This article studies the impact of health insurance on individual out-of-pocket health expenditures in China. Using China Health and Nutrition Survey data between 1991 and 2006, we apply two-part and sample selection models to address issues caused by censored data and selection on unobservables. We find that, although the probability of accessing health care increases with the availability of health insurance, the level of out-of-pocket health expenditure decreases. Our results from a selection model with instrumental variables suggest that having health insurance reduces the expected out-of-pocket health expenditure of an individual by 29.42% unconditionally. Meanwhile, conditional on being subjected to positive health expenditure, health insurance helps reduce out-of-pocket spending by 44.38%. This beneficial effect of health insurance weakens over time, which may be attributable to increases in the coinsurance rates of health insurances in China.
{"title":"Does Health Insurance Decrease Health Expenditure Risk in Developing Countries? The Case of China","authors":"Juergen Jung, Jialu Liu","doi":"10.2139/ssrn.2008987","DOIUrl":"https://doi.org/10.2139/ssrn.2008987","url":null,"abstract":"This article studies the impact of health insurance on individual out-of-pocket health expenditures in China. Using China Health and Nutrition Survey data between 1991 and 2006, we apply two-part and sample selection models to address issues caused by censored data and selection on unobservables. We find that, although the probability of accessing health care increases with the availability of health insurance, the level of out-of-pocket health expenditure decreases. Our results from a selection model with instrumental variables suggest that having health insurance reduces the expected out-of-pocket health expenditure of an individual by 29.42% unconditionally. Meanwhile, conditional on being subjected to positive health expenditure, health insurance helps reduce out-of-pocket spending by 44.38%. This beneficial effect of health insurance weakens over time, which may be attributable to increases in the coinsurance rates of health insurances in China.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130750990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Mennini, A. Marcellusi, M. Andreoni, A. Gasbarrini, Salvatore Salomone, A. Craxì
Background: This study is aimed at describing the epidemiological and economic burden that HCV will generate in the next few years in Italy. Furthermore, the impact that future anti-HCV treatments may have on the burden of disease was considered. The analysis has been developed over the period 2013-2030 from the Italian National Health Service (NHS) perspective. Methods: A published system dynamic model was adapted for Italy in order to quantify the HCV-infected population, the disease progression and the associated cost from 1950 to 2030. The model structure was based on transition probabilities reflecting the natural history of the disease. In order to estimate the efficacy of current anti-HCV treatment strategies for different Genotypes, it was estimated the sustained virological response (SVR) rate in registration clinical trials for both Boceprevir and Telaprevir. It was assumed that the efficacy for patients treated with peginterferon+ribavirin was equal to the placebo arm of randomized clinical trial (RCT) relating to Boceprevir and Telaprevir. According to the aim of the study, only direct healthcare costs (hospital admissions, drugs, treatment and care of patients) incurred by the Italian NHS have been included in the model. Costs have been extrapolated by the published scientific literature available in Italy and actualized at 2011 ISTAT Price Index system for monetary revaluation. Three different scenario was assumed in order to evaluate the impact of future anti-HCV treatments may have on the burden of disease. Results: Overall, in Italy 1.2 million infected subjects were estimated in 2012. Out of these, about 211 thousand patients were diagnosed, while about 11,800 subjects are actually being treated with anti-HCV drugs. A reduction of healthcare costs is associated with a prevalence decrease. Indeed, once the spending peak is reached during this decade (about € 527 million), the model predicts a cost reduction in the following 18 years. In 2030, due to the more effective treatments currently available, the direct healthcare cost associated with the management of HCV patients HCV may reach € 346 million (-34.3% compared to 2012). The first scenario (new treatment in 2015 with SVR = 90% and same number of treated patients) was associated with a significant reduction in HCV-induced clinical consequences (prevalence = -3%) and a decrease in healthcare direct expenses corresponding to € 11.1 million. The second scenario (increasing treated patients until 12,790) produced an incremental cost reduction of € 7.3 million, reaching a net decrease equal to € 18.4 million. In the third scenario (treated patients = 16,770), a higher net healthcare direct cost decrease vs the base-case (€ 44.0 million ) was estimated. Conclusions: This study does not have the pretension of being or creating a model of epidemiological projection. Its primary objective is to supply data and a careful consideration for a encourage dialogue among the different profes
