SELECTED FOR YOU... DECEMBER 2009: books of the month - working papers

All the Selected for you


Health at a Glance 2009. OECD Indicators

Organisation for Economic Co-Operation and Development. (OECD). Paris.

Paris: OCDE : 2009: 200 p.

This fifth edition of Health at a Glance provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. Key indicators provide information on health status, the determinants of health, health care activities and health expenditure and financing in OECD countries. This edition also contains new chapters on the health workforce and on access to care, an important policy objective in all OECD countries. The chapter on quality of care has been extended to include a set of indicators on the quality of care for chronic conditions.




Achieving Better Value for Money in Health Care.

Morgan D., Oxley H., Docteur E., Paris V., Klazinga N., Ronchi E., Smith P.C.

Organisation for Economic Co-Operation and Development. (OECD). Paris.

Rising public health care spending remains a problem in virtually all OECD and EU member countries. As a consequence, there is growing interest in policies that will ease this pressure through improved health system performance. This report examines selected policies that may help countries better achieve the goal of improved health system efficiency and thus better value for money. Drawing on multinational data sets and case studies, it examines a range policy instruments. These include: the role of competition in health markets; the scope for improving care coordination; better pharmaceutical pricing policies; greater quality control supported by stronger information and communication technology in health care; and increased cost sharing.


Health Insurance

Co-Pay and Feel Okay: Evidence of Illusory Health Gains from a Health Insurance Reform

Paloyo A.R.

SOEPpapers on Multidisciplinary Panel Data Research ; 172

The reliability of general self-rated health status is examined using the reform of the public health insurance system of Germany in 2004 as a source of exogenous variation. Among others, the reform introduced a co-payment for ambulatory doctor visits and increased the co-payments for prescription drugs. This natural experiment allows identification of the causal impact of the program on self-assessed health and hence reveals the sensitivity of this subjective measure to a perturbation in the insurance system. Using data from the German Socio-Economic Panel, the results indicate that after the policy intervention, the respondents in the treated group perceived their own health status as better than their hypothetical untreated state even when there is no discernible impact on actual health.The reliability of general self-rated health status is examined using the reform of the public health insurance system of Germany in 2004 as a source of exogenous variation. Among others, the reform introduced a co-payment for ambulatory doctor visits and increased the co-payments for prescription drugs. This natural experiment allows identification of the causal impact of the program on self-assessed health and hence reveals the sensitivity of this subjective measure to a perturbation in the insurance system. Using data from the German Socio-Economic Panel, the results indicate that after the policy intervention, the respondents in the treated group perceived their own health status as better than their hypothetical untreated state even when there is no discernible impacton actual health (Author's abstract).

Drugs and Technological Innovations

Technological Adoption in Health Care

Barros P.P., Martinez-Giralt X.

Barcelone : Universitat de Barcelona : 2009/11 : 34 p.

This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients' benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients' benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favours more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems (Authors' abstract).

Health Economics

The Relationship Between Household Size and the Demand for Medical Care

Halliday T., Park M.

Manoa : University of Hawai : 2009/11, 18 p.

This article documents a robust negative relationship between household size and medical expenditures. Residing in a larger family is associated with less consumption of medical care ceteris paribus. An additional household member is associated with between $255.60 and $277.36 fewer expenditures on health care on average. Using quantile regression, we found that the magnitude of cost saving associated with living in a larger family increases with the demand for medical care. Based on these findings, we conclude that larger family size may be beneficial to a person's health. Future research is needed to verify the mechanisms underlying this correlationInégalités de santé (Authors' abstract).

Health Status, Health Inequalities

An Economic Framework for Analysing the Social Determinants of Health and Health Iinequalities

Epstein D., Jimenez-Rubio D. Suhrcke M.

York : University of York : 2009/10 : 58 p.

Reducing health inequalities is an important part of health policy in most countries. This paper discusses from an economic perspective how government policy can influence health inequalities, particularly focusing on the outcome of performance targets in England, and the role of sectors of the economy outside the health service – the ‘social determinants' of health - in delivering these targets (Authors' abstract).

Intergenerational Aspects of HealthCare

Federal Reserve Board. Divisions of research and statistics and monetary affairs. Washington D.C. USA

Washington : Federal reserve board : 2009 : 3 p.

The physical process of aging means that the use of health services varies significantly by age. This association between age and health care consumption raises a number of issues related to intergenerational and intragenerational equity, including the allocation of societal resources across age groups and the effects of population aging and health cost growth on public sector health care burdens and, hence, on intergenerational redistribution. This working paper (forthcoming as a chapter in the Oxford Handbook of Health Economics) provides a detailed look at the theoretical and empirical relationships between health spending and age, both in the US and internationally, and reviews the evidence on the intergenerational redistribution associated with public health spending over time (Author's abstract).

