The Production of Perinatal Health in Scotland

Forbes, John Franklin (1989) The Production of Perinatal Health in Scotland. PhD thesis, University of Glasgow.

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This thesis presents an economic perspective on the determinants of perinatal mortality in post-war Scotland. Unlike previous work which has used cross-sectional data, the focus is on developing and testing models which may provide a more informed explanation for the improvement in perinatal mortality over time. The theory of investment in human capital and the application of this paradigm to the study of health and health related behaviour is surveyed as a way of developing a more precise taxonomy for identifying the principal sources of change in Scottish perinatal mortality. Empirical studies of health during the earliest stages of the life cycle which employ the human capital theoretical framework are reviewed. Post-war trends in Scottish perinatal mortality are investigated using a time series of dis-aggregated perinatal mortality rates that have been constructed especially for use in the estimates of the health production functions presented in this thesis. A model is also developed for describing the post-war pattern of public expenditure on perinatal hospital services in Scotland. A perinatal hospital service demand equation is specified in terms of the share of NHS hospital expenditure devoted to the perinatal hospital sector which is related to real NHS hospital expenditure (income), relative hospital prices and policy targets and indicators of the need for perinatal services. Total public spending on hospital care appears to have had no consistent and clear impact on the perinatal hospital budget share. Relative prices or costs of perinatal care in relation to other forms of hospital care are important determinants of expenditure. A partial adjustment model suggested that virtually all the adjustment required to achieve desired perinatal budget shares occurs within five years. An error correction model also supported the hypothesis that disequilibirium between target and actual perinatal shares was an important determinant of the change in budget shares over time. The health production function estimates quantify the relative impact of medical and nursing labour inputs, hospital capital inputs, hospital expenditure and population factors on perinatal mortality. A variety of functional forms are tested against each other using a general to specific approach to estimation and testing. Alternative ways of augmenting the production function by introducing empirical measures of technical change are investigated. Production functions are presented for a range of mortality rates in different age and birthweight groups. The results confirmed that hospital medical and nursing inputs are important determinants of perinatal mortality across different birthweight strata. Increases in the num- ber of obstetricians and nurses have a beneficial and similar impact on mortality in low birthweight infants. Nurses also appear to have a more important impact on mortality in the normal weight infant. Decreases in the bed stock are associated with improvements in perinatal mortality, particularly for low birthweight infants. In terms of cost per life year gained, investment in perinatal hospital services has generated health outcomes at a cost which is lower than many other health care programmes whose costs and effectiveness have been evaluated from an economic perspective. Finally, the possible links between income, unemployment and infant health are investigated. The main findings failed to support the hypothesis that unemployment excerts an impact on perinatal and post-neonatal mortality, let alone an adverse impact. In addition, measures of economic instability (short and long-run changes in economic growth) seem to play little role in determining the chances of survival of new born children.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Economics
Date of Award: 1989
Depositing User: Enlighten Team
Unique ID: glathesis:1989-78236
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Feb 2020 12:09
Last Modified: 28 Feb 2020 12:09

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