of state prisons from 1979 to 1990 and a fixed effects Poisson model to estimate the change in mortality associated with increase in the percentage of medical personnel employed under contract. In contrast to the first stated aim of contracting, we find that a 13% increase in percentage of medical personnel employed under contract increases mortality by 1.3%. Copyright © 2009 John Wiley & Sons, Ltd. (Source: Health Economics) Health Economics journals http://www.medworm.com/rss/comments.php?id=2103726 Tue, 13 Jan 2009 05:00:00 +0100 2103726 http://www.medworm.com/index.php?rid=2051211&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1432 This article analyzes the effect of gatekeeper and network restrictions on use of health-care services using simulation-based estimation methods. Data from the Community Tracking Survey (1996-1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office-based visits to non-physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary-care provider have more visits to non-physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out-of-network services have more office-based and emergency room visits, but less surgeries a... Health Economics journals http://www.medworm.com/rss/comments.php?id=2051211 Sat, 20 Dec 2008 05:00:00 +0100 2051211 http://www.medworm.com/index.php?rid=2051214&cid=s_33632_51_f&fid=33632&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhec.1422 This paper compares two quite different approaches to estimating costs: a 'bottom-up' approach, represented by the US Department of Veterans Affairs' (VA) Decision Support System that uses local costs of specific inputs; and a 'top-down' approach, represented by the costing system created by the VA Health Economics Resource Center, which assigns the VA national healthcare budget to specific products using various weighting systems. Total annual costs per patient plus the cost for specific services (e.g. clinic visit, radiograph, laboratory, inpatient admission) were compared using scatterplots, correlations, mean difference, and standard deviation of individual differences. Analysis are based upon 2001 costs for 14 915 patients at 72 facilities. Correlations ranged from 0.24 for the cost o... Health Economics journals http://www.medworm.com/rss/comments.php?id=2051214 Thu, 18 Dec 2008 05:00:00 +0100 2051214