Forthcoming seminars are announced at CRES home page.
Contact
Contact us if you would like to present your work in a CRES seminar.
For further information:
Natàlia Pascual Argenté
Office 23.111 Phone number (0034) 935 421 586
natalia.pascual@upf.edu
CRES Seminars 2007-2011
08/02/2012 Cristina Blanco-Pérez Department of Applied Economics (Universitat Autònoma de Barcelona), "Rethinking the relative income hypothesis"
This paper focuses on the understanding of the effect of relative income on health. Traditionally, relative income was expected to have a negative association with individual health by means of negative psychological effects. However, the empirical evidence is not conclusive. In order to explain the results disparity in previous literature, I use new evidence regarding the effect of income comparisons within a reference group on well-being. Using German Socio-Economic Panel data (SOEP), I analyse whether income comparisons affect health through psychological well-being in different directions, depending whether the comparisons are "upwards" or "downwards", and not only through relative deprivation, as it was suggested initially. In addition, income endogeneity, due to omitted variables, have been tackled considering unobserved heterogeneity after a POLS transformation. The results show that relative income is more important for health than absolut income. Both "upwards" and "downwards" comparisons are significantly associated with health.
22/12/2011 Marta Trapero-Bertran (Health Economics Research Group (HERG); Brunel University) "Building the business case for tobacco control: a toolkit to estimate economic impact of tobacco"
The new context for public health delivery within England is set out including reference to the 'Healthy Lives, Healthy People - a tobacco plan for England' published in March 2011 which provides a clear sense of direction for national and local tobacco delivery.This research provides an overview to the impact (health, economic and societal) of tobacco use in the UK and the subsequent evidence base for effective tobacco control delivery. The added value of a sub-national level of tobacco control is discussed and, analyzed through an economic model used to develop a tobacco control toolkit. This aims to support local commissioners to make evidence based decisions around tobacco control commissioning. The clear case for investment in a sub-national level of tobacco control is outlined including the economies of scale to be achieved through a 'locally together' approach particularly around areas of action including media and communications campaigns, addressing illicit tobacco and in the advocacy agenda. The research highlights how effective tobacco control results from programmes that are designed and implemented as one where the parts complement and reinforce each other. Their effectiveness is dependent on their comprehensive nature rather than any one part of the intervention.
22/11/2011 Judit Vall Castello, José I. Silva (Universitat de Girona) "Why are so many disabled individuals not working in Spain? A job search approach"
Contrary to other disability systems in developed economies, the Spanish system allows partially disabled individuals to work while receiving the disability benefits. The puzzle is, however, that employment rates of this group of partially disabled individuals prove to be very low. The aim of this paper is to understand the incentives and disincentives to work provided by the partial disability scheme in Spain. We first present a theoretical job search model for partially disabled individuals and then estimate a complementary log-log duration model. According to both models, the job finding probability falls with the level of disability, the age at which the individual starts receiving disability benefits, and the increase in the local unemployment rate. Moreover, as a result of an increase in the level of disability benefits we find a strong income effect that reduces to near zero the job finding probability of disabled individuals older than 55 years old both in the theoretical and the empirical models.
06/07/2011 Marc Carreras Pijuan (GRESSiRES (SSIBE) - Universitat de Girona) "Evolución de las condiciones crónicas y del coste sanitario a lo largo de la vida" [Download]
Objetivos:
El contexto económico actual exige el máximo acierto en el cálculo de los recursos financieros necesarios para atender la morbilidad de la población. En la actualidad existen modelos de ajuste de riesgo que permiten evaluar y en algunos casos anticipar la morbilidad de un colectivo. No obstante, los modelos existentes anticipan, en el mejor de los casos, la morbilidad del año siguiente. Por este motivo, no existe demasiada información sobre el comportamiento de la morbilidad a medio y largo plazo. El objetivo de este trabajo es comprender la evolución de la carga de morbilidad a lo largo de la vida y determinar la estructura temporal de los recursos financieros necesarios para atenderla.
