nep-hea New Economics Papers
on Health Economics
Issue of 2007‒12‒01
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  2. Disability and Marginal Utility of Income By Tengstam, Sven
  3. Routes of Infection: Exports and HIV Incidence in Sub-Saharan Africa By Emily Oster
  4. Mortality, Mass-Layoffs, and Career Outcomes: An Analysis using Administrative Data By Daniel Sullivan; Till von Wachter
  5. Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans By Florian Heiss; Daniel McFadden; Joachim Winter
  6. A Theory of Retirement By David E. Bloom; David Canning; Michael Moore
  7. Do women with higher autonomy seek more maternal and child health-care? Evidence from Ethiopia and Eritrea By Gebremariam Woldemicael
  8. Why Parents Worry: Initiation into Cannabis Use by Youth and their Educational Attainment By Jan C. van Ours; Jenny Williams
  9. Pesticides And Farmer Health In Nicaragua: A Willingness To Pay Approach By Garming, Hildegard; Waibel, Hermann
  10. Fiscal Decentralization, Chinese Style: Good for Health Outcomes? By Uchimura, Hiroko; Jütting, Johannes P.
  11. Life of elderly in India By prasad, syam
  12. Health Econometric: Uncovering the Anthropometric Behavior on Women's Labor Market By Lopez-Pablos, Rodrigo A.
  13. Population ageing, taxation, pensions and health costs, CHERE Working Paper 2007/10 By Patricia Apps; Ray Rees; Margi Wood
  14. Decisions about Pap tests: What influences women and providers? By Denzil Fiebig; Marion Haas; Ishrat Hossain; Rosalie Viney
  15. The Public/Private Mix in Irish Acute Public Hospitals: Trends and Implications By Jacqueline O'Reilly; Miriam M. Wiley

  1. By: Dolores Jiménez-Rubio (Universidad de Granada. Dpto. Economía Aplicada)
    Abstract: An important recent change in the Spanish society is the increasing proportion of the population who are immigrants. Immigrants often face situations of social exclusion and disadvantage, circumstances that may affect their health status. Empirical evidence about differences in health status or the utilisation of health services between native and immigrant population is however insufficient. This paper uses the 2003 National Health Survey to explore whether non-Spaniards, for the same level of need, use health care services at the same rate as national citizens. The findings show different patterns of health care use to the disadvantage of immigrants.
    Keywords: Equity in health care, immigrant population, Spanish National Health System
    JEL: I11 J15
    Date: 2007–11–22
  2. By: Tengstam, Sven (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: Many argue that disability generally lowers the marginal utility of income. This paper questions this view. Individuals’ marginal utility (measured by a von Neumann-Morgenstern utility function) of income are estimated in two states; when being paralyzed and when not being paralyzed. Experimental choices between imagined lotteries, where the outcome includes both income and disability status, are used. This allows for estimation of the ratio of the individual’s marginal utility of income when being paralyzed and when not being paralyzed, the Relative Marginal Utility of Income when Disabled (RMUID). The median RMUID is estimated to between 1.33 and 2. It is extremely (at the 0.005 % level) statistically significant higher than one. Individuals with personal experience of mobility impairment and of university studies, and voters for the Left Block and the Liberal Party, have higher RMUID than others. The results have implications for the optimal level of insurance and for the question of whether we should use distributional weights in cost-benefit analysis.<p>
    Keywords: Disability; Mobility impairment; Marginal utility; Hypothetical lotteries; Risk
    JEL: D10 D60 D63 I10 I30
    Date: 2007–11–21
  3. By: Emily Oster
    Abstract: I generate new data on HIV incidence and prevalence in Africa based on inference from mortality rates. I use these data to relate economic activity (specifically, exports) to new HIV infections in Africa and argue there is a significant and large positive relationship between the two: a doubling of exports leads to as much as a quadrupling in new HIV infections. This relationship is consistent with a model of the epidemic in which truckers and other migrants have higher rates of risky behavior, and their numbers increase in periods with greater exports. I present evidence suggesting that the relationship between exports and HIV is causal and works, at least in part, through increased transit. The result has important policy implications, suggesting (for example) that there is significant value in prevention focused on these transit oriented groups. I apply this result to study the case of Uganda, and argue that a decline in exports in the early 1990s in that country appears to explain between 30% and 60% of the decline in HIV infections. This suggests that the success of the Ugandan anti-HIV education campaign, which encouraged changes in sexual behavior, has been overstated.
    JEL: F13 I12 J1 O24
    Date: 2007–11
  4. By: Daniel Sullivan; Till von Wachter
    Abstract: This paper uses administrative data on quarterly employment and earnings matched to death records to estimate the effects of job displacement on mortality. We find that job displacement leads to a 15-20% increase in death rates during the following 20 years. If such increases were sustained beyond this period, they would imply a loss in life expectancy of about 1.5 years for a worker displaced at age 40. These results are robust to extensive controls for sorting and selection, and are consistent with estimates of the effects of job loss on mortality pooling displaced workers and stayers that are not affected by selective job displacement. To examine the channels through which mass layoffs raise mortality, we exploit the panel nature of our data -- covering over 15 years of earnings -- to analyze the correlation of long-run career outcomes, such as the mean and standard deviation of earnings, with mortality at the individual and group level, something not possible with typical data sets. Our findings suggest that factors correlated with a decrease in mean earnings and a rise in standard deviation of earnings have the potential to explain an important fraction of the effect of a job displacement on mortality.
