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Adoption of Mobile Money for Healthcare Utilisation and Spending in Rural Ghana 在加纳农村采用移动货币进行医疗保健利用和支出
Pub Date : 2020-04-27 DOI: 10.2139/ssrn.3586449
Chei Bukari, Isaac Koomson
In this chapter, the authors discuss the potential link between mobile money adoption and health outcomes, which has not received much attention in the existing literature. They empirically examine the effects of mobile money adoption on healthcare utilisation and spending of rural households in Ghana. Using data from the Ghana Living Standards Survey, the authors show that mobile money adoption enhances rural households’ healthcare utilisation, a finding which is more pronounced in the case of female-headed households. The authors demonstrate that this finding is due to the positive association between mobile money use and the ability of rural households to spend on healthcare.
在本章中,作者讨论了移动货币采用与健康结果之间的潜在联系,这在现有文献中没有得到太多关注。他们实证研究了移动货币对加纳农村家庭医疗保健利用和支出的影响。利用加纳生活水平调查的数据,作者表明,移动货币的采用提高了农村家庭对医疗保健的利用,这一发现在女户主家庭中更为明显。作者证明,这一发现是由于移动货币的使用与农村家庭医疗保健支出能力之间的正相关。
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引用次数: 1
The Determinants of Physicians’ Location Choice: Understanding the Rural Shortage 医生区位选择的决定因素:对农村短缺的认识
Pub Date : 2019-06-25 DOI: 10.2139/ssrn.3493178
Elena Falcettoni
A long-standing challenge in the US health care system is the provision of medical services to rural areas. This paper develops a structural spatial equilibrium model with heterogeneous physicians and uses it to explore the impact of policies, namely loan forgiveness and salary incentives, on the geographical distribution of physicians. I collect micro data from physicians’ directories on their medical school, residency, and first-job choices and use this new dataset to both allow for physicians’ preference to remain close to their residency location and to implement an instrumental-variable approach to overcome endogeneity issues caused by the correlation between wages and unobserved amenities. I find that residents strongly prefer remaining close to their residency location. The combination of loan forgiveness and salary incentives has led to 1.2 percent more physicians choosing rural areas. Using the government spending currently allocated to loan forgiveness to further increase salary incentives would lead to 6 times more primary care physicians choosing rural areas and a higher average quality of rural physicians compared to the impact of current policies.
美国医疗保健系统的一个长期挑战是向农村地区提供医疗服务。本文建立了异质性医生的结构空间均衡模型,并利用该模型探讨了贷款减免和薪酬激励等政策对医生地域分布的影响。我从医生的目录中收集了关于他们的医学院、住院医师和第一份工作选择的微观数据,并使用这个新的数据集来允许医生的偏好保持在他们的住院医师所在地附近,并实施工具变量方法来克服由工资和未观察到的便利设施之间的相关性引起的内生性问题。我发现居民们非常喜欢住在离居住地近的地方。贷款减免和工资激励相结合,使得选择农村地区的医生增加了1.2%。利用目前拨给贷款减免的政府支出,进一步提高工资激励,将使选择农村地区的初级保健医生增加6倍,农村医生的平均素质也比现行政策的影响高。
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引用次数: 9
Does Universal Health Coverage at Early Age Reduce Medical Needs at Later Age? Evidence from Vietnam 早期全民健康保险会减少晚年的医疗需求吗?来自越南的证据
Pub Date : 2019-06-24 DOI: 10.2139/ssrn.3409107
K. Vu
This study examines the impacts of exposure to a universal health coverage policy at early age on utilization of health services at later age. Our empirical strategy identifies the effects of the program by exploiting cross-cohort variation in exposure, generated by the age eligibility of the policy, and cross-province variation in the policy's intensity, generated by differences in provincial geographic characteristics. We find that exposure to the program at early age reduces probability of visit for treatment, mainly hospitalization, but does not affect preventive care and outpatient treatment at later age. Our results are robust to various controls for cohort-varying factors and ongoing poverty-reduction policies. We document larger impacts among individuals from low-income and low-education households, and those living in areas with higher risks from natural disasters. These results imply that the program benefited the most vulnerable population. Exploring potential mechanisms, we find no substantial change in household's financial well-being and household's labor market decisions associated with exposure at early age. Combining with results from previous studies, these findings suggest that the main mechanism is through increases in utilization at early age.
