nep-hea New Economics Papers
on Health Economics
Issue of 2009‒05‒16
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Part-time work and Health among Older Workers in Ireland and Britain By Brenda Gannon; Jennifer Roberts
  2. Early retirement and inequality in Britain and Germany: How important is health? By Jennifer Roberts; Nigel Rice; Andrew M. Jones
  3. Health and Income: A Robust Comparison of Canada and the US By Jean-Yves Duclos; Damien Échevin
  4. Critical Periods During Childhood and Adolescence: A Study of Adult Height Among Immigrant Siblings By van den Berg, Gerard J.; Lundborg, Petter; Nystedt, Paul; Rooth, Dan-Olof
  5. AIDS and dualism : Ethiopia's burden under rational expectations By Bell, Clive; Koukoumelis, Anastasios
  6. How can donors help build global public goods in health ? By Das Gupta, Monica; Gostin, Lawrence
  7. Institutional Ambivalence and Permanently Failing Health Care: Access by Immigrants and the Categorically Unequal in the Nation and New Jersey By Donald Light
  8. The American Health System and Immigration: An Institutional Interpretation By Alejandro Portes; Donald Light; Patricia Fernández-Kelly
  9. The Value of Countermarketing Information to Smokers: Evidence from Field Auctions By Rousu, Matthew C.; Nonnemaker, James; farrelly, Matthew
  10. Changes in Food, Alcohol and Cigarettes Consumption during Transition: Evidence from Russia By Herzfeld, Thomas; Huffman, Sonya K.; Oskam, Arie; Rizov, Marian
  11. Are you are what you eat? Overweight Status and Soft Drink Choices By Huang, Rui; Lopez, Rigoberto A.
  12. Eating a Healthy Diet: Is Cost a Major Factor? By Carlson, Andrea; Lino, Mark; Fungwe, Thomas V.; Guenther, Patricia M.
  13. The Supplemental Nutrition Assistance Program and Child Obesity: Revisiting the NLSY79 By Schmeiser, Maximilian D.
  14. Obesity in Urban Food Markets: Evidence from Geo-referenced Micro Data By Chen, Susan E.; Florax, Rayond J.G.M.; Snyder, Samantha D.
  15. Can nutritional label use influence body weight outcomes? By Andreas Drichoutis; Rodolfo M. Nayga, Jr.; Panagiotis Lazaridis
  16. Social capital and health across European countries By Bas van Groezen; Rashmi Jadoenandansing; Giacomo Pasini
  17. The Long-Term Economic Impact of In Utero and Postnatal Exposure to Malaria By Alan Barreca
  18. Taxation and Regulation of Smoking, Drinking and Gambling in the European Union By Sijbren Cnossen; David Forrest; Stephen Smith
  19. Modelling health care expenditures By Roel van Elk; Esther Mot; Philip Hans Franses
  20. Education and the Prevalence of Pain By Steven J. Atlas; Jonathan S. Skinner
  21. Pollution, Health, and Avoidance Behavior: Evidence from the Ports of Los Angeles By Enrico Moretti; Matthew Neidell

  1. By: Brenda Gannon; Jennifer Roberts (Department of Economics, The University of Sheffield)
    Abstract: Part-time work is viewed as a viable option for people who wish to have a gradual transition to retirement. From a policy viewpoint, this may help to alleviate some labour supply shortages, especially in the context of the aging population. Factors such as health or pension provision may influence a person´s decision to work part-time. This paper considers the impact of health on the work decision for people aged 50 and over in the UK and Ireland. Methodological issues are discussed and the impact of unobserved individual effects is estimated using the Mundlak estimator applied to the multinomial probit model. The impact of health on part-time work is negative in Ireland, but we find no significant effect in the UK. The paper discusses potential reasons for these impacts and current policies on part-time work..
    Keywords: health, retirement, panel data
    JEL: J26 I10 C23
    Date: 2008–12
  2. By: Jennifer Roberts (Department of Economics, The University of Sheffield); Nigel Rice; Andrew M. Jones
    Abstract: Both health and income inequalities have been shown to be much greater in Britain than in Germany. One of the main reasons seems to be the difference in the relative position of the retired, who, in Britain, are much more concentrated in the lower income groups. Inequality analysis reveals that while the distribution of health shocks is more concentrated among those on low incomes in Britain, early retirement is more concentrated among those on high incomes. In contrast, in Germany, both health shocks and early retirement are more concentrated among those with low incomes. We use comparable longitudinal data sets from Britain and Germany to estimate hazard models of the effect of health on early retirement. The hazard models show that health is a key determinant of the retirement hazard for both men and women in Britain and Germany. The size of the health effect appears large compared to the other variables. Designing financial incentives to encourage people to work for longer may not be sufficient as a policy tool if people are leaving the labour market involuntarily due to health problems.
