Health Economics Commons^™

High-Frequency Internet Survey Of A Probability Sample Of Older Singaporeans: The Singapore Life Panel, Rhema Vaithianathan, Bryce Hool, Michael D. Hurd, Susann Rohwedder

Research Collection School Of Economics

Facing a rapidly ageing population, Singapore is presented with urgent policy challenges. Yet there is very little data on the economic, health and family circumstances of older Singaporeans. In response, the Centre for Research on the Economics of Ageing (CREA) at Singapore Management University has been collecting monthly data on a panel of Singaporeans aged between 50 and 70 years. We detail the methodology by which the Singapore Life Panel® (SLP) was constructed using a population-representative sampling frame from the Singapore Department of Statistics. Contact was made with 25,000 households through postal, phone and in-person canvassing. More than 15,200 respondents …

Government Management Capacities And The Containment Of Covid-19: A Repeated Cross-Sectional Study Across Chinese Cities, Wenchao Li, Jing Li, Junjian Yi

Research Collection School Of Economics

Objectives: Better understanding of the dynamics of the COVID-19 (2019 novel coronavirus disease) pandemic to curb its spread is now a global imperative. While travel restrictions and control measures have been shown to limit the spread of the disease, the effectiveness of the enforcement of those measures should depend on the strength of the government. Whether, and how, the government plays a role in fighting the disease, however, has not been investigated. Here, we show that government management capacities are critical to the containment of the disease. Setting: We conducted a statistical analysis based on cross-city comparisons within China. China …

Change In Outbreak Epicentre And Its Impact On The Importation Risks Of Covid-19 Progression: A Modelling Study, Oyelola A. Adegboye, Adeshina I. Adekunle, Anton Pak, Ezra Gayawan, Denis H. Y. Leung, Diana P. Rojas, Emma S. Mcbryde, Damon P. Eisen

Research Collection School Of Economics

Background: The outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first detected in the city of Wuhan, China has now spread to every inhabitable continent, but now the attention has shifted from China to other epicentres. This study explored early assessment of the influence of spatial proximities and travel patterns from Italy on the further spread of SARS-CoV-2 worldwide. Methods: Using data on the number of confirmed cases of COVID-19 and air travel data between countries, we applied a stochastic meta-population model to estimate the global spread of COVID-19. Pearson's correlation, semi-variogram, and Moran's Index were used to …

The Effects Of Income On Health: Evidence From Lottery Wins In Singapore, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We estimate the causal effects of household income on self-reported health status by exploiting random variations in the amount of lottery prizes won. We find that a S$10,000 (US$7,245) increase in income via lottery wins improves individuals’ health by a standard deviation of 0.18. As possible mechanisms, we find that lottery wins increase household consumption spending and improve overall life satisfaction, but do not change healthcare spending, labor supply, and risky health behavior. Previous studies, which focused on the health effects of lottery prizes in Western European countries with strong social safety nets, do not find positive effects other than …

Public Health Insurance And Pharmaceutical Innovation: Evidence From China, Xuan Zhang, Huihua Nie

Research Collection School Of Economics

Developing countries are characterized by low levels of pharmaceutical innovation. A likely reason is their small market size, which is not because of the population size but because of low levels of income and lack of health insurance coverage. This study exploits a natural experiment from the implementation of a public health insurance program for rural residents in China (New Cooperative Medical Scheme [NCMS]) to examine whether the pharmaceutical industry increases innovation regarding diseases covered by the NCMS that are prevalent in rural areas. We examine the 1993–2009 patent data to gauge pharmaceutical innovation in China. Diseases with a 10% …

Retirement Preparedness In Singapore, Junxing Chay, Seonghoon Kim

Research Collection School Of Economics

This chapter presents empirical evidence on a variety of measures to assess the social and economic well-being of near-retirees and retirees in Singapore based on rich data from the Singapore Life Panel, a nationally representative monthly panel survey of 50- to 70-year-old adults in Singapore. Large differences in retirement behaviour and household financial conditions related to retirement preparedness across education and wealth groups are documented. This suggests the importance of a retirement-related policy that focuses on the low-skilled and low-wealth groups. In addition, we discuss and evaluate current public policy designed to increase the employment of older workers and propose …

