nep-hea New Economics Papers
on Health Economics
Issue of 2008‒06‒21
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Re-visiting the Health Care Luxury Good Hypothesis: Aggregation, Precision, and Publication Biases? By Joan Costa-Font; Marin Gemmill; Gloria Rubert
  2. On applying synthetic indices of multidimensional well-being: health and income inequalities in selected EU countries By Andrea Brandolini
  3. The Health Returns to Education - What Can We Learn from Twins? By Petter Lundborg
  4. The Socio-Economic Distribution of AIDS Incidence and Output By Pedro de Araujo
  5. Subjective Health Expectations By Juergen Jung
  6. The role of health and safety representatives in Sweden – The implementation of EEC Directive 89/391 By Trägårdh, Björn
  7. Consumer Loyalty in the Swedish Pharmaceuticals Market By Granlund, David; Rudholm, Niklas
  8. Environmental Quality, Life Expectancy, and Sustainable Economic Growth By Dimitrios Varvarigos
  9. Do We Want to Measure the Quality of Care for Vulnerable Older People? The ACOVE Approach. Syracuse Seminar on Aging. By Neil S. Wenger
  10. Do early life and contemporaneous macroconditions explain health at older ages? An application to functional limitations of Dutch older individuals. By France Portrait; Rob Alessie; Dorly Deeg
  11. Knowledge, understanding and the dynamics of medical innovation By Ramlogan, Ronnie; Consoli, Davide
  12. Health of Immigrants in European countries. By Aïda Solé-Auró; Eileen M.Crimmins

  1. By: Joan Costa-Font; Marin Gemmill; Gloria Rubert (Universitat de Barcelona)
    Abstract: While a growing literature examining the relationship between income and health expenditures suggests that health care is a luxury good, this conclusion is contentiously debated due to heterogeneity of the existing results. This paper tests the luxury good hypothesis using meta-regression analysis, taking into consideration publication selection, precision, and aggregation bias. The findings suggest that publication bias exists, a result that is robust irrespectively of the tests employed. Precision and aggregation bias also appear to play a role in the generation of estimates. The corrected income elasticity estimates range from 0.26 to 0.84, although we cannot reject the luxury good hypothesis for some of the performed corrections.
    Keywords: aggregate health expenditure, luxury good, regional health expenditure, health care, income elasticity, meta-regression analysis
    JEL: I1 I11 I18 I10
    Date: 2008
  2. By: Andrea Brandolini (Bank of Italy, Department for Structural Economic Analysis)
    Abstract: The multidimensional view of well-being is receiving growing attention, both in academic research and policy-oriented analysis. This paper examines empirical strategies to measure poverty and inequality in multiple domains, concentrating on two problems in the use of synthetic multidimensional indices: the weighting structure of different functionings and the functional form of the index. These problems are illustrated by comparing inequality and deprivation in income and health in the four largest countries of the EU: France, Germany, Italy and the United Kingdom.
    Keywords: inequality, poverty, multidimensional analysis, capability approach
    JEL: I31 I32 D63 D31
    Date: 2008–04
  3. By: Petter Lundborg (Free University Amsterdam)
    Abstract: This paper estimates the health returns to education, using data on identical twins. I adopt a twin-differences strategy in order to obtain estimates that are not biased by unobserved family background and genetic traits that may affect both education and health. I further investigate to what extent within-twin-pair differences in schooling correlates with within-twin-pair differences in early life health and parent-child relations. The results suggest a causal effect of education on health. Higher educational levels are found to be positively related to self-reported health but negatively related to the number of chronic conditions. Lifestyle factors, such as smoking and overweight, are found to contribute little to the education/health gradient. I am also able to rule out occupational hazards and health insurance coverage as explanations for the gradient. In addition, I find no evidence of heterogenous effects of education by parental education. Finally! , the results suggest that factors that may vary within twin pairs, such as birth weight, early life health, parental treatment and relation with parents, do not predict within-twin pair differences in schooling, lending additional credibility to my estimates and to the general vailidy of using a twin-differences design to study the returns to education.
