Individual vs. household determinants of the demand for medical care: A study of rural families

This article investigates, from a household perspective, the demand for medical care. Earlier (economic) studies have typically focused on individual utilization patterns; however, the data set employed here allows for an investigation of the role of other family members on individual demand. The theoretical results suggest that the labor force status (via the wage rate) of one family member may, in addition to influencing that person's rate of medical care use, effect the utilization of other household members. Separate physician visit demand equations are estimated for husbands, wives, and the household unit. The empirical results indicate that the wife's (full) cost of receiving medical care is a significant determinant of utilization by both the husband and other family members. Overall, the findings suggest that demand studies should take the presence of other household members and family structure into consideration when analyzing the determinants of individual medical care utilization.This study was supported in part by grant no. 1R03 HSO 2417-01 from the National Center for Health Services Research, HHS.Laurence Miners received his Ph.D. in economics from the University of North Carolina at Chapel Hill. He is currently an Associate Professor at Fairfield University and his research interests are focused mainly in the areas of health and labor economics. Correspondence concerning this article should be addressed to Laurence Miners, Department of Economics, Fairfield University, Fairfield, CT 06430.     

HOW HEALTH INSURANCE AFFECTS HEALTH CARE DEMAND—A STRUCTURAL ANALYSIS OF BEHAVIORAL MORAL HAZARD AND ADVERSE SELECTION

Individuals with health insurance use more health care. One reason is that health care is cheaper for the insured. Additionally, having insurance can encourage unhealthy behavior via moral hazard. Previous work studying the effect of health insurance on medical utilization has mostly ignored behavioral changes due to having health insurance, and how that in turn affects medical utilization. This paper investigates the structural causal relationships among health insurance status, health behavior, and medical utilization theoretically and empirically, and separates price effects from behavioral moral hazard effects. Also distinguished are the extensive versus intensive margins of insurance effects on behavior. (JEL C51, I12, D12)     

Informal caregivers' leisure time and stress

This article explores the disruption informal caregiving creates in the caregiver's family life and the relationship between leisure and stress caused by caregiving. The study finds that the caregiving setting, caregiver's sociodemographic characteristics, and economic variables (i.e., wage rate, nonwage income, and Medicaid coverage) significantly affect the caregiver's leisure. Additionally, reducing leisure leads to emotional and physical stress and less satisfaction with life overall. The article concludes with implications for public policy. Her research interests include long-term health care and medical service utilization for minority populations. She holds a doctorate from Northwestern University. He has published extensively in the areas of health services research and nonprofit organizations. His doctorate is from the University of Virginia.     

Health and the household

We underscore the close link between the economics of the household and health economics in a framework in which consumers produce their fundamental objects of choice. Health is produced with inputs of market goods and services and the own time of the consumer. Health is demanded not only because it is an argument in the utility function but also because it determines the amount of time available for market and nonmarket production. The latter motive points to health capital as one component of the stock of human capital. The economics of the household has much to say about the determinants of investment in this type of capital. The five health economics papers in this issue of Review of Economics of the Household are connected by an emphasis on the role of time in the production of two aspects of health: obesity and the general health of elderly persons.      

“Starting Points Matter”: Humanizing Economics Pedagogy through New Economic Paradigms

Abstract

This paper considers the implications of the neoclassical dominant narrative in economics education and conceptualizes specific responses that teachers and teacher educators can take to promote a humanizing economics pedagogy. I briefly describe alternative economic paradigms and contrast them with neoclassical fundamentals. Then, I include economic lesson ideas to showcase ways to teach traditional economic content in ways that attend to neoclassicism but expand the potential of the discipline into new paradigms. By interrogating the fundamentals of neoclassical economics, students and teachers of economics can use these new economic paradigms to foster a counternarrative that is more critical and humanizing and can help address the prevailing themes of an era marked by systemic oppression.     

Expanded medical home model works for children in foster care

The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates.These children used the health care system more effectively and cost-effective as reflected in the higher utilization rates of primary care and well-child visits and lower utilization of emergency room care for children with chronic conditions.     

Health economics--concepts and conceptual problems.

Awareness of the economic manifestation of health and diseases and the limited resources allocated to health care services has brought to the focus a new discipline - health economics. Cost accounting, cost benefit, cost effectiveness methods etc. are increasingly becoming an integral part of the health management and evaluation of health programmes. Various concepts and problems relating to health economics are discussed in the present paper. More efforts should be made to conduct health economic studies in hospitals and health centres by which the process of standardisation of the concepts, would be easier. Health economics should also find its due place in the medical curriculum.     

Modern health services and health care behavior: a survey in Kathmandu, Nepal

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed.     

HEALTH CARE, INSURANCE, AND THE CONTRACT CHOICE EFFECT

This article explores the interdependence between the individual consumer's demand for medical care and choice of health insurance coverage, with emphasis on its implications for demand behavior and empirical analysis. We show that an increase in the price of medical care has two effects on demand, the usual response of reduced quantity demanded and a health insurance contract choice effect resulting from the consumer's incentive to change insurance plan. The contract choice effect, widely neglected in studies of medical care demand, alters both the quantitative and qualitative predictive properties of the consumer's demand for medical services. (JEL D11, D81, I11 )     

Mexican immigration and health care: a political economy perspective.

