Hugh Waters - Academia.edu (original) (raw)
Papers by Hugh Waters
The American journal of drug and alcohol abuse, 2016
Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of... more Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of alcohol sales taxes on sales of specific alcoholic beverages have received little research attention. Data on sales are generally less subject to reporting biases than self-reported patterns of alcohol consumption. We aimed to assess the effects of Maryland's July 1, 2011 three percentage point increase in the alcohol sales tax (6-9%) on beverage-specific and total alcohol sales. Using county-level data on Maryland's monthly alcohol sales in gallons for 2010-2012, by beverage type, multilevel mixed effects multiple linear regression models estimated the effects of the tax increase on alcohol sales. We controlled for seasonality, county characteristics, and national unemployment rates in the main analyses. In the 18 months after the tax increase, average per capita sales of spirits were 5.1% lower (p < 0.001), beer sales were 3.2% lower (p < 0.001), and wine sales were 2.5%...
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.
En este trabajo se evalúa la eficacia del sistema de salud pública y del seguro privado de salud ... more En este trabajo se evalúa la eficacia del sistema de salud pública y del seguro privado de salud en Brasil para dar protección financiera al cuidado de la salud. Los factores determinantes de los gastos catastróficos en salud se estiman mediante regresiones probit con control de ajustes de selección de Heckman en materia de necesidad de atención de salud. Se concluye que con el sistema público se reduce considerablemente (47%) la probabilidad de que una familia tenga gastos de salud catastróficos y que con un seguro privado esto resulta 36% más probable. Las recomendaciones que se formulan apuntan al mejoramiento de la cantidad, accesibilidad, calidad y confiabilidad de los prestadores públicos de servicios de salud, a una provisión más adecuada de medicamentos por el sistema público y a una regulación más estricta del seguro privado de salud.
US Agency for International Development Bureau for Global Programs Office of Population Contract ... more US Agency for International Development Bureau for Global Programs Office of Population Contract No. CCP-3024-Q-00-3012 Project No. 936-3024 ... Population Technical Assistance Project 1611 North Kent Street, Suite 508 Arlington, VA 22209 USA Phone: 703/247-8630 Fax: ...
Bulletin of the World Health Organization, 2000
This paper summarizes eight country studies of inequality in the health sector. The analyses use ... more This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worth...
Journal of Health Politics, Policy and Law, 2008
This article provides an overview of the current role of private health insurance and private car... more This article provides an overview of the current role of private health insurance and private care management organizations around the globe. We describe past experiences and challenges associated with the export of U.S.-style managed care. We provide a framework for understanding the potential opportunities within a national health system for expanding managed care approaches and also private health insurance more generally. This article is relevant to both the United States and members of the international community.
Health Affairs, 2008
Health insurance systems in Central and Eastern Europe have evolved in different ways from the ce... more Health insurance systems in Central and Eastern Europe have evolved in different ways from the centralized health systems inherited from the Soviet era, but there remain common trends and challenges in the region. Health spending is low in comparison to the spending of pre-2004 European Union members, but population aging, medical technology, economic growth, and heightened expectations will generate major spending pressures. Social health insurance is the dominant model in the region, but coverage is uneven. Key reform issues include identifying ways to encourage additional investment in the health sector; and defining formal benefit packages, copayments, and the role of private insurance. [Health Affairs 27, no. 2 (2008): 478-486; 10.1377/hlthaff.27.2.478] 4 7 8 M a r c h /A p r i l 2 0 0 8
ABSTRACT For humanitarian reasons and the concern for households' economic and health sec... more ABSTRACT For humanitarian reasons and the concern for households' economic and health security, the health sector is at the center of global development policy. Developing countries and the international community are scaling up health systems to meet the Millennium Development Goals (MDGs) and are improving financial protection by securing long-term support for these gains. Yet money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills; well structured, results-based financing reforms are needed. Unfortunately, global evidence of "successful" health financing policies that can guide the reform effort is very limited and therefore the policy debate is often driven by ideological, one-size-fits-all solutions.Good Practices in Health Financing: Lessons from Reforms in Low- and Middle-Income Countries attempts to begin to fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The participating countries are: Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. The study seeks to identify common enabling factors of their good performance. While the findings for each country are important, collectively they send a clear message to the global community that more attention is needed to define "good practice" and then to evaluate and disseminate the global evidence base.
