nep-hea New Economics Papers
on Health Economics
Issue of 2007‒07‒07
twenty papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Incentive and spill-over effects of supplementary sickness compensation By Hesselius, Patrik; Persson, Malin
  2. Early Childbirth, Health Inputs and Child Mortality: Recent Evidence from Bangladesh By Pushkar Maitra; Sarmistha Pal
  3. Tax Incentives as a Solution to the Uninsured: Evidence from the Self-Employed By Gulcin Gumus; Tracy L. Regan
  4. Birth Spacing, Fertility Selection and Child Survival: Analysis Using a Correlated Hazard Model By Pushkar Maitra; Sarmistha Pal
  5. Behavioural Economics and Drinking Behaviour: Preliminary Results from an Irish College Study By Liam Delaney; Colm Harmon; Patrick Wall
  6. Cross-Country Variation in Obesity Patterns among Older Americans and Europeans By Pierre-Carl Michaud; Arthur van Soest; Tatiana Andreyeva
  7. Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey By Florence Jusot; Michel Grignon; Paul Dourgnon
  8. Health-Care Utilization in Canada: 25 Years of Evidence By Lori J. Curtis; William J. MacMinn
  9. Health Status of On and Off-reserve Aboriginal Peoples: Analysis of the Aboriginal Peoples Survey By Lori J. Curtis
  10. Mental Health in Childhood and Human Capital By Janet Currie; Mark Stabile
  11. Extreme Weather Events, Mortality and Migration By Olivier Deschenes; Enrico Moretti
  12. Driven to Drink. Sin Taxes Near a Border By Timothy K.M. Beatty, Erling Røed Larsen and Dag Einar Sommervoll
  13. Determinants of outpatient antibiotic consumption in Europe: bacterial resistance and drug prescribers By Giuliano Masiero; Massimo Filippini; Matus Ferech; Herman Goossens
  14. Privatization of health sector in ex socialist states By Strazisar, Borut
  15. The Timing of Screenings for Lung Cancer: A Decisional Model Based on U.S. Data By Soiliou Namoro
  16. Monetary Policies for an MDG-Related Scaling up of ODA to Combat HIV/AIDS:Avoiding Dutch Disease Versus Supporting Fiscal Expansion By Matías Vernengo
  17. The Fiscal Implications of Scaling up ODA to Deal with the HIV/AIDS Pandemic By Bernard Walters
  18. Scaling-up HIV/AIDS Financing and the Role of Macroeconomic Policies in Kenya By Degol Hailu
  19. Pathways to Disability: Predicting Health Trajectories By Florian Heiss; Axel Börsch-Supan; Michael Hurd; David Wise
  20. Work Disability, Health, and Incentive Effects By Axel Börsch-Supan

  1. By: Hesselius, Patrik (IFAU - Institute for Labour Market Policy Evaluation); Persson, Malin (Department of Economics, Uppsala University)
    Abstract: In 1998 the Swedish national sickness insurance policy changed to allow additional compensation from e.g. collective agreements after the 90th day of absence without a reduction of the public sickness benefit. We estimate the effects of this policy change on the duration of sickness absence for employees in the municipal sector. After the change in policy, this group received 10 percentage points additional compensation during day 91 to 360 in a sick leave. The results indicate that durations of at least 91 days increased by 4.7 days on average. As a consequence, the cost for the national sickness insurance increased by 3.0 percent. For the supplementary insurance to cover its total cost, insurance premiums should be increased by 22 percent.
    Keywords: Social insurance; sickness absence; collective agreements
    JEL: H51 H55 I38 J22
    Date: 2007–06–19
  2. By: Pushkar Maitra (Monash University); Sarmistha Pal (Brunel University and IZA)
    Abstract: This paper examines the relationship between early childbearing and child mortality in Bangladesh, a country where adolescent childbearing is of particular concern. We argue that effective use of specific health inputs could however significantly lower child mortality rates even among adolescent women. This offers an attractive policy option particularly when compared to the costly alternative of delaying age at marriage. In particular, we find that women having early childbirth tend to use health inputs differently from all other women. After correcting for this possible selectivity bias, the adverse effects of early childbirth on child mortality are reversed. The favourable effects of use of health inputs however continue remain statistically significant.
