SELECTED FOR YOU... OCTOBER 2010: books of the month - working papers

All the Selected for you


Manuel sur la pauvreté et l'inégalité.
Handbook on poverty and inequality.

Haughton J., Khandker S.R.
Washington : Banque Mondiale. 2009. 419 p.

The handbook on poverty and inequality provides tools to measure, describe, monitor, evaluate, and analyze poverty. It provides background materials for designing poverty reduction strategies. This book is intended for researchers and policy analysts involved in poverty research and policy making. The handbook began as a series of notes to support training courses on poverty analysis and gradually grew into a sixteen, chapter book. Now the Handbook consists of explanatory text with numerous examples, interspersed with multiple-choice questions (to ensure active learning) and combined with extensive practical exercises using stata statistical software. The handbook has been thoroughly tested. The World Bank Institute has used most of the chapters in training workshops in countries throughout the world, including Afghanistan, Bangladesh, Botswana, Cambodia, India, Indonesia, Kenya, the Lao People's Democratic Republic, Malawi, Pakistan, the Philippines, Tanzania, and Thailand, as well as in distance courses with substantial numbers of participants from numerous countries in Asia (in 2002) and Africa (in 2003), and online asynchronous courses with more than 200 participants worldwide (in 2007 and 2008). The feedback from these courses has been very useful in helping us create a handbook that balances rigor with accessibility and practicality. The handbook has also been used in university courses related to poverty (4e de couverture).


Health Care Insurance

Public and Private Health Insurance in Germany: The Ignored Risk Selection Problem.
Assurance santé privée et publique en Allemagne : les risques ignorés du problème de la sélection au risque.

Grunow M., Nuscheler R.
Augsburg : University of Augsburg : 2010/08 : 25 p.

While risk selection within the German public health insurance system has received considerable attention, risk selection between public and private health insurers has largely been ignored. This is surprising since – given the institutional structure – risk selection between systems is likely to be more pronounced. We find clear evidence for risk selection in favor of private insurers. While private insurers are unable to select the healthy upon enrollment they manage to dump high risk individuals who then end up in the public system. This gives private insurers an unjustified competitive advantage vis-à-vis public insurer. A risk adjusted compensation would mitigate this advantage.

Health Insurance Competition: The Effect of Group Contracts.
La concurrence dans le domaine de l'assurance maladie. L'effet des contrats collectifs.

Boone J., Douven R., Droge C., Mosca I.
Le Tilburg : Center for Economic Research. : 2010/05 : 23 p.

In countries like the US and the Netherlands health insurance is provided by private firms. These private firms can offer both individual and group contracts. The strategic and welfare implications of such group contracts are not well understood. Using a Dutch data set of about 700 group health insurance contracts over the period 2007-2008, we estimate a model to determine which factors explain the price of group contracts. We find that groups that are located close to an insurers' home turf pay a higher premium than other groups. This finding is not consistent with the bargaining argument in the literature as it implies that concentrated groups close to an insurers home turf should get (if any) a larger discount than other groups. A simple Hotelling model, however, does explain our empirical results.

Health Economics

Economic Policies, Socieconomic Factors and Overall Health: A Short Review .
Politiques économiques, facteurs socio-économiques et la santé en général : un bref aperçu.

Drakopoulos S.A.
Bruxelles : EERI : 2010/08 : 26 p.

Many researchers have found that socioeconomic factors play a crucial role in determining physiological and psychological health levels of the population. This implies that socioeconomic inequalities tend to produce health inequalities. It is also generally accepted that the level of unemployment, income inequality and poverty levels are largely affected by economic policies and the economic cycles. They can also influence economic growth, human capital levels and thus productivity which play an important role on health inequalities. Economic policies can also influence the occurrence, frequency, duration and the strength of economic cycles which in turn influence socioeconomic factors and therefore health inequalities. Thus, this short review will discuss the conduct and the effects of economic policy on health inequalities especially during recessionary periods. The paper starts with a discussion of the need and of the instruments of economic policy and also its effectiveness in smoothing the economic cycle. It also examines the interplay between main policy targets such as unemployment and inflation with political considerations. Finally, it concentrates on the effects of economic policies for health inequalities in view of economic recessions.

