HEALTH CARE PROVIDER CHOICE

In order to achieve an ‘optimal health system’, health policies should not only be focused on the supply of health care, but also take cognisance of the demand for health care. Studies of health care demand in South Africa are scarce due to considerable data limitations. This analysis attempts to fill this gap by combining two data sets (specifically, the GHS 2004 and IES/LFS 2000) in order to be able to utilize the wealth of information regarding health care utilization in the General Household Survey. The aim is to inform and encourage debate on how to incorporate demand side considerations in order to arrive at improved public health care in South Africa.     

COST AND QUALITY PERFORMANCE INDICATORS FOR HOME COMMUNITY-BASED CARE SERVICES TO ORPHANS AND VULNERABLE CHILDREN

The encouragement of care of orphans and vulnerable children by non-profit organisations (NPOs) is a major policy response to the HIV and AIDS epidemic in South Africa. The purpose of this article is to present a quality–cost model with five performance indicators for quality and two for costs and to test these against actual performance using data collected from nine rural and urban organisations in 2004 and 2005. Six NPOs had acceptable cost but all had unacceptable quality scores; three had unacceptable cost and unacceptable quality scores. Each rural caregiver had many more orphans and vulnerable children beneficiaries than their urban counterparts but made fewer total visits. As a result, urban beneficiaries received, on average, 3.5 times more visits than their rural counterparts. The results suggest the need for different performance indicators and expectations for rural and urban NPOs and that monitoring and evaluation using the model could improve horne community-based care services.     

Poverty: Insurance Theory and the Medically Uninsured

The federal/state Medicaid program is designed to provide health insurance for the nation's poorest, yet between 15 and 20 percent of the population continue to have no health insurance. Classic utility-based insurance theory is examined to see if it well explains why some do and some do not purchase health insurance at the state level or if a host of other non-economic factors are needed. This pooled, cross-sectional time-series analysis shows that the state characteristics most strongly associated with the prevalence of a lack of health insurance is the percent of persons whose income falls below the poverty line, the percent of the state's population that is female and the percent of the population with only a high school education. This analysis suggests that the starting point for policies aimed at limiting the number of insured should be limiting poverty and perhaps recognizing the gender/education influence in designing state eligibility requirements.     

Health insurance reform and economic growth: Simulation analysis in Japan

This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations. Our simulation produced the following results: first, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior following the increase in co-payment rates, however, reduces economic growth. Third, Japan's trend of increasing the future public health insurance benefits can mainly be explained by its aging population, and increasing the co-payment rate does little to reduce future payments of public health insurance benefits. Fourth, the effect on future economic burdens of reducing medical costs through efficiencies in public health insurance, emphasis on preventive medical care, or technological progress in the medical field is small. Finally, a policy of maintaining public health insurance at a fixed percentage of GDP will require reducing public health insurance benefits, perhaps up to 45% by 2050. Such a policy also reduces economic growth until approximately 2035. Our simulation indicates that the reform does not significantly reduce future public health insurance benefits, but it can enhance economic growth and welfare by encouraging private saving.     

Can Empirical Demand Models Assist in CON Comparative Reviews? A Case Study in Florida

Certificate‐of‐Need (CON) programs for new hospital construction are intended to foster the best selection among competing hospital applications, given demands for hospital care in the community. Yet, the merits of CON depend in part on the quality of the comparative review process. This article examines a case study in Florida to illustrate the utility of empirical evaluations using patient choice models. I estimate such models to show how patients would respond to a change in hospital choices. By simulating the welfare effects of the proposed hospitals, I can further predict how prices of hospital care differ by applicant. Results suggest that empirical analysis using data on patient choice of hospitals may better inform the review process. At the same time, however, it may not give a unique ranking without additional analysis of the fixed costs of proposed services in the context of existing marketwide capacity.     

Does School Lunch Fill the “SNAP Gap” at the End of the Month?

This article investigates the relationship between the timing of Supplemental Nutrition Assistance Program (SNAP) benefit payments and participation in school lunch and breakfast using the National Household Food Acquisition and Purchase Survey. An event study approach examines participation over the five‐day window before and after the SNAP payment. We find that school lunch participation decreases by 17–23 percentage points immediately after the SNAP payment among 11–18 year olds while breakfast drops by 19–36 percentage points. The decline begins the day prior to payment. We find no effects for 5–10 year olds. Models examining participation over the full SNAP month using individual fixed effects yield similar findings. Among teenagers, participation in school lunch and breakfast decline in the first two weeks of the SNAP month, increasing afterward. Non‐school meals show the opposite pattern. Overall, results indicate SNAP households rely more on school lunch and breakfast toward the end of the SNAP month.