{"title":"Health Policy Model: Long-Term Predictive Results Associated with the Management of HCV-Induced Diseases in Italy","authors":"F. Mennini, A. Marcellusi, M. Andreoni, A. Gasbarrini, Salvatore Salomone, A. Craxì","doi":"10.2139/ssrn.2397300","DOIUrl":"https://doi.org/10.2139/ssrn.2397300","url":null,"abstract":"Background: This study is aimed at describing the epidemiological and economic burden that HCV will generate in the next few years in Italy. Furthermore, the impact that future anti-HCV treatments may have on the burden of disease was considered. The analysis has been developed over the period 2013-2030 from the Italian National Health Service (NHS) perspective. Methods: A published system dynamic model was adapted for Italy in order to quantify the HCV-infected population, the disease progression and the associated cost from 1950 to 2030. The model structure was based on transition probabilities reflecting the natural history of the disease. In order to estimate the efficacy of current anti-HCV treatment strategies for different Genotypes, it was estimated the sustained virological response (SVR) rate in registration clinical trials for both Boceprevir and Telaprevir. It was assumed that the efficacy for patients treated with peginterferon+ribavirin was equal to the placebo arm of randomized clinical trial (RCT) relating to Boceprevir and Telaprevir. According to the aim of the study, only direct healthcare costs (hospital admissions, drugs, treatment and care of patients) incurred by the Italian NHS have been included in the model. Costs have been extrapolated by the published scientific literature available in Italy and actualized at 2011 ISTAT Price Index system for monetary revaluation. Three different scenario was assumed in order to evaluate the impact of future anti-HCV treatments may have on the burden of disease. Results: Overall, in Italy 1.2 million infected subjects were estimated in 2012. Out of these, about 211 thousand patients were diagnosed, while about 11,800 subjects are actually being treated with anti-HCV drugs. A reduction of healthcare costs is associated with a prevalence decrease. Indeed, once the spending peak is reached during this decade (about € 527 million), the model predicts a cost reduction in the following 18 years. In 2030, due to the more effective treatments currently available, the direct healthcare cost associated with the management of HCV patients HCV may reach € 346 million (-34.3% compared to 2012). The first scenario (new treatment in 2015 with SVR = 90% and same number of treated patients) was associated with a significant reduction in HCV-induced clinical consequences (prevalence = -3%) and a decrease in healthcare direct expenses corresponding to € 11.1 million. The second scenario (increasing treated patients until 12,790) produced an incremental cost reduction of € 7.3 million, reaching a net decrease equal to € 18.4 million. In the third scenario (treated patients = 16,770), a higher net healthcare direct cost decrease vs the base-case (€ 44.0 million ) was estimated. Conclusions: This study does not have the pretension of being or creating a model of epidemiological projection. Its primary objective is to supply data and a careful consideration for a encourage dialogue among the different profes","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129604194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Numerous studies have examined the effects of direct-to-consumer advertising (DTC) on patient and physician behaviors; however, none has focused on the relationship between DTC and insurance benefit design. In this study, we explored the impact of DTC advertising on the cost control behaviors of private firms supplying insurance in the Medicare Part D program. We used data from the IMS National Prescription Drug Promotions database and formulary information from Medicare Part D prescription drug plans from the Centers for Medicare and Medicaid Services (CMS) to study the relationship between DTC spending and formulary tier placement, using an instrumental variables estimator to control for the endogeneity of DTC spending. Our results suggest that direct-to-consumer advertising puts pressure on insurers for more favorable formulary placement. Television direct-to-consumer advertising and other measures of manufacturer market power had a significant and negative effect on the likelihood of a branded drug being classified as nonpreferred in formularies. Similarly, we found that when insurers had more market power, branded drugs were more likely to be placed in a nonpreferred formulary tier. We hypothesize that consumers play an important mediating role in the relationship between DTC advertising and insurance coverage for drugs.