    JEL: I1 J63 J65
    Date: 2007–11
  5. By: Florian Heiss; Daniel McFadden; Joachim Winter
    Abstract: Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans.
    JEL: C25 C61 C81 D12 D91 H51 I10 I12 I18
    Date: 2007–11
  6. By: David E. Bloom; David Canning; Michael Moore
    Abstract: We construct a life-cycle model in which retirement occurs at the end of life as a result of declining health. We show that improvements in life expectancy, coupled with a delay in the onset of disability, increases both the optimal consumption level and the proportion of life spent in leisure. The retirement age increases proportionally less than the increase in life expectancy.
    JEL: D91 J26
    Date: 2007–11
  7. By: Gebremariam Woldemicael (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Current research and policy on maternal and child health-care in Eritrea and Ethiopia focus primarily on female education and employment, while little attention is placed on women’s decision-making autonomy. However, the role of women’s decision-making in reproductive health cannot be overemphasized. In this paper, different dimensions of women’s decision-making autonomy and their relationship to maternal and child health-care utilization are investigated using data from the Demographic and Health Surveys of Ethiopia and Eritrea. We simultaneously consider the role of socio-economic (indirect) indicators of women’s status . The study shows that most autonomy indicators are important predictors of maternal and child health-care utilization although the strength and statistical significance vary by health-care utilization outcome and country, and in some cases significance is lost when socio-economic indicators are held constant. The strong positive effect of women’s sole decision-making in visiting family or relatives on use of antenatal care and child immunization is particularly impressive. On the other hand, the loss of significance of other dimensions of women’s decision-making when socio-economic factors are controlled for indicates that some health-care seeking behaviours are more dependent on socio-economic factors like education and employment. The results show that most socio-economic indicators have strong influence on both women’s decision-making autonomy and on maternal and child health-care utilization. These findings suggest that both women’s autonomy and socio-economic indicators should be analyzed in order to derive a complete understanding of the determinants of maternal and child health-care utilization.
    Keywords: Eritrea, Ethiopia
    JEL: J1 Z0
    Date: 2007–11
  8. By: Jan C. van Ours; Jenny Williams
    Abstract: In this paper we use individual level data from the Australian National Drug Strategy Household Survey to study the relationship between initiation into cannabis use and educational attainment. Using instrumental variable estimation and bivariate duration analysis we find that those initiating into cannabis use early in life are much more likely to dropout of school compared to those who start later on. Moreover, we find that the reduction in years of schooling depends on the age at which initiation occurs, and that it is larger for females than males.
    Keywords: cannabis use; age of initiation; educational attainment
    JEL: C41 D12 I19
    Date: 2007
  9. By: Garming, Hildegard; Waibel, Hermann
    Abstract: This study presents an economic valuation of health risks of pesticides among Nicaraguan vegetable farmers. A comprehensive valuation of market and non-market value components of human health is established through farmers’ willingness to pay (WTP) for low toxicity pesticides. Results show, that farmers are willing to spend about 28% of current pesticide expenditure for avoiding health risks. The validity of results is established in scope tests and a two-step regression model. WTP depends on farmers’ experience with poisoning, income variables and pesticide exposure. The results can help in targeting of rural health policies and the design of programmes aiming to reduce negative effects of pesticides.
    Keywords: Health risks of pesticides, Contingent Valuation, Nicaragua
    Date: 2007
  10. By: Uchimura, Hiroko; Jütting, Johannes P.
    Abstract: This study analyzes the effect of fiscal decentralization on health outcomes in China using a panel data set with nationwide county-level data. We find that counties in more fiscal decentralized provinces have lower infant mortality rates compared with those counties in which the provincial government retains the main spending authority, if certain conditions are met. Spending responsibilities at the local level need to be matched with county government’s own fiscal capacity. For those local governments that have only limited revenues, their ability to spend on local public goods such as health care depends crucially upon intergovernmental transfers. The findings of this study thereby support the common assertion that fiscal decentralization can indeed lead to more efficient production of local public goods, but also highlights the necessary conditions to make this happen.
