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Health expenditure and income in the United StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: Health Economics - October 19, 2009 Category: Health Management Authors: F. Moscone, E. Tosetti Source Type: journals

The influence of traffic-related pollution on individuals' life-style: results from the BRFSSEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 interesti...
Source: Health Economics - October 14, 2009 Category: Health Management Authors: Cinzia Di Novi Source Type: journals

The possible macroeconomic impact on the UK of an influenza pandemicEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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%, respectivel...
Source: Health Economics - October 8, 2009 Category: Health Management Authors: Marcus R. Keogh-Brown, Simon Wren-Lewis, W. John Edmunds, Philippe Beutels, Richard D. Smith Source Type: journals

How sensitive is physician performance to alternative compensation schedules? Evidence from a large network of primary care clinicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 e...
Source: Health Economics - October 7, 2009 Category: Health Management Authors: Lorens A. Helmchen, Anthony T. Lo Sasso Source Type: journals

Investment in antiviral drugs: a real options approachEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Health Economics - October 7, 2009 Category: Health Management Authors: Arthur E. Attema, Anna K. Lugnér, Talitha L. Feenstra Source Type: journals

Estimating the impacts of cigarette taxes on youth smoking participation, initiation, and persistence: empirical evidence from CanadaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - October 7, 2009 Category: Health Management Authors: Anindya Sen, Tony Wirjanto Source Type: journals

DRG prospective payment systems: refine or not refine?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 s...
Source: Health Economics - September 24, 2009 Category: Health Management Authors: Elin Johanna Gudrun Hafsteinsdottir, Luigi Siciliani Source Type: journals

The cost-effectiveness of a law banning the use of cellular phones by driversEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Health Economics - September 17, 2009 Category: Health Management Authors: Daniel Sperber, Alan Shiell, Ken Fyie Source Type: journals

Willingness-to-pay to avoid the time spent and discomfort associated with screening colonoscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Health Economics - September 1, 2009 Category: Health Management Authors: Daniel E. Jonas, Louise B. Russell, Jon Chou, Michael Pignone Source Type: journals

Equity and efficiency in HIV-treatment in South Africa: the contribution of mathematical programming to priority settingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - August 31, 2009 Category: Health Management Authors: Susan Cleary, Gavin Mooney, Di McIntyre Source Type: journals

The impact of income on the weight of elderly AmericansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Health Economics - August 18, 2009 Category: Health Management Authors: John Cawley, John Moran, Kosali Simon Source Type: journals

Testing the Fetal Origins Hypothesis in a developing country: evidence from the 1918 Influenza PandemicEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pa...
Source: Health Economics - August 17, 2009 Category: Health Management Authors: Richard E. Nelson Source Type: journals

Cost-effectiveness acceptability curves - caveats quantifiedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 a...
Source: Health Economics - August 17, 2009 Category: Health Management Authors: Micha[lstrok] Jakubczyk, Bogumi[lstrok] Kami[nacute]ski Source Type: journals

Improving costing methods in multicentre economic evaluation: the use of multiple imputation for unit costsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 wi...
Source: Health Economics - August 16, 2009 Category: Health Management Authors: Richard Grieve, John Cairns, Simon G. Thompson Source Type: journals

The determinants of health-care expenditure: new results from semiparametric estimationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 re...
Source: Health Economics - August 7, 2009 Category: Health Management Authors: Helmut Herwartz, Bernd Theilen Source Type: journals

Comments on contingency management and conditional cash transfersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 o...
Source: Health Economics - August 6, 2009 Category: Health Management Authors: Stephen T. Higgins Source Type: journals

Drug development costs when financial risk is measured using the Fama-French three-factor modelEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - August 4, 2009 Category: Health Management Authors: John A. Vernon, Joseph H. Golec, Joseph A. Dimasi Source Type: journals

The role of the staff MFF in distributing NHS funding: taking account of differences in local labour market conditionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Health Economics - August 3, 2009 Category: Health Management Authors: Robert Elliott, Ada Ma, Matt Sutton, Diane Skatun, Nigel Rice, Stephen Morris, Alex McConnachie Source Type: journals

Search costs and Medicare plan choiceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Bayesia...
Source: Health Economics - August 3, 2009 Category: Health Management Authors: Ian M. McCarthy, Rusty Tchernis Source Type: journals

The effects of an incentive program on quality of care in diabetes managementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 probabil...
Source: Health Economics - July 30, 2009 Category: Health Management Authors: Anthony Scott, Stefanie Schurer, Paul H. Jensen, Peter Sivey Source Type: journals

Inequality of opportunity in health: evidence from a UK cohort studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - July 29, 2009 Category: Health Management Authors: Pedro Rosa Dias Source Type: journals

Does job loss cause ill health?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ©...
Source: Health Economics - July 24, 2009 Category: Health Management Authors: Martin Salm Source Type: journals