Staying Connected: The Importance Of Social Integration On The Well-Being Of Older Adults, Paulin T. Straughan, Vincent Chua, Stephen Hoskins, Frosch Quek

ROSA Research Briefs

It has been about a year since COVID-19 first emerged and reshaped the daily lives of people around the globe, including Singaporeans. Since moving past the circuit breaker in June, Singapore has gradually re-opened and relaxed its restrictions in different phases. As Singapore prepares for Phase 3- the final and least restrictive phase, it is important to examine how Singaporeans have coped and responded with the circuit breaker (7 April 2020) and its gradual easing of restriction in Phase 1 (2nd June 2020) and Phase 2 (19 June 2020), and identify the groups which have fallen through the gaps in …

Does Early Access To Pension Wealth Improve Health?, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We examine the health impacts of early access to public pension wealth by exploiting a unique policy in Singapore allowing individuals to withdraw a proportion of their pension savings after their 55th birthday. For the identification, we employ a regression discontinuity design by comparing individuals before and after their 55th birthday. To address anticipated and lagged health impacts, we adopt the donut regression discontinuity approach. Using nationally representative monthly panel data, we find that early access to pension wealth improves self‐reported overall health.

Attitudes, Behaviours, And The Well-Being Of Older Singaporeans In The Time Of Covid-19: Perspectives From The Singapore Life Panel, Paulin T. Straughan, William Tov, Seonghoon Kim, Terence Cheng, Stephen Hoskins, Micah Tan

ROSA Research Briefs

COVID-19 has affected all Singaporeans, regardless of age and socioeconomic status (SES). Many measures have been implemented by the government to control the spread of this disease, including restrictions on social gatherings, restrictions on overseas travel, and making it compulsory to wear a mask. Measures have also included a partial lockdown – known as the ‘circuit breaker’ – which began in April 2020. This forced Singaporeans to quickly adapt to a new normal with some doing better than others. This research brief provides an overview of how COVID-19 and its related measures have affected seniors in Singapore using data from …

A Pragmatic Randomized Controlled Trial Of A Cardiac Hospital-To-Home Transitional Care Program In A Singapore Academic Medical Center, Yanying @ Tan Yanying Chen, Yi Jin Tan, Ya Sun, Cheng Zhan Chua

PhD Student’s Publications Collection

BackgroundRehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital.MethodsStudy population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary …

Policy Impact Evaluations On Labour And Health, Junxing Chay

Dissertations and Theses Collection (Open Access)

This dissertation consists of three chapters that evaluate the impacts of public policies on labour and health.

The first chapter studies a wage supplement scheme in Singapore, called the Workfare Income Supplement, which targets older low-income workers. I exploit differences in maximum benefits across age and over time to find that increasing benefits generosity encourages labour market participation and selfemployment. I also find improved life satisfaction and happiness among those with low education, who are likely to be eligible for the scheme. These results suggest that wage supplements can ease some burdens of an ageing population.

The second chapter investigates …

Refusal Bias In Hiv Data From The Demographic And Health Surveys: Evaluation, Critique And Recommendations, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung

Research Collection School Of Economics

Non-response is a commonly encountered problem in many population-based surveys. Broadly speaking, non-response can be due to refusal or failure to contact the sample units. Although both types of non-response may lead to bias, there is much evidence to indicate that it is much easier to reduce the proportion of non-contacts than to do the same with refusals. In this article, we use data collected from a nationally representative survey under the Demographic and Health Surveys program to study non-response due to refusals to HIV testing in Malawi. We review existing estimation methods and propose novel approaches to the estimation …

Welfare Consequences Of Access To Health Insurance For Rural Households: Evidence From The New Cooperative Medical Scheme In China, Jessica Ya Sun

