Anikó Bíró

Copayments, gatekeeping, and the utilization of outpatient public and private care at age 50 and above in Europe.

I analyze the relationship between health care institutions and the utilization of outpatient services by individuals aged 50 and above. I use cross-sectional micro data from thirteen European countries. I focus on the out-of-pocket costs of health care utilization, the gatekeeper role of general practitioners, and how these institutional settings are related to public and private care utilization. I find that copayments are related negatively to the probability of visiting a general practitioner among those in good health condition. I estimate the utilization of private specialist care to be higher in countries where copayments are required for public specialist care, and where the general practitioners have gatekeeper role. These estimated associations with private specialist care utilization are relatively large in magnitude, and are driven by individuals in the top income quartile.

Determinants of H1N1 vaccination uptake in England

OBJECTIVE This study aims to investigate which individual characteristics influenced the uptake of the 2009 H1N1 vaccination in England. The vaccination was provided for free to a specified target group who also received invitation letters, but the coverage rate was still far from universal among them. METHODS Data from the 2010 edition of the Health Survey for England are used (size of the estimation sample: 7211). In order to partial out the effect of unobservable time costs, attitudes or access to vaccinations, immunisations against the seasonal and pandemic influenza are jointly estimated. RESULTS Health risks, health behaviours and preferences, and exposure to various information help explain the immunisation decision. Receiving the seasonal flu vaccine increases the probability of H1N1 vaccination uptake by 20 percentage points. CONCLUSIONS The widespread refusal of the vaccination can be worrying for the control of potential future pandemics. Providing clear, well targeted information, ensuring that high risk groups are contacted, and raising the level of health consciousness can increase the coverage rate with vaccinations.

Adaptation or recovery after health shocks? Evidence using subjective and objective health measures: BAJI AND BIRO

In this paper, we analyse the effect of an onset of a health shock on subjective survival probability and compare it with objective survival probability and self-reported health measures. In particular, we are interested in whether expectations of people respond to health shocks and whether these follow the evolution of objective life expectations and self-reported health measures over time. Using longitudinal data from the Health and Retirement Study, we estimate fixed effects models of adaptation for the objective and subjective survival probabilities and for some self-reported health measures. The results show that after cancer diagnosis, conditional on surviving, both the objective and subjective longevity and self-reported health measures drift back to the before diagnosis trajectories. For stroke and heart attack, in spite of their persistent negative effect on survival, subjective life expectations and self-reported health measures seem to indicate only a transient effect of the health shock. The differences between the objective and subjective measures are in line with the concept of adaptation. We discuss the policy implications of our results.

Public–private sector interactions and the demand for supplementary health insurance in the United Kingdom

We examine the demand for private health insurance (PHI) in the United Kingdom and relate this to changes in the supply of public and private healthcare. Using a novel collection of administrative, private sector and survey data, we re-assess the relationships between the quality and availability of public and private sector inpatient care, and the demand for PHI. We find that PHI coverage in the United Kingdom is positively related to the median of the region- and year-specific public sector waiting times. We find that PHI prevalence ceteris paribus increases with being self-employed and employed, while it decreases with having financial difficulties. In addition, we highlight the complexities of inter-sectoral relations and their impact on PHI demand. Within a region, we find that an increase in private healthcare supply is associated with a decrease in public sector waiting times, implying lower PHI demand. This may be explained by the usage of private facilities by NHS commissioners. These results have important implications for policymakers interested in the role of private healthcare supply in enhancing the availability of and equitable access to acute inpatient care.

DISCOUNT RATES AND THE EDUCATION GRADIENT IN MAMMOGRAPHY IN THE UK

I analyse intertemporal decisions on undertaking breast cancer screening by women aged 50-64  years in the UK and provide estimates of the rate of discounting potential future benefits of screening. I also analyse education differences in mammography decisions and examine the underlying mechanisms by which education influences breast cancer screening attendance. I estimate a structural model, which reveals that although there are differences in the disutility of breast cancer screening between education groups, there is no difference in the estimated discount factor. These results suggest that the observed education gradient is mainly due to differences in health behaviours and healthcare attitudes.

Health of Central and Eastern European migrants in Germany: healthy migrant effects and good health maintained?

