nep-hea New Economics Papers
on Health Economics
Issue of 2008‒01‒05
27 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Customer & Employee Satisfaction in the Health Service Sector: Analysis and Measurement Methodologies By Francesca De Battisti; Laura Iacovone; Giovanna Nicolini
  2. Agency in Health-Care: Are Medical Care-Givers Perfect Agents? By Neuman, Einat; Neuman, Shoshana
  3. A closer look at the relationship between life expectancy and economic growth By Raouf, BOUCEKKINE; Bity, DIENE; ThŽophile, AZOMAHOU
  4. Return Migration and the "Healthy Immigrant Effect" By Monika Sander
  5. The Determinants of Smoking Initiation : Empirical Evidence for Germany By Silja Göhlmann
  6. The Impact of Child and Maternal Health Indicators on Female Labor Force Participation after Childbirth : Evidence from Germany By Annalena Dunkelberg; C. Katharina Spieß
  7. Health Insurance Status and Physician-induced Demand for Medical Services in Germany : New Evidence from Combined District and Individual Level Data By Hendrik Jürges
  8. Social networks and vaccination decisions By Neel Rao; Markus M. Möbius; Tanya Rosenblat
  9. Income Volatility and Health By Timothy Halliday
  10. Bad Apples, Goody Two Shoes and Average Joes: The Role of Peer Group Definitions in Estimation of Peer Effects By Timothy J. Halliday; Sally Kwak
  11. Social Interaction and Sickness Absence By Lindbeck, Assar; Palme, Mårten; Persson, Mats
  12. The Relationship between Health and Labour Force Participation: Evidence from a Panel Data Simultaneous Equation Model By Lixin Cai
  13. Effects of Health on Wages of Australian Men By Lixin Cai
  14. Severity of Work Disability and Work By Umut Oguzoglu
  15. Hospital Type and Patient Outcomes: An Empirical Examination Using AMI Re-admission and Mortality Records By Paul H. Jensen; Elizabeth Webster; Julia Witt
  16. The Health Sector in the Slovak Republic: Efficiency and Reform By Victoria Gunnarsson; Sergio Lugaresi; Marijn Verhoeven
  17. Education and Health in G7 Countries: Achieving Better Outcomes with Less Spending By Stéphane Carcillo; Victoria Gunnarsson; Marijn Verhoeven
  18. Our Troubled Health Care System: Why Is It So Hard to Fix? Nineteenth Annual Herbert Lourie Memorial Lecture on Health Policy. By Judy Feder
  19. Health, Economic Resources and the Work Decisions of Older Men By John Bound; Todd Stinebrickner; Timothy Waidmann
  20. Does Medicare Save Lives? By David Card; Carlos Dobkin; Nicole Maestas
  21. Aging and Death under a Dollar a Day By Abhijit V. Banerjee; Esther Duflo
  22. Impact of First Occupation on Health at Older Ages By Jody L. Sindelar; Jason Fletcher; Tracy Falba; Patricia Keenan; William T. Gallo
  23. Service Production and Patient Satisfaction in Primary Care By Fredrik Carlsen; Jostein Grytten; Irene Skau
  24. The distortionary effect of health insurance on health demand By Nathalie Fombaron; Carine Milcent
  25. Alchol Consumption and Sickness Absence: Evidence from Panel Data. By Edvard Johansson; Petri Böckerman; Antti Uutela
  26. Inequality in Health Coverage, Empirical Analysis with Microdata for Argentina 2006 By Diego Battistón; Francisco Franchetti
  27. Determinants of Household Health Expenditure: Case of Urban Orissa By Prof Bhabesh, Sen; Dr. Himanshu , Sekhar Rout

  1. By: Francesca De Battisti; Laura Iacovone; Giovanna Nicolini (Department of Economics, Business and Statistics)
    Abstract: In order measure the competitiveness of a local Health Service organisation it is necessary to analyse not only internal performance levels but also the perceived quality of the services provided and the level of customer satisfaction attained; this is directly linked to the management aspects of the Healthcare provider. Therefore we suggest performing a comparison between the external and internal 'image' of the structure. In addition, having specified a global subjective measure of satisfaction, we will perform a comparison between customer and employee satisfaction. We will illustrate the results of a survey, carried out on two subject samples (customers and employees of the Healthcare provider in question) to which two different types of questionnaire, similar for some items, are provided.
