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Health Economics

Roxanne J Kovacs, Mylene Lagarde, John Cairns
Despite its importance in health care, empirical evidence on patient trust is limited. This is likely because, as with many complex concepts, trust is difficult to measure. This study measured patient trust in health care providers in a sample of 667 patients in Senegal. Two instruments were used to measure patient trust in providers: a survey questionnaire and an incentivised behavioural economic experiment-a "trust game." The results show that the two measures are significantly, but weakly, associated...
February 14, 2019: Health Economics
Nicolas Krucien, Jonathan Sicsic, Mandy Ryan
Discrete choice experiments (DCEs) are frequently used in health economics to measure preferences for nonmarket goods. Best-worst discrete choice experiment (BWDCE) has been proposed as a variant of the traditional "pick the best" approach. BWDCE, where participants choose the best and worst options, is argued to generate more precise preference estimates because of the additional information collected. However, the validity of the approach relies on two necessary conditions: (a) best and worst decisions provide similar information about preferences and (b) asking individuals to answer more than one choice question per task does not reduce data quality...
February 13, 2019: Health Economics
Itamar Megiddo, Dusan Drabik, Tim Bedford, Alec Morton, Justus Wesseler, Ramanan Laxminarayan
Over 95% of post-mortem samples from the 1918 pandemic, which caused 50 to 100 million deaths, showed bacterial infection complications. The introduction of antibiotics in the 1940s has since reduced the risk of bacterial infections, but growing resistance to antibiotics could increase the toll from future influenza pandemics if secondary bacterial infections are as serious as in 1918, or even if they are less severe. We develop a valuation model of the option to withhold wide use of an antibiotic until significant outbreaks such as pandemic influenza or foodborne diseases are identified...
February 11, 2019: Health Economics
Olivier Bargain, Jinan Zeidan
Obesity can spread more easily if it is not perceived negatively. This issue may be more pronounced among the poor, a conjecture that we test in this paper. We start with general evidence on the concave relationship between income and obesity, both across countries and within Mexico, a country characterized by very unequal development levels and the highest obesity rate in the world. We suggest a general model that explains this stylized fact from a simple necessary condition, namely, the complementarity between nonfood consumption and health concerns...
February 10, 2019: Health Economics
Christine Dauth, Julia Lang
Demographic change has increased the need for elderly care. Training unemployed workers might be one way to increase the supply of elderly care nurses. This study analyzes the effectiveness of subsidized training for unemployed individuals in the elderly care professions in Germany over 11.5 years. We find that short further training and long retraining courses significantly increase workers' long-term employment. As approximately 25% to 50% of trained nurses have permanent jobs in the care sector, we estimate that approximately 5% of all employed nurses are formerly trained unemployed workers...
February 5, 2019: Health Economics
Jeah Jung, Roger Feldman, Yamini Kalidindi
Hospital-physician integration has substantially grown in the United States for the past decade, particularly in certain medical specialties, such as oncology. Yet evidence is scarce on the relation between integration and outpatient specialty care use and spending. We analyzed the impact of oncologist integration on outpatient provider-administered chemotherapy use and spending in Medicare, where prices do not depend on providers' integration status or negotiating power. We addressed oncologists' selective integration and patients' nonrandom choice of oncologists using an instrumental variables method...
January 29, 2019: Health Economics
Hana Bataineh, Rose Anne Devlin, Vicky Barham
The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014). We find a robustly negative relationship between health care use and unmet health care needs...
January 28, 2019: Health Economics
Richard A Iles
Government doctor absenteeism from their public posts is a sizable problem across developing economies. The consumer demand estimation for outpatient fever treatment presented in this paper investigates the interrelationship between government doctor absenteeism and the large informal healthcare sector. Using a counterfactual framework, this paper estimates treatment effect of eliminating government doctor absenteeism. The effects are measured by changes to the market share of government Bachelor of Medicine and Bachelor of Surgery (MBBS) providers and resulting own-price elasticities of demand for government MBBS providers and unqualified providers...
January 28, 2019: Health Economics
Bingxiao Wu, Jeah Jung, Hyunjee Kim, Daniel Polsky
Economic theory suggests that competition and information are complementary tools for promoting health care quality. The existing empirical literature has documented this effect only in the context of competition among existing firms. Extending this literature, we examine competition driven by the entry of new firms into the home health care industry. In particular, we use the certificate of need (CON) law as a proxy for the entry of firms to avoid potential endogeneity of entry. We find that home health agencies in non-CON states improved quality under public reporting significantly more than agencies in CON states...
January 28, 2019: Health Economics
John Gibson, Bonggeun Kim
We use household survey data to estimate the price elasticity of quantity, and of quality, for tobacco products. In our data, commonly used estimation methods suggest an own-price elasticity of demand of about -1. These methods add together responses on the quantity margin and the quality margin. Just one third of the response to price is from quantity and two thirds is from quality. The simulated effect of higher excise taxes is to reduce overall quantity by just one third of what is predicted if the quality response is ignored...