    Keywords: family formation, adolescent childbearing, hospital delivery, child vaccination, child mortality, selectivity bias, unobserved heterogeneity, correlated estimates
    JEL: D13 I12 O15
    Date: 2007–06
  3. By: Gulcin Gumus (Florida International University and IZA); Tracy L. Regan (University of Miami)
    Abstract: Between the years 1996 and 2003, a series of amendments were made to the Tax Reform Act of 1986 (TRA86) that gradually increased the tax credit for health insurance purchases by the self-employed from 25 to 100 percent. We study how these changes in the tax code have influenced the likelihood that a self-employed person has health insurance coverage as the policy holder of the plan. The Current Population Survey (CPS) is used to construct a data set corresponding to 1995-2005. The empirical analysis is performed for prime-age men and women, and accounts for differences in family structure and potential eligibility. The difference-in-difference estimates suggest that the series of tax credits did not provide sufficient incentives for the self-employed to obtain health insurance coverage. Estimates of the price elasticity of demand confirm the limited response to changes in the after-tax health insurance premium. The effect was largest, however, among the single men and women in our sample, suggesting that a 10 percent decrease in the after-tax price increases the likelihood of coverage by 0.68 and 1.02 percentage points, respectively.
    Keywords: health insurance, self-employment, elasticity, CPS
    JEL: J32 J48 I11
    Date: 2007–06
  4. By: Pushkar Maitra (Monash University); Sarmistha Pal (Brunel University and IZA)
    Abstract: If fertility reflects the choice of households, results of their choice (duration between successive births and health of the children) cannot be considered to be randomly determined. While most existing studies of child health tend to overlook the effects of fertility selection on child health, this paper argues that not accounting for this selection issue yields biased estimates. Additionally it is difficult to a priori predict the direction of this bias, thereby over or under estimating the effect of spacing on child survival. We find that the estimates of birth spacing on child mortality are different when we do not account for fertility selection. Additionally the correlated hazard estimates that we present here better fit our samples than the corresponding bivariate probit estimates used in the literature. A comparison of the fertility behaviour of households in the Indian and Pakistani Punjab highlights the differential nature of institutions on demographic transition in these neighbouring regions.
    Keywords: child mortality, fertility selection, correlated recursive hazard system
    JEL: J13 O10 C41 C24
    Date: 2007–06
  5. By: Liam Delaney (University College Dublin); Colm Harmon (University College Dublin and IZA); Patrick Wall (University College Dublin)
    Abstract: This paper examines the results of single-equation regression models of the determinants of alcohol consumption patterns among college students modelling a rich variety of covariates including gender, family and peer drinking, tenure, personality, risk perception, time preferences and age of drinking onset. The results demonstrate very weak income effects and very strong effects of personality, peer drinking (in particular closest friend), time preferences and other substance use. The task of future research is to verify these results and assess causality using more detailed methods.
    Keywords: alcohol, peer effects, time preferences
    JEL: I12
    Date: 2007–06
  6. By: Pierre-Carl Michaud; Arthur van Soest; Tatiana Andreyeva
    Abstract: While the fraction of obese people is not as large in Europe as in the United States, obesity is becoming an important issue in Europe as well. Using comparable data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study in the U.S. (HRS), we analyze the correlates of obesity in the population ages 50 and above, focusing on measures of energy intake and expenditure as well as socio-economic status. Our main results are as follows: 1) Obesity rates differ substantially on both sides of the Atlantic and across European countries, with most of the difference coming from the right tail of the weight distribution. 2) Part of the difference in obesity prevalence between the U.S. and Europe is explained by a higher fraction of food eaten away from home and notably lower time devoted to cooking in the U.S. 3) Sedentary lifestyle or a lack of vigorous and moderate physical activity may also explain a substantial share of the cross-country differences. 4) Differential SES patterns of energy intake and expenditure across countries cannot fully account for the observed cross-country variation in the SES gradient in obesity.