El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarril... more El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarrillos incrementaría el impuesto total, con IVA incluido, a 75% del precio de venta al público, prevendría casi 1 millón de muertes y generaría ingresos fiscales de más de 41,000 millones de pesos en 2013".
El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarril... more El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarrillos incrementaría el impuesto total, con IVA incluido, a 75% del precio de venta al público, prevendría casi 1 millón de muertes y generaría ingresos fiscales de más de 41,000 millones de pesos en 2013".
stagingglobal.tobaccofreekids.org
excise tax component to 20 pesos per pack by 2013 would increase total tax inclusive of VAT to 75... more excise tax component to 20 pesos per pack by 2013 would increase total tax inclusive of VAT to 75% of retail price, prevent nearly 1 million deaths, and raise excise tax revenues of over 41 billion pesos."
North Carolina Medical Journal, 2011
BACKGROUND: The health hazards of exposure to secondhand smoke (SHS) are well-defined. Less is kn... more BACKGROUND: The health hazards of exposure to secondhand smoke (SHS) are well-defined. Less is known about the economic costs. We performed an analysis of the medical costs of SHS in North Carolina that was based on a similar study conducted in Minnesota.METHODS: We used 2006 Blue Cross and Blue Shield of North Carolina claims data and national and state surveillance data to calculate the treated prevalence of medical conditions that have been found to be related to exposure to SHS, as established by a 2006 report from the US surgeon general. We used the population attributable risk for these conditions to calculate the number of individuals whose episodes of illness could be attributed to exposure to SHS. We adjusted these treatment costs for other types of insurance provided in the state, using Medical Expenditure Panel Survey data.RESULTS: The total annual cost of treatment for conditions related to SHS exposure in North Carolina was estimated to be 293,304,430,in2009inflation−adjusteddollars.Sensitivityanalysisshowedarangeof293,304,430, in 2009 inflation-adjusted dollars. Sensitivity analysis showed a range of 293,304,430,in2009inflation−adjusteddollars.Sensitivityanalysisshowedarangeof208.2 million to $386.3 million. The majority of individuals affected were children, but the greatest costs were for cardiovascular conditions.CONCLUSION: These cost data provide additional rationale for regulating smoking in all work sites and public places.
International Journal of Environmental Research and Public Health, 2011
Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and prema... more Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the OPEN ACCESS Int. J. Environ. Res. Public Health 2011, 8 1272 cost-effectiveness ratio ranges from 2to2 to 2to112 per LY gained and 37to37 to 37to386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.
This study calculates the economic costs of exposure to secondhand tobacco smoke (SHS) in Marylan... more This study calculates the economic costs of exposure to secondhand tobacco smoke (SHS) in Maryland -for individuals, employers, and society as a whole. The total costs reported in this study for calendar year 2005 are as follows:
Health Economics
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.
Social Science & Medicine, 2000
This article develops and uses methodologies to: (1) measure equity in the distribution of access... more This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to health care Ð a concentration coecient derived from the Gini coecient, and the Atkinson distributional measure Ð and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article de®nes access as the use of health care by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose aliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic health care demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted percapita household expenditure. The study also predicts health care use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to health care, but has a negative impact on equity in the distribution of health services. The bene®ts of the program, calculated as its marginal impact on the probability of using of health care, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the bene®t more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar eects, although less important in magnitude. 7
Health Economics, 1999
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.
