nep-hea New Economics Papers
on Health Economics
Issue of 2009‒02‒28
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Puzzle of Muslim Advantage in Child Survival in India By Bhalotra, Sonia R.; Valente, Christine; van Soest, Arthur
  2. Imitative Obesity and Relative Utility By Blanchflower, David G.; Oswald, Andrew J.; Van Landeghem, Bert
  3. Workplace Disability Diversity and Job-Related Well-Being in Britain: A WERS2004 Based Analysis By Haile, Getinet Astatike
  4. External Validation of the Use of Vignettes in Cross-Country Health Studies By Datta Gupta, Nabanita; Kristensen, Nicolai; Pozzoli, Dario
  5. Policies for Healthy Ageing: An Overview By Howard Oxley
  6. Socioeconomic Differences in Health over the Life Cycle in an Egalitarian Country By Hans van Kippersluis; Owen O'Donnell; Eddy van Doorslaer; Tom Van Ourti
  7. Do You Think Your Risk Is Fair Paid? Evidence From Italian Labor Market By Vincenzo Carrieri; Edoardo Di Porto; Leandro Elia
  9. Select Birth Cohorts By MacMinn, Richard; Weber, Frederik
  10. A Dynamic Analysis of the Demand for Health Insurance and Health Care By Bolhaar, Jonneke; Lindeboom, Maarten; van der Klaauw, Bas
  11. Intrafamily Resource Allocations: A Dynamic Model of Birth Weight By del Bono, Emilia; Ermisch, John F; Francesconi, Marco
  12. Choice Inconsistencies Among the Elderly: Evidence from Plan Choice in the Medicare Part D Program By Jason T. Abaluck; Jonathan Gruber

  1. By: Bhalotra, Sonia R. (University of Bristol); Valente, Christine (University of Nottingham); van Soest, Arthur (Tilburg University)
    Abstract: The socio-economic status of Indian Muslims is, on average, considerably lower than that of upper caste Hindus. Muslims have higher fertility and shorter birth spacing and are a minority group that, it has been argued, have poorer access to public goods. They nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper documents and analyses this seeming puzzle. The religion gap in survival is much larger than the gender gap but, in contrast to the gender gap, it has not received much political or academic attention. A decomposition of the survival differential reveals that some compositional effects favour Muslims but that, overall, differences in characteristics between the communities and especially the Muslim deficit in parental education predict a Hindu advantage. Alternative outcomes and specifications support our finding of a Muslim fixed effect that favours survival. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.
    Keywords: religion, caste, gender, child survival, anthropometrics, Hindu, Muslim, India
    JEL: O12 I12 J15 J16 J18
    Date: 2009–02
  2. By: Blanchflower, David G. (Dartmouth College); Oswald, Andrew J. (University of Warwick); Van Landeghem, Bert (Catholic University of Leuven)
    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.
    Keywords: mental health, dieting, peer effects, happiness, imitation, comparisons, body mass index BMI, well-being, obesity
    JEL: D1 I12 I31
    Date: 2009–02
  3. By: Haile, Getinet Astatike (Policy Studies Institute)
    Abstract: This paper attempts to establish empirically whether there is a link between workplace disability and employee job-related well-being. Using nationally representative linked employer-employee data for Britain, I employ alternative econometric techniques to account for unobserved workplace heterogeneity. I find that workplace disability diversity is associated with lower employee well-being among people with no reported disability. Tests conducted also indicate that workplace equality policies do not ameliorate this effect.
    Keywords: disability diversity, job-related well-being, linked employer-employee data, Britain
    JEL: J14 J82 J7 I31
    Date: 2009–02
  4. By: Datta Gupta, Nabanita (SFI - Danish National Centre for Social Research); Kristensen, Nicolai (Aarhus School of Business); Pozzoli, Dario (University of Aarhus)
    Abstract: Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignettes as a means to re-scale across sample populations critically rests on the assumption of "response consistency" (RC): that vignettes and self-assessments are evaluated on the same scale. In this paper, we seek to test this assumption by applying objective measures of health along with subjective measures and vignettes. Our results indicate that the assumption of RC is not innocuous and that our extended model relaxing this assumption improves the fit and significantly changes the cross-country rankings of health vis-à-vis the standard Chopit model.
