nep-hea New Economics Papers
on Health Economics
Issue of 2009‒10‒10
sixteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Mandatory Sick Pay Provision: A Labor Market Experiment By Stefan Bauernschuster; Jörg Oechssler; Peter Duersch; Radovan Vadovic
  2. The Effect of Lone Motherhood on the Smoking Behaviour of Young Adults By Francesconi, Marco; Jenkins, Stephen P.; Siedler, Thomas
  3. The Value of a Statistical Injury: New Evidence from the Swiss Labor Market By Kuhn, Andreas; Ruf, Oliver
  4. Happiness and Health Care Coverage By Blanchflower, David G.
  5. Grazing, Goods and Girth: Determinants and Effects By Hamermesh, Daniel S.
  6. Disability and Skill Mismatch By Jones, Melanie K.; Sloane, Peter J.
  7. Work Disability, Work, and Justification Bias in Europe and the U.S. By Kapteyn, Arie; Smith, James P.; van Soest, Arthur
  8. Healthcare access for migrants in China : A new frontier By Carine Milcent
  9. Health Status After Cancer. Does It Matter Which Hospital You Belong To? By Jon H. Fiva, Torbjørn Hægeland and Marte Rønning
  10. Improving the Performance of the Public Health Care System in Greece By Charalampos Economou; Claude Giorno
  11. Technical Efficiency, Specialization and Ownership Form: Evidences from a Pooling of Italian Hospitals. By Silvio Daidone; Francesco D'Amico
  12. Income Distribution, Infant Mortality, and Health Care Expenditure By Tilman Tacke; Robert J. Waldmann
  13. Valuing Health Conditions - Insights from Happiness Surveys across Countries and Cultures By Carol Graham; Lucas Higuera; Eduardo Lora
  14. Schooling, Fertility, and Married Female Labor Supply: What Role for Health? By Matthias Cinyabuguma; Bill Lord; Christelle Viauroux
  15. 28th out of 30: Poor medicine and unhealthy Americans By Fullbrook, Edward
  16. A Time-Series Analysis of U.S. Kidney Transplantation and the Waiting List: Donor Substitution Effects and "Dirty Altruism" By Beard, T. Randolph; Jackson, John D.; Kaserman, David; Kim, Hyeongwoo

  1. By: Stefan Bauernschuster (University of Jena); Jörg Oechssler (Department of Economics, University of Heidelberg, Germany); Peter Duersch (University of Heidelberg); Radovan Vadovic (ITAM, Mexico City)
    Abstract: The question whether a minimum rate of sick pay should be mandated is much debated. We study the effects of this kind of intervention in an experimental labor market that is rich enough to allow for moral hazard, adverse selection, and crowding out of good intentions to occur. We find that higher sick pay is reciprocated by workers through higher effort but only if sick pay is not mandated. We also study adverse selection effects when workers have different probabilities of getting sick and can reject the hypothesis that this leads to market breakdown. Overall, we find that mandating sick pay actually leads to a higher voluntary provision of sick pay by ?rms.
    Keywords: sick pay, sick leave, experiment, gift exchange
    JEL: J3 C7 C9
    Date: 2009–09–25
  2. By: Francesconi, Marco (University of Essex); Jenkins, Stephen P. (University of Essex); Siedler, Thomas (DIW Berlin)
    Abstract: We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany.
    Keywords: smoking, lone parent, childhood family structure, divorce, unobserved heterogeneity
    JEL: I10 J12 J18
    Date: 2009–09
  3. By: Kuhn, Andreas (University of Zurich); Ruf, Oliver (Suva)
    Abstract: We study the monetary compensation for non-fatal accident risk in Switzerland using the number of accidents within cells defined over industry x skill-level of the job and capitalizing on the partial panel structure of our data which allows us to empirically isolate the wage component specific to the employer. Our results show that using accident risk at a lower level of aggregation, using narrower samples of workers, and using the wage component that is specific to the firm all yield higher estimates of risk compensation. Our preferred estimate gives an estimate of about 36,000 Swiss francs per prevented injury per year.
