Sam Watson’s journal round-up for 4th July 2016

Every Monday our authors provide a round-up of some of the most recently published peer reviewed articles from the field. We don’t cover everything, or even what’s most important – just a few papers that have interested the author. Visit our Resources page for links to more journals or follow the HealthEconBot. If you’d like to write one of our weekly journal round-ups, get in touch.

The determinants of productivity in medical testing: intensity and allocation of care. American Economic Review [PDF] Forthcoming

The overuse of medical testing is a growing problem for the health system. Many people believe regular check-ups and a frequent use of healthcare services for preventative reasons can help avoid debilitating ailments, yet the evidence does not bear this out. It is costly and can lead to overdiagnosis and other harms. This fascinating study examines this problem but also looks at whether physicians, for a given level of spending, are allocating resources to where they might have the most benefit. This latter problem of misallocation of resources by physicians, as the authors show, has significant effects on efficiency but has remained previously unexamined in the health economics literature. Looking at CT scans for pulmonary embolism, the study demonstrates significant variation between doctors in their threshold for referring a patient for a scan. More cautious doctors who refer lower risk patients have a significantly lower number of patients who return a positive test, as one might expect. But, interestingly they also find that many of the highest risk patients are not being referred, and doctors appear to rely more on the presence of symptoms to determine a referral rather than purpose-built risk scores. Evidence such as this has a significant bearing on the generalisability of cost-effectiveness studies; while a treatment or test may be cost-effective in the idealised setting of a trial, in practice it may well not be being used optimally.

The effect of local area crime on mental health. The Economic Journal [RePEcPublished 8th June 2016

Neighbourhood effects are an oft studied but poorly understood phenomenon where the context of the local environment affects individual health, wealth, and well-being. In a recent journal round-up we featured new results from the Moving to Opportunity experiment that demonstrated that those people who randomly received a voucher allowing them to move to better neighbourhoods had better health outcomes and their children had better health, educational, and labour market outcomes. This study here provides some evidence about one possible pathway that may mediate such effects. European citizens cite crime as one of their top five concerns despite the very low crime rates in European nations; crime’s effect on well-being likely has an effect beyond direct victimisation. Indeed, this fear and anxiety caused by crimes, such as terrorism, may well be the largest source of harm from such acts. Using the British Household Panel Survey and the English Longitudinal Study of Aging, this study examines the effects of local area crime on individual mental health outcomes. The principal finding is that a one standard deviation increase in the overall crime rate leads to a decrease of approximately 0.08 to 0.15 standard deviations in mental well-being. This, the authors write, is two to four times the magnitude of the effect of an equivalent increase in local area unemployment.

Long-term effects of famine on chronic diseases: evidence from China’s Great Leap Forward Famine. Health Economics [PubMedPublished 16th June 2016

And finally, not one, but two papers on the effects of prenatal conditions and mother and child health! In the last post on this blog, we discussed many of the ways in which economic conditions might affect infant health at birth. The first of these two papers contributes to the literature on the consequences of economic conditions and infant health at the aggregate level. Major events, such as the Great Famine of 1959-61 in China that this paper studies, can impact the birth cohort in different and opposing ways: a selection effect means the average health of babies is improved as many of those in the poorest health do not survive, while the health of a fetus is negatively impacted by the conditions faced by the mother lowering infant health – an adverse effect. By comparing the effects of the famine on the outcomes of those who were children and those who were in utero at the time, the authors find evidence of both the selection and adverse effects, although the former appears to predominate among those who were in utero. This finding fits in neatly to the discussion of the last post. But this discussion focused mostly on infant health – what of maternal health?

The effects of prenatal care utilization on maternal health and health behaviors. Health Economics [RePEcPublished 3rd July 2016

The second of these two studies considers adverse maternal health outcomes, such as insufficient or excessive gestational weight gain and smoking, and their relationship to prenatal care. Unsurprisingly, it is found that poor quality of prenatal care, a low frequency of prenatal care visits, or a combination of the two has an adverse impact on maternal health as measured by the aforementioned outcomes. As this area of research continues to grow the benefits of improved care for mothers become more obvious both for mother and child. However, the measurement of such benefits for cost-effectiveness studies is significantly impacted by a choice of social discount rate owing to the long term consequences of interventions in this area (the life of mother and child). Perhaps another reason to revisit the arguments for the appropriate social discount rate.

Photo credit: Antony Theobald (CC BY-NC-ND 2.0)


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