Sam Watson’s journal round-up for August 15th

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 association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy. Journal of the Royal Statistical Society A. Published August 2016.

The measurement and analysis of factors that affect hospital quality is a popular topic in both the economic and statistical literature. We recently discussed a paper by Martin Gaynor and colleagues that examined the effects that increased patient choice and quality information had on hospital quality. This new paper by Paolo Berta et al considers the same question in Italian hospitals in Lombardy. Analyses are considered at the ward level, rather than the hospital level since this, it is argued, is more likely to be the level of choice that the patient makes given a specific condition. Furthermore, patients do not have access to information such as adjusted hospital mortality rates, so it is assumed that patients may be getting information via their social network – a coefficient for the proportion of people in the local municipality who used the same ward is added to the patient choice model. The predicted probabilities from this choice model are used to generate a Herfindal index for hospital competition, which is used as a covariate in a multi-level model of 30-day hospital mortality.

They find that firstly patients are more likely to go to a ward if more people in the local area go to that ward and secondly that hospital competition does not appear to have an effect on the mortality rate. Given these two findings it is concluded that in the absence of decent quality information – an information asymmetry – patients are choosing based on information from their social networks, which is why increased competition does not lead to improved outcomes. This may explain the difference in findings between the Gaynor paper, where patients did have information, and this paper. This paper present a thorough and clear analysis but questions surrounding the measurement of quality remain. The dynamic equilibrium between patient choice over hospital and hospital choice over quality is complex; and hospital choice about quality may be further constrained by their budgets. Putting all this together is no simple task.

Alcohol Availability, Prenatal Conditions, and Long-Term Economic Outcomes. Journal of Political Economy. Forthcoming.

The fetal origins hypothesis has certainly generated no end of new papers, even in top ranked journals, for this journal round up. So this week in “infant health corner” we have a new study that examines the effect of the availability of alcohol to expectant parents on the health of the infant. While maternal alcohol consumption has been the subject of innumerable previous studies, this is the first to consider its effects on long term outcomes such school attendance and wages. In 1967-8, in an attempt to encourage substitution from high alcohol content spirits to lower content beer, the Swedish government allowed grocery stores in some regions to sell beer. Previously all alcohol was sold in state owned off-license stores. The policy inadvertently led to an increase in alcohol consumption and was ended soon thereafter. This policy experiment provides the foundation for this analysis. Expectant mothers also increased their alcohol consumption during this period. People who were exposed in utero to the policy were found to have lower school completion rates, lower cognitive and non-congitive ability, and lower wages.

Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses. American Economic Review: Economic Policy. [RePEcPublished August 2016.

Recent federal healthcare reform in the United States mandates insurance companies to provide access to preventative health services and prohibits cost-sharing for these schemes. One such service is breast cancer screening using mammograms. The aim of the reform is to increase utilization of such screening programs, which a number of US bodies have determined is currently too low. This paper investigates the effects the healthcare reform had on mammogram uptake and finds significant increases in the numbers of screened women and diagnoses of breast cancer. The authors do attempt to address one of the key questions about breast cancer screening programs – that they may cause more harm than good. They find that in most cases the increases in screening were not consistent with guidelines from the American Cancer Society, suggesting harms were being caused by the program. Perhaps another case of policy not following the evidence.

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