nep-hea New Economics Papers
on Health Economics
Issue of 2007‒11‒10
eleven papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Modeling multiple source risk factor data and health outcomes in twins By Andy Bogart; Jack Goldberg
  2. Human capital externalities and adult mortality in the U.S. By Christopher H. Wheeler
  3. Economic Fluctuations and Mortality:Evidence from Wavelet Analysis for Sweden 1800-2000 By Krüger, Niclas A; Svensson, Mikael
  4. Maternal Health Financing in Gujarat: Preliminary Results from a Household Survey of Beneficiaries under Chiranjeevi Scheme By Bhat Ramesh; Mavalankar Dileep; Singh Prabal V.; Singh Neelu
  5. Fatal Fluctuations? Cyclicality in Infant Mortality in India By Sonia Bhalotra
  6. Pinning Down the Value of Statistical Life By Thomas J. Kniesner; W. Kip Viscusi; Christopher Woock; James P. Ziliak
  7. How Much Uncompensated Care do Doctors Provide? By Jonathan Gruber; David Rodriguez
  8. Economic Inequality and Health: Looking Beyond Aggregate Indicators By Petri Böckerman; Edvard Johansson; Satu Helakorpi; Antti Uutela
  9. Does Working Longer Make People Healthier and Happier? By Calvo, Esteban
  10. Health Econometric: Uncovering the Anthropometric Behavior on Women's Labor Market By Lopez-Pablos, Rodrigo A.
  11. The absolute health income hypothesis revisited: A Semiparametric Quantile Regression Approach. By Thanasis Stengos; Yiguo Sun

  1. By: Andy Bogart (University of Washington Center for Clinical and Epidemiological Research); Jack Goldberg
    Abstract: One challenging feature of some medical research is the existence of multiple sources of exposure information about individual subjects. When an exposure of interest has been measured in a variety of ways, or has been reported on by multiple informants, analysts must decide how best to estimate its association with some interesting outcome. Simply performing a multiple regression analysis of the outcome on all the sources together can be problematic, since those reports are likely to be highly correlated. Alternatively, collapsing the reports into a single measure invariably implies an unfortunate loss of information, and a nagging question as to whether one has done the right thing. Instead, we used Stata 9 to implement a novel application of complex sample survey methods1,2 which allows simultaneous use of multiple reports in single regression model. We further extended the method to accommodate estimation of within- and between-pair effects in twin research. My presentation will use Vietnam era veteran twin data to explore the association between military service in Vietnam with post traumatic stress disorder, and address within-and between-pair effects. We will gently explore how to properly reshape data, derive necessary variables, specify models, and implement Stata’s svy commands to apply the method.
    Date: 2007–10–31
  2. By: Christopher H. Wheeler
    Abstract: Human capital is now widely recognized to confer numerous benefits, including higher incomes, lower incidence of unemployment, and better health, to those who invest in it. Yet, recent evidence suggests that it also produces larger, social (external) benefits, such as greater aggregate income and productivity as well as lower rates of crime and political corruption. This paper considers whether human capital also delivers external benefits via reduced mortality. That is, after conditioning on various individual-specific characteristics including income and education, do we observe lower rates of mortality in economies with higher average levels of education among the total population? Evidence from a sample of more than 200 U.S. metropolitan areas over the decade of the 1990s suggests that there are significant human capital externalities on health. After conditioning on a variety of city-specific characteristics, the findings suggest that a 5 percentage point decrease in the fraction of college graduates in the population corresponds to a 14 to 36 percent increase in the probability of death, on average. Although I am unable to identify the precise mechanism by which this relationship operates, it is certainly consistent with the idea that interactions with highly educated individuals - who tend to exhibit relatively healthy behaviors - encourage others to adopt similar behaviors. Evidence of a significant inverse relationship between aggregate human capital and smoking, conditional on personal characteristics, in a sample of 201 U.S. metropolitan areas is also consistent with this hypothesis.
    Date: 2007
  3. By: Krüger, Niclas A (Department of Business, Economics, Statistics and Informatics); Svensson, Mikael (Department of Business, Economics, Statistics and Informatics)
    Abstract: In this paper we investigate the relationship between crude and age adjusted mortality andeconomic conditions by wavelet analysis in Sweden over the period 1800-2000. We use wavelet correlations and cross-correlations to analyze the contemporaneous connection as well as the lead/lag relationship between mortality and GDP at different time scales. Our results indicate a countercyclical relationship, i.e. mortality decreases in economic upturns, for all time horizons. The relationship is strongest and highly significant for dynamics with a period between 4 and 8 years, corresponding to the length of a typical Swedish business cycle. By means of vector autoregressive modelling, we further examine the dynamics of the response in mortality to an exogenous GDP growth shock. Our results indicate that economic upturns decreases contemporaneous mortality and increases mortality between six and eight years ahead.