    Date: 2007
  11. By: prasad, syam
    Abstract: Abstract of the paper Aging of population is a major aspect of the process of demographic transition. It is generally expressed as older individuals forming large share of the total population. Such an increase is considered to be an end product of demographic transition or demographic achievements with a decline in both fertility and mortality rates and consequent increase in the life expectancy at birth and older ages. The recent emphasis on studies pertaining to the elderly in the developing world is attributed to their increasing numbers and deteriorating conditions. The lives of many older people are affected more frequently by the social and economic insecurity that accompany demographic and development process (World Bank 1994). The growth of individualism and desire of the independence and autonomy of the young generation (serow 2001) affect the status of the elderly. The studies show that the socio economic condition of older women is more vulnerable in the context of the demographic and the socio cultural change (Tout 1993). The situation of the elderly poverty has been a consistent phenomenon in the third world as the older population is deprived of the basic needs (Keyfitz and Flieger 1990). In this paper we make an attempt to profile life of elderly that reflects on deprivation among the elderly. Here most important question is whether age acts a determining factor in the life of a person. Or does age mediates living condition along with other factors that coexistence in life. Is there any change in the living condition over chronological ladders of human life? How does differ life varies across chronological ladder across space in India over time through a narration of what is happening in the Indian states in the past decade. Here we look into four parameters that create risk and to which chronologically disadvantaged population has to respond. They are marital status, work status, living arrangements of the elderly and dependency. Then look into how close interactions between these factors affect the overall living of the elderly by using an index of life for the Indian states. Here we mainly focuses on how there is an over all decline in the life of elderly by looking into four dimensions of life in terms of marital status, economic status( work participation) dependency and living arrangements. Here we profile these aspects to understand pattern of living among elderly in Indian states. The paper highlights that the living condition of the elderly varies differently across Indian states. The various dimensions are vertically integrated to get a weighted index called in this paper as quality of life among the elderly that take value zero to one with higher value provides worse living condition. It is clear that position of the elderly in terms of material and social well being is betterly positioned in the states of north India rather than south India.
    Keywords: ageing; life of elderly; quality of life; demographic transition
    JEL: J14 I31 I3
    Date: 2007–11–27
  12. 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
  13. By: Patricia Apps (University of Sydney); Ray Rees; Margi Wood
    Abstract: This paper argues against the policy position that begins with a doomsday scenario of publicly provided health insurance and pension systems threatened with collapse under the stresses imposed by population ageing, and instead contends that the threat of crisis in these systems is policy driven. The central thesis of the paper is that a range of policies lead to the creation of an ageing crisis by inhibiting the efficient reallocation of female labour from the home to the market in response to the decline in fertility. The analysis focuses on family support policies that create large effective tax burdens on female labour supply, by means testing the support on family income, or selectively on the second income. Examples include Family Tax Benefit Part A and Part B, the Medicare Levy and the Medicare Safety Net. The analysis draws on household survey data to show that female labour supply is strongly positively associated with household saving, the purchase of private health insurance and spending on family health generally. Policies that inhibit female labour supply therefore have the effect of reducing the tax base for funding public pensions and health care, while simultaneously reducing the capacity of families to fund them privately.
    Keywords: life cycle, health costs, pensions, household taxation
    JEL: D19 I18 J26
  14. By: Denzil Fiebig (University of NSW); Marion Haas (CHERE, University of Technology, Sydney); Ishrat Hossain (CHERE, University of Technology, Sydney); Rosalie Viney (CHERE, University of Technology, Sydney)
    Abstract: Despite the success internationally of cervical screening programs debate continues about optimal program design. This includes increasing participation rates among under-screened women, reducing unnecessary early re-screening, improving accuracy of and confidence in screening tests, and determining the cost-effectiveness of program parameters, such as type of screening test, screening interval and target group. For all these issues, information about consumer and provider preferences and insight into the potential impact of any change to program design on consumer and provider behaviour are essential inputs into evidence-based health policy decision making. This paper reports the results of discrete choice experiments to investigate women?s choices and providers? recommendations in relation to cervical screening in Australia. Separate experiments were conducted with women and general practitioners, with attributes selected to allow for investigation of interaction between women?s and providers? preferences and to determine how women and general practitioners differ in their preferences for common attributes. The results provide insight into the agency relationship in this context. Our results indicate a considerable commonality in preferences but the alignment was not complete. Women put relatively more weight on cost, chance of a false positive and if the recommended screening interval were changed to one year.
    Keywords: Cervical Screening; Discrete choice experiments; Agency relationships, Consumer preferences
    JEL: I10
  15. By: Jacqueline O'Reilly (Economic and Social Research Institute (ESRI)); Miriam M. Wiley (Economic and Social Research Institute (ESRI))
    Abstract: The public/private mix in Irish health care is nowhere more evident than in the acute hospital system where both public and private patients can be treated in public hospitals by the same consultant. By undertaking new analyses of data from the Hospital In-Patient Enquiry Scheme, this study investigates this public/private mix and its impact on utilisation of hospital services. Demand- and supply-side factors were both found to be statistically significant in explaining the ratio of private to public discharges across hospitals and over time. Private discharges are found to have higher levels of utilisation of surgical procedures, even though the level of comorbidity did not appear to be any greater for this group. The analysis also found that ‘excess utilisation’ of public hospital facilities by private discharges in particular hospitals increased over the time period of the study. Despite limitations of available data and methods, this study provides useful insights into the factors driving private and public utilisation in the acute public hospital system in Ireland.
    Date: 2007–11

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