Abstract

About 88 percent of India’s total labor force is composed of informal (officially labeled “unorganized”) workers. As many as 388 million such workers lack old age income security by way of a pension system. The Atal Pension Yojana (APY) is the latest contributory, national-level old age pension scheme for unorganized workers, with an entry age of 18–40 years. In other words, all current unorganized workers above the age of 40 are excluded. How could a national pension system viably guarantee equal pension benefits to all current unorganized workers? This paper considers how such a system might work by offering a case study of a non-contributory pension scheme for building and other construction workers in Karnataka State, India. The results indicate that this state-level pension scheme, fully funded by sector-specific receipts, is financially viable and sustainable with high levels of coverage and adequacy. The robustness of these results is shown via sensitivity analyses of discount rates, inflation rates, and growth rates of specific purpose tax collections. Additional analyses outline the scenarios under which pension benefits could be extended to all informal workers in the sector studied.

Keywords: Informal sector workers, pensions, India, Atal Pension Yojana

JEL codes: H55, J18

Abstract

Objective: Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.

Methods: This retrospective study used 10 years (2005–2014) of hospital electronic health records (EHRs) from the Shandong Center for Mental Health (SCMH) and the DaiZhuang Psychiatric Hospital (DZPH), two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities.

Results: Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients.

Conclusion: Consistent with the existing literature, our study suggests that increasing insurance schemes’ reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.

Published, available at: https://link.springer.com/content/pdf/10.1007%2Fs10754-018-9238-z.pdf

Abstract
Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased.
Extrapolated country-wide in recent data, the estimated number of people who have used at least one addictive substance at some time in their lives was 2,964,444 or 5.8% of the total population aged 12 - 65 years. Kratom, Methamphetamine, methamphetamine hydrochloride crystal (ice), and cannabis were the most prevalent substances of abuse.

Historical documentation and policy reports were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous measures to control illegal substance abuse in Thailand, and consider options for the future.

Controlling illegal substance abuse in the future and minimizing total harm requires a delicate balance of efforts to reduce the prevalence, quantity, and harmful effects of substances. Drug policy interventions should be continually evaluated for their effectiveness.
The strategies relevant to drug policy, apart from primary prevention, are health services for chronic drug users, reform of criminal sanctions against drug addicts, and legalization of kratom.

Keywords: substance abuse policy, Thailand

Abstract

This paper considers household decision making on living arrangements and maternal labor supply in an extended family with young children. In such a context, the decision making is driven by the concern that the companionship of children is a household public good and that family members share childcare and related domestic duties. The incentive to share children’s companionship is affected by son preference, whereas the economic motive of labor division hinges on the potential wage rate of the mother. Both channels play important roles in households with mothers whose wage rates are high,  while sharing the companionship of (grand)sons is the main driving force in households with mothers whose wage rates are low. Using China Health and Nutrition Survey (CHNS) data, we find that among less-educated mothers, the incidence of a family co-residing with the paternal grandmother is at least 8.6 percentage points higher if the firstborn is a boy. At the same time, maternal labor supply increases by 2.9 days per month. By contrast, for educated mothers, the propensity for co-residence is higher, and the working hours are longer than for less-educated mothers, and the impact of the child’s sex is not significant. This paper not only provides a better understanding of the demographic and economic factors determining co-residence and intra-household time allocations, but also lends empirical support to policies aiming to increase female labor supply and improve the well-being of girls.

Abstract

As many other countries, Japan is working on development of personalized and precision medicine. This paper explains Japan’s policies regarding personalized and precision medicine, including data collection, supports for its development and its insurance coverage such as its process and criteria and describes four drugs and companion diagnosis. Especially as for the insurance coverage, Japan has not examined the cost-effectiveness of personalized and precision medicine and its impact on healthcare expenditures. On the other hand, since the United Kingdom considers cost-effectiveness in considering the insurance coverage, the United Kingdom limits the use of Imatinib due to cost-effectiveness while Japan does not limit it.

