nep-hea New Economics Papers
on Health Economics
Issue of 2009‒09‒11
fifteen 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. The Convergence of Health Care Financing Structures: Empirical Evidence from OECD-Countries By Andrea M. Leiter; Engelbert Theurl
  3. Choosing among Competing Blockbusters: Does the Identity of the Third-party Payer Matter for Prescribing Doctors? By Dalen, Dag Morten; Sorisio, Enrico; Strøm, Steinar
  4. The Gate is Open: Primary Care Physicians as Social Security Gatekeepers By Carlsen, Benedicte; Nyborg, Karine
  5. Horizontal inequity in access to health care in four South American cities By Ana I. Balsa; Máximo Rossi; Patricia Triunfo
  6. Impact of Air Pollution on Human Health in Dehra Doon City By A. Gautam
  7. The effect of lone motherhood on the smoking behaviour of young adults By Francesconi M; Jenkins S; Siedler T
  8. The Effects of Soft Drink Taxes on Child and Adolescent Consumption and Weight Outcomes By Jason Fletcher; David Frisvold; Nathan Tefft
  9. Portfolio Choice in Retirement: Health Risk and the Demand for Annuities, Housing, and Risky Assets By Motohiro Yogo
  10. The Effect of Maternal Depression and Substance Abuse on Child Human Capital Development By Richard G. Frank; Ellen Meara
  11. Genetic Adverse Selection: Evidence from Long-Term Care Insurance and Huntington Disease By Emily Oster; Ira Shoulson; Kimberly Quaid; E. Ray Dorsey
  12. The Short-Term Mortality Consequences of Income Receipt By William N. Evans; Timothy J. Moore
  13. Induced Innovation and Social Inequality: Evidence from Infant Medical Care By David M. Cutler; Ellen Meara; Seth Richards
  14. Estimating Heterogeneity in the Benefits of Medical Treatment Intensity By William N. Evans; Craig L. Garthwaite
  15. Liquidity, Activity, Mortality By William N. Evans; Timothy J. Moore

  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; German Socio-Economic Panel Study (SOEP)
    JEL: D30 D31 D63 I10 I12
    Date: 2009
  2. By: Andrea M. Leiter; Engelbert Theurl
    Abstract: In this paper we concentrate on the question whether the financing structure of the health care systems converges. In a world of increasing economic integration convergence in health care financing (HCF) and, hence, decreasing differences in HCF across countries enhance individuals' (labour) mobility and support harmonization processes. As an indicator for convergence we take the public financing ratio in % of total HCF and in % of GDP. The major finding is that HCF in the OECD countries converged in the time period 1970 - 2005. This conclusion also holds when looking at smaller sub groups of countries and shorter time periods. However, we find evidence that countries do not move towards a common mean and that the rate of convergence is decreasing over time.
    Keywords: Convergence, health care system, health care financing
    JEL: I11 I18 H55
    Date: 2009–08
  3. By: Dalen, Dag Morten (Norwegian School of Management BI); Sorisio, Enrico (PharmaNess and University of Oslo); Strøm, Steinar (Dept. of Economics, University of Oslo)
    Abstract: TNF-alpha inhibitors represent one of the most important areas of biopharmaceuticals by sales, with three blockbusters accounting for 8 % of total pharmaceutical sale in Norway. With use of a unique natural policy experiment in Norway, this paper examines to what extent the identity of the third-party payer affects doctors choice between the three available drugs. We are able to investigate to what extent the price responsiveness of prescription choices is affected when the identity of the third-party payer changes. The three dominating drugs in this market, Enbrel, Remicade, and Humira, are substitutes, but have had different and varying funding schemes - hospitals and the national insurance plan. We find that treatment choices are price responsive, and that the price response increases when the doctor’s affiliated hospital covers the cost instead of a traditional fee-for-service insurance plan.
    Keywords: Pharmaceuticals; discrete choice model; funding schemes
    JEL: C35 D43 I18 L11
    Date: 2009–05–14
  4. By: Carlsen, Benedicte (The Rokkan Centre, University of Bergen); Nyborg, Karine (Dept. of Economics, University of Oslo)
    Abstract: Primary care physicians have two roles: the healer and the gatekeeper. We show that, due to information asymmetries, they cannot be expected to fulfill the latter role. Better gatekeepers will be poorer healers; hence all patients, both truly sick and shirkers, will strictly prefer physicians who give priority to healing. The choice between work and sick leave thus lies, essentially, with the patient. Interviews with Norwegian primary care physicians confirm this: Our interviewees report that shorter sick leaves are granted at request, while longer sick leaves are normally granted if the patient still prefer so after discussions with the physician.
