nep-hea New Economics Papers
on Health Economics
Issue of 2005‒10‒29
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Medical Interventions among Pregnant Women in Fee-for-Service and Managed Care Insurance: A Propensity Score Analysis By Leo Turcotte; John Robst; Solomon Polachek
  2. The Aggregate Demand for Private Health Insurance Coverage in the U.S. By Carmelo Giaccotto; Rexford E. Santerre; Francis W. Ahking
  3. Body Size, Activity, Employment and Wages in Europe: A First Approach By Jaume Garcia Villar; Climent Quintana
  4. A sequential model for older workers’ labor transitions after a health shock By Sergi Jiménez-Martín; José M. Labeaga; Cristina Vilaplana Prieto
  5. Examining the Dutch Disability Trends in the Nineteen-nineties: Age, Period, and Cohort Effects By France Portrait; Dorly Deeg; Rob Alessie
  6. Moral Hazard and Cash Benefits in Long-term Home Care By Bernard van den Berg; Wolter Hassink
  7. When Will Judgment Proof Injurers Take Too Much Precaution? By Giuseppe Dari-Mattiacci; Gerrit de Geest
  8. Estimating the Impact of Experience Rating on the Inflow into Disability Insurance in the Netherlands By Pierre Koning

  1. By: Leo Turcotte (West Chester University); John Robst (University of South Florida); Solomon Polachek (State University of New York at Binghamton and IZA Bonn)
    Abstract: We extend prior research on the effect of managed care on the receipt of four medical interventions for pregnant women: ultrasound, induction/stimulation of birth, electronic fetal monitor, and cesarean delivery. Propensity score methods are used to account for sample selection issues regarding insurance choice. Managed care enrollees are more likely to receive an ultrasound, which may be indicative of receiving better prenatal care. Managed care plans reduce the rate of cesarean deliveries, but such limitations may be beneficial given the substantial medical evidence that cesarean deliveries are over utilized. The results indicate that insurance coverage does influence treatment intensity, but that utilization controls and provider financial incentives do not adversely affect care for pregnant women.
    Keywords: health insurance, managed care, procedure utilization
    Date: 2005–10
  2. By: Carmelo Giaccotto (University of Connecticut); Rexford E. Santerre (University of Connecticut); Francis W. Ahking (University of Connecticut)
    Abstract: This paper estimates the aggregate demand for private health insurance coverage in the U.S. using an error-correction model and by recognizing that people are without private health insurance for voluntary, structural, frictional, and cyclical reasons and because of public alternatives. Insurance coverage is measured both by the percentage of the population enrolled in private health insurance plans and the completeness of the insurance coverage. Annual data for the period 1966-1999 are used and both short and long run price and income elasticities of demand are estimated. The empirical findings indicate that both private insurance enrollment and completeness are relatively inelastic with respect to changes in price and income in the short and long run. Moreover, private health insurance enrollment is found to be inversely related to the poverty rate, particularly in the short-run. Finally, our results suggest that an increase in the number cyclically uninsured generates less of a welfare loss than an increase in the structurally uninsured.
    JEL: I10
    Date: 2005–10
  3. By: Jaume Garcia Villar; Climent Quintana
    Abstract: In this article we present the first empirical analysis on the associations between body size, activity, employment and wages for several European countries. The main advantage of the present work with respect to the previous literature is offered by the comparability of the data and its large geographical coverage. According to our results, for Spanish women, being obese is associated with both a 9% lower wage and probability of being employed, while for Swedish and Danish, obesity is associated with a 12% lower probability of being employed, and a 10% lower wage respectively. In Belgium, obesity is associated with a 19% lower probability of being employed for men. These robust estimates are strongly informative and may be used as a simple statistical rule of thumb to decide the countries in which lab and field experiments should be run.
    Keywords: Obesity, wages, activity, employment
    JEL: J3 I1
    Date: 2005–08
  4. By: Sergi Jiménez-Martín; José M. Labeaga; Cristina Vilaplana Prieto
    Abstract: In this work we study older workers’ (50—64) labor force transitions after a health/disability shock. We find that the probability of keeping working decreases with both age and severity of the shock. Moreover, we find strong interactions between age and severity in the 50—64 age range and none in the 30–49 age range. Regarding demographics we find that being female and married reduce the probability of keeping work. On the contrary, being main breadwinner, education and skill levels increase it. Interestingly, the effect of some demographics changes its sign when we look at transitions from inactivity to work. This is the case of being married or having a working spouse. Undoubtedly, leisure complementarities should play a role in the latter case. Since the data we use contains a very detailed information on disabilities, we are able to evaluate the marginal effect of each type of disability either in the probability of keeping working or in returning back to work. Some of these results may have strong policy implications.