Obesity and the Economics of Prevention: Fit not Fat.
L'obésité et l'économie de la prévention : mince, mais pas gros.

Sassi F.
Paris : OCDE : 2010/09 : 265 p.

This report examines the scale and characteristics of the current obesity epidemic, the respective roles and influences of market forces and governments, and the impact of interventions to tackle obesity. Its report presents for the first time analyses and comparisons of the most detailed data on obesity available from 11 OECD countries. It includes a unique analysis of the health and economic impact of a range of interventions to tackle obesity in 5 countries, carried out jointly by the OECD and the World Health Organization. Obesity has risen to the top of the public health policy agenda worldwide. Before 1980, rates were generally well below 10%. They have since doubled or tripled in many countries, and in almost half of the OECD, 50% or more of the population is overweight. A key risk factor for numerous chronic diseases, obesity is a major public health concern. There is a popular perception that explanations for the obesity epidemic are simple and solutions within reach. But the data reveal a more complicated picture, one in which even finding objective evidence on the phenomenon is difficult. Policy makers, health professionals and academics all face challenges in understanding the epidemic and devising effective counter strategies. This book contributes to evidence-based policy making by exploring multiple dimensions of the obesity problem. It examines the scale and characteristics of the epidemic, the respective roles and influence of market forces and governments, and the impact of interventions. It outlines an economic approach to the prevention of chronic diseases that provides novel insights relative to a more traditional public health approach.

The Asset Cost of Poor health.
Le coût en matière d'actifs financiers d'un mauvais état de santé.

Poterba J.M., Venti S.F., David A. Wise D.A
Cambridge : NBER : 2010/09 : 29 p.

This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This “asset cost of poor health” appears to be larger for persons with substantial 1992 asset balances than for those with lower balances.


Is there a Future for Small Hospitals in Germany?
Les petits hôpitaux ont-ils un avenir en Allemagne ?

Augurzky B., Schmitz H.
Essen : RWI : 2010/09 : 18 p.

We analyse the financial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of financial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We find that, on average, small hospitals have more financial difficulties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profit hospitals tend to perform very well, small public hospitals face considerable financial problems. Apart from ownership, we find that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better financial performance.

For-profit hospitals : a comparative and longitudinal study of the for-profit hospital sector in four western countries.
Hôpitaux à but lucratif : une étude comparative et longitudinale sur le secteur des hôpitaux lucratifs dans quatre pays occidentaux.

Jeurissen P.
Rotterdam : Erasmus Universiteit Rotterdam : 2010 : 17 p.+326 p.
Thèse à commander auprès de l'auteur

The central purpose of this study is to provide an international comparison and historical explanation of the development of for-profit hospital care. It will seek to answer the following questions. 1) How did for-profit hospital ownership actually develop within the context of different Western health care systems? 2) How can one understand and explain growth (and decline) in for-profit hospitals over the long term? 3) Why does the development of the for-profit hospital sector differ between Western countries? This research will look for plausible answers to these three questions and provide hypotheses for future study. Such work is still uncommon and limited to shorter periods or tends to be somewhat polemical in nature. Scholarly efforts have concentrated on the development of the much larger nonprofit and public hospital sectors or have sought to provide more general overviews. A comparative perspective on the development of for-profit hospitals is - with the exception of explorative work of Henry Burdett in the nineteenth century (1895) - still lacking to the knowledge of this study.

Health inequalities

Longitudinal analysis of income-related health inequality: welfare foundations and alternative measures.
Analyse longitudinale des inégalités de santé liées au revenu : les fondations de l'Etat providence et les mesures alternatives.

Allanson P.
Dundee : University of Dundee : 2010/08 : 30 p.