    Keywords: Sicklisting; subjective diagnoses; asymmetric information; focus group interviews.
    JEL: D11 D21 H42 I11 I18
    Date: 2009–03–25
  5. By: Ana I. Balsa (University of Miami); Máximo Rossi (Universidad de la República (Uruguay)); Patricia Triunfo (Universidad de la República (Uruguay))
    Abstract: This paper analyzes and compares socioeconomic inequalities in the use of healthcare services by the elderly in four South-American cities: Buenos Aires (Argentina), Santiago (Chile), Montevideo (Uruguay) and San Pablo (Brazil). We use data from SABE, a survey on Health, Well-being and Aging administered in several Latin American cities in 2000. After having accounted for socioeconomic inequalities in healthcare needs, we find socioeconomic inequities favoring the rich in the use of preventive services (mammograms, pap tests, breast examinations, and prostate exams) in all of the studied cities. We also find inequities in the likelihood of having a medical visit in Santiago and Montevideo, and in some measures of quality of access in Santiago, Sao Paulo, and Buenos Aires. Santiago depicts the highest inequities in medical visits and Uruguay the worse indicators in mammograms and pap scans tests. For all cities, inequities in preventive services at least double inequities in other services. We do not find evidence of a trade-off between levels of access and equity in access to healthcare services. The decomposition of healthcare inequalities suggests that inequities within each health system (public or private) are more important than between systems.
    Keywords: inequalities, healthcare, medical visit, preventive services.
    JEL: I1 I11 I12 I18
    Date: 2009
  6. By: A. Gautam
    Abstract: To study the adverse health effects of exposure to ambient air pollution in different areas of Dehra Doon. To examine the relationship between the levels of air pollution and the percentage of affected people in selected area of Dehra Doon city. Air quality monitoring and a questionnaire-based health survey in four areas of Dehra Doon were conducted during January and February 2003. The selected areas included two commercial areas, Lakhi Bagh and Clock Tower, both with highly congested vehicular traffic. For comparison two residential areas, Vasant Vihar and Kedarpuram were also studied. Kedarpuram is a less urbanised but a medium density area compared to Vasant Vihar.
    Keywords: health eefects, air pollution, pollution, Dehra Doon, questionnaire, residential areas, India, health, health survey, vehicular traffic,
    Date: 2009
  7. By: Francesconi M (Department of Economics, University of Essex); Jenkins S (Institute for Social and Economic Research); Siedler T (DIW Berlin)
    Abstract: We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany.
    Date: 2009–09–02
  8. By: Jason Fletcher; David Frisvold; Nathan Tefft
    Abstract: Childhood and adolescent obesity is associated with serious lifetime health consequences and has seen a recent rapid increase in prevalence. Soft drink consumption has also expanded rapidly, so much so that soft drinks are currently the largest single contributors to energy intake. In this paper, we investigate the potential for soft drink taxes to combat rising levels of adolescent obesity through a reduction in consumption. Our results, based on state soft drink sales and excise tax information between 1988 and 2006 and the National Health Examination and Nutrition Survey, suggest that soft drink taxation, as currently practiced in the United States, leads to a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high calorie drinks.
    Date: 2009–08
  9. By: Motohiro Yogo
    Abstract: This paper develops a consumption and portfolio-choice model of a retiree who allocates wealth in four asset classes: a riskless bond, a risky asset, a real annuity, and housing. The retiree chooses health expenditure endogenously in response to stochastic depreciation of health. The model is calibrated to explain the joint dynamics of health expenditure, health, and asset allocation for retirees in the Health and Retirement Study, aged 65 and older. The calibrated model is used to assess the welfare gain from private annuitization. The welfare gain ranges from 13 percent of wealth at age 65 for those in worst health, to 18 percent for those in best health.
    JEL: D91 G11 I10 J26
    Date: 2009–09
  10. By: Richard G. Frank; Ellen Meara
    Abstract: Recent models of human capital formation represent a synthesis of the human capital approach and a life cycle view of human development that is grounded in neuroscience (Heckman 2007). This model of human development, the stability of the home and parental mental health can have notable impacts on skill development in children that may affect the stock of human capital in adults (Knudsen, Heckman et al. 2006; Heckman 2007). We study effects of maternal depression and substance abuse on children born to mothers in the initial cohort of the 1979 National Longitudinal Survey of Youth (NLSY), a national household survey of high school students aged 14-22 in 1979. We follow 1587 children aged 1-5 in 1987, observing them throughout childhood and into high school. We employ a variety of methods to identify the effect of maternal depression and substance abuse on child behavioral, cognitive, and educational related outcomes. We find no evidence that maternal symptoms of depression affect contemporaneous cognitive scores in children. However, maternal depression symptoms have a moderately large effect on child behavioral problems. These findings suggest that the social benefits of effective behavioral health interventions may be understated. Based on evidence linking early life outcomes to later well-being, efforts to prevent and/or treat mental and addictive disorders in mothers and other women of childbearing age have the potential to improve outcomes of their children not only early in life, but throughout the life cycle.