    Keywords: health, early retirement, hazard models
    JEL: J26 I10 C23 C41
    Date: 2008–11
  3. By: Jean-Yves Duclos; Damien Échevin
    Abstract: This paper uses sequential stochastic dominance procedures to compare the joint distribution of health and income across space and time. It is the First application of which we are aware of methods to compare multidimen- sional distributions of income and health using procedures that are robust to aggregation techniques. The paper's approach is more general than com- parisons of health gradients and does not require the estimation of health equivalent incomes. We illustrate the approach by contrasting Canada and the US using comparable data. Canada dominates the US over the lower bi-dimensional welfare distribution of health and income, though not generally in terms of the uni-dimensional distribution of health or income. The paper also finds that welfare for both Canadians and Americans has not unambiguously improved during the last decade over the joint distribution of income and health, in spite of the fact that the uni-dimensional distributions of income have clearly improved during that period.
    Keywords: Health inequality; Self-reported health status; Income distribution; Stochastic dominance; Social welfare
    JEL: I10 I32 I38 D63 D30 H51
    Date: 2009–04–20
  4. By: van den Berg, Gerard J. (VU University Amsterdam); Lundborg, Petter (VU University Amsterdam); Nystedt, Paul (Linköping University); Rooth, Dan-Olof (Kalmar University)
    Abstract: We identify the ages that constitute critical periods in children's development towards their adult health status. For this we use data on families migrating into Sweden from countries that are mostly poorer, with less healthy conditions. Long-run health is proxied by adult height. The relation between siblings' ages at migration and their heights after age 18 allows us to estimate the causal effect of conditions at a certain age on adult height. Moreover, we compare siblings born outside and within Sweden. We apply fixed-effect methods to a sample of about 9,000 brothers. We effectively exploit that for siblings the migration occurs simultaneously in calendar time but at different developmental stages (ages). We find important critical periods at ages 5/6 and 9. The effects are stronger in families migrating from poorer countries but weaker if the mother is well-educated.
    Keywords: developmental origins, fetal programming, age, height retardation, adult health, parental education, migration, early-life conditions
    JEL: I10 I12 I18 F22 I20 I30 J10 N30
    Date: 2009–04
  5. By: Bell, Clive; Koukoumelis, Anastasios
    Abstract: An AIDS epidemic threatens Ethiopia with a long wave of premature adult mortality, and thus with an enduring setback to capital formation and economic growth. The authors develop a two-sector model with three overlapping generations and intersectorally mobile labor, in which young adults allocate resources under rational expectations. They calibrate the model to the demographic and economic data, and perform simulations for the period ending in 2100 under alternative assumptions about mortality with and without the epidemic. Although the epidemic does not bring about a catastrophic economic collapse, which is hardly possible in view of Ethiopia's poverty and high background adult mortality, it does cause a permanent, downward displacement of the path of output per head, amounting to 10 percent in 2100. An externally funded program to combat the disease is socially very profitable.
    Keywords: Population Policies,Economic Theory&Research,,Access to Finance,Adolescent Health
    Date: 2009–04–01
  6. By: Das Gupta, Monica; Gostin, Lawrence
    Abstract: Aid to developing countries has largely neglected the population-wide health services that are core to communicable disease control in the developed world. These mostly non-clinical services generate"pure public goods"by reducing everyone's exposure to disease through measures such as implementing health and sanitary regulations. They complement the clinical preventive and treatment services which are the donors'main focus. Their neglect is manifested, for example, in a lack of coherent public health regulations in countries where donors have long been active, facilitating the spread of diseases such as avian flu. These services can be inexpensive, and dramatically reduce health inequalities. Sri Lanka spends less than 0.2% of GDP on its well-designed population-wide services, which contribute to the country's high levels of health equity and life expectancy despite low GDP per head and civil war. Evidence abounds on the negative externalities of weak population-wide health services. Global public health security cannot be assured without building strong national population-wide health systems to reduce the potential for communicable diseases to spread within and beyond their borders. Donors need greater clarity about what constitutes a strong public health system, and how to build them. The paper discusses gaps in donors'approaches and first steps toward closing them.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Disease Control&Prevention,Population Policies,Gender and Health
    Date: 2009–04–01
  7. By: Donald Light (University of Medicine and Dentistry of New Jersey)
    Abstract: Immigrants seeking health care, especially those without some kind of public or private insurance, highlight the barriers to access that arose as intended or unintended barriers of how dominant stakeholders shaped American medicine. This paper draws on a new study of those consequences for immigrants and focuses on efforts by one state to increase access. Such efforts are framed and constrained by past institutional developments and the layered actions of federal, state, and sometimes county or city actions. We develop a conceptual framework based on Merton & Barber, Meyer & Zucker, Tilly, and Massey that is useful for analyzing health care and other human service programs. Categorical inequalities underlie institutional ambivalence in many programs and policies, and in efforts to reduce or increase them. These inequalities and ambivalence contribute to American health care and health insurance being permanently failing systems driven by provider and insurer moral hazard that never collapse but run inefficiently, ineffectively, and inequitably.
