Assessing equitable health financing for universal health coverage: a case study of South Africa

This article argues that an assessment of progressivity over time can provide an indication of progress towards a ‘more’ progressive or a ‘less’ regressive health financing system and can be useful to policymakers. It introduces a framework to characterize ‘shifts’ in progressivity in health financing between two time periods using the popularly known Kakwani index of progressivity and other associated indices. It also decomposes the ‘shifts’ in progressivity into the relative contributions of the changes in income distribution and the changes in the distribution of health payments. Further, it proposes graphics that statistically analyses how the ‘shifts’ in progressivity vary along the distribution of income. A pro-poor (pro-rich) shift implies that the health financing mechanism is becoming more (less) progressive or less (more) regressive between two time periods. A proportional shift means that progressivity is constant between the two periods. This framework is applied to nationally representative household data from South Africa. It emerged that such characterization is a very useful tool for policy in assessing progress towards equitable health financing.     

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.     

Effects of health insurance on labour supply: evidence from the health care fund for the poor in Vietnam

The expansion of health insurance in emerging countries raises concerns about the unintended negative effects of health insurance on labour supply. This article examines the labour supply effects of the Health Care Fund for the Poor (HCFP) in Vietnam in terms of the number of work hours per month and labour force participation (the probability of employment). Employing various matching methods combined with a Difference-in-Differences approach on the Vietnam Household Living Standard Surveys 2002–2006, we show that the HCFP, which aims to provide poor people and disadvantaged minority groups with free health insurance, has a negative effect on labour supply. This is manifested in both the average number of hours worked per month and the probability of employment, suggesting the income effect of the HCFP. Interestingly, the effects are mainly driven by the non-poor recipients living in rural areas, raising the question of the targeting strategy of the programme.     

Small firms,bigger changes: health insurance coverage take-up rates in small firms after the ACA

Measuring the impact of the Affordable Care Act of 2010 (ACA) on employer-sponsored health insurance is essential in an era of constant changes to health policy. Using data from the Kaiser Family Foundation Employer Survey, we focus on firms with fewer than 50 employees in order to isolate the effect of the ACA on small firms. We utilize a differences‐in‐differences approach with a time fixed effect structure to provide analysis for a treatment group of small firms and a control group of large firms. After excluding firms with grandfathered plans, we find that the ACA provisions reduced health insurance coverage take-up rates in small firms by 1.96 to 2.67 percentage points (compared to large firms).     

Investments in worker health and production: Evidence from Vietnam

In manufacturing industries, occupational health and safety measures ensure better working conditions for employees, which may influence their productivity. We study the impact of investments undertaken by small and medium enterprises in Vietnam in mitigating indoor pollution (including air quality improvements, heat and noise protection as well as lighting) on firm-level gross output and value added. We find that the amount invested by the firm in health has a significant positive effect on both outcomes. Given historically poor working conditions in Vietnam, policy implications relate to incentivizing and enabling firms to undertake such investments, on both moral and economic grounds.     

Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis

Objectives: Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective.

Methods: A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses.

Results: In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers).

Conclusions: The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.     

Assessing the price and output effects of monetary policy in Vietnam: evidence from a VAR analysis

Using monthly data, we perform a vector-autoregressive analysis to measure the effects of monetary policy on the Vietnamese economy. We concentrate our attention on the period following the introduction of the Law on Central Bank in January 1998 (which brought the national monetary policy and its objectives in line with international practices). Contrary to previous studies on Vietnam, we find evidence suggesting that monetary policy (through the manipulation of interest rates) is an effective policy tool in stabilizing prices. However, credit growth tends to induce inflationary pressures. In addition, we find that an expansion of broad money supply leads to an increase in industrial production.     

The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP

We examine Medicaid enrollment and private coverage loss following expansions of Medicaid eligibility. We attempt to replicate Cutler and Gruber's [Q. J. Econ. 111 (1996) 391.] results using the Survey of Income and Program Participation (SIPP), and find smaller rates of take-up and little evidence of crowding out. We find that some of the difference in results can be attributed to different samples and recall periods in the data sets used. Extending the previous literature, we find that take-up is slightly increased if a child's siblings are eligible and with time spent eligible. Focusing on children whose eligibility status changes during the sample, we estimate smaller take-up effects. We find little evidence of crowding out in any of our extensions.     

Influence of policy,operational and market conditions on seaport efficiency in newly emerging economies: the case of Vietnam

ABSTRACT

Located in Southeast Asia as one of the most dynamic economic regions in the world and close to north-south shipping routes, Vietnam’s seaports play a vital role in promoting its international trade and economic growth. And yet, most ports are small and owned by the public sector. Their performance is subject to various factors relating to government policy, operational and market conditions. Although the Government has been trying to improve the sector’s performance through corporatization, its corporatization model is unique in many ways compared with reform models in other countries. This study seeks to analyse the effects of government policy, operational and market conditions among other factors, on Vietnamese seaports’ efficiency. Double-bootstrap data envelopment analysis (DEA) and univariate and multivariate analyses were conducted using the data sample of 41 ports for years 2015 and 2016. The analysis results show that the factors of production, regional location and reform policy had a significant impact on port performance.     

