Shushing the press shortens lives: cross-national evidence of the impact of press freedom on life expectancy.

AIMS: Press freedom around the globe has deteriorated over the past decade, especially during the COVID-19 pandemic. This paper explores the effect of press freedom, as a cornerstone of democracy, on life expectancy. METHODS: Exploring cross-country data, we use the ordinary least square method to estimate the association between press freedom and life expectancy. In addition, we adopt three novel instrumental variables to explore the causal relationship. RESULTS: Our estimations indicate that a freer press leads to higher life expectancy, and the effect exists independently of the level of democracy. In addition, the effect of continuous exposure to press freedom is stronger than sporadic free press status. The results are robust to measurement errors, influential outliers, and country-specific heterogeneity. CONCLUSIONS: This study reveals the fundamental role of press freedom in promoting public health that was previously underexplored. Therefore, enhancing freedom of expression can be an effective tool to address three of the United Nations Millennium Development Goals, that is, reduce under-five mortality, improve maternal health, and combat HIV/AIDS.JEL:I1 H7 D02.

International accreditation, linguistic proximity and trade in medical services.

The recent growth in the globalization of medical services has attracted broad attention from scholars and policymakers. The intimacy and risk associated with many medical services makes these markets especially sensitive to trade barriers, transaction costs and asymmetric information. This paper uses a gravity model to investigate the factors associated with the global pattern of bilateral trade in medical services. Using data from the United Nations International Trade in Services Database, we differentiate between trade flows in which the recipient travels to the service provider, 'medical tourism,' and those trade flows in which the service is delivered to the recipient, 'other health services.' Our findings indicate that, after controlling for various economic, historical and geographic linkages, linguistic proximity and international accreditation are not significant predictors of the bilateral pattern of medical tourism, though they are associated with greater trade in other health services. We argue the key difference is that trade in other health services, including medical transcription, diagnostic analysis and laboratory services, is akin to trade in intermediate inputs. The medical service providers contracting for these services are especially sensitive to risk and have strong incentives to monitor quality. By contrast, medical tourism is a market in which patients do not have strong incentives to engage in costly monitoring or information gathering. Providers seeking to market their services to patients abroad have mitigated the effects of linguistic dissimilarity and asymmetric information by exploiting the strong complementarities between medical and non-medical tourism services.

Bias-corrected estimates of reduction of post-surgery length of stay and corresponding cost savings through the widespread national implementation of fast-tracking after liver transplantation: a quasi-experimental study.

Background: Fast-tracking is an approach adopted by Mayo Clinic in Florida's (MCF) liver transplant (LT) program, which consists of early tracheal extubation and transfer of patients to surgical ward, eliminating a stay in the intensive care unit in select patients. Since adopting this approach in 2002, MCF has successfully fast-tracked 54.3% of patients undergoing LT. Objectives: This study evaluated the reduction in post-operative length of stay (LOS) that resulted from the fast-tracking protocol and assessed the potential cost saving in the case of nationwide implementation. Methods: A propensity score for fast-tracking was generated based on MCF liver transplant databases during 2011-2013. Various propensity score matching algorithms were used to form control groups from the United Network of Organ Sharing Standard Analysis and Research (STAR) file that had comparable demographic characteristics and health status to the treatment group identified in MCF. Multiple regression and matching estimators were employed for evaluation of the post-surgery LOS. The algorithm generated from the analysis was also applied to the STAR data to determine the proportion of patients in the US who could potentially be candidates for fast-tracking, and the potential savings. Results: The effect of the fast-tracking on the post-transplant LOS was estimated at approximately from 2.5 (p-value = 0.001) to 3.2 (p-value < 0.001) days based on various matching algorithms. The cost saving from a nationwide implementation of fast-tracking of liver transplant patients was estimated to be at least $78 million during the 2-year period. Conclusion: The fast-track program was found to be effective in reducing post-transplant LOS, although the reduction appeared to be less than previously reported. Nationwide implementation of fast-tracking could result in substantial cost savings without compromising the patient outcome.

Trends and structural shifts in health tourism: evidence from seasonal time-series data on health-related travel spending by Canada during 1970-2010.

There has been a growing interest in better understanding the trends and determinants of health tourism activities. While much of the expanding literature on health tourism offers theoretical or qualitative discussion, empirical evidences has been lacking. This study employs Canada's outbound health tourism activities as an example to examine the trends in health tourism and its association with changing domestic health care market characteristics. A time-series model that accounts for potential structural changes in the trend is employed to analyze the quarterly health-related travel spending series reported in the Balance of Payments Statistics (BOPS) during 1970-2010 (n = 156). We identified a structural shift point which marks the start of an accelerated growth of health tourism and a flattened seasonality in such activities. We found that the health tourism activities of Canadian consumers increase when the private investment in medical facilities declines or when the private MPI increases during the years following the structural-change. We discussed the possible linkage of the structural shift to the General Agreement on Trade in Services (GATS), which went into effect in January, 1995.

Health tourism on the rise? Evidence from the Balance of Payments Statistics.

