nep-hea New Economics Papers
on Health Economics
Issue of 2007‒09‒09
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Cigarette smoking and food insecurity among low-income families in the United States, 2001 By Brian S. Armour; M. Melinda Pitts; Chung-won Lee
  2. How responsive is body weight to transitory income changes? Evidence from rural Tanzania By Bengtsson, Niklas
  3. Strategic Competition in Swedish Local Spending on Childcare, Schooling and Care for the Elderly By Edmark, Karin
  4. Dynamic Inefficiencies in Employment-Based Health Insurance System Theory and Evidence By Hanming Fang; Alessandro Gavazza
  5. The Effect of Alcohol Consumption on Mortality Regression: Discontinuity Evidence from the Minimum Drinking Age By Christopher Carpenter; Carlos Dobkin
  6. A Tax on Work for the Elderly: Medicare as a Secondary Payer By Gopi Shah Goda; John B. Shoven; Sita Nataraj Slavov
  7. An inquiry on the change profile of healthcare managers and entrepreneurs By E. COOLS; H. VAN DEN BROECK
  8. Pensions, Education and Life Expectancy By Michael Gorski; Tim Krieger; Thomas Lange
  9. Child mortality, income and adult height By Carlos Bozzoli; Angus Deaton; Climent Quintana-Domeque
  10. Health Care Services and Government Spending in Pakistan By Muhammad Akram; Faheem Jehangir Khan
  11. Patients? perceptions of the value of PET in diagnosis and management of non-small call lung cancer, CHERE Working Paper 2007/5 By Marion Haas; Siggi Zapart; Rosalie Viney

  1. By: Brian S. Armour; M. Melinda Pitts; Chung-won Lee
    Abstract: The goal of this research is to quantify the association between food insecurity and smoking among low-income families. This analysis is a retrospective study using data from the 2001 Panel Study of Income Dynamics, a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. Family income is linked with U.S. poverty thresholds to identify 2,099 families living near or below 200 percent of the federal poverty level. Food insecurity (that is, having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) is calculated from the eighteen core items in the food security module of the U.S. Department of Agriculture. The results indicate that smoking prevalence is higher among low-income families who are food insecure compared to low-income families who are food secure (43.6 percent versus 31.9 percent). Multivariate analysis reveals that smoking is associated with an increase in food insecurity of approximately 6 percentage points. Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food assistance and tobacco control programs to work together to help low-income people quit smoking.
    Date: 2007
  2. By: Bengtsson, Niklas (Department of Economics)
    Abstract: We use time-series of rainfall along with individual fixed effects to estimate the response of body weight to transitory changes in house-hold income and expenditure. Our data consist of a longitudinal sample of subsistence farmers in rural Tazania, representing one of the poorest populations in the world. We find that the response of body weight to transitory changes in household income is positive on average, but that the impact decreases with age and being male. For female children, a ten percent increase in household income implies an increase in body weight with about 0.4 kilo. The body weight of male adults is practically invariant to income changes.
    Keywords: Income variability; Consumption; Nutrition; sub-Saharan Africa
    JEL: D13 I12 O12
    Date: 2007–08–30
  3. By: Edmark, Karin (Department of Economics)
    Abstract: This study tests for strategic competition in public spending on childcare and primary education, and care for the elderly, using panel data on Swedish municipalities over 1996-2005. The high degree of decentralization in the organization of the public sector implies that Swedish data is highly suitable for this type of study. The study is not limited to interactions in the same type of expenditure, but also allows for e¤ects across expenditures. The results give no robust support for the hypothesis that municipalities react on the spending policy of neighbouring municipalities in the decision on own spending on care of the elderly, childcare and education.
    Keywords: Strategic interactions; Spatial econometrics; Decentralization; Local Public Spending
    JEL: C31 H72 H77
    Date: 2007–09–03
  4. By: Hanming Fang; Alessandro Gavazza
    Abstract: We investigate how the employment-based health insurance system in the U.S. affects individuals' life-cycle health-care decisions. We take the viewpoint that health is a form of human capital that affects workers' productivities on the job, and derive implications of employees' turnover on the incentives to undertake health investment. Our model suggests that employee turnovers lead to dynamic inefficiencies in health investment, and particularly, it suggests that employment-based health insurance system in the U.S. might lead to an inefficient low level of individual health during individuals' working ages. Moreover, we show that under-investment in health is positively related to the turnover rate of the workers' industry and increases medical expenditure in retirement. We provide empirical evidence for the predictions of the model using two data sets, the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). In MEPS, we find that employers in industries with high turnover rates are much less likely to offer health insurance to their workers. When employers offer health insurance, the contracts have higher deductibles and employers' contribution to the insurance premium is lower in high turnover industries. Moreover, workers in high turnover industries have lower medical expenditure and undertake less preventive care. In HRS, instead we find that individuals who were employed in high turnover industries have higher medical expenditure when retired. The magnitude of our estimates suggests significant degree of intertemporal inefficiencies in health investment in the U.S. as a result of the employment-based health insurance system. We also evaluate and cast doubt on alternative explanations.