{"title":"Direct-to-Consumer Advertising and Insurers’ Spending Control Mechanisms for Prescription Drugs","authors":"C. Yarbrough, W. Bradford","doi":"10.2139/ssrn.2396606","DOIUrl":"https://doi.org/10.2139/ssrn.2396606","url":null,"abstract":"Numerous studies have examined the effects of direct-to-consumer advertising (DTC) on patient and physician behaviors; however, none has focused on the relationship between DTC and insurance benefit design. In this study, we explored the impact of DTC advertising on the cost control behaviors of private firms supplying insurance in the Medicare Part D program. We used data from the IMS National Prescription Drug Promotions database and formulary information from Medicare Part D prescription drug plans from the Centers for Medicare and Medicaid Services (CMS) to study the relationship between DTC spending and formulary tier placement, using an instrumental variables estimator to control for the endogeneity of DTC spending. Our results suggest that direct-to-consumer advertising puts pressure on insurers for more favorable formulary placement. Television direct-to-consumer advertising and other measures of manufacturer market power had a significant and negative effect on the likelihood of a branded drug being classified as nonpreferred in formularies. Similarly, we found that when insurers had more market power, branded drugs were more likely to be placed in a nonpreferred formulary tier. We hypothesize that consumers play an important mediating role in the relationship between DTC advertising and insurance coverage for drugs.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121090740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-31DOI: 10.7575/AIAC.IJKSS.V.2N.1P.13
E. Lenz, A. Swartz, S. Strath
Evidence suggests sedentary behavior (SB) negatively impacts the health of adults but less is known about SB impact on older adult (OA) health. Seventy OA (73.4±6years) living in the southeast region of Wisconsin, United States of America (USA) completed three SB diaries and had risk factors associated with cardiovascular disease (CVD) assessed. Sedentary behaviors were quantified as time spent in sitting/lying activities. Pearson correlation coefficients, independent samples t-tests, and one-way ANOVA were performed to explore the relationship between SB and health. Older adults engaged in 620.3±91.2min s/d of SB with television watching (144.3±99.8mins/d) being the most prominent. Total SB and television watching were correlated to multiple risk factors for CVD (r=-.241-.415, p=.009.027) and these variables worsened as OA spent more time in those activities. Television watching was the only SB that increased across risk categories of CVD [ F (2,67) =4.158, p=.020, eta squared=.11]. These results suggest SB, especially television watching to be related to risk factors of CVD in OA.
{"title":"Do Sedentary Behaviors Modify the Health Status of Older Adults?","authors":"E. Lenz, A. Swartz, S. Strath","doi":"10.7575/AIAC.IJKSS.V.2N.1P.13","DOIUrl":"https://doi.org/10.7575/AIAC.IJKSS.V.2N.1P.13","url":null,"abstract":"Evidence suggests sedentary behavior (SB) negatively impacts the health of adults but less is known about SB impact on older adult (OA) health. Seventy OA (73.4±6years) living in the southeast region of Wisconsin, United States of America (USA) completed three SB diaries and had risk factors associated with cardiovascular disease (CVD) assessed. Sedentary behaviors were quantified as time spent in sitting/lying activities. Pearson correlation coefficients, independent samples t-tests, and one-way ANOVA were performed to explore the relationship between SB and health. Older adults engaged in 620.3±91.2min s/d of SB with television watching (144.3±99.8mins/d) being the most prominent. Total SB and television watching were correlated to multiple risk factors for CVD (r=-.241-.415, p=.009.027) and these variables worsened as OA spent more time in those activities. Television watching was the only SB that increased across risk categories of CVD [ F (2,67) =4.158, p=.020, eta squared=.11]. These results suggest SB, especially television watching to be related to risk factors of CVD in OA.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124337290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Siljander, I. Linnosmaa, U. Hâkkinen, M. Heliovaara, S. Koskinen
Aim and Motivation: This paper investigates the income and socio-economic effects on institutional long-term care demand (LTC) in Finland from an economics perspective. If lessons are learned from major contributors of care needs and costs then preventative measures can be designed to answer these challenges. The motivation for this paper is that LTC costs are expected to increase in Finland by 50 percent per annum in the next 25 years due to the doubling of the 65 years old population (by 2039). Aging of populations and workforce is a European wide phenomenon. Definitions: LTC for old age people is by definition care for chronic sickness and disability in the last years of life. It can be either formal or informal care (or both) delivered to a homelike environment (home care) or given at an institution (institutional care).Methods: The economics of LTC care are reviewed based on existing literature. Next the econometric and institutional context is described. A longitudinal competing risks