nep-hea New Economics Papers
on Health Economics
Issue of 2005‒05‒07
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Modeling Usage of Medical Care Services: The Medical Expenditure Panel Survey Data, 1996-2000 By Michael Creel; Montserrat Farell
  2. Live and Let Live:Healthcare is a Fundamental Human Right By Anita Pereira
  3. Retirement Age and Health Expenditures By Cremer, Helmuth; Lozachmeur, Jean-Marie; Pestieau, Pierre
  4. Competence indicators in academic education and early labour market success of graduates in health sciences By Semeijn,Judith, H.; Velden,Rolf,van der; Heijke,Hans; Vleuten,Cees,van der; Boshuizen,Henny, P.A.
  5. A note on stochastic survival probabilities and their calibration. By Elisa Luciano; Elena Vigna
  6. On the identification of the effect of smoking on mortality By Jerome Adda; Valérie Lechene
  7. The Incidence of the Healthcare Costs of Obesity By Jay Bhattacharya; M. Kate Bundorf
  8. Employment-Contingent Health Insurance, Illness, and Labor Supply of Women: Evidence from Married Women with Breast Cancer By Cathy J. Bradley; David Neumark; Zhehui Luo; Heather L. Bednarek
  9. The Great Escape: A Review Essay on Fogel's 'The Escape from Hunger and Premature Death, 1700-2100' By Angus Deaton
  10. Advanced Purchase Commitments for a Malaria Vaccine: Estimating Costs and Effectiveness By Ernst R. Berndt; Rachel Glennerster; Michael R. Kremer; Jean Lee; Ruth Levine; Georg Weizsacker; Heidi Williams
  11. Persistent Knowledge Specialisation and Intra-Industry Heterogeneity: an Analysis of the Spanish Pharmaceutical Industry By Pablo D'Este Cukierman
  12. Long Term Consequences Of Early Childhood Malnutrition By Harold Alderman; John Hoddinott; Bill Kinsey

  1. By: Michael Creel; Montserrat Farell
    Abstract: We explore the determinants of usage of six different types of health care services, using the Medical Expenditure Panel Survey data, years 1996-2000. We apply a number of models for univariate count data, including semiparametric, semi-nonparametric and finite mixture models. We find that the complexity of the model that is required to fit the data well depends upon the way in which the data is pooled across sexes and over time, and upon the characteristics of the usage measure. Pooling across time and sexes is almost always favored, but when more heterogeneous data is pooled it is often the case that a more complex statistical model is required.
    Keywords: medical care; count data; maximum likelihood
    JEL: C25 I10
    Date: 2005–04–21
  2. By: Anita Pereira
    Abstract: Healthcare is a fundamental human right. The right to health is as important as the right to food and shelter. Although the United States leads the world in advancing medical technology and science, it significantly lags behind other industrialized nations in regard to the basic human right to health. Healthcare has become a commodity in the United States. The affluent have absolute access to health; the disadvantaged and marginalized are denied this necessary access.
    Keywords: health insurance, poverty, human rights,
  3. By: Cremer, Helmuth; Lozachmeur, Jean-Marie; Pestieau, Pierre
    Abstract: This Paper studies the design of pension benefits and contributions when an individual’s health status (disutility of continued activity) is endogenous and depends on consumption of health services. Health services can be subsidized (in a linear or non-linear way, depending on the information structure). Uniform public provision of health services is also considered. We show that as with exogenous health status, the second-best policy may induce early retirement for some types of individuals. Furthermore, whatever the specific information structure considered (individual levels or anonymous transactions) for health services, a subsidization of health expenditures obtains under fairly plausible assumptions. Third, when the information structure permits only linear subsidies, the case for uniform public provision of health services (which can be supplemented but not resold) appears to be quite strong.