    Keywords: cross-country health comparison, vignettes, subjective and objective measures
    JEL: C25 I10
    Date: 2009–02
  5. By: Howard Oxley
    Abstract: This paper reviews policies in the area of healthy ageing. With the ageing of OECD countries’ population over coming decades, maintaining health in old age will become increasingly important. Successful policies in this area can increase the potential labour force and the supply of non-market services to others. They can also delay the need for longer-term care for the elderly. A first section briefly defines what is meant by healthy ageing and discusses similar concepts – such as “active ageing”. The paper then groups policies into four different types and within each, it describes the range of individual types of programmes that can be brought to bear to enhance improved health of the elderly. A key policy issue in this area concerns whether such programmes have a positive effect on health outcomes and whether they are costeffective.<BR>Ce document de travail examine les politiques relatives au vieillissement en bonne santé. Compte tenu du vieillissement démographique annoncé dans les pays de l’OCDE au cours des prochaines décennies, préserver la bonne santé des personnes âgées deviendra de plus en plus important. Des politiques réussies dans ce domaine peuvent augmenter la main-d’oeuvre potentielle ainsi que l’offre de services non marchands. Elles peuvent aussi retarder le besoin de soins de longue durée pour les personnes âgées. Une première partie définit brièvement ce que l’on entend par « vieillir en bonne santé » et analyse des concepts similaires – tels que le « vieillissement actif ». Le rapport présente ensuite quatre groupes de politiques et, pour chacun, les différents programmes mobilisables afin d’améliorer l’état de santé des personnes âgées. Une question importante sur l’action publique dans ce domaine consiste à savoir si ces programmes ont un effet positif sur les résultats de santé et s’ils sont coût-efficaces.
    JEL: I18
    Date: 2009–02–16
  6. By: Hans van Kippersluis (Erasmus University Rotterdam); Owen O'Donnell (University of Macedonia, Thessaloniki, Greece); Eddy van Doorslaer (Erasmus University Rotterdam); Tom Van Ourti (Erasmus University Rotterdam)
    Abstract: A strong relationship between health and socioeconomic status is firmly established. Yet, partly due to the multidimensional and dynamic nature of the variables, the causal mechanisms connecting them are poorly understood. This paper argues that adoption of a life-cycle perspective is essential to uncover these causal pathways. A life-cycle perspective also allows investigation of whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of their health over the life cycle. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate. The observed narrowing of the gradient in old age is partly an artefact stemming from the fact that only the most healthy of the disadvantaged survive into old age. It also reflects that after middle age, withdrawal from the labor force increasingly occurs for non health-related reasons.
    Keywords: Health; Socioeconomic Status; Life Cycle
    JEL: D30 D31 I10 I12
    Date: 2009–01–19
  7. By: Vincenzo Carrieri; Edoardo Di Porto; Leandro Elia
    Abstract: Starting from Adam Smith's intuition, compensating wage differentials are one of the most widespread explanation to describe why agents should bear occupational risk of injury and death. For nearly thirty years, economists have attempted to and empirical evidence on such wage differentials mostly relying on estimation of a simple wage equation. This paper claims to put one step forward. Using the Survey of Household Income and Wealth (SHIW) 2004 we estimate for Italy the wage premium held by workers in risky occupations by means of the matching estimator. Such technique is desirable because it attempts to remove all the differences in wage coming from heterogeneity across individuals and not directly imputable to risk. Estimates suggest that net hourly wage premium is about 3% to manual workers and nearly null to non-manual workers. When we split the sample along the employer size, our findings show a heterogeneous treatment with respect to occupational status. Small firms tend to flatten out any risk premium to manual workers, while they recognize roughly 6% to non-manual workers; the opposite occurs when we look at medium-large firms wherein manual workers gain 1.5% to 5% more with respect their counterparts. Therefore, it seems that wage-risk trade off does not always emerge as hedonic wage theory would predict.
    Keywords: wage differentials; risky jobs; value of a statistical life; propensity score matching.
    JEL: C14 J31 J28 I19
    Date: 2009
  8. By: Claire M. Kamp Dush (Ohio State University); Kate S. Adkins (Ohio State University)
    Abstract: Using data from years one and three of the Fragile Families and Child Well-being Study, changes in depressive and anxious symptoms are compared for mothers and fathers who: 1) dissolve a cohabitating union versus remain intact; 2) dissolve a marital union versus remain intact; and 3) dissolve a cohabiting as compared to a marital union. In order to take into account potential sources of third variable bias from selection factors that differentiate those who are in cohabitations from those who are in marriages, mothers and fathers were matched on several sociodemographic control variables that research has demonstrated to be related to union formation and mental health outcomes. Results indicated that fathers who dissolve cohabitating or marital unions have greater increases in depressive and anxious symptoms over time than those who remain in their unions. In contrast, mothers increased in depressive and anxious symptoms, regardless of the type or stability of the union. For both mothers and fathers, no differences were found in change in mental health by type of union dissolution. In this lowincome sample of parents, results suggest that the impact of cohabitation and marital dissolution on mental health are similar in magnitude.
