nep-hea New Economics Papers
on Health Economics
Issue of 2008‒09‒20
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Life expectancy and the environment By Fabio Mariani; Agustin Pérez-Barahona; Natacha Raffin
  2. Worker Sorting, Health Insurance and Wages: Further Evidence from Displaced Workers in the United States By Steven F. Lehrer; Nuno Sousa Pereira
  3. Too Sick To Start: Health of the Entrepreneur and Business Entry in Townships around Durban, South Africa By Li-Wei Chao; Helena Szrek; Nuno Sousa Pereira; Mark V. Pauly
  4. Socio-Economic Status, HIV/AIDS Knowledge and Stigma, and Sexual Behavior in India By Pedro de Araujo
  5. The Socio-Economic Distribution of AIDS Incidence and Output By Pedro de Araujo
  6. Information Availability for Measuring and Comparing Quality of Mental Health Care Across OECD Countries By Sandra Garcia Armesto; Helena Medeiros; Lihan Wei
  7. Effects of Subsidized Health Insurance on Newborn Health in Colombia By Adriana Camacho; Emily Conover
  8. The relationship between alcohol consumption and self-reported health status using the EQ5D By Dennis Petrie; Chris Doran; Anthony Shakeshaft; Rob Sanson-Fisher
  9. Learning from the Extreme Poor: Participatory Approaches to Fostering Child Health in Madagascar By Blanchard, Caroline; Godinot, Xavier; Laureau, Chantal; Wodon, Quentin
  10. Does better information about hospital quality affect patients’ choice? Empirical findings from Germany By Wübker, Ansgar; Sauerland, Dirk; Wübker, Achim
  11. The Effect of Childhood Economic Deprivation on Physical and Psychological health Status By Drakopoulos, Stavros A.; Lakioti, E; Theodossiou, Ioannis
  12. What makes you work while you are sick? Evidence from a survey of union members By Böckerman, Petri; Laukkanen, Erkki
  13. Imitative Obesity and Relative Utility By David G. Blanchflower; Andrew J. Oswald; Bert Van Landeghem
  14. Medicare Part D's Effects on Elderly Drug Costs and Utilization By Jonathan D. Ketcham; Kosali Simon
  15. Long-Term Care of the Disabled Elderly: Do Children Increase Caregiving by Spouses? By Liliana E. Pezzin; Robert A. Pollak; Barbara S. Schone
  16. Socioeconomic Status and Health: Dimensions and Mechanisms By David M. Cutler; Adriana Lleras-Muney; Tom Vogl

  1. By: Fabio Mariani (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, Ecole d'économie de Paris - Paris School of Economics - Université Panthéon-Sorbonne - Paris I); Agustin Pérez-Barahona (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I); Natacha Raffin (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I, Ecole d'économie de Paris - Paris School of Economics - Université Panthéon-Sorbonne - Paris I)
    Abstract: We present an OLG model in which life expectancy and environmental quality dynamics are jointly determined. Agents may invest in environmental quality, depending on how much they expect to live, but also in order to leave good environmental conditions to future generations. In turn, environmental conditions affects life expectancy.The model produces multiple steady states development regimes) and initial conditions do matter. In particular, some countries may be trapped in a low life expectancy /low environmental quality trap. This outcome is consistent with stylized facts relating life expectancy and environmental performance measures. Possible strategies to escape from this kind of trap are also discussed. Finally, this result is robust to the introduction of human capital through parental education expenditures.
    Keywords: Environmental quality; life expectancy; poverty traps.
    Date: 2008–09
  2. By: Steven F. Lehrer (School of Policy Studies and Department of Economics, Queen’s University); Nuno Sousa Pereira (CETE, Faculdade de Economia, Universidade do Porto)
    Abstract: The United States has the distinction of being the only industrialized nation without universal health insurance. Health insurance may have impacts on the US labor market. We use data on displaced workers over a 25 year period to document how the role of health insurance on wages and worker sorting has evolved. We find that the provision of health insurance increasingly influences wage inequality. Our results indicate that the portion of the unadjusted wage gap due only to selection bias from unobserved (to the analyst) characteristics, such as ability or innate health status has grown rapidly since 2000. Further, while there have been substantial changes in how displaced workers sort to firms that offer health insurance benefits over the last 25 years, many of the patterns have reversed directions over the past six years. Finally, we discuss the policy implications of our results.
