nep-hea New Economics Papers
on Health Economics
Issue of 2009‒08‒08
nine papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Measurement of Health, the Sensitivity of the Concentration Index, and Reporting Heterogeneity By Nicolas R. Ziebarth
  2. Population and Health Policies By T. Paul Schultz
  3. Does Schooling Affect Health Behavior? Evidence from the Educational Expansion in Western Germany By Jürges, Hendrik; Reinhold, Steffen; Salm, Martin
  4. Severity of Work Disability and Work By Oguzoglu, Umut
  5. Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery By David M. Cutler; Robert S. Huckman; Jonathan T. Kolstad
  6. Contracts for Providers of Medical Treatments By Alex Gershkov; Motty Perry
  7. Food Away from Home Consumption and Obesity: Is âAverage Consumerâ a Myth or Reality? By Kyureghian, Gayaneh
  8. Does Education Reduce Blood Pressure? Estimating the Biomarker Effect of Compulsory Schooling in England By Nattavudh Powdthavee; ;
  9. Older Aboriginal Peoples in Canada – Demographics, Health Status and Access to Health Care By Mark W. Rosenberg; Kathi Wilson; Sylvia Abonyi; Adam Wiebe; Kelsey Beach; Robert Lovelace

  1. By: Nicolas R. Ziebarth
    Abstract: Using representative survey data from the German Socio-Economic Panel Study (SOEP) for 2006, we show that the magnitude of such health inequality measures as the concentration index (CI) depends crucially on the underlying health measure. The highest degree of inequality is found when dichotomized subjective health measures like health satisfaction or self-assessed health (SAH) are employed. Measures of medical care usage like doctor visits result in substantially lower concentration indices. Moreover, with the use of SF12, a generic health measure, the inequality indicator is reduced by a factor of ten. Scaling SAH by means of the SF12 leads to similar results to those with the pure SF12 measure. Employing generic health measures used with other populations like the Canadian HUI-III or the Finish 15D to cardinalize SAH has a significant impact on the degree of inequality measured. Finally, by contrasting the physical health component of the SF12 to the unambiguously objective grip strength measure, we provide evidence of the presence of income-related reporting heterogeneity in generic health measures.
    Keywords: Health measures, health inequality, SF12, grip strength, SOEP
    JEL: D30 D31 D63 I10 I12
    Date: 2009
  2. By: T. Paul Schultz (Yale University)
    Abstract: The literature evaluating population and health policies is in flux, with many disciplines exploring biological and behavioral linkages from fetal development to chronic disease, disability, and late life mortality. The focus here is on research methods, findings, and questions that economists can clarify regarding the causal relationships between economic development, health outcomes, and reproductive behavior, which operate in many directions. The connection between conditions under which people live and their expected life span and health status refer to “health production functions”. The relationships between an individual’s stock of health and productivity, well being, and life span encompasses the “returns to health human capital”. The control of reproduction improves the well being of women, the economic opportunities of her offspring, and slows population growth. Evaluation of policy interventions is more than a question of technological efficiency, but also involves the behavioral responsiveness of individuals, families, social networks, and communities.
    Keywords: Health, Fertility and Family Planning, Biology of Health Human Capital, Economic Development
    JEL: D13 I18 O12
    Date: 2009–07
  3. By: Jürges, Hendrik (University of Mannheim); Reinhold, Steffen (MEA, University of Mannheim); Salm, Martin (Tilburg University)
    Abstract: During the postwar period German states pursued policies to increase the share of young Germans obtaining a university entrance diploma (Abitur) by building more academic track schools, but the timing of educational expansion differed between states. This creates exogenous variation in the availability of higher education, which allows estimating the causal effect of education on health behaviors. Using the number of academic track schools in a state as an instrumental variable for years of schooling, we investigate the causal effect of schooling on health behavior such as smoking and related outcomes such as obesity. We find large negative effects of education on smoking. These effects can mostly be attributed to reductions in starting rates rather than increases in quitting rates. We find no causal effect of education on reduced overweight and obesity.
    Keywords: education, smoking, obesity
    JEL: I12 I20
    Date: 2009–07
  4. By: Oguzoglu, Umut (University of Manitoba)
    Abstract: This paper analyzes the effect of severity of disability on labour force participation by using a self-reported work limitation scale. A dynamic labour force participation model is used to capture the feedback effect of past participation on current participation. The results suggest that net of persistence and unobserved heterogeneity, differences in severity levels explain a significant portion of the variance in the participation rates among disabled individuals. Moreover, the disability is shown to have longer lasting adverse effects on female participation and work limited women will be more likely to benefit from the work requirements imposed on Disability Support Pension recipients.