Providing care for an elderly parent: interactions among siblings?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 sel...
Source: Health Economics - July 23, 2009 Category: Health Management Authors: Roméo Fontaine, Agnès Gramain, Jérôme Wittwer Source Type: journals

Hospital-based pay-for-performance in the United StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No Abstract (Source: Health Economics)
Source: Health Economics - July 20, 2009 Category: Health Management Authors: Andrew Ryan Source Type: journals

Secondary school fees and the causal effect of schooling on health behaviorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Health Economics - July 18, 2009 Category: Health Management Authors: Steffen Reinhold, Hendrik Jürges Source Type: journals

Non-pecuniary returns to higher education: the effect on smoking intensity in the UKEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 a...
Source: Health Economics - July 14, 2009 Category: Health Management Authors: Massimiliano Bratti, Alfonso Miranda Source Type: journals

Inequality of opportunities in health in France: a first passEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Health Economics - July 8, 2009 Category: Health Management Authors: Alain Trannoy, Sandy Tubeuf, Florence Jusot, Marion Devaux Source Type: journals

Caring for mom and neglecting yourself? The health effects of caring for an elderly parentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 sym...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: Norma B. Coe, Courtney Harold Van Houtven Source Type: journals

A model to predict the cost-effectiveness of disease management programsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: Afschin Gandjour Source Type: journals

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 incentiv...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: James Marton, Patricia G. Ketsche, Mei Zhou Source Type: journals

Adolescent depression and educational attainment: results using sibling fixed effectsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 educ...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: Jason M. Fletcher Source Type: journals

The impact of health on individual retirement plans: self-reported versus diagnostic measuresEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 measu...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: Nabanita Datta Gupta, Mona Larsen Source Type: journals

Modelling health and output at business cycle horizons for the USAEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 expenditu...
Source: Health Economics - July 5, 2009 Category: Health Management Authors: Paresh Kumar Narayan Source Type: journals

Contingent valuation: (still) on the road to nowhere?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No Abstract (Source: Health Economics)
Source: Health Economics - June 29, 2009 Category: Health Management Authors: Richard D. Smith, Tracey H. Sach Source Type: journals

Alcohol use and the labor market in UruguayEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 dri...
Source: Health Economics - June 24, 2009 Category: Health Management Authors: Ana I. Balsa, Michael T. French Source Type: journals

An analysis of life-course smoking behavior in ChinaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 decis...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Don Kenkel, Dean R. Lillard, Feng Liu Source Type: journals

Regional inequality in China's health care expendituresEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Win Lin Chou, Zijun Wang Source Type: journals

Effects of Rural Mutual Health Care on outpatient service utilization in Chinese village medical institutions: evidence from panel dataEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 nega...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Zhongliang Zhou, Jianmin Gao, Qinxiang Xue, Xiaowei Yang, Ju'e Yan Source Type: journals

Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural ChinaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 perceiv...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Hongmei Yi, Linxiu Zhang, Kim Singer, Scott Rozelle, Scott Atlas Source Type: journals

Are services delivered by community health centers more cost-effective? Evidence from urban ChinaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 treat...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Hongli Jiang, Wen Chen, Kangning Bi, Xiaohua Ying Source Type: journals

Does per-diem reimbursement necessarily increase length of stay? The case of a public psychiatric hospitalEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Weiyan Jian, Yan Guo Source Type: journals

The Urban Resident Basic Medical Insurance: a landmark reform towards universal coverage in ChinaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 re...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Wanchuan Lin, Gordon G. Liu, Gang Chen Source Type: journals

Health-seeking behavior and hospital choice in China's New Cooperative Medical SystemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Philip H. Brown, Caroline Theoharides Source Type: journals

The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ph...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Xiaoyan Lei, Wanchuan Lin Source Type: journals

China's health system and its reform: a review of recent studiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 roll...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Adam Wagstaff, Winnie Yip, Magnus Lindelow, William C. Hsiao Source Type: journals

Economic analysis of China's health care system: turning a new pageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No Abstract (Source: Health Economics)
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Winnie Yip, Adam Wagstaff, William C. Hsiao Source Type: journals

ForewordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No Abstract (Source: Health Economics)
Source: Health Economics - June 22, 2009 Category: Health Management Authors: William C. Hsiao, Alan Maynard Source Type: journals

The value of informal care-a further investigation of the feasibility of contingent valuation in informal caregiversEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, 9...
Source: Health Economics - June 22, 2009 Category: Health Management Authors: Claudine de Meijer, Werner Brouwer, Marc Koopmanschap, Bernard van den Berg, Job van Exel Source Type: journals

Alcohol consumption and body weightEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 c...
Source: Health Economics - June 21, 2009 Category: Health Management Authors: Michael T. French, Edward C. Norton, Hai Fang, Johanna Catherine Maclean Source Type: journals

Do regional primary-care organisations influence primary-care performance? A dynamic panel estimationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 genera...
Source: Health Economics - June 17, 2009 Category: Health Management Authors: Anthony Scott, William Coote Source Type: journals