    Keywords: health production; education; schooling; twins; siblings; returns to education; ability bias
    JEL: I12 I11 J14 J12 C41
    Date: 2008
  4. By: Pedro de Araujo (Indiana University Bloomington)
    Abstract: This paper investigates the effect of HIV/AIDS on steady state output in an overlapping generations economy calibrated to resemble sub-Sahara Africa. I use skill heterogeneity as a proxy for socioeconomic status and test scenarios where the AIDS epidemic affects skills differently. The results indicate that the effects of the epidemic are sensitive to the distribution of the disease across skills. In general, the effect is much greater as the epidemic mainly affects skilled workers. Output is found to be below a no-AIDS output in a range between 3% (10%), when only unskilled workers are affected, and 10% (28%), when only skilled workers affected, whenever the overall infection rate is 7% (20%). When investigating the hypothesis that AIDS affects skilled workers more severely than unskilled at the beginning of the epidemic, with the effect switching as the epidemic becomes more mature, the findings are that the economy can be 8% smaller along the transition path. In all scenarios where the epidemic is temporary, it would take 4 to 5 generations or about 90 years for sub-Saharan Africa to recover.
    Keywords: HIV/AIDS, capital-skill complementarity, heterogeneity, and sub-Sahara Africa
    JEL: E20
    Date: 2008–06
  5. By: Juergen Jung (Indiana University Bloomington)
    Abstract: In this paper, I derive subjective health expectations curves using the RAND-HRS data. These curves can be used in the estimation of structural life-cycle models. I first construct "health tables" from the RAND-HRS data and update subjective health expectations with information from these tables. The Bayesian updating mechanism corrects for focal point responses and reporting errors of the original health expectations variable. In addition, I test the quality of the health expectations measure and describe its correlation with various health indicators and other individual characteristics. I find that subjective health expectations do contain additional information that is not incorporated in subjective mortality expectations and that the rational expectations assumption cannot be rejected for subjective health expectations.
    Keywords: Subjective Health Expectations, Health Expectations, Bayesian Updating of Expectations
    JEL: I10 D84 C11 C23
    Date: 2008–06
  6. By: Trägårdh, Björn (Studier av organisation och samhälle)
    Abstract: In Sweden, workers´ representatives have been involved in risk assessment at workplaces since the beginning of the 20th century. One of the main results is the development of a large net of health and safety representatives called “skyddsombud”; regional safety representatives (RSR) on many small workplaces and joint safety committees on large workplaces. One result of EU Directive 89/391 in Sweden seems to be a further development of both regulations and praxis, i.e. regulation AFS 2001:1 and the development of systematic work environment management (‘SWEM’). However, since the 1990’ies there has been some serious cutbacks. The report demonstrates a gap between a lack of praxis implementation and what is stated in EU Directive 89/391. The implementation of the Directive is normally weaker due to lack of control and workers’ representation in certain industries, as in the construction industry or in small companies with few or no organized workers and/or with foreign workers. Health and safety work still seems to be controversial. Trade unions worry about too little implementation of the Directive and want EU to step up their efforts, while employee organizations worry about too much implementation and warn for ‘gold plating’. Built on these findings, a neo-institutional analysis is made claiming to explain the results. The report ends with some policy recommendations.<p>
    Keywords: risk assessment; health and safety representatives; skyddsombud; EU Directive 89/391; implementation; neo-institutional analysis.
    Date: 2008–06–09
  7. By: Granlund, David (Department of Economics); Rudholm, Niklas (Department of Economics)
    Abstract: The purpose of this paper is to test if consumer loyalty is stronger toward brand name prharmaceutical products and branded generics as compared to "true" generics in the Swedish pharmaceutical market. The results show that consumers are equally loyal toward brand name pharmaceuticals and branded generics, while substantially less loyal toward generics. The results thus seem to give support to the idea that brand name recognition is important in creating consumer loyalty toward pharmaceutical products.