Research Collection School Of Economics

This study evaluates the welfare benefits of the New Cooperative Medical Scheme (NCMS), the main public health insurance plan for the rural population in China. The findings show that the value of the NCMS to recipients is slightly lower than the government's costs of implementation, ranging from 0.79 to 0.97 per RMB of the resource cost of the NCMS. The estimated moral hazard costs are low compared with the total benefits. It is also estimated that the benefits originating from the NCMS's insurance function only constitute 20% of the total benefits, suggesting a need for higher generosity levels among rural …

To Extubate Or Not To Extubate: Risk Factors For Extubation Failure And Deterioration With Further Mechanical Ventilation, Jingui Xie, Guang Cheng, Zhichao Zheng, Haidong Luo, Oon Cheong Ooi

Research Collection Lee Kong Chian School Of Business

Background: Extubation is a critical step in the intensive care unit (ICU). In this study, we aim to investigate the risk factors for both extubation failure and deterioration with further mechanical ventilation (MV). Methods: Data were collected from a cardiothoracic ICU in a tertiary hospital. The risk factors for extubation failure and deterioration with further MV were investigated by multivariate logistic regression. Results: A total of 676 patients were enrolled in the study. Patients with extubation failure had a longer ICU length of stay and a higher mortality rate than patients without extubation failure. An age greater than 65 years, …

The Aging Of A Young Nation: Population Aging In Singapore, Rahul Malhotra, Andre M. Muller, Su Aw, Gerald Choon Huat Koh, Yin-Leng Theng, Stephen James Hoskins, Chek Hooi Wong, Chunyan Miao, Wee-Shiong Lim, Chetna Malhotra, Angelique Chan

Research Collection School Of Economics

The juxtaposition of a young city-state showing relative maturity as a rapidly aging society suffuses the population aging narrative in Singapore and places the “little red dot” on the spotlight of international aging. We first describe population aging in Singapore, including the characteristic events that shaped this demographic transition. We then detail the health care and socioeconomic ramifications of the rapid and significant shift to an aging society, followed by an overview of the main aging research areas in Singapore, including selected population-based data sets and the main thrust of leading aging research centers/institutes. After presenting established aging policies and …

Refusal Bias In Hiv Data From The Demographic And Health Surveys: Evaluation, Critique And Recommendations, Oyelola A. Adegboye, Tomoki Fujii, Denis H. Y. Leung

Research Collection School Of Economics

Non-response is a commonly encountered problem in many population-based surveys. Broadly speaking, non-response can be due to refusal or failure to contact the sample units. Although both types of non-response may lead to bias, there is much evidence to indicate that it is much easier to reduce the proportion of non-contacts than to do the same with refusals. In this article, we use data collected from a nationally-representative survey under the Demographic and Health Surveys program to study non-response due to refusals to HIV testing in Malawi. We review existing estimation methods and propose novel approaches to the estimation of …

Monthly Spending Dynamics Of The Elderly Following A Health Shock: Evidence From Singapore, Terence C. Cheng, Jing Li, Rhema Vaithianathan

Research Collection School Of Economics

We use novel longitudinal data from 19 monthly waves of the Singapore Life Panel to examine the short-term dynamics of the effects health shocks have on household health and non-health spending and income by the elderly. The health shocks we study are the occurrence of new major conditions such as cancer, heart problems, and minor conditions (e.g. diabetes, and hypertension). Our empirical strategy exploits unanticipated changes in health status through the diagnosis of new health conditions, combined with an individual fixed effect framework. We find that major shocks have large and persistent effects while minor shocks have small and mainly …

Sources Of Health Financing And Health Outcomes: A Panel Data Analysis, Tomoki Fujii

Research Collection School Of Economics

We study the differential impacts of public and private sources of health spending on health outcomes using a triple difference approach. We find that private health spending has on average a higher health-promoting effect than public health spending. This result is robust with respect to the choice of outcome measure and covariates in the regression and driven primarily by the countries with ineffective governments. Once we restrict our sample to countries with effective governments, private health spending is no better than public health spending for improving the health outcome.