    Keywords: compensating wage differentials, value of a statistical injury, risk measurement
    JEL: J17 J28 J31
    Date: 2009–09
  4. By: Blanchflower, David G. (Dartmouth College)
    Abstract: In this paper I examine the characteristics of adults who report on whether they have health care coverage and of people who say that they are unable to see a doctor over the preceding year because of the cost. I make use of a unique data set, the Behavioral Risk Factor Surveillance System, a phone survey undertaken in the United States for the years 2005-2009. I find evidence that not having the ability to see a doctor because of an inability to pay is a major and substantial source of unhappiness in the United States, even for people with high income.
    Keywords: life satisfaction, health care coverage
    JEL: I18
    Date: 2009–09
  5. By: Hamermesh, Daniel S. (University of Texas at Austin)
    Abstract: Using the 2006-07 American Time Use Survey and its Eating and Health Module, I show that over half of adult Americans report grazing (secondary eating/drinking) on a typical day, with grazing time almost equaling primary eating/drinking time. An economic model predicts that higher wage rates (price of time) will lead to substitution of grazing for primary eating/drinking, especially by raising the number of grazing incidents relative to meals. This prediction is confirmed in these data. Eating meals more frequently is associated with lower BMI and better self-reported health, as is grazing more frequently. Food purchases are positively related to time spent eating − substitution of goods for time is difficult − but are lower when eating time is spread over more meals.
    Keywords: household production, BMI, time use
    JEL: J10
    Date: 2009–08
  6. By: Jones, Melanie K. (University of Wales, Swansea); Sloane, Peter J. (University of Wales, Swansea)
    Abstract: This paper integrates two strands of literature on overskilling and disability using the 2004 British Workplace Employment Relations Survey (WERS). It finds that the disabled are significantly more likely to be mismatched in the labour market, to suffer from a pay penalty and to have lower job satisfaction, the effects being stronger for the work-limited disabled. Giving workers more discretion over how they perform their work would significantly reduce these negative effects.
    Keywords: skills, disability, job matching, earnings, job satisfaction
    JEL: I0 J2 J3 J7 J24 J31
    Date: 2009–09
  7. By: Kapteyn, Arie (RAND); Smith, James P. (RAND); van Soest, Arthur (Tilburg University)
    Abstract: To analyze the effect of health on work, many studies use a simple self-assessed health measure based upon a question such as "do you have an impairment or health problem limiting the kind or amount of work you can do?" A possible drawback of such a measure is the possibility that different groups of respondents may use different response scales. This is commonly referred to as "differential item functioning" (DIF). A specific form of DIF is justification bias: to justify the fact that they don't work, non-working respondents may classify a given health problem as a more serious work limitation than working respondents. In this paper we use anchoring vignettes to identify justification bias and other forms of DIF across countries and socio-economic groups among older workers in the U.S. and Europe. Generally, we find differences in response scales across countries, partly related to social insurance generosity and employment protection. Furthermore, we find significant evidence of justification bias in the U.S. but not in Europe, suggesting differences in social norms concerning work.
    Keywords: work limiting disability, vignettes, reporting bias
    JEL: J28 I12 C81
    Date: 2009–09
  8. By: Carine Milcent
    Abstract: How to improve healthcare access for Chinese migrants? We show that the social network is a major key. It uses a 2006 dataset from a survey of rural migrant workers conducted in five cities amongst the most economically advanced. We use a fixed effect logit model and we control for the non-exogeneity of the health insurance. The empirical findings support the hypothesis of return to the hometown for migrant workers with deteriorated health. The residence registration system and the importance of family/relative support in the outcome of the treatment incent them to then leave the city. Besides the level of income, the social integration of migrant workers is such a decisive criteria of the access to healthcare. Politicies aiming at improving the latter should involve organisations working at the local level, such as the resident committees.
    Date: 2009
  9. By: Jon H. Fiva, Torbjørn Hægeland and Marte Rønning (Statistics Norway)
    Abstract: Survival rates are widely used to compare quality of health care. In this paper we introduce post-illness employment as a supplemental indicator of successful treatment of serious diseases. Utilizing rich register based data on cancer patients we document substantial differences across Norwegian hospital catchment areas with respect to employment five years after diagnosis. Conventional quality indicators based on survival rates indicate smaller differences. The two sets of indicators are only weakly correlated, suggesting that they capture different parts of the quality distribution, and that using only one of them may be insufficient.
