Tandvårdsmarknaden är unik ur ett hälsoekonomiskt perspektiv. Den finansieras delvis av privata konsumenter och delvis av staten. Produktionen av tandvård är till skillnad från generell vård relativt jämnt uppdelad mellan privat och statlig sektor. Nya aktörer i form av tandvårdskedjor ägda av riskkapitalbolag har på senare år gått in på marknaden. Den här uppsatsen tittar på huruvida nyetableringen av tandvårdskedjor har påverkat utfallet hos medianen av intakta tänder som mått på tandhälsa. Metoden för att finna sambandet mellan den beroende variabeln medianen av intakta tänder och den oberoende variabeln nyetablering av tandvårdskedjor ägda av riskkapitalbolag var fixa effekter. Data samlades in för Sveriges samtliga 290 kommuner under en tidsperiod av 6 år, vilket sammanlagt resulterade i 1740 observationer. Resultatet är att 1 nyetablering av en tandvårdskedjas klinik gav ett positivt utfall i kommun per 100 000 invånare med 0.04 tänder vad gäller variabeln medianen av intakta tänder. Signifikansen var dock högre än 0.1. Slutsatsen i det hela blir därmed att det inte går att finna statistiskt stöd för att nyetableringen av tandvårdskedjor haft en positiv effekt på svensk tandhälsa eller inte. Vi kan därmed inte förkasta att den sanna effekten av privata tandvårdskedjor är lika med noll (eller till och med negativ).

Doctor of Philosophy / Department of Economics / Dong Li / The dissertation examines empirical issues related to health and labor economics. It has long been debated whether breastfeeding leads to a higher intelligence quotient (IQ) and greater scholastic achievement. The first study empirically examines the issue. Many past studies fail to take into account the possible endogeneity of the breastfeeding decision and thus falsely identify the correlation between breastfeeding and IQ as a causal relationship. We attempt to distinguish the causation and correlation between the two variables. Our results show that, after controlling for possible endogeneity, breastfeeding has no significant impact on IQ or scholastic achievement. The second essay examines the link between breastfeeding and childhood obesity. Heath economics researchers view breastfeeding as a determining factor as to whether a child becomes obese. There are many theories, involving both biological and psychological factors, as to why breastfeeding is negatively linked to childhood obesity. This essay argues that the breastfeeding decision is not an exogenous one, so estimation technique such as ordinary least squares is not the correct way to estimate the relationship between breastfeeding and childhood obesity. Instruments are used to generate exogenous variations in the breastfeeding variable. After correcting for any estimation bias due to the breastfeeding variable being endogenous, this study documents the benefits of breastfeeding. The third essay analyzes 19 semesters of student evaluations at Kansas State University. Faculty fixed effects are sizable and indicate that, as assessed by students, the best principles teachers also tend to be the best non-principles teachers. OLS estimates are biased because principles teachers are drawn from the top of the distribution and because unmeasured faculty characteristics are correlated with such variables as the response rate and student effort. Student ratings are lowest for new faculty but stabilize quickly. Expected GPA of the class is not an important determinant of student ratings, but equitable grading is; and the rewards for equitable grading appear larger for principles classes. The lower ratings in principles classes are fully accounted for by greater class size.

