nep-hea New Economics Papers
on Health Economics
Issue of 2009‒06‒17
seventeen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Expanding Exposure: Can Increasing the Daily Duration of Head Start Reduce Childhood Obesity? By David Frisvold; Julie C. Lumeng
  2. Does Competition from Ambulatory Surgical Centers Affect Hospital Surgical Output and Hospital Profit? By Plotzke, Michael; Courtemanche, Charles
  3. Long-Term Health Effects on the Next Generation of Ramadan Fasting During Pregnancy By Reyn van Ewijk
  4. Anatomy of a Health Scare: Education, Income and the MMR Controversy in the UK By Dan Anderberg; Arnaud Chevalier; Jonathan Wadsworth
  5. The Value of Rude Health: Employees Well Being, Absence and Workplace Performance By David Marsden; Simone Moriconi
  6. Grossman's Missing Health Threshold By Titus J. Galama; Arie Kapteyn
  7. Access to primary care and workers’ opportunity costs. Evidence from Italy By De Luca, Giuliana; Ponzo, Michela
  8. Health Shocks and Retirement: The Role of Welfare State Institutions By Datta Gupta, Nabanita; Larsen, Mona
  9. Short run and long run dynamics of impact of health status on economic growth Evidence from Pakistan By Akram, Naeem
  10. Risk Taking of HIV-Infection and Income Uncertainty: Empirical Evidence from Sub-Saharan Africa By Djemaï, Elodie
  11. Birth Cohort and the Black-White Achievement Gap: The Roles of Access and Health Soon After Birth By Kenneth Y. Chay; Jonathan Guryan; Bhashkar Mazumder
  12. Direct and Indirect Effects of Teenage Body Weight on Adult Wages By Euna Han; Edward C. Norton; Lisa M. Powell
  13. Physical Activity: Economic and Policy Factors By Melayne M. McInnes; Judith A. Shinogle
  14. Economic Contextual Factors and Child Body Mass Index By Lisa M. Powell; Frank J. Chaloupka
  15. Why Do Mothers Breastfeed Girls Less Than Boys? Evidence and Implications for Child Health in India By Seema Jayachandran; Ilyana Kuziemko
  16. The Quality of Medical Care, Behavioral Risk Factors, and Longevity Growth By Frank R. Lichtenberg
  17. Geographic Decomposition of Inequality in Health and Wealth: Evidence from Cambodia By Tomoki Fujii

  1. By: David Frisvold; Julie C. Lumeng
    Abstract: Coinciding with the work requirements of welfare reform in the mid-1990s, the early childhood education program, Head Start, increased the availability of full-day classes. Using unique administrative data, we examine the effect of full-day compared to half-day attendance on childhood obesity. This effect is identified using the elimination of a state-provided full-day expansion grant that led to an exogenous decrease in the supply of full-day classes for the program in our study. Our results suggest that full-day Head Start attendance significantly reduces the proportion of obese children at the end of the academic year.
    Date: 2009–04
  2. By: Plotzke, Michael (Abt Associates, Inc.); Courtemanche, Charles (University of North Carolina at Greensboro, Department of Economics)
    Abstract: Hospital administrators have expressed concern that ambulatory surgical centers (ASCs) lower the profitability of hospitals' outpatient departments by reducing their volume and cherry picking their most profitable patients. This could lead to welfare losses by causing hospitals to reduce their provision of less profitable services such as uncompensated care. This paper estimates the effects of ASC prevalence on hospital surgical volume and profit margins using hospital and year fixed effects models with a variety of robustness checks. We show that ASC entry only appears to influence a hospital's outpatient volume if the facilities are within a few miles of each other. Even then, the average reduction in hospital volume is a modest 2-4%, although the effect is stronger for large ASCs and the first ASCs to enter the market. We find no evidence that entering ASCs reduce a hospital's outpatient profit margins, inpatient surgical volume, or inpatient profit margins. In most cases, our results suggest that competition from ASCs does not cause serious financial harm to hospitals.