    Keywords: Body Mass Index, International Comparison, SHARE
    JEL: I12
    Date: 2007–05
  7. By: Florence Jusot; Michel Grignon; Paul Dourgnon
    Abstract: We study the psychosocial determinants of health, and their impact on social inequalities in health in France. We use a unique general population survey to assess the respective impact on selfassessed health status of subjective perceptions of social capital controlling for standard socio-demographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and selfesteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.
    Keywords: social capital, social support, relative deprivation, sense of control, social health inequalities, France
    JEL: J12 I10
    Date: 2007–05
  8. By: Lori J. Curtis; William J. MacMinn
    Abstract: An abundance of literature links socio-economic status to health and health care in Canada and other countries. Recent anecdotal evidence indicates that Canadians believe their access to health care is diminishing over time. This study provides a brief description of utilization patterns in health-care services provided under public health insurance (physicians, specialists and hospitals) in Canada between 1978 and 2003. The relationships between socio-economic status (SES) and utilization, controlling for demographic characteristics are examined to investigate whether changes in the equity of utilization have occurred over time. Results indicate that SES inequities in utilization are apparent in publicly insured services, appearing to be more relevant in initial contact with the system rather than in the number of visits. Specialist’s services are particularly problematic and becoming more so over time.
    Keywords: health-care utilization, socio-economic status, Canada
    JEL: I10 I11 I18
    Date: 2007–05
  9. By: Lori J. Curtis
    Abstract: The government of Canada is committed to closing the health status gap between First Nation’s (FN) and non-First Nation’s peoples in Canada. The government of Canada is also committed to evidenced-based policy making and accountability. To provide evidence of effective programming, it must monitor the health and well-being of its First Nations and Inuit populations over time. Evidence on the health status of FN peoples living on-reserve is difficult to obtain due to limited data sources. However, the Aboriginal Peoples Survey (APS) provides information on the health status of on-reserve and off-reserve FN peoples. Important determinants of health such as socio-economic status (SES), health-care utilization and health behaviours will also be documented, as many of the government programmes offered aim to improve health status by affecting the behavioural determinants of health.
    Keywords: health status, First Nations, Aboriginal Peoples Survey
    JEL: I10 I18 I30 I38
    Date: 2007–05
  10. By: Janet Currie; Mark Stabile
    Abstract: Although mental disorders are common among children, we know little about their long term effects on child outcomes. This paper examines U.S. and Canadian children with symptoms of Attention Deficit Hyperactivity Disorder (ADHD), depression, conduct disorders, and other behavioral problems. Our work offers a number of innovations. First we use large nationally representative samples of children from both countries. Second, we focus on "screeners" that were administered to all children in our sample, rather than on diagnosed cases. Third, we address omitted variables bias by estimating sibling-fixed effects models. Fourth, we examine a range of outcomes. Fifth, we ask how the effects of mental health conditions are mediated by family income and maternal education. We find that mental health conditions, and especially ADHD, have large negative effects on future test scores and schooling attainment, regardless of family income and maternal education.
    JEL: I1 I2
    Date: 2007–07
  11. By: Olivier Deschenes; Enrico Moretti
    Abstract: We estimate the effect of extreme weather on life expectancy in the US. Using high frequency mortality data, we find that both extreme heat and extreme cold result in immediate increases in mortality. However, the increase in mortality following extreme heat appears entirely driven by temporal displacement, while the increase in mortality following extreme cold is long lasting. The aggregate effect of cold on mortality is quantitatively large. We estimate that the number of annual deaths attributable to cold temperature is 27,940 or 1.3% of total deaths in the US. This effect is even larger in low income areas. Because the U.S. population has been moving from cold Northeastern states to the warmer Southwestern states, our findings have implications for understanding the causes of long-term increases in life expectancy. We calculate that every year, 5,400 deaths are delayed by changes in exposure to cold temperature induced by mobility. These longevity gains associated with long term trends in geographical mobility account for 8%-15% of the total gains in life expectancy experienced by the US population over the past 30 years. Thus mobility is an important but previously overlooked determinant of increased longevity in the United States. We also find that the probability of moving to a state that has fewer days of extreme cold is higher for the age groups that are predicted to benefit more in terms of lower mortality compared to the age groups that are predicted to benefit less.