Is the emerging non‐farm market economy the route out of poverty in Vietnam?

Are the household characteristics that are good for the transition to a more diversified market‐oriented economy in Vietnam also important for reducing poverty? Or are there trade‐offs? The determinants of both poverty incidence and participation in rural off‐farm activities are modeled as functions of household and community characteristics using comprehensive national household surveys for 1993 and 1998. While there are some common causative factors, such as education and region of residence, the processes determining poverty and inhibiting diversification are clearly not the same. Participation in the emerging rural non‐farm market economy will be the route out of poverty for some, but certainly not all, of Vietnam's poor.     

The impact of microcredit on self‐employment profits in Vietnam

This study examines the impact of microcredit on household self‐employment profits in Vietnam. For two indicators of credit participation – a dichotomous participation dummy and the accumulated amount of microcredit received per household – the analysis reveals a positive effect on household profits. The analysis also reveals that an instrumental variable method within a fixed‐effects framework can control for the possible endogeneity of credit and thereby identify the true effect of credit.     

The impact of medical insurance coverage and molecular monitoring frequency on outcomes in chronic myeloid leukemia: real-world evidence in China

Objectives: Imatinib (Glivec) has been covered by critical disease insurance for treatment of chronic myeloid leukemia (CML) in Jiangsu province of China since 2013. Further, free molecular monitoring has been provided to patients at top clinical centers as part of a pilot study that has changed the local treatment pattern and outcomes of patients with CML. This study evaluates the impact of medical insurance coverage and the molecular monitoring frequency on outcomes of patients with CML treated at a central hospital in Jiangsu, China, according to patient-level data.

Methods: The study investigated 335 CML patients receiving medical treatment in a central hospital between January 1, 2011 and December 31, 2014. Demographic and clinical characteristics were extracted from the patients’ clinical records. Univariate and multivariate analyses using the logistic regression model were performed to identify the differences in outcomes of major molecular response (MMR) or complete cytogenetic response (CCyR) between patients who were insured vs uninsured, or between patients with frequency of PCR monitoring ≤2 times vs ≥3 times per year.

Results: Both the achievement of MMR (BCR-ABL^IS ≤0.1%) (50.4% vs 37.5%) and CCyR (80.7% vs 62.8%) at 12 months have shown significant differences that favored patients with insurance coverage of imatinib, while there was no significant difference in the outcome of BCR-ABL^IS ≤1% between insured and non-insured groups (56.0% vs 51.3%) at 6 months. The long-term results at 24 months demonstrated that there was a statistically significant difference in MMR rates between the group with 3 or more PCR monitoring tests per year and the group of patients with 2 or less PCR tests per year (76.9% vs 52.2%).

Conclusions: The study findings suggest that CML patients benefit from insurance coverage of imatinib and higher frequency (≥3) of regularly scheduled molecular monitoring PCR in China.     

No time to look after the kids: The unintended consequences of export expansion on child health*

In this paper, we examine the effect of export expansion on the health of children under the age of 6 years in China. Using the CHNS survey, we exploit trade exposure variation among regions after China's entry into the WTO to construct a difference-in-differences and instrumental variable identification. We show that 1% increase in export expansion over GDP share exacerbates child' illness rates by 0.6%, and the effect is more pronounced for less educated parents. The increasing workloads and having less time to look after the child account for the increasing illness rates, especially for mothers.     

A comment on “Economy-wide estimates of the implications of climate change: Human health”

In a recent article in this journal, Francesco Bosello, Roberto Roson, and Richard Tol make the remarkable prediction that one degree of global warming will, on balance, save more than 800,000 lives annually by 2050. They introduce enormous, controversial monetary valuations of mortality and morbidity, varying with income; they then focus primarily on modeling the much smaller, indirect economic effects of the changes in health outcomes. Their calculations, large and small, are driven by the huge projected reduction in mortality — an estimate that Bosello et al. fail to substantiate. They rely on research that identifies a simple empirical relationship between temperature and mortality, but ignores the countervailing effect of human adaptation to gradual changes in average temperature. While focusing on small changes in average temperatures, they ignore the important health impacts of extreme weather events. They extrapolate the effects of small changes in average temperature far beyond the level that is apparently supported by their principal sources, and introduce arbitrary assumptions that may bias the result toward finding net health benefits from warming.     

