nep-hea New Economics Papers
on Helth Economics
Issue of 2004‒12‒12
six papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Efficient Estimation of Mortality Rates Using Micro and Macro Data By Derek S. Brown; Holger Sieg
  2. Competition Among Hospitals By Martin Gaynor; William Vogt
  3. The Importance of Sickness Benefits Rights for a Comparison of Wages By Selén, Jan; Ståhlberg, Ann-Charlotte
  4. Health Effects of Stress and Insecurity among Employees in the Banking Sector - Comparison with Employees in other Sectors By Gianfranco Domenighetti; Jacqueline Quaglia; Annamaria Fahrlaender; Michele Tomamichel; Alain Kiener
  5. Evidence of Construct Validity for Stoke and Arthritis in a Population Health Survey By Paul Grootendorst; David Feeney; W. Furlong
  6. Social Cohesion and Health By J. Lavis; Greg Stoddart

  1. By: Derek S. Brown; Holger Sieg
    Abstract: Dynamic discrete choice models are a well established and widely used methodology to study behavior of older individuals. A key aspect of the analysis is to characterize life expectancy and how it is affected by behavioral choices. Researchers, therefore, need to estimate conditional mortality rates to implement these estimators. However, publicly available data sets which follow older individuals are often not large enough to get reliable estimates of mortality rates. Hence estimates of conditional mortality probabilities may not be informative since they have large estimated standard errors. Imbens and Lancaster (1994) have recently proposed a solution to this problem. The key idea is to obtain a more efficient estimator by combining panel data with aggregate data. Following this approach, we estimate qualitative response models of mortality rates by combining panel data from the Health and Retirement Survey with aggregate data from U.S. life tables. Our empirical results show that the Imbens and Lancaster estimator achieves significant efficiency gains over simpler estimators which ignore macro data. We also find that the estimated coefficients of the mortality model change significantly as we add additional orthogonality conditions based on life tables in estimation. These finding supports our conjecture that estimators based on simple qualitative response models may be subject to small sample bias. Finally, we illustrate that the improvements in estimation of mortality probabilities can have significant consequences for evaluating public policies. We consider simple life-cycle computations of health care expenditures associated with smoking and heavy drinking.
  2. By: Martin Gaynor; William Vogt
    Abstract: Our objective is to determine the effect of ownership type (for-profit, not-for-profit, government) on firm conduct in hospital markets. Secondary objectives include estimating hospital demand systems useful for market definition and merger simulation. To this end, we estimate a structural model of demand and pricing in the short term hospital industry in California, and then use the estimates to simulate the effect of a merger. Demand is modeled at the level of individual consumers using discrete choice techniques and micro data on individuals. Price in the demand equation is endogenous, and we use recently developed instrumental variables techniques to correct for this. We allow the behavior of for-profit and not-for-profit firms to differ, modeling these differences structurally following the relevant theory literature. We find that California hospitals in 1995 faced a downward-sloping demand for their products, with an average price elasticity of demand of -5.67. Not-for-profit hospitals face less elastic demand and have lower marginal costs. Their prices are lower, but markups are higher than those of for-profits. We simulate the effects of the 1997 merger of two hospital chains. In unconcentrated markets such as Los Angeles and San Diego, the merger has virtually no effect on prices. However, in San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 58%, and the predicted price increase would not be substantially smaller were the chains to be not-for-profit.
    Date: 2002–11
  3. By: Selén, Jan (Trade Union Institute for Economic Research (FIEF)); Ståhlberg, Ann-Charlotte (Swedish Institute for Social Research, Stockholm University)
    Abstract: In a total wage concept we include fringe benefits and earnings-related insurance rights, in addition to money wage. Sickness benefit rights are an important part of insurance rights in many industrial countries. In this paper we analyse sickness benefit insurance rights and estimate their importance compared to money wage, as well as for wage differentials and wage dispersion for Sweden. The estimation of money value for the sickness benefit rights requires data on absences due to sickness, data not readily available since the first part of a sickness period is handled by the employer. Data from registers and interview data from different surveys are combined in order to describe sickness behaviour and sickness remuneration of different occupational groups.