    JEL: D91 D92 I1 I12
    Date: 2007–09
  5. By: Christopher Carpenter; Carlos Dobkin
    Abstract: This paper estimates the effect of alcohol consumption on mortality using the minimum drinking age in a regression discontinuity design. We find that granting legal access to alcohol at age 21 leads to large and immediate increases in several measures of alcohol consumption, including a 21 percent increase in the number of days on which people drink. This increase in alcohol consumption results in a discrete 9 percent increase in the mortality rate at age 21. The overall increase in deaths is due primarily to a 14 percent increase in deaths due to motor vehicle accidents, a 30 percent increase in alcohol overdoses and alcohol-related deaths, and a 15 percent increase in suicides. Combining the reduced-form estimates reveals that a 1 percent increase in the number of days a young adult drinks or drinks heavily results in a .4 percent increase in total mortality. Given that mortality due to external causes peaks at about age 21 and that young adults report very high levels of alcohol consumption, our results suggest that public policy interventions to reduce youth drinking can have substantial public health benefits.
    JEL: I1
    Date: 2007–09
  6. By: Gopi Shah Goda; John B. Shoven; Sita Nataraj Slavov
    Abstract: Medicare as a Secondary Payer (MSP) legislation requires employer-sponsored health insurance to be a primary payer for Medicare-eligible workers at firms with 20 or more employees. While the legislation was developed to better target Medicare services to individuals without access to employer-sponsored insurance, MSP creates a significant implicit tax on working beyond age 65. This implicit tax is approximately 15-20 percent at age 65 and increases to 45-70 percent by age 80. Eliminating this implicit tax by making Medicare a primary payer for all Medicare-eligible individuals could significantly increase lifetime labor supply due to the high labor supply elasticities of older workers. The extra income tax receipts from such a policy would likely offset a large percentage of the estimated costs of making Medicare a primary payer.
    JEL: H51 J14 J21 J26
    Date: 2007–09
    Abstract: The aim of this study was to investigate the extent to which people from two different sectors are ‘armed’ to deal effectively with change. Change is apparently the only constant factor in current work surroundings. A crucial issue to manage change professionally is coping with the involved uncertainty. The individual manager plays an important role in this regard, as successfully coping with change is strongly influenced by the psychological predispositions of the individual experiencing the change. We compared Flemish entrepreneurs and healthcare managers on four traits (locus of control, self-efficacy, tolerance for ambiguity, proactive personality) and on cognitive styles (i.e., individual preferences for organising and processing information). Entrepreneurs (n = 177) scored significantly higher on all traits than healthcare managers (n = 60). Healthcare managers scored significantly higher on the knowing and planning style than entrepreneurs, but no significant differences were found for the creating style. With this study, we hope to enhance the knowledge about the influence of particular characteristics in organisational change processes
    Keywords: change management, leadership, cognitive styles, micro-perspective
    Date: 2007–08
  8. By: Michael Gorski (University of Paderborn); Tim Krieger (University of Paderborn); Thomas Lange (Ifo institute for economic research & University of Konstanz)
    Abstract: In a two-period model with agent heterogeneity we analyze a pension reform toward a stronger link between contributions and benefits (as recently observed in several countries) in a pension system with a Bismarckian and a Beveridgian component. We show that such a policy change reduces the educational level in an economy. The life expectancy differential between skilled and unskilled individuals drives this result. Furthermore, we investigate the consequences on the intragenerational redistribution characteristics of the pension system – in the sense of the number of net-recipients relative to net-payers – as well as welfare effects.
    Keywords: social security, education, life expectancy, pension reform, redistribution
    JEL: H55 I21 D39
    Date: 2007–03
  9. By: Carlos Bozzoli (Princeton University); Angus Deaton (Princeton University); Climent Quintana-Domeque (Princeton University)
    Abstract: We investigate the childhood determinants of adult height in populations, focusing on the respective roles of income and of disease. We develop a model of selection and scarring, in which the early life burden of nutrition and disease is not only responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height, as well as in late-life disease. Across a range of European countries and the United States, we find a strong inverse relationship between post-neonatal (one month to one year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. In pooled birth-cohort data over 30 years for the United States and eleven European countries, post-neonatal mortality in the year of birth accounts for more than 60 percent of the combined cross-country and cross-cohort variation in adult heights. The estimated effects are smaller but remain significant once we allow for country and birth-cohort effects. In the poorest and highest mortality countries of the world, there is evidence that child mortality is positively associated with adult height. That selection should dominate scarring at high mortality levels, and scarring dominate selection at low mortality levels, is consistent with the model for reasonable values of its parameters.
    Date: 2007–03
  10. By: Muhammad Akram (International Islamic University, Islamabad.); Faheem Jehangir Khan (Pakistan Institute of Development Economics, Islamabad.)
    Abstract: The study has been carried out to measure the incidence of government spending on health in Pakistan at provincial, both rural and urban level; using the primary data of the Pakistan Social Standard Living Measures Survey (PSLM), 2004-05, and by employing the three-step Benefit Incidence Approach (BIA) methodology. The paper reviews the national policies emphasising health services as well as the trend in access to and public sector spending on health care facilities in Pakistan. The study explores the inequalities in resource distribution and service provision against the government health expenditures. The rural areas of Pakistan are the more disadvantaged in the provision of the health care facilities. The expenditures in health sectors are overall regressive in rural Pakistan as well as at provincial and regional levels. Mother and Child subhead is regressive in Punjab and General Hospitals and Clinics are regressive in all provinces. Only the Preventive Measures and health facilities sub-sector is progressive in Pakistan. Public health expenditures are pro-rich in Pakistan.
    Keywords: Health, Expenditure, Public Policy, Gini, Concentration Coefficient, Mother and Child, Preventive Measures, Hospital and Clinics
    JEL: H51 H53 I11 I18 I38 O18
    Date: 2007
  11. By: Marion Haas (CHERE, University of Technology, Sydney); Siggi Zapart (CHERE, University of Technology, Sydney); Rosalie Viney (CHERE, University of Technology, Sydney)
    Abstract: A randomized controlled trial comparing the use of PET versus no PET provided the opportunity to investigate the value patients placed on any additional information provided by the PET scan. Interviews were undertaken with patients after their diagnosis had been made and, in the case of those who had surgery, once they had returned home following the operation. Content analysis was used to describe and analyse the text of the interviews. The aims of the research were to explore with people receiving PET their perceptions of its impact on aspects of well being, acquire a better understanding of how patients understand and deal with the outcomes (both benefits and dis-benefits) of PET, and assess the decision making processes regarding PET and subsequent treatment (surgical and non-surgical) from the patients? perspectives with the aim of providing information which can be used by providers of care in improving the process of care. Interviews were conducted with a sub-sample of 59 trial participants between February 2000 and July 2001, between six and eight weeks post-surgery. Thirty-three, (56%) had received a PET scan and 26 (44%) had not. The majority of patients consulted a surgeon in the expectation of having surgery to remove their cancer. Participants viewed PET (along with the other tests) as being most likely to provide information and reassurance to the surgeon, rather than having any impact on their (patients?) decisions. As far as these participants were concerned, there was only one important decision - whether to have surgery - and that decision was in the hands of the surgeon. All other decisions were subordinate to this major milestone and thus did not appear significant to patients. Thus, on its own, PET appeared to be of little additional value to this group of patients. Between 23%-45% of respondents reported some complications whilst in hospital or some difficulties at home but these were mostly of a relatively minor nature. Even though some patients reported that their health was worse than when they entered hospital, most participants reported that their health was improving at the time of the interview. Most participants had, at least briefly, discussed the issue of relapse with a doctor at a consultation subsequent to their surgery. The diagnosis of cancer is the key issue; all that happens to them subsequently seems to be determined by clinicians. It is important that clinicians explain the reasons for tests such as PET to patients and use diagnostic tests appropriately in the management of the disease. Understanding the experiences of patients provides useful information for clinicians in preparing patients for surgery for lung cancer and for cancer services in considering the level of ongoing support required for patients following surgery.
    Keywords: Positron emission tomography, lung cancer
    JEL: I10

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