Testing for Adverse Selection into Private Medical Insurance

We develop a test for adverse selection and use it to examine privatehealth insurance markets. In contrast to earlier papers that consider apurely private system or a system in which private insurance supplementsa public system, we focus our attention on a system where privately fundedhealth care is substitutive of the publicly funded one. Using a model ofcompetition among insurers, we generate predictions about the correlationbetween risk and the probability of taking private insurance under bothsymmetric information and adverse selection. These predictions constitutethe basis for our adverse selection test. The theoretical model is also usefulto conclude that the setting that we focus on is especially attractive to testfor adverse selection. Using the British Household Panel Survey, we findevidence that adverse selection is present in this market. We develop a test for adverse selection and use it to examine privatehealth insurance markets. In contrast to earlier papers that consider apurely private system or a system in which private insurance supplementsa public system, we focus our attention on a system where privately fundedhealth care is substitutive of the publicly funded one. Using a model ofcompetition among insurers, we generate predictions about the correlationbetween risk and the probability of taking private insurance under bothsymmetric information and adverse selection. These predictions constitutethe basis for our adverse selection test. The theoretical model is also usefulto conclude that the setting that we focus on is especially attractive to testfor adverse selection. Using the British Household Panel Survey, we find evidence that adverse selection is present in this market

Evaluar intervenciones sanitarias sin experimentos

ResumenEn el presente artículo se revisa la bibliografía reciente en evaluación cuantitativa de intervenciones no experimentales, poniendo especial énfasis en su aplicación a la economía y la gestión sanitarias. En particular, se han descrito las técnicas de matching y de doble diferencia combinada con matching. El parámetro elegido como objeto de la estimación es la ganancia media para los participantes en la intervención, bajo la hipótesis de heterogeneidad en las ganancias no observables que produce la intervención entre los individuos elegibles. Se ha llevado a cabo una exposición no técnica de las metodologías descritas con el espíritu de fomentar al lector una lectura más profunda de la bibliografía relevante.AbstractThis paper summarizes recent literature on quantitative techniques for the evaluation of non experimental reforms. We closely look at the application of the methods to health economics and health management. The methods of matching and difference in differences combined with matching have been analysed in greatest detail. We have focused our attention on the estimation of the average treatment for the treated as the relevant parameter to be estimated. Along the paper, we have assumed that gains from the reform are heterogeneous in non observable variables across eligible individuals. The methods are described in a non technical manner to motivate further reading

Should cash transfer be conditional? Condition, preventive care, and health outcomes

We study a Conditional Cash Transfer program in which the cash transfers to the mother only depends on the fulfillment of the national preventive visit schedule by her children born before she registered in the program. We estimate that preventive visits of children born after the mother registered in the program are 50% lower because they are excluded from the conditionality requirement. Using the same variation, we also show that attendance to preventive care improves children's health

Breast feeding and the weekend effect: an observational study

OBJECTIVE: To compare the incidence of breast feeding by day of week of birth. DESIGN: Retrospective database study using 16 508 records from the 2005 and 2010 Infant Feeding Surveys. SETTING: England and Wales, UK. PARTICIPANTS: Mothers of a sample of births from among all registered births in the periods August-September 2005 and August-October 2010. MAIN OUTCOME MEASURE: Incidence of breast feeding after birth. RESULTS: Among babies of mothers who left full-time education aged 16 or under, the incidence of breast feeding was 6.7 percentage points lower (95% CI 1.4 to 12.1 percentage points) for those born on Saturdays than for those born on Mondays-Thursdays. No such differences by day of week of birth were observed among babies of mothers who left school aged 17 or over. CONCLUSIONS: Breastfeeding policy should take into account differences in breast feeding by day of week of birth, which are apparent among low-educated mothers. Further research is needed to ascertain the reason for this finding

Incentivizing Demand for Supply-Constrained Care: Institutional Birth in India

We study the effects of incentivizing individuals to use healthcare in the presence of congestion externalities. Our theoretical model highlights interesting interactions between the size and shape of the congestion externality, and what drives selection into institutional delivery. We focus on a conditional cash transfer program (JSY) in India that paid women to give birth in medical facilities. In areas with below-median health-system capacity, JSY increased perinatal mortality. We provide evidence that a congestion externality was a key driver of these harmful effects. Moreover, JSY reduced childhood vaccination rates suggesting a diversion of resources away from routine services

Going beyond simple sample size calculations: a practitioner's guide

Basic methods to compute required sample sizes are well understood and supported by widely available software. However, the sophistication of the methods commonly used has not kept pace with the complexity of commonly employed experimental designs. We compile available methods for sample size calculations for continuous and binary outcomes with and without covariates, for both clustered and non-clustered RCTs. Formulae for both panel data and unbalanced designs are provided. Extensions include methods to: (1) optimise the sample when costs constraints are binding, (2) compute the power of a complex design by simulation, and (3) adjust calculations for multiple testing

Public Hospital Spending in England: Evidence from National Health Service Administrative Records

© 2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal StudiesHealth spending per capita in England has almost doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the life cycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after age 70. Spending is highly concentrated in a small section of the population, but the degree of concentration is lower for older age groups. For those aged 25 and under, a third of all hospital spending is accounted for by 1 per cent of the population under 25 and a fifth of spending is accounted for by 1 per cent of patients under 25. For those aged 65 and over, these figures fall to 22 and 13 per cent, respectively. There is persistence in spending over time, with patients with high spending more likely to have spending in subsequent years and those with zero expenditures more likely to remain out of hospital

Discontinuidades estratigráficas en el Jurásico de Sierra Gorda (Subbético intnerno, Provincia de Granada)

En el Jurásico de la unidad de Sierra Gorda (Subbético interno, prov. Granada) se reconocen cinco discontinuidades estratigráficas:en el Carixiense, en la base del Dogger, en la base del Calloviense en la base del Oxfordense y en el Kimmeridgiense. En el sector septentrional de la unidad se detectan por superficies de omisión y hardgrounds, mientras que en el borde meridional muesitran gran desarrollo de diques neptúnicos

La sedimentación liásica en el sector central del Subbético medio: registro de la evolución de un rift intracontinental

Durante el Lias medio tuvo lugar el paso brusco de la sedimenta-ción carbonatada somera a la pelágica en la Zona Subbética, en relación con la evolución de un rift intracontinental. Se han podido delimitar cuatro etapas con sus sedimentos correspondientes: a) Etapa prerruptura (sedimentación marina somera). b) Inicio de la rup-tura (hardgrounds y paleokarst). c) Comienzo de la sedimentación hemipelágica (niveles de calizas  condensadas). d) Individualización del surco subbético (ritmita  calizas/margas)

Household Responses to Information on Child Nutrition: Experimental Evidence from Malawi

Incorrect knowledge of the health production function may lead to inefficient household choices, and thereby to the production of suboptimal levels of health. This paper studies the effects of a randomized intervention in rural Malawi which, over a six-month period, provided mothers of young infants with information on child nutrition without supplying any monetary or in-kind resources. A simple model first investigates theoretically how nutrition and other household choices including labor supply may change in response to the improved nutrition knowledge observed in the intervention areas. We then show empirically that the intervention improved child nutrition, household food consumption and consequently health. We find evidence that labor supply increased, which might have contributed to partially fund the increase in food consumption. This paper is the first to establish that non-health choices, particularly parental labor supply, are affected by parents’ knowledge of the child health production function