    Keywords: Customer Satisfaction, Employee Satisfaction, External Image, Internal Image,
    Date: 2007–07–20
  2. By: Neuman, Einat; Neuman, Shoshana
    Abstract: It has been suggested in the literature that a source of incompleteness in the agency relationship between the doctor and the patient is that the provider may respond to an incomplete or biased perception of the patient’s interests. However, this has not been shown empirically. This paper is novel in presenting an empirical test of the fundamental assumption of the agency model that health care professionals understand what their patients want. Discrete Choice Experiments (DCEs) are conducted simultaneously within samples of patients (women who gave birth) and care-givers (doctors and nurses), to elicit and contrast patients’ authentic preferences (for five maternity ward attributes) with what care-givers believe them to be. Conclusion: agents have a biased perception of principals’ preferences, and therefore a complete agency relationship does not exist. Our findings add a novel empirical contribution to the agency relationship literature. Moreover, parallel preference patterns of patients and care-givers are certainly of much interest to the field of health economics: Informing the unaware medical care-givers about the patients' preferences, will improve treatment and patients' satisfaction.
    Keywords: Discrete Choice Experiment; health-care; maternity wards; preferences; principal-agent relationship
    JEL: I1
    Date: 2007–12
  3. By: Raouf, BOUCEKKINE (UNIVERSITE CATHOLIQUE DE LOUVAIN, Department of Economics); Bity, DIENE; ThŽophile, AZOMAHOU
    Abstract: We first provide a nonparametric inference of the relationship between life expectancy and economic growth on an historical data for 18 countries over the period 1820-2005. The obtained shape shows up convexity for low enough values of life expectancy and concavity for large enough values. We then study this relationship on a benchmark model combining Òperpetual youthÓ and learning-by-investing. In such a benchmark, the generated relationship between life expectancy and economic growth is shown to be strictly increasing and concave. We finally examine a model departing from Òperpetual youthÓ by assuming age-dependent survival probabilities. We show that life-cycle behavior combined with age-dependent survival laws can reproduce our empirical finding.
    Keywords: Life expectancy, economic growth, perpetual youth, age-dependent mortality, nonparametric estimation
    JEL: O41 I20 J10
    Date: 2007–12–14
  4. By: Monika Sander
    Abstract: According to the "healthy immigrant effect" (HIE), immigrants upon arrival are healthier than locally born residents. However, this health advantage is supposed to diminish or even disappear over a relatively short period and the immigrants' health status is converging to that of the natives. The causes for this gradient of immigrants' health are subject to an ongoing discussion and the underlying trajectories are not yet fully understood. This paper investigates whether return migration can serve as an additional explanation for the declining health of immigrants, and thus aims at shedding some light on the trajectories underlying the HIE. The data used are drawn from 13 waves of the German Socio-Economic Panel. Using a random-effects probit model, this analysis explores the factors influencing re-migration by means of a sample of 4,426 migrants. In line with the existing literature, the study shows that e.g. having spouse and children in the home country, or being non-working or jobless yield a higher return probability, whereas all factors associated with attachment to Germany (e.g. language fluency, German citizenship, house ownership) reduce the probability of re-migration. Additionally, the results indicate that men reporting poorer health ('good', 'satisfactory', 'poor' or 'bad') are significantly less likely to return home relative to male immigrants who describe their health as 'very good'. However, for women, the effects are adverse to that of men, and none of the health coefficients for women is significant. Hence - at least for men - re-migration can be seen as an additional explanation for the HIE.
    Keywords: Return migration, healthy immigrant effect, SOEP
    JEL: C25 F22 I19
    Date: 2007
  5. By: Silja Göhlmann
    Abstract: This paper aims at analyzing the determinants of the decision to start smoking using data from the German Socio-Economic Panel (GSOEP). The data used is a combination of retrospective information on the age individuals started smoking and, by tracing back these individuals within the panel structure up to the point they started smoking, information on characteristics at the age of smoking initiation. In contrast to other papers, it is possible to control for the environment at the time of smoking on set that might have influenced the decision to start. Moreover, never-smokers can be distinguished from ex-smokers. I estimate discrete, but also continuous time hazard models. Results indicate that young higher educated individuals are less likely to start, whereas the hazard of starting among older individuals is not affected by education. Furthermore, parental smoking during the whole childhood significantly increases the probability to start. Almost no significant effects are found regarding parental education, labor market status and living in a large city. Price effects could not be identified, because in Germany prices did not vary during the last decades up to 2002.
