nep-hea New Economics Papers
on Health Economics
Issue of 2009‒04‒05
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Parental Income and Child Health in Germany By Steffen Reinhold; Hendrik Jürges
  2. The effect of health care expenditures on survival in locally advanced and metastatic Non Small Cell Lung Cancer By Lionel Perrier; Magali Morelle; Nathalie Havet; Anthony Montella; Bertrand Favier; David Pérol; Frédéric Gomez; Marie-Odile Carrère; Paul Rebattu
  3. Macroeconomic Consequences of Alternative Reforms to the Health Insurance System in the U.S. By Zhigang Feng
  4. Wage Penalty of Abstinence and Wage Premium of Drinking - A misclassification bias due to pooling of drinking groups? By Jarl, Johan; Gerdtham, Ulf-G
  5. The Long-Term Care Workforce: Overview and Strategies to Adapt Supply to a Growing Demand By Rie Fujisawa; Francesca Colombo
  6. The Obesity Epidemic: Analysis of Past and Projected Future Trends in Selected OECD Countries By Franco Sassi; Marion Devaux; Michele Cecchini; Elena Rusticelli
  7. Measuring educational differences in mortality among women living in highly unequal societies with defective data: the case of Brazil By Elisenda Rentería; Cassio M. Turra
  8. Health investments and economic growth : macroeconomic evidence and microeconomic foundations By Jack, William; Lewis, Maureen
  9. Mortality in Russia: Microanalysis By Irina Denisova
  10. Health care expenditure and GDP: An international panel smooth transition approach By Chakroun, Mohamed
  11. Coping with Chronic Disease? Chronic Disease and Disability in Elderly American Population 1982-1999 By Gabriel Aranovich; Jay Bhattacharya; Alan M. Garber; Thomas E. MaCurdy
  12. Employer-Sponsored Health Insurance and the Promise of Health Insurance Reform By Thomas C. Buchmueller; Alan C. Monheit
  13. Needle Sharing and HIV Transmission: A Model with Markets and Purposive Behavior By Ajay Mahal; Brendan O'Flaherty; David E. Bloom

  1. By: Steffen Reinhold; Hendrik Jürges
    Abstract: We use newly available data from Germany to study the relationship between parental income and child health. We find a strong gradient between parental income and subjective child health as has been documented earlier in the US, Canada and the UK. The relationship in Germany is about as strong in the US and stronger than in the UK. However, in contrast to US results, we do not find that the disadvantages associated with low parental income accumulate as the child ages, nor that children from low socioeconomic background are more likely to suffer from `objectively measured¿ health problems ¿ except for obesity. There is some evidence, however, that high income children are better able to cope with the adverse consequences of chronic conditions. Finally, we do not find that child health (except for low birth weight) plays a major role in the explanation of educational attainment once parental income and education are controlled for.
    Keywords: Parental Income, Child Health
    JEL: I12 J13
    Date: 2009
  2. By: Lionel Perrier (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines); Magali Morelle (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines); Nathalie Havet (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines); Anthony Montella (Centre Léon Bérard - Centre Léon Bérard); Bertrand Favier (Centre Léon Bérard - Centre Léon Bérard); David Pérol (Centre Léon Bérard - Centre Léon Bérard); Frédéric Gomez (Centre Léon Bérard - Centre Léon Bérard); Marie-Odile Carrère (GATE - Groupe d'analyse et de théorie économique - CNRS : UMR5824 - Université Lumière - Lyon II - Ecole Normale Supérieure Lettres et Sciences Humaines); Paul Rebattu (Centre Léon Bérard - Centre Léon Bérard)
    Abstract: Context: The significant survival benefit of chemotherapy over best supportive care for locally advanced and metastatic NSCLC has been amply demonstrated in the literature. However, there is no clear evidence of the impact of the type of chemotherapy or of a superiority of combination chemotherapy over single-agent chemotherapy.Objective: The present study empirically examines, in real-life practise and using multiple proxies, the impact of health care expenditures on overall survival in locally advanced and metastatic NSCLC in order to guide medical decision-making.Methods: Disease characteristics, the resources used, the costs of treatment and survival data were retrospectively collected from the records of 175 patients treated between 2000 and 2004 at Léon Bérard Regional Cancer Center (Lyon, France). Survival data were modelled using multivariate Cox models and controlled for endogeneity with the instrumental variable method.Results: The median survival for the whole cohort was 289 days. The average total cost of treatment reached €35,160. Survival was significantly shorter for patients with stage IV disease, poor performance status, and past or concomitant cardiovascular disease and/or diabetes, for current smokers, and for patients with adenocarcinoma compared to large cell carcinoma. Survival duration was not significantly associated with the total cost of treatment per day of hospitalisation, the number of chemotherapy drugs administered, nor inpatient length of stay.Conclusion: Higher care expenditures do not appear to improve survival for patients with locally advanced or metastatic NSCLC. Hence, maintaining patient quality of life and tailoring therapy to stage, histology and comorbidities appears to be the less bad choice.