The study assesses the presence and magnitude of global trends in health tourism using health-related travel (HRT) spending reported in the International Monetary Fund's Balance of Payments Statistics database. Linear regression and quantile regression are applied to estimate secular trends of the import and export of HRT based on a sample of countries from 2003 to 2009. The results show that from 2003 to 2009 the import and export of health tourism rose among countries with a high volume of such activities (accounting for the upper 40% of the countries), but not among those with a low volume. The uneven growth in health tourism has generated greater contrast between countries with high and low volumes of health tourism activities. However, the growth in the total import of health tourism did not outpace the population growth, implying that in general the population's tendency to engage in health tourism remained static.

The role of financial wellbeing, sociopolitical attitude, self-interest, and lifestyle in one's attitude toward social health insurance.

BACKGROUND: There has been continuous debate in the United States, Germany, and China about their respective healthcare systems. While these three countries are dealing with their own unique problems, the question of how social a healthcare system should be is a topic in this debate. OBJECTIVE: This study examined how strongly college students' attitudes toward a social healthcare system relate to ideological orientation and self-interest. METHODS: We used samples of college students in the People's Republic of China, Germany, and the US, and extracted factors measuring "financial wellbeing," "sociopolitical attitude," "self-interest," and "lifestyle" to explain the "attitude toward social health insurance" (ASHI) construct developed in recent literature (Loh et al. in Eur J Health Econ 13:707-722). RESULTS: The results of regression analysis showed that sociopolitical attitude/progressivism is positively related to the ASHI, but the degree of association varies considerably from country to country. We also found that a self-interest factor, measured by health status, seems to be inversely related to an individual's ASHI in the US, but not in China or Germany. Individuals with relatively healthy lifestyle choices were less likely to have a favorable ASHI in Germany, but no such relationship was found in China and the US. These results indicate that while some commonalities exist, there are also considerable differences in the structure of ASHI across these three countries. CONCLUSION: Ultimately, the results reported here could help to develop a predictive model that can be utilized to forecast a country's ASHI. Such a predictive model could be used by politicians to gauge the popularity of a healthcare plan that is under consideration in a particular country.

Peer effects in adolescent bodyweight: evidence from rural China.

Peer effect is a potential determinant of individual weight gain that has drawn considerable attention recently. The presence of peer effect implies that policies targeted at changing bodyweight can have enhanced effectiveness through a multiplier effect. This study aims to measure the peer effects on adolescent bodyweight in China. Using the small community nature of the rural sample of the wave 2000 of the China Health and Nutrition Survey, we define plausible peer groups and assess the effect of the average BMI of his/her peer group on the BMI of an adolescent. An instrumental variable (IV) approach is applied to control for potential endogeneity of the peer group's BMI. We find evidence supporting peer effect on BMI in general. The peer effect is around 0.3 with slight variation between two alternative peer definitions. Split sample analysis shows that the peer effect is significant for females (0.32-0.37), and insignificant for male adolescents. Furthermore, we find strong influence of same-gender peers (0.34-0.42) for female adolescents. Conditional quantile regressions show that the peer effect in weight gain is mainly present at or below the median in the conditional BMI distribution for girls, and at the higher end of the BMI distribution for boys. Multiple tests show strong identification, and strong instruments in our IV estimation. Placebo tests suggest that our results are reasonably robust to the correlated effect, due to unobserved community- and province-level factors.

Measuring attitude toward social health insurance.

In order to understand the health care system a country chooses to adopt or the health care reform a country decides to undertake, one must first be able to measure a country's attitude toward social health insurance. Our primary goal was to develop a construct that allows us to measure this "attitude toward social health insurance". Using a sample of 724 students from the People's Republic of China, Germany, and the United States and an initial set of sixteen items, we extract a scale that measures the basic attitude toward social health insurance in the three countries. The scale is internally consistent in each of the three countries. A secondary factor labeled "government responsibility" is marginally consistent for the total sample and for the German sample. German respondents have the most favorable attitude toward social health insurance, followed by China, and then the United States. Chinese respondents have the most favorable attitude toward government responsibility in health insurance. The scale developed here can be used to further investigate and understand which health care system will succeed and which will fail in a given country, which is important from both a political and an economic perspective.

Changes in access to health care in China, 1989-1997.

The post-1979 period in China has seen the implementation of reforms that dismantled much of the Maoist era social welfare system and permitted a significant reallocation of society's resources. The result has been rapid but uneven economic development that has profoundly altered the environment within which consumers make health investment decisions. Many studies report significant and apparently non-random reductions in health care utilization during this period. Scholars have tended to focus on the loss of insurance coverage and the growth of fees for services in explaining such reductions. An alternative explanation is growing inequality in access to care. This possibility has not received much research attention. As a result, our understanding of the patterns of changes in health care access, and of the types of populations that have been most adversely affected, has been rather limited. This research examines the distribution of the changes in several indicators of access to health care across communities during the period 1989 to 1997. We find evidence of relatively uneven changes to these indicators. Money charges for routine services increased consistently, though this trend was less pronounced in lower-income communities. Most communities experienced reductions in travel distance to clinics but increases in distance to hospitals. There were major improvements to the quality of care in wealthier rural areas, but not in poorer villages. Wealthier villages experienced less improvement in waiting time and drug availability. These trends appear to be closely associated with changing economic circumstances during the reform era.