    Keywords: GSOEP, youths, discrete time hazard model,log-logistic duration analysis
    JEL: I12
    Date: 2007
  6. By: Annalena Dunkelberg; C. Katharina Spieß
    Abstract: This paper analyzes the influence of children's health and mothers' physical and mental wellbeing on female labor force participation after childbirth in Germany. Our analysis uses data from the German Socio-Economic Panel (SOEP) study, which enables us to measure children's health based on the occurrence of severe health problems including mental and physical disabilities, hospitalizations, and preterm births. Since child health is measured at a very young age, we can rule out any of the reverse effects of maternal employment on child health identified in US studies. Within a two-year time period, we investigate the influence of these indicators on various aspects of female labor force participation after childbirth, including continuous labor force participation in the year of childbirth and the transition to employment in the year following childbirth. Since the majority of women in Germany do not go back to work within a year after childbirth, we also investigate their intention to return to work, and the preferred number of working hours. We find that the child's severe health problems have a significant negative effect on the mothers' labor force participation and a significant positive effect on her preferred number of working hours, but that hospitalizations or preterm births have no significant effect. For the mothers' own health, we find a significant negative effect of poor mental and physical wellbeing on female labor force participation within a year of childbirth. To our knowledge, this is the first empirical study of this kind on data outside the US.
    Keywords: Female labour supply, Childhealth, Well-being
    JEL: J22 J23 I19
    Date: 2007
  7. By: Hendrik Jürges
    Abstract: Germany is one of the few OECD countries with a two-tier system of statutory and primary private health insurance. Both types of insurance provide fee-for-service insurance, but chargeable fees for identical services are more than twice as large for privately insured patients than for statutorily insured patients. This price variation creates incentives to induce demand primarily among the privately insured. Using German SOEP 2002 data, I analyze the effects of insurance status and district (Kreis-) level physician density on the individual number of doctor visits. The paper has four main findings. First, I find no evidence that physician density is endogenous. Second, conditional on health, privately insured patients are less likely to contact a physician but more frequently visit a doctor following a first contact. Third, physician density has a significant positive effect on the decision to contact a physician and on the frequency of doctor visits of patients insured in the statutory health care system, whereas, fourth, physician density has no effect on privately insured patients' decisions to contact a physician but an even stronger positive effect on the frequency of doctor visits than the statutorily insured. These findings give indirect evidence for the hypothesis that physicians induce demand among privately insured patients but not among statutorily insured.
    Keywords: Supplier-induced demand, Health care utilization
    JEL: I11
    Date: 2007
  8. By: Neel Rao; Markus M. Möbius; Tanya Rosenblat
    Abstract: We combine information on social networks with medical records and survey data in order to examine how friends affect one’s decision to get vaccinated against the flu. The random assignment of undergraduates to residential halls at a large private university allows us to estimate how peer effects influence health beliefs and vaccination choices. Our results indicate that social exposure to medical information raises people’s perceptions of the benefits of immunization. The average student’s belief about the vaccine’s health value increases by $5.00 when an additional 10 percent of her friends are assigned to residences that host inoculation clinics. Among students with no recent flu experience, a 10 percent rise in the number of friends living in residences with clinics raises cumulative valuations of the vaccine by $10.92, with 85 percent of this increase attributable to heightened perceptions about the medical benefits of immunization. We also find evidence of positive peer effects on individuals’ vaccination decisions. A student becomes up to 8.3 percentage points more likely to get immunized if an additional 10 percent of her friends receive flu shots. Furthermore, the excess clustering of friends at inoculation clinics suggests that students coordinate their vaccination decisions with their friends.