Purpose The purpose of this paper is to analyse the health level and health dynamics of migrants from Central and Eastern Europe (CEE), broadly defined, in Germany. Population health in CEE compares badly to Germany. Lifestyle changes and access to better health care in Germany can lead to health improvement of migrants. Design/methodology/approach Longitudinal data from the German Socio-Economic Panel are used. First, the time trends of immigrant and native health are analysed graphically. Second, regression analysis is conducted, controlling for demographic and socio-economic factors when estimating the country of origin effects on health. Finally, regression models are estimated to investigate if social and economic integration significantly improves the subjective well-being of the immigrant groups. Findings Evidence is found for significantly better subjective health of migrants compared to the natives, even if demographic and socio-economic factors are controlled for. Only part of the health advantage is explained by selective migration. The health of the more advantaged migrants tend to decline slower than of the natives. Social implications If migrants are economically and socially integrated in the host country then their presence is unlikely to increase the health burdens of the host country. Originality/value The existing knowledge on the health developments of migrants from CEE in other European countries is limited. Based on richer statistical information, the results of this paper partly contradict earlier findings in the literature, in particular no evidence is seen for worse or quickly declining health of immigrants.

How does retirement affect healthcare expenditures? Evidence from a change in the retirement age: Retirement and health care expenditures

Using individual-level administrative panel data from Hungary, we estimate causal effects of retirement on outpatient and inpatient care expenditures and pharmaceutical expenditures. Our identification strategy is based on an increase in the official early retirement age of women, using that the majority of women retire upon reaching that age. According to our descriptive results, people who are working before the early retirement age have substantially lower healthcare expenditures than nonworkers, but the expenditure gap declines after retirement. Our causal estimates from a two-part (hurdle) model show that the shares of women with positive outpatient care, inpatient care, and pharmaceutical expenditures, respectively, decrease by 3.0, 1.4, and 1.3 percentage points in the short run due to retirement. These results are driven by the relatively healthy, by those who spent some time on sick leave and by the less educated. The effect of retirement on the size of positive healthcare expenditures is generally not significant.

Effect of ageing on the ownership of durable goods

I analyse how ageing affects the demand for non-housing durable goods. Based on the English Longitudinal Study of Ageing, individual characteristics, cohort and time effects can explain most of the age variation in the ownership and purchase of durable goods. A life-cycle model is derived to capture the complex relation between ageing and the demand for non-housing durable goods. Decreasing survival probability, deteriorating health and changing preferences are jointly reflected in the age gradient of demand. Simulations indicate that higher chances of survival increase the ownership ratio of the durable items.

Determinants of biological drug survival in rheumatoid arthritis: evidence from a Hungarian rheumatology center over 8 years of retrospective data

Objective To compare drug survival of biological therapies in patients with rheumatoid arthritis (RA), and analyze the determinants of discontinuation probabilities and switches to other biological therapies. Materials and methods Consecutive RA patients initiating first biological treatment in one rheumatology center between 2006 and 2013 were included. Log-rank test was used to analyze the differences between the survival curves of different biological drugs. Cox regression was applied to analyze the discontinuation due to inefficacy, the occurrence of adverse events, or to any reasons. Results A total of 540 patients were included in the analysis. The most frequently used first-line biological treatments were infliximab (N=176, 33%), adalimumab (N=150, 28%), and etanercept (N=132, 24%). Discontinuation of first tumor necrosis factor-alpha (TNF-α) treatment was observed for 347 (64%) patients, due to inefficacy (n=209, 60%), adverse events (n=103, 30%), and other reasons (n=35, 10%). Drug survival rates for TNF-α and non-TNF-α therapies were significantly different, and were in favor of non-TNF-α therapies. Every additional number of treatment significantly increased the risk of inefficacy by 27% (p<0.001) and of adverse events by 35% (p=0.002). After the discontinuation of the initial TNF-α treatment, switching to rituximab and tocilizumab was associated with significantly longer treatment duration than switching to a second TNF-α. The non-TNF-α therapies resulted in significantly longer treatment duration, due to both less adverse events and longer maintenance of effectiveness. Conclusion Non-TNF-α therapies resulted in significantly longer treatment duration, and lost their effectiveness later. Increase in the number of switches significantly increased the risk of discontinuation of any biological therapy.

Differences between Subjective and Predicted Survival Probabilities and Their Relation to Preventive Care Use

Abstract I analyse how differences between subjective and predicted survival probabilities are related to preventive healthcare use. Based on the Health and Retirement Study, I find that private information inherent in subjective survival probability affects the decisions on preventive care use: positive and negative deviations between the subjective and predicted survival probabilities both imply lower likelihood of use, the relations with negative deviations being stronger. These results are driven by perceptions verified by later survival and health outcomes. A theoretical model provides explanation for the empirical results, in which preventive care increases the chances of survival, but the benefits of preventive care also vary with the survival probability.