Does Health Insurance Make People Happier? Evidence From Massachusetts’ Healthcare Reform, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We study the effects of Massachusetts' healthcare reform on individuals' subjective well-being. Using data from the Behavioral Risk Factor Surveillance System, we find that the reform significantly improved Massachusetts residents' overall life-satisfaction. This result is robust to various sensitivity checks and a falsification test. We also find that the reform improved mental health. An additional analysis on the Tennessee healthcare reform supports our findings' external validity. Using the reform as an instrument for health insurance coverage, we estimate its large impact on overall life-satisfaction. Our results provide novel evidence on the psychological consequences of Massachusetts' healthcare reform.

Regional Prevalence Of Health Worker Absenteeism In Tanzania, Tomoki Fujii

Research Collection School Of Economics

Absenteeism of health workers in developing countries is common and can severely undermine the reliability of health system. Therefore, it is important to understand where the prevalence of absenteeism is high. We develop a simple imputation method that combines a Service Delivery Indicators survey and a Service Provision Assessment survey to estimate the prevalence of absenteeism of health workers at the level of regions in Tanzania. The resulting estimates allow one to identify the regions in which the prevalence of absenteeism is significantly higher or lower than the national average and help policymakers determine the priority areas for intervention.

Essays In The Economics Of Health And Ageing, Yi Jin Tan

Dissertations and Theses Collection (Open Access)

This dissertation consists of four papers in applied microeconomics / the economics of health and ageing that analyse the causal effect of public policies, or of events / issues amenable to policy intervention. Chapter 1 provides an overview of the papers in this dissertation.

Chapter 2 investigates whether a major and growing environmental disamenity – dengue fever – leads to protective behavior that increases residential electricity consumption. Being near a dengue cluster leads to a persistent increase in electricity consumption in 4-room and 5-room/bigger flats (by 1.7% and 1.1% respectively). In addition, electricity consumption rises discontinuously when a dengue cluster’s …

Impact Of Electrification On Children's Nutritional Status In Rural Bangladesh, Tomoki Fujii, Abu S. Shonchoy, Sijia Xu

Research Collection School Of Economics

Access to electricity has the potential to improve the nutritional status of children by a variety of pathways such as increased wealth, reduced fertility through the change in time use, spread of information through technology such as TV, and improved health care services. Yet, the relationship between electrification and children’s nutritional status is rarely explored in the literature. We attempt to fill this lacuna by offering microeconometric evidence from rural Bangladesh, where a rapid expansion of electrification and significant improvement in children’s nutritional status were observed in the past two decades. We find that access to electricity has a positive …

Three Essays On Social Insurance, Jessica Ya Sun

Dissertations and Theses Collection (Open Access)

This dissertation consists of three chapters on the economics of social insurance. Each chapter explores an aspect of the evaluation and design of social insurance in terms of nutrition, healthcare and unemployment.

The first chapter, Kim, Fleisher and Sun (2016) report evidence of long-term adverse health impacts of fetal malnutrition exposure of middle-aged survivors of the 1959-1961 China Famine using data from the China Health and Retirement Longitudinal Study. We find that fetal exposure to malnutrition has large and long lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, …

Evidence Of Racial And Geographic Disparities In The Use Of Medicare Observation Stays And Subsequent Patient Outcomes Relative To Short-Stay Hospitalizations, Brad Wright, Xuan Zhang, Momotazur Rahman, Mahshid Abir, Padmaja Ayyagari, Keith E. Kocher

Research Collection School Of Economics

To examine racial and geographic disparities in the use of-and outcomes associated with-Medicare observation stays versus short-stay hospitalizations.\nWe used 2007-2010 fee-for-service Medicare claims, including 3,555,994 observation and short-stay hospitalizations for individuals over age 65. We estimated linear probability models with hospital fixed effects to identify within-facility disparities in observation stay use, and estimated in-hospital mortality, and 30- and 90-day post-discharge mortality, return ED visits, and hospital readmissions as a function of placement in observation using linear probability models, propensity-score matching, and interaction terms.\nWe identified racial and geographic disparities in the likelihood of observation stay use within hospitals (blacks 3.9 percentage …

Informing Medicare's Two-Midnight Rule Policy With An Analysis Of Hospital-Based Long Observation Stays, Brad Wright, Xuan Zhang, Momotazur Rahman, Keith Kocher