    Keywords: Stochastic analysis ; Human behavior ; Altruism ; Medical care
    Date: 2007
  9. By: Timothy Halliday (Department of Economics & John A. Burns School of Medicine, University of Hawaii at Manoa; Institute for Labor Study (IZA))
    Abstract: We investigate the impact of exogenous income fluctuations on health using twenty years of data from the Panel Study of Income Dynamics. To unravel the impact of income on health from unobserved heterogeneity and reverse causality, we employ techniques from the literature on the estimation of dynamic panel data models. Contrary to much of the previous literature on health and socio-economic status, we find that, on average, adverse income shocks lead to a deterioration of health. These effects are most pronounced for working-aged men and are dominated by transitions into the very bottom of the earnings distribution. We also provide suggestive evidence of an association between negative income shocks and higher mortality for working-aged men.
    Keywords: Gradient, Health, Dynamic Panel Data Models, Recessions
    JEL: I0 I12 J1
    Date: 2007–11–30
  10. By: Timothy J. Halliday (Department of Economics & John A. Burns School of Medicine, University of Hawaii at Manoa); Sally Kwak (Department of Economics, University of Hawaii at Manoa)
    Abstract: The potential influence of peers and social networks on individual outcomes is important to a variety of educational policy debates including school vouchers, special education, middle school grade configurations and tracking. Researchers usually address the identification problems associated with credibly estimating peer effects in these settings but often do not account for ad-hoc definitions of peer-groups. In this paper, we use extensive information on peer groups to demonstrate that accurate definitions of the peer network seriously impact estimation of peer effects. We estimate the effect of peers’ smoking, drinking, sexual behavior and educational achievement on a teen’s propensity to engage in like-minded behavior and address the major identification problems that plague estimation of these effects.
    Keywords: Peer Effects, Education, Adolescent Health
    JEL: I12 I20
    Date: 2007–12–01
  11. By: Lindbeck, Assar (Research Institute of Industrial Economics (IFN)); Palme, Mårten (Stockholm University); Persson, Mats (Institute for International Economic Studies)
    Abstract: Does the average level of sickness absence in a neighborhood affect individual sickness absence through social interaction on the neighborhood level? To answer this question, we consider evidence of local benefit-dependency cultures. Well-known methodological problems in this type of analysis include avoiding the so-called reflection problem and disentangling the causal effects of group behavior on individual behavior from the effects of individual sorting on neighborhoods. Based on data from Sweden, we adopt several different approaches to deal with these problems. The results are robust in the sense that regardless of approach and identifying assumptions, we obtain statistically significant estimates indicating group effects.
    Keywords: Sick-pay Insurance; Work Absence; Moral Hazard; Social Norms
    JEL: H56 I38 J22 Z13
    Date: 2007–12–17
  12. By: Lixin Cai (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: A concern when estimating the effect of health on labour supply is that health might be endogenous, and in particular that people might use poor health to justify non-participation. This would result in the effect of health being overestimated if health were treated as exogenous. The paper employs a simultaneous equation model to explore the relationship between health and labour force status, allowing for the endogeneity of health. In addition, the paper takes advantage of panel data to control for unobserved heterogeneity so that more efficient estimation results can be obtained than using cross-sectional data. The results confirm the finding in the literature that health has a positive and significant effect on labour force participation for both males and females. As for the reverse effect, it is found that labour force participation has a negative effect on male health but a positive effect on female health, implying that the justification hypothesis is rejected for males but not for females. The exogeneity hypothesis on the health variable is rejected for both samples based on a joint test.
    Date: 2007–02
  13. By: Lixin Cai (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: As a form of human capital health like education determines individuals’ productivity and thus wage rates. While there are numerous overseas studies that examine the effect of health on wages, research on this issue using Australian data is scarce. This paper uses the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate the effect of health on the wages of working-age Australian men. A simultaneous equation model of health and wages is estimated to account for endogeneity of health. The results confirm the finding in the literature that health has a significant and positive effect on wages, but the significant effect is found only when measurement error and endogeneity of health are accounted for. The reverse effect of wages on health is found insignificant, but there is evidence on the endogeneity of health arising from unobserved factors.
    Date: 2007–02
  14. By: Umut Oguzoglu (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: At any given time, individuals may be subject to health shocks whose impact on work capacity can vary in magnitude. Therefore the variation in severity levels can explain changes in labour force decisions that can not be picked up by the general disability status alone. This paper analyses the effect of severity of disability on labour force participation by using two measures of severity: the self-reported work limitation scales and the SF-36 physical component summary scores. Using five waves of the Household, Income and Labour Dynamics in Australia Survey, several static and dynamic panel data models are estimated to account for state dependence and unobserved heterogeneity in participation. The results suggest that differences in severity levels explain a significant portion of the variance in the participation rates among disabled individuals. It is also found that severe work limitations have a more immediate impact on individuals’ labour force outcomes. Moreover, the disabilities are shown to have longer lasting adverse effects on female participation.
