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This paper uses longitudinal data from the British Household Panel Survey to calculate the compensating income variation (CIV) of cardiovascular disease. It is found that the CIV decreases with age and is higher for men than for women. For women the estimated CIV is similar to those calculated by Groot et al. (2004). For men the estimates are somewhat higher than earlier reported.
The objective of this paper is to analyse the impact that attribute ordering has on the relative importance of the price attribute. A discrete choice experiment was performed in order to elicit psoriasis patients' preferences for treatment. We tested for ordering effect with respect to the price attribute, and disclosed noticeable higher price sensitivity when the price attribute was placed at the end of the program description. Our results indicate that preferences are context dependent and that heuristics may be used in the choice process. Our result does not, however, suggest that ordering effect is a symptom of lexicographic ordering.
We show that the proportion of community social capital attributable to religious groups is inversely and strongly related to the number of cigarettes that smokers consume. We do not find overall community social capital or the proportion of community social capital attributable to religious groups to be related to the overall prevalence of smoking. Using a new validated measure of community social capital, the Petris Social Capital Index and three years (1998-2000) of US data on 39 369 adults, we estimate a two-part demand model incorporating the following controls: community-level fixed effects, price (including excise taxes), family income, a smuggling indicator, nonsmoking regulations, education, marital status, sex, age, and race/ethnicity.
This research examines how teenage drug and alcohol use responds to changes in the economy. In contrast to the recent literature confirming pro-cyclical alcohol use among adults, this research offers strong evidence that a weaker economy leads to greater teenage marijuana and hard-drug use and some evidence that a weaker economy also leads to higher teenage alcohol use. The findings are based on logistic models with state and year fixed effects, using teenagers from the NLSY-1997. The evidence also indicates that teenagers are more likely to sell drugs in weaker economies. This suggests one mechanism for counter-cyclical drug use - that access to illicit drugs is easier when the economy is weaker. These results also suggest that the strengthening economy in the 1990s mitigated what would otherwise have been much larger increases in teenage drug use.
Compensating wage differentials are used to estimate marginal rates of substitution between income and both fatal and non-fatal occupational-injury risks in the Mexico City metropolitan area. Data are obtained by in-person survey of almost 600 workers and include workers' perceived risks of fatal and non-fatal occupational injury supplemented by actuarial-risk estimates from government statistics. Results using both actuarial- and perceived-risk estimates are reasonably consistent. Estimates of the value per statistical life are between 235,000 US dollars and 325,000 US dollars and estimates of the value per statistical non-fatal injury are between 3500 US dollars and 11,000 US dollars (2002 US dollars). These values are much smaller than corresponding estimates for higher-income countries but are compatible with the small number of prior estimates for lower-income countries.
ESRD patients have to deal with two choices: the first is related to the dialysis modality; the second concerns the type of dialysis unit (public vs private) where to undertake the treatment. Such a choice is related to unobservable factors, among which there might be patients' clinical factors as well as factors related to the characteristics of each unit. We employ a recursive bivariate probit estimation on a sample of ESRD Sicilian patients in order to evaluate the impact of these factors. Results can have important implications for Sicily in order to organize dialysis services: here, in fact, the number of private centres is higher than in other Italian Regions.
This article focuses on the modelling and prediction of costs due to disease accrued over time, to inform the planning of future services and budgets. It is well documented that the modelling of cost data is often problematic due to the distribution of such data; for example, strongly right skewed with a significant percentage of zero-cost observations. An additional problem associated with modelling costs over time is that cost observations measured on the same individual at different time points will usually be correlated. In this study we compare the performance of four different multilevel/hierarchical models (which allow for both the within-subject and between-subject variability) for analysing healthcare costs in a cohort of individuals with early inflammatory polyarthritis (IP) who were followed-up annually over a 5-year time period from 1990/1991. The hierarchical models fitted included linear regression models and two-part models with log-transformed costs, and two-part model with gamma regression and a log link. The cohort was split into a learning sample, to fit the different models, and a test sample to assess the predictive ability of these models. To obtain predicted costs on the original cost scale (rather than the log-cost scale) two different retransformation factors were applied. All analyses were carried out using Bayesian Markov chain Monte Carlo (MCMC) simulation methods.
A positive relationship between income and child outcomes has been observed in data from numerous countries. A key question concerns the extent to which this association represents a causal relationship as opposed to unobserved heterogeneity. We use data from the National Longitudinal Survey of Children and Youth to implement a series of empirical strategies for estimating the existence and size of the effect of income on behavioural-emotional outcomes. We also examine the role of parenting style. Our results indicate that there is little evidence of an effect of income on behavioural-emotional scores. The exclusion of parenting style from the models was found to not bias the estimated income effect, but parenting style was found to have a consistent impact on child outcomes.
In this paper we attempt to identify behavioral differences between public and private not-for-profit hospitals, by exploiting the introduction of the DRG-based payment system in the Italian NHS during the second half of the 1990s. We estimate the technical efficiency of a sample of hospitals for the period 1995-2000 considering an output distance function, and adopting both parametric (COLS and SF) and nonparametric (DEA) approaches. Our results show a convergence of mean efficiency scores between not-for-profit and public hospitals, and seem to suggest that differences in economic performances between competing ownership forms are more the result of the institutional settings in which they operate than the effect of the incentive structures embedded in the different proprietary forms. We also observe a decline in technical efficiency, probably due to policies aimed at reducing hospitalization rates.
