Background: Socio-economic disparities in health are persistent, pervasive and difficult to modify. Disparities, particularly for non-communicable chronic diseases, appear to change with economic development and may be specific to the stage of economic development and/or epidemiological transition. Most evidence concerning health disparities comes from Europe and North America, where contextual or cultural effects may have built up over centuries of economic development. Evidence from other socio-historical settings, with a much more recent history of economic development, can be particularly valuable. Uniquely, the Hong Kong population has already experienced transition from pre- to post- industrial living conditions over one lifetime, and as such serves as a unique setting to examine health disparities during economic development. In this context, I assessed the association of small area-based (tertiary planning unit (TPU)) income with potential years of life lost (PYLL), life expectancy and mortality over 30 years of rapid economic development, and the association of the level of TPU-based income inequality with mortality. I also assessed the contribution of major causes of death to any changes. Finally, to provide additional insight concerning the observed changes I took a novel approach and examined whether any changes overall and by cause of death related to population wide exposures (period effects), generational exposures (cohort effects) or differences with aging. Methods: I used concentration indices to assess neighbourhood (TPU-based) income disparities in PYLL. I used abridged life tables to assess changes in life expectancy by income group. I used negative binomial regression to assess the association of TPU-based income and the level of TPU-based income inequality with mortality rates during the period. Finally, I used an age, period, cohort model, stratified by income group, to identify the contribution of age, period and cohort to changes in mortality disparities from 1976 to 2005 in Hong Kong. Results: The concentration index for all-cause TPU-based PYLL was negligible in 1976, but increased over the period. PYLL attributable to injury and poisoning was consistently associated with lower TPU-based income, but PYLL attributable to cardiovascular diseases and cancer reversed from an association with higher TPU-based income in 1976 to an association with lower TPU-based income in 2006. Life expectancy at 0-4 years increased by 8.1 years during that period, but gains were greater for people with higher TPU-based income (10.1 years) than lower TPU-based income (6.2 years). A positive association of neighbourhood (TPU-based) Gini with all-cause mortality became more evident during the later period. Disease-specific cohort effects contributed to the widening TPU-based income disparities in Hong Kong from 1976 to 2006; the lower TPU-based income group tended to be more strongly affected by population wide exposures, such as economic downturns. Conclusion: Health disparities widened in Hong Kong during a period of rapid economic development from 1976 to 2006. Social patterning of major chronic diseases, such as cardiovascular disease, emerged, partially as a disease-specific cohort effect. Disparities in health in a developed setting may partially be the result of long-term disease-specific processes that have accumulated over generations, with corresponding implications for contemporaneous interventions. / published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

In the labor market, workers can increase their chances of meeting potential employers through costly search. My first chapter aims to empirically quantify the search intensity of workers, both employed and unemployed. My second chapter develops a theoretical model to study the optimal unemployment insurance with search intensity endogenously chosen by unemployed workers. I devote my third chapter to empirical identification of whether major illness leads to persistent household poverty in rural China. My first chapter studies the search behaviors both on and off the job, and the effect of search intensity on wage determination. Four determinants of wages are considered: productivity, workers’ bargaining power, competition between employers due to on-the-job search, and search intensity. I estimate the structural model using the 2001 panel of the Survey of Income and Program Participation (SIPP), together with supplementary information from the American Time Use Survey (ATUS). The empirical results demonstrate that search intensity declines as the worker gets a wage rise from her current job. My second chapter addresses the efficiency issues arising from the externalities and hidden-action features of search effort. The solution to the social planner’s problem may not be decentralized in a competitive market. Calibration shows that the current US unemployment insurance (UI) system generates an 8.07% welfare loss relative to the socially optimal allocation. In the third chapter, I use a unique dataset on Chinese rural households to test whether severe illness can cripple a rural household’s economic resources leading to temporary and/or persistent poverty. When health shocks are assumed to be exogenous, in the sense that households cannot control the arrival rate of adverse health shocks by choosing the amount of medical expenditures, a Markov regime-switching regression model reveals no significant evidence that a severe illness causes persistent household poverty. To endogenize health shocks and choices on medical expenses, a dynamic structural model is employed. The structural estimates support the view that major illness leads to persistent household poverty. / text

published_or_final_version / Social Sciences / Master / Master of Philosophy

Huang Ying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 29-31). / Abstracts in English and Chinese. / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Literature Review --- p.3 / Chapter 3. --- Methodology --- p.7 / Chapter 3.1. --- Basic Model --- p.7 / Chapter 3.2. --- Instrumental Variable Strategy --- p.8 / Chapter 4. --- Data Description --- p.10 / Chapter 4.1. --- China Health and Nutrition Survey --- p.10 / Chapter 4.2. --- Sample Selection --- p.11 / Chapter 4.3. --- Variable Definition --- p.12 / Chapter 4.4. --- Summary Description of Samples --- p.14 / Chapter 5. --- The Effects of Health on Labor Supply --- p.15 / Chapter 5.1. --- Rural Adults --- p.15 / Chapter 5.2. --- Urban Adults --- p.19 / Chapter 5.3. --- Results --- p.22 / Chapter 6. --- The Effects of Health on Household Income --- p.23 / Chapter 7. --- Conclusion --- p.26 / References --- p.29 / Tables --- p.32 / Appendix --- p.66