Cette thèse s’intéresse, d'une part à la question de la maîtrise des dépenses de médicaments, et d'autre part à l’analyse de la concurrence en prix sur le marché des médicaments non remboursables, à la lumière des politiques de déremboursement.Ces dernières années, des actions visant à modifier les pratiques des prescripteurs se développent avec des actions de ciblage des médecins. Le premier chapitre de cette thèse pose ainsi la question de l’identification de ces médecins dans les systèmes d’informations actuels. Les résultats montrent que si les médecins généralistes outliers peuvent être identifiés correctement, il est néanmoins nécessaire, pour élargir le ciblage, de privilégier des indicateurs relevant de pathologies précises ou d’enrichir les systèmes d’informations avec les codes diagnostic pour définir des indicateurs plus généraux.Outre l'état de santé des patients, différents déterminants, sociologiques et économiques, peuvent influencer les pratiques des médecins, dont l'environnement concurrentiel. Le deuxième chapitre s’intéresse à l’effet de l’inégale répartition spatiale des médecins, dans le cas de la prescription de médicaments. Les résultats sont sensibles à la spécification retenue de la variable de densité médicale et invitent à conclure à une absence d’effet de l’évolution de la densité sur la variation des dépenses de prescription. Néanmoins, ce résultat reflète la somme de deux effets contraires qui se compensent.Le troisième chapitre s’inscrit dans un contexte où la question d’ouvrir la vente des médicaments non remboursables en dehors des officines se pose de plus en plus. Les résultats soulignent un manque de concurrence en prix entre officines sur ce segment de marché. / This thesis addresses several issues: on the one hand, we focus on policies for controlling drug expenditures: on the other hand, we analyze the price competition on the OTC drugs market, in a context of drugs delisting policies.In recent years, some plans to affect change and improve prescribing practices are developed, with the emergence of physician profiling methods. The first chapter wonders about such a profiling in the current information system. Results show that outliers can be correctly identified; but to broaden profiling, we have to use some disease-specific indicators, or to improve information systems with diagnostic codes to define more general indicators.In addition to patient health, various sociological and economic factors may influence physician practices, including the competitive environment. The second chapter focuses on the unequal spatial distribution of general practitioners on drugs prescribing variability. Results are sensitive to the specification used for the medical density variable and suggest there is no effect of the density variation on the average prescribing cost per patient and per physician. However, this result reflects the sum of two opposite effects that cancel.In a context where the sale of OTC drugs outside pharmacies is controversial, the third chapter show there is no price competition between pharmacies on this market segment.

In this thesis, I analyze whether nutritional intake at the time of adolescence can impact academic attainment and earnings later on in life. Millions of children in the United States are living in food insecure households and do not have access to an adequate nutritious diet. Since adolescence is a time period of intense growth and development, it is essential to meet nutritional needs at this time. Using data from the Longitudinal Study of Adolescent to Adult Health (Add Health), I measure the nutrition of a nationally representative sample of youth in the United States through their daily food intake, and test the effects nutrition during adolescence has on future outcomes. I find a positive relationship between healthy eating and educational achievement, as well as a negative relationship between unhealthy eating and educational attainment. Nutrition has a smaller effect on earnings, but the results show that there is a minor negative relationship between healthy eating and earnings.

Thesis "A NEW CONCEPT OF HEALTH CARE IN THE CZECH REPUBLIC IN RELATION TO PUBLIC ADMINISTRATION "deals with health care in the Czech Republic. In the most economically developed countries health care is becoming a part of their health care policy. The diploma thesis reflects the health reform efforts in recent years of economic reality in the Czech Republic. The state acts as a guarantor, whose task is to regulate health care, establish legal and economic rules and thereby to ensure availability. Focus of the thesis is analytical and descriptive. The introductory chapter describes the health systems, the second focuses on the legal framework and then the third on the demographic and health status of the population. The focus of the work is in the fourth chapter, this chapter describes the economics of health policy, financing of individual groups, the fifth drug policy. Consistency of health care associated with the Czech Republic's accession to the EU, its principals and strategies are presented in the final chapter

Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.

