nep-hea New Economics Papers
on Health Economics
Issue of 2005‒11‒19
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Impact of Parental Income and Education on the Health of their Children By Orla Doyle; Colm Harmon; Ian Walker
  2. Survey Results of the New Health Care Worker Study: Implications of Changing Employment Patterns By Isik Urla Zeytinoglu; Margaret Denton; Sharon Davies; Andrea Baumann; Jennifer Blythe; Ann Higgins
  3. The Effect of Health Changes and Long-term Health on the Work Activity of Older Canadians By Doreen Wing Han Au; Thomas F. Crossley; Martin Schellhorn
  4. Users and Suppliers of Physician Services: A Tale of Two Populations By Frank T. Denton; Amiram Gafni; Byron G. Spencer
  5. Socioeconomic Influences on the Health of Older Canadians: Estimates Based on Two Longitudinal Surveys By Neil J Buckley; Frank T Denton; A Leslie Robb; Byron G Spencer
  6. Drug Advertising and Health Habits By Toshiaki Iizuka; Ginger Zhe Jin
  7. Subjective Health Measures, Reporting Errors and Endogeneity in the Relationship Between Health and Work By Maarten Lindeboom University of Amsterdam - Department of Economics; Marcel Kerkhofs
  8. Health Effects of Child Work: Evidence from Rural Vietnam By Owen A O'Donnell; Furio C. Rosati
  9. Affordability of Medicines and Patients' Cost Reduction Behaviors: Empirical Evidence Based on SUR Estimates from Italy and the United Kingdom By Vincenzo Atella; Peter R. Noyce; Karen Hassell
  10. Competitive Markets with Endogenous Health Risks By Alberto Bennardo; Salvatore Piccolo

  1. By: Orla Doyle (Geary Institute, University College Dublin); Colm Harmon (University College Dublin, CEPR and IZA Bonn); Ian Walker (University of Warwick, Institute for Fiscal Studies and IZA Bonn)
    Abstract: This paper investigates the robustness of recent findings on the effect of parental background on child health. We are particularly concerned with the extent to which their finding that income effects on child health are the result of spurious correlation rather than some causal mechanism. A similar argument can be made for the effect of education - if parental education and child health are correlated with some common unobservable (say, low parental time preference) then least squares estimates of the effect of parental education will be biased upwards. Moreover, it is very common for parental income data to be grouped, in which case income is measured with error and the coefficient on income will be biased towards zero and there are good reasons why the extent of bias may vary with child age. Fixed effect estimation is undermined by measurement error and here we adopt the traditional solution to both spurious correlation and measurement error and use an instrumental variables approach. Our results suggest that the income effects observed in the data are spurious.
    Keywords: child health, intergenerational transmission
    JEL: I1
    Date: 2005–11
  2. By: Isik Urla Zeytinoglu; Margaret Denton; Sharon Davies; Andrea Baumann; Jennifer Blythe; Ann Higgins
    Abstract: This report examines the effects of contemporary employment arrangements on the quality of nursing work life, and the implications of these employment arrangements for individual nurses, the hospitals, and also for the organization. First we look at nurse work status (full-time, part-time or casual job), contract status (permanent or temporary), and employment preference as factors affecting commitment to the hospital and profession, job satisfaction, retention in the organization, and absenteeism from work. Second, we examine stress, burnout, and physical occupational health problems (in particular, musculoskeletal disorders), as affecting nurse and hospital outcomes. This project investigated how the quality of nursing worklife and career choices differ for nurses in full-time, part-time and casual employment, and whether nurses who have the employment arrangements they prefer enjoy a standard of worklife that encourages retention. We collected data for the study from 1,396 nurses employed at three large teaching hospitals in Southern Ontario (Hamilton Health Sciences, Kingston General Hospital, and St. Michael's Hospital in Toronto) using the New Health Care Worker Questionnaire. Results indicate that although a substantial majority of the nurses were employed in the type of job that they preferred, problems of stress, burnout and physical health problems were reported. Further, these problems affected the nurses' job satisfaction, commitment, and propensity to leave the hospitals.
    Keywords: health care workers, employment status, nurses, job satisfaction, commitment, stress, burnout, physical health problems, MSD, propensity to leave
    JEL: I11 I18
    Date: 2005–09
  3. By: Doreen Wing Han Au; Thomas F. Crossley; Martin Schellhorn
    Abstract: Using longitudinal data from the Canadian National Population Health Survey (NPHS), we study the relationship between health and employment among older Canadians. We focus on two issues: (1) the possible problems with self-reported health, including endogeneity and measurement error, and (2) the relative importance of health changes and long-term health in the decision to work. We contrast estimates of the impact of health on employment using self- assessed health, an objective health index contained in the NPHS - the HUI3, and a "purged" health stock measure. Our results suggest that health has an economically significant effect on employment probabilities for Canadian men and women aged 50 to 64, and that this effect is underestimated by simple estimates based on self- assessed health. We also corroborate recent U.S. and U.K. findings that changes in health are important in the work decision.
    Keywords: health, health changes, employment, older workers
    JEL: I12 J26
    Date: 2005–10
  4. By: Frank T. Denton; Amiram Gafni; Byron G. Spencer
    Abstract: Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.