and multinomial logit model are estimated. The two competing risks are institutional entry or death outside institution. Data: Finnish Health2000 individual level survey data from year 2000 linked with a day-by-day care register follow-up till end of 2010. The sample consists of N=3245 over 50 year old age population.Results: It is found that higher household (OECD) and personal income reduce demand for institutional LTC care controlling for health, functional capacity and key living habits. The difference between extreme income quintiles (lowest vs. highest) is 1,3 percent for men and 0,6 percent for women. This result suggests that institutional care may include disutility from a consumer preferences point of view. The highest risks of institutional LTC care are found among small income, single living and cognitively disabled highly aged people (over 80, 90 years old). Neurological diseases and cancer are the biggest risk factors of institutional entry. For deaths outside institution the biggest risks are dementia and cancer. ADL problems and old age frailty contribute to both competing risks.Policy conclusions: There are significant socio-economic inequalities in institutional LTC care entry. Prevention of neurological and living habits diseases (smoking, weight disorders) has potential for cost savings in institutional care services.
{"title":"Income as a Determinants for Old Age Institutional Care in Finland","authors":"E. Siljander, I. Linnosmaa, U. Hâkkinen, M. Heliovaara, S. Koskinen","doi":"10.2139/ssrn.1833342","DOIUrl":"https://doi.org/10.2139/ssrn.1833342","url":null,"abstract":"Aim and Motivation: This paper investigates the income and socio-economic effects on institutional long-term care demand (LTC) in Finland from an economics perspective. If lessons are learned from major contributors of care needs and costs then preventative measures can be designed to answer these challenges. The motivation for this paper is that LTC costs are expected to increase in Finland by 50 percent per annum in the next 25 years due to the doubling of the 65 years old population (by 2039). Aging of populations and workforce is a European wide phenomenon. Definitions: LTC for old age people is by definition care for chronic sickness and disability in the last years of life. It can be either formal or informal care (or both) delivered to a homelike environment (home care) or given at an institution (institutional care).Methods: The economics of LTC care are reviewed based on existing literature. Next the econometric and institutional context is described. A longitudinal competing risks and multinomial logit model are estimated. The two competing risks are institutional entry or death outside institution. Data: Finnish Health2000 individual level survey data from year 2000 linked with a day-by-day care register follow-up till end of 2010. The sample consists of N=3245 over 50 year old age population.Results: It is found that higher household (OECD) and personal income reduce demand for institutional LTC care controlling for health, functional capacity and key living habits. The difference between extreme income quintiles (lowest vs. highest) is 1,3 percent for men and 0,6 percent for women. This result suggests that institutional care may include disutility from a consumer preferences point of view. The highest risks of institutional LTC care are found among small income, single living and cognitively disabled highly aged people (over 80, 90 years old). Neurological diseases and cancer are the biggest risk factors of institutional entry. For deaths outside institution the biggest risks are dementia and cancer. ADL problems and old age frailty contribute to both competing risks.Policy conclusions: There are significant socio-economic inequalities in institutional LTC care entry. Prevention of neurological and living habits diseases (smoking, weight disorders) has potential for cost savings in institutional care services.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122474778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE We studied whether increased emergency contraception availability for women over age 18 was associated with a higher probability of risky sexual practices. DATA A total of 34,030 individual/year observations on 3,786 women aged 18 and older were extracted from the National Longitudinal Survey of Youth, 1997 from October 1999 through November 2009. STUDY DESIGN We modeled three binary outcome variables: any sexual activity; sexual activity with more than one partner; and any sex without a condom for women with multiple partners for women in states with state-level policy changes (prior to the 2006 FDA ruling) and for women in states subject to only the national policy change both jointly and separately. FINDINGS We found different results when estimating the state and federal changes separately. The national change was associated with a reduction in the probability of sexual activity, a reduction in the likelihood of reporting multiple partnerships, and there was no relationship between the national policy change and unprotected sexual activity. There was no relationship between the probability of sexual activity or multiple partnerships for women in states with their own policy changes, but we did find that women in these states were more likely to report unprotected sex.