    Date: 2004–12
  4. By: Semeijn,Judith, H.; Velden,Rolf,van der; Heijke,Hans; Vleuten,Cees,van der; Boshuizen,Henny, P.A. (ROA rm)
    Abstract: In this study, the effects of several educational and non-educational indicators of (aspects of) competence on short-term labour market outcomes for university graduates are estimated. The research question we address is: To what extent do indications of specific and generic competence during the educational program predict labour market outcomes? Labour market outcomes in this study pertain to employment chances and quality of the job (having a job, academic level, matching occupational domain and wages). We use data on specific and generic aspects of competence, all of which were assessed during the academic study course, i.e. test scores on the attainment of domain specific knowledge, scores on group functioning, and the Masters’ thesis result. In addition, some other indicators of human capital acquired outside education are used, i.e. relevant work experience and managerial experience. The results indicate a rather differentiated pattern for the value of specific and generic competence acquired during education for the labour market.
    Keywords: labour market entry and occupational careers;
    Date: 2005
  5. By: Elisa Luciano; Elena Vigna
    Abstract: In this note we use doubly stochastic processes (or Cox processes) in order to model the evolution of the stochastic force of mortality of an individual aged x. These processes have been widely used in the credit risk literature in modelling the default arrival, and in this context have proved to be quite flexible and useful. We investigate the applicability of these processes in describing the individual's mortality, and provide a calibration to the Italian case. Results from the calibration are twofold. Firstly, the stochastic intensities seem to better capture the development of medicine and long term care which is under our daily observation. Secondly, when pricing insurance products such as life annuities, we observe a remarkable premium increase, although the expected residual lifetime is essentially unchanged.
    Date: 2005–01
  6. By: Jerome Adda (Institute for Fiscal Studies and University College London); Valérie Lechene (Institute for Fiscal Studies and Wadham College, Oxford)
    Abstract: This paper considers the identification of the effect of tobacco on mortality. If individuals select into smoking according to some unobserved health characteristic, then estimates of the effect of tobacco on health that do not account for this are biased. We show that using information on mortality, morbidity and smoking, it is possible to control for this selection effect and obtain consistent estimates of the effect of smoking on mortality. We implement our method on Swedish data. We show that there is selection into smoking, and considerable dispersion around the average effect, so that health policies that aim at decreasing smoking prevalence and quantities smoked might have less effect in terms of average number of years of life gained than previously estimated. We also empirically show that selection into smoking has increased over the last fifty years with the availability of information on the dangers of smoking, so that future studies comparing smokers and non smokers will spuriously reveal a worsening effect of tobacco on health if they fail to control for selection.
    Keywords: Health, Duration, Smoking, Selection, Mortality, Life Expectancy, Causality.
    JEL: I12
    Date: 2004–02
  7. By: Jay Bhattacharya; M. Kate Bundorf
    Abstract: The incidence of obesity has increased dramatically in the U.S. Obese individuals tend to be sicker and spend more on health care, raising the question of who bears the incidence of obesity-related health care costs. This question is particularly interesting among those with group coverage through an employer given the lack of explicit risk adjustment of individual health insurance premiums in the group market. In this paper, we examine the incidence of the healthcare costs of obesity among full time workers. We find that the incremental healthcare costs associated with obesity are passed on to obese workers with employer-sponsored health insurance in the form of lower cash wages. Obese workers in firms without employer-sponsored insurance do not have a wage offset relative to their non-obese counterparts. Our estimate of the wage offset exceeds estimates of the expected incremental health care costs of these individuals for obese women, but not for men. We find that a substantial part of the lower wages among obese women attributed to labor market discrimination can be explained by the higher health insurance premiums required to cover them.
    JEL: I1 J7
    Date: 2005–05
  8. By: Cathy J. Bradley; David Neumark; Zhehui Luo; Heather L. Bednarek
    Abstract: We examine the effects of employment-contingent health insurance on married women's labor supply following a health shock. First, we develop a theoretical model that examines the effects of employment-contingent health insurance on the labor supply response to a health shock, to clarify under what conditions employment-contingent health insurance is likely to dampen the labor supply response. Second, we empirically evaluate this relationship using primary data. The results from our analysis find that -- as the model suggests is likely -- health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer. Employment-contingent health insurance appears to create incentives to remain working and to work at a greater intensity when faced with a serious illness.