    Keywords: Brand loyalty; Branded generics; Parallel import; Generic competition
    JEL: D12 I11
    Date: 2008–06–09
  8. By: Dimitrios Varvarigos
    Abstract: I construct a model of a growing economy with pollution. The analysis of the model shows that the interactions between capital accumulation, endogenous longevity and environmental quality determine both the long-run growth rate of the economy and the pattern of convergence (i.e., monotonic or cyclical) towards the balanced growth path. I argue that such interactions can provide a possible explanatory factor behind the, empirically observed, negative correlation of longrun growth with its short-term cycles. Furthermore, the model may capture the observed pattern whereby economic growth and mortality rates appear to be negatively related in the long-run, but positively related in the short-run.
    Keywords: Environmental quality; longevity; economic growth; cycles
    JEL: O13 O41 Q56
    Date: 2008–06
  9. By: Neil S. Wenger (University of California at Los Angeles; RAND Health)
    Abstract: There's limited information available about measuring the quality of medical care that is targeted to the needs of older patients. And there's very limited pressure on the system to provide high quality geriatric care. Why is that? Because the quality measures haven't been adequately developed and implemented, and it's more difficult to measure care for an older sample. Measuring care for ill older adults is complex, because they tend to have multiple medical conditions, and they demonstrate substantial variation in goals for care (Wenger and colleagues 2007). The Assessing Care of Vulnerable Elders (ACOVE) project began in 1998 as a collaboration between RAND Health and Pzizer Inc to develop and apply quality indicators (QIs) for assessment and treatment targeted at vulnerable older persons. The project involved defining and identifying the target population, identifying health conditions that cover much of the medical care provided to this population, developing quality-of-care indicators to measure how well those conditions are being addressed, and applying thoseindicators to determine the actual quality of care received by older adults.
    Keywords: health care, medical care, elderly, assessment, geriatrics, gerontology
    JEL: H51 I10 I18 J14
    Date: 2008–06
  10. By: France Portrait; Rob Alessie; Dorly Deeg
    Abstract: The paper presents an approach which thoroughly assesses the role of early life and contemporaneous macro-conditions in explaining health at older ages. In particular, we investigate the role of exposure to infectious diseases and economic conditions during infancy and childhood, as well as the effect of current health care facilities. Specific attention is paid to the impact of unobserved heterogeneity, selective attrition and omitted relevant macro-variables. We apply our approach to self-reports on functional limitations of Dutch older individuals. Our analysis is performed using data from the Longitudinal Aging Study Amsterdam. The prevalence of functional limitations is found to increase in the nineteen-nineties, in part due to restricted access to hospital care.
    Keywords: Panel Data, Wage Distribution, Inequality, Mobility
    JEL: C23 D31 J31 J60
    Date: 2008–05
  11. By: Ramlogan, Ronnie; Consoli, Davide
    Abstract: This paper investigates the processes by which scientific knowledge is created and legitimized. It focuses on scientific developments in a branch of medicine and explores the pathways through which the growth of knowledge enables advances in medical science and in clinical practice. This work draws conceptually on evolutionary approaches to technological change. The empirical part presents a longitudinal analysis of a database of scientific publications in the field of ophthalmology over a period of 50 years. Such an exercise allows us to identify pathways of shared understanding on a disease area, and to map out distinctive trajectories followed by the ophthalmology research community. The paper also contributes to general understanding of the innovation process by supporting the notion that knowledge coordination is a distributed process that cuts across and connects complementary areas of expertise.
    JEL: O33 D83 O31
    Date: 2008–04–01
  12. By: Aïda Solé-Auró (Faculty of Economics, University of Barcelona); Eileen M.Crimmins (Andrus Gerontology Center, University of Southern California.)
    Abstract: The health of older immigrants can have important consequences for needed social support and demands placed on health systems. This paper examines health differences between immigrants and the nativeborn populations aged 50 years and older in 11 European countries. We examine differences in functional ability, disability, disease presence and behavioral risk factors, for immigrants and non-immigrants using data from the Survey of Health, Aging and Retirement in Europe (SHARE) database. Among the 11 European countries, migrants generally have worse health than the native population. In these countries, there is a little evidence of the “healthy migrant” at ages 50 years and over. In general, it appears that growing numbers of immigrants may portend more health problems in the population in subsequent years.
    Keywords: Immigrants, Mortality, Health, Disability,SHARE.
    Date: 2008–06

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