    Date: 2009–04
  8. By: Alejandro Portes (Princeton University); Donald Light (University of Medicine and Dentistry of New Jersey); Patricia Fernández-Kelly (Princeton University)
    Abstract: We examine the institutions that comprise the American health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States is used as empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.
    Date: 2009–04
  9. By: Rousu, Matthew C.; Nonnemaker, James; farrelly, Matthew
    Abstract: Information about cigarettes can help smokers come to an informed decision about what cigarettes to purchase. Countermarketing information, which helps counter potentially biased marketing information, can fill this void, but little is known about the value of this information to smokers. In this paper, we use data from experimental auctions to estimate the value of countermarketing information to smokers. We find that countermarketing information has significant value to smokers who have been exposed to marketing information from tobacco companies, but we find no evidence it provides value to smokers not exposed to marketing information
    Keywords: field auctions, value of information, cigarettes, Consumer/Household Economics, Health Economics and Policy,
    Date: 2009
  10. By: Herzfeld, Thomas; Huffman, Sonya K.; Oskam, Arie; Rizov, Marian
    Abstract: This paper examines the changes in nutritional behavior of Russian adults over the ten-year transition period, between 1994 and 2004. We present evidence on the impact of individual as well as regional characteristics on changes in fat, protein, alcohol and cigarette consumption, and on diversity of diet. The results from a dynamic empirical model suggest that among microeconomic determinants, initial levels of consumption, gender, holding a university degree, and having access to a garden plot have a significant impact on the changes in consumption behavior in Russia. Regarding the macroeconomic variables, economic growth has a significant impact on changes in fat and protein consumption and on alcohol use, while unemployment changes significantly impact protein intake, alcohol consumption and the diversity of diet.
    Keywords: consumption, smoking, alcohol, economic transition, Russia, Consumer/Household Economics, Food Consumption/Nutrition/Food Safety,
    Date: 2009
  11. By: Huang, Rui; Lopez, Rigoberto A.
    Abstract: The rising obesity during the past three decades poses a severe public health challenge and spurred enormous research interests. This paper contributes to the growing literature on how obesity spreads by empirically investigating whether social norms affect soft drink consumption choices. Combining market level soft drink scanner data and survey data with consumer level characteristics, we employ reduced form regressions to test whether social norms of body weight affects per capita consumption of total or caloric soft drink consumption, on a market level. We also utilize a random-coefficient logit model to examine whether social norms of body weight affect consumer choices on a brand level. Our results from the market level analyses support that a heavier socially normal body weight leads to more average total consumption of soft drink and caloric intake from soft drink, suggesting a social multiplier effect. The results from the brand level choices are less clear at this point.
    Keywords: social norm, body weight, food choices, Agribusiness, Agricultural and Food Policy, Health Economics and Policy,
    Date: 2009
  12. By: Carlson, Andrea; Lino, Mark; Fungwe, Thomas V.; Guenther, Patricia M.
    Abstract: We examine the association between food expenditure and overall diet quality using a model where we assumed dietary quality is a function of health conditions, life style choices, total food expenditures, and socio-economic status. We use cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2001-02 and the U.S. Department of Agriculture (USDA)âs Center for Nutrition Policy and Promotion Food Prices Database. Diet quality is measured using the USDA Healthy Eating Index-2005. Our findings suggest that there is no statistically significant association between total diet quality and diet cost for men, but a small association for women. Compared with diet cost, health conditions, life style choices, and socio-economic status play an important role in determining diet quality.
