Prenatal care and birthweight in Mexico

We estimate the marginal impact of prenatal care (PNC) on birth outcomes in Mexico using nationally representative data on about 14 million births from 2009 to 2014. Given the possible self-selection into PNC, we attempt to identify the causal impact of PNC on birth outcomes by estimating an instrumental variable model. We find positive impacts of increased prenatal visits on birthweight (BW), length and apgar score of the newborn. Moreover, the impacts of PNC on birth outcomes differ by mother’s education, development level of the municipality where the mother resides and BW distribution. We also find suggestive evidence that PNC visits affect birth outcomes through the reduction in pre-term births.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

Do Hispanic immigrants spend less on medical care? Implications of the Hispanic health paradox

ABSTRACT

The literature of the Hispanic heath paradox has found that in the U.S. Hispanic immigrants have better health than U.S. natives, even though they tend to have lower socioeconomic status. The main objective of the current study is to investigate whether Hispanic immigrants also use less medical care goods and services. Main contributions of the article include using a data set of older Americans from the Health and Retirement Study covering the period from 1992 to 2012 as well as using three new measures of health, rather than the more common use of morbidity or mortality. We estimate the impact of relevant factors including health, race, and immigrant status upon five different measures of healthcare usage. Even though Hispanic immigrants do have lower mean levels of most measures of healthcare usage, when controlling for other factors in our regressions we find some evidence of increased healthcare usage for Hispanic immigrants. Increased health care utilization may be one explanation for the Hispanic health paradox.     

Impact of remittances on household health care expenditure: Evidence from the Nepal Living Standards Survey

This paper examines the effect of remittance inflows on health care expenditure in Nepal using the Nepal Living Standards Survey 2010–2011. Using the recursive three‐stage least square regression method, the propensity score matching method, and the Oaxaca–Blinder decomposition method, we find a positive and significant effect of remittances on health care expenditure. In particular, our analysis shows a 0.099% increase in health care expenditure for every 1% increase in overall remittances. This effect increases to 0.189% for earned remittances (remittances received from a household member). We also find that remittance‐receiving households with at least one migrant family member have different health care spending behavior than those with no migrant members.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

Income-related inequalities of health and health care utilization

By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China’s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of health care utilization accounts for 0.13–0.2; insurance also enlarges the inequality of health care utilization; health inequality in rural area is larger than that of in urban area; and both rural and urban health inequality are increasing. From 1991 to 2006, income changes in urban districts and rural area account for 7.08% and 13.38% respectively of raising inequality of rural and urban health.     

Prenatal care and pregnancy outcome in Cebu, Philippines

This paper examines the direct and indirect effects of patterns of prenatal care usage on birth weight and gestational age for a randomly selected sample of 3,080 rural and urban women. We analyze indirect effects of prenatal care on intermediate maternal factors (nutritional, stress, smoking, and drinking), then the impacts of these factors along with prenatal care on pregnancy outcome. The simultaneous equations statistical approach corrects for endogeneity of prenatal care and the intermediate maternal factors. Results of simulations of the effects of changes in the number of prenatal visits on intermediate and health outcome factors have important policy implications.     

Testing cointegration between health care expenditure and GDP in Japan with the presence of a regime shift

Using quarterly data from 1994 through 2013, this article is the first to use the Hansen and Seo (2002) tests to examine the long-term relationship between real per-capita GDP (PGDP) and real per-capita health care expenditure (PHCE) in Japan with threshold effects. We detect the presence of a threshold cointegrating relationship between the two variables. In addition, we find that error correction adjustments are significantly conducted only through PGDP in a typical regime, whereas both PGDP and PHCE drive the adjustments in the extreme regime. We find that the extreme regime occurred mainly after Q4 2008, implying that the policy introducing the late-stage medical care system for the elderly in April 2008, which expanded the ratio of personal expenses for the elderly, may be effective for attaining a long-run equilibrium between PGDP and PHCE.     

Is health care a luxury? The debate revisited with new evidence from emerging economies

This paper studies the long-run relationship between health care expenditure and income using a panel data set of emerging economies over the period 1995–2012. The results show that expenditure on health care and income are non-stationary and cointegrated. After controlling for cross-sectional dependence and unobserved heterogeneity among different countries, we find that the income elasticity of health care is less than 1, indicating that health care is a necessity and not a luxury. Government expenditure and out-of-pocket expenditure turn out to be important determinants of health care expenditure. Among non-monetary factors, results show that old age dependency and female education seem to have significant bearings on health care expenditures. Policy recommendations suggest that government should increase spending on health care in emerging economies since higher incomes may not automatically translate into higher health care spending by the people of these countries.     

Robust determinants of health care expenditure growth

Our aim is to disclose robust explanatory variables for health care expenditure (HCE) growth by introducing to this field of research a method that is especially well suited for situations of ‘model uncertainty’: the Extreme Bounds Analysis (EBA). We analyse data for 33 OECD countries over the period 1970–2010 and include – as far as it is statistically feasible – all macroeconomic and institutional determinants of HCE growth in the EBA that have been suggested in the literature. Furthermore, we analyse to what extent outliers in the data influence the results. Our results confirm earlier findings that GDP growth and a variable representing Baumol’s ‘cost disease’ theory emerge as robust and statistically significant determinants of HCE growth. Depending on whether or not outliers are excluded, we find up to six additional robust drivers: the growth in expenditure on health administration, the change in the share of inpatient expenditure in total health expenditure, the (lagged) government share in GDP, the change in the insurance coverage ratio, the growth in land traffic fatalities and the growth in the population share undergoing renal dialysis.     

