nep-hea New Economics Papers
on Health Economics
Issue of 2009‒10‒17
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health-enhancing activities and the environment:How competition for resources make the environmental policy beneficial By Xavier Pautrel
  2. The Impact of Medical and Nursing Home Expenses and Social Insurance Policies on Savings and Inequality By Karen Kopecky; Tatyana Koreshkova
  3. The dynamics of the Russian lifestyle during transition: Changes in food, alcohol and cigarette consumption By Herzfeld, Thomas; Huffman, Sonya K.; Oskam, Arie; Rizov, Marian
  4. The Public Finance of Healthy Behavior By Robert Rosenman
  5. How to evaluate the impact of part-time sick leave on the probability of recovering By Andrén, Daniela
  6. Small-area variation in health care affecting the choice of cesarean delivery: the case of a colombian health insurer By Vecino Ortiz, Andrés Ignacio; Bardey, David; Castano-Yepes, Ramón
  7. Health Investment over the Life-Cycle By Timothy J. Halliday; Hui He; Hao Zhang
  8. Rural Health Services at Cross-Roads: Insights from Gujarat By Ratnawali Sinha
  9. Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe By Aïda Solé-Auró; Montserrat Guillén; Eileen M. Crimmins
  10. Poverty and Health in India: A Comparative Study about Pre-Reform and Post-Reform Periods By sarvalingam, a; sivakumar, marimuthu
  11. Informal Caring-Time and Caregiver Satisfaction By Marcén, Miriam; Molina, José Alberto
  12. Social Interaction in Patients'Hospital Choice: Evidences from Italy By Moscone, Francesco; Tosetti, Elisa; Vittadini, Giorgio
  13. Traffic Congestion and Infant Health: Evidence from E-ZPass By Janet Currie; Reed Walker

  1. By: Xavier Pautrel (LEMNA - Laboratoire d'économie et de management de Nantes Atlantique - Université de Nantes : EA4272)
    Abstract: In a two-period overlapping generations model, this paper demonstrates that the relationship between environmental taxation and economic activity (output level and output growth) becomes inverted-U shaped when the detrimental impact of pollution on health and the private decision of each working-age agent to improve her health are taken into account. In particular, a tighter environmental tax is more likely to promote (rather than to harm) output-level and -growth when health is very sensitive to pollution, the weight of health in preferences is high, the polluting capacity of the production technology is high and the rate of natural purification of pollutants is low. The inverted-U shaped relationship between environmental tax and economic activity is due to a positive effect arising from the competition for resources between the final output sector and the health-enhancing activities. This offsets the conventional detrimental “drag-down effect” for low values of the environmental tax. We also demonstrate that the link between environmental tax and lifetime welfare is inverted-U shaped as well. Finally, we investigate the social optimum and the determinants of the optimal environmental tax.
    Date: 2009
  2. By: Karen Kopecky (University of Western Ontario); Tatyana Koreshkova (Concordia University)
    Abstract: We consider a life-cycle model with idiosyncratic risk in labor earnings, out-of-pocket medical and nursing home expenses, and survival. Partial insurance is available through welfare, Medicaid, and social security. Calibrating the model to the U.S., we find that nursing home expenses play an important role in the savings of the wealthy. In our policy analysis, we find that elimination of out-of-pocket expenses through public health care would reduce the capital stock by 12 percent, Medicaid and old-age welfare programs crowd out 44 percent of savings and greatly increase wealth inequality, and social security effects are influenced by out-of-pocket health expenses.
    Keywords: health expenses, nursing home, idiosyncratic risk, savings, wealth inequality, old-age social insurance
    JEL: E21 I18 I38
    Date: 2009–06–20
  3. By: Herzfeld, Thomas; Huffman, Sonya K.; Oskam, Arie; Rizov, Marian
    Abstract: This paper examines changes in aspects of the lifestyle of Russian adults 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 diet’s diversity. The results from a dynamic econometric model suggest that among individual determinants, initial levels of consumption, gender, holding a university degree, household income changes and having access to a garden plot have a significant impact on the changes in consumption behavior in Russia. Regarding the macroeconomic variables, inflation has a significant impact on changes in alcohol and cigarettes consumption, while unemployment changes significantly impact smoking behavior. Analysis of subsamples conditional on initial consumption behavior reveals significant differences in consumption patterns, which is important for effective policy targeting different population groups in achieving healthier lifestyle choices in Russia.
    Keywords: food consumption, smoking, alcohol, economic transition, Russia
    Date: 2009–10–14
  4. By: Robert Rosenman (School of Economic Sciences, Washington State University)
    Abstract: Lifestyle can often affect the likelihood an individual will have a future illness. Subsidies often mitigate the consequences of poor lifestyle choices. In this paper we explore tax-subsidy policies that lower the consequences of incurring a non-infectious disease. We find that a funding mechanism consistent with current US policy lowers the investment in healthy lifestyles by both the wealthy, who pay taxes, and the poor, who receive subsidies. We also explore alternative policy interventions such as investing in research to lessen the impact or probability of the disease if an individual gets sick.