January 28, 2019: Health Economics
R Tamara Konetzka, Fan Yang, Rachel M Werner
Health economists are often interested in the effects of provider-level attributes (e.g., nonprofit status or quality rating) on patient outcomes, but estimation is subject to selection bias due to correlation with other omitted provider-level attributes that also affect patient outcomes. Recently, researchers have attempted to use patient-level instrumental variables, such as differential distance, to solve this problem of a provider-level endogenous treatment variable in settings where patients are nested within providers...
January 22, 2019: Health Economics
Gerald Manthalu
The literature on health care utilisation has focussed on the interaction of supply and demand factors in determining utilisation. At the aggregate level, studies have modelled the simultaneity of demand and supply, and different methods have been used. This study proposes an alternative framework for modelling utilisation, which yet separates demand and supply factors, the disequilibrium theory of demand and supply. This theory is useful in modelling data that reflect that not all health care demand is met by health care providers and not all health care supply is taken by consumers...
January 21, 2019: Health Economics
María José Aragón Aragón, Adriana Castelli, Martin Chalkley, James Gaughan
Health-care systems around the world face limited financial resources, and England is no exception. The ability of the health-care system in England to operate within its financial resources depends in part on continually increasing its productivity. One means of achieving this is to identify and disseminate throughout the system the most efficient processes. We examine the annual productivity growth achieved by 151 hospitals over five financial years, using the same methods developed to measure productivity of the National Health Service as a whole...
January 18, 2019: Health Economics
Dhaval Dave, Bo Feng, Michael F Pesko
We use difference-in-differences models and individual-level data from the national and state Youth Risk Behavior Surveillance System from 2005 to 2015 to examine the effects of e-cigarette minimum legal sale age (MLSA) laws on youth cigarette smoking, alcohol consumption, and marijuana use. Our results suggest that these laws increased youth smoking participation by about one percentage point and approximately half of the increased smoking participation could be attributed to smoking initiation. We find little evidence of higher cigarette smoking persisting beyond the point at which youth age out of the laws...
January 15, 2019: Health Economics
Abraham Abebe Asfaw
This paper provides empirical evidence on the health behavior effect of prescription drug insurance. Using the difference in the regression discontinuity research design, I compare health behavior changes at age 65 before and after the introduction of Medicare Part D. I find that the implementation of Medicare Part D increased prescription drug insurance coverage and reduced out-of-pocket spending per prescription and the use of cardiovascular and metabolic therapeutic class drugs. I also find that Medicare Part D led to a 6...
January 8, 2019: Health Economics
Giuseppe Moscelli, Rowena Jacobs, Nils Gutacker, Maria Jose Aragón, Martin Chalkley, Anne Mason, Jan Böhnke
Reimbursement of English mental health hospitals is moving away from block contracts and towards activity and outcome-based payments. Under the new model, patients are categorised into 20 groups with similar levels of need, called clusters, to which prices may be assigned prospectively. Clinicians, who make clustering decisions, have substantial discretion and can, in principle, directly influence the level of reimbursement the hospital receives. This may create incentives for upcoding. Clinicians are supported in their allocation decision by a clinical clustering algorithm, the Mental Health Clustering Tool, which provides an external reference against which clustering behaviour can be benchmarked...
December 27, 2018: Health Economics
Paul Niekamp
This paper uses the American Time Use Survey from 2003 to 2015 to analyze the effect of economic conditions on sleep duration. Prior work has found that increases in the employment rate cause sleep duration of individuals to fall. No previous research considers that weekday sleep behavior and weekend sleep behavior may be differentially related to economic conditions. Estimates suggest that weekday sleep duration is indeed countercylical whereas weekend sleep duration is procyclical. Results are driven by individuals most susceptible to economic fluctuations: minorities, single adults, and individuals with less education...
December 20, 2018: Health Economics
Marcel F Jonker, Bas Donkers, Esther de Bekker-Grob, Elly A Stolk
A randomized controlled discrete choice experiment (DCE) with 3,320 participating respondents was used to investigate the individual and combined impact of level overlap and color coding on task complexity, choice consistency, survey satisfaction scores, and dropout rates. The systematic differences between the study arms allowed for a direct comparison of dropout rates and cognitive debriefing scores and accommodated the quantitative comparison of respondents' choice consistency using a heteroskedastic mixed logit model...
December 18, 2018: Health Economics
Carlo Alberto Biscardo, Alessandro Bucciol, Paolo Pertile
We utilize a large administrative dataset of sickness leave in Italy (a) to investigate whether private firms are more effective than the public insurer in choosing who to monitor and (b) to study the correlation between potentially opportunistic behavior and the observable characteristics of the employee. We find that private employers are more likely to select into monitoring employees who are fit for work despite being on sick leave, if the public insurer is not supported by any data-driven tool. However, the use of a scoring mechanism, based on past records, allows the public insurer to be as effective as the employer...
December 18, 2018: Health Economics
Heike Hennig-Schmidt, Hendrik Jürges, Daniel Wiesen
Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context...
December 13, 2018: Health Economics
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