This paper elaborates the approach to the longitudinal analysis of income-related health inequalities first proposed in Allanson, Gerdtham and Petrie (2010). In particular, the paper establishes the normative basis of their mobility indices by embedding their decomposition of the change in the health concentration index within a broader analysis of the change in “health achievement” or wellbeing. The paper further shows that their decomposition procedure can also be used to analyse the change in a range of other commonly-used income related health inequality measures, including the generalised concentration index and the relative inequality index. We illustrate our work by extending their investigation of mobility in the General Health Questionnaire measure of psychological well-being over the first nine waves of the British Household Panel Survey from 1991 to 1999.

The impact of education on health knowledge.
L'impact de l'éducation sur la connaissance en matière de santé.

Altindag D.T., Cannonier C., Mocan N.H.
Cambridge : NBER : 2010/09 : 48 p.

The theory on the demand for health suggests that schooling causes health because schooling increases the efficiency of health production. Alternatively, the allocative efficiency hypothesis argues that schooling alters the input mix chosen to produce health. This suggests that the more educated have more knowledge about the health production function and they have more health knowledge. This paper uses data from the 1997 and 2002 waves of the NLSY97 to conduct an investigation of the allocative efficiency hypothesis by analyzing whether education improves health knowledge. The survey design allows us to observe the increase in health knowledge of young adults after their level of schooling is increased by differential and plausibly exogenous amounts. Using nine different questions measuring health knowledge, we find weak evidence that an increase in education generates an improvement in health knowledge for those who ultimately attend college. For those with high school as the terminal degree, no relationship is found between education and health knowledge. These results imply that the allocative efficiency hypothesis may not be the primary reason for why schooling impacts health outcomes.

A Theory of Socioeconomic Disparities in Health over the Life Cycle.
Une théorie des inégalités socioéconomiques de santé tout au long de la vie.

Galama T., Van Kippersluis H.
Santa Monica : Rand Corporation : 2010 : 49 p.

Understanding of the substantial disparity in health between low and high socioeconomic status (SES) groups is hampered by the lack of a sufficiently comprehensive theoretical framework to interpret empirical facts and to predict yet untested relations. The authors present a life-cycle model that incorporates multiple mechanisms explaining (jointly) a large part of the observed disparities in health by SES. In their model, lifestyle factors, working conditions, retirement, living conditions and curative care are mechanisms through which SES, health and mortality are related. Their model predicts a widening and possibly a subsequent narrowing with age of the gradient in health by SES.


Regulation of Pharmaceutical Prices : Evidence from a Reference Price Reform in Denmark
La régulation des prix des médicaments : évidence issue de la réforme du prix de référence au Danemark.

Kaiser U., Mendez S.J., Ronde T.
Copenhague : Centre for Industrial Economics : 2010/01 : 41 p.

On April 1, 2005, Denmark changed the way references prices, a main determinant of reimbursements for pharmaceutical purchases, are calculated. The previous reference prices, which were based on average EU prices, were substituted to minimum domestic prices. Novel to the literature, we estimate the joint effects of this reform on prices and quantities. Prices decreased more than 26 percent due to the reform, which reduced patient and government expenditures by 3.0 percent and 5.6 percent, respectively, and producer revenues by 5.0 percent. The prices of expensive products decreased more than their cheaper counterparts, resulting in large differences in patient benefits from the reform.

Health care policy

Implementing health financing reform: lessons from countries in transition.
Mise en oeuvre des réformes du financement des soins : leçons issues des pays en transition.

Kutzin J., Cashin C., Jakab M.
Copenhague : OMS Bureau régional de l'Europe 2010 : 20 + 411 p.