{"title":"Association between Increased Emergency Contraception Availability and Risky Sexual Practices","authors":"Danielle N. Atkins, W. Bradford","doi":"10.2139/ssrn.2369988","DOIUrl":"https://doi.org/10.2139/ssrn.2369988","url":null,"abstract":"OBJECTIVE\u0000We studied whether increased emergency contraception availability for women over age 18 was associated with a higher probability of risky sexual practices.\u0000\u0000\u0000DATA\u0000A total of 34,030 individual/year observations on 3,786 women aged 18 and older were extracted from the National Longitudinal Survey of Youth, 1997 from October 1999 through November 2009.\u0000\u0000\u0000STUDY DESIGN\u0000We modeled three binary outcome variables: any sexual activity; sexual activity with more than one partner; and any sex without a condom for women with multiple partners for women in states with state-level policy changes (prior to the 2006 FDA ruling) and for women in states subject to only the national policy change both jointly and separately.\u0000\u0000\u0000FINDINGS\u0000We found different results when estimating the state and federal changes separately. The national change was associated with a reduction in the probability of sexual activity, a reduction in the likelihood of reporting multiple partnerships, and there was no relationship between the national policy change and unprotected sexual activity. There was no relationship between the probability of sexual activity or multiple partnerships for women in states with their own policy changes, but we did find that women in these states were more likely to report unprotected sex.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131843177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-12-18DOI: 10.11575/SPPP.V6I0.42452
J. Emery, V. Fleisch, L. McIntyre
The federal Conservative government recently began phasing in a plan to raise the age of eligibility for Old Age Security from 65 to 67. But a more sensible move for improving the effectiveness of Canada’s social safety-net system may be to actually lower the age below 65 and rely strictly on an income test instead, regardless of age. The government could go a lot further toward the reduction of poverty in Canada by building on the success of its income supports for seniors, and making them available to poor Canadians of all ages. Canada can boast of having one of the lowest rates for poverty among seniors in the world, largely due to its guaranteed income programs for those 65 years and older. When low-income Canadians turn 65 years old and leave behind low-paying, often unstable jobs, their poverty levels drop substantially. What a guaranteed income provides, that their vulnerable job situation did not, is a form of protection against budget shocks — a sudden volatility in income or expenses without the access to savings or credit to smooth things out until stability returns. A guaranteed income provides a kind of “disaster insurance” that can protect someone in a crisis situation from going without necessities such as food or even shelter. Statistics show that the rate of Canadians experiencing “food insecurity” — that is, lack of access to food because of financial constraints — is half that among Canadians aged 65 to 69 years than it is among those aged 60 to 64. Self-reported rates of physical and mental health improve markedly as well after lowincome Canadians move from low-wage, insecure employment to a guaranteed income at the age of 65. That dramatic shift in physical and mental health indicates that expanding guaranteed income programs to younger Canadians is more than a simple cost calculation: there are potential savings to be found as poorer Canadians, given a guaranteed income, become healthier and therefore reduce the burden on the public health-care system. Canadian governments already spend billions of dollars on the downstream effects of poverty, but scant emphasis is put on programs targeting poverty’s roots. There is no evidence, where smaller-scale experiments have been tried, to show that a guaranteed income program creates a serious problem with negative incentives and discourages people from working who otherwise might. But because this is a common worry with working-age guaranteed income eligibility, phasing in the program gradually, by lowering eligibility a few years at a time, will allow ongoing investigation and analysis of the effects, before the program is rolled out on a large scale. The tremendous impact that guaranteed incomes have had on reducing poverty and improving health among seniors is something for which Canadians can be rightly proud. So much so that it is incumbent upon us to investigate whether Canada could use the same policy tools to drastically reduce poverty and improve health among Canadians of a
