Chris Sampson’s journal round-up for 15th February 2021

Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. If you’d like to write one of our weekly journal round-ups, get in touch.

Journal of Health Economics

Volume 75

This month we have another dozen articles from JHE on a variety of topics. But no COVID!

A few papers look at maternal and infant health. One study focused on the impact of maternity ward crowding in Denmark between 2000 and 2014. As you might expect, the delivered care changes according to the number of admissions, in line with managing the workload. However, there is no impact on the management of complications during labour. The researchers found that this form of variation has a minimal impact on health outcomes, such as the infants’ diagnoses and APGAR scores. Another study considers incentives for caesarian deliveries in Chile. A reduction in out-of-pocket costs was associated with an 8.6 percentage point increase in c-sections. Off the back of this evidence, the authors outline a theoretical framework that can describe hospitals’ demand-smoothing behaviour for planned c-sections. Finally, a regression discontinuity analysis demonstrates the return to early life interventions identified using the 1.5kg threshold for very low birth weight (VLBW) status. Crossing the threshold (and being classified as VLBW) is associated with increased test scores in school and $67,000 less being spent on social support by age 14.

Another study concerned with child health looks at the spillover effects of insurance coverage for low-income adults. In the US, parental Medicaid coverage is associated with greater dental service use by young children.

Several studies in this issue are concerned with medication and prescribing behaviours. One analysis is conducted in the context of prescription drug monitoring programmes (PDMPs) in the US, which attempt to reduce deaths associated with prescription opioid use. A difference-in-differences analysis shows that introducing a policy requiring providers to check a patient’s prescription history was associated with more deaths relating to heroin use, suggesting that the benefits of PDMPs are at least partially offset. Another study looks at health monitoring and medication adherence. The introduction of automated repeat prescriptions in Mexico, which effectively reduced monitoring frequency from 30 to 90 days, increased adherence. Also on adherence is a study looking at physician patients, which suggests that the doctors aren’t much better than matched non-doctors when it comes to conforming to guidelines for both low- and high-value care.

You don’t hear much about the ‘fair innings’ argument these days. A study in this issue explores its presence in social preferences in the context of the social value of risk reduction (SVRR) compared with the value of a statistical life (VSL). The authors outline a conceptual framework to model a social welfare function that is either utilitarian or prioritarian and use this to explore the effect on SVRR of age, income, and baseline risk. The functional form of the social welfare function is important and consistently differs from a standard VSL approach. The upshot of this is that the SVRR approach can provide a clear rationale for the fair innings argument in the prioritarian social welfare function, while the VSL approach cannot. The authors suggest that cost-benefit analysis should be looking to the SVRR approach to evaluate public policy, rather than using VSL.

Other studies in this issue are concerned with the relationship between health and income in the US, antifraud enforcement in Medicare in the US, the demand for insurance in Australia, and a demonstration of the potential value of health screening in Malawi.

Cost Effectiveness and Resource Allocation

Volume 19, January 2021

Six articles were published in CERA last month, with a trip around the world. But no COVID!

Closest to home is a study on the role of the health care sector in the EU economy using an input-output framework. This involves looking at interdependencies in the supply and demand across sectors within the economy. The headline findings are that most health care activities in the EU are publicly funded and produced by the market, with weak links in production between health care and other sectors.

A study from Chile models the transmission dynamics of syphilis in prisons and shows that several alternative detection strategies are likely to be cost-effective.

A study from Ethiopia reports a cost-effectiveness league table for 159 interventions that were used to determine Ethiopia’s essential health service package. The researchers used the WHO-CHOICE generalised cost-effectiveness analysis tool. Two things that may upset readers are that the study uses average cost-effectiveness ratios and healthy life years rather than ICERs and QALYs. Interventions aimed at infectious diseases tended to be more cost-effective than those for non-communicable diseases. On a similar note, a review study from Iran presents a QALY league table for the country. The authors tried to identify every cost-utility analysis in the Iranian context, with 51 studies included. Iranian research gets a lot of attention this month. There’s also a study on the burden of cardiovascular disease and a protocol for a DCE to estimate the value of life in the country.

Journal of Political Economy

Volume 129, Issue 2

I’ll just highlight two articles from the latest issue of JPE. Neither about COVID, would you believe!

There’s one study on the value of competition in health insurance. The researchers try to identify the welfare gains associated with the competitive bidding rules of the Medicare Advantage programme. The analysis relies on administrative records for 2006-2011 analysed alongside a model of bidding competition outlined by the authors. The findings demonstrate an economic surplus to the tune of around $200 per enrollee per month, around two-thirds of which is captured by insurers.

There’s also a study attempting to identify the causal impacts of water fluoridation in Sweden, which used the variation in natural fluoridation that arises from geological differences. The authors looked at population-wide data for people born between 1985 and 1992 alongside fluoride data from 1,726 water treatment plants. It turns out that fluoridation is good for your teeth and does not affect cognition. More surprising, perhaps, is that the study shows that fluoridation is associated with higher incomes among people with lower socioeconomic background.

This issue also reports the journal’s turnaround times, including the fact that, on average, it takes 441 days from submission to acceptance, excluding any time spent by the authors on revisions. Why would anyone bother?

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  • Founder of the Academic Health Economists' Blog. Principal Economist at the Office of Health Economics. ORCID: 0000-0001-9470-2369

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