Essays in health economics

Abstract

HEALTH IS A DECEPTIVE TERM, LACKING PRECISION AND CLARITY. IN SOCIAL SCIENCES HEALTH STATUS IS APPROXIMATED BY SEVERAL OBJECTIVE AND SUBJECTIVE MEASURES AND MANY ATTEMPTS HAVE BEEN MADE IN ORDER TO DISTINGUISH ITS MOST IMPORTANT DETERMINANTS. HEALTH IS AFFECTED BY SOCIOECONOMIC STATUS. INCOME, LABOR FORCE STATUS, POVERTY ARE OF MAJOR IMPORTANCE WHEN EXAMINING HEALTH INEQUALITIES. MOREOVER, INDIVIDUAL CHARACTERISTICS WERE FOUND TO HAVE A STRONG IMPACT ON HEALTH. IF ALL THESE FACTORS, INDEED, INFLUENCE HEALTH STATUS, IT IS EXPECTED THAT THEY WILL PLAY A CRUCIAL ROLE IN DETERMINING THE EXTENT OF HEALTH CARE UTILIZATION. TO GO FURTHER, HEALTH CARE UTILIZATION IS FINANCED BY PRIVATE AND PUBLIC HEALTH EXPENDITURE, BURDENING SIGNIFICANTLY THE FAMILY AND THE COUNTRY BUDGET. IT IS EXPECTED THAT COUNTRIES WHICH SPEND LITTLE ON HEALTH ALSO HAVE POORER HEALTH CONDITIONS. DESPITE THE FACT THAT HEALTH SPENDING CAN AFFECT HEALTH OUTCOMES, IT IS IMPORTANT TO MENTION THAT THE EFFICIENCY WITH WHICH COUNTRIES ARE ABLE TO TRANSFORM THEIR SPENDING INTO BETTER HEALTH STATUS VARIES SIGNIFICANTLY. IF HEALTH CARE IS MANAGED IN AN EFFICIENT MANNER, HEALTH PRODUCTION WILL BRING OUT SIGNIFICANT HEALTH IMPROVEMENTS, INCREASING THE ECONOMY’S HEALTH CAPITAL. TAKING INTO ACCOUNT ALL THE ABOVE, WE DECIDED TO INCLUDE IN THIS THESIS SIX ESSAYS CONCERNING VARIOUS ASPECTS IN THE ECONOMICS OF HEALTH. IN THE FIRST CHAPTER, WE ATTEMPT TO SHED LIGHT TO THE VARIOUS DEFINITIONS AND APPROXIMATIONS OF HEALTH. HEALTH-RELATED QUALITY OF LIFE SEEMS TO BE AN IMPORTANT APPROXIMATION OF THE TERM AND IT IS PROPOSED INSTEAD OF IT FOR USE IN SOCIAL SCIENCES. WE ALSO PROVIDE EVIDENCE ON THE INSTRUMENTS USED FOR HEALTH-RELATED QUALITY OF LIFE MEASUREMENT AND THEIR STATISTICAL PROPERTIES. IN THE SECOND CHAPTER, THE DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE ARE ANALYZED. IN ORDER TO INVESTIGATE EMPIRICALLY THE FINDINGS OF THE RELEVANT LITERATURE, WE USED THE SILC 2006 DATA SET AND INVESTIGATED HOW UNEMPLOYMENT AFFECTS HEALTH STATUS. SEEING THAT LABOR FORCE STATUS IS OF SIGNIFICANT INFLUENCE AND INTENDING TO STUDY THE GREEK CASE WE CONDUCTED A PERSONAL SURVEY, USING THE GENERAL HEALTH QUESTIONNAIRE FOLLOWED BY SOME DEMOGRAPHIC QUESTIONS IN 21 NATIONAL EMPLOYMENT AGENCIES ALL OVER GREECE ON JULY 2008. WE SUCCEEDED TO COLLECT 3000 QUESTIONNAIRES. OUR FINAL SAMPLE CONSISTS OF 2163 INDIVIDUALS WHO VISITED THE CENTRES OF EMPLOYMENT PROMOTION DURING THIS MONTH. AS MANY STUDIES HAVE EXPLORED THE IMPACT OF LABOUR FORCE STATUS ON HEALTH STATUS, WE WENT FURTHER AND BY USING THIS UNIQUE DATA SET, WE EXPLORED THE EFFECTS OF LONG-TERM UNEMPLOYMENT ON HEALTH AND NOT GENERALLY THE IMPACT OF UNEMPLOYMENT. IN