    JEL: J1
    Date: 2007–07
  12. By: Timothy K.M. Beatty, Erling Røed Larsen and Dag Einar Sommervoll (Statistics Norway)
    Abstract: This paper investigates household purchasing behavior in response to differing alcohol and tobacco taxes near an international border. Our study suggests that large tax differentials near borders induce economically important tax avoidance behavior that may limit a government’s ability to raise revenue and potentially undermine the pursuit of important health and social policy goals. We match novel supermarket scanner and consumer expenditure data to measure the size and scope of the effect for households and stores. We find that stores near/far from the international border have statistically significantly lower/higher sales of beer and tobacco than comparable stores far/near the border. Moreover, we find that households near the border report higher consumption of these same goods. This is consistent with households facing lower prices. Finally, we find measures of externalities associated with the consumption of alcohol and tobacco are higher near the border.
    Keywords: Alcohol Consumption; Tobacco Consumption; Border Trade; Taxation
    JEL: C31 F14 I18
    Date: 2007–06
  13. By: Giuliano Masiero (Department of Economics and Technology Management, University of Bergamo, Italy; Department of Economics, University of Lugano, Switzerland.); Massimo Filippini (Department of Economics, University of Lugano; Swiss Federal Institute of Technology, Zurich, Switzerland.); Matus Ferech (Laboratory of Microbiology, University of Antwerp, Belgium; Enterprise and Industry DG, Pharmaceuticals Unit, European Commission, Brussels.); Herman Goossens (Laboratory of Microbiology, University of Antwerp, Belgium; Laboratory of Microbiology, Leiden University Medical center, Leiden, The Netherlands.)
    Abstract: This paper investigates socioeconomic determinants of outpatient antibiotic consumption in Europe. Comparable data on antibiotic use measured in the defined daily doses per 1000 inhabitants (DID) are currently provided by the ESAC project. Results from applied econometric estimations for panel data reveal a link between antibiotic use and the per capita income, the demographic structure of the population, the level of education and cultural aspects. Supply-side factors, such as the density of providers and their remuneration methods, are also considered. We provide the first estimate of the impact of bacterial resistance on consumption when the e?ect of other determinants is simultaneously taken into account.
    Keywords: Antibiotic use, Cross-country variations, Bacterial resistance, Supply-induced demand
    JEL: I0 C3
    Date: 2007–06
  14. By: Strazisar, Borut
    Abstract: Privatization of health care system in ex socialist states is one of the most controversial political and legal questions. On one part there is a widening discrepancy between the costs of health care system and the capability of public finances to cover these costs. On the other part there is a widening discrepancy between the users’ expectations and the technical and personal capability of health care system. So many governments in ex socialist countries see the privatization of health care system as a magical stick which will resolve all the problems. With privatization governments want to achieve following goals: - to improve the cost – benefit relation in health system; - to enlarge the citizens’ responsibility to live healthy; - to prevail the responsibility for the development of health system to private sector; - to liberate themselves from the political responsibility for malfunctioning health care system. Modern local governments are increasingly outsourcing to private firms for public service provision. Privatization is used as a solution where government programs are failing because private firms offer flexibility in program operation and management and are more adept at responding to changing circumstances than governmental entities. Governments also benefit from private partnerships by way of the resulting resources and personnel that become available for other uses. In this submission I’ll try to discuss about the problems of health care system’s privatization in ex socialist countries and about the necessary regulatory steps to be used for successful and citizens’ friendly privatization.