    Keywords: Ambulatory Surgical Center; Hospital Competition; Physician Ownership; Hospital Profit
    JEL: I11
    Date: 2009–06–03
  3. By: Reyn van Ewijk
    Abstract: Each year, many pregnant women fast from dawn to sunset during the Islamic holy month ofRamadan. Medical theory suggests that this may have negative long-term health effects on theiroffspring. Building upon the work of Almond and Mazumder (2008), and using Indonesian crosssectionaldata, I show that people who were exposed to Ramadan fasting during their mother'spregnancy have a poorer general health and are sick more often than people who were not exposed.This effect is especially pronounced among older people, who, when exposed, also report healthproblems more often that are indicative of coronary heart problems and type 2 diabetes. The exposedare a bit smaller in body size and weigh less. Among Muslims born during, and in the months after,Ramadan, the share of males is lower, which is most likely to be caused by death before birth. I showthat these effects are unlikely to be an artifact of common health shocks, correlated to the occurrenceof Ramadan, or o f fasting mainly occurring among women who, irrespective of fasting or not, wouldhave had unhealthier children anyway.
    Keywords: health, Ramadan, pregnancy, nutrition, Indonesia
    JEL: I2 I12 J1 J14
    Date: 2009–04
  4. By: Dan Anderberg; Arnaud Chevalier; Jonathan Wadsworth
    Abstract: One theory for why there is an education gradient in health outcomes is that more educatedindividuals more quickly absorb new health-related information. The measles, mumps, andrubella (MMR) controversy provides a case where, for a short period, some publicizedresearch suggested that the particular childhood vaccine could have serious side-effects. Asthe controversy unfolded, uptake of the vaccine by more educated parents decreased relativeto that of less educated parents, turning a positive education gradient into a negative one. Wealso consider the response in terms of uptake of other childhood vaccines and purchases ofalternatives to the MMR.
    Keywords: Childhood vaccinations, health outcomes, education
    JEL: H42 I18
    Date: 2009–05
  5. By: David Marsden; Simone Moriconi
    Abstract: This paper brings new evidence on the relationship between employees' well being, sickness absence and fourdimensions of workplace performance i.e. productivity, efficiency, quality of service and profitability. It uses anew panel dataset with monthly observations over two years for 48 local units of a large multi-site organisationin the logistics sector. It finds that good consultation and communication at the local level are associated withlower absenteeism. It also finds that lower absence is associated with higher efficiency, productivity, quality ofthe service and profitability of the firm. Finally, the authors suggest that the link between workers' absence andthis firm's profitability runs through the increased use of replacement labour which raises short-run costs andreduces quality of service.
    Keywords: Time Allocation, absenteeism, Safety, Accidents, Industrial Health
    JEL: J22 J28
    Date: 2009–04
  6. By: Titus J. Galama; Arie Kapteyn
    Abstract: The authors present a generalized solution to Grossman's model of health capital (1972), relaxing the widely used assumption that individuals can adjust their health stock instantaneously to an "optimal" level without adjustment costs. The Grossman model then predicts the existence of a health threshold above which individuals do not demand medical care. Their generalized solution addresses a significant criticism: the model's prediction that health and medical care are positively related is consistently rejected by the data. They suggest structural and reduced form equations to test their generalized solution and contrast the predictions of the model with the empirical literature.
    JEL: I10 I12 J00 J24
    Date: 2009–05
  7. By: De Luca, Giuliana; Ponzo, Michela
    Abstract: This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Data used in the analysis come from the 2004/2005 “Health conditions and recourse to health services” survey provided by the Italian National Institute of Statistics (ISTAT). We apply a negative binomial regression to model the relationship between the number of GP visits and employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We interpret these findings as being due to the fact that these type of workers have higher opportunity costs than white and blue collars, since they suffer more from the loss of earnings related to the absence from work
    Keywords: Opportunity cost; hours of work; utilisation of GP; labour market.