Happiness in Europe: Cross-Country Differences in the Determinants of Subjective Well-Being

Pedersen P.J., Torben Dall Schmidt T.D.

Bonn : The Institute for the Study of Labor : 2009/10 : 26 p.

The purpose in the present paper is to use individual panel data in the European Community Household Panel to analyse the impact on self-reported satisfaction from a number of economic and demographic variables. The paper contributes to the ongoing discussion of the relationship between life satisfaction and income. The panel property of the data makes it possible to study also the impact on satisfaction from income changes as well as the impact from acceleration in income and changes in labour market status on changes in satisfaction. A number of demographic variables and individual attitude indicators are also entered into the analysis of both the level of satisfaction and the change in satisfaction from one wave of the survey to the next. We find a strong impact from the level of income in all countries, an impact from change and acceleration in income for a smaller number of countries, a strong impact from most changes in labour market status and finally important effects from a number of demographic variables (Authors' abstract).


How Should We Support PharmaceuticalInnovation?

Grootendorst P.

Hamilton : SEDAP : 2009/05 : 16 p.

The question as to how society should support pharmaceutical (‘pharma') innovation is both pertinent and timely: Pharma drugs are an integral component of modern health care and hold the promise to treat more effectively various debilitating health problems. The rate of pharma innovation, however, has declined since the 1980s. Many observers question whether the patent system is capable of providing the appropriate incentives for pharma innovation and point to several promising alternative mechanisms. These mechanisms include both ‘push' programs – subsidies directed towards the cost of pharma R&D – and ‘pull' programs – lumpsum rewards for the outputs of pharma R&D, that is, new drugs. I review evidence why our current system of pharma patents is defective and outline the various alternative mechanisms that may spur pharma innovation more effectively. (Author's abstract).

Competition and the Reference Pricing Scheme for Pharmaceuticals

Ghislandi S.

New York : Social Science Electronic Publishing : 2009/04 : 28 p.

In a pharmaceuticals Reference Price Scheme (RPS), firms are free to set their prices, but the (insured) consumer pays only the difference between the Reference level (R) and the actual price of the drug, if this is higher than R.By introducing n (>1) firms with infinite cross-price elasticity (i.e.generic drugs), we explore the effects of competition on the optimal pricing strategies under a RPS. A two-stage model repeated either once or an infinite number of times is presented: in the first stage firms compete or collude in prices and set R, while in the second they take R. as exogenous. When stage 1 is a competitive, the equilibrium in pure strategies exists and is efficient only if R does not depend on the price of the branded product. When generics collude, the way R is designed is crucial for both the stability pf the cartel among generics and the collusive prices in equlibrium. Is is shown that an optimally designed RPS must set R as a function only of the infinitely elastic side of the market and should provide the right incentives for cartel's decepition (Author's abstract).


Improving Lifestyles, Tackling Obesity: The Health and Economic Impact of Prevention Strategies

Sassi F., Cecchini M., Lauer J. Chisholm D.

OECD Health Working Paper; 48 Paris : OECD : 2009 : 102 p.

In an attempt to contain rising trends in obesity and associated chronic diseases, many governments have implemented a range of policies to promote healthy lifestyles. These efforts have been hindered by the limited availability of evidence about the effectiveness of interventions in changing lifestyles and reducing obesity. Evaluations of the cost-effectiveness and distributional impacts of such interventions are even fewer and narrower in terms of numbers of options considered. An economic analysis was developed jointly by the OECD and the WHO with the aim of strengthening the existing evidence-base on the efficiency of interventions to tackle unhealthy diets and sedentary lifestyles. The analysis was broadly based on the WHO-CHOICE (CHOosing Interventions that are Cost-Effective) approach, and it aimed at assessing the efficiency of a range of policy options to tackle unhealthy lifestyles and related chronic diseases. Additionally, compared to the traditional CHOICE framework, the analysis assessed the distributional impacts of preventive strategies on costs and health outcomes. Most of the preventive interventions evaluated as part of the project have favourable cost-effectiveness ratios, relative to a scenario in which no systematic prevention is undertaken and chronic diseases are treated once they emerge. However, since the determinants of obesity are multi-factorial and affect all age groups and social strata, interventions tackling individual determinants or narrowly targeted to one groups of individuals will have a limited impact at the population level, and will not reduce significantly the scale of the obesity problem. Although the most efficient interventions are found to be outside the health sector, health care systems can have the largest impact on obesity and related chronic conditions by focusing on individuals at high risk. Interventions targeting younger age groups are unlikely to have significant health effects at the population level for many years. The cost-effectiveness profiles of such interventions may be favourable in the long-term, but remain unfavourable for several decades at the start of the interventions. Preventive interventions do not always generate reductions in health expenditure, when the costs oftreating a set of diseases that are directly affected by diet, physical activity and obesity are considered. (Authors' abstract).