    Date: 2007–11
  15. By: Paul H. Jensen (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Elizabeth Webster (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Julia Witt (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne)
    Abstract: This paper investigates whether there are differences in patient outcomes across different types of hospitals using patient-level data on re-admission and mortality associated with acute myocardial infarction (AMI). Hospitals are grouped according to their ownership status (private, teaching, non-teaching) and their location (metropolitan, country and remote country). Using data collected from 130 Victorian hospitals on 19,000 patients admitted to a hospital with their first AMI between January 2001 and December 2003, we consider how treatment affects the likelihood of various outcomes based on unplanned re-admission and mortality. A hazard rate model is used to assess the effect of hospital type on patient outcome. Control variables included in the estimating model are patient-level characteristics such as age, gender, co-morbidity, country of birth, and indigenous, marital and socio-economic status. We find that there are significant differences across hospital types in the outcomes observed for patients presenting with their first AMI – private hospitals persistently outperform teaching, non-teaching and country hospitals. Interestingly, we find that result is that the impact of hospital type is quite robust to the definition of “patient outcomes” that we adopt and our attribution strategy, but not to whether we include multiple-hospital patients.
    Keywords: mortality; acute myocardial infarction; hospital performance; hazard model
    Date: 2007–11
  16. By: Victoria Gunnarsson; Sergio Lugaresi; Marijn Verhoeven
    Abstract: The paper assesses the financial situation of the health sector in the Slovak Republic. It also evaluates the efficiency of health expenditures and service delivery in comparison to the OECD and other new EU member states and suggests avenues for cost recovery and reform. The health sector of the Slovak Republic is plagued by financial problems. To turn around health system finances and achieve larger gains in health outcomes, the efficiency of health spending needs to increase and the mix and quality of real health resources need to be improved. Although Slovak's overall health spending efficiency is on par with that of the OECD, substantial inefficiencies occur in the process of transforming intermediate health inputs into health outcomes. Efficiency may be enhanced by containing the cost of drugs and reducing reliance on hospital care. Also, although cost-effectiveness may be relatively high at present, its sustainability in the future is an issue.
    Keywords: Working Paper , Health care , Slovak Republic ,
    Date: 2007–09–26
  17. By: Stéphane Carcillo; Victoria Gunnarsson; Marijn Verhoeven
    Abstract: Enhancing the efficiency of education and health spending is a key policy challenge in G7 countries. The paper assesses this efficiency and seeks to establish a link between differences in efficiency across countries and policy and institutional factors. The findings suggest that reforms aimed at increasing efficiency need to take into account the nature and causes of inefficiencies. Inefficiencies in G7 countries mostly reflect lack of cost effectiveness in acquiring real resources, such as teachers and pharmaceuticals. We also find that high wage spending is associated with lower efficiency. In addition, lowering student-teacher ratios is associated with reduced efficiency in the education sector, while immunizations and doctors' consultations coincide with higher efficiency in the health sector. Greater autonomy for schools seems to raise efficiency in secondary education.
    Keywords: Education , Health care , Wages , Public sector , Government expenditures ,
    Date: 2007–11–21
  18. By: Judy Feder (Georgetown Public Policy Institute, Georgetown University)
    Abstract: This brief draws heavily on Judith Feder, 2004, "Crowd-Out and the Politics of Health Reform," The Journal of Law, Medicine, and Ethids 32(3): 461-464. We all know that affordable health care is now back on the political agenda, and it's about time! Because all of us--families, businesses, and governments--are struggling with the ever-increasing costs of care. Every year about a million people are added to the rolls of the uninsured. In 2006, it was even more, over 2 million. The number of people without health insurance coverage has reached more than 47 million. People *with* insurance are seeing their benefits dwindle and their health care costs consume their wabes. Even people with health insurance find themselves unable to pay their medical bills and going without needed care. The bottom line is that, increasingly, our health insurance system fails to protect us when we get sick.
