nep-hea New Economics Papers
on Health Economics
Issue of 2005‒03‒20
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Social interactions and the contemporaneous determinants of individuals’ weight By Joan Costa-Font; Joan Gil
  2. Demographic Uncertainty and Health Care Expenditure in Spain By Namkee Ahn; Juan Ramón García; José A. Herce
  3. Poverty, Inequality and Health: А case study of Armenia By Tamara Tonoyan
  4. Happy Birthday! You are Insured - Differences in Work Ethics Between Female and Male Workers By Skogman Thoursie, Peter
  5. Nonprofit/For-Profit Status and Earning Differentials in the Japanese At-home Elderly Care Industry: Evidence from Micro-level Data on Home Helpers and Staff Nurses By Haruko Noguchi; Satoshi Shimizutani
  6. The Effect of the 1998 Master Settlement on Prenatal Smoking By Douglas E. Levy; Ellen Meara
  7. Reading, Writing and Raisinets: Are School Finances Contributing to Children's Obesity? By Patricia M. Anderson; Kristin F. Butcher
  8. Out-of-Pocket Health Spending Between Low- and High-Income Populations: Who is at Risk of Having High Financial Burdens? By Yu-Chu Shen; Joshua McFeeters
  9. Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals By Robert S. Huckman; Jason Barro
  10. Hospital Ownership Mix Efficiency in the US: An Exploratory Study By Rexford E. Santerre; John A. Vernon

  1. By: Joan Costa-Font; Joan Gil
    Abstract: Obesity and overweight are central issues in the public health debate in most developed countries. In this debate, some of the socio-economic determinants of obesity and overweight are still relatively unexplored. This paper presents an empirical examination of the possible influence of social interactions on contemporaneous obesity and (over)underweight. We apply a joint estimation model for obesity and self-image to a sample for Spain taken from the European Union household panel for 1998. Our results suggest that obesity might be in part a social phenomenon connected to individuals’ social life
  2. By: Namkee Ahn; Juan Ramón García; José A. Herce
    Abstract: Usual projections of health care expenditure combine age-sex profiles of health expenditure and scenarios of population projection. However, it has been shown repeatedly that both age-sex specific health expenditures and the population structures in the future are highly uncertain and most projections turned out wrong. Therefore, the projections based on the traditional approach are often unhelpful in evaluating future health care expenditures. In this project we try to improve upon the existing literature by incorporating uncertainties in population projection and future age-sex specific health expenditure. Combining the stochastic population projection with age-specific health expenditure we obtain probabilistic distributions of health expenditure. The median projection shows that public health expenditure will increase by about 40% during the next 47 years, that is, an average annual increase of 0.74%. There is a 10% chance that the expenditure will increase by more than 66% during the projection period, which corresponds to an annual increase of 1.1%. At the optimistic side the total public health expenditure will grow only by 17% (0.35% annual) with a 10% probability. The main part of the increase in total expenditure is driven by the increase in average per-capita expenditure due to ageing. The average per-capita expenditure increases by 33%, from 980 in 2004 to 1307 euros in 2050. If we assume that real per-capita public health expenditure increases by the same rate as per-capita GDP, the share of the public health expenditure in GDP will increase from 5% today to 6.7% in 2050, solely due to demographic change. One factor that could reduce the expenditure pressure in the future is that with decreasing mortality rate there will be fewer people in their last year of life. This, combined with the fact that a major part of health expenditure is driven by decedents, could reduce future health expenditure. Our estimation suggests that distinguishing hospital costs by survival status could reduce somewhat (by about 8%) total hospital expenditure in 2049
  3. By: Tamara Tonoyan (Armenian Medical Institute)
    Abstract: The paper describes the issue of the impact of poverty and income inequality on the health of the population using Armenia as a case study. In the framework of this paper author provides an overview of research relating to inequalities in health to the disadvantage of the poor, and to changes in impoverishment and income inequality associated with payments for health care. After demonstrating the logic of the investigation, the paper recapitulates the information about results of reforms that do not appear to meet all the objectives of health care policy. The paper indicates that the gains in freedom have been accompanied by the losses of many basic economic and social services that the population had come to enjoy and expect. At the same time the success of reforms applied in Armenia is often evaluated against improvements in the health status of the population. Funding shortages often means that even vulnerable groups have to pay. Thus, the principle of equity with respect to financing and access is undermined. It is emphasized that reducing poverty and income inequality should be grounded in a pro-poor growth approach, i.e. for equality to be achieved economic growth in the development process should be deliberately adapted to the needs of the poor. The paper concludes that there is undoubtedly a large gap in our knowledge on how best to reach the poor in the health sector. In order to fill this gap, more work is needed along the lines of the above studies related to health sector inequalities and public policy. There is necessity to encourage the development of insurance companies, pension funds, and funds for public health care education, which have not yet been properly undertaken.
    Keywords: poverty, inequality, health, income distribution
    JEL: D63 I11 I12 I18
    Date: 2005–02–01
  4. By: Skogman Thoursie, Peter (FIEF)
    Abstract: In this paper information on individual birth dates is used as a natural experiment when estimating potential cheating behavior within the Swedish sickness insurance program. In the psychological literature there are theories why men and women react differently to ethical situations. Results in this paper are in line with these theories. The results indicate that only younger male workers cheated which supports the idea that men have lower work ethics. But additional findings also suggest that younger male workers do have some shame since they reported sick to a significant less extent the week before they had their birthday. In fact the net change in reporting sick is zero.