    JEL: I12 J22
    Date: 2005–05
  9. By: Angus Deaton
    Abstract: In this essay, I review Robert Fogel's The Escape from Hunger and Premature Death, 1700-2100 which is concerned with the past, present, and future of human health. Fogel's work places great emphasis on nutrition, not only for the history of health, but for explaining aspects of current health, not only in comparing poor and rich countries, but in thinking about rich countries now and in the future. I discuss Fogel's analysis alongside alternative interpretations that place greater emphasis on the historical role of public health, and on the current and future role of improvements in medical technology.
    JEL: I1 N3
    Date: 2005–05
  10. By: Ernst R. Berndt; Rachel Glennerster; Michael R. Kremer; Jean Lee; Ruth Levine; Georg Weizsacker; Heidi Williams
    Abstract: To overcome the problem of insufficient research and development (R&D) on vaccines for diseases concentrated in low-income countries, sponsors could commit to purchase viable vaccines if and when they are developed. One or more sponsors would commit to a minimum price that would be paid per person immunized for an eligible product, up to a certain number of individuals immunized. For additional purchases, the price would eventually drop to short-run marginal cost. If no suitable product were developed, no payments would be made. We estimate the offer size which would make the revenues from R&D investments on a malaria vaccine similar to revenues realized from investments in typical existing commercial pharmaceutical products, as well as the degree to which various contract models and assumptions would affect the cost-effectiveness of such a commitment for the case of a malaria vaccine. Under conservative assumptions, we document that the intervention would be highly cost-effective from a public health perspective. Sensitivity analyses suggest most characteristics of a hypothetical malaria vaccine would have little effect on the cost-effectiveness, but that the duration of protection against malaria conferred by a vaccine strongly affects potential cost-effectiveness. Readers can conduct their own sensitivity analyses employing a web-based spreadsheet tool.
    JEL: I18 O19 O31 O38
    Date: 2005–05
  11. By: Pablo D'Este Cukierman (SPRU, University of Sussex)
    Abstract: This paper aims to contribute to the analysis of within industry inter-firm variety. Building upon the knowledge-based theory of the firm (Nelson and Winter, 1982; Penrose, 1959; Fransman, 1994), this paper develops two themes. First, the analysis of intra-industry heterogeneity: why do firms that operate in the same industry differ, and why are such differences persistent? Second, the paper investigates the extent to which higher performance is associated with the capacity of firms to expand their knowledge base (rather than with their initial conditions). The main contribution of the paper is empirical, based on a data source consisting of information on documents published in scientific international journals by Spanish pharmaceutical firms. The empirical results support the argument that the firm's knowledge base is a main driver of persistent heterogeneity within industries on the one hand, because of the systematic variety in terms of how firms articulate and organise their research activities and their background knowledge, and on the other hand, because of the positive correlation between the firms' knowledge diversification and performance.
    Keywords: Firm heterogeneity, Knowledge diversification, Bibliometric analysis, Spanish pharmaceutical industry
    JEL: O33 L65
    Date: 2005–04–26
  12. By: Harold Alderman (World Bank); John Hoddinott (International Food Policy Research Institute); Bill Kinsey (University of Zimbabwe and Free University, Amsterdam)
    Abstract: This paper examines the impact of preschool malnutrition on subsequent human capital formation in rural Zimbabwe using a maternal fixed effects - instrumental variables (MFE-IV) estimator with a long term panel data set. Representations of civil war and drought “shocks” are used to identify differences in preschool nutritional status across siblings. Improvements in height-for-age in preschoolers are associated with increased height as a young adult and number of grades of schooling completed. Had the median pre-school child in this sample had the stature of a median child in a developed country, by adolescence, she would be 3.4 centimeters taller, had completed an additional 0.85 grades of schooling and would have commenced school six months earlier.
    Keywords: health, education, shocks, Zimbabwe
    JEL: I12 I20 O15
    Date: 2004–07

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