过度医疗行为的理论、实证与管理式医疗制度

本文是一篇文献综述,主要回顾过度医疗行为的理论与实证研究成果;其次,阐述与分析了以该理论为基础的美国管理式医疗与支付制度。     

The effectiveness of government spending on education and health care in developing and transition economies

Recent studies show that corruption is associated with higher military spending [Eur. J. Polit. Econ. 17 (2001) 794] and lower government spending on education and health care [J. Publ. Econ. 69 (1998) 263]. This suggests that policies aimed at reducing corruption may lead to changes in the composition of government outlays toward more productive spending. However, little empirical evidence has been presented to support the claim that public spending improves education and health indicators in developing and transition countries. This paper uses cross-sectional data for 50 such countries to show that increased public expenditure on education and health care is associated with improvements in both access to and attainment in schools, and reduces mortality rates for infants and children. The education regressions are robust to different specifications, but the relationship between health care spending and mortality rates is weaker.     

中国城镇医疗体制改革前后的医疗融资比较

The health financing schemes is the foundation for the nation’s health care system, and the health insurance is a main one of some options for financing health care. This article compares two health care financing schemes in urban areas before and after the health reform, and targets at the impacts facing coverage groups, the financing methods, decision-making power or financial management (i.e. the distribution of responsibility and rights between the central government and local governments), payment arrangement and cost containment of health care financing mechanisms. Prior to reform, the equal access and universal coverage of health care services were implemented through the employment-based health insurance in a state-controlled economy with guaranteed full employment and central control in general. The decentralization reforms of fiscal system and tax sharing reforms disrupts the past economic foundation, the rebuilding health insurance system which still benefits the employed bring the limited coverage. The next trend is to make transition from health insurance covering only part of the employed population to what are in effect national health services covering the whole population in urban areas.      

A dynamic analysis of the demand for health insurance and health care

We find that asymmetric information is important for the uptake of supplementary private health insurance and health care utilization. We use dynamic panel data models to investigate the sources of asymmetric information and distinguish short-run selection effects into insurance from long-run selection effects. Short-run selection effects (i.e. responses to shocks) are adverse, but small in size. Also long-run effects driven by differences in, for example, preferences and risk aversion, are small. But we find some evidence for multidimensional asymmetric information. For example, mental health causes advantageous selection. Estimates of health care utilization models suggest that moral hazard is not important.     

Immigration and health care reform: shared struggles

The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.     

A model to optimize investments in health technologies,quality of care and research

Funds for health technologies compete with funds for implementing health technologies as well as funds for conducting research to reduce uncertainty around treatment and implementation cost-effectiveness. No study has yet shown how to allocate a combined budget for health technologies, implementation and research. The purpose of this work was to present an allocation model with the goal to maximize health. Based on a constrained optimization formulation, we show that considering opportunities to invest in implementation and research may justify considerable disinvestment in health technologies. This may reduce the willingness to pay for new health technologies significantly.     

Home care reimbursement,long-term care utilization,and health outcomes

Using a substantial change in Medicare reimbursement policy to study the market for home health care, I find that the introduction of tightly binding average per-patient reimbursement caps led to a large drop in the provision of home care, particularly to the least healthy beneficiaries. This decline in home health utilization was not offset by increases in institutional long-term care or other medical care and there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations.     

Is health care a necessity or a luxury? Evidence from urban China

This article uses a smooth transition regression (STR) model to research the income elasticity of the health care expenditure of China’s urban residents in the 1990–2013 period. The results demonstrate that if the real income of China’s urban residents that lags a period is taken as a transition variable, urban residents’ health expenditure follows an LSTR1 nonlinear two-regime model. Here, the income elasticity of health care expenditure of China’s urban residents is 1.4919 in 1990–2002 and 1.2216 in 2003–2013. Overall, the income elasticity of health care of China’s urban residents is greater than 1, indicating that health care is a luxury.     

Empirics of health-aid,education and infant mortality: a semiparametric study

The present article uses semiparametric regression to capture the impact of foreign-aid given for health purposes on the Infant Mortality Rate (IMR) of poor developing countries, after controlling for other covariates. We also investigate whether education (general awareness) helps lower IMR directly or helps improve effectiveness of health-aid in reducing IMR. In addition, the study investigates whether various disaggregated components of health-aid (for example, aid that goes for infectious disease control or nutrition) help lower IMR. We find that although adult education (awareness) always lowers IMR, the overall effect of health-aid remains insignificant. Our conclusion is robust to various disaggregated components of health-aid as well. We also check if health-aid has improved prenatal care for expecting mothers but our conclusion regarding the overall ineffectiveness of aid remains unchanged. Interestingly, we find that total health-aid as well as nutrition aid may lower IMR only after education exceeds a threshold level – a new angle that has not been explicitly explored before. We also find interesting role of education in making the aid more effective for prenatal care. Our semiparametric nonlinear estimation strategy helps us unravel certain interesting thresholds and facts which cannot be captured in a linear parametric estimation framework.     

Using composite indicators to evaluate the efficiency of health care system

This article produces a system-level composite indicator on population health in publicly provided primary health care. We first summarize information from various indicators of care by principal component analysis (PCA). We then regress the costs of care against these indicators to evaluate whether they are related. The existing health status indicator provides a point of comparison. Our results suggest that PCA can be used to extract information efficiently and thus to reduce the dimensionality of data. Furthermore, the use of the existing health status indicator to estimate cost-efficiency leads to invalid inference on overall efficiency, while the use of composite indicator significantly reduces the bias.