Publication: Four Decades of Health Economics Through a Bibliometric Lens
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2012-03
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2012-03
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Culyer, Anthony J.
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In this paper, we take a bibliometric tour of the last forty years of health economics using bibliographic “metadata” from EconLit supplemented by citation data from Google Scholar and our own topical classifications. We report the growth of health economics (we find 33,000 publications since 1969—12,000 more than in the economics of education) and list the 300 most-cited publications broken down by topic. We report the changing topical and geographic focus of health economics (the topics ‘Determinants of health and ill-health’ and ‘Health statistics and econometrics’ both show an upward trend, and the field has expanded appreciably into the developing world). We also compare authors, countries, institutions and journals in terms of the volume of publications and their influence as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at the top on a variety of measures).
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Publication Four Decades of Health Economics through a Bibliometric Lens(2011-10-01)This paper takes a bibliometric tour of the past 40 years of health economics using bibliographic "metadata" from EconLit supplemented by citation data from Google Scholar and the authors' topical classifications. The authors report the growth of health economics (33,000 publications since 1969 -- 12,000 more than in the economics of education) and list the 300 most-cited publications broken down by topic. They report the changing topical and geographic focus of health economics (the topics 'Determinants of health and ill-health' and 'Health statistics and econometrics' both show an upward trend, and the field has expanded appreciably into the developing world). They also compare authors, countries, institutions, and journals in terms of the volume of publications and their influence as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at the top on a variety of measures).Publication The Economic Consequences of Health Shocks(World Bank, Washington, DC, 2005-06)While there is a great deal of anecdotal evidence on the economic effects of adverse health shocks, there is relatively little hard empirical evidence. The author builds on recent empirical work to explore in the context of postreform Vietnam two related issues: (1) how far household income and medical care spending responds to health shocks, and (2) how far household consumption is protected against health shocks. The results suggest that adverse health shocks - captured by negative changes in body mass index (BMI) - are associated with reductions in earned income. This appears to be only partly - if at all - due to a reverse feedback from income changes to BMI changes. By contrast, there is a hint - the relevant coefficient is not significant - that adverse BMI shocks may result in increases in unearned income. This may reflect additional gifts, remittances, and so on, from family and friends following the health shock. Medical spending is found to increase following an adverse health shock, but not among those with health insurance. The impact for the uninsured is large, equal in absolute size to the income loss associated with a BMI shock. The lack of impact for the insured points to complete insurance against the medical care costs associated with health shocks, and is consistent with the very generous coverage of Vietnam's health insurance program in this period. The question arises: have Vietnamese households been able to hold their food and nonfood consumption constant in the face of these income reductions and extra medical care outlays? The results suggest not. For the sample as a whole, both food and nonfood consumption are found to be responsive to health shocks, indicating an inability to smooth nonmedical consumption in the face of health shocks. Further analysis reveals some interesting differences across different groups within the sample. Households with insurance come no closer to smoothing nonmedical consumption than uninsured households. Furthermore, and somewhat counterintuitively, better-off households - including insured households - fare worse than poorer households in smoothing their nonmedical consumption in the face of health shocks, despite the fact that in the case of insured households there are no medical bills associated with an adverse health event. Why the poor rely on dissaving and borrowing to such an extent, and do not apparently reduce their food and nonfood consumption following an adverse health shock while the better-off do, may be because the levels of food and nonfood consumption of the poor are simply too low relative to basic needs to enable them to cut back in the face of an adverse BMI shock.Publication Health Insurance Impacts on Health and Nonmedical Consumption in a Developing Country(World Bank, Washington, DC, 2005-04)The authors examine the effects of the introduction of Vietnam's health insurance (VHI) program on health outcomes, health care utilization, and non-medical household consumption. The use of panel data collected before and after the insurance program's introduction allows them to eliminate any confounding effects due to selection on time-invariant un-observables, and their coupling of propensity score matching with a double-difference estimator allows them to reduce the risk of biases due to inappropriate specification of the outcome regression model. The authors' results suggest that Vietnam's health insurance program impacted favorably on height-for-age and weight-for-age of young school children, and on body mass index among adults. Their results suggest that among young children, VHI increases use of primary care facilities and leads to a substitution away from the use of pharmacists as a source of advice and non-prescribed medicines toward the use of them as a supplier of medicines prescribed by a health professional. Among older children and adults, VHI results in a marked increase in the use of hospital inpatient and outpatient departments. The results also suggest that VHI causes a reduction in annual out-of-pocket expenditures on health and an increase in non-medical household consumption, including food consumption, but mostly nonfood consumption. The authors' estimate of the VHI-induced reduction in out-of-pocket health spending is considerably smaller than their estimate of the VHI-induced increase in non-medical consumption, which is consistent with the idea that households hold back their consumption considerably if, through lack of health insurance, they are exposed to the risk of large out-of-pocket expenditures. This is especially plausible in a country where at the time (1993), a single visit to a public hospital cost on average the equivalent of 20 percent of a person's annual nonfood consumption.Publication Estimating Health Insurance Impacts under Unobserved Heterogeneity : The Case of Vietnam's Health Care Fund for the Poor(2010)Vietnam's health care fund for the poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces, and all households living in communes officially designated as highly disadvantaged. As of 2006, the program, which started in 2003, covered around 60% of those eligible. Those who were covered (about 20% of the population) were disproportionately poor, and around 80% of those covered were eligible. Estimates of the program's impact were obtained using a method that takes into account unobserved heterogeneity--including unobserved idiosyncratic returns--but requires minimal assumptions. The downside is that it provides an estimate only of the program's impact on those covered by it; it cannot therefore answer the question of how those currently uncovered will fare when they are eventually covered. The results suggest that HCFP has had no impact on use of services, but has substantially reduced out-of-pocket spending.Publication Europe and Central Asia's Great Post-communist Social Health Insurance Experiment : Aggregate Impacts on Health Sector Outcomes(2009)The post-Communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs regression-based generalizations of the difference-in-differences method on panel data from 28 countries for the period 1990-2004. We find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes.
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