    Keywords: Health insurance; Worker sorting; Displacement; Comparative advantage; Non-linear instrumental variables
    JEL: I11 J33 C23
    Date: 2008–09
  3. By: Li-Wei Chao (Population Studies Department, University of Pennsylvania); Helena Szrek (CETE, Faculdade de Economia, Universidade do Porto); Nuno Sousa Pereira (CETE, Faculdade de Economia, Universidade do Porto); Mark V. Pauly (Health Care Systems Department, The Wharton School, University of Pennsylvania)
    Abstract: Small businesses contribute a substantial share of economic activity in all countries, and may be an engine for job creation in developing economies. Unlike large firms with management teams, small businesses are usually run by one key person, the owner-entrepreneur, who bears almost all of the risks and who makes almost all of the decisions related to the business. Because the owner-entrepreneur also embodies most of the firm-specific knowledge capital, health of the owner-entrepreneur is an important factor contributing to the production process. Following a cohort of respondents with and without small businesses around Durban, South Africa, over a three-year period, our prior study found that poor baseline health and deteriorations in the health of the owner-entrepreneur were strongly associated with subsequent business exit. In the current study, we examined the relationship between an individual’s physical health and the decision to start a business. Our results suggest that respondents who were recent business entrants were in better health than respondents who did not start new businesses. Moreover, respondents without a business at the beginning of the study but who later opened businesses during the three-year study interval were significantly more likely to have better health before business entry than those respondents who never started a new business. Hence, good health among entrepreneurs seems to be an important prerequisite to both small business survival and small business entry.
    Keywords: South Africa; small businesses; business entry; health; entrepreneur
    JEL: I12
    Date: 2008–09
  4. By: Pedro de Araujo (Colorado College)
    Abstract: Using data from the National Family Health Surveys (NFHS-3), this paper analyzes the socioeconomic correlates of sexual behavior, HIV/AIDS knowledge and stigma in India. The main findings are that, overall, the Indian population is faithful and abstains from sex with very small variations across socioeconomic classes. However, given the large size of the population, there is still room for some concern as condom use is low, knowledge about the disease is poor, and stigma is high; especially with respect to less educated, poorer, single males and women in general. Obvious policy recommendations are; therefore, to increase condom distribution and awareness, increase very heavily HIV/AIDS basic education, and promote women empowerment with respect to sexual choices.
    Keywords: HIV/AIDS, Condom, Stigma, India
    JEL: C13 C25 O53
    Date: 2008–09
  5. By: Pedro de Araujo (Colorado College)
    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: 2008–09
  6. By: Sandra Garcia Armesto; Helena Medeiros; Lihan Wei
    Abstract: This paper provides an overview of the present mental health care information systems in 18 OECD countries with the aim to explore the possibilities for measuring the quality of mental health care and identify potential indicators to be included in OECD’s HCQI set. A survey was conducted to support this analysis. The questionnaire sought to gather information on three areas of interest for the description of national information systems linked to mental health services: Types of mental health data available at system level; data sources available at national level; and institutional arrangements framing ownership and use of the information system. An additional section was included to assess potential improvements in availability of the indicators recommended in OECD Health Technical Paper 17, updating the availability survey conducted in 2005. <BR>Ce document présente un panorama des systèmes d’information sur les soins de santé mentale en place dans 18 pays de l’OCDE avec pour objectif d’examiner les possibilités de mesure de la qualité de ces soins et d’identifier des indicateurs qui pourraient être inclus dans la batterie d’indicateurs de la qualité des soins de santé (HCQI) de l’Organisation. Pour étayer cette analyse, une enquête a été effectuée. Le questionnaire s’efforçait de recueillir des informations sur trois domaines d’intérêt permettant de décrire les systèmes nationaux d’information liés aux services de santé mentale : types de données sur la santé mentale disponibles au niveau du système ; sources de données disponibles au niveau national ; et modalités institutionnelles régissant la propriété et l’utilisation du système d’information. Une section supplémentaire a été ajoutée pour évaluer les possibilités d’amélioration de la disponibilité des indicateurs recommandées dans le Rapport technique sur la santé n° 17 de l’OCDE, actualisant ainsi les résultats de l’enquête sur la disponibilité d’indicateurs menée en 2005.