    Date: 2009–01
  9. By: MacMinn, Richard; Weber, Frederik
    Abstract: Worldwide demographic changes and their implications for governments, corporations, and individuals have been in the focus of public interest for quite some time due to the fiscal risk related to adequate retirement benefits. Through a more detailed analysis of mortality data an additional type of risk can be identified: differences in mortality improvements by birth year, also known as "cohort effects." Previous contributions have, however, not formalized a suitable measure to further investigate mortality improvements but rather relied on graphical representations without particular focus on individual cohorts but groups of the overall population. No criterion to identify single birth year cohorts as select has been established. A simple criterion for identifying select cohorts is proposed and used here to what country mortality data reveals about the mortality and longevity experience of cohorts. Select cohorts are rare but can be quite different from surrounding cohorts and so may generate financial risks that need to be hedged naturally or artificially with new ART instruments.
    Keywords: mortality improvement; longevity trend; select cohort; longevity risk
    JEL: I12 J1 N3
    Date: 2009–02
  10. By: Bolhaar, Jonneke; Lindeboom, Maarten; van der Klaauw, Bas
    Abstract: We investigate the presence of moral hazard and advantageous or adverse selection in a market for supplementary health insurance. For this we specify and estimate dynamic models for health insurance decisions and health care utilization. Estimates of the health care utilization models indicate that moral hazard is not important. Furthermore, we find strong evidence for advantageous selection, largely driven by heterogeneity in education, income and health preferences. Finally, we show that ignoring dynamics and unobserved fixed effects changes the results dramatically.
    Keywords: advantageous selection; health care utilization; moral hazard; panel data; supplementary private health insurance
    JEL: C33 D82 G22 I11
    Date: 2008–09
  11. By: del Bono, Emilia; Ermisch, John F; Francesconi, Marco
    Abstract: This paper estimates a model of dynamic intrahousehold investment behavior which incorporates family fixed effects and child endowment heterogeneity. This framework is applied to large American and British survey data on birth outcomes, with focus on the effects of antenatal parental smoking and maternal labor supply net of other maternal behavior and child characteristics. We find that maternal smoking during pregnancy reduces birth weight and fetal growth, while paternal smoking has virtually no effect. Mothers' work interruptions of up to two months before birth have a positive effect on birth outcomes, especially among British children. Parental behavior appears to respond to permanent family-specific unobservables and to child idiosyncratic endowments in a way that suggests that parents have equal concerns, rather than efficiency motives, in allocating their prenatal inputs across children. Evidence of equal concerns emerges also from the analysis of breastfeeding decisions, although the effects in this case are weaker.
    Keywords: Birth outcomes; child health production functions; instrumental variables; mother's work; sibling estimators; smoking
    JEL: C33 D13 I12 J13
    Date: 2008–09
  12. By: Jason T. Abaluck; Jonathan Gruber
    Abstract: The Medicare Part D Prescription Drug Plan represents the most significant privatization of the delivery of a public insurance benefit in recent history, with dozens of private insurers offering a wide range of products with varying prices and product features; the typical elder had a choice of roughly 40 stand-alone drug plans. In this paper we evaluate the choices of elders across this wide array of Part D options using a unique data set of prescription drug claims matched to information on the characteristics of choice sets. We first document that the vast majority of elders are choosing plans that are not on the “efficient portfolio†of plan choice in the sense that an alternative plan offers better risk protection at a lower cost. We then estimate several discrete choice models to document three dimensions along which elders are making choices which are inconsistent with optimization under full information: elders place much more weight on plan premiums than they do on expected out of pocket costs; they place almost no value on variance reducing aspects of plans; and they value plan financial characteristics beyond any impacts on their own financial expenses or risk.These findings are robust to a variety of specifications and econometric approaches. We develop an "adjusted" revealed preference approach that combines data from consumer choices with ex ante restrictions on preferences, and find that in a partial equilibrium setting, restricting the choice set to the three lowest average cost options would have likely raised welfare for elders under the program.
    JEL: I11 I18
    Date: 2009–02

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