{"title":"How a Guaranteed Annual Income Could Put Food Banks Out of Business","authors":"J. Emery, V. Fleisch, L. McIntyre","doi":"10.11575/SPPP.V6I0.42452","DOIUrl":"https://doi.org/10.11575/SPPP.V6I0.42452","url":null,"abstract":"The federal Conservative government recently began phasing in a plan to raise the age of eligibility for Old Age Security from 65 to 67. But a more sensible move for improving the effectiveness of Canada’s social safety-net system may be to actually lower the age below 65 and rely strictly on an income test instead, regardless of age. The government could go a lot further toward the reduction of poverty in Canada by building on the success of its income supports for seniors, and making them available to poor Canadians of all ages. Canada can boast of having one of the lowest rates for poverty among seniors in the world, largely due to its guaranteed income programs for those 65 years and older. When low-income Canadians turn 65 years old and leave behind low-paying, often unstable jobs, their poverty levels drop substantially. What a guaranteed income provides, that their vulnerable job situation did not, is a form of protection against budget shocks — a sudden volatility in income or expenses without the access to savings or credit to smooth things out until stability returns. A guaranteed income provides a kind of “disaster insurance” that can protect someone in a crisis situation from going without necessities such as food or even shelter. Statistics show that the rate of Canadians experiencing “food insecurity” — that is, lack of access to food because of financial constraints — is half that among Canadians aged 65 to 69 years than it is among those aged 60 to 64. Self-reported rates of physical and mental health improve markedly as well after lowincome Canadians move from low-wage, insecure employment to a guaranteed income at the age of 65. That dramatic shift in physical and mental health indicates that expanding guaranteed income programs to younger Canadians is more than a simple cost calculation: there are potential savings to be found as poorer Canadians, given a guaranteed income, become healthier and therefore reduce the burden on the public health-care system. Canadian governments already spend billions of dollars on the downstream effects of poverty, but scant emphasis is put on programs targeting poverty’s roots. There is no evidence, where smaller-scale experiments have been tried, to show that a guaranteed income program creates a serious problem with negative incentives and discourages people from working who otherwise might. But because this is a common worry with working-age guaranteed income eligibility, phasing in the program gradually, by lowering eligibility a few years at a time, will allow ongoing investigation and analysis of the effects, before the program is rolled out on a large scale. The tremendous impact that guaranteed incomes have had on reducing poverty and improving health among seniors is something for which Canadians can be rightly proud. So much so that it is incumbent upon us to investigate whether Canada could use the same policy tools to drastically reduce poverty and improve health among Canadians of a","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130976621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Using NSS data for 1993-94 and 2004-05 this paper highlights the impact of growing incomes, social and household decisions of households, and regional and ethnic factors on patterns of household level fertility in India. These have helped determine the composition of India's young (aged 9 to 34) today. Demographic transition is well underway in India with rising incomes associated with fewer children and smaller family size. The number of women in the childbearing age group significantly affects the number of children. Households with more women in the age group 26-35 have more children, are more likely to have children than not having them as well as having larger family size, ceteris paribus. Average education of females lowers household size whereas (instrumented) shares of expenditure on education and health have varying effects. The impact of a household being SC or ST varies by year and by the regression model chosen. Over both time periods Muslim households have more children and are more likely than the general population to have larger family sizes. Households in BIMARU states have more children and have larger family sizes as do urban households. Thus demographic transition has occurred unevenly across various groups in India.