    Date: 2008–09–02
  7. By: Adriana Camacho; Emily Conover
    Abstract: Colombia's rapid expansion of health insurance coverage in the 1990s provides an opportunity to evaluate whether health insurance coverage positively affects health care usage and outcomes. We use the discontinuity in eligibility for the Subsidized Regime (SR), the subsidized health insurance for the poor, to see if the Subsidized Regime increased the incidence of doctor assisted births, prenatal care, and hospital deliveries; and if it improved newborn health measured by birth weight, gestation period, Apgar score and incidence of low (lbw) and very low birth weight (vlbw). We find that the Subsidized Regime had positive effects on newborn birth weight, but although positive, not consistently significant effects on other health measures or access to medical personnel and facilities.
    Date: 2008–08–14
  8. By: Dennis Petrie; Chris Doran; Anthony Shakeshaft; Rob Sanson-Fisher
    Abstract: Alcohol misuse represents one of the leading causes of preventable death, illness and injury in Australia. Extensive research exists estimating the effect of risky alcohol use on mortality but little research quantifies the impact of risky alcohol consumption on morbidity. Estimates are needed to measure the benefit of interventions which reduce risky alcohol use. Ordered probit and tobit models are used to analyse the impact of risky drinking on self reported health status using data from rural Australians. It is found that risky alcohol use is associated with lower self-reported health however the average effect is small apart for those drinking at very high risk.
    Keywords: Alcohol Misuse, Morbidity, Ordered Probit, Tobit, EQ5D
    JEL: I1 I12
    Date: 2007–09
  9. By: Blanchard, Caroline; Godinot, Xavier; Laureau, Chantal; Wodon, Quentin
    Abstract: Very poor people are often considered ignorant and even incapable of thinking, because they have had no opportunity to gain skill in expression through education. The experience of contempt and exclusion is deep among the poorest, whether they live in rich or poor countries, and it often prevents them from participating in social programs. This note provides a summary of a study on access to health care conducted by the International Movement ATD Fourth World in Madagascar, with the aim to outline the organization's approach to reaching the very poor and building projects in close partnership with them.
    Keywords: Extreme Poverty; Health Care; Community Development; Madagascar
    JEL: I30 I10
    Date: 2007–08–01
  10. By: Wübker, Ansgar; Sauerland, Dirk; Wübker, Achim
    Abstract: Background: Economic theory strongly suggests that better information about the quality of care affects patients’ choice of health service providers. However, we have little empirical evidence about the impact of information provided on provider’s choice in Germany. Problem: In Germany, we recently find publicly available information about hospital quality. For example, 50 percent of the hospitals in the Rhine-Ruhr area do now publish their quality data voluntarily in a comprehensive, understandable and well prepared publication. Empirically, we see a strong demand for this publication. However, we do not have information so far, if – and how – this information affect patients’ choice of hospitals. Data and methodology: We take cross sectional time series data from more than 700.000 patients in the Rhine-Ruhr area and in the Cologne-Bonn area (control group) for the time period 2003 to 2006, i.e. 16 quarters. We examine whether the publication of quality information affects market shares and number of cases of the hospitals as well as travelling distance that patients accept to get to the hospital of their choice. In order to account for hospital-specific heterogeneity, we use fixed and random effects models. Results: First: Hospitals, which publish their quality data voluntarily, do attract more patients – compared to such hospital, that do not publish their quality data. Second: In the group of the publishing hospitals, hospitals with a higher than average quality slightly increased their market shares, whereas hospitals with a lower than average quality lost market shares. Conclusion: The provision of quality data has a significant impact on hospital choice: a higher quality leads to a higher demand. Based on these finding decision makers in hospitals have strong incentives (i) to make quality information publicly available and (ii) to keep their quality of care high.
    Keywords: Keywords: Quality of care; Information; Hospital Choice JEL Classifications: I 12; C 33
    JEL: I11 I12
    Date: 2008–05–08
  11. By: Drakopoulos, Stavros A.; Lakioti, E; Theodossiou, Ioannis
    Abstract: This paper investigates the effects of childhood deprivation on health at the later stages of the working age. The results indicate that there is an effect of childhood socioeconomic conditions on later adulthood overall health profile and second on the likelihood of suffering from a number of medical conditions. The risk of frail health is higher among adult respondents of the age between 50 to 65 who grew up in unfavourable socioeconomic circumstances, after controlling for their genetic risk traits, and their current educational and wealth status.
