Sibling spillovers and the choice to get vaccinated: Evidence from a regression discontinuity design.

We investigate the effects of introducing population-wide free-of-charge Human Papillomavirus (HPV) vaccination programs on the targeted adolescent cohorts and their siblings. For identification, we rely on regression discontinuity designs and high-quality Danish administrative data to exploit that date of birth determines program eligibility. We find that the programs increased the HPV vaccine take-up of both the targeted children (53.2 percentage points for girls and 36.0 percentage points for boys) and their older same-sex siblings (4.5 percentage points for sisters and 3.5 percentage points for brothers). We show that while the direct effects of the programs reduced HPV vaccine take-up inequality, the spillover effects, in contrast, contributed to an increase in vaccine take-up inequality highlighting the potential importance of spillover effects in the determination of distributional consequences of public health programs. Finally, we find some evidence of cross-vaccine spillovers.

Comparison of Public Health Investments of Various Countries Amid a Need for Greater Transparency: A Narrative Review.

A robust health system demands investments in public health and healthcare as they aid in closing the health protection gap. They are primarily responsible for longer life expectancies, disease prevention, and protection. Loopholes in the public health system were formed due to a lack of transparency and have only worsened throughout COVID-19. Spending more on public health is associated with fewer deaths, fewer food-borne illnesses, better sanitation, food safety, clean air and water, increased immunizations to stave against infectious diseases, and a decline in low birth weight. A comprehensive literature and data search was conducted using web-based search engines like PubMed, National Center for Biotechnology Information (NCBI), Google Scholar, Science Direct, and the New England Journal of Medicine. The review study standpoints healthcare spending, out-of-pocket expenditures, and other monetary use in various low-to-high-income countries, and the results are graphically represented. Countries with a strong public health system provide all the necessary aid to protect their citizens. They have cost-effective, readily available resources with fewer out-of-pocket expenditures (OOPs), government schemes, and health insurance to help their people. During our research, it was found how little the Indian government spends on healthcare as a percentage of gross domestic product (GDP) as compared to 'thought-to-be' poor countries like Bhutan.

A call for an evidence-informed criteria selection to guide equitable health investments in the era of Universal Health Care: Policy analysis

Background@#The passage of the Universal Health Care (UHC) Act in the Philippines in early 2019 intensified the need to ensure equitable health investments by the government. Exploring the different criteria and indicators that are used to determine areas that are most in need of health services can help local and national health authorities determine priorities for health investments given finite resources. @*Methods@#A systematic review of literature on determinants of health equity and other indicators was conducted as pre-work to generate discussion points to the roundtable discussion participated by all major key stakeholders. Shared insights and expertise were thematically analyzed to produce a policy paper with consensus policy recommendations. @*Results@#Based on the review of the literature and the discussion, indicators (mainly physical inaccessibility and socioeconomic factors) for identifying Geographically Isolated and Disadvantaged Areas (GIDA) in DOH Administrative Order 185, s. 2004 is used to prioritize municipalities for health investments. Review of other policies and guidelines to determine the level of health needs and prioritizing investments yielded to four laddered domains: geographic, population characteristics (e.g., social and cultural determinants of access), health system (e.g., health service delivery), and health status. These domains may provide a more equitable set of metrics for health investment. The Local Investment Plan for Health (LIPH) is the current process used for health-related investments at the local level and may be revised to be more responsive to the requirements set by the UHC Act 2018. Hot spotting to concentrate health services by communities may be a more rapid approach to investment planning for health. Bed capacity as a specific metric in the UHC Act 2018 highlights the need for a review of the Hospital Licensure Act 2004. @*Conclusion and Recommendations@#To aid in determining priorities for health investments, a comprehensive integrated analysis of resources, determinants, and indicators should be done to determine the need and the gaps in the available resources. Innovative strategies can also be best implemented such as mathematical models or formulas. Lastly, current strategies in the development, monitoring, and evaluation of investment planning for health at different levels should be strengthened, expanded, and harmonized with other existing development plans.

Limited self-control and longevity.

This paper proposes a new framework to discuss self-control problems in the context of life-cycle health and longevity. Individual decisions are conceptualized as the partial control of impulsive desires of a short-run self by a rationally forward-looking long-run self. The short-run self strives for immediate gratification through consumption of health-neutral and unhealthy goods. The long-run self reflects the long-term consequences of unhealthy behavior on health outcomes and longevity and invests time and money to improve current and future health. The model is calibrated with data from the United States and used to provide an assessment of the impact of imperfect self-control on unhealthy consumption, health investments, lifetime health, and the age at death.