    Keywords: diet quality, food expenditure, HEI-2005, food prices data, Agricultural and Food Policy, Consumer/Household Economics, Demand and Price Analysis, Food Consumption/Nutrition/Food Safety,
    Date: 2009
  13. By: Schmeiser, Maximilian D.
    Abstract: Over the past three decades the prevalence of obesity among children in the United States has more than tripled. A clear income gradient exists in the prevalence of obesity, with low-income children significantly more likely to be obese. One suggested cause of the higher prevalence of obesity among children in low-income families is participation in the Supplemental Nutrition Assistance Program (SNAP), as the obesity prevalence among SNAP participants is consistently higher than that of eligible non-participants. This paper examines the effect of long-term SNAP participation on the obesity status of children ages 3 to 11 using data from the Children and Young Adults of the National Longitudinal Survey of Youth 1979 and an instrumental variables identification strategy. Doing so, I find that there is no effect of the SNAP on obesity status for either boys or girls.
    Keywords: Child obesity, Food Stamps, Supplemental Nutrition Assistance, Overweight, Food Consumption/Nutrition/Food Safety, Food Security and Poverty, Health Economics and Policy, I1, I3, H3,
    Date: 2009
  14. By: Chen, Susan E.; Florax, Rayond J.G.M.; Snyder, Samantha D.
    Abstract: This paper provides quantitative estimates of the effect of proximity to fast food restaurants and grocery stores on obesity in urban food markets. Our empirical model combined georeferenced micro data on access to fast food restaurants and grocery stores with data about salient personal characteristics, individual behaviors, and neighborhood characteristics. We defned a "local food environment" for every individual utilizing 0.5-mile buffers around a person's home address. Local food landscapes are potentially endogenous due to spatial sorting of the population and food outlets, and the body mass index (BMI) values for individuals living close to each other are likely to be spatially correlated because of observed and unobserved individual and neighborhood effects. The potential biases associated with endogeneity and spatial correlation were handled using spatial econometric estimation techniques. Our policy simulations for Indianapolis, Indiana, focused on the importance of reducing the density of fast food restaurants or increasing access to grocery stores. We accounted for spatial heterogeneity in both the policy instruments and individual neighborhoods, and consistently found small but statistically signifcant effects for the hypothesized relationships between individual BMI values and the densities of fast food restaurants and grocery stores.
    Keywords: obesity, fast food, grocery store, spatial econometrics, micro data, Agricultural and Food Policy, Community/Rural/Urban Development, Consumer/Household Economics, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, Public Economics, Research Methods/ Statistical Methods, C31, D12, I12, I18,
    Date: 2009–03
  15. By: Andreas Drichoutis (Department of Economics, University of Ioannina, Greece); Rodolfo M. Nayga, Jr. (Department of Agricultural Economics & Agribusiness, University of Arkansas, USA); Panagiotis Lazaridis (Department of Agricultural Economics & Rural Development, Agricultural University of Athens, Greece)
    Abstract: Nutritional labeling has been of much interest to policy makers and health advocates due to rising obesity trends. So can nutritional label use really help reduce body weight outcomes? This study evaluates the impact of nutritional label use on body weight using the propensity score matching technique. We conducted a series of tests related to variable choice of the propensity score specification, quality of matching indicators, robustness checks, and sensitivity to unobserved heterogeneity using Rosenbaum bounds to validate our propensity score exercise. Our results generally suggest that nutritional label use does not affect body mass index. Implications of our findings are discussed.
    Keywords: Nutritional Labels, Body Mass Index, Propensity Score Matching, sensitivity analysis
    JEL: I1 C14
    Date: 2009
  16. By: Bas van Groezen; Rashmi Jadoenandansing; Giacomo Pasini
    Abstract: We compare the effect of trust and civic participation on self-assessed health across ten European countries. We find that, after controlling for a rich set of socio-economic characteristics, for actual health status and for health-related behaviours, trust has a significantly positive effect on perceived health in Sweden and in Germany, but none in the other countries. Civic participation does have a positive and quite similar effect in all countries. Our conclusion is that they measure two different aspects of social capital that must be treated separately.
    Keywords: Panel Data, Wage Distribution, Inequality, Mobility
    JEL: I12 J14
    Date: 2009–04
  17. By: Alan Barreca (Department of Economics, Tulane University)
    Abstract: I use an instrumental-variables identification strategy and historical data from the United States to estimate the long-term economic impact of in utero and postnatal exposure to malaria. My research design matches adults in the 1960 Decennial Census to the malaria death rate in their respective state and year of birth. To address potential omitted variables bias and measurement-error bias, I use variation in ``malaria-ideal'' temperatures to instrument for malaria exposure. My estimates indicate that it in utero and postnatal exposure to malaria led to considerably lower levels of educational attainment and higher rates of poverty later in life.