本研究考察了早期接受全民健康覆盖政策对后期利用卫生服务的影响。我们的实证策略通过利用政策的年龄资格所产生的暴露的跨队列差异,以及政策强度的跨省差异所产生的省份地理特征差异,来确定该计划的效果。我们发现,早期接触该计划降低了就诊概率,主要是住院治疗,但不影响老年预防保健和门诊治疗。我们的结果对于不同群体因素和现行减贫政策的各种控制都是稳健的。我们发现,来自低收入和低教育程度家庭的个人以及生活在自然灾害风险较高地区的个人受到的影响更大。这些结果表明,该计划使最弱势群体受益。在探索潜在的机制时,我们发现家庭的财务状况和家庭的劳动力市场决策与早期暴露没有实质性的变化。结合先前的研究结果,这些发现表明,主要机制是通过早期使用的增加。
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引用次数: 0
How Reliable Are the Health Responses of Elders? Evidence from India 长者的健康反应有多可靠?来自印度的证据
Pub Date : 2019-04-09 DOI: 10.2139/ssrn.3368976
D. Ghosh
Purpose – This paper explored the reliability of self-reported health and the impact of the social position in determining the inconsistent health response, in late life. Methodology – The study uses nationally representative unit level data from the National Sample Survey of India. Using the bivariate probit model, joint estimation of reported health and inconsistent health responses are determined for all factors that manifest social injustice and constitutes individual characteristics. Findings – The study has two significant results: firstly, in the privileged socioeconomic segment, reported health underestimates the presence of morbidity might because it can be controlled by the treatment due to greater access to healthcare services, economic resources, and health awareness; and secondly, among the deprived elderly the reported health pulls down the redundancy of chronicle ailment. Therefore, the factors, responsible for social justice like social caste, economic status, and attainment of education have a significant impact on reporting inconsistent health responses. Social implications – Results from bivariate-probit model offer deeper understandings about the reliability of self-reported health and provide further insights to improve policy design designed to mitigate the health inequality among the elders. Originality/value – The study identifies, the type of inconsistent health responses, and the factors responsible for the inconsistency of self-reported health with the existence of chronicle morbidity among the elderly population.
目的-本论文探讨了自我健康报告的可靠性和社会地位在决定晚年不一致的健康反应中的影响。研究方法:该研究使用了印度全国抽样调查中具有全国代表性的单位数据。使用双变量probit模型,对报告的健康状况和不一致的健康反应进行联合估计,确定所有表现出社会不公正并构成个人特征的因素。研究结果-该研究有两个重要结果:首先,在享有特权的社会经济阶层,报告的健康状况低估了发病率的存在,因为由于获得更多的医疗保健服务、经济资源和健康意识,发病率可以通过治疗来控制;其次,在贫困的老年人中,报告的健康状况降低了慢性病的冗余。因此,社会种姓、经济地位和受教育程度等对社会公正负责的因素对报告不一致的健康反应有重大影响。社会影响-双变量概率模型的结果对自我报告健康的可靠性提供了更深入的理解,并为改善旨在减轻老年人健康不平等的政策设计提供了进一步的见解。原创性/价值-该研究确定了不一致的健康反应类型,以及导致老年人自我报告的健康状况与慢性发病率存在不一致的因素。
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引用次数: 0
Mortality in Midlife for Subgroups in Germany 德国中年亚群死亡率
Pub Date : 2019-01-28 DOI: 10.2139/ssrn.3339179
P. Haan, Anna Hammerschmid, Julia Schmieder
Case and Deaton (2015) document that, since 1998, midlife mortality rates are increasing for white non-Hispanics in the US. This trend is driven by deaths from drug overdoses, suicides, and alcohol-related diseases, termed as deaths of despair, and by the subgroup of low-educated individuals. In contrast, average mortality for middle-aged men and women continued to decrease in several other high-income countries including Germany. However, average mortality rates can disguise important differences between subgroups and the phenomenon of increasing mortality rates might also be present for subpopulations in these countries. Hence, we analyze how mortality in midlife is changing for several important demographic subgroups in Germany over the 1990 to 2015 period with a focus on deaths of despair. Our results show a very clear pattern: We find that mortality rates declined between 1990 and 2015, with no increases in deaths of despair for any of the subgroups. Thus, our findings starkly contrast with those for the US.