    Keywords: childhood deprivation; health; socioeconomic status
    JEL: I12 I00
    Date: 2008–09
  12. By: Böckerman, Petri; Laukkanen, Erkki
    Abstract: We examine the prevalence of sickness absenteeism and presenteeism, using survey data covering 725 Finnish union members in 2008. Controlling for worker characteristics, we find that sickness presenteeism is much more sensitive to working-time arrangements than sickness absenteeism. Permanent full-time work, mismatch between desired and actual working hours, shift or period work and overlong working weeks increase the prevalence of sickness presenteeism. We also find an interesting trade-off between two sickness categories: regular overtime decreases sickness absenteeism, but increases sickness presenteeism. Furthermore, the adoption of three days’ paid sickness absence without a sickness certificate and the easing of efficiency demands decrease sickness presenteeism.
    Keywords: absenteeism; presenteeism; working-time arrangements
    JEL: J28 I10
    Date: 2008–09–18
  13. By: David G. Blanchflower; Andrew J. Oswald; Bert Van Landeghem
    Abstract: If human beings care about their relative weight, a form of imitative obesity can emerge (in which people subconsciously keep up with the weight of the Joneses). Using Eurobarometer data on 29 countries, this paper provides cross-sectional evidence that overweight perceptions and dieting are influenced by a person's relative BMI, and longitudinal evidence from the German Socioeconomic Panel that well-being is influenced by relative BMI. Highly educated people see themselves as fatter -- at any given actual weight -- than those with low education. These results should be treated cautiously, and fixed-effects estimates are not always well-determined, but there are grounds to take seriously the possibility of socially contagious obesity.
    JEL: D01 I12 I31
    Date: 2008–09
  14. By: Jonathan D. Ketcham; Kosali Simon
    Abstract: We analyze Medicare Part D’s net effect on elderly out-of-pocket (OOP) costs and use of prescription drugs using a dataset containing 1.4 billion prescription records from Wolters Kluwer Health (WKH). These data span the period December 2004-December 2007 and include pharmacy customers whose age as of 2007 is greater than 57 years. The outcomes we examine are OOP cost per day’s supply of a medication, the days of medication supplied per capita, and the number of individuals filling prescriptions. We compare outcomes before vs. after January 2006, for those over age 66 years vs. for those age 58-64 years, adjusting for the under-reporting of certain cash-only transactions in the WKH data. Our results indicate that from 2005-2007, Part D reduced elderly OOP costs per day’s supply of medication by 21.7%, and increased elderly use of prescription drugs by 4.7%, implying a price elasticity of demand of -0.22. These effects occurred primarily during the first year of the program. An age- and time-standardized comparison of our quantity results with previous estimates from Walgreens data shows that our findings are 2.6 times as large. We conclude that Part D lowered elderly patients’ OOP costs substantially and increased utilization modestly, and note that in comparing results across studies on this topic, magnitudes may vary substantially due to differences in data and methods.
    JEL: H42 I11 I18
    Date: 2008–09
  15. By: Liliana E. Pezzin; Robert A. Pollak; Barbara S. Schone
    Abstract: Do adult children affect the care elderly parents provide each other? We develop two models in which the anticipated behavior of adult children provides incentives for elderly parents to increase care for their disabled spouses. The "demonstration effect" postulates that adult children learn from a parent's example that family caregiving is appropriate behavior. The "punishment effect" postulates that adult children may punish parents who fail to provide spousal care by not providing future care for the nondisabled spouse when necessary. Thus, joint children act as a commitment mechanism, increasing the probability that elderly spouses will provide care for each other; stepchildren with weak attachments to their parents provide weaker incentives for spousal care than joint children. Using data from the HRS, we find evidence that spouses provide more care when they have children with strong parental attachment.
    JEL: D1 J1 J2
    Date: 2008–09
  16. By: David M. Cutler; Adriana Lleras-Muney; Tom Vogl
    Abstract: This paper reviews the evidence on the well-known positive association between socioeconomic status and health. We focus on four dimensions of socioeconomic status -- education, financial resources, rank, and race and ethnicity -- paying particular attention to how the mechanisms linking health to each of these dimensions diverge and coincide. The extent to which socioeconomic advantage causes good health varies, both across these four dimensions and across the phases of the lifecycle. Circumstances in early life play a crucial role in determining the co-evolution of socioeconomic status and health throughout adulthood. In adulthood, a considerable part of the association runs from health to socioeconomic status, at least in the case of wealth. The diversity of pathways casts doubt upon theories that treat socioeconomic status as a unified concept.
    JEL: I1
    Date: 2008–09

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