    Keywords: Cost; NSCLC; Oncology; Survival
    Date: 2009
  3. By: Zhigang Feng (Department of Economics, University of Miami)
    Abstract: This paper examines the macroeconomic and welfare implications of alternative re- forms to the U.S. health insurance system. In particular, I study the effect of the expansion of Medicare to the entire population, the expansion of Medicaid, an individ- ual mandate, the removal of the tax break to purchase group insurance and providing a refundable tax credit for insurance purchases. To do so, I develop a stochastic OLG model with heterogenous agents facing uncertain health shocks. In this model individ- uals make optimal labor supply, health insurance, and medical usage decisions. Since buying insurance is endogenous, my model captures how the reforms may affect the characteristics of the insured as well as health insurance premiums. I use the Medi- cal Expenditure Panel Survey to calibrate the model and succeed in closely matching the current pattern of health expenditure and insurance demand as observed in the data. Numerical simulations indicate that reforming the health insurance system has a quantitatively relevant impact on the number of uninsured, hours worked, and welfare.
    Keywords: Health insurance reform, Heterogeneous agent model, Welfare analysis
    JEL: E21 E62 I10
    Date: 2009–01–12
  4. By: Jarl, Johan (Deptartment of Clinical Science, Lund University); Gerdtham, Ulf-G (Department of Economics, Lund University)
    Abstract: Several studies have found protective effects of low/moderate (hereafter “light”) alcohol consumption compared with “abstinence” on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption. It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers. The aim of this paper is to study whether pooled groups risk create bias in the form of misclassification and confounding. The analysis focuses on: ‘former drinker error’ (pooling of lifelong abstainers and former drinkers); ‘former abstainer error’ (pooling of former abstainers and lifelong light drinkers); and ‘former heavy drinker error’ (pooling of light drinkers with and without a history of heavy drinking). Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups. The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers. The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and can therefore not explain the wage penalty of abstinence compared to light drinking.