Case和Deaton(2015)的文献表明,自1998年以来,美国非西班牙裔白人的中年死亡率正在上升。这一趋势是由药物过量、自杀和与酒精有关的疾病造成的死亡(称为绝望死亡)以及受教育程度低的个人造成的。相比之下,在包括德国在内的其他几个高收入国家,中年男性和女性的平均死亡率继续下降。然而,平均死亡率可能掩盖了亚群体之间的重要差异,这些国家的亚群体也可能出现死亡率上升的现象。因此,我们分析了1990年至2015年期间德国几个重要人口亚组的中年死亡率是如何变化的,重点是绝望死亡。我们的结果显示了一个非常清晰的模式:我们发现死亡率在1990年至2015年间下降,任何一个亚组的绝望死亡人数都没有增加。因此,我们的研究结果与美国的结果形成鲜明对比。
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引用次数: 5
What Comprises Effective Formal Elder Care at Home? Estimating Effects for Combinations of Multiple Services 什么是有效的正规居家长者护理?多业务组合效应估计
Pub Date : 2019-01-18 DOI: 10.2139/ssrn.3138435
S. Sugawara
I estimate the effects for combinations of multiple services in formal elder care at home on health status. As a reasonable substitute for expensive institutional care, formal care for the elderly in their own homes is gaining popularity in developed countries. Because care at home consists of many small and complementary services, the effects for combinations of multiple services need to be analyzed. However, the high dimensionality of these combinations makes estimation difficult. This research employs a regression analysis, using combinations of care services as cross-dummy explanatory variables. To reduce the dimension of the combinations, I select the combinations that are purchased jointly by a sufficient number of the elderly using a basket analysis. I apply this method to claims data for Japanese long-term care, where the social insurance program has resulted in the emergence of markets for many care services for the elderly. The empirical results show that only 200 combinations of 14 care at home services are utilized by more than 0.03% of insurance users in Japan. Of these combinations, rehabilitation services improve the health status of the elderly considerably. However, their use is limited owing to regional disparities in the location of such services.
我估计了多种正规居家老人护理服务组合对健康状况的影响。作为昂贵的机构护理的合理替代品,老年人在自己家中的正式护理在发达国家越来越受欢迎。由于家庭护理由许多小型和互补的服务组成,因此需要分析多种服务组合的效果。然而,这些组合的高维性使得估计变得困难。本研究采用回归分析,使用护理服务组合作为交叉虚拟解释变量。为了减少组合的维度,我选择了由足够数量的老年人共同购买的组合,使用篮子分析。我将这种方法应用于日本长期护理的索赔数据,在那里,社会保险计划导致了许多老年人护理服务市场的出现。实证结果表明,日本超过0.03%的保险用户仅使用了14种家庭护理服务的200种组合。在这些组合中,康复服务大大改善了老年人的健康状况。但是,由于这些服务地点的区域差异,它们的使用受到限制。
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引用次数: 1
Medicaid Expansion – Why States Are Reevaluating Whether to Expand Eligibility? 医疗补助扩大-为什么各州要重新评估是否扩大资格?
Pub Date : 2018-11-27 DOI: 10.2139/ssrn.3291808
Russell S. Autry
The 2018 U.S. mid-term elections saw three additional states vote to expand their Medicaid eligibility, bringing the total to 35 states plus the District of Columbia. So why are states continuing to expand? In this paper, I review four primary reasons for this. Foremost, healthcare is a top issue for most voters. I also examine how the state costs of expanding are not nearly as high as they seem when you factor in ancillary factors. Further, the paper highlights the plight of rural healthcare and how Medicaid expansion can help. Lastly, I review how states can take advantage of alternative expansion waivers to craft a unique expansion solution that works for them.
在2018年美国中期选举中,又有三个州投票决定扩大其医疗补助资格,使总数达到35个州加上哥伦比亚特区。那么,为什么各州还在继续扩张呢?在本文中,我回顾了造成这种情况的四个主要原因。最重要的是,医疗保健是大多数选民最关心的问题。我还研究了当你考虑到辅助因素时,扩张的国家成本如何不像看起来那么高。此外,论文还强调了农村医疗保健的困境,以及扩大医疗补助计划的帮助。最后,我回顾了各州如何利用可选择的扩展豁免来制定适合他们的独特扩展解决方案。
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引用次数: 0
Interrelationships Between Violent Crime, Demographic and Socioeconomic Factors: A Preliminary Analysis Between Central-Northern European Countries and Mediterranean Countries 暴力犯罪、人口和社会经济因素的相互关系:中欧-北欧国家与地中海国家的初步分析
Pub Date : 2018-07-20 DOI: 10.1453/JEST.V5I3.1679
Matteo Bellitto, M. Coccia
Abstract. The paper here investigates possible relationships between violent crime, migration and unemployment. Results seem to show an association between some crimes - such as theft, assaults and sexual violence- and immigration but not between intentional homicides and immigration. Preliminary evidence also suggests that intentional homicides are associated with high rates of unemployment, linking this violent crime to socioeconomic and situational factors within countries. In addition, unlike commonplace opinions, statistical evidence here reveals that rich countries have levels of violent crime higher than poor countries. Especially, violent crime in central-northern European regions (geo-economic areas with high GDP per capita, e.g., Germany, Finland, Norway, etc.) is higher than Mediterranean countries with lower GDP per capita (e.g., Greece, Italy, Spain, etc.). These conclusions are of course tentative. There is need for much more detailed research into the relations between unemployment, immigration and violent crime to explain general causes of these social issues in modern economies. This study concludes with some socioeconomic implications and explanations.  Keywords. Violent crime, Violence, Theft, Sexual violence, Intentional homicides, Immigrants, Migration, Unemployment, Europe, Poverty, Mediterranean countries. JEL. C10, I30, J10, J11, J15, J20, J60, J61, J62, O15.