    Keywords: privatizaton of health sector; regulatory action
    JEL: K23
    Date: 2006–06
  15. By: Soiliou Namoro
    Abstract: Health policy organizations do not recognize a reliable cost-benefit metric upon which to recommend the screening of individuals for lung cancer. However, many physicians find substantial merit in the procedure as an effective tool for managing the risk of lung cancer for individual patients. Between these two positions, one can observe a continuing search for a diagnostic methodology that permits early detection and justifies the initiation of therapies that will lower mortality rates while also reducing the social and economic costs of the leading form of cancer among adults in the United States. In this context, organizations such as the National Cancer Institute articulate present public policy, which sees no appreciable overall benefit for society from early screening, while physicians groups such as the Como International Position Conference and the International Early Cancer Action Program Investigators advocate early screening because of its potential efficacy for high-risk patients. The present paper exploits the recent availability of information about individual patient risk of lung cancer to propose a model for deciding upon the timing of a screening for this disease. The model embodies a subject’s risk characteristics and a ratio to weigh the benefit of a test that accurately discloses the presence of cancery against the costs of a false positive.
    Date: 2005–06
  16. By: Matías Vernengo (Assistant Professor, Department of Economics, University of Utah)
    Abstract: This Conference Paper by Matias Vernengo was presented at the ?Global Conference on Gearing Macroeconomic Policies to Reverse the HIV/AIDS Epidemic?, jointly organized by UNDP?s HIV/AIDS Group and IPC and held in Brasilia, November 2006. It is part of an IPC-supported Research Programme on ?Macroeconomic Policies to Combat HIV/AIDS?. The paper maintains that the monetary policies best suited to manage the macroeconomic effects of an MDG-related scaling up of HIV/AIDS financing are those that support the needed expansion of public spending - namely, monetary policies that maintain low rates of interest, increase overall liquidity in the economy and try to achieve a relatively depreciated currency.
    Keywords: Poverty, MDG, HIV/AIDS, Monetary Policies
    JEL: B41
    Date: 2007–03
  17. By: Bernard Walters (Economics Discipline Area, School of Social Sciences, University of Manchester)
    Abstract: .
    Keywords: Fiscal, Implications,ODA, HIV, AIDS, Pandemic
    Date: 2007–05
  18. By: Degol Hailu (UNDP SURF)
    Abstract: .
    Keywords: Scaling-up, HIV, AIDS, Financing, Macroeconomic, Policies, Kenya
    Date: 2007–06
  19. By: Florian Heiss; Axel Börsch-Supan; Michael Hurd; David Wise (Mannheim Research Institute for the Economics of Aging (MEA))
    Abstract: The paper considers transitions in the health and disability status of persons as they age. In particular, we explore the relationship between health and disability at younger ages (say 50) and health and disability in future ages. We consider for example, the future health path of persons who are in good health at age 50 compared to the future health path of persons who are in poor health at age 50. To do this, we develop a model that jointly considers health and mortality. The key feature of the model is the assumption of underlying “latent” health that determines both mortality and self-reported responses to categorical health and disability questions. Latent health allows for heterogeneity among individuals and allows for correlation of health status over time, thus allowing for state dependence as well as heterogeneity. The model also allows for classification errors in self-reported response to categorical health and disability questions. All of these are important features of health and disability data, as we show with descriptive data. The model accommodates the strong relationship between self-reported health status and mortality, which is critical to an understanding of the paths of health and disability of the survivors who are observed in panel data files. Our empirical analysis is based on all four cohorts of the Health and Retirement Study (HRS) -- the HRS, AHEAD, CODA and WB cohorts). We find that self-reported health and self-reported disability correspond very closely to one another in the HRS. We find that both self-reported health and disability are strong predictors of mortality. Health and disability at younger ages are strongly related to future health and disability paths of persons as they age. There are important differences in health and disability paths by education level, race, and gender.
    Date: 2007–07–03
  20. By: Axel Börsch-Supan (Mannheim Research Institute for the Economics of Aging (MEA))
    Abstract: Disability insurance – the insurance against the loss of the ability to work – is a substantial part of social security expenditures in many countries. The enrolment rates in disability insurance vary strikingly across European countries and the US. This paper investigates the extent of, and the causes for, this variation, using data from SHARE, ELSA and HRS. We show that even after controlling for differences in the demographic structure and health status these differences remain. In turn, indicators of disability insurance generosity explain 75% of the cross-national variation. We conclude that country-specific disability insurance rules are a prime candidate to explain the observed cross-country variation in disability insurance enrolment.
    Date: 2007–07–03

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