    Keywords: Alcohol consumption; Drinking history; Consumption groups; Misclassification bias
    JEL: C10 I12 J31
    Date: 2009–03–26
  5. By: Rie Fujisawa; Francesca Colombo
    Abstract: This working paper offers an overview of the LTC workforce and reviews country responses to a growing demand for LTC workers. In the context of ageing societies, the importance of long-term care is growing in all OECD countries. In 2005, long-term care expenditure accounted for slightly over 1% of GDP across OECD countries (OECD Health Data 2008), but this is projected to reach between 2% and 4% of GDP by 2050 (Oliveira Martins et al., 2006). Spending on long-term care as a share of GDP rises with the share of the population that is over 80 years old, which is expected to triple from 4 per cent to 11-12 per cent between 2005 and 2050. In addition to ageing, there are other factors likely to affect future spending. Trends in severe disability among elderly populations across 12 OECD countries for which data are available do not show a consistent sign of decline (Lafortune and Balestat, 2007), while the number of elderly that need assistance in carrying out activities of daily living is also growing. Meanwhile, societal changes – notably possible reductions in the importance of informal care due to rising labour market participation by women and declining family size, as well as growing expectations for more responsive, quality health and social-care systems – are creating pressures to improve value for money in long-term care systems. These factors add pressures on the workforce of this highly labour-intensive sector. Adding to this are the difficulties in attracting and retaining caregivers to a physically and mentally gruelling profession.<P>Soins de longue durée: l'accroissement de la demande de travailleurs du secteur<BR>Ce document de travail présente une vue d’ensemble sur les travailleurs du secteur des soins de longue durée (SLD) et passe en revue les réponses des pays à l'accroissement de la demande de travailleurs des SLD. Dans le contexte du vieillissement des sociétés, l’importance des soins de longue durée va se développer dans tous les pays de l’OCDE. En 2005, les dépenses de SLD ne représentaient guère plus de 1 % du PIB dans ces différents pays (Éco-Santé OCDE 2008), mais d’après les projections, cette proportion pourrait atteindre entre 2 et 4 % du PIB à l’horizon 2050 (Oliveira Martins et al., 2006). La part des dépenses de SLD exprimées en pourcentage du PIB augmente en même temps que s’accroît la part de la population âgée de plus de 80 ans. Or, cette part devrait tripler entre 2005 et 2050 et passer de 4 % à 11 ou 12 % sur cette période. Outre le vieillissement, d’autres facteurs pouvant affecter les dépenses futures sont impliqués. Dans 12 pays de l’OCDE pour lesquels on dispose de données, la tendance à l’incapacité sévère chez les personnes âgées ne diminue pas de manière régulière (Lafortune et Balestat, 2007), tandis que le nombre de personnes âgées ayant besoin d’aide pour accomplir les activités élémentaires de la vie quotidienne est en augmentation. En même temps, l’évolution de la société (notamment, la possible diminution d’importance qui devrait être accordée aux soins informels du fait de l’accroissement du taux d’activité des femmes et de la diminution de la taille des familles, mais aussi les attentes croissantes face à des systèmes de soins de santé et de protection sociale que l’on voudrait plus réactifs et de meilleure qualité) accroît la nécessité d’une utilisation plus efficiente des ressources des systèmes de SLD. Ces facteurs renforcent la pression qui s’exerce sur les travailleurs de ce secteur à très forte intensité de main-d’oeuvre. S’y ajoutent les difficultés rencontrées pour attirer des soignants vers un métier pénible à la fois physiquement et psychologiquement et pour les retenir.
    JEL: I1 I10 I12 J1 J10 J14 J20 J61
    Date: 2009–03–17
  6. By: Franco Sassi; Marion Devaux; Michele Cecchini; Elena Rusticelli
    Abstract: This paper provides an overview of past and projected future trends in adult overweight and obesity in OECD countries. Using individual-level data from repeated cross-sectional national surveys, some of the main determinants and pathways underlying the current obesity epidemic are explored, and possible policy levers for tackling the negative health effect of these trends are identified. First, projected future trends show a tendency towards a progressive stabilisation or slight shrinkage of pre-obesity rates, with a projected continued increase in obesity rates. Second, results suggest that diverging forces are at play, which have been pushing overweight and obesity rates into opposite directions. On one hand, the powerful influences of obesogenic environments (aspects of physical, social and economic environments that favour obesity) have