The study integrates two methodologies so that income-related inequality in general health can be decomposed into contributions from socio-demographic characteristics to each of the dimensions defining general health. It is found that these relative contributions vary substantially across dimensions. For policy purposes such information is valuable as it indicates at which population groups and at which aspects of health efforts to reduce inequalities in health should be targeted.
This paper examines the determinants of GP visiting in Ireland, using panel data from the Living in Ireland Survey from 1995-2001. While cross-sectional studies provide important information on GP visiting patterns at a certain point in time, with panel data we can also control for unobserved individual heterogeneity, as well as identify whether it is the same individuals who consistently visit their GP year on year, or whether there is more mobility in visiting. We therefore estimate dynamic models of GP utilisation, and attempt to decompose the observed variation in GP visiting into components attributable to observed individual characteristics, unobserved individual heterogeneity and state dependence.
This paper explores the relationship between height-adjusted weight and economic conditions in Finland, using individual microdata for the period 1978-2002. If anything, the results reveal that an improvement in regional economic conditions measured by the employment rate produces a decrease in BMI, other things being equal. The Finnish evidence presented does not support the conclusions reported for the USA, according to which temporary economic slowdowns are good for health. In contrast, at least BMI seems to increase during slumps.
In the stated preference method called graded pairs comparisons respondents are asked to rate the intensity of their preference for their preferred alternative in a pairwise comparison of alternatives. Econometricians anticipate that the additional information will improve statistical efficiency compared to the standard DCE format. However, this paper reveals that added information inherent in graded pairs scale does not provide smaller standard deviations for the WTP estimated. Secondly, the ordered-response regression models employing the full range of the graded pairs data tend to overestimate WTP, which presumably is caused by the inherent tendency of the ordered-response models to 'predict to the extremes'.
Decision makers within a jurisdiction facing evidence of positive but uncertain incremental net benefit of a new health care intervention have viable options where no further evidence is anticipated to:(1)adopt the new intervention without further evidence;(2)adopt the new intervention and undertake a trial; or(3)delay the decision and undertake a trial.Value of information methods have been shown previously to allow optimal design of clinical trials in comparing option (2) against option (1), by trading off the expected value and cost of sample information. However, this previous research has not considered the effect of cost of reversal on expected value of information in comparing these options. This paper demonstrates that, where a new intervention is adopted, the expected value of information is reduced under optimal decision making with costs of reversing decisions. Further, the paper shows that comparing expected net gain of optimally designed trials for option (2) vs (1) conditional on cost of reversal, and (3) vs (1) conditional on opportunity cost of delay allow systematic identification of an optimal decision strategy and trial design.
In this paper we estimate and validate a three-period sequential model of older workers' labor force transitions following a health/disability shock, using retrospective information from Spanish cross-section data. Central to the analysis are the effects of the various disabilities and their severity. We find that the probability of remaining employed decreases both with age and the severity of the shock. Moreover, we find strong interactions between age and severity for older workers and none for prime-age workers. Suffering any kind of disability reduces the probability of being employed immediately prior to retirement age, and in such cases it is severity which is the strongest indicator. With respect to demographics, we find that female gender, having a retired spouse or being married all reduce the probabilities of both remaining in employment and returning to work following a spell of inactivity; in turn, principal breadwinner status, education and skill levels increase this likelihood.
In this paper we evaluate the respective effects of demographic change, changes in morbidity and changes in practices on growth in health care expenditures. We use microdata, i.e. representative samples of 3441 and 5003 French individuals observed in 1992 and 2000. Our data provide detailed information about morbidity and allow us to observe three components of expenditures: ambulatory care, pharmaceutical and hospital expenditures. We propose an original microsimulation method to identify the components of the drift observed between 1992 and 2000 in the health expenditure age profile. On the one hand, we find empirical evidence of health improvement at a given age: changes in morbidity induce a downward drift of the profile. On the other hand, the drift due to changes in practices is upward and sizeable. Detailed analysis attributes most of this drift to technological innovation. After applying our results at the macroeconomic level, we find that the rise in health care expenditures due to ageing is relatively small. The impact of changes in practices is 3.8 times larger. Furthermore, changes in morbidity induce savings which more than offset the increase in spending due to population ageing.
In 1996, free choice of health insurers was introduced to the German social health insurance system. One objective was to increase efficiency through competition. A crucial precondition for effective competition among health insurers is that consumers search for lower-priced health insurers. We test this hypothesis by estimating the price elasticities of insurers' market shares. We use unique panel data and specify a dynamic panel model to explain changes in market shares. Estimation results suggest that short-run price elasticities are smaller than previously found by other studies. In the long-run, however, estimation results suggest substantial price effects.
The National Institute for Clinical Excellence has recently changed its guidelines on discounting costs and effects in economic evaluations. In common with most other regulatory bodies it now requires that health effects should be discounted at the same rate as costs. We show that the guideline leads to sub-optimal decisions because it fails to account for the changing value of health. NICE (and other regulatory bodies) should either use differential discounting or stipulate how the changing value of health should otherwise be dealt with. We also show how binding health service budget constraints should be incorporated in evaluations.