Smoking kills: An economic theory of addiction, health deficit accumulation, and longevity.

In this paper I unify the economic theories of addiction and health deficit accumulation and develop a life cycle theory in which individuals take into account the fact that the consumption of addictive goods reduces their health and longevity. I distinguish two types of addiction: sophisticated and naive. Individuals with sophisticated addiction perfectly control their addiction. Individuals with naive addiction, though otherwise rational and forward looking, fail to fully understand how their addiction develops. I argue that the life cycle consumption pattern predicted for naive addiction is more suitable for motivating empirically observable patterns of addictive goods consumption. I take the case of smoking as unhealthy behavior, calibrate the model with U.S. data, and apply it in order to investigate the life cycle patterns of smoking and quitting smoking and the socioeconomic gradients of unhealthy consumption and longevity.

Non-monotonic health behaviours - implications for individual health-related behaviour in a demand-for-health framework.

A number of behaviours influence health in a non-monotonic way. Physical activity and alcohol consumption, for instance, may be beneficial to one's health in moderate but detrimental in large quantities. We develop a demand-for-health framework that incorporates the feature of a physiologically optimal level. An individual may still choose a physiologically non-optimal level, because of the trade-off in his or her preferences for health versus other utility-affecting commodities. However, any deviation above or below the physiologically optimal level will be punished with respect to health. Distinguishing between two individual types we study (a) the qualitative properties of optimal time-paths of health capital and health-related behaviour, (b) the perturbations of the optimal time-paths that result from changes in exogenous parameters, and (c) steady state properties. Predictions of the model and the implications for empirical analysis are discussed at length. Some comments on potential future extensions conclude the paper.

The effect of metropolitan-area mortgage delinquency on health behaviors, access to health services, and self-rated health in the United States, 2003-2010.

The recent housing crisis offers the opportunity to understand the effects of unique indicators of macroeconomic conditions on health. We linked data on the proportion of mortgage borrowers per US metropolitan-area who were at least 90 days delinquent on their payments with individual-level outcomes from a representative sample of 1,021,341 adults surveyed through the Behavioral Risk Factor Surveillance System (BRFSS) between 2003 and 2010. We estimated the effects of metropolitan-area mortgage delinquency on individual health behaviors, medical coverage, and health status, as well as whether effects varied by race/ethnicity. Results showed that increases in the metropolitan-area delinquency rate resulted in decreases in heavy alcohol consumption and increases in exercise and health insurance coverage. However, the delinquency rate was also associated with increases in smoking and obesity in some population groups, suggesting the housing crisis may have induced stress-related behavioral change. Overall, the effects of metropolitan-area mortgage delinquency on population health were relatively modest.

[Public health infrastructure investment difficulties in Chile: concessions and public tenders]. / Dificultades de la inversión en infraestructura pública de salud en Chile: concesiones y licitación pública.

This paper seeks to highlight the problems of gaps in health infrastructure in Chile, and to analyze the mechanisms by which it is provided. In Chile this is done in two ways: the first is through competitive bidding or sector-wide modality. The second way is through hospital concessions. Both mechanisms have had difficulties in recent years, which are reported. Finally, we propose ways to improve the provision of health infrastructure in Chile.

El presente trabajo busca evidenciar los problemas de brechas en infraestructura sanitaria en Chile, así como analizar los mecanismos mediante los cuales ésta se provee. Ello se realiza mediante dos modalidades, la primera es la licitación competitiva o modalidad sectorial. La segunda forma es la concesión hospitalaria. En los últimos años ambos mecanismos presentan dificultades, las cuales se relatan en este documento. Finalmente, se plantean propuestas con el fin de mejorar la provisión de infraestructura sanitaria en Chile.

Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands.

This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received from the government by an individual. All costs were discounted to their net present values and adjusted for survival. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive to changes in the growth of healthcare costs, economic growth and the discount rate. Therefore, it is concluded that, similarly to naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits. This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative those naturally conceived. A model based on the method of generational accounting to evaluate investments in IVF was used. Calculations were based on average investments paid and received from the government by an individual. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive for changes in the growth in healthcare costs, economic growth and the discount rate. Just as naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits.