Numerous studies have shown that consumers react imperfectly to changes in health insurance coverage. To justify consumer valuation in health insurance decision-making, I use Medical Expenditure Panel Survey (MEPS) data and conduct three studies to examine consumer’s private information in health insurance decision-making under a conceptual framework of consumer perception, which potentially is informative about Affordable Care Act (ACA) Health Insurance Marketplace consumer behavior. In the first study, I examine the joint role of individual preferences and health risk in two types of insurance decision-making: the probability of being insured and the probability of employment-based insurance if insured. Using logistic regression, I find that the healthier and wealthier consumers tend to have more positive attitudes towards health insurance and thus are more likely to be insured. The effects of health risk measures vary largely in insurance decisions conditional on different preference measures and preference levels. In the second study, I investigate insurance coverage bundle choices with multi-dimensional private information in an artificially created market setting. I adapt the approach developed by Lokshin and Ravallion (2005) and conduct logistic regression modeling to estimate the reduced forms for coverage bundle choice and consumer attitude respectively. Predicted linear indices for consumer attitude and coverage bundle choices are calculated separately, then their correlation coefficients are compared. In this study I find that consumer attitude plays a dominating role in health insurance decision-making, suggesting that risk preferences may internalize health risks and influence insurance purchasing decisions. To further explore consumer perceptions within an individual’s personal system of decision rules, in the third study, I construct coverage bundle choices in an order from the least complete to the most complete, and examine the effect of consumer perceived plan quality to coverage bundle choice decisions. I use the generalized ordered logit method and a Bayesian learning process for the analysis. I find that coverage bundle choice decisions are value-based, for which perceived plan quality plays a significant and persistent role. The study results also have important policy implications to enhancing consumer engagement and optimizing health insurance management to provide high quality care to health insurance beneficiaries.

This thesis serves to investigate the varying effects of public health-care expenditure and private health-care expenditure on economic growth in developed and developing countries. I have contributed to the literature by using an expansive geographical dataset, lagged variables to address endogeneity, and model averaging techniques. I do so by first addressing the issue of model uncertainty, which is inherent in growth studies, by using Bayesian Model Averaging as the method of analysis in the thesis. Examination of 126 countries (32 developed and 94 developing) in the period 2000-2018 reveals that there is no variation in the impact of public health expenditure on economic growth between developed and developing countries. Contrary to public health expenditure, private health expenditure has a varying impact on both developed and developing countries. My analysis also reveals that the results hold when lagged variables are used in the model. Public health expenditure has unanimously a negative effect on economic growth in both developed and developing countries. Private health expenditure, on the other hand, has a positive impact on economic growth in developed and developing countries. Furthermore, I found that the results are robust to different model specifications. JEL Classification I15, O11,...

The determinants of health expenditures have been studied extensively for the past 50 years and income has been seen as the major driver. The focus has rarely left developed countries which raises the question as to whether the same positive relationship exists in developing countries as well. The purpose of this thesis is to answer this question by conducting a fixed effect regression on a sample of 38 countries labelled as the least developed in the world by the United Nations with data stretching between 2000 to 2017. The results indicate a weaker relationship in the sample compared to estimates on developed countries. However, due to a lack of theoretical guidance on how health expenditures are determined and indications that omitted variable bias is present, the results do not provide definitive conclusions.

Includes bibliographical references / BACKGROUND: People with disabilities encounter major barriers that prevent them realising their right to health in South Africa. Health committees are legislated structures for community participation in health at a local level. This study investigated how health committee members understand and practise their role in community participation and how this advances the right to health for persons with disability. METHODS: A qualitative study was conducted with three health committees in the Cape Town Metropole in the Western Cape province of South Africa purposively selected for the study. Three facility managers and eight health committee members took part in focus group discussions and semi-structured interviews, supplemented by participant observations of committee meetings. Additionally, semi-structured interviews were conducted with 2 disability activists. These methods were used to gain a rich understanding of health committees’ roles and practises in relation to persons with disabilities. Thematic analysis was used to analyse the data. RESULTS: The main research findings were: (i) health committees did not prioritise disability on their respective agendas; (ii) persons with disabilities were not adequately represented on health committees; (iii) health committees exhibited poor understanding of disability barriers relating to health; (iv) lack of egalitarian values led to persons with disabilities not trusting the health committee, and distrust amongst health committee members; lastly (v) health committees augment health facility operations instead of fulfilling their governance and oversight function. These factors may have contributed to health committees not helping to advance the right to health for persons with disabilities. CONCLUSIONS: Health committees should include mandated representation of persons with disabilities, whilst addressing marginalisation directed toward persons with disabilities on committees. Training of health committees, as well as networking with disabled organisations, could help improve their limited understanding of disability. Health committees should consider addressing disability a human rights issue, which critically involves community mobilisation, raising awareness around issues of disability and promoting agency amongst persons with disabilities to claim their rights.