    Keywords: Health shocks, disability, labor force transitions, older workers, Spain
    JEL: J23 J26 I12
    Date: 2005–10
  5. By: France Portrait; Dorly Deeg; Rob Alessie
    Abstract: The paper focuses on changes in the prevalence of disability at older ages in the Netherlands during the nineteen-nineties. Disability is characterized by two selfreported indicators of mild and severe disability and two self-reported and objective measures of functional limitations. Age, period, and cohort (APC) factors are potential determinants of disability at older ages. Understanding the role of APC factors is crucial to get insight into current and future disability trends. To reach this objective, we had to deal with the well-known identification problem -- namely year of birth plus age equals calendar year of measurement. The identification problem is tackled by modeling cohort and period effects using lifetime macro-indicators. This approach -- innovative in analyses on disability trends ­ also explains mechanisms underlying period and cohort effects. Analyses are conducted using data from the Longitudinal Aging Study Amsterdam. We produce evidence of increasing trends in functional limitations and disability at all ages above 60 and for both genders. These are largely caused by adverse period effects due to restrictions in acute and home care services. In addition, we find evidence of cohort effects -- mainly because of differences in exposure to tuberculosis mortality in year of birth ­ on functional status and disability. This holds more specifically for females.
    Keywords: Trends in Disability, Trends in Functional Limitations, Cohort effects, Period effects, Netherlands.
    JEL: I12 J14 C33
    Date: 2004–03
  6. By: Bernard van den Berg; Wolter Hassink
    Abstract: This paper tests empirically for ex-post moral hazard in a system based on demandside subsidies. In the Netherlands, demand-side subsidies were introduced in 1996. Clients receive a cash benefit to purchase the type of home care (housework, personal care, support with mobility, organisational tasks or social support) they need from the care supplier of their choice (private care provider, regular care agency, commercial care agency or paid informal care provider). Furthermore, they negotiate with the care supplier about price and quantity. Our main findings are the following. 1) The component of the cash benefit a client has no residual claimant on, has a positive impact on the price of care. 2) In contrast, the components of the cash benefit a client has residual claimant on, have no or a negative impact on the price of care. Both results point at the existence of ex-post moral hazard in a system of demand-side subsidies
    Keywords: long-term care, cash benefits, consumer directed services, demand-side subsidies, direct payments, moral hazard
    JEL: I10
    Date: 2005–03
  7. By: Giuseppe Dari-Mattiacci; Gerrit de Geest
    Abstract: This article identifies the conditions under which potentially insolvent injurers overinvest in precaution. We show that this may happen only with respect to precautionary measures that reduce the probability of the accident. No such result occurs if precaution only reduces the magnitude of the harm. Contrary to the literature, we find that over-precaution may also occur when precaution is nonmonetary. The reason being is that over-precaution can not only be due to the implicit precaution-subsidy effect (the fact that care-taking reduces the injurer's exposure to liability when precaution is monetary) but also to a substitution effect between precaution that reduces the probability of accidents and precaution that reduces the magnitude of the harm. Finally, we find that when the injurer's wealth is sufficiently low, precautions may actually be lower when they are monetary than when they are non-monetary, despite the implicit precaution subsidy in the former case.
    Keywords: insolvency, judgement, liability, bankruptcy, over precaution
    JEL: K13 K32
    Date: 2004–11
  8. By: Pierre Koning
    Abstract: This paper examines the effects of experience rating on the inflow into disability insurance (DI) in the Netherlands, using unique longitudinal administrative data from the social benefit administration. We follow a difference-in-differences approach to identify the impact of changes in DI premiums. Due to unawareness of the experience rating system, employers seem to have been triggered to increase preventative activities, once they have experienced increases in DI premium. We find this impact to be substantial, amounting to a 15% reduction of the DI inflow.
    Keywords: experience rating, disability insurance, panel data
    JEL: H22 I12 C23
    Date: 2005–02

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