Métodos:
Se ha simulado la evolución de una población de 100.000 individuos mediante una cadena de Markov, utilizando información sobre morbilidad y costes relativa a la población de la comarca del Baix Empordà (Girona). Periodo observado: 2004-2007.
Resultados:
Se han obtenido, para cada grupo de edad y sexo, las probabilidades de permanecer sano, incurrir en un proceso agudo, padecer diferentes combinaciones de enfermedades crónicas o fallecer. Se ha obtenido la distribución del coste sanitario vital.
Conclusiones:
La modelización estocástica mediante la cadena de Markov permite obtener estimaciones razonables sobre la evolución futura de una población en términos de morbilidad y costes. Los resultados obtenidos sugieren que la canalización de recursos hacia el colectivo de pacientes sanos puede producir un ahorro importante en el largo plazo.
21/06/2011 Iván Moreno (CRES i ACCO) "What if it was pharmaceutical price competition in Spain? When regulation has the same effect that collusion" [Download]
04/04/2011 Ana Tur (CRES i UCL) "The impact of co-payment exemption on pharmaceuticals consumption: evidence from a regression discontinuity design"
Abstract: :Under the Spanish system of co-payment for prescription pharmaceuticals, working-age people must pay either 40% or 10% of their prescription pharmaceutical bills. Retirees are exempted from co-payment. The aim of this study is to estimate the effect of co-payment exemption on the rate of pharmaceutical consumption.
Methodology and data:
We exploit the jump in the probability of retirement (and thus the exemption from pharmaceutical co-payment) at age 65 due to legal incentives to apply a fuzzy regression-discontinuity. This framework allows us to identify causal effects by comparing retirees' pharmaceutical consumption to that of people about to retire. We use administrative data from all individuals aged 58-64 covered by the National Health System in Catalonia, Spain (n=447.888), from 2004-2006. We estimate the discontinuity in the retirement rate using microdata from the Spanish Active Population Survey for the same period of analysis.
Results:
Our first-stage results indicate that reaching legal retirement age increases the probability of being out of the labor force by 10 percentage points. We then conduct separate analyses regarding the level of co-payment for chronic drugs (10%) and non-chronic drugs (40%). For those who are paying 40% of the price of the prescribed drugs and retire at age 65 because of legal incentives (local average treatment effect), we find a 41% increase in pharmaceutical consumption. This effect is statistically significant and can be attributed exclusively to the co-payment exemption. For those who are paying 10% of the price of prescription medication, we find a statistically non-significant consumption increase of 10%. We compute standard errors using wild bootstrap techniques and assuming a multi-cluster structure by age and individual. Finally, we find that prescription drug use is price sensitive, with elasticities of -0.2 for non-chronic drugs and -0.06 for chronic drugs.
Conclusions:
This study contributes valuable evidence to the empirical understanding of co-payment and its effects, using an appropriate evaluation method that provides more credible causal inferences than those arrived at by typical evaluation methods.
01/03/2011 Ángela Blanco (Instituto de Estudios Fiscales) "Projecting health expenditure in Spain under different scenarios with cost of death approach" [Download]
In this work we analyze the evolution of healthcare expenditure in Spain under different scenarios as a result of the progress of the drivers underlying it. We group these drivers into the following factors: pure demographic factor (including population volume and structure), health status factor (healthcare expenditure per capita by age and gender profile), global volume (average healthcare expenditure per capita at constant prices), and healthcare prices. We consider different scenarios depending on the evolution assumptions of these factors. In order to measure accurately these effects, we suggest that the highest healthcare costs associated with those who die should be incorporated into the projection model, making it coherent with the mortality rates underlined in the demographic scenario. To do this, we calculate the average per capita health cost of survivors and decedents by age and gender starting from an estimation of health by age and gender produce from the macroeconomic figures that provide the Spanish System of Health Accounts and the National Information System on Diagnosis-Related Group (DRG) together with the National Health Survey. Then we use the methodology of the Ageing Working Group (AWG) of the European Commission to calculate the projections for the period 2008-2060. The result points to a more temperate pressure of demography when considering the "cost of death" hypothesis. We also find that the improvements in health status will moderate the effect of cost of death hypothesis.