Research Collection School Of Economics

Outpatient observation stays are increasingly substituting for standard inpatient hospitalizations. In 2013, the Centers for Medicare & Medicaid Services adopted the controversial Two-Midnight Rule policy to curb long observation stays and better define the use of hospital-based observation services versus inpatient hospitalizations. We seek to determine the extent to which Medicare beneficiaries exposed to long observation stays (>48 hours) are clinically similar to those with short observation stays (≤48 hours) because this has relevance to the Two-Midnight Rule.\nUsing 100% Medicare claims data from 2008 to 2010, we identified all patients with long observation stays (>48 hours) who were …

The Long-Term Health Effects Of Fetal Malnutrition: Evidence From The 1959-1961 China Great Leap Forward Famine, Seonghoon Kim, Belton Fleisher, Jessica Ya Sun

Research Collection School Of Economics

We report evidence of long-term adverse health impacts of fetal malnutrition exposure of middle-aged survivors of the 1959-1961 China Famine using data from the China Health and Retirement Longitudinal Study. We find that fetal exposure to malnutrition has large and long-lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, walking and vision, and measures of mental acuity even half a century after the tragic event. Our findings imply that policies and programs that improve the nutritional status of pregnant women yield benefits on the health of a fetus that …

Sources Of Health Financing And Health Outcomes: A Panel Data Analysis, Tomoki Fujii

Research Collection School Of Economics

We study the differential impacts of public and private sources of health spending on health outcomes using a triple difference approach. We find that private health spending has on average a higher health-promoting effect than public health spending. This result is robust with respect to the choice of outcome measure and covariates in the regression and driven primarily by the countries with ineffective governments. Once we restrict our sample to countries with effective governments, private health spending is no better than public health spending for improving the health outcome.

Incense Burning During Pregnancy And Birth Weight And Head Circumference Among Term Births: The Taiwan Birth Cohort Study, Le-Yu Chen, Christine Ho

Research Collection School Of Economics

Incense burning for rituals or religious purposes is an important tradition in many countries. However, incense smoke contains particulate matter and gas products such as carbon monoxide, sulfur and nitrogen dioxide, which are potentially harmful to health. We analyzed the relationship between prenatal incense burning and birth weight and head circumference at birth using the Taiwan Birth Cohort Study. We performed multivariate regression analysis on a sample of 15,773 Taiwanese babies born in 2005 and controlled extensively for factors that may be correlated with incense burning and birth outcomes. Prenatal incense burning environment was associated with lower birth weight and …

Hospital-Skilled Nursing Facility Referral Linkage Reduces Readmission Rates Among Medicare Patients Receiving Major Surgery, Andrew J. Schoenfeld, Xuan Zhang, David C. Grabowski, Vincent Mor, Joel S. Weissman, Momotazur Rahman

Research Collection School Of Economics

BACKGROUND:In the health reform era, rehospitalization after discharge may result in financial penalties to hospitals. The effect of increased hospital-skilled nursing facility (SNF) linkage on readmission reduction after surgery has not been explored.METHODS:To determine whether enhanced hospital-SNF linkage, as measured by the proportion of surgical patients referred from a hospital to a particular SNF, would result in reduced 30-day readmission rates for surgical patients, we used national Medicare data (2011-2012) and evaluated patients who underwent 1 of 5 operative procedures (coronary artery bypass grafting [CABG], hip fracture repair, total hip arthroplasty, colectomy, or lumbar spine surgery). Initial evaluation was performed …

The Impact Of Agglomeration Economies On Hospital Input Prices, Andrew Friedson, Jing Li

Research Collection School Of Economics

This paper examines the extent to which agglomeration of the hospital service industry enhances the productivity of producing health care. Specifically, we use a large set of private insurance claims from the FAIR Health database to show that an increasing spatial concentration of hospital services results in a decreased cost of obtaining intermediate medical services. We explicitly test whether the reduced cost at concentrated locations arises from the ability to share intermediate service providers. The identification relies on state variation in medical lab technician licensure requirements, which influence the cost of intermediate services only through the cost of running a …