转轨经济中的梯状演进和枝状演进--兼议目前国有银行的分业或混业经营问题

本文根据是否在系统中内生出异质于国有产权组织的竞争因素，区分了经济转轨过程中社会经济系统的两种演进形态：梯状演进和权状演进。指出社会经济系统以何种形态演进取决于国家在一定的现实约束条件下对界定产权的外生交易费用和不界定产权的内生交易费用之间的权衡。面对加入WTO以后外资银行的竞争，我们要坚持国有银行既有的改革逻辑，坚持分业经营原则，同时推进民营银行的发展，构建多资银行的竞争，我们要坚持国有银行既有改革逻辑，坚持分业经营原则，同时推进民营银行的发展，构建多样化的银行组织体系，这是提高我国银行业竞争力的关键，而回入WTO本身提供了推动我国金融改革的历史机遇。     

Public provision of health insurance and aggregate saving in an overlapping generations model with endogenous health risk: The South Korean case

This paper examines the effect of expanding public health insurance in South Korea on medical expenditures and aggregate saving using an overlapping generations model with endogenous health risk. South Korea had a substantial underinsured population, which is aging rapidly. Higher public health insurance benefits reduce individual medical expenditure and health risks but lead to a modest decline in individual and aggregate saving. Even after the expansion, the medical care coverage remains incomplete, and the elderly face a substantial risk of out-of-pocket medical expenditures.     

Promise and shortcomings of a green turn in recent policy responses to the “double crisis”

The paper analyses six international-scale responses to the financial and climate change ‘double crisis’ in order to: review how they define problems and solutions, analyse what underpins the policy choices revealed in these responses (the ‘green turn’), reflect on the implications of the proposed solutions in terms of sustainability and global environmental justice, and to suggest three elements for a paradigm shift towards an ‘alternative’ turn embedded in ecological economics theory. The analysis reveals that responses by leading international organisations continue to appeal to the precepts of neoclassical economy. We argue that from an ecological economics perspective, policy responses under the various labels of green economy, green growth, sustainable growth, green new deal, fall well short of what is needed to fight the environmental crisis and rising inequality across and within countries. The idea of justice and equity that underpins the mainstream approach seems inadequate in terms of sustaining our environmental base and global environmental justice. Based on this critical review, we propose an ‘alternative turn’, centred on three elements of a paradigm shift leading to a new economy where the environmental base and global environmental justice are at the centre of the discourse.     

The impacts of energy insecurity on household welfare in Cambodia: Empirical evidence and policy implications

This study investigates the impacts of energy insecurity on household welfare in Cambodia. The notion of energy insecurity is not well understood in the literature as well as in local contexts. This study defines household energy insecurity as the status quo derived from the interplay of inadequate and insufficient energy consumption that prevents households from meeting basic energy needs. The notion of energy insecurity can only be well understood by investigation in the local context as it varies from place to place. Households facing insufficient energy consumption may forgo many other opportunities. Once energy security has been defined in the Cambodian context, the study employs multiple regression models using the Cambodia Socio-Economic Survey Data (2015) to investigate the impacts of household energy insecurity. The study confirmed that energy insecurity has enormous negative impact on welfare of the households, with a further negative impact on the human capital formation of the children. The findings will lead to policy implications to improve household energy security, and thus impact economic, social, and environmental development.     

Household-level analysis of the impacts of electricity consumption on welfare and the environment in Cambodia: Empirical evidence and policy implications

Cambodia’s biomass consumption is the most dominant energy source at residential sector, and its use is mainly for cooking and heating which could affect health due to indoor air pollution. The biomass is mainly sourced from wood cutting and forest-encroachment that could impact the environment due to reduction of forest at considerable scale. By using the data 2015 of Cambodia Socio-Economic Survey, the study investigates the impacts of electricity consumption on household welfare, such as earnings and the school performance of children in the households, and further to investigate its impacts on the environment. The study found that household’s access to electricity with ability to spend on electricity consumption contributes to the positive household welfare effects and environment via a reduction of biomass consumption, and the more household spends on biomass, the more they are prone to sickness of lung problem. The study also confirmed the important role of human capital formation for the positive impact on the welfare and the environment. These findings lead to policy implications that would improve affordable access to electricity to ensure that all households can use electricity for their basic needs and productivity, and also to reduce the negative effects on environment.     

Health Policy and Equity of Health Care Financing in Australia: 1973–2010

Using data from Australian Taxation Statistics and Household Expenditure Surveys we analyze the distribution of health care financing in Australia over almost four decades. We compute Kakwani Progressivity indices for four sources of health care financing: general taxation, Medicare Levy payments, Medicare Levy Surcharge payments, and direct consumer payments, and estimate the effects of major policy changes on them. The results demonstrate that the first three of these sources of health care financing are progressive in Australia, while the distribution of direct payments is regressive. Surprisingly, we find that neither the introduction of Medicare in Australia in 1984 nor the Extended Medicare Safety Net in 2004 had significant effects on the progressivity of health care financing in Australia. By contrast, the Lifetime Cover scheme—introduced in 2000 to encourage people to buy and hold private health insurance—had a progressive effect on health care financing.