    Keywords: physician shortages, physician requirements, population aging
    JEL: I11 J11
    Date: 2005–10
  5. By: Neil J Buckley; Frank T Denton; A Leslie Robb; Byron G Spencer
    Abstract: It is well established that there is a positive statistical relationship between socioeconomic status (SES) and health but identifying the direction of causation is difficult. This study exploits the longitudinal nature of two Canadian surveys, the Survey of Labour and Income Dynamics and the National Population Health Survey, to study the link from SES to health (as distinguished from the health-to-SES link). For people aged 50 and older who are initially in good health we examine whether changes in health status over the next two to four years are related to prior SES, as represented by income and education. Although the two surveys were designed for different purposes and had different questions for income and health, the evidence they yield with respect to the probability of remaining in good health is similar. Both suggest that SES does play a role and that the differences across SES groups are quantitatively significant, increase with age, and are much the same for men and women.
    Keywords: health transitions, income, education
    JEL: I10
    Date: 2005–10
  6. By: Toshiaki Iizuka; Ginger Zhe Jin
    Abstract: We examine the effect of direct-to-consumer advertising (DTCA) of drug treatment on two important health habits, smoking and exercise, using the 1997-2001 Behavioral Risk Factor Surveillance System (BRFSS), the National Health Insurance Survey (NHIS), and MSA-level DTCA data. We find that the DTCA of tobacco cessation products increases the tendency to smoke for insured people with college education. Similarly, the DTCA related to four chronic conditions reduces the likelihood to engage in moderate exercise. These findings suggest that DTCA does not only affect pharmaceutical demand in the short-run, but also have long-run impacts on people's health by affecting their health habits.
    JEL: I12 I18 D83
    Date: 2005–11
  7. By: Maarten Lindeboom University of Amsterdam - Department of Economics (Tinbergen Institute Amsterdam; Institute for the Study of Labor (IZA)); Marcel Kerkhofs (OSA Institute for Labour Studies, Tilburg University)
    Abstract: This paper explores the interrelation between health and work decisions of older workers. For this, two issues are of relevance. Firstly, health and work may be endogenously related because of direct effects of health on work and vice versa, and because of unobservables that may relate observed health and work outcomes. Secondly, social surveys usually contain self-assessed health measures and research indicates that these may be affected by endogenous, state-dependent, reporting behavior. A solution to the 'Health and Retirement Nexus' requires an integrated model for work decisions, health production and health-reporting mechanisms. We formulate such a model and estimate it on a longitudinal dataset of Dutch elderly.
    Keywords: Work, health, endogeneity, subjective health, state-dependent reporting errors
    JEL: I12 J14
    Date: 2004–02–16
  8. By: Owen A O'Donnell (University of Macedonia); Furio C. Rosati (UCW Project; Erasmus University Rotterdam - Department of Health Policy and Management)
    Abstract: We test whether work in childhood impacts on health. We focus on agricultural work, the dominant form of child work worldwide. Data are from the Vietnam Living Standards Survey, 1992-93 and 1997-98. We correct for both unobservable heterogeneity and simultaneity biases. Instruments include small area labour market and education conditions obtained from community level surveys. We use three indicators of health: body mass index; reported illness; and, height growth. There is clear evidence of a healthy worker selection effect. We find little evidence of a contemporaneous impact of child work on health but work undertaken during childhood raises the risk of illness up to five years later and the risk is increasing with the duration of work. There is no evidence that work impedes the growth of the child.
    Keywords: Child labour, health, Vietnam
    JEL: I12 J13 J22 J28 J43
    Date: 2004–04–07
  9. By: Vincenzo Atella (University of Rome II - Faculty of Economics); Peter R. Noyce (University of Manchester - School of Pharmacy & Pharmaceutical Sciences; University of Manchester - School of Pharmacy & Pharmaceutical Sciences); Karen Hassell (University of Manchester - School of Pharmacy & Pharmaceutical Sciences)
    Abstract: The aim of the paper is to shed some light on consumers' attitudes to adopting strategies to contain the cost of medication. Using micro-data from an ad hoc survey conducted in Italy and the UK, several hypotheses are tested regarding patients' decision-making behavior and how it is influenced by health status, socio-demographic characteristics and the novel concept of a self-rated affordability measure. Results show that there is a discernable tendency for both UK and Italian patients to use cost reducing strategies and that these strategies are strongly influenced by income and drug affordability problems. These are important findings in two countries, where the National Health System (NHS) should provide health care services that are accessible to all citizens in need, and provide interesting insights for policy makers in other countries, such as USA, where patients have to pay a large share of their drugs out-of-pocket.
    Keywords: Health policy reform, health services demand, re-distributive impact, prescription charge, co-payment
    JEL: C35 C81 D12 I12
    Date: 2005–01–13
  10. By: Alberto Bennardo (Università di Salerno, CSEF and CEPR); Salvatore Piccolo (Università di Salerno, CSEF and Northwestern University)
    Abstract: We study a general equilibrium model where agents’ preferences, productivity and labor endowments depend on their health status, and occupational choices affect individual health distributions. Efficiency typically requires agents of the same type to obtain different expected utilities if assigned to di¤erent occupations. Under mild assumptions, workers with riskier jobs must get higher expected utilities if health a¤ects production capabilities. The same holds if health affects preferences and health enhancing consumption activities are sufficiently effective, so that income and health are substitutes. The converse obtains when health a¤ects preferences, but health enhancing consumption activities are not very effective, and hence income and health are complements. Competitive equilibria are first-best if lottery contracts are enforceable, but typically not if only assets with deterministic payoffs are traded. Compensating wage differentials which equalize the utilities of workers in different jobs are incompatible with ex-ante efficiency. Finally, absent asymmetric information, there exist deterministic cross-jobs transfers leading to ex-ante efficiency.
    Keywords: compensating wage differentials, competitive markets, individual health risks, Pareto efficiency
    JEL: D5 D61 D80 I18
    Date: 2005–10–01

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