    Keywords: Quality indicators; health sector; survival; employment; cancer
    JEL: I11 I12 J21
    Date: 2009–09
  10. By: Charalampos Economou; Claude Giorno
    Abstract: Greek health outcomes compare favourably with the OECD average. However, the health care system is seen as not working well by the population. One source of dissatisfaction is the high proportion of private household spending on health, including informal payments, while public health spending relative to GDP is one of the lowest in the OECD. This situation leads to inequities in access to certain medical services. Also, there is a weakening of efficiency of the system, which should be addressed sooner than later in view of a rising demand for medical services, which is going to intensify in the coming decades, and the need to keep government health care spending in check. This calls for reforms in four areas: (i) reviewing the excessively fragmented structure of the health care system and its governance; (ii) enhancing the quality of public primary health care services; (iii) modernising hospital administration; and (iv) further tightening control over pharmaceutical expenditure.<P>Améliorer la performance du système public de santé en Grèce<BR>Les résultats de la Grèce dans le domaine de la santé se comparent favorablement avec la moyenne de l’OCDE. Cependant, le fonctionnement du système de soins n’est pas satisfaisant selon la population. Une source d’insatisfaction concerne la proportion élevée des dépenses privées de santé des ménages, y compris des paiements informels, alors que les dépenses médicales publiques en proportion du PIB sont parmi les plus faibles de l’OCDE. Cette situation conduit à des problèmes d’équité d’accès à certains services médicaux. On observe aussi une baisse d’efficacité du système à laquelle il import de remédier au plus tôt compte tenu de la hausse de la demande de soins, qui devrait s’intensifier au cours des prochaines décennies et du besoin de contrôle sur la croissance des dépenses publiques de santé. Ceci milite en faveur d’une réforme dans quatre domaines : (i) réviser la structure très fragmentée du système de soins et sa gouvernance; (ii) améliorer la qualité des services publics de soins primaires ; (iii) moderniser l’administration hospitalière ; et (iv) renforcer davantage le contrôle sur les dépenses pharmaceutiques.
    Keywords: health care systems, hospital, data envelopment analysis, analyse par enveloppement des données, copayment, copaiement, excise tax, accises, general practitioners, médecins généralistes, generic drugs, génériques, health insurance funds, caisses d’assurance médicales, health policy, medical demography, démographie médicale, medical prevention, prévention médicale, National health system, système national de santé, primary health care, soins primaires de santé, pharmaceutical expenditure, dépenses pharmaceutiques, prescription system, referral system, système de médecin référent, hôpital
    JEL: I10 I12 I18 I19
    Date: 2009–09–21
  11. By: Silvio Daidone (Faculty of Economics, University of Rome "Tor Vergata"); Francesco D'Amico (Faculty of Economics, University of Rome "Tor Vergata")
    Abstract: We evaluate how the productive structure and level of specialization of a hospital affect technical efficiency by analyzing a six-year panel database (2000/2005) drawn from hospital discharge records and Ministry of Health data. We adopt a distance function approach, while measuring the technical efficiency level with stochastic frontier techniques. After controlling for environmental variables and hospital case-mix, inefficiency is negatively associated with specialization and positively associated with capitalization. Capitalization is typical of private structures which, on average, use resources less efficiently with respect to public and not-for-profit hospitals. Finally, by looking at scale elasticities, we find some evidence of unexploited economies of scale, leaving room for centralization.
    Keywords: Stochastic frontiers, Hospital Discharge Records, Hospital Specialization, Distance Functions, Technical Efficiency.
    JEL: C16 I12 I18 L25 L33
    Date: 2009–09–30
  12. By: Tilman Tacke (Faculty of Economics, University of Rome "Tor Vergata"); Robert J. Waldmann (Faculty of Economics, University of Rome "Tor Vergata")
    Abstract: Do health outcomes depend on relative income as well as on an individual?s absolute level of income? We use infant mortality as a health status indicator and ?nd a signi?cant and positive link between infant mortality and income inequality using cross-national data for 98 countries. Holding constant the income of each of the three poorest quintiles of a country's population, we ?nd that an increase in the income of the upper 20% of the income distribution is associated with higher, not lower infant mortality. Our results imply that a one percentage point decrease in the income share of the richest quintile correlates with a decrease in infant mortality by nearly two percent. The surprisingly positive coe¢cient becomes insignificant when we control for public health care expenditure. Low public expenditure on health care seems to translate into limited access to health care for the poor.
    Date: 2009–09–30
  13. By: Carol Graham; Lucas Higuera; Eduardo Lora
    Abstract: This paper assesses the effects of different health conditions on happiness. Based on a large data set for Latin America, the effects of different conditions are examined across age, gender, and income cohorts. Anxiety and pain have stronger effects than physical problems, likely because people can adapt better to one-time shocks than to constant uncertainty. The negative effects of health conditions are very large when compared to the effects of income on happiness. While higher peer income typically elicits envy, better peer health provides positive signals for life and health satisfaction. Nonetheless, health norms vary widely across countries. The results suggest that the life satisfaction approach applied to surveys of health may contribute to better health expenditure and policy decisions.
    Keywords: Happiness, Health economics, Public policy, Surveys
    JEL: I18 I30 I38
    Date: 2009–07
  14. By: Matthias Cinyabuguma (UMBC); Bill Lord (UMBC); Christelle Viauroux (UMBC)
    Abstract: Between the latter nineteenth century and the 1930s there was a dramatic revolution in American families. Family size continued its long-term decline, the schooling of older children expanded and the proportion of married females' adulthood devoted to market-oriented activities increased. Over this same period there were significant reductions in mortality, especially among the young, and impressive reductions in morbidity. This paper considers all these trends jointly, modeling the changes in fertility, child schooling and lifetime married female labor supply as a consequence of exogenous changes in health. These interactions are then quantified using calibration techniques. The simulations suggest that reductions in child mortality alone cannot explain the transformation of the American family. Indeed, in our preferred calibration, reductions in child mortality lead to a modest decline in human capital and increase in fertility, with little effect on married female labor force involvement. In sharp contrast, reductions in morbidity are found to lower fertility and increase education. The time savings from lower fertility more than offset the increased time mothers invest in their childrens' quality, freeing some time for market work. Nevertheless, to quantitatively account for the increase in mother's time spent at work it proves necessary to generate further reductions in mother's household production time. In our framework this is driven by a narrowing of the gender wage gap. More generally, viewing the implications of health improvements deepens our understanding of the American family transformation, complementing explanations based on narrowing of the gender wage gap, skill biased technical change and changes in household technology.
    Keywords: Schooling, Fertility, Health, Human Capital Accumulation, Labor Supply
    JEL: D1 J13 I21 I10 J24 J22 N3
    Date: 2009–09–11
  15. By: Fullbrook, Edward
    Abstract: In 1970 the USA spent 7% of its GNP on healthcare, in 200716%. Whereas the OECD average per capita expenditure on healthcare in 2007 was $2,964, the USA spent $7,290. Yet in that same period, the health of America’s citizens relative to those of other developed countries declined dramatically, so much so that the CIA lists 49 countries whose citizens now can look forward to on average living longer than Americans. This paper looks for the causes of this colossal disparity between expenditure and results. It argues that they are due to the unique economic institutions that, beginning during WWII, have grown up around healthcare in the USA. Because the magnitude of the relative decline in healthcare in the USA is poorly appreciated, especially by Americans, this paper begins with a set of OECD data tables documenting that decline. The main body of the paper is an historical analysis of the institutional economics of American healthcare from 1940 to the present. The paper concludes with a brief consideration of the possibilities for serious reform.
    Keywords: USA; health expenditure; health indicators; life expectancy; OECD; obesity; healthcare; American healthcare; HMOs; healthcare reform; medicine; heath insurance; pharmaceutical industry; Obama
    JEL: N32 H51 I1
    Date: 2009–10–06
  16. By: Beard, T. Randolph; Jackson, John D.; Kaserman, David; Kim, Hyeongwoo
    Abstract: This paper provides an econometric analysis of the relationship between live and deceased (cadaveric) kidney donations for the United States for the period 1992:IV through 2006:II. Statistical analysis shows that increases in deceased donor transplants reduce future live donor grafts, controlling for both waiting list effects and exogenous trends. This result has important, and potentially dire, implications for efforts to reduce the organ shortage by increasing use of cadaver donors.
    Keywords: Kidney Transplantations; Donor Substitution Effects; Dirty Altruism; Cointegration
    JEL: I18 I19
    Date: 2009–09

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