ABSTRACT

Low fertility is a major policy focus in Japan. Many policies, such as an increase in replacement allowances during parental leave, were rolled out during the 1990s and early 2000s with little evidence that they had any effect on fertility or labor supply. This study assesses the impact of policies designed to promote a family-friendly work culture on childbirth and labor supply from the mid-2000s on. The causal effects are identified by investigating two reform policies targeted at two different sizes of firms. The paper contributes to the literature on laws that impact organizational culture in a society where both gender and organizational norms are strong. The short-hour option in Japan significantly increased childbirth among working women who had been childless. The intent to give birth also increased among childless women at the treated firms, and there was an increased likelihood of women taking up permanent employment at reduced hours following their first childbirth. The policy effect was not significant for second or third births.

Key words: short-hour option mandate, childbirth hazard, labor supply following childbirth

Between 1950 and 1980, China experienced the most rapid sustained increase in life expectancy in documented global history. However, no study of which we are aware has quantitatively assessed the relative importance of the various explanations proposed for these gains in survival. We have created and analysed a new, province-level panel dataset spanning the decades between 1950 and 1980 by combining historical information from China’s public health archives, official provincial yearbooks, and infant and child mortality records contained in the 1988 National Survey of Fertility and Contraception. Although exploratory, our results suggest that gains in school enrolment and public health campaigns together are associated with 55-70 per cent of China’s dramatic reductions in infant and under-five mortality during our study period. These results underscore the importance of non-medical determinants of population health – and suggest that, under some circumstances, general education of the population may amplify the effectiveness of public health interventions.

We estimate the degree of supplier-induced demand for newborn treatment by exploiting changes in reimbursement arising from the introduction of the partial prospective payment system (PPS) in Japan. Under the partial PPS, neonatal intensive care unit (NICU) utilization became relatively more profitable than other procedures, since it was excluded from prospective payments. We find that hospitals have responded to PPS adoption by increasing NICU utilization and by more frequently manipulating infants’ reported birth weights which in large part determine their maximum allowable stay in the NICU. This induced demand substantially increases the reimbursements received by hospitals.

Published: Shigeoka, Hitoshi, and Kiyohide Fushimi. "Supplier-induced demand for newborn treatment: Evidence from Japan." Journal of health economics 35 (2014): 162-178.

June 2020 Update:
Dr. Do wins the 2020 Rothman Epidemiology Prize for this article that has been selected as the best paper published in the journal Epidemiology in 2019.
View the announcement of the editors and editorial board of Epidemiology and our news post.

November 2019 Update: 
Paper published: Do, Young Kyung. "Causal Effect of Sleep Duration on Body Weight in Adolescents: A Population-based Study Using a Natural Experiment." Epidemiology 30, no. 6 (2019): 876-884.

Despite a large number of observational studies consistently reporting the association between shorter sleep duration and higher body weight, causality has yet to be established at a population level. This study aims to estimate the population-level causal effect of sleep duration on adolescent body weight, using an instrumental variable (IV) approach that exploits a unique natural experiment in the context of South Korea’s highly competitive secondary education. In March 2011, amid growing concerns over the negative consequences of late-night tuition at private tutoring institutes (hagwon), authorities in 3 of the 16 administrative regions in South Korea decreed adjusting the closing hours of hagwon to 10 p.m. This policy change caused a substantial and plausibly exogenous variation in the sleep duration of the “marginal student,” whose sleep duration is most likely to be affected by the policy. The IV estimation results on a sample of general high school 10^th- and 11^th-graders in the 2009−2012 Korea Youth Risk Behavior Web-based Survey show that a 1-hour increase in sleep duration led to a 0.56 kg/m² reduction in body mass index, or a 4.3 percentage-point decrease in overweight/obesity. Short sleep duration among adolescents may be an important contributor to increased body weight at the population level.

How do demand- and supply-side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China’s Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient-level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out-of-pocket spending did not change, when taking account of patient utilization outside primary care.

This paper has been published: Brian Chen, Y. Tony Yang, and Karen Eggleston, 2017.  Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China’s 2009 Healthcare Reform,” World Medical & Health Policy 9(1): 24–44."