nep-hea New Economics Papers
on Health Economics
Issue of 2006‒09‒23
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. A Multilevel Approach to Explain Child Mortality and Undernutrition in South Asia and Sub-Saharan Africa By Harttgen, Kenneth; Misselhorn, Mark
  2. Mortality and survivors' consumption By Grimm, Michael
  3. The causal effect of income on health: Evidence from German reunification By Paul Frijters
  4. Adaption of New Technologies and Costs of Health Care By Martti Kulvik; Ismo Linnosmaa; Raine Hermans
  5. Evaluating the Effectiveness of Child Safety Seats and Seat Belts in Protecting Children from Injury By Steven D. Levitt; Joseph J. Doyle
  6. The Health Effects of Medicare for the Near-Elderly Uninsured By Daniel Polsky; Jalpa A. Doshi; Jose Escarce; Willard Manning; Susan M. Paddock; Liyi Cen; Jeannette Rogowski
  7. Assessing the Effect of Mother’s Migration on Childhood Mortality in the Informal Settlements of Nairobi By Adama Konseiga; Eliya Msiyaphazi Zulu; Yazoumé Yé
  8. Copayments in the German Health System: Does It Work? By Boris Augurzky; Thomas K. Bauer; Sandra Schaffner
  9. Early childhood nutrition, schooling, and sibling inequality in a dynamic context: evidence from South Africa By Yamauchi, Futoshi
  10. The Sale of Alcohol in Denmark By Cour, Lisbeth la; Milhøj, Anders
  11. Gender, labor, and prime-age adult mortality: evidence from South Africa By Yamauchi, Futoshi; Buthelezi, Thabani; Velia, Myriam
  12. Nutrition mapping in Tanzania: an exploratory analysis By Simler, Kenneth R.
  13. The impact of an experimental nutritional intervention in childhood on education among Guatemalan adults: By Maluccio, John A.; Hoddinott, John; Behrman, Jere R.; Martorell, Reynaldo; Quisumbing, Agnes R.; Stein, Aryeh D.

  1. By: Harttgen, Kenneth; Misselhorn, Mark
    Abstract: While undernutrition among children is very pervasive both in Sub- Saharan Africa and South Asia, child mortality is rather low in South Asia. In contrast to that Sub-Saharan African countries suffer by far the worst from high rates of child mortality. This different pattern of child mortality and undernutrition in both regions is well known, but approaches using aggregated macro data have not been able to explain it appropriately. In this paper we analyze the determinants of child mortality as well as child undernutrition based on DHS data sets for a sample of six developing countries in South Asia and Sub-Saharan Africa. We investigate the effects of individual, household and cluster socioeconomic characteristics using a multilevel model approach and examine their respective influences on both phenomena. We find that the determinants of child mortality and undernutrition differ significantly from each other. Access to health infrastructure is more important for child mortality, whereas the individual characteristics like wealth and educational and nutritional characteristics of mothers play a larger role for anthropometric shortfalls. Although very similar patterns in the determinants of each phenomenon are discernable, there are large differences in the magnitude of the coefficients. Besides regressions using a combined data set of all six countries show, that there are still significant differences between the two regions although taking account of a large set of covariates.
    Keywords: Child mortality, child undernutrition, multilevel modelling
    JEL: C40 I12 I31 I32 O57
    Date: 2006
  2. By: Grimm, Michael
    Abstract: The literature suggests that in developing countries illness shocks at the household level can have a negative and severe impact on household income. Few studies have so fare examined the effects of mortality. The major difference between illness and mortality shocks is that a death of a household member does not only induce direct costs such as medical and funeral costs and possibly a loss in income, but that also the number of consumption units in the household is reduced. Studies so far focused mainly on adult mortality, disregarded the death of other household members and distinguished only insufficiently between the immediate impact, and the impact after coping strategies have been implemented. Using data for Indonesia, I show that the economic costs related to the death of children and older persons seem to be fully compensated by the decrease of consumption units in the household. In contrast, when prime-age adults die, survivors face additional costs due to the loss of income and, in consequence, implement coping strategies. These strategies are quite efficient and it seems that on average households even over-compensate their loss. This suggests that the implementation of general formal safety nets which are still absent in Indonesia—as in most developing countries—can give priority to the insurance of other types of risks, such as unemployment, illness or natural disasters.
    Keywords: Mortality, risk, insurance, micro-model of consumption growth, Indonesia
    JEL: D12 I12 J12 O12
    Date: 2006
  3. By: Paul Frijters (School of Economics and Finance, Queensland University of Technology)
    Keywords: Income, Health, German Reunification, Panel Data, Attrition
    Date: 2005
  4. By: Martti Kulvik; Ismo Linnosmaa; Raine Hermans
    Keywords: technology, health care, costs
    JEL: I11 L65
    Date: 2006–09–11
  5. By: Steven D. Levitt; Joseph J. Doyle
    Abstract: Young children are required to use child safety seats, and the age threshold at which children can legally graduate to seat belts has steadily increased. This paper tests the relative effectiveness of child safety seats, lap-and-shoulder seat belts, and lap belts in preventing injuries among motor vehicle passengers aged 2-6. We analyze three large, representative samples of crashes reported to police, as well as linked hospital data. We find no apparent difference in the two most serious injury categories for children in child safety seats versus lap-and-shoulder belts. Child safety seats provide a statistically significant 25% reduction in the least serious injury category. Lap belts are somewhat less effective than the two other types of restraints, but far superior to riding unrestrained.