{"title":"The Determinants of Household Level Fertility in India","authors":"R. Jha","doi":"10.2139/ssrn.2331062","DOIUrl":"https://doi.org/10.2139/ssrn.2331062","url":null,"abstract":"Using NSS data for 1993-94 and 2004-05 this paper highlights the impact of growing incomes, social and household decisions of households, and regional and ethnic factors on patterns of household level fertility in India. These have helped determine the composition of India's young (aged 9 to 34) today. Demographic transition is well underway in India with rising incomes associated with fewer children and smaller family size. The number of women in the childbearing age group significantly affects the number of children. Households with more women in the age group 26-35 have more children, are more likely to have children than not having them as well as having larger family size, ceteris paribus. Average education of females lowers household size whereas (instrumented) shares of expenditure on education and health have varying effects. The impact of a household being SC or ST varies by year and by the regression model chosen. Over both time periods Muslim households have more children and are more likely than the general population to have larger family sizes. Households in BIMARU states have more children and have larger family sizes as do urban households. Thus demographic transition has occurred unevenly across various groups in India.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127779283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The paper analyses the evolution of China Mobile – one of China’s pioneer ‘national champions’, and one of the world’s largest telecom companies – through the lens of Global Financial Networks, an extension of the Global Production Networks approach, focusing on the role of advanced business services, world cities, and offshore jurisdictions in economic development. It demonstrates that despite being only a nascent Global Production Network, China Mobile is plugged firmly into the Global Financial Network, with incorporation in Hong Kong, cross-listing in Hong Kong and New York, and opaque offshore companies registered in the British Virgin Islands. Global advanced business services firms, with Goldman Sachs in the lead, have been instrumental in the very conception of China Mobile in 1997, and its subsequent expansion, thus helping the Chinese government consolidate and modernize the whole telecom sector. The case study highlights the position of Hong Kong as an onshore-offshore financial centre intermediating between global financial markets and Mainland China, and underwriting the reputation of China’s ‘national champions’. The analysis also points to the advantages of Beijing over Shanghai as a command centre of state owned and controlled enterprises, acting as a magnet for advanced business services. In political-economic terms, the articulation of China Mobile as a ‘national champion’ in the Global Financial Network sheds light on the limits of the Chinese model of centrally managed globalization and financialisation.
{"title":"'Capitalist Tools in Socialist Hands'? China Mobile in the Global Financial Network","authors":"D. Wójcik, James Camilleri","doi":"10.2139/ssrn.2297372","DOIUrl":"https://doi.org/10.2139/ssrn.2297372","url":null,"abstract":"The paper analyses the evolution of China Mobile – one of China’s pioneer ‘national champions’, and one of the world’s largest telecom companies – through the lens of Global Financial Networks, an extension of the Global Production Networks approach, focusing on the role of advanced business services, world cities, and offshore jurisdictions in economic development. It demonstrates that despite being only a nascent Global Production Network, China Mobile is plugged firmly into the Global Financial Network, with incorporation in Hong Kong, cross-listing in Hong Kong and New York, and opaque offshore companies registered in the British Virgin Islands. Global advanced business services firms, with Goldman Sachs in the lead, have been instrumental in the very conception of China Mobile in 1997, and its subsequent expansion, thus helping the Chinese government consolidate and modernize the whole telecom sector. The case study highlights the position of Hong Kong as an onshore-offshore financial centre intermediating between global financial markets and Mainland China, and underwriting the reputation of China’s ‘national champions’. The analysis also points to the advantages of Beijing over Shanghai as a command centre of state owned and controlled enterprises, acting as a magnet for advanced business services. In political-economic terms, the articulation of China Mobile as a ‘national champion’ in the Global Financial Network sheds light on the limits of the Chinese model of centrally managed globalization and financialisation.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123099264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study scrutinizes socio-demographic variables impact upon health status. Ordinary Least squares (OLS), Probit and Tobit regression models have used for examining socio-demographic parameters shock. All of the three models are statistically significant. Tobit model produces better result than other two models. This analysis provides a valuable contribution in that individual data gives an insight on how to improve you overall health status. This study finds that age, degree of religion, income, education, employment status, marital status, health expenditure, provider health service quality, and working environment have a large effect on health status. Other variables such as gender, living quarter, and body mass index, and smoking status also significantly affect health status.
{"title":"An Analyzing the Socio-Demographic Variables Impact on Health Status of Bangladesh","authors":"M. Howlader","doi":"10.2139/ssrn.2294871","DOIUrl":"https://doi.org/10.2139/ssrn.2294871","url":null,"abstract":"This study scrutinizes socio-demographic variables impact upon health status. Ordinary Least squares (OLS), Probit and Tobit regression models have used for examining socio-demographic parameters shock. All of the three models are statistically significant. Tobit model produces better result than other two models. This analysis provides a valuable contribution in that individual data gives an insight on how to improve you overall health status. This study finds that age, degree of religion, income, education, employment status, marital status, health expenditure, provider health service quality, and working environment have a large effect on health status. Other variables such as gender, living quarter, and body mass index, and smoking status also significantly affect health status.","PeriodicalId":441838,"journal":{"name":"Geographic Health Economics eJournal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128593315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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