03/02/2011 Roger Feldman (University of Minnesota) "Stated and revealed preferences to infer consumers' perceptions of unobservable hospital attributes such as reputation" [Download]
We examine the effects of diverse dimensions of hospital quality on future hospital choice, including consumers' perceptions of unmeasured quality attributes (e.g., hospital reputation), clinical quality, and consumers' satisfaction after experience with a prior hospitalization. We utilize consumers' stated preference weights for unmeasured quality attributes to estimate parameters representing their perceptions of unmeasured quality attributes offered by each hospital in the choice set. Analyzing survey data about a hypothetical future hospital choice, we report three main findings. First, consumers perceive differences in reputation and medical services across hospitals and those perceptions contribute substantially to utility in future hospital choice. Second, consumers tend to select hospitals with high clinical quality scores even before the scores are publicized. However, the effect of informal information about clinical quality on hospital choice is smaller than the effects of consumers' perceptions about reputation or medical services. Third, consumers' satisfaction ratings from their own experience have a large impact on future hospital choice, close to that of perceptions about hospital reputation or medical services. Our findings suggest that including measures of consumer experience in report cards may increase consumers' responses to the disclosed information. They also suggest that strategies are needed to improve consumers' awareness and use of publicized information to overcome the large effects of consumers' beliefs about other attributes on hospital choice.
20/10/2010 Andy Street (Centre for Health Economics, University of York) "How will the English National Health Service survive the recession?"
The UK's coalition government has threatened massive cuts in public expenditure and, despite promising to protect its budget, is requiring the
English NHS to make major savings as well. In this talk I consider what form the NHS might take when (if) we emerge from the recession. I'll start by discussing the Labour government's legacy, summarising my research and other evidence on the impact of 12 year's worth of demand- and supply-side reforms on the productivity and efficiency of the NHS. I'll then describe the current government's proposals that include yet another structural re-organisation, greater involvement of the private sector, and a so-called information revolution. I'll conclude by recommending that, if Spain is to seek to improve the efficiency of its own NHS, it may not wish to follow the English example.
15/10/2010 Ali McGuire, (LSE Health and the Department of Social Policy, LSE), presentará "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms"
14/07/2010 Judit Vall (CRES-Universitat Pompeu Fabra)"Business Cycle Effects on Labour Force Transitions for Older People in Spain"
This paper analyses the determinants of observed exits from employment for people aged 45-59 years old in the context of the Spanish labour market in 1981-2006. The main aim of the paper is to identify the effect of the business cycle (BC) on the timing and the type of exit route out of the labour force. We proceed in two stages. In the first stage, we study the determinants of exits from employment to non-employment. In the second, we take into account the fact that there are several competing exit routes (unemployment, disability or inactivity) and estimate a competing risk model to evaluate how important BC conditions are in determining the respective exit probabilities. We make use of the recently released Muestra Continua de Vidas Laborales to estimate discrete time hazard regression models. We match this information with a number of variables constructed with macroeconomic data derived from the Instituto Nacional de Estadistica to measure growth and employability performance of different economic sectors and regions in Spain in order to capture the variation in the business cycle between times, sectors and regions. Time-varying covariates are also included in the analysis to model the monetary incentives provided by the system. We find that both BC conditions and a un mber of special schemes included in the unemployment and disability legislation affect the exit timing and also the choice of the route out of the labour market.
21/06/2010 Harol Luft (Director, Palo Alto Medical Foundation Research Institute) "Observations on Doing Research in Academic and Real-World Settings Place"
07/06/2010 Robert Kaestner, Professor del Institute of Government of Public Affairs University of Illinois (Chicago), "New Evidence on the Efficacy of Medicare Spending".