    JEL: K2 R4
    Date: 2006–09
  6. By: Daniel Polsky; Jalpa A. Doshi; Jose Escarce; Willard Manning; Susan M. Paddock; Liyi Cen; Jeannette Rogowski
    Abstract: We study how the trajectory of health for the near-elderly uninsured changes upon enrolling into Medicare at the age of 65. We find that Medicare increases the probability of the previously uninsured having excellent or very good health, decreases their probability of being in good health, and has no discernable effects at lower health levels. Surprisingly, we found Medicare had a similar effect on health for the previously insured. This suggests that Medicare helps the relatively healthy 65 year olds, but does little for those who are already in declining health once they reach the age of 65. The improvement in health between the uninsured and insured were not statistically different from each other. The stability of insurance coverage afforded by Medicare may be the source of the health benefit suggesting that universal coverage at other ages may have similar health effects.
    JEL: I1 J14
    Date: 2006–09
  7. By: Adama Konseiga (African Population and Health Research Center (APHRC) and IZA Bonn); Eliya Msiyaphazi Zulu (African Population and Health Research Center (APHRC)); Yazoumé Yé (African Population and Health Research Center (APHRC))
    Abstract: Between one and two million migrants reside in cramped conditions in Nairobi’s slums without proper access to sanitation or affordable clean water. Children in such areas are exposed to enormous risks, health risks in particular. Using longitudinal data collected every four months during the period between 2002 and 2004, we analyze their survival patterns of children under five year of age who resided in two informal settlements (Viwandani and Korogocho). The research question assumes that children born to recent migrant mothers are more likely to die. The assumption is that migrant mothers do not have social network, which translates to a lack of information and lower access to health facilities. In the subsequent event history analysis, childhood mortality is shown to remain very high in the Nairobi informal settlements, especially among new migrants. Given the high degree of rural urban migration, which is bound to increase in the foreseeable future for most African countries, our study raises critical public health concerns. Another important finding in the context of the HIV AIDS pandemic is the risk factor associated to the mortality among children who have lost their mother. Our study also demonstrated a persistent disadvantage of children born to migrant mothers irrespective the length of stay in the receiving zone. The latter seems to point out the difficulties for migrant to develop social network outside their area of origin.
    Keywords: migration, informal settlements, childhood mortality, Nairobi
    JEL: C24 C41 I12 R23
    Date: 2006–09
  8. By: Boris Augurzky (RWI Essen and IZA Bonn); Thomas K. Bauer (RWI Essen, Ruhr-University Bochum, CEPR London and IZA Bonn); Sandra Schaffner (RWI Essen)
    Abstract: This paper examines the effect of copayments on doctor visits using the German health care reform of 2004 as a natural experiment. In January 2004, copayments of 10 euros for the first doctor visit in each quarter have been introduced for all adults in the statutory health insurance. Individuals covered by private health insurance as well as youths have been exempted from these copayments. We use them as control groups in a difference-indifferences approach to identify the causal impact of these copayments on doctor visits. In contrast to expectations and public opinion our results indicate that there are no statistically significant effects of the copayments on the decision of visiting a doctor.
    Keywords: copayment, doctor visits, difference-in-differences, fixed-effect logit
    JEL: I11 I18
    Date: 2006–09
  9. By: Yamauchi, Futoshi
    Abstract: "This paper examines the effects of early childhood nutrition on schooling inputs and outcomes to assess the dynamic nature of human capital production, using panel data from South Africa. Height-for-age Z-score is used as a measure of health and nutritional status in early childhood. Based on a comparison of siblings, this analysis concludes that improving children's health significantly lowers the age when they start school, increases grade attainment, and decreases grade repetition in the early stage of schooling. However, this positive effect diminishes at later stages. The results also show that households allocate more of their resources (such as school fee expenditure) to healthy children at the early stage, although wealthier households may invest more in less well endowed children in an attempt to reduce sibling inequality. However, fewer resources are allocated to healthy children at later stages. By the time of transition from primary to secondary school, the healthy child can increase household income by seeking employment in the labor market. In other words, while health capital augments the efficiency of investment in schooling at the early stage, it may increase opportunity costs at the later stage, which may deter investment in schooling." Authors' Abstract
    Keywords: Children Nutrition, Health capital, Height-for-age, Schooling, Investments, South Africa, Nutrition Evaluation, Nutritional status, Household resource allocation, Households Economic aspects,
    Date: 2006
  10. By: Cour, Lisbeth la (Department of Economics, Copenhagen Business School); Milhøj, Anders (Department of Economics, Copenhagen Business School)
    Abstract: In the following we will analyse the sale of alcohol in Denmark. Various figures related to this question are published by Statistics Denmark at different frequencies. Our main concern will be with quarterly data for the sale of beer, wine and spirits from the period 1990 – 2004. Our two hypotheses are: First we want to convince the reader that the total sale of alcohol in Denmark since 1980 has been fairly stable. By total sale we mean the total sale of 100% alcohol so the three categories – beer, wine and spirits are measured in litres of 100% alcohol equivalents. In order to convince the reader that the total sale of alcohol has been fairly constant we will present graphs and various indicators and tests of the degree of temporal dependence in this series. The overall impression from this analysis is that our first hypothesis seems to be supported – at least not contradicted – by the data. Next, we want to model the sale of beer and wine as shares of the total sale of alcohol. Even though the total sale can be considered fairly stable there have been divergent paths of evolvement for the sub-groups: the sale of beer has decreased over the period and the sale of wine has increased. The sale of spirits has been fairly stable. Modelling the system of the beer-share and the wine-share we want to split the total development into a part that can be ascribed to changes in the relative prices and a part that can be explained by changes in taste and drinking habits specified as a trend. By specifying a system conditionally on the prices of beer, wine and spirits and a trend we manage to estimate price sensitivity and taste sensitivity. A small forecasting exercise shows that the final model is fairly good at predicting changes in the shares due to price changes. Finally, the effects on the market shares of hypothetical changes in the taxation of alcohol are discussed.