    JEL: I18 J21 J20 I10
    Date: 2009–05
  8. By: Datta Gupta, Nabanita; Larsen, Mona
    Abstract: We investigate the effect of an acute health shock on retirement among elderly male workers in Denmark, 1991-1999, and in particular whether various welfare state programs and institutions impinge on the retirement effect. The results show that an acute health event increases the retirement chances of elderly male workers by 8%, and that this increase in the baseline retirement probability is not affected by eligibility to early exit programs and persists even after accounting for selection due to take-up of disability pension. Neither is it affected by the relatively long duration of sickness benefits in Denmark nor by the promotion of corporate social responsibility initiatives since the mid-1990s. In the late 1990s, however, the retirement rate following a health shock is reduced to 3% with the introduction of the subsidized employment program (fleksjob) but this effect is on the margin of being significant. For the most part, the retirement effect following a health shock seems to be immune to the availability of a multitude of government programs for older workers in Denmark.
    Keywords: retirement; health shocks; welfare state programs; medical diagnoses
    JEL: I12 I18 J26
    Date: 2007–08–10
  9. By: Akram, Naeem
    Abstract: The paper investigates the impacts of different health indicators on Economic growth in Pakistan. The Cointegration and Error Correction techniques were applied on the time series data of Pakistan for the period of 1972-2006. We find that Per capita GDP is positively influenced by health indicators in the long run and health indicators are having significant impact on per capita GDP. However, in the short run the health indicators fails to put significant impact on per capita GDP. It reveals that health indicators have a long run impact on economic growth. . It suggests that impact of health is only a long run phenomenon and in the short run there is no significant relationship exists between health variables and economic growth. The major policy implication of the study is that if we desire a high levels of per capita income, we can achieve it by increasing and improving the stock of health human capital, especially if current stocks are at lower end. Moreover, study also points out a rather diminutive role of public health expenditure in determining the per capita GDP.
    Keywords: Health human capital; Economic growth; Per capita GDP; Cointegration; Error Correction
    JEL: O1 O53 C22 O4 I1
    Date: 2009–05–20
  10. By: Djemaï, Elodie
    Abstract: This paper questions the positive relationship between HIV prevalence and income in Sub-Saharan Africa. In this paper, we hypothesize that a greater economic instability would reduce the incentives to engage in self-protective behaviors inducing people to increasingly take the risk of HIV-infection and hence causing a rise in HIV prevalence. We provide a simple model to stress on the effects of an increase in income risk in the incentives for protection. We test the prediction using a panel of Sub-Saharan African countries over the period 1980-2001. It is shown that the epidemic is widespread in countries that experience a great instability in gross domestic product over the whole period. When introducing income instability, GDP per capita is devoid of predictive power and the puzzle of the positive relationship between income and prevalence in Africa is lifted. Additional finding states that the risk taking of HIV-infection increases when the individuals are facing frequent and large crop shocks.
    Keywords: HIV/AIDS epidemic; incentives; self-protection; macroeconomic instability; Sub-Saharan Africa
    JEL: J10 I12 C23
    Date: 2008–11
  11. By: Kenneth Y. Chay; Jonathan Guryan; Bhashkar Mazumder
    Abstract: One literature documents a significant, black-white gap in average test scores, while another finds a substantial narrowing of the gap during the 1980's, and stagnation in convergence after. We use two data sources -- the Long Term Trends NAEP and AFQT scores for the universe of applicants to the U.S. military between 1976 and 1991 -- to show: 1) the 1980's convergence is due to relative improvements across successive cohorts of blacks born between 1963 and the early 1970's and not a secular narrowing in the gap over time; and 2) the across-cohort gains were concentrated among blacks in the South. We then demonstrate that the timing and variation across states in the AFQT convergence closely tracks racial convergence in measures of health and hospital access in the years immediately following birth. We show that the AFQT convergence is highly correlated with post-neonatal mortality rates and not with neonatal mortality and low birth weight rates, and that this result cannot be explained by schooling desegregation and changes in family background. We conclude that investments in health through increased access at very early ages have large, long-term effects on achievement, and that the integration of hospitals during the 1960's affected the test performance of black teenagers in the 1980's.
