Prenatal care: Mechanisms and impacts on infant health and health care utilization

We estimate that prenatal care has positive impacts on health measured at birth, shifts the distribution of future health care utilization away from inpatient care, and find that some of these impacts likely come from an informational mechanism. We also find well child visits are used in a complementary fashion with emergency department care in the production of infant health, suggesting that factors beyond barriers to access may drive the demand for emergency care. Finally, we find differential impacts of prenatal care across racial groups with evidence that the information mechanism may be particularly important for black mothers.     

How do income and education affect health inequality: evidence from four developing countries

Using household survey data from four countries ? Albania, Nepal, Tajikistan and Tanzania ? this article calculates income-related inequality in health care utilization. We measure health disparity separately for generally and chronically ill individuals by constructing two models: one for the probability of a visit to a physician and another for the number of visits. Following model-based measurements, we decompose inequality into two major parts: one accounted for by identity-related factors and another by socioeconomic and other factors such as education, geography and distance to a clinic. We propose a new method to quantify the effect of changes in income and education on health disparity. One of our important findings suggests that health disparity is pro-rich in all our sample countries. The pro-rich disparity is prevalent among generally ill as well as chronically ill patients, in both visit probability and visit frequency models. Health inequality seems primarily driven by income differences followed by nonidentity factors. Further, the principle of equal treatment for equal need is not fulfilled in any of our countries. Among policy implications, increasing average income and education in a way that also reduces disparity in income and education, respectively, will substantially shrink inequality in health care utilization.     

Decomposing differences in health and inequality using quasi-objective health indices

People in Canada and the United States often make claims regarding whose country has a better health system. Several researchers have attempted to address this question by analysing subjective health measures in the two countries, thus assuming a common definition of ‘good’ health. Using data from the Joint Canada/US Survey of Health, which provides rich and comparable health information for the two countries, I generate two quasi-objective health indices and show that Canadians and Americans define ‘good’ health differently. After controlling for cross-country reporting heterogeneity, health differences between Americans and Canadians are eliminated for intermediate health statuses, while health differences at the tails of the health distribution lead to slightly better average population health in Canada. With respect to health inequality, my results show that income and education gradients increase steeply with poor health in both countries. Hence, considering differences along the health distribution is crucial when assessing population health or health inequality.     

Decomposition and wage inequality

Earning differentials are investigated by a quantile regressions based decomposition, which disentangles the inequalities linked to the covariates and coefficients at various quantiles. Gender and region are considered the main sources of inequality. The unexplained gender and regional differences decrease at the highest wages. Their combination at the lower wages’ level affects women more, causing a so-called sticky floor. Gender and regional covariate effects show a prevalence of women covariates compared with the men’s group, and a prevalence of southern women covariates within the women’s group, particularly at the higher quantiles. This can be interpreted as a glass ceiling hindering southern women at higher wages.     

Retirement and health services utilization in a low-income country*

We estimate the causal effects of retirement on health services utilization in Vietnam. Using authorized retirement ages as instruments for exogenous changes in retirement, we find positive and strong effects of retirement on outpatient health services in the public health sector. Retirement increases the probability of an outpatient visit by 51 percentage points for males and 36 percentage points for females, and the frequency of outpatient visits by 1.4 times for males and 2 times for females. However, we find no effect on the use of public inpatient services as well as private health services.     

Economic reform and interprovincial inequalities in China

This note is an attempt to explore two issues: (1) the trend of interprovincial inequality in the post-1978 reform era in China; and (2) the factors behind the dynamics of interprovincial inequality. Using recently released provincial gross domestic product (GDP) data, we have shown that interprovincial inequality decreased in the fast half of the 1980s, but started to increase in the second half of the 1980s. To understand the impact of sectoral reforms on interprovincial inequality, the overall inequality in provincial per capita GDP is decomposed into the contributions by the primary, secondary and tertiary sectors. It seems that the trend of interprovincial inequality has been largely induced by the reforms of the industrial sector which make up a large share of the secondary sector. In addition, national income data from the socialist national accounting system are used to identify the impact of interprovincial resource flows on interprovincial inequalities. The findings seem to suggest a relative decline in the role of redistributive budgetary transfers.     

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.     

Income Distribution and Redistribution

Abstract:

It seems that some observable structural trends in recent decades such as globalization, skills-biased technological advances and level of unionization all over the world have been affected by income distribution, in addition to other economic variables. The latest trends in the 2000s exhibited a widening gap between the rich and the poor not only in some of the already high inequality countries, but also in traditionally low inequality countries. In order to mitigate inequality, many countries have followed redistribution policies (taxes and transfers). In this article, we will mainly focus on the effects of redistribution policies consisting of income taxes and social transfers on income inequality using the micro data in Turkey. Additionally, since financial crises have been becoming more important with increasing frequency of crises all over the world, we also search for the effects of crises on inequality and the degree of mitigation of redistributive policies, especially during the Global Recession.     

Variations in care: a retrospective database analysis of healthcare utilization patterns for patients with inflammatory bowel disease

Abstract

Background:

Biologic therapy has been shown to be effective in achieving and maintaining remission in the treatment of inflammatory bowel disease (IBD). However, their impact on healthcare resource utilization is not well understood. This study explored the impact of biologic use on IBD-related hospital admissions and emergency room visits and healthcare expenditures.