    Keywords: Alcohol; Sale; drinking habits
    JEL: H00
    Date: 2005–09–14
  11. By: Yamauchi, Futoshi; Buthelezi, Thabani; Velia, Myriam
    Abstract: "This paper examines the impact of prime-age adult mortality on the transition from school to the labor market of adolescents and on decisions by female adults to participate in the labor force in South Africa. The analysis focuses on that period—1998–2004—when South Africa experienced excess mortality due to the HIV/AIDS epidemic. We find, first, that deaths of prime-age adults significantly increase both male and female adolescents' labor force participation because they stop their schooling in order to help support their families. Female school enrollment may also decrease because girls are required to stay at home to take care of the sick. Therefore, the total negative impact on schooling is larger among female adolescents than among male adolescents. Second, we find that female adults tend to join the labor force following the death of prime-age adult males. This change could cause a decrease in the time they spend on housework and child rearing. Combined, these findings imply that excess mortality of prime-age adults disrupts human capital formation." Authors' Abstract
    Keywords: South Africa, Gender, Labor supply, Schooling, Prime-age adult mortality, Human capital,
    Date: 2006
  12. By: Simler, Kenneth R.
    Abstract: "For effective decisionmaking, policymakers and program managers often need detailed information about the welfare of the population, including knowledge about which specific areas are most affected by poverty and undernutrition. Household sample surveys are an important source of information, yet because the typical sample size is only a few thousand observations, the information is only useful for inferences at high levels of aggregation, such as the nation or large regional units. In contrast, data sources with wider coverage, such as national censuses, rarely capture detailed information on welfare levels. Recently small-area estimation techniques have been applied to the study of poverty to produce estimates of poverty, or poverty maps, for small geographic units. This paper uses household survey and unit record census data from Tanzania to explore the possibility of applying small-area estimation methods to the study of children's nutritional status as measured by anthropometry. Overall, undernutrition models have had lower explanatory power than poverty models, which has important implications for the precision of the small-area estimates. The analysis finds that applying small-area estimation techniques to anthropometric data is feasible, although the relatively low explanatory power of the regressions does limit both the degree of disaggregation possible and the power to detect significant differences in undernutrition prevalence between districts and subdistricts. In the case of Tanzania, the nutrition mapping approach reveals considerable heterogeneity in nutritional status within regions and within districts. The most striking finding is the much lower levels of undernutrition in areas classified as urban, including relatively small district centers." Authors' Abstract
    Keywords: Nutrition mapping, malnutrition, Anthropometry, Small area estimation, Tanzania,
    Date: 2006
  13. By: Maluccio, John A.; Hoddinott, John; Behrman, Jere R.; Martorell, Reynaldo; Quisumbing, Agnes R.; Stein, Aryeh D.
    Abstract: "Early childhood nutrition is thought to have important effects on education, broadly defined to include various forms of learning. We advance beyond previous literature on early childhood nut ition on education in developing countries by (1) using unique longitudinal data from a nutritional experiment with lifetime educational measures; (2) avoiding confounding the estimates by excluding potentially endogenous right-side variables; and (3) using estimators that allow for nonnormal distributions. Our results indicate significantly positive, and fairly substantial, effects of the randomized intervention a quarter century after it ended: increased grade attainment by women, via increased likelihood of entering and completing primary school and some secondary school; speedier grade progression by women; higher scores on cognitive tests for both men and women; and higher scores on educational achievement tests for both men and women. To account for possible biases in the calculation of standard errors and to control for sample attrition, alternative estimations were run and found to be robust." Authors' Abstract
    Keywords: malnutrition, Children, Education, Early childhood nutrition, Nutritional intervention,
    Date: 2006

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