In this paper, we examine the effect of inpatient spending on mortality of Medicare patients admitted to the hospital for medical conditions (AMI, CHF, Stroke, and gastrointestinal Bleeding).and the effect of inpatient spending on failure-to-rescue of Medicare patients admitted for surgery (general, orthopedic, vascular). Results indicate that inpatient spending is significantly and negatively associated with mortality and failure-to-rescue. The increase in survival was non-trivial-a ten percent increase in inpatient spending is associated with a three to six percent increase in survival. Our estimates suggest a cost of life year saved of between $43 thousand and $227 thousand depending on the illness. These findings add to other recent studies that have found that greater inpatient spending is beneficial, which raises questions as to the applicability of the "flat-of-the-curve" argument that marginal spending on health care is ineffective.
03/03/2010 Marta Trapero-Bertran (CRES-Universitat Pompeu Fabra, HERG-Brunel University) "Yo no fumo pero, ¿por qué debería ser considerado en la evaluación económica de las intervenciones antitabáquicas?"
Fumar no solo afecta los fumadores sino a aquellos que los rodean. La evaluación económica calcula los costes y beneficios de las intervenciones de salud pública y los compara en términos relativos de su coste-efectividad. Sin embargo, el problema es que este análisis realizado hasta ahora no tiene en cuenta los beneficios y costes sociales generados por las diferentes intervenciones públicas en salud. Este trabajo trata de incorporar los efectos externos o externalidades generadas por el hábito tabáquico, (fumar pasivo, fumar durante el embarazo y la transmisión del comportamiento de los fumadores) en las evaluaciones económicas de las intervenciones antitabáquicas. Este trabajo pretende presentar evidencia de cómo las externalidades pueden afectar al proceso de decisión en salud pública.
10/02/2010 Meritxell Solé (Universitat de Barcelona), "Las condiciones de trabajo como determinantes de las desigualdades socioeconómicas en salud: ¿hay diferencias entre inmigrantes y autóctonos en España?"
2/12/09 Jeffrey E. Harris (Massachusetts Institute of Technology ,MIT): "Why We Don't Have An HIV Vaccine, And How We Can Develop One"
7/10/2009 Rhema Vaithianathan (University of Auckland): "Truth-In-Advertising Laws and Pharmaceutical
17/04/2009 Norma A. Padrón (Universitat Pompeu Fabra): "Preferences, Beliefs and Self-Management of Diabetes" (with J Frank A. Sloan and Alyssa C. Platt)
Objective. To assess relationships between self-assessed control over life events, subjective beliefs about longevity, time and risk preference, and other factors on use of recommended care for diabetes mellitus (DM), self-assessed control of diabetes, general health, and laboratory measures of HbA1c levels.
Data Sources. Health and Retirement Study (HRS) and 2003 HRS Diabetes Study (HRS-DS).
Study Design. We used logit and ordered logit analyses to assess use of recommended care, and subjective and objective measures of health outcomes.
Data Collection. Secondary analysis of HRS and HRS-DS data.
Principal Findings. Individuals with higher self-assessed control over life events and higher subjective probabilities of living 10 years engaged in more recommended DM care practices, and had better self-assessed DM control and general health. However, these beliefs did not influence HbA1c levels. More highly educated and cognitive able persons were more likely to follow care recommendations. There were differences by race/ethnicity in health outcomes, but not in health investment among Hispanics.
Conclusions. Individuals' beliefs about control over life events and longevity influenced health investment and subjective health outcomes, although these beliefs did not translate into differences inHbA1c levels. Hispanics may realize lower returns on health investments, at least for diabetes care
27/02/2009 Javier Coronado (NERA): "Entry in a Regulated Pharmaceutical Market"
Entry regulations affecting professional services such as pharmacies are common practice in many European countries. We assess the impact of entry regulations on proffits estimating a structural model of entry using the information provided by a policy experiment. We use the case of different regional policies governing the opening of new pharmacies in Spain to show that structural models of entry ought to be estimated with data from policy experiments to pin down how entry regulations change payoff functions of the incumbents. Contrary to the public interest rationales, regulations are not only boosting small pharmacist payoffs nor increasing all pharmacies payoffs alike. The gains from regulations are very unevenly distributed, suggesting that private interest are shaping the current mix of entry and markup regulations.