THE THIRD CHAPTER WE ENRICHED OUR PREVIOUS ANALYSIS WITH INCOME AND POVERTY MEASURES. AT THE BEGINNING USING OUR QUESTIONNAIRE’S INFORMATION WE EXPLORED THE EFFECT OF INCOME SATISFACTION ON HEALTH. BECAUSE HEALTH STATUS WAS FOUND TO DETERIORATE AS DURATION OF UNEMPLOYMENT AND INCOME DISSATISFACTION INCREASED, WE ALSO ASSESSED WHETHER POOR HEALTH STATUS IS ASSOCIATED WITH MORE OFTEN DOCTOR VISITS. AFTERWARDS, USING THE SILC 2006 DATA SET WE MEASURED POVERTY IN TWO DIFFERENT WAYS. AT FIRST, WE CALCULATED THE INCOME QUINTILE RATIO AND AT A SECOND STEP WE CREATED THE “AT RISK OF POVERTY” LINE. THROUGH ORDERED LOGIT ESTIMATIONS THE NEGATIVE IMPACT OF POVERTY ON HEALTH WAS VERIFIED. IN THE FOURTH PART OF THE THESIS WE INVESTIGATE THE DETERMINANTS OF HEALTH SPENDING. OUR CONTRIBUTION TO THE EXISTING LITERATURE IS THAT WE USED TWO DIFFERENT METHODS. ON THE ONE, WE CONDUCTED PANEL ANALYSIS AND ON THE OTHER, WE EXPLORED THE LONG-RUN RELATIONSHIP BETWEEN THE VARIABLES UNDER CONSIDERATION BY EMPLOYING COINTEGRATION ANALYSIS. IN ADDITION, HAVING SHOWN IN CHAPTER THREE THAT THE POORER IS THE HEALTH CONDITION THE MORE OFTEN DO THE INDIVIDUALS VISIT THE DOCTOR’S OFFICE, WE EMPIRICALLY CHECKED THE ASSUMPTION THAT INCREASED HEALTH EXPENDITURE CONTRIBUTES TO BETTER HEALTH OUTCOMES. TAKING INTO ACCOUNT THAT SPENDING ON HEALTH LEADS TO DECREASING MORTALITY RATES WE THOUGHT THAT HEALTH EXPENDITURE MAY CONTRIBUTE TO INCREASING THE ECONOMY’S HEALTH CAPITAL. SINCE HEALTH CAPITAL IS AN IMPORTANT ASPECT FOR PRODUCTIVITY IMPROVEMENTS AND ECONOMIC GROWTH INCREASES, IN THE FIFTH CHAPTER WE ASSESSED THE IMPACT OF HEALTH SPENDING ON ECONOMIC GROWTH. THE DIFFERENCE OF OUR STUDY LIES ON OUR IDEA TO TEST WHETHER THE EMPIRICAL RESULTS ARE DIFFERENT WHEN CONTROLLING FOR THE COUNTRIES’ PUBLIC DEBT. MOTIVATION FOR THIS WAS THE SIGNIFICANT VARIATIONS IN THE LEVEL PUBLIC DEBT THAT ARE OBSERVED BETWEEN THE COUNTRIES. ANOTHER IMPORTANT NOVELTY IN OUR ANALYSIS IS THAT WE USE MORE RECENT DATA TO EXAMINE THE IMPACT OF HEALTH SPENDING ON GROWTH. OUR FINDINGS SUGGESTED THAT HEALTH SPENDING POSITIVELY INFLUENCES GDP GROWTH, IRRESPECTIVE OF THE COUNTRIES’ LEVEL OF DEPT. MOTIVATED BY THIS RESULT, WE DECIDED IN THE SIXTH PART OF THE THESIS TO EXPLORE THE EFFICIENCY OF HEALTH SYSTEMS’ PERFORMANCE. TO ACHIEVE THIS WE APPLIED TWO DIFFERENT TECHNIQUES: DATA ENVELOPMENT ANALYSIS AND FREE DISPOSAL HULL. MOREOVER, SEEING THAT EFFICIENCY CAN BE HAMPERED BY A NUMBER OF FACTORS WHOSE VALUES CANNOT BE CONTROLLED DIRECTLY BY THE HEALTH SYSTEMS, AT A SECOND STEP, WE REGRESSED INEFFICIENCY ON A NUMBER OF NON-DISCRETIONARY INPUTS, SUCH AS FEE FOR SERVICE, GATE-KEEPING AND GLOBAL BUDGETING IN HEALTH CARE AS WELL AS OUT OF POCKET PAYMENTS AND PUBLIC DEBT.