Since 1990, the social and economic policies of the transition countries of central and eastern Europe, the Caucasus and central Asia have diverged, including the way they have reformed the financing of their health systems. This book analyses this rich experience in a systematic way. It reviews the background to health financing systems and reform in these countries, starting with the legacy of the systems in the USSR and central and eastern Europe before 1990 and the consequences (particularly fiscal) of the transition for their organization and performance. Using in-depth country case experiences, chapters focus on how policies were implemented to change the mechanisms for revenue collection, pooling of funds, purchasing of services and the policy on benefit entitlements. Later chapters highlight particular reform topics: the financing of capital costs; the links between health financing reform and the wider public finance system; the financing of public health services and programmes; the role of voluntary health insurance; informal payments; and accountability in health financing institutions. From practical experience of implementing, advising or evaluating health financing policies in the region, the authors offer important lessons, as well as pitfalls to avoid in the reform process. This book is essential reading for health finance policy-makers, advisers and analysts in this region and beyond.

Work and Health

Ageing, chronic conditions and the evolution of future drugs expenditures.
Vieillissement, maladies chroniques et l'évolution des futures dépenses pharmaceutiques.

Barnay T., Thiebaud S., Ventelou B.
Paris : TEPP : 2010 : 25 p.

The healthy ageing assumptions may lead to substantial changes in paths of aggregate healthcare expenditures, notably catastrophic expenditures of people at the end of the life. But clear assessments of involved amounts are not available when we specifically consider ambulatory care (as drug expenditures) generally offered to chronically-ill people who can remain in this health-status for a long time onward. The Government and Social Security need tools to predict the future cost of health in particular drugs expenditures taking account epidemiological changes on future. This study estimates the evolution in reimbursable outpatient drug expenditures, attributable to age structure and chronic conditions changes, of the French population up to 2029.

Health and Early Retirement: Evidence from French Data for individuals.
Santé et départ prématuré à la retraite : Résultats fondés sur des données françaises individuelles.

Barnay T., Briard K.
Paris : TEPP : 2010 : 29 p.

Health status during the working life plays a major role in the retirement decision. Significant links between professional paths, retirement age and retirement conditions (disability pension, inability pension, reduced-rate pension, or full rate by age) can be highlighted by logistic models regressions and a typology of the professional careers of the 1940-generation of the French Social Security insured, whose the insurance period is insufficient to fulfill the fullrate pension criterion.

Health and Early Retirement: Evidence from French Data for individuals.
Santé et départ prématuré à la retraite : Résultats fondés sur des données françaises individuelles.

Barnay T., Briard K.
Paris : TEPP : 2010 : 29 p.

Health status during the working life plays a major role in the retirement decision. Significant links between professional paths, retirement age and retirement conditions (disability pension, inability pension, reduced-rate pension, or full rate by age) can be highlighted by logistic models regressions and a typology of the professional careers of the 1940-generation of the French Social Security insured, whose the insurance period is insufficient to fulfill the fullrate pension criterion.

Sickness, Disability and Work : Breaking the barriers : Canada. Opportunities for collaboration.
Maladie, Invalidité et travail : surmonter les obstacles : Canada. Des possibilités de collaboration.

Organisation de coopération et de développement économiques. (OCDE).
Paris : OCDE : 2010 : 95 p.

Trop de travailleurs quittent définitivement le marché du travail pour des raisons de santé ou à cause d'une incapacité, et rares sont les personnes qui conservent un emploi lorsque leur capacité de travail est réduite. C'est là une tragédie sociale et économique commune à la quasi-totalité des pays de l'OCDE, qui est à l'origine d'un paradoxe apparent méritant explication : alors qu'en moyenne la santé s'améliore, pourquoi de nombreux individus en âge de travailler quittent-ils la population active pour vivre de leurs prestations de maladie de longue durée ou d'invalidité ? Ce rapport, le dernier de la série de l'OCDE intitulée Maladie, invalidité et travail : surmonter les obstacles fait la synthèse des conclusions du projet et étudie les facteurs qui peuvent expliquer ce paradoxe. Il met en lumière le rôle des institutions en place et des politiques mises en œuvre et conclut qu'il est essentiel pour les principaux acteurs – travailleurs, employeurs, médecins, organismes publics et prestataires de services – de rehausser les attentes et d'améliorer les incitations. A partir d'un examen des bonnes et mauvaises pratiques observées dans les pays de l'OCDE, le rapport suggère qu'une série de réformes de fond s'impose afin de promouvoir l'emploi des personnes atteintes de problèmes de santé. Le rapport examine plusieurs options d'arbitrage essentiels entre des politiques de diminution du nombre de nouveaux bénéficiaires du régime d'invalidité et d'augmentation du nombre de sorties du régime, de maintien dans l'emploi ou de recrutement de personnes souffrant de problèmes de santé. Il s'interroge sur la nécessité de dissocier chômage et invalidité en tant qu'aléas distincts, souligne combien il importe de disposer d'une meilleure base de données d'observation et insiste sur les difficultés de mise en œuvre des politiques retenues.