    Keywords: Mortality; GDP growth; Wavelet
    JEL: E32 I12
    Date: 2007–10–29
  4. By: Bhat Ramesh; Mavalankar Dileep; Singh Prabal V.; Singh Neelu
    Abstract: The objective of this paper is to provide preliminary analysis of information collected at household level from beneficiaries of the Chiranjeevi scheme and from those who have not used the scheme (non-user group). The key findings have been discussed. Some of the questions which have guided this exercise are: understanding the socio-economic profile and differences of the households who have used the scheme and those who have not used the scheme, ability of scheme to target the poor and out-of-pocket expenditures incurred both users and non-users of the scheme. We have discussed this by analysing education, land holding, number of earning members in the family, possession of specific assets, age of women at the time of delivery, ANC services received, place of delivery, distance and time taken to reach the facility, status (normal or complication) of delivery, complications experienced, and cost incurred during the process. The total sample size consists of 656 respondents from 3 talukas of Dahod District. Of these total 656 respondents, 262 (40 per cent) are Chiranjeevi clients and 394 (60 per cent) comprise the non-user group. Key findings of the study are: * The Chiranjeevi scheme is being used by relatively younger mothers and having lesser number of children at the time of index delivery. * Most of the Chiranjeevi users have income levels less than Rs. 12,000 per annum indicating the scheme is able to target the poor families in these three blocks of the district, * The expenditure incurred by non-user group on index (recent) delivery at a private facility is Rs. 4000. * The average expenditure incurred by the Chiranjeevi beneficiary on their previous delivery was Rs. 3070. On index delivery a Chiranjeevi client has spent out-of- pocket on an average Rs. 727 per delivery on medicine (self Rs. 297, child Rs. 358) and transportation Rs.72 indicating that the delivery is not really cash-less. However, the average amount saved by the Chiranjeevi client by availing the benefit of the scheme is Rs 3273 (Rs. 4000 minus Rs. 727). * The average distance travelled by a Chiranjeevi client to reach the health care facility is 13.79 kms and the average time taken is 44 minutes. * The average expenditure on transportation using mostly private transport by a Chiranjeevi client is Rs.272 as compared to Rs. 200 which the Chiranjeevi client is reimbursed, * Private doctors have conducted 41 per cent of deliveries where as rest of the deliveries have been conducted by staff at the private health care facility under the Chiranjeevi scheme, * ANMs have been the source of information to 55 per cent of Chiranjeevi scheme users. Anganwadi workers provided information to 17 percent of the clients and Female Health Workers to 10 per cent of the Chiranjeevi clients. Thus, 82 per cent of the total beneficiaries of the Chiranjeevi scheme were provided information by the community health workers.
    Date: 2007–10–20
  5. By: Sonia Bhalotra (University of Bristol and IZA)
    Abstract: This paper investigates the impact of macroeconomic shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature shows that mortality at most ages is pro-cyclical but similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses individual data on infant mortality for about 150000 children born in 1970-1997, merged by birth-cohort with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks. I cannot reject the null that income shocks have no effect on mortality in urban households, but I find that rural infant mortality is counter-cyclical, the elasticity being about -0.46. This is despite the possibility that relatively high risk women avert birth or suffer fetal loss in recessions. It seems related to the fact that women’s participation in the (informal) labour market increases in recessions, presumably, to compensate a decline in their husband’s wages. Consistent with this but, in contrast to results for richer countries, antenatal and postnatal health-care decline in recessions. These effects are reinforced by pro-cyclicality in state health and development expenditure. Another interesting finding that is informative about the underlying mechanisms is that the effect of aggregate income on rural mortality is driven by non-agricultural income.
    Keywords: infant mortality, income volatility, business cycles, India, health care, maternal labour supply, public expenditure
    JEL: I12 J10 O49
    Date: 2007–09
  6. By: Thomas J. Kniesner (Syracuse University and IZA); W. Kip Viscusi (Vanderbilt University); Christopher Woock (The Conference Board); James P. Ziliak (University of Kentucky)
    Abstract: Our research addresses fundamental long-standing concerns in the compensating wage differentials literature and its public policy implications: the econometric properties of estimates of the value of statistical life (VSL) and the wide range of such estimates from about $0.5 million to about $21 million. We address most of the prominent econometric issues by applying panel data, a new and more accurate fatality risk measure, and systematic selection of panel estimator in our research. Controlling for measurement error, endogeneity, individual heterogeneity, and state dependence yields both a reasonable average level and narrow range for the estimated value of a statistical life of about $5.5-$7.5 million.