    JEL: I12 I18 J15 J24
    Date: 2009–06
  12. By: Euna Han; Edward C. Norton; Lisa M. Powell
    Abstract: Previous estimates on the association between body weight and wages in the literature have been contingent on education and occupation. This paper examines the direct effect of BMI on wages and the indirect effects operating through education and occupation choice, particularly for late-teen BMI and adult wages. Using the National Longitudinal Survey of Youth 1979 data, we show that education is the main pathway for the indirect BMI wage penalty. The total BMI wage penalty is underestimated by 18% for women without including those indirect effects. Whereas for men there is no statistically significant direct BMI wage penalty, we do observe a small indirect wage penalty through education.
    JEL: I1 J31
    Date: 2009–06
  13. By: Melayne M. McInnes; Judith A. Shinogle
    Abstract: While much research has focused on the costs of obesity and economic factors that drive obesity growth, little economic research has examined the factors that contribute to obesity -- physical inactivity and poor nutrition. This paper will examine correlates and predictors of physical activity over time with emphasis on economic factors. We use data for adults from the 2000-2005 Behavioral Risk Factor Surveillance System (BRFSS) survey that includes state and county codes for each individual that allows us to add supplementary data on state beer and cigarette taxes, local transportation costs, availability of gyms and recreational facilities, county unemployment, crime rates, and prices of related goods. We find that income and education has a strong and consistently positive effect on physical activity across specifications. Sin taxes have no effect on the likelihood of any exercise but generally have negative effects on vigorous exercise or moderate and vigorous exercise. Physical activity is more likely when there are more parks per capita in a county. Our results above are robust to the inclusion of weight status and use of flu shots (a measure of an individual's tendency towards prevention).
    JEL: I1
    Date: 2009–06
  14. By: Lisa M. Powell; Frank J. Chaloupka
    Abstract: This study examines the relationship between child weight and fast food and fruit and vegetable prices and the availability of fast food restaurants, full-service restaurants, supermarkets, grocery stores and convenience stores. We estimate cross-sectional and individual-level fixed effects (FE) models to account for unobserved individual-level heterogeneity. Data are drawn from the Child Development Supplement of the Panel Study of Income Dynamics combined with external food price and outlet density data at the zip code level. FE results show that higher fruit and vegetable prices are statistically significantly related to a higher body mass index (BMI) percentile ranking among children with greater effects among low-income children: fruit and vegetable price elasticity for BMI is estimated to be 0.25 for the full sample and 0.60 among low-income children. Fast food prices are statistically significantly related to child weight only in cross-sectional models among low-income children with a price elasticity of -0.77. Increased supermarket availability and fewer available convenience stores are related with lower weight outcomes among low-income children. These results provide evidence on the potential effectiveness of using fiscal pricing interventions such as taxes and subsidies and other interventions to improve supermarket access as policy instruments to address childhood obesity.
    JEL: I1
    Date: 2009–06
  15. By: Seema Jayachandran; Ilyana Kuziemko
    Abstract: Medical research indicates that breastfeeding suppresses post-natal fertility. We model the implications for breastfeeding decisions and test the model's predictions using survey data from India. First, we find that breastfeeding increases with birth order, since mothers near or beyond their desired total fertility are more likely to make use of the contraceptive properties of nursing. Second, given a preference for having sons, mothers with no or few sons want to conceive again and thus limit their breastfeeding. We indeed find that daughters are weaned sooner than sons, and, moreover, for both sons and daughters, having few or no older brothers results in earlier weaning. Third, these gender effects peak as mothers approach their target family size, when their decision about future childbearing (and therefore breastfeeding) is highly marginal and most sensitive to considerations such as ideal sex composition. Because breastfeeding protects against water- and food-borne disease, our model also makes predictions regarding health outcomes. We find that child-mortality patterns mirror those of breastfeeding with respect to gender and its interactions with birth order and ideal family size. Our results suggest that the gender gap in breastfeeding explains 14 percent of excess female child mortality in India, or about 22,000 "missing girls" each year.
    JEL: I1 J13 O12 O15
    Date: 2009–06
  16. By: Frank R. Lichtenberg
    Abstract: The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal state-level data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure.
    JEL: I1 J1 O3
    Date: 2009–06
  17. By: Tomoki Fujii (School of Economics, Singapore Management University)
    Date: 2007–12

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