In 2009 China launched an ambitious health care reform to ensure equal and affordable access to basic health care for all by 2020. The reform was not only a response to changing patterns of disease, rising health expenditures, and widening regional inequalities, but part of a wider strategy to improve the social security system covering residents in order to increase domestic consumption. Its success will be defined by the efficient use of funds in financing and delivering health care. Against this backdrop, this dissertation evaluates the importance of health insurance characteristics on measures of financial risk protection, household saving and consumption, and preference for health care providers. It uses an experimental design to study the effect of more generous outpatient coverage and a tiered reimbursement structure that sets rates higher at primary care facilities than tertiary hospitals. While middle income households benefitted most in terms of financial risk protection, poorer and sicker households increased utilization at primary care facilities and food consumption – two pathways by which health insurance can improve health outcomes. This suggests that as outpatient coverage improves those most vulnerable will increase their access to health care, where there was previous underutilization, but not necessarily see an improvement in financial risk protection. The increased cover would also offer greater protection for those already using healthcare, but on its own not necessarily change their utilization patterns or reduce household savings. Looking at the quality-price trade-off in choice of provider reveals that, while at lower levels of household consumption demand for outpatient care is elastic with respect to price, as living standards rise past subsistence, individuals begin to value other provider characteristics. Together, these findings highlight the importance of benefit design and quality improvements at lower levels of care to shift patterns of utilization and ensure health services are accessed cost-effectively.

University of Macau / Institute of Chinese Medical Sciences

Lam Siu Kuen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 77-79). / Abstracts in English and Chinese. / Acknowledgments --- p.ii / English Abstract --- p.iv / Chinese Abstract --- p.vi / Table of Contents --- p.vii / List of Tables --- p.x / List of Figures --- p.xii / List of Appendices --- p.xiv / Chapter Chapter 1. --- Introduction --- p.1 / Chapter Chapter 2. --- Research Background --- p.7 / Chapter 2.1 --- Epidemiology of Hepatitis B Virus (HBV) --- p.7 / Chapter 2.2 --- The prevalence of HBV around the world --- p.12 / Chapter 2.3 --- The prevalence of HBV in Hong Kong --- p.16 / Chapter 2.4 --- Standard medical treatment --- p.17 / Chapter Chapter 3. --- Literature Review --- p.20 / Chapter Chapter 4. --- Data compilation --- p.31 / Chapter 4.1 --- Prince of Wales Hospital's Dataset --- p.31 / Chapter 4.2 --- Expert Opinion and other published data --- p.35 / Chapter 4.3 --- Definition of health states under study --- p.36 / Chapter Chapter 5. --- Empirical Findings I --- p.39 / Chapter 5.1 --- Estimation of disease costs from Department of Hepatology --- p.39 / Chapter 5.1.1 --- Methodology and sample size --- p.39 / Chapter 5.1.2 --- Summary of costs included in the analysis --- p.42 / Chapter 5.1.3 --- Descriptive analysis --- p.43 / Chapter 5.1.4 --- Calculation method --- p.44 / Chapter 5.1.5 --- Empirical results --- p.47 / Chapter 5.2 --- Estimation of direct medical cost from the Department of Oncology --- p.51 / Chapter 5.2.1 --- Methodology and sample size --- p.51 / Chapter 5.2.2 --- Summary of Costs included in the analysis --- p.52 / Chapter 5.2.3 --- Descriptive analysis --- p.52 / Chapter 5.2.4 --- Calculation method --- p.54 / Chapter 5.2.4 --- Empirical results --- p.58 / Chapter 5.3 --- Kernel estimators --- p.61 / Chapter 5.4 --- Sensitivity to cost variations in medical procedures --- p.63 / Chapter Chapter 6. --- Empirical Findings II --- p.65 / Chapter 6.1 --- Estimation of indirect medical costs --- p.65 / Chapter 6.1.1 --- Methodology --- p.65 / Chapter 6.1.2 --- Calculation method --- p.67 / Chapter 6.1.3 --- Empirical results --- p.68 / Chapter 6.2 --- Estimation of indirect cost (HCC-deceased) --- p.70 / Chapter 6.3 --- Premature death --- p.71 / Chapter 6.4 --- Limitation --- p.72 / Chapter Chapter 7. --- Conclusion --- p.75 / Bibliography --- p.77 / Tables --- p.80 / Figures --- p.120 / Appendices --- p.128