    Keywords: VSL, panel data, fixed effects, random effects, PSID
    JEL: I10 J17 J28 K00
    Date: 2007–10
  7. By: Jonathan Gruber; David Rodriguez
    Abstract: The magnitude of provider uncompensated care has become an important public policy issue. Yet existing measures of uncompensated care are flawed because they compare uninsured payments to list prices, not to the prices actually paid by the insured. We address this issue using a novel source of data from a vendor that processes financial data for almost 4000 physicians. We measure uncompensated care as the net amount that physicians lose by lower payments from the uninsured than from the insured. Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments. Even our most conservative estimates suggest that uncompensated care amounts to only 0.8% of revenues, or at most $3.2 billion nationally. These results highlight the important distinction between charges and payments, and point to the need for a re-definition of uncompensated care in the health sector going forward.
    JEL: I1
    Date: 2007–11
  8. By: Petri Böckerman; Edvard Johansson; Satu Helakorpi; Antti Uutela
    Abstract: ABSTRACT : This paper examines the relationship between relative income inequality and health in Finland, using individual microdata over the period 1993-2005. Our data allows us to analyse a large spectrum of health indicators. Overall, our results suggest that income inequality is not associated with increased morbidity in the population. The results for women differ to quite a large extent from those of men and the pooled sample. There is evidence that an increase in the Gini coefficient is negatively related to the probability of good physical health and no disability retirement. For men, relative income inequality is clearly not important for health.
    Keywords: health, health behaviour, economic inequality, relative income inequality, relative deprivation, Gini coefficient
    JEL: I12 I30
    Date: 2007–11–06
  9. By: Calvo, Esteban
    Abstract: PURPOSE: This study addresses the impact of late-life paid work on physical and psychological well-being. METHODS: Longitudinal data was drawn from the Health and Retirement Survey and the RAND-HRS data base for more than 6,000 individuals aged 59 to 69 who were working or not-working in the year 2000 and were alive in 2002. Well-being was assessed by using a set of six measures including: self-rated health; self-rated memory; activities of daily living; instrumental activities of daily living and mood indicators. The study controls for previous well-being status in 1998 and for demographic and socioeconomic factors. RESULTS: Those who worked in 2000 tended to report greater well-being in 2002 than those who did not work in 2000, even after introducing rigorous controls (p<.01). Working in undesirable jobs changes the favorable effects of paid work on mood indicators and mortality. For those forced into retirement (20% of the sample), work is not an alternative. IMPLICATIONS: This study suggests that late-life work will help most people maintain their overall well-being. While working longer seems beneficial for most people, it will likely have negative consequences for some. The type of job seems to be a critical factor. Another critical factor is the opportunity to continue working. Older workers may be willing to prolong paid work, but, in order to find a job, they need to be able to work and have a real demand for their labor. Gerontologists and policymakers need to consider these factors when evaluating proposals to keep people in the labor force.
    Keywords: work; retirement; health; happiness; mortality; well-being; old age; policy; job satisfaction; control
    JEL: J21 I10 I12 J26 I31 J28
    Date: 2006
  10. By: Lopez-Pablos, Rodrigo A.
    Abstract: Exploring current literature which assess relations between cognitive ability and height, obesity, and its productivity-employability effect on women's labor market; we appraised the Argentine case to find these social-physical relations that involve anthropometric and traditional economic variables. Adapting an anthropometric Mincer approach by using probabilistic and censured econometric models which were developed for it. Have been found evidence that could be understood as existence of discriminative behavior on obese women to market entrance; besides, a good performance of women height as an unobserved approximation of cognitive ability measure to explain feminine productivity.
    Keywords: Height; Obesity; Anthropometric Mincer; Discrimination.
    JEL: I12 J24 C34
    Date: 2007–08–30
  11. By: Thanasis Stengos (University of Guelph, Canada and The Rimini Centre for Economics Analysis, Rimini, Italy.); Yiguo Sun (University of Guelph, Canada)
    Abstract: This paper uses the 1998-99 Canadian National Population Health Survey (NPHS) data to examine the health-income relationship that underlies the absolute income hypothesis. To allow for nonlinearity and data heterogeneity, we use a partially linear semiparametric quantile regression model. The “absolute income hypothesis” is partially true; the negative aging effects appear more pronounced for the illhealthy population than for the healthy population and when annual income is below 40,000 Canadian dollars.
    Keywords: Absolute income hypothesis · Partially linear quantile
    JEL: C14 C51 I12
    Date: 2007–07

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