been consolidating over the course of the past 20-30 years. On the other hand, the long term influences of changing education and socio-economic conditions have made successive generations increasingly aware of the health risks associated with lifestyle choices, and sometimes more able to handle environmental pressures. Third, the distribution of overweight and obesity in OECD countries consistently shows pronounced disparities by education and socio-economic condition in women (with more educated and higher socio-economic status women displaying substantially lower rates), while mixed patterns are observed in men. Fourth, the findings highlight the spread of overweight and obesity within households, suggesting that health-related behaviours, particularly those concerning diet and physical activity, are likely to play a larger role than genetic factors in determining the convergence of BMI levels within households.<P>Obésité : Analyses des tendances dans les pays de l’OCDE<BR>Ce document fournit une vue d’ensemble des tendances passées et futures des taux de surpoids et d’obésité dans les pays de l’OCDE. L’utilisation de données individuelles issues d’enquêtes transversales nationales a permis d’explorer les déterminants principaux et les cheminements sous-jacents à l’épidémie d’obésité, et d’identifier de possibles leviers politiques pour contrer les effets négatifs de ces tendances sur la santé. Premièrement, les projections futures confirment la tendance vers une stabilisation progressive voire une faible baisse des taux de pré-obésité, accompagnée d’une augmentation continuelle des taux d’obésité. Deuxièmement, les résultats suggèrent que des forces divergentes sont en jeu, poussant les taux de surpoids et d’obésité dans deux directions opposées. D’une part, la forte influence d’un environnement obésogène (les aspects de l’environnement physique, social et économique qui favorisent l’obésité) a été confirmée au cours des 20-30 dernières années. D’autre part, l’influence sur le long terme de l’évolution de l’éducation et des conditions socio-économiques a rendu les générations successives de plus en plus conscientes des risques pour la santé liés aux choix de vie, et parfois plus aptes à gérer la pression de l’environnement. Troisièmement, les distributions des taux de surpoids et d’obésité dans les pays de l’OCDE montrent de façon cohérente des disparités marquées selon l’éducation et les conditions socio-économiques chez les femmes (plus éduquées et ayant un statut socio-économique plus élevé, les femmes ont des taux considérablement plus faibles), alors que des résultats variés sont observés chez les hommes. Quatrièmement, les résultats soulignent l’étendu du surpoids et de l’obésité au sein des ménages, et suggèrent que les comportements liés à la santé en particulier ceux concernant l’alimentation et l’activité physique, jouent probablement un rôle plus important que les facteurs génétiques dans la détermination du niveau de l’IMC au sein des ménages.
    Keywords: obesity, obesogenic environment, socio-economic inequality, household
    JEL: D12 I12 I32
    Date: 2009–03–20
  7. By: Elisenda Rentería (Cedeplar-UFMG); Cassio M. Turra (Cedeplar-UFMG)
    Abstract: Social and economic inequalities in health and mortality are widely observed around the world. Individuals with lower socioeconomic status – usually defined by education, income and occupational status – have lower chances of survival and higher morbidity rates than individuals with higher socioeconomic status (Goldman, 2001). This association extends across all the distribution of socioeconomic variables, also within the highest social groups, defining what researchers call social “gradient” in health (Adler et al., 1994). This association has been studied for both sexes, but the relationship among women remains unclear. Also, it is a question rarely studied in developing countries, mostly due to a lack of reliable information. That is the case of Brazil, were although social and income inequality has been very high and persistent over time, with a long tradition of studies in this field (Barros, Foguel e Ulyssea 2007), we know very little about health and mortality disparities. Some previous works suggest a great gap in mortality by income in Brazil (Wood & Carvalho, 1988). However, all the efforts to investigate mortality inequality in Brazil run into the lack of information, especially in adult ages. This article combines information about the mother’s survival and education of respondents from a nationally representative household survey collected in Brazil in 1996 (Pesquisa de Padrões de Vida - PPV), to examine how mortality among adult women varied by level of education during the last decades. This study contributes to the discussion on the adult’s mortality differentials in developing countries with defective data.