Methods:

This study used a retrospective cohort design to analyze data from the MarketScan Commercial and Medicare databases (Truven Health Analytics Inc.) for the years 2006–2010. Patients were identified using ICD-9 diagnosis codes for IBD and age 18 or older at time of initial diagnosis. Linear models were used to predict the probability of an IBD-related hospitalization or ER visit and healthcare expenditures with binary variables indicating use of biologics in the current year and in the previous 2 years, as well as patient- and area-level control variables.

Results:

Patients using biologics in the current year were 14.1–17.6% more likely to be hospitalized for IBD. However, biologic use in the previous year was associated with a 3.8–5.6% reduction in hospitalizations, and biologic use 2 years prior was associated with a 1–2.8% reduction in hospitalizations in the current year. Similar results are found for ER visits. All indicators for biologic use were associated with increased expenditures.

Conclusions:

There was a negative association between lagged use of biologics and the proportion of patients with IBD-related hospitalizations and ER visits. This finding may suggest that increased use of biologics over time is associated with a decrease in IBD-related healthcare utilization.     

Health care resource utilization and burden of disease in a U.S. Medicare population with a principal diagnosis of osteoarthritis of the knee

Abstract

Aims

To assess the prevalence, health care resource utilization (HCRU), and economic burden of disease among Medicare beneficiaries with a principal diagnosis of osteoarthritis (OA) of the knee.     

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.     

代际收入流动性与收入不平等——基于面板数据联立方程模型的分析

利用CHNS数据,在测度收入不平等的代际传递性的基础上,通过面板数据联立方程模型实证分析代际收入流动与收入不平等之间的关系。实证研究结果表明,收入不平等程度的上升阻碍了代际收入的流动,而代际收入弹性的提高也会导致收入不平等状况的恶化。     

城乡居民收入差距的动态演变:1988～2002年

中国城乡居民收入差距已经引起广泛关注。文章以住户调查数据为基础,利用泰尔指数分解、G.Fields分解、Blinder分解、分位回归分解等多种方法讨论了1988年、1995年和2002年“城乡”因素本身对城乡居民收入差距的贡献。这些分解结果表明我国的城乡差距较显著并在不断扩大;而且城乡差距更不利于农村中的低收入人群。     

Problems of elderly health care and welfare arrangement --Case study of demand on elder care in northeastern of Thailand

This research attempted to explain the problems of elderly health care, the problems and suggestion in elder welfare arrangement and the demand on elder care. The survey underlying this study was conducted in Muang district, Khon Kaen province, Thailand. Eighteen subdistricts were interviewed in the study area. Data were collected in two areas of Khon Kaen province, that are, the city of Khon Kaen and the outside Thesaban Nakhon Khon Kaen. The random sample consisted of 386 elders： 112 elders lived in the city of Khon Kaen and 234 elders lived outside Thesaban Nakhon Khon Kaen, Muang district, Khon Kaen. The analysis of the demand on elderly welfare gave an interesting result that the elders demanded on monthly income to support living cost and medical services at high level; The demand on housing was at low level; The demand on education, religion and culture the demand on club, sport and entertainment, and the demand on job and art were at the moderate level; The main problem of elderly welfare arrangement was the scarcity of budget support, the weakness of elder health, and activities announcement. The analysis of pattern of elder welfare： The case study of elder care identified that 31.87 percent of the elders had demand on elder care. Price of the elder care at 100 Baht per day was mostly selected about one-fourth of all the case occurred. Female elder selected the elder care at 100 Baht per day, while male elder choose at a higher price level, which were 200 Baht per day and 150 Baht per day respectively. The female elder care was the most popular. The elder care age between 30-39 years was mostly selected. Finally, most of elders purposed the working day of the elder care depend on their appointment.     

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。     

Provision of health care services in Austria

It is the aim of this paper to investigate three important variables of the health care system in Austria, that is the number of physicians working in the ambulatory sector, the number of medical services provided by the physicians and the related costs, by applying time series analysis to the quantities under consideration. The work analyzes stationarity, autocorrelation functions, presents unit root tests and calculates the Beveridge Nelson decomposition for an ARIMA(1,1,0)-model. The obtained findings are used to forecast future trends based on past values.The author is indebted to Ulrike Leopold, Klaus Neusser, Thomas Url and Peter Zweifel for many useful conversations and suggestions as well as to Keith Chester for English proofreading. The first version of the analysis presented was done as part of a project that was carried out at the Austrian Federal Institute of Public Health on behalf of the Austrian Government.     

浅析贫困、经济增长与脱贫时间——基于中国城镇居民调查数据的分析

20世纪90年代以来，经济增长和收入分配不平等对于城镇人口脱贫时间产生了消极影响。研究发现，城镇贫困在1997年达到高峰，然后逐渐缓和；贫困人口的收入增长在初期能使脱贫时间迅速减少，但边际效果是递减的；贫困人口之间的收入分配不平等延长了脱贫时间，如果贫困人口的初始收入增加，则会明显缩短脱贫时间。     

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.     

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.