    Keywords: health insurance, uninsurance, cost of medical care
    JEL: D14 H51 I10 I18 L33
    Date: 2008–01
  19. By: John Bound; Todd Stinebrickner; Timothy Waidmann
    Abstract: In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. Unlike previous work which has typically used self reported health of disability status as a proxy for health status, we model health as a latent variable, using self reported disability status as an indicator of this latent construct. Our model is explicitly designed to account for the possibility that the reporting of disability may be endogenous to the labor market behavior we are studying. The model is estimated using data from the Health and Retirement Study. We compare results based on our model to results based on models that treat health in the typical way, and find large differences in the estimated effect of health on behavior. While estimates based on our model suggest that health has a large impact on behavior, the estimates suggest a substantially smaller role for health than we find when using standard techniques. We use our model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether and eliminating the Social Security Disability Insurance program.
    JEL: J14 J22 J26
    Date: 2007–11
  20. By: David Card; Carlos Dobkin; Nicole Maestas
    Abstract: The health insurance characteristics of the population changes sharply at age 65 as most people become eligible for Medicare. But do these changes matter for health? We address this question using data on over 400,000 hospital admissions for people who are admitted through the emergency room for "non-deferrable" conditions -- diagnoses with the same daily admission rates on weekends and weekdays. Among this subset of patients there is no discernible rise in the number of admissions at age 65, suggesting that the severity of illness is similar for patients on either side of the Medicare threshold. The insurance characteristics of the two groups are much different, however, with a large jump at 65 in the fraction who have Medicare as their primary insurer, and a reduction in the fraction with no coverage. These changes are associated with significant increases in hospital list chargers, in the number of procedures performed in hospital, and in the rate that patients are transferred to other care units in the hospital. We estimate a nearly 1 percentage point drop in 7-day mortality for patients at age 65, implying that Medicare eligibility reduces the death rate of this severely ill patient group by 20 percent. The mortality gap persists for at least two years following the initial hospital admission.
    JEL: H51 I11
    Date: 2007–11
  21. By: Abhijit V. Banerjee; Esther Duflo
    Abstract: This paper uses household survey data form several developing countries to investigate whether the poor (defined as those living under $1 or $2 dollars a day at PPP) and the non poor have different mortality rates in old age. We construct a proxy measure of longevity, which is the probability that an adult's mother and father are alive. The non-poor's mothers are more likely to be alive than the poor's mothers. Using panel data set for Indonesia and Vietnam, we also find that older adults are significantly more likely to have died five years later if they are poor. The direction of causality is unclear: the poor may be poor because they are sick (and thus more likely to die), or they could die because they are poor.
    JEL: I12 I32 O12 O15
    Date: 2007–12
  22. By: Jody L. Sindelar; Jason Fletcher; Tracy Falba; Patricia Keenan; William T. Gallo
    Abstract: Occupation is discussed as a social determinant of health. Occupation has received little attention in this light in the economics literature. We examine occupation in a life-course framework and use measures of first-occupation, initial health, and mother’s education. We contend that first occupation is a choice made relatively early in life that affects health outcomes at later ages. We examine first-occupation for two reasons: 1) there is growing evidence that early determinants affect later health and occupation has received little attention in this regard and 2) first occupation is predetermined in analysis of later health, which helps to address the issue of potential simultaneity. Using data from the Panel Study of Income Dynamics (PSID) we estimate the impact of initial occupation on two measures of health later in life: respondent-reported fair/poor health and ever suffering a heart attack. The PSID offers the opportunity to examine a lifecycle perspective as we can examine the impact of early occupation on later health while controlling for several predetermined conditions such as mother’s education and health in youth. Estimates suggest that first-occupation has a durable impact on later health, ceteris paribus, but that the impact varies by health measure and the set of control variables in regression specifications. Early choice of occupation could be a critical factor in successful aging and this information may pave the way to developing more effective workplace and public policies to improve health in older ages.