    Keywords: severity, work disability, labour force participation
    JEL: J28 I12 C81
    Date: 2009–07
  5. By: David M. Cutler (Harvard University); Robert S. Huckman (Harvard Business School, Technology and Operations Management Unit); Jonathan T. Kolstad (The Wharton School, University of Pennsylvania)
    Abstract: Prior studies suggest that, with elastically supplied inputs, free entry may lead to an inefficiently high number of firms in equilibrium. Under input scarcity, however, the welfare loss from free entry is reduced. Further, free entry may increase use of high-quality inputs, as oligopolistic firms underuse these inputs when entry is constrained. We assess these predictions by examining how the 1996 repeal of certificate-of-need (CON) legislation in Pennsylvania affected the market for cardiac surgery in the state. We show that entry led to a redistribution of surgeries to higher-quality surgeons and that this entry was approximately welfare neutral.
    Date: 2009–07
  6. By: Alex Gershkov; Motty Perry
    Abstract: We analyze the nature of optimal contracts in a dynamic model of repeated (and persistent) adverse selection and moral hazard. In particular we consider the case of surgeons who diagnose patients and then decide whether to perform an operation, and if so, whether to exert a costly but unobservable effort. The probability of a successful operation is a function of the surgeon’s effort, his quality, and the severity of the patient’s problem, all of which are the surgeon’s private information. The principal observes only the history of successes and failures and is allowed to promise financial rewards as a function of the observed history. His goal is to provide incentives at minimum cost so that if the patient needs minor surgery he will be treated by any type of surgeon (low- or high-quality) but if he needs major surgery, only a high-quality surgeon will perform the operation. The optimal contract-pair is characterized and is shown to reflect the practice often observed in the medical industry. Performing an operation is a gamble whose probability of success is higher, the higher the quality of the surgeon. A sequence of operations is exponentially less likely to be successful if the surgeon is not high-quality. An optimal contract for a high-quality surgeon exploits this fact by stipulating a high reward conditional on a long history of successes, while such a stipulation makes the contract much less attractive to a low-quality surgeon.
    Date: 2009–07
  7. By: Kyureghian, Gayaneh
    Abstract: The epidemic proportions of overweight and obesity prevalence have made it not only a public health threat, but also an economic problem. The high caloric density and increased consumption of food-away-from-home endorse the possibility of significant effects of it on obesity. The objective of this study is to model meals consumed away from home consumption by accounting for consumer heterogeneity in making food consumption decisions. We use random coefficient modeling to estimate a negative binomial model to reveal consumer heterogeneity effects on food away from home. The results reveal significant associations between BMI_Status categories and food consumption both at home, but no significant associations with food away from home. We also established positive significant effects of caloric intake on meal consumption both at and away from home, with the latter being significantly larger than the former. The effects of the nutrient intake on meal consumption both at home and away from home have almost identical magnitude but opposite signs. The results of this research have significant policy implications as information on demographic profiles of people with overabundant but nutritionally poor food consumption habits would help to create more efficient and well targeted policy choices.
    Keywords: Food Consumption/Nutrition/Food Safety,
    Date: 2009–05
  8. By: Nattavudh Powdthavee; ;
    Abstract: This paper is the first of its kind to estimate the exogenous effect of schooling on reduced blood pressure and the incidence of hypertension. Using the changes of the minimum school-leaving age in the United Kingdom from age 14 to 15 in 1947, and from age 15 to 16 in 1973, as instruments, the IV-probit estimates imply that completing an extra year of schooling reduces the probability of developing subsequent hypertension by approximately 5%-11% points. The correct estimates of the LATE for schooling indicate the presence of a large and negative bias in the least square/probit estimates of schooling-health relationship.
    Keywords: blood pressure; compulsory schooling; biomarker; IV; hypertension; health
    JEL: H1 I1 I2
  9. By: Mark W. Rosenberg; Kathi Wilson; Sylvia Abonyi; Adam Wiebe; Kelsey Beach; Robert Lovelace
    Abstract: This paper takes advantage of 2006 Census data, the Aboriginal Peoples Survey (APS) and the Canadian Community Health Survey (CCHS) to highlight some basic demographic trends among Older Aboriginal Peoples, their health status and their use of health services in the first part of this paper. In the second part of the paper, we connect the findings to what has been specifically written about Older Aboriginal Peoples, their health status and use of health services. Not surprisingly both the data analysis and literature are limited because the preponderance of data, analyses and the literature have focused on younger Aboriginal Peoples. In essence, this underscores the need for more in-depth research on Older Aboriginal Peoples as the demographics and health status of Aboriginal Peoples.
    Keywords: Older Aboriginal Peoples, First Nations, Inuit, Metis, health, health care, demographics
    JEL: I10
    Date: 2009–07

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