Health Care Quality

Health Care Quality Indicators Project: Patient Safety Indicators Report 2009

Drosler S., Romano P., Wei L.

Paris : OECD : 2009 : 45 p.

This paper reports on the progress in the research and development of the set of patient safety indicators developed by the Health Care Quality Indicators project. The indicators presented here have been recommended by an expert group for further consideration in international reporting on the quality of care on the key dimension of safety. The indicators have been selected by expert consensus, undergone validity testing and have been tested for comparability. While concern remains related to differences in coding and reporting from administrative hospital databases, the rigour with which the indicator work has been undertaken has resulted in the improved ability of countries to report on the quality of care. The work on the development of the patient safety indicators highlights the technical progress made in constructing measures and the ongoing need for methodological improvements. The indicators reported here should not be considered as making inferences on the state of patient safety in countries, but are intended to raise questions towards improving understanding of the reported differences. (Authors' abstract).

Health and Employment

A Survey of Safety and Health at Work in Greece

Drakopoulos S., Economou A., Grimani K.

Munich : MRPA : 2009 : 22 p.

The subject of Occupational Safety and Health (OSH) is increasingly gaining the interest of policy makers and researchers in European countries given that the economic and social losses from work-related injuries and diseases are quite substantial. Under this light, this paper will present an overview of the Greek legislation framework regarding OSH issues, and the current status of empirical research on the subject in Greece. In addition, the paper identifies the knowledge gaps and methodological shortcomings of the existing literature in order to contribute towards future research in the OSH field in Greece (Authors' abstract).

Health care systems

Competition in Canadian Health Care Service Provision: Good, Bad or Indifferent?

Ruseski J.E.

Calgary : University of Calgary : 2009/11 : 43 p.

This paper evaluates what has been learned from the recent literature on competition in health care markets in the context of expanding the role of the private sector in Alberta. The evidence does not provide a definitive answer. Competition introduced by an expanded private sector is likely to be beneficial on some measures, indifferent on others, but not likely bad (Author's abstract).


Home Care for the Elderly: Family, Friends, and the State

Kalwij A., Pasini G., Mingqin W.

Tilburg : Network for Studies on Pensions, Aging and Retirement : 2009/07 : 45 p.

This paper uses data from the Survey of Health, Ageing and Retirement in Europe to examine the home care received by elderly in Western Europe. Specifically, we relate the demand for home care to the health status of the elderly household members and like previous studies find that health limitations, age, and marital status are important determinants of home care. New findings come from a detailed analysis of the relative demand from different potential home care providers (children, other relatives, friends and the state). The results reveal that relatives and friends provide as much home care as children and that the relative importance of the different home care providers changes with household characteristics like age and total health care demand. Furthermore, the results show that friends act as a substitute for informal care from adult children (Authors' abstract).

Social Security and Well-Being of the Elderly: the Case of France

Roger M., Walraet E.

Paris : Insee : 2008/12 : 42 p.

We use the 1982 and 1993 reforms of the French pension system in the private sector to study the relationship between Social Security benefits and the well-being of the elderly between the late 70's and the beginning of the new century. Affecting people in a different way, depending on year of birth, gender or socio-economic status, these reforms provide some sources of identification to estimate the effect of benefit changes on the standard of living of elderly families. To avoid spurious correlation or endogeneity problems in the determination of the impact of Social Security benefits on well-being we compute simulated social security payments and compare their evolution to various measures of well-being based on income, consumption, poverty, inequality or life satisfaction for both elderly and non-elderly families. We then focus on the 1982 and 1993 reforms. Our estimations conclude to a general increase in income, consumption and subjective well-being. However, a one euro increases in simulated benefit does not induce a one euro increase in after tax income (except at the top of the distribution), which shows some substitution between the different sources of income available for the elderly households. Estimation of difference in difference models to evaluate the impact on income and consumption of the 1982 and 1993 reforms underlines that it may exist asymmetry in the substitution effect between the different sources of income of the elderly depending on the sign of the change in generosity of the pension reforms. (Authors' abstract).