    Keywords: Reporting sick; Cheating; Work ethics; Natural experiment
    JEL: J22 J29
    Date: 2005–03–14
  5. By: Haruko Noguchi; Satoshi Shimizutani
    Abstract: In April 2000, Japan embarked on a reform of its health care market. Along with the introduction of the long-term care insurance scheme, the government for the first time allowed for-profit operators to compete head-on with non-profit operators in the provision of at-home care services. Taking advantage of a unique and rich micro-level survey, this study is the first to examine wage differentials between the nonprofit and the for-profit sector in Japan's nursing care industry, concentrating on home helpers and staff nurses. Controlling for nonrandom unobserved selection biases, our results show that a nonprofit wage premium exists. This finding supports the hypothesis that nonprofit providers operate under non-distributional constraints.
    Keywords: Japanese long-term care insurance, long-term care, nursing home, home helpers, staff nurses, nonprofit wage premium, quality of care, Heckman's two-stage approach
    JEL: I11
    Date: 2005–02
  6. By: Douglas E. Levy; Ellen Meara
    Abstract: The Master Settlement Agreement (MSA) between the major tobacco companies and 46 states created an abrupt 45 cent (21%) increase in cigarette prices in November, 1998. Earlier estimates of the elasticity of prenatal smoking implied that the price rise would reduce prenatal cigarette smoking by 7% to 21%. Using birth records on 10 million U.S. births between January 1996 and February 2000, we examined the change in smoking during pregnancy and conditional smoking intensity in response to the MSA. Overall, adjusting for secular trends in smoking, prenatal smoking declined much less than predicted in response to the MSA.
    JEL: I12 I18
    Date: 2005–03
  7. By: Patricia M. Anderson; Kristin F. Butcher
    Abstract: The proportion of adolescents in the United States who are obese has nearly tripled over the last two decades. At the same time, schools, often citing financial pressures, have given students greater access to "junk" foods, using proceeds from the sales to fund school programs. We examine whether schools under financial pressure are more likely to adopt potentially unhealthful food policies. We find that a 10 percentage point increase in the probability of access to junk food leads to about a one percent increase in students' body mass index (BMI). However, this average effect is entirely driven by adolescents who have an overweight parent, for whom the effect of such food policies is much larger (2.2%). This suggests that those adolescents who have a genetic or family susceptibility to obesity are most affected by the school food environment. A rough calculation suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade.
    JEL: I1 I2 J1
    Date: 2005–03
  8. By: Yu-Chu Shen; Joshua McFeeters
    Abstract: We examined characteristics of people with little, moderate, and high burden of out-of-pocket health spending separately for low-income (below 200% of Federal Poverty Line) and higher-income populations. We find that public insurance appears to offer the best financial protection against high out-of-pocket burden. People with private non-group coverage, regardless of their income levels, have the highest risk of being exposed to high out-of-pocket burden. Low-income adults with employer-sponsored insurance are also more likely to be in high burden group than the low-income uninsured adults. For higher-income families, having a family member in fair or poor health is another significant risk factor to increase the likelihood of high out-of-pocket burden. Increasing presence of HMO and Federally Qualified Health Centers appear to have lowered the odds of being in the high-burden category relative to low-burden category, especially for the low-income group.
    JEL: I1
    Date: 2005–03
  9. By: Robert S. Huckman; Jason Barro
    Abstract: The impact of labor turnover on productivity has received a great deal of attention in the literature on organizations. We consider the impact of cohort turnover %u2013 the simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers %u2013 on productivity in the context of teaching hospitals. In particular, we examine the impact of the annual July turnover of house staff (i.e., residents and fellows) in American teaching hospitals on levels of resource utilization (measured by risk-adjusted length of hospital stay) and quality (measured by risk-adjusted mortality rates). Using patient-level data from roughly 700 hospitals per year over the period from 1993 to 2001, we compare monthly trends in length of stay and mortality for teaching hospitals to those for non-teaching hospitals, which, by definition, do not experience systematic turnover in July. We find that the annual house-staff turnover results in increased resource utilization (i.e., higher risk-adjusted length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher risk-adjusted mortality rates) for major teaching hospitals. Further, these effects with respect to mortality are not monotonically increasing in a hospital%u2019%u2019s reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover. We provide a preliminary examination of the roles of supervision and worker ability in explaining the ability of the most-intensive teaching hospitals to reduce turnover%u2019%u2019s negative effect on performance.
    JEL: I1 J0
    Date: 2005–03
  10. By: Rexford E. Santerre; John A. Vernon
    Abstract: This paper offers an empirical test of ownership mix efficiency in the U.S. hospital services industry. The test compares the benefits of quality assurance with the costs from the attenuation of property rights that result from an increased presence of nonprofit organizations. The empirical results suggest that too many not-for-profit and public hospitals may exist in the typical market area of the U.S. The policy implication is that more quality of care per dollar might be obtained by attracting a greater percentage of for-profit hospitals into some market areas. This conclusion, however, is tempered with several caveats. We discuss these and also make recommendations for further research.
    JEL: I1 L3 L2
    Date: 2005–03

This nep-hea issue is ©2005 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.