Publications

The effect of primary care availability on antibiotic consumption in Hungary: a population based panel study using unfilled general practices (Bíró, Elek 2019)

BMJ Open; 9:e028233. doi: 10.1136/bmjopen-2018-028233 Objective We analyse the effect of primary care availability on antibiotic consumption and on the quality of antibiotic prescribing behaviour. Design Retrospective panel design, secondary analysis of settlement-level administrative panel data (n=2320 settlements, T=72 months). Participants and setting We analyse antibiotic consumption of the population of villages in Hungary, over years 2010 to 2015. We exploit the geographical and time variation in unfilled (mainly single-handed) general practices as a source of exogenous variation in the availability of primary care. We control for socioeconomic characteristics and settlement fixed effects in a panel regression framework. Outcome measures Antibiotic expenditures and days of therapy (DOT);...

Health Differences at Birth between Roma and non‐Roma Children in Hungary: Long‐run Trends and Decomposition (Hajdu, Kertesi, Kézdi, 2019)

Population and Development Review, DOI: 10.1111/padr.12276 This paper uses birth records linked to census data to document health differences at birth between Roma and non-Roma children in Hungary between 1981 and 2010. It focuses on differences in average birth weight and average gestational age, as well as the likelihood of low birth weight and the likelihood of preterm birth. The paper shows large gaps in all indicators over the 30 years, with a small narrowing of the gap in absolute terms but not in relative terms. Roma mothers are twice as likely to give birth to babies with low birth weight...

Reduced user fees for antibiotics under age 5 in Hungary: Effect on antibiotic use and imbalances in the implementation (Anikó Bíró, 2019)

PLoS ONE, 14(6): e0219085. DOI: 10.1371/journal.pone.0219085 Objectives In August 2016, new prescription guidelines were introduced in Hungary to reduce the co-payments for antibiotics among children aged 0-4. This study aims at analysing the implementation of this policy and its effect on the use of antibiotics. Methods The analysis is based on administrative prescription records between January 2010—February 2018, covering the entire population of Hungary aged 0-7. Spatial autocorrelation indices are calculated and settlement level regression models are estimated to analyse the spatial variation in the application of the new guidelines. The effect of reduced co-payments on antibiotic use is...

Health gap in post-socialist Central and Eastern Europe: A life-course perspective (Anikó Bíró, Réka Branyiczki, 2019)

in: Börsch-Supan, Axel; Bristle, Johanna; Andersen-Ranberg, Karen; Brugiavini, Agar; Jusot, Florence; Litwin, Howard; Weber, Guglielmo (eds.) (2019): Health and socio-economic status over the life course. First results from SHARE Waves 6 and 7. De Gruyter, Berlin/Boston. ► The origins of the health gap between post-socialist central and eastern Europe and western Europe are analysed ► Health disparities existed even before the transition ► Stressful periods, financial difficulties and job losses around the transition are associated with worse health at older ages

The closer the better: does better access to outpatient care prevent hospitalization? (Péter Elek, Balázs Váradi, 2019)

The European Journal of Health Economics, https://doi.org/10.1007/s10198-019-01043-4 In 2010–2012, new outpatient service locations were established in poor Hungarian micro-regions. We exploit this quasi-experiment to estimate the extent of substitution between outpatient and inpatient care. Fixed-effects Poisson models on individual-level panel data for years 2008–2015 show that the number of outpatient visits increased by 19% and the number of inpatient stays decreased by 1.6% as a result, driven by a marked reduction of potentially avoidable hospitalization (PAH) (5%). In our dynamic specification, PAH effects occur in the year after the treatment, whereas non-PAH only decreases with a multi-year lag. The instrumental variable...

How does retirement affect health care expenditures? Evidence from a change in the retirement age (Anikó Bíró, Péter Elek, 2018)

Health Economics, 27(5): 803-818. DOI: 10.1002/hec.3639 Using individual‐level administrative panel data from Hungary, we estimate causal effects of retirement on outpatient and inpatient care expenditures and pharmaceutical expenditures. Our identification strategy is based on an increase in the official early retirement age of women, using that the majority of women retire upon reaching that age. According to our descriptive results, people who are working before the early retirement age have substantially lower healthcare expenditures than nonworkers, but the expenditure gap declines after retirement. Our causal estimates from a two‐part (hurdle) model show that the shares of women with positive outpatient...

Smoking ban and health at birth: Evidence from Hungary (Tamás Hajdu, Gábor Hajdu, 2018)

Economics and Human Biology, 30, 37-47. https://doi.org/10.1016/j.ehb.2018.05.003 In 2012, smoking restrictions were extended to hospitality venues in Hungary. Women working in bars and restaurants were primarily affected by the intervention. In this research, we analyze the effect of this smoking ban on the outcomes of their pregnancies. Using individual live birth, fetal loss, and infant mortality registry data, we examine the probability of live birth, indicators of health at birth, and the probability of death in the first year of life. We apply a difference-in-differences framework and show that the smoking ban has improved health at birth. We observed birth...

Adaptation or recovery after health shocks? Evidence using subjective and objective health measures (Anikó Bíró, Petra Baji, 2018)

Health Economics, 27(5): 850-864. DOI: 10.1002/hec.3644 In this paper, we analyse the effect of an onset of a health shock on subjective survival probability and compare it with objective survival probability and self‐reported health measures. In particular, we are interested in whether expectations of people respond to health shocks and whether these follow the evolution of objective life expectations and self‐reported health measures over time. Using longitudinal data from the Health and Retirement Study, we estimate fixed effects models of adaptation for the objective and subjective survival probabilities and for some self‐reported health measures. The results show that after cancer...

Implication of external price referencing and parallel trade on pharmaceutical expenditure: indirect evidence from lower-income European countries (Péter Elek et al., 2017)

Elek, P., Takács, E., Merész, G., & Kaló, Z. Health Policy and Planning, 32(3), 349-358. External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that—after controlling for compounding factors such as GDP, the proportion of the...