This paper examines the case of Mexican immigrants in the United States and their access to medical services within a political economy of health framework. Such an approach stresses that the provision of health care is independent of health factors per se and that access to health care is not equally distributed throughout a population. The first section reviews the three major concepts influencing medical anthropologists working within a political economy framework: the social origins of illness; the allocation of health resources; and fieldwork in Third World countries. The analysis then focuses upon the reasons for limiting immigrants' access to health care, followed by an examination of the socioeconomic characteristics of Mexican immigrants, including an undocumented immigration status, which limit their access to health care. Finally, the consequences of limited access to health services are suggested, including a low utilization of preventive health services resulting from the high cost of care combined with the immigrants' generally low income, lack of medical insurance and fear of using U.S. health services.     

Behaviorally caused loss of health and the use of medical care

This paper extends the analysis of the demand for medical care to an aspect which has previously been ignored: variations in expected, as opposed to experienced, cause of losses of health and the current use of medical care. Losses of health which cannot be prevented by the prior use of medical care are hypothesized to decrease the use of medical care by reducing the rate of return to investments in health, ceteris paribus. The reduction in the rate of return occurs both because these losses curtail the length of the stream of benefits to the use of medical care and because prior use of medical care is not effective in reducing the occurrence of these types of loss. Empirical findings support this hypothesis. Results suggest that differences in expected losses may account for some of the differences in utilization of medical care by sex.     

Racial differences in health and health care service utilization in later life: the effect of socioeconomic status.

In this paper we examine the hypothesis that health differences between Blacks and Whites in later life are related to socioeconomic status. Using the 1984 panel of the Survey of Income and Program Participation, we construct four measures of health and two measures of health care service utilization. Multivariate analyses show that the racial differences are eliminated in some measures of health and health care service utilization after holding constant individual-level socioeconomic characteristics and resources. However, even after accounting for differences in socioeconomic status, Black self-rated health is poorer than that of Whites. Further, Blacks report more visits to medical personnel but do not report higher rates of hospitalization when levels of health and economic resources are controlled. Additional analyses suggest that the impact of socioeconomic status on health is different for Blacks than for Whites.     

Gender, acculturation, and health among Mexican Americans

This study examines whether the relationship between acculturation and physical health varies by gender among Mexican Americans, and if the mechanisms that mediate the acculturation-health relationship operate differently by gender. Using the 1998-2007 National Health Interview Study, we construct a composite measure of acculturation and estimate regression models for the total number of health conditions, hypertension, heart disease, and diabetes. Immigrants with the lowest levels of acculturation are the healthiest, but this association is stronger for men. Medical care plays a central role in accounting for gender and acculturation differences across health outcomes-increased access to and utilization of medical care is associated with worse health, which suggests that better health among recent arrivals (particularly men) partially results from their lack of knowledge about their own poor health.     

Access to health care in urban areas of developing societies

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.     

Latino caregiver psychosocial factors and health care services for children involved in the child welfare system

Children in the child welfare system have a high prevalence of health problems, making pediatric health service use critical. Latino children represent a growing proportion of the child welfare system, and are at increased risk for health problems. Many have argued that Latino caregivers can provide Latino children with the least disruptive out-of-home placement, but little is known about how caregiver factors might relate to health services utilization or child health status within this population. This study assessed relationships between caregiver psychosocial factors, health care service utilization, and health status for children in the child welfare system. This sample featured 48 Latino caregivers involved in child welfare. Logistic regression models were used to test for relationships between caregiver psychosocial factors and appointment adherence and child health status. Problem-focused coping was positively related to well-child status. No psychosocial factors were related to medical appointment adherence. Case workers may help improve child health outcomes by promoting problem-focused coping skills among Latino caregivers.     

Health promotion and disease prevention: a look at demand management programs

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.     

THE EFFECT OF INSURANCE COVERAGE ON PREVENTIVE CARE

Despite the growth in health insurance products that differentially cover preventive care and nonpreventive care, little is known about how preventive care utilization responds to targeted changes in coverage. Using administrative data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the price of nonpreventive care while decreasing the price of prevention. Leveraging a difference‐in‐differences research strategy, we find that preventive care utilization did not increase and even declined due to the differential price change. This evidence indicates a meaningful negative cross‐price effect, suggesting that nonpreventive care and preventive care are complements. (JEL I13, I11)     

Psychic distance, psychic distance paradox and behavioral economics: Modeling MNC entry behavior in foreign markets

Assuming that MNCs face a much more complex environment that local enterprizes, the paper begins by discussing what economist Beckerman called psychic distance. After a historical discussion of this concept, I also discuss what O’Gardy and Lane called psychic distance paradox. Then, I argue that these two concepts have a great deal of relevance beyond their original intent of international trade-they are also relevant to FDI and all other formas of international production and exchange. Next, I argue, as I have done in several previous papers, that behavioral economics has a great deal of relevance to FDI and international productive activity; I also argue that behavioral economics can be utilized to describe the concepts of psychic distance and psychic distance paradox. Then, I develop a behavioral economics-based model that can explain the concepts of psychic distance and psychic distance paradox, and their relevance to the modes of entry of MNCs in international markets. In doing so, I argue that FDI and MNC behavior in general need not be explained outside of economics, since, in contrast to neo-classical economics, behavioral economics is capable of capturing the complexities of global markets.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

城市经济学发展历程研究综述

城市经济学（urban economic）是以城市这一独特的空间组织结构为研究对象的经济学科,与区域经济学（Regional Economics）、新经济地理学（newgeo graphyeconomic;）等学科同属于空间经济学（spatial economy）,与这些学科关系极为密切。在对城市经济学的形成历程、理论渊源、研究对象和与其他学科的关系进行回顾的基础上,最后对城市经济学的未来发展方向进行分析。