The American journal of drug and alcohol abuse, 2016
Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of... more Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of alcohol sales taxes on sales of specific alcoholic beverages have received little research attention. Data on sales are generally less subject to reporting biases than self-reported patterns of alcohol consumption. We aimed to assess the effects of Maryland's July 1, 2011 three percentage point increase in the alcohol sales tax (6-9%) on beverage-specific and total alcohol sales. Using county-level data on Maryland's monthly alcohol sales in gallons for 2010-2012, by beverage type, multilevel mixed effects multiple linear regression models estimated the effects of the tax increase on alcohol sales. We controlled for seasonality, county characteristics, and national unemployment rates in the main analyses. In the 18 months after the tax increase, average per capita sales of spirits were 5.1% lower (p < 0.001), beer sales were 3.2% lower (p < 0.001), and wine sales were 2.5%...
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.
En este trabajo se evalúa la eficacia del sistema de salud pública y del seguro privado de salud ... more En este trabajo se evalúa la eficacia del sistema de salud pública y del seguro privado de salud en Brasil para dar protección financiera al cuidado de la salud. Los factores determinantes de los gastos catastróficos en salud se estiman mediante regresiones probit con control de ajustes de selección de Heckman en materia de necesidad de atención de salud. Se concluye que con el sistema público se reduce considerablemente (47%) la probabilidad de que una familia tenga gastos de salud catastróficos y que con un seguro privado esto resulta 36% más probable. Las recomendaciones que se formulan apuntan al mejoramiento de la cantidad, accesibilidad, calidad y confiabilidad de los prestadores públicos de servicios de salud, a una provisión más adecuada de medicamentos por el sistema público y a una regulación más estricta del seguro privado de salud.
US Agency for International Development Bureau for Global Programs Office of Population Contract ... more US Agency for International Development Bureau for Global Programs Office of Population Contract No. CCP-3024-Q-00-3012 Project No. 936-3024 ... Population Technical Assistance Project 1611 North Kent Street, Suite 508 Arlington, VA 22209 USA Phone: 703/247-8630 Fax: ...
Bulletin of the World Health Organization, 2000
This paper summarizes eight country studies of inequality in the health sector. The analyses use ... more This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worth...
Journal of Health Politics, Policy and Law, 2008
This article provides an overview of the current role of private health insurance and private car... more This article provides an overview of the current role of private health insurance and private care management organizations around the globe. We describe past experiences and challenges associated with the export of U.S.-style managed care. We provide a framework for understanding the potential opportunities within a national health system for expanding managed care approaches and also private health insurance more generally. This article is relevant to both the United States and members of the international community.
Health Affairs, 2008
Health insurance systems in Central and Eastern Europe have evolved in different ways from the ce... more Health insurance systems in Central and Eastern Europe have evolved in different ways from the centralized health systems inherited from the Soviet era, but there remain common trends and challenges in the region. Health spending is low in comparison to the spending of pre-2004 European Union members, but population aging, medical technology, economic growth, and heightened expectations will generate major spending pressures. Social health insurance is the dominant model in the region, but coverage is uneven. Key reform issues include identifying ways to encourage additional investment in the health sector; and defining formal benefit packages, copayments, and the role of private insurance. [Health Affairs 27, no. 2 (2008): 478-486; 10.1377/hlthaff.27.2.478] 4 7 8 M a r c h /A p r i l 2 0 0 8
ABSTRACT For humanitarian reasons and the concern for households' economic and health sec... more ABSTRACT For humanitarian reasons and the concern for households' economic and health security, the health sector is at the center of global development policy. Developing countries and the international community are scaling up health systems to meet the Millennium Development Goals (MDGs) and are improving financial protection by securing long-term support for these gains. Yet money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills; well structured, results-based financing reforms are needed. Unfortunately, global evidence of "successful" health financing policies that can guide the reform effort is very limited and therefore the policy debate is often driven by ideological, one-size-fits-all solutions.Good Practices in Health Financing: Lessons from Reforms in Low- and Middle-Income Countries attempts to begin to fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The participating countries are: Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. The study seeks to identify common enabling factors of their good performance. While the findings for each country are important, collectively they send a clear message to the global community that more attention is needed to define "good practice" and then to evaluate and disseminate the global evidence base.