    Keywords: Mortality Rates, Socioeconomic Status, Brazil
    JEL: I12
    Date: 2009–03
  8. By: Jack, William; Lewis, Maureen
    Abstract: This paper reviews the correlations and potential links between health and economic growth and summarizes the evidence on the role of government in improving health status. At the macroeconomic level, the evidence of an impact of health on growth remains ambiguous due both to difficulties in measuring health, and to the methodological challenges of identifying causal links. The evidence on the micro linkages from health investments to productivity and income are robust. Progress in life expectancy over the past two centuries has been spectacular, fueled by: improved agriculture that has increased food quantity; knowledge of disease transmission, and effective public health interventions that have controlled communicable diseases such as malaria, yellow fever, and hookworm; and, most recently and importantly, investments in very young children that pay off in healthier and more productive adults. Whether public investments in medical care affect health hinges on the quality of health institutions. In much of the developing world, factors such as chronic absenteeism among public providers, poor budget execution, ineffective management, and virtually no accountability weaken public efforts. Institutional issues are central in efforts to enhance public health investments, which in turn have a direct impact on the population's welfare and, perhaps over the long term, improvements in national income.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Health Economics&Finance,Disease Control&Prevention
    Date: 2009–03–01
  9. By: Irina Denisova (Center for Economic and Financial Research (CEFIR), Moscow)
    Abstract: The paper studies determinants of Russian adult mortality controlling for individual and household heterogeneity. We utilize twelve rounds of the Russian Longitudinal Monitoring Survey spanning the period of 14 years to study determinants of adult mortality. Survival analysis is the main methodology employed. The results are original in several respects. We find empirical support to the importance of relative status measured in non-income terms in shaping mortality hazards while income-measured relative position is confirmed to be statistically insignificant. We find evidence on the influence of labor market behavior, and sectoral and occupational mobility in particular, on longevity. The health detrimental role of smoking is found to be comparable to the role of excess alcohol consumption which is novel in the Russian context where the influence of smoking is downplayed in comparison to the alcoholism. Finally, we find no micro evidence in support to the regional data result underlying Treisman (2008) political economy story.
    Keywords: Mortality, Relative Deprivation, Survival Analysis, Transition, Russia
    JEL: J1 J10 J18 I1 I12 D31
    Date: 2009–03
  10. By: Chakroun, Mohamed
    Abstract: In this paper, we investigate the potential threshold effects in the relationship between national expenditures on health care and national income. Using a panel threshold regression model, we derive country-specific and time-specific income elasticities for 17 OECD countries over the period 1975–2003. In contrast to many previous analyses, our empirical results show that health care is a necessity rather than a luxury. Further, the relationship between health expenditure and income seems rather nonlinear, changing over time and across countries.
    Keywords: Health expenditure; Income elasticity; Panel smooth threshold regression models
    JEL: I1
    Date: 2009–05
  11. By: Gabriel Aranovich; Jay Bhattacharya; Alan M. Garber; Thomas E. MaCurdy
    Abstract: It is well known that disability rates among the American elderly have declined over the past decades. The cause of this decline is less well established. In this paper, we test one important possible explanation--that the decline in disability occurred because of chronic disease prevention efforts among the elderly. For this purpose we analyze data from the National Long Term Care Survey and from the National Health and Interview Survey. Our findings suggest that primary prevention, as reflected in decreased disease prevalence, was not responsible for advances made in elderly functioning between 1980 and 2000. We found a broad decline in less severe forms of disability that is unlikely to have resulted from improved disease management. Instead, these measured improvements in functioning may reflect environmental, technological, and/or socioeconomic changes. Improvements in the more severe forms of disability were modest and were restricted to those suffering from particular illnesses, which make improved and/or more aggressive management a plausible explanation and one that might increase costs should the trend persist.
    JEL: I1 I18
    Date: 2009–03
  12. By: Thomas C. Buchmueller; Alan C. Monheit
    Abstract: The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as source of health care financing. In this paper, we consider the "goodness of fit" of ESI in the current economic and health insurance environments and in light of prospects for a vigorous national debate over shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage, to create expanded health plan choices and competition in health insurance markets, and to structure incentives for the more efficient use of health services.
    JEL: I11 I18 I38
    Date: 2009–04
  13. By: Ajay Mahal; Brendan O'Flaherty; David E. Bloom
    Abstract: Without well designed empirical studies, mathematical models are an important way to use data on needle infection for inferences about human infection. We develop a model with explicit behavioral foundations to explore an array of policy interventions related to HIV transmission among IDU. In our model, needle exchanges affect the spread of HIV in three ways: more HIV-negative IDUs use new needles instead of old ones; needles are retired after fewer uses; and the proportion of HIV-positive IDUs among users of both old and new needles rises owing to sorting effects. The first and second effects reduce the long-run incidence of HIV, while the third effect works in the opposite direction. We compare the results of our model with those of Kaplan and O'Keefe (1993) that is the foundation of many later models of HIV transmission among IDU.
    JEL: I18 K42
    Date: 2009–03

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