    Keywords: Absenteeism; Non-wage benefits; Occupational insurance; Social insurance; Sickness benefit insurance.
    JEL: J22 J32 J33 J38
    Date: 2001–06–01
  4. By: Gianfranco Domenighetti; Jacqueline Quaglia; Annamaria Fahrlaender; Michele Tomamichel; Alain Kiener
    Abstract: This study measures, on a representative sample of employees in the banking sector (N=428), the prevalence of 18 work condition factors which may have an influence on the levels of stress and insecurity. The analysis then points out the relationship between these two latter factors and 16 health indicators of subjective morbidity and medical consumption. The main results show a significant increase in the prevalence of subjective morbidity and medical consumption with the increase in exposure to a "medium to high" level of fear of dismissal and to a continuous level of stress in the previous 12 months. The comparative analysis carried out on a representative sample of employees in other economic sectors (N=859) shows that employees in the banking sector declare higher levels of stress and insecurity and show evidence of significantly worse health indicators with respect to those of employees working in other sectors.
    Keywords: economic development; labour market; unemployment; job insecurity; deprivation; health; public health; health impact assessment
    JEL: A13 E24 E60 H10 I12 I30 J20 J6 K2 L20 O11
    Date: 2004–10
  5. By: Paul Grootendorst; David Feeney; W. Furlong
    Abstract: Background The Health Utilities Index Mark 3 (HUI3) is a comprehensive, compact health status classification and health state preference system. The HUI3 system has been implemented in 4 Canadian population health surveys. Objectives To evaluate the construct validity of the HUI3 for the measurement of health related quality of life (HRQL) and attribute-specific morbidity of respondents to the 1990 Ontario Health Survey reported to have arthritis or stroke. We tested (1) whether those with stroke, arthritis, and both conditions had lower HRQL than those with neither condition; (2) whether HUI3 detects morbidity in specific health attributes affected by arthritis and stroke. We expected stroke to affect primarily speech and cognition, arthritis to affect primarily pain and neither condition to affect vision or hearing. Research Design Linear regression models of global HRQL, 8 measures of attribute-specific utilities and logit regression models of 8 measures of attribute-specific functional disability were estimated as a function of 3 illness indicators (stroke only, arthritis only, both) and a set of variables included to reduce confounding. Results Subjects with stroke, arthritis and both conditions had substantially lower HRQL than those with neither condition. Stroke subjects had greater morbidity in speech and cognition than arthritics; somewhat surprisingly stroke subjects endured burdens of pain similar to arthritics; neither condition affected vision or hearing. The tests were robust to several different model specifications. Conclusions The HUI3 system appears to be valid for the measurement of health status and HRQL for stroke and arthritis.
    Date: 1999–09
  6. By: J. Lavis; Greg Stoddart
    Abstract: More social cohesion has been posited to lead to "more" health; less social cohesion has been posited to lead to "less" health. As well, government performance may influence or be influenced by both social cohesion and health. After defining each of these constructs, we describe changes in measures of these constructs over time (between 1981 and 1990) in Canada, the individual-level factors that are associated with high levels of these measures in Canada, and how these levels compare with those in other G7 countries. We then develop a conceptual framework within which relationships between social cohesion and health can be considered and present the results of new empirical research regarding these relationships in G7 countries. Finally, we synthesize and critically appraise empirical research to inform discussions about the strength of some of these relationships, specifically those involving selected pathways through the determinants of health. We conclude that social cohesion can have significant health consequences (through, for example, known health determinants like income distribution, employment and working conditions, and social support) and that the concepts related to social cohesion don't need reconciliation so much as they need links to the "right" policy environment.
    Date: 1999–10

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