    Keywords: early-life health, malaria, education, poverty
    JEL: I12 I31 J0 J24
    Date: 2009–05
  18. By: Sijbren Cnossen; David Forrest; Stephen Smith
    Abstract: Smoking is the single largest cause of avoidable death in the European Union accounting for over half a million deaths each year. One in ten of all 11-year olds have been drunk twice or more times, possibly causing lasting physical and mental harm. Electronic gaming machines are the crack cocaine of gambling. Consumer sovereignty, on the other hand, indicates that people should be allowed to smoke as long as they do not harm others. There is sound medical evidence, furthermore, that a drink each day keeps the doctor away, while recreational gambling can be an enjoyable form of entertainment for many people. These and other salient facts about the harmful and positive effects of smoking, drinking and gambling provide the background for a dispassionate economic analysis of the taxation and regulation of these activities. The main message the studies convey is that it would be unrealistic to rely solely on duty levels and differentiation to curb abusive use. Duty levels do have a clear impact in restraining consumption by children and young adults - an important priority for policy. But complementary policies - including direct regulation and provision of information - also have a meaningful role to play in each of the markets for tobacco, alcohol and gambling.
    Keywords: taxation; tobacco; alcohol; gambling; regulation; externalities; European Union
    JEL: H2 H8 H23 I18 L83
    Date: 2009–02
  19. By: Roel van Elk; Esther Mot; Philip Hans Franses
    Abstract: Health care expenditures in industrial countries have been growing rapidly over the past forty years. This rapid growth jeopardizes the sustainability of public budgets and causes an increasing interest in the determinants of health care expenditures. The first purpose of this paper is to give an up to date overview of the literature on health care expenditures. Secondly, this paper tries to contribute to the existing literature by investigating the impact of several factors on health care expenditures in an empirical analysis using an error-correction model. Additional to the ‘usual suspects’ for rising health care expenditures, we pay attention to a somewhat neglected driving factor, which is the increase in the relative price of health care compared to other goods and services. We find that the increasing price of health care helps to explain the increase in real health care expenditures. However, the use of health care in volume terms is negatively affected by the increasing price. This effect seems to be stronger in periods of cost containment policy. Consistent with most recent findings in the literature, we find that income and ageing are important drivers of health care expenditures.
    Keywords: health care expenditures; error-correction model
    JEL: I10 H51
    Date: 2009–02
  20. By: Steven J. Atlas; Jonathan S. Skinner
    Abstract: Many Americans report chronic and disabling pain, even in the absence of identifiable clinical disorders. We first examine the prevalence of pain in the older U.S. population using the Health and Retirement Study (HRS). Among 50-59 year females, for example, pain rates ranged from 26 percent for college graduates to 55 percent for those without a high school degree. Occupation, industry, and marital status attenuated but did not erase these educational gradients. Second, we used a study of patients with lower back pain and sciatica arising from intervertebral disk herniation (IDH). Initially, nearly all patients reported considerable pain and discomfort, with a sizeable fraction undergoing surgery for their IDH. However, baseline severity measures and surgical or medical treatment explained little of the variation in 10-year outcomes. By contrast, education exerted a strong impact on changes over time in pain: just 9 percent of college graduates report leg or back pain "always" or "almost always" after 10 years, compared to 34 percent for people without a high school degree. This close association of education with pain is consistent with recent research emphasizing the importance of neurological – and perhaps economic -- factors in the perception of pain.
    JEL: I1
    Date: 2009–05
  21. By: Enrico Moretti; Matthew Neidell
    Abstract: A pervasive problem in the literature on the health costs of pollution is that optimizing individuals may compensate for increases in pollution by reducing their exposure to protect their health. This implies that estimates of the health effects of pollution may vastly understate the full welfare effects of pollution, particularly for individuals most at risk who have the greatest incentive to adopt compensatory behavior. Furthermore, using ambient monitors to approximate individual exposure to pollution may induce considerable measurement error. We overcome these issues by estimating the short run effects of ozone on respiratory related health conditions using daily boat arrivals and departures into the two major ports of Los Angeles as an instrumental variable for ozone levels. While daily variation in boat traffic is a major contributor to local ozone pollution, time-varying pollution due to port activity is arguably a randomly determined event uncorrelated with factors related to health. Instrumental variable estimates are significantly larger than OLS estimates, indicating the importance of accounting for avoidance behavior and measurement error in understanding the full welfare effects from pollution.
    JEL: I12 I18 Q53
    Date: 2009–05

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