Alternativas para la adopción de políticas centradas en el acceso a medicamentos / Alternatives for adopting policies centered on access to medicines

América Latina está incorporando regulaciones que incidan en el costo y el gasto en medicamentos. Sus objetivos centrales son cuatro: i) garantizar la competitividad en el mercado, ii) asegurar precios asequibles a los consumidores individuales (canal comercial), iii) contener el gasto público en medicamentos (canal institucional) y iv) garantizar la eficiencia del gasto en medicamentos. La experiencia de América Latina difiere de la de los países de regiones desarrolladas. En estas últimas los países tienden a converger en sus políticas, tanto en la promoción de medicamentos genéricos y estrategias de control de precios, como en las medidas de racionalización y contención del gasto farmacéutico. En contraste, en América Latina ciertas debilidades institucionales impiden la consolidación y aplicación de una política regulatoria efectiva. El presente trabajo revisa la experiencia acumulada en la adopción de regulaciones económicas dirigidas a reducir el gasto y mejorar el acceso a los medicamentos, postula lecciones aprendidas a nivel internacional y ofrece recomendaciones para los países de América Latina. Su propósito es aportar elementos clave para los decisores de política y las autoridades de los países interesados en llevar adelante la regulación económica de medicamentos.

Latin America is adopting regulations that bear on medicinal costs and spending. The regulations have four main goals: i) to guarantee a competitive market, ii) to ensure affordability for individual consumers (commercial channel), iii) to contain public spending on medicines (institutional channel), and iv) to guarantee efficient spending on medicines. The experience of Latin America differs from that of countries in developed regions. In the latter, the countries tend to have similar policies, both in promoting generic medicines and in price control strategies, and in optimizing and containing pharmaceutical expense. In contrast, in Latin America, certain institutional weaknesses impede the consolidation and application of an effective regulatory policy. This paper reviews the experience gained through the adoption of economic regulations aimed at reducing spending and improving access to medicines, suggests lessons learned at the international level, and offers recommendations for the countries of Latin America. Its purpose is to offer key elements to decision-makers and the authorities of the countries concerned in pursuing economic regulation of medicines.

The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005 / Impacto de los cambios en los indicadores de salud sobre las tasas de mortalidad infantil en Brasil, 2000 y 2005

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions...

OBJETIVOS: Investigar las asociaciones entre los cambios en los indicadores de recursos y cobertura relacionados con la salud y las variaciones en las tasas de mortalidad infantil (TMI) en los 27 estados de Brasil entre los años 2000 y 2005. MÉTODOS: Los datos se obtuvieron de la base de datos en línea del Ministerio de Salud, DATASUS. Mediante regresión múltiple paso a paso se modelaron los cambios en la TMI y sus componentes (mortalidades temprana, tardía y posneonatal), utilizando como predictores los cambios en indicadores seleccionados de salud. RESULTADOS: Según el análisis de regresión, el mejoramiento del acceso a la atención prenatal (B = -0,89 por 1 000; P < 0,001) y al suministro de agua (B = -0,22 por 1 000; P = 0,033), y el aumento del gasto público en salud como proporción del producto interno bruto (PIB) (B = -0,72 por 1 000; P = 0,031) se asociaron con reducciones significativas de las TMI. Las reducciones de las tasas de mortalidad neonatal temprana se asociaron con la atención prenatal (B = -0,14 por 1 000; P = 0,026) y el acceso a servicios de saneamiento (B = -0,05 por 1 000; P = 0,026). Las reducciones en las tasas de mortalidad neonatal tardía se asociaron con la atención prenatal (B = -0,12 por 1 000; P = 0,003) e, inversamente, con la tasa de partos por cesárea (B = 0,13 por 1 000; P = 0,005). Las reducciones en las tasas de mortalidad posneonatal se asociaron con la atención prenatal (B = -0,64 por 1 000; P < 0,001), el aumento en el gasto público en salud como proporción del PIB (B = -0,76 por 1 000; P = 0,005) y el acceso a fuentes de agua (B = -0,17 por 1 000; P = 0,037). CONCLUSIONES: El mejoramiento del acceso al cuidado prenatal, el incremento del gasto público en salud y el acceso al saneamiento y a fuentes de agua se correlacionaron independientemente con la reducción en las TMI; mayores tasas de partos por cesárea se asociaron con mayores tasas de mortalidad neonatal tardía. Se recomienda mantener la...