摘要本文调查了暴力犯罪、移民和失业之间可能存在的关系。调查结果似乎表明,某些犯罪(如盗窃、袭击和性暴力)与移民之间存在关联,但故意杀人与移民之间没有关联。初步证据还表明,故意杀人与高失业率有关,将这种暴力犯罪与国家内部的社会经济和环境因素联系起来。此外,与一般观点不同的是,这里的统计证据显示,富裕国家的暴力犯罪水平高于贫穷国家。特别是,中欧-北欧地区(人均GDP较高的地缘经济区,如德国、芬兰、挪威等)的暴力犯罪高于人均GDP较低的地中海国家(如希腊、意大利、西班牙等)。这些结论当然是试探性的。有必要对失业、移民和暴力犯罪之间的关系进行更详细的研究,以解释现代经济中这些社会问题的一般原因。本研究总结了一些社会经济意义和解释。关键词。暴力犯罪,暴力,盗窃,性暴力,故意杀人,移民,移民,失业,欧洲,贫穷,地中海国家。冻胶。C10, i30, j10, j11, j15, j20, j60, j61, j62, o15。
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引用次数: 3
Untangling the Health Impacts of Mexico-U.S. Migration 解开美墨关系对健康的影响迁移
Pub Date : 2018-06-30 DOI: 10.15353/rea.v10i2.1442
David L. Ortmeyer, M. Quinn
Research has found that immigrant health has a tendency to decline with time spent in the United States.  Using data from the Mexican Migration Project from 2007-2014, this paper is the first to test the impact of domestic and international migration on different types of health measures.  Results find cumulative U.S. migration experience has a negative impact both on self-reported and objective health measures.  By contrast, the number of trips to the United States and migrations made within Mexico impact individual’s self-assessment of their health but not objective health measures.  The analyses suggest that differences in self-reported versus objective health measures may help to explain mixed results in the literature.  Results suggest that individual’s health will suffer considerably more from U.S. migrations than from migration within Mexico which is consistent with the acculturation hypothesis.  Not surprisingly, high levels of BMI and smoking are significant predictors of negative self-reported and objective health.  There is also a troubling significant negative trend in health over time observed in the sample. Taken as a whole, these results suggest that even short trips to the United States can have a negative health effect on immigrants if they are repeated.
研究发现,移民的健康状况随着在美国的时间推移而呈下降趋势。本文使用2007-2014年墨西哥移民项目的数据,首次测试了国内和国际移民对不同类型健康措施的影响。结果发现,累积的美国移民经历对自我报告和客观健康指标都有负面影响。相比之下,前往美国和在墨西哥境内移民的次数会影响个人对其健康的自我评估,但不会影响客观的健康措施。分析表明,自我报告与客观健康指标的差异可能有助于解释文献中不同的结果。结果表明,美国移民对个人健康的影响要比墨西哥境内移民大得多,这与文化适应假说是一致的。毫不奇怪,高BMI和吸烟水平是自我报告和客观健康状况不佳的重要预测因素。随着时间的推移,在样本中还观察到一个令人不安的显著的健康负面趋势。总的来说,这些结果表明,即使是短暂的美国之旅,如果重复的话,也会对移民的健康产生负面影响。
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引用次数: 0
Time Trends Matter: The Case of Medical Cannabis Laws and Opioid Overdose Mortality 时间趋势很重要:医用大麻法律和阿片类药物过量死亡率的案例
Pub Date : 2018-06-06 DOI: 10.2139/ssrn.3192703
Vincent Pohl
Mortality due to opioid overdoses has been growing rapidly in the U.S., with some states experiencing much steeper increases than others. Legalizing medical cannabis could reduce opioid-related mortality if potential opioid users substitute towards cannabis as a safer alternative. I show, however, that a substantial reduction in opioid-related mortality associated with the implementation of medical cannabis laws can be explained by selection bias. States that legalized medical cannabis exhibit lower pre-existing mortality trends. Accordingly, the mitigating effect of medical cannabis laws on opioid-related mortality vanishes when I include state-specific time trends in state-year-level difference-in-differences regressions.
在美国,阿片类药物过量导致的死亡率一直在迅速增长,一些州的增幅比其他州要大得多。如果潜在的阿片类药物使用者改用大麻作为更安全的替代品,医用大麻合法化可以减少与阿片类药物有关的死亡率。然而,我表明,与实施医用大麻法有关的阿片类药物相关死亡率的大幅下降可以用选择偏差来解释。医用大麻合法化的国家显示出较低的原有死亡率趋势。因此,当我将各州具体时间趋势纳入各州年度差异中差异回归时,医用大麻法律对阿片类药物相关死亡率的缓解作用就消失了。
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引用次数: 6
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Geographic Health Economics eJournal
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