    JEL: I1
    Date: 2009–09
  11. By: Emily Oster; Ira Shoulson; Kimberly Quaid; E. Ray Dorsey
    Abstract: Individual, personalized genetic information is increasingly available, leading to the possibility of greater adverse selection over time, particularly in individual-payer insurance markets; this selection could impact the viability of these markets. We use data on individuals at risk for Huntington disease (HD), a degenerative neurological disorder with significant effects on morbidity, to estimate adverse selection in long-term care insurance. We find strong evidence of adverse selection: individuals who carry the HD genetic mutation are up to 5 times as likely as the general population to own long-term care insurance. We use these estimates to make predictions about the future of this market as genetic information increases. We argue that even relatively limited increases in genetic information may threaten the viability of private long-term care insurance.
    JEL: D82 I11 I18
    Date: 2009–09
  12. By: William N. Evans; Timothy J. Moore
    Abstract: Many studies find that households increase their consumption after the receipt of expected income payments, a result inconsistent with the life-cycle/permanent income hypothesis. Consumption can increase adverse health events, such as traffic accidents, heart attacks and strokes. In this paper, we examine the short-term mortality consequences of income receipt. We find that mortality increases following the arrival of monthly Social Security payments, regular wage payments for military personnel, the 2001 tax rebates, and Alaska Permanent Fund dividend payments. The increase in short-run mortality is large, potentially eliminating some of the protective benefits of additional income.
    JEL: D91 H31 H55 I10 I12 I38
    Date: 2009–09
  13. By: David M. Cutler; Ellen Meara; Seth Richards
    Abstract: We develop a model of induced innovation where research effort is a function of the death rate, and thus the potential to reduce deaths in the population. We also consider potential social consequences that arise from this form of induced innovation based on differences in disease prevalence across population subgroups (i.e. race). Our model yields three empirical predictions. First, initial death rates and subsequent research effort should be positively correlated. Second, research effort should be associated with more rapid mortality declines. Third, as a byproduct of targeting the most common conditions in the population as a whole, induced innovation leads to growth in mortality disparities between minority and majority groups. Using information on infant deaths in the U.S. between 1983 and 1998, we find support for all three empirical predictions. We estimate that induced innovation predicts about 20 percent of declines in infant mortality over this period. At the same time, innovation that occurred in response to the most common causes of death favored the majority racial group in the U.S., whites. We estimate that induced innovation contributed about one third of the rise in the black-white infant mortality ratio during our period of study.
    JEL: I1 I12 J1 J15
    Date: 2009–09
  14. By: William N. Evans; Craig L. Garthwaite
    Abstract: Federal and state laws passed in the late 1990 increased considerably postpartum stays for newborns. Using all births in California over the 1995-2001 period, 2SLS estimates suggest that for the average newborn impacted by the law, increased treatment intensity had modest and statistically insignificant (p-value>0.05) impacts on readmission probabilities. Allowing the treatment effect to vary by pre-existing conditions or the pre-law propensity score of being discharged early, two objective measures of medical need, demonstrates that the law had large and statistically significant impacts for those with the greatest likelihood of a readmission. These results demonstrate heterogeneity in the returns to greater treatment intensity, and the returns to the average and marginal patient vary considerably.
    JEL: I10 I12 I18
    Date: 2009–09
  15. By: William N. Evans; Timothy J. Moore
    Abstract: We document a within-month mortality cycle where deaths decline before the 1st day of the month and then spike after the 1st. This cycle is present across a wide variety of causes and demographic groups. A similar cycle exists for a range of activities, suggesting the mortality cycle may be due to short-term variation in levels of activity. We provide evidence that the within-month activity cycle is generated by liquidity. Our results suggest a causal pathway whereby liquidity problems reduce activity, which in turn reduces mortality. These relationships help explain the pro-cyclic nature of mortality.
    JEL: D10 D12 I10 I12 I38
    Date: 2009–09

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