    JEL: I1 I12 J14
    Date: 2007–12
  23. By: Fredrik Carlsen (Department of Economics, Norwegian University of Science and Technology); Jostein Grytten (Dental Faculty, University of Oslo, Norway); Irene Skau (Dental Faculty, University of Oslo, Norway)
    Abstract: Context: The institutional setting for the study was the primary physician service in Norway, where there is a regular general practitioner scheme. Each inhabitant has a statutory right to be registered with a regular general practitioner. There are large differences between physicians in service production. Objective: We studied whether difference in services production between physicians has an effect on how satisfied patients are with the services that are provided. Methodology: Data about patient satisfaction were obtained from a survey of a representative sample of the population. We obtained data about how satisfied the respondents were with waiting time to get an appointment and with two aspects of the quality of care they actually received: the amount of time the physician spent with them, and to what extent they perceived that the physician took their medical problems seriously. The survey data were merged with data on service production for the primary physician that the respondent was registered with. Service production was measured as the number of consultations per person on the list, and as the number of laboratory tests per consultation. Results: There was a positive and relatively strong association between the level of service production of the general practitioners and patient satisfaction with waiting time for a consultation. The association was weaker for satisfaction with the quality of care the respondents actually received. Conclusion: A high level of service production can be justified, since it increases patient satisfaction, particularly satisfaction with access to services.
    Keywords: primary physician services; patient satisfaction; service production; access
    Date: 2007–12–18
  24. By: Nathalie Fombaron; Carine Milcent
    Abstract: This paper presents a general framework for modeling the impact of insurance on healthcare demand extending some of the results of the two-risk model of Rothschild and Stiglitz (1976), but including the latter as a special case. Rothschild and Stiglitz's approach assumes equivalence between the price of treatment and the discomfort caused by the disease. Relaxing this assumption turns out to be key in understanding participation in the insurance and healthcare markets. The demands for insurance and healthcare are modeled simultaneously, under symmetric and asymmetric information. Four main results arise from the relaxation of this assumption. First, only the presence of an insurance market can produce healthcare consumption at higher prices than the discomfort. Second, adverse selection may lead healthcare to be sold at a price lower than that under perfect information. Third, the potential non-participation of one type risk arises despite competition, depending on the degree of information. Last, in a public voluntary regime, one type risk may prefer to be uninsured and still consume healthcare.
    Date: 2007
  25. By: Edvard Johansson; Petri Böckerman; Antti Uutela
    Abstract: ABSTRACT : Objective : This paper examines the relationship between alcohol consumption and sickness absence. Methods : We use regional panel data from Finland over the period 1993-2005. The data on individuals’ health that we are using originates from Health Behaviour and Health among the Finnish Population conducted by the National Public Health Institute. To control for the effect of economic conditions on the prevalence of sickness absence, we aggregate Health Behaviour and Health among the Finnish Population to the regional level. Then we link the data, using information on individuals’ residence, to the regional statistics produced by Statistics Finland. Panel data allows us to control for unobserved determinants of lifestyle behaviours associated with the region and survey year. Results : The results show that alcohol consumption is associated with sickness absence, and particularly so for men. Therefore, the earlier aggregate time-series evidence from Sweden is largely confirmed in a regional panel data setting. Conclusion : It is important to take into account the effects of alcohol consumption on sickness absence when considering the appropriate level of taxation of wines and spirits in Nordic countries.
    Keywords: alcohol consumption, sickness absence
    JEL: I10
    Date: 2007–12–17
  26. By: Diego Battistón (Centro de Estudios Distributivos, Laborales y Sociales (CEDLAS) - Universidad Nacional de La Plata); Francisco Franchetti (Centro de Estudios Distributivos, Laborales y Sociales (CEDLAS) - Universidad Nacional de La Plata)
    Date: 2008–01
  27. By: Prof Bhabesh, Sen; Dr. Himanshu , Sekhar Rout
    Abstract: The main objective of the paper is to increase awareness – not only among health researchers but also among policy makers and practitioners who use health research findings – about the influence of socioeconomic characteristics in terms of income and education on household health expenditures, as well as to encourage improved approaches. The study finds that income of the household has significant influence on its health expenditure where as the effect of education is insignificant. From the study it is found that as disposable income of the household increases, individual takes more care of his life, hence, health expenditure increases but at a particular level of income, due to high life risk, health expenditure becomes independent of income and perfectly elastic, which is termed as “High Life Risk Path (HLRP)”. The health expenditure during HLRP depends on household’s past saving and loanable capacity.
    Keywords: Household Health Expenditure; Income and Health
    JEL: I00 I1
    Date: 2007–07–10

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