Chris Sampson’s journal round-up for 8th March 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.

Health Economics

Volume 30, Issue 2

Yet again, we see a collection of studies on the impact of environmental or political events on infant health. Have these studies always dominated, or am I only just noticing? Evidence from China shows that droughts are associated with poorer outcomes for children in the short and long term, with the effect seemingly driven by changes in access to safe drinking water. Another study looks at the impact of the 2004 tsunami in Indonesia, with the researchers finding an increase in under-5 mortality in the short-term and mixed results a few years down the line. On the political side, this issue includes a study on the impact of a failed coup d’etat in Spain in 1981. Greater in utero exposure to the coup was associated with lower birthweight, presumably due to maternal stress. On a related topic, another study (reassuringly) shows that pregnancy is associated with reductions in alcohol purchases.

Keeping with young people, some more evidence from China shows that air pollution is associated with reductions in adolescents’ self-esteem, self-satisfaction, and confidence in the future, while adults fair OK. A study from the UK finds that children who grow up with a mother who experiences financial problems have poorer cognitive and non-cognitive outcomes and that these impacts are in part explained by mothers’ mental health. A study from Australia highlights barriers to free dental programmes for children, which see uptake by only one-third of eligible people, with mothers’ mental health and indicators of a risky lifestyle being key explanatory factors.

It’s back to school for the UK today, so it’s fitting that this issue includes a paper on commuting, co-authored by my MSc course mate (the great Luke Munford) and my undergrad personal tutor. The researchers sought to demonstrate the impact on people’s health of different modes of transport for commuting. Using longitudinal UK data, they matched individuals who did and did not change their mode of commuting. Switching to walking or cycling from using a car improves mental and physical health while making the reverse switch has the reverse effect.

This issue includes a couple of studies on inequality. One study presents a new way to compare inequality of health opportunity between populations using a variation on latent-class analysis. Another study demonstrates that the Affordable Care Act reduced income-related inequality in health insurance in the US, highlighting the value of insurance exchanges in this regard.

Various other topics are covered in this issue. There’s a study on the labour market impact of public health insurance in China, with no overall impact on labour market participation but some positive effects on employment mobility and flexibility. A study on spillovers in US health care shows that Medicare Advantage penetration is associated with reductions in expenditure for enrollees in traditional Medicare.

With some relevance to COVID-19, an experimental study explores how students-playing-doctor respond to different levels of resource scarcity, finding that they prioritise equal allocation over efficiency. Another experimental study provides evidence on smoking behaviour and information sources. Finally, a study on marijuana legalisation suggests that some people may claim disability and even migrate to get their hands on the stuff.

Health Economics

Volume 30, Issue 3

Yes, it’s a Health Economics double bill this week. And the latest issue brings us more on infant and maternal health and the environment, with a study of water quality deterioration in the US. The change in water supply was associated with an increase in smoking during pregnancy and a drop in breastfeeding, which seemed to be driven by maternal stress. The authors demonstrate that the change in smoking behaviour induced a drop in birth weight, which was associated with extra costs of $700 per birth. Also on infant health, a study from Uruguay shows that giving young mothers access to private facilities can improve birth outcomes. The researchers only observed the benefits in the medium term, and the effects seem to have been driven by the increased choice and competition.

You may have noticed a slow down in COVID-related studies in recent round-ups. I guess most journals have got the initial influx out of their systems. They haven’t completely dried up, with one article appearing in this issue having done the rounds online a few months back. It’s a short article outlining a method for deriving QALYs from COVID mortality estimates, with an application to cross-country comparisons.

This issue includes a couple of studies on reimbursement systems. A study from Japan evaluates the impact of switching to a hybrid reimbursement model. The partial adoption of bundled prospective payments resulted in providers choosing to shift some procedures to fee-for-service. This undermined the potential cost savings such that the hybrid model may be no better than purely fee-for-service reimbursement. A study from Germany assessed the introduction of treatment intensity codings for reimbursement in stroke care, finding a jump in the proportion of admissions classified as high-intensity following the reform.

There are two studies relating to HIV in this issue. The ever-controversial PrEP (pre‐exposure prophylaxis) is the subject of a dynamic HIV transmission model, which demonstrates the importance of understanding market forces among female sex workers to accurately model the impact of PrEP. Another study evaluates the impact of education on HIV outcomes using a policy reform in Botswana. An extra year of school was associated with delayed sexual activity and marriage for women but more risky sexual behaviour for men. HIV infection significantly dropped for women, while the effect for men is unclear.

Other topics include a study looking at the productivity of GPs in France in the context of task sharing and integration. There’s also a study showing that longer wait times for social security not only decrease future earnings, as people hold-off participating in the labour market, but they also increase the number of health conditions that limit activity. There’s also a theoretical study of provider and patient collusion against insurers, an analysis of health care assistants’ career choices, and an experimental study on the sale of chlorine tablets.

Health Economics Review

Volume 11, January 2021

Health Economics Review published four articles in January. Of most interest to me is a review study outlining alternative approaches to priority setting and resource allocation. The authors identify HTA-type processes, programme budgeting and marginal analysis, and multiple-criteria value assessment as three major decision-making frameworks applied in high-income countries. The paper provides a useful discussion of these three broad approaches, as well as some lesser-known frameworks. Still, the authors aren’t able to do justice to the complexity of current practice. In reality, there are many alternative approaches, each being a collection of related methods and processes, which might rightly or otherwise be given one of the three labels mentioned.

If you’ve ever done a microcosting study, you’ll know that the methodological guidance out there is pretty weak. A new review of microcosting studies should prove useful. The researchers extracted information from 195 studies and critically appraised their methods. Unfortunately, the reporting is a little too brief, but the summary of common practices and shortcomings along with the database of included studies make it a valuable reference. Another review study is a systematic review of economic evaluations comparing antibiotics and faecal microbiota transplantation for C. diff infection, which found that FMT is likely to be cost-effective.

If you like big numbers, you’ll enjoy a study simulating the value – in terms of cost savings and life-years – of using adaptive clinical trials for the research and development of new pharmaceuticals. By increasing the success rate of trials by around 4 percentage points, the authors estimate that $4.2 billion would be freed from the global cost of developing new drugs, and 3.5 million additional life years would be generated.

Health Economics Review

Volume 11, February 2021

Yes, this week is a double-double bill! Another four articles appeared in Health Economics Review in February. A study from the US shows that grocery taxes are associated with higher rates of obesity and diabetes, and the benefits of the extra tax revenue do not appear to be worthwhile. Also from the US is a study looking at the extent to which hospital ownership and market conditions affect treatment choices. There’s a paper on the organisation of telemedical emergency doctors, with the authors arguing that the system should be coordinated centrally in their case study of a district in Germany. Finally, a study of the cost of a neonatal care programme in Ghana suggests that digital training platforms and ‘training of trainers’ may provide solutions to the programme’s unsustainability.

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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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