Η ΥΓΕΙΑ ΕΙΝΑΙ ΕΝΑΣ ΑΣΑΦΗΣ ΟΡΟΣ ΚΑΙ ΣΤΙΣ ΚΟΙΝΩΝΙΚΕΣ ΕΠΙΣΤΗΜΕΣ ΤΟ ΕΠΙΠΕΔΟ ΥΓΕΙΑΣ ΜΕΤΡΑΤΑΙ ΜΕΣΑ ΑΠΟ ΑΡΚΕΤΟΥΣ ΥΠΟΚΕΙΜΕΝΙΚΟΥΣ ΚΑΙ ΑΝΤΙΚΕΙΜΕΝΙΚΟΥΣ ΔΕΙΚΤΕΣ. ΠΟΛΛΕΣ ΠΡΟΣΠΑΘΕΙΕΣ ΕΠΙΣΗΣ ΕΧΟΥΝ ΓΙΝΕΙ ΩΣΤΕ ΝΑ ΠΡΟΣΔΙΟΡΙΣΤΟΥΝ ΟΙ ΠΑΡΑΓΟΝΤΕΣ ΠΟΥ ΤΟ ΕΠΗΡΕΑΖΟΥΝ. ΤΟ ΔΙΑΘΕΣΙΜΟ ΕΙΣΟΔΗΜΑ, ΤΟ ΕΠΙΠΕΔΟ ΕΚΠΑΙΔΕΥΣΗΣ Κ.Τ.Λ. ΕΧΕΙ ΥΠΟΣΤΗΡΙΧΘΕΙ ΟΤΙ ΕΠΗΡΕΑΖΟΥΝ ΤΟ ΕΠΙΠΕΔΟ ΥΓΕΙΑΣ ΤΟΥ ΠΛΗΘΥΣΜΟΥ , ΤΟ ΟΠΟΙΟ ΜΕ ΤΗ ΣΕΙΡΑ ΤΟΥ ΑΜΕΣΑ ΣΥΝΔΕΕΤΑΙ ΜΕ ΤΗ ΧΡΗΣΗ ΤΩΝ ΥΠΗΡΕΣΙΩΝ ΥΓΕΙΑΣ. ΚΑΘΩΣ ΟΙ ΥΠΗΡΕΣΙΕΣ ΥΓΕΙΑΣ ΧΡΗΜΑΤΟΔΟΤΟΥΝΤΑΙ ΑΠΟ ΙΔΙΩΤΙΚΟΥΣ ΚΑΙ ΔΗΜΟΣΙΟΥΣ ΦΟΡΕΙΣ, ΑΝΑΜΕΝΕΤΑΙ ΟΤΙ ΜΕΓΑΛΥΤΕΡΕΣ ΔΑΠΑΝΕΣ ΓΙΑ ΤΗΝ ΥΓΕΙΑ ΟΔΗΓΟΥΝ ΣΕ ΚΑΛΥΤΕΡΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΥΓΕΙΑΣ. ΣΕ ΑΥΤΟ ΕΠΙΣΗΣ ΣΥΜΒΑΛΛΕΙ ΚΑΙ Η ΑΠΟΤΕΛΕΣΜΑΤΙΚΗ ΑΞΙΟΠΟΙΗΣΗ ΤΩΝ ΕΙΣΡΟΩΝ ΤΟΥ ΣΥΣΤΗΜΑΤΟΣ ΥΓΕΙΑΣ. ΕΠΙΠΛΕΟΝ ΑΝΑΜΕΝΕΤΑΙ ΟΤΙ ΚΑΛΥΤΕΡΗ ΠΑΡΑΓΩΓΗ ΥΓΕΙΑΣ ΟΔΗΓΕΙ ΣΕ ΑΥΞΗΣΗ ΤΟΥ ΑΝΘΡΩΠΙΝΟΥ ΚΕΦΑΛΑΙΟΥ ΚΑΙ ΣΥΜΒΑΛΛΕΙ ΣΤΗΝ ΟΙΚΟΝΟΜΙΚΗ ΑΝΑΠΤΥΞΗ. ΣΤΟ ΠΡΩΤΟ ΚΕΦΑΛΑΙΟ ΤΗΣ ΔΙΑΤΡΙΒΗΣ ΠΑΡΟΥΣΙΑΖΟΝΤΑΙ ΟΙ ΔΙΑΦΟΡΟΙ ΟΡΙΣΜΟΙ ΚΑΙ ΤΡΟΠΟΙ ΜΕΤΡΗΣΗΣ ΤΟΥ ΕΠΙΠΕΔΟΥ ΥΓΕΙΑΣ. ΕΠΙΣΗΣ ΠΑΡΟΥΣΙΑΖΟΝΤΑΙ ΤΑ ΕΡΩΤΗΜΑΤΟΛΟΓΙΑ ΠΟΥ ΧΡΗΣΙΜΟΠΟΙΟΥΝΤΑΙ ΓΙΑ ΤΟΝ ΠΑΡΑΠΑΝΩ ΣΚΟΠΟ ΚΑΙ ΑΝΑΦΕΡΟΝΤΑΙ ΟΙ ΣΤΑΤΙΣΤΙΚΕΣ ΤΟΥΣ ΙΔΙΟΤΗΤΕΣ. ΣΤΟ ΔΕΥΤΕΡΟ ΚΕΦΑΛΑΙΟ ΠΡΟΣΔΙΟΡΙΖΕΤΑΙ Η ΣΧΕΣΗ ΜΕΤΑΞΥ ΜΑΚΡΟΧΡΟΝΙΑΣ ΑΝΕΡΓΙΑΣ ΚΑΙ ΕΠΙΠΕΔΟΥ ΥΓΕΙΑΣ, ΚΑΝΟΝΤΑΣ ΧΡΗΣΗ Α) ΕΝΟΣ ΣΥΝΟΛΟΥ ΔΕΔΟΜΕΝΩΝ ΠΟΥ ΑΠΟΚΤΗΣΑΜΕ ΜΕΣΩ ΠΡΟΣΩΠΙΚΩΝ ΣΥΝΕΝΤΕΥΞΕΩΝ ΣΕ ΑΝΕΡΓΟΥΣ ΤΗΣ ΧΩΡΑΣ ΚΑΙ Β) ΔΕΔΟΜΕΝΩΝ ΤΗΣ ΕΡΕΥΝΑΣ SILC. Η ΑΝΑΛΥΣΗ ΜΑΣ ΕΔΕΙΞΕ ΟΤΙ ΟΙ ΕΠΙΔΡΑΣΕΙΣ ΤΗΣ ΜΑΚΡΟΧΡΟΝΙΑΣ ΑΝΕΡΓΙΑΣ ΣΤΗΝ ΥΓΕΙΑ ΕΙΝΑΙ ΑΡΝΗΤΙΚΕΣ. ΣΤΟ ΕΠΟΜΕΝΟ ΚΕΦΑΛΑΙΟ ΕΜΠΛΟΥΤΙΣΑΜΕ ΤΙΣ ΠΑΡΑΠΑΝΩ ΑΝΑΛΥΣΕΙΣ ΛΑΜΒΑΝΟΝΤΑΣ ΥΠΟΨΗ ΤΟ ΕΙΣΟΔΗΜΑ ΚΑΙ ΤΗ ΦΤΩΧΕΙΑ ΚΑΙ ΕΠΙΒΕΒΑΙΩΣΑΜΕ ΤΗ ΘΕΤΙΚΗ ΕΠΙΔΡΑΣΗ ΤΟΥ ΠΡΩΤΟΥ ΚΑΙ ΤΟΝ ΑΡΝΗΤΙΚΟ ΑΝΤΙΚΤΥΠΟ ΤΗΣ ΔΕΥΤΕΡΗΣ ΣΤΟ ΕΠΙΠΕΔΟ ΥΓΕΙΑΣ. ΣΤΗ ΣΥΝΕΧΕΙΑ ΕΞΕΤΑΣΑΜΕ ΤΟΥΣ ΠΡΟΣΔΙΟΡΙΣΤΙΚΟΥ ΠΑΡΑΓΟΝΤΕΣ ΤΩΝ ΔΑΠΑΝΩΝ ΥΓΕΙΑΣ ΧΡΗΣΙΜΟΠΟΙΩΝΤΑΣ ΠΑΝΕΛ ΑΝΑΛΥΣΗ ΚΑΙ ΤΕΧΝΙΚΕΣ ΣΥΝΟΛΟΚΛΗΡΩΣΗΣ. ΕΠΙΠΡΟΣΘΕΤΑ ΕΠΙΒΕΒΑΙΩΣΑΜΕ ΤΗΝ ΥΠΟΘΕΣΗ ΟΤΙ ΑΥΞΗΜΕΝΕΣ ΔΑΠΑΝΕΣ ΥΓΕΙΑΣ ΟΔΗΓΟΥΝ ΣΕ ΚΑΛΥΤΕΡΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΥΓΕΙΑΣ. ΣΤΟ ΠΕΜΠΤΟ ΚΕΦΑΛΑΙΟ ΕΞΕΤΑΣΑΜΕ ΤΗ ΣΧΕΣΗ ΠΟΥ ΣΥΝΔΕΕΙ ΤΙΣ ΔΑΠΑΝΕΣ ΥΓΕΙΑΣ ΚΑΙ ΤΗΝ ΟΙΚΟΝΟΜΙΚΗ ΑΝΑΠΤΥΞΗ ΜΕΣΑ ΑΠΟ GMM ΕΚΤΙΜΗΣΕΙΣ. ΒΡΗΚΑΜΕ ΟΤΙ ΑΥΞΗΣΕΙΣ ΣΤΙΣ ΔΑΠΑΝΕΣ ΥΓΕΙΑΣ, ΑΥΞΑΝΟΥΝ ΤΟ ΑΝΘΡΩΠΙΝΟ ΚΕΦΑΛΑΙΟ ΚΑΙ ΒΟΗΘΟΥΝ ΤΗΝ ΟΙΚΟΝΟΜΙΚΗ ΑΝΑΠΤΥΞΗ. ΤΕΛΟΣ, ΜΕΛΕΤΗΣΑΜΕ ΤΗΝ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑ ΤΩΝ ΣΥΣΤΗΜΑΤΩΝ ΥΓΕΙΑΣ ΕΝΟΣ ΣΥΝΟΛΟΥ ΧΩΡΩΝ ΕΦΑΡΜΟΖΟΝΤΑΣ ΤΙΣ ΤΕΧΝΙΚΕΣ DEA ΚΑΙ FDH KAI ΕΞΕΤΑΣΑΜΕ ΕΠΙΠΛΕΟΝ ΤΗΝ ΕΠΙΔΡΑΣΗ ΔΙΑΦΟΡΩΝ ΠΕΡΙΒΑΛΛΟΝΤΙΚΩΝ ΠΑΡΑΓΟΝΤΩΝ ΣΤΗΝ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑ ΑΥΤΗ. ΒΡΗΚΑΜΕ ΟΤΙ Η ΑΠΟΔΟΣΗ ΤΩΝ ΣΥΣΤΗΜΑΤΩΝ ΥΓΕΙΑΣ ΜΕΤΑΞΥ ΤΩΝ ΑΛΛΩΝ ΕΞΑΡΤΑΤΑΙ ΑΠΟ ΠΑΡΑΓΟΝΤΕΣ ΠΟΥ ΑΦΟΡΟΥΝ TO ΔΗΜΟΣΙΟ ΧΡΕΟΣ ΚΑΙ ΤΟΝ ΤΡΟΠΟ ΧΡΗΜΑΤΟΔΟΤΗΣΗΣ ΤΗΣ ΥΓΕΙΑΣ, ΟΠΩΣ ΤΟ FEE FOR SERVICE, OI GLOBAL BUDGETS ΚΑΙ ΤΟ GATE KEEPING.