21/01/2009 Joan Ramon Borrell (Universitat de Barcelona): "Assessing excess profits from different entry regulations"18/12/2008 Climent Quintana-Domeque (Universitat d'Alacant): "A look at the lives of the unemployed in Catalonia: preliminary evidence from the Catalan Health Survey 2006”.
24/11/2008 Maarten Lindeboom (Vrije Universiteit Amsterdam): “When dreams do not come true: the ex-ante effect of a change in the retirement system on the mental health of workers nearing retirement”
5/11/2008 Donald J Wright (University of Sydney): "Medical Malpractice and Physician Liability Under a Negligence Rule"
This paper develops a model of medical malpractice claims to examine the impact of physicians being liable for actual damage under a negligence rule. It is found that this arrangement does not provide strong incentives for physicians to attain the socially optimal level of expertise nor quality of service. The incentive effects of physicians being liable for actual damage can be strengthened by the central provision of publicly available information that assists patients to accurately determine whether their health outcome was more likely the result of medical malpractice rather than just a poor outcome from the correct diagnosis or treatment.
22/10/2008 Mônica Viegas Andrade (Universidade Federal de Minas Gerais, Brasil): "Prevention and Control of Homicides: An Impact Evaluation in Brazil"
In this article we assess the impact of Fica Vivo programme. Fica Vivo is a social program built for prevention and control of criminality, set up in Brazil. Its design is inspired by the American programme CeaseFire and the principal objective is the reduction of homicides in areas where its incidence is high, in general, slums. The impact variable is th half-yearly homicide rate per one hundred thousand inhabitants and the methodology used is Double Difference Matching (DDM). We utilize a specification of the model that allows us to consider the impact of the programme in a differentiated way for each area treated and for each stage of programm expansion. The data utilized are the georeferenced records of the Military Police of Minas Gerais running from 2000 to 2006, and data from the demographic census of 2000. The principal results indicate that Fica Vivo reduces criminality, although the effect of the programme is not homogeneous over the areas treated, and has increased with the passage of time during the period studied.
03/07/2008 Andrew Street (Centre for Health Economics, University of York): "Measurement of health system output growth"18/06/2008 Claudia Desogus (U. de Bologna): "Does parallel trade on pharmaceuticals undermine R&D incentives? Shaping an appropriate efficiency defence under European competition law".
02/06/2008 Juan-Rafael Vargas (Universidad de Costa Rica): TBA
20/05/2008 Anna Cabré (Centre d'Estudis Demogràfics, Universitat Autònoma de Barcelona): Viure Cent Anys? Reflexió des de la Demografia
05/05/2008 Iván Moreno Torres (CRES, Universitat Pompeu Fabra): "Demanda de Medicamentos: La competencia de los genéricos en un mercado farmacéutico regulado"
01/04/2008 Ipek Aktar (UPF) "Volluntary Full Transparency (Registry and Disclosure) of Clinical Trials by Pharmaceuticals"
07/03/2008 Bernard van den Berg (Institute of Health Sciences. VU University Amsterdam) "Economic evaluation of informal care"
24/01/2008 David Casado (UPF) "Impacte de l'envelliment sobre les necessitats de finançament sanitari a Catalunya: Projeccions fins l'any 2030"
5/12/2007 Begoña García (Comissió del Mercat de Telecomunicacions) "External referencing, pharmaceutical price negotiations and others"
External referencing imposes a price cap for pharmaceuticals based on prices of identical products in other countries. Suppose country A negotiates prices with a pharmaceutical firm while country B can either do the same or base her external referencing on A´s price. We show that B may prefer the latter option if drug copayments in B are sufficiently high and that the effects of external referencing crucially depend on whether it is conditioned on the drug being listed in A or not. Country B will never implement non conditional ER, who instead will find that different sorts of conditional referencing are worth pursuing. We show that size effects are relatively small.
31/10/2007 Pere Ibern (UPF) "Sanitat a Xile: Ajust de risc i redisseny dels sistemes de pagament"