El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarril... more El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarrillos incrementaría el impuesto total, con IVA incluido, a 75% del precio de venta al público, prevendría casi 1 millón de muertes y generaría ingresos fiscales de más de 41,000 millones de pesos en 2013".
El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarril... more El aumento del componente específico del impuesto al consumo a 20 pesos por cajetilla de cigarrillos incrementaría el impuesto total, con IVA incluido, a 75% del precio de venta al público, prevendría casi 1 millón de muertes y generaría ingresos fiscales de más de 41,000 millones de pesos en 2013".
stagingglobal.tobaccofreekids.org
excise tax component to 20 pesos per pack by 2013 would increase total tax inclusive of VAT to 75... more excise tax component to 20 pesos per pack by 2013 would increase total tax inclusive of VAT to 75% of retail price, prevent nearly 1 million deaths, and raise excise tax revenues of over 41 billion pesos."
North Carolina Medical Journal, 2011
BACKGROUND: The health hazards of exposure to secondhand smoke (SHS) are well-defined. Less is kn... more BACKGROUND: The health hazards of exposure to secondhand smoke (SHS) are well-defined. Less is known about the economic costs. We performed an analysis of the medical costs of SHS in North Carolina that was based on a similar study conducted in Minnesota.METHODS: We used 2006 Blue Cross and Blue Shield of North Carolina claims data and national and state surveillance data to calculate the treated prevalence of medical conditions that have been found to be related to exposure to SHS, as established by a 2006 report from the US surgeon general. We used the population attributable risk for these conditions to calculate the number of individuals whose episodes of illness could be attributed to exposure to SHS. We adjusted these treatment costs for other types of insurance provided in the state, using Medical Expenditure Panel Survey data.RESULTS: The total annual cost of treatment for conditions related to SHS exposure in North Carolina was estimated to be 293,304,430,in2009inflation−adjusteddollars.Sensitivityanalysisshowedarangeof293,304,430, in 2009 inflation-adjusted dollars. Sensitivity analysis showed a range of 293,304,430,in2009inflation−adjusteddollars.Sensitivityanalysisshowedarangeof208.2 million to $386.3 million. The majority of individuals affected were children, but the greatest costs were for cardiovascular conditions.CONCLUSION: These cost data provide additional rationale for regulating smoking in all work sites and public places.
International Journal of Environmental Research and Public Health, 2011
Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and prema... more Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the OPEN ACCESS Int. J. Environ. Res. Public Health 2011, 8 1272 cost-effectiveness ratio ranges from 2to2 to 2to112 per LY gained and 37to37 to 37to386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.
This study calculates the economic costs of exposure to secondhand tobacco smoke (SHS) in Marylan... more This study calculates the economic costs of exposure to secondhand tobacco smoke (SHS) in Maryland -for individuals, employers, and society as a whole. The total costs reported in this study for calendar year 2005 are as follows:
Health Economics
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.
Social Science & Medicine, 2000
This article develops and uses methodologies to: (1) measure equity in the distribution of access... more This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to health care Ð a concentration coecient derived from the Gini coecient, and the Atkinson distributional measure Ð and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article de®nes access as the use of health care by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose aliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic health care demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted percapita household expenditure. The study also predicts health care use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to health care, but has a negative impact on equity in the distribution of health services. The bene®ts of the program, calculated as its marginal impact on the probability of using of health care, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the bene®t more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar eects, although less important in magnitude. 7
Health Economics, 1999
This article develops and uses methodologies to evaluate the impact of publicly-financed health i... more This article develops and uses methodologies to evaluate the impact of publicly-financed health insurance programmes on the use of health care. Using univariate and bivariate probit estimation techniques, the study tests and corrects for endogeneity resulting from selection bias. Potential endogeneity arises from the choice to be insured, eligibility for insurance, and differences in individuals' health status.