Sickness Absence and Local Cultures.
Arrêt maladie et cultures locales.

Ekblad K., Bokenblom M.
Orebro : Orebro University : 2010 : 22 p.

Sickness absence has been found to vary substantially across geographical areas. There are large differences between different countries but also between different regions within a particular country. In the literature some of these observed differentials have been suggested to stem from differences in local norms with regard to the legitimacy of living off benefits. The aim of our study is to investigate the effect of geographical and presumed cultural context on sickness absence. In order to identify this effect we compare changes in sickness related absence for individuals who move from one Swedish region to another with those occurring when individuals move within Swedish regions. Our results indicate that the region of residence is important to the individual sickness related absence. Moreover, we cannot rule out the possibility that the observed patterns are caused by local cultures regarding sickness absence and the existence of a so called “cultural illness”.

The Impact of Early Retirement on Health.
L'impact de la retraite précoce sur l'état de santé.

Lindeboom M., Andersen H.L.
New York : Social Science Research Network : 2010 : 36 p.

This paper investigates the impact of early retirement on the health after retirement. Although the correlation between retirement and mental health is negative, this is not necessarily a causal impact because retirement may be endogenous to health. We address the endogeneity using two sources of exogenous variation in retirement; the first arises because of a reform of the early retirement scheme, and the second is due to an eligibility discontinuity in age. Our results are based on a large Danish administrative dataset for everyone born 1936-42 (N = 376, 909). We measure health outcomes by purchase of different types of prescription medicine and mortality. Our results support prior findings in the literature: early retirement has no effect on the medicine purchase risk in either short or long run.

Health at work - indicators and determinants : a revised literature and data review for Germany.
Santé au travail - indicateurs et déterminants : une revue de la littérature et de données révisées pour l'Allemagne.

Schneider J., Beblo M.
Nüremberg : IAB : 2010/07 : 52 p.

In this paper, the current knowledge and issues regarding the economic impact of health at work in Germany is reviewed as a part of the EU project : An inquiry into health and safety at work: a European Union perspective (acronym: HEALTHat-WORK). After a description of the German institutional framework for occupational safety and health (OSH), it presents indicators of health and safety at work - such as sickness absences, occupational accidents and diseases, disability rents, working conditions, and OSH policy. The paper's major contribution is a review of economic research on the determinants of OSH indicators in Germany, and a review of the data sets that have been or may be used. The aim is to identify the main issues addressed in the literature, the approaches adopted, the data analyzed, and the research gaps that still exist with respect to analyzing health at work in Germany.


The Impact of the crisis on cash-for-care scheme for dependent elderly. A comparative study of France, Italy and England (2010).
L'impact de la crise sur le système des prestations en espèce pour les personnes âgéées dépendantes. Une étude comparée entre la France, l'Italie et l'Angleterre.

Geogantzi A.E.
Lewen : Catholic University of Leuven : 2007/07 : 46 p.

Ce document examine les répercussions de la crise économique et financière sur les programmes de soins de longue durée offerts aux personnes âgées. L'auteur s'attarde plus particulièrement sur les cas de l'Italie, de la France et de l'Angleterre, en mettant l'accent sur la prestation aux aînés fragiles et à leurs aidants informels.