    Keywords: lifestyle, health, policy, non-infectious diseases
    JEL: I1 H2 H4
    Date: 2009–07
  5. By: Andrén, Daniela (Department of Business, Economics, Statistics and Informatics)
    Abstract: This paper presents an econometric framework for analyzing part-time sick leave as a treatment method. We exemplify how the discrete choice one-factor model can address the importance of controlling for unobserved heterogeneity in understanding the selection into part-time/full-time sick leave and the probability to fully recover from a reduced work capacity. The results indicate that part-time sick listing increases the probability to recover compared to full-time sick listing when the expected time to recover is longer than 120 days.
    Keywords: part-time sick leave; discrete choice model; selection; unobserved heterogeneity.
    JEL: I12 J21 J28
    Date: 2009–10–13
  6. By: Vecino Ortiz, Andrés Ignacio; Bardey, David; Castano-Yepes, Ramón
    Abstract: In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.
    Date: 2009–10–04
  7. By: Timothy J. Halliday (Department of Economics, University of Hawaii at Manoa; Institute for the Study of Labor (IZA)); Hui He (Department of Economics, University of Hawaii at Manoa); Hao Zhang (Department of Economics, University of Hawaii at Manoa)
    Abstract: We study the evolution of health investment over the life-cycle by calibrating a model of endogenous health accumulation. The model is able to produce the decline in labor supply with age as well as the hump-shaped consumption profile. In both cases, health and health investment play a crucial role as the former encroaches upon healthy time and the latter crowds out non-medical expenditures as people age. Finally, we quantify the value of health as both an investment and a consumption good. We show that the investment motive is about three times higher than the consumption motive during the early 20s, but decreases over the life-cycle until it disappears at retirement. In contrast, the consumption motive increases with age and surpasses the investment motive during the mid 40s.
    Keywords: Health Investment, Consumption motive, investment motive, life-cycle
    JEL: E21 I12
    Date: 2009–10–07
  8. By: Ratnawali Sinha
    Abstract: The health status of the rural population from a study carried out in ten villages of Bharuch district in South Gujarat is presented. The objective is to i) understand and document the morbidity profile, ii) examine utilisation of health services, and iii) estimate approximate expenses on health care by the rural households.
    Keywords: health status, rural population, villages, morbidity, househols, utilisation, services, infrastructurs, area, population, Rural health services, Primary, Health Centre, Sub Centres, Morbidity, Major illness, Minor, illness, Out of pocket expenditure, on health, Mobilisation of finance, gujarat,
    Date: 2009
  9. By: Aïda Solé-Auró (Faculty of Economics, University of Barcelona); Montserrat Guillén (Faculty of Economics, University of Barcelona); Eileen M. Crimmins (Andrus Gerontology Center. University of Southern California)
    Abstract: Objective: This study examines health care utilization of immigrants relative to the native-born populations aged 50 years and older in eleven European countries. Methods: We analyzed data from the Survey of Health Aging and Retirement in Europe (SHARE) from 2004 for a sample of 27,444 individuals. Negative Binomial regression was conducted to examine the difference in number of doctor visits, visits to General Practitioners (GPs), and hospital stays between immigrants and the native-born. Results: We find evidence those immigrants above age 50 use health services on average more than the native-born populations with the same characteristics. Our models show immigrants have between 6% and 27% more expected visits to the doctor, GP or hospital stays when compared to native-born populations in a number of European countries. Discussion: Elderly immigrant populations might be using health services more intensively due to cultural reasons.
    Keywords: count data, physician services, immigration
    Date: 2009–10
  10. By: sarvalingam, a; sivakumar, marimuthu
    Abstract: In India, Economic Reforms has been explicitly started in 1991. Even with some controversy in the initial period now it intruded in almost all the sectors. At present days economic reforms is mingled with every sphere of economic activities. But the effects of economic reforms are highly debatable.Social sector is an important ingredient for over all development of a country. Development of social sector reveals the standard of living of people as well as the volume and potential of human resource in a country. Hence the analysis of economic reforms and its impact on social sector is imperative. This paper analysis poverty and health status during pre-reforms and post-reforms periods and compare them to find out that during which period the decrease in poverty and the increase in health status are better. For the analysis of poverty, people living below poverty line and for health status analysis life expectancy at birth and infant mortality are used in this study.
    Keywords: Economic Reforms; Social Sector; Poverty; Health; Below Poverty Line; Life Expectancy at Birth; Infant Mortality Rate; India.
    JEL: I3 I38 D60 I10 I1
    Date: 2009–10–12
  11. By: Marcén, Miriam; Molina, José Alberto
    Abstract: We study the effect that the care decision process has on the amount of caring-time and on informal caregiver satisfaction. We develop a theoretical framework in which we compare three two-stage sequential games, each of which corresponds to a different care decision (family, caregiver, and recipient). We find cases of overprovision of informal care in both the family and the recipient decision models, since the caregiver is obliged to spend more time than he/she would prefer. We then use the Spanish Survey of Informal Assistance for the Elderly (2004) to study the relationship between the care decision processes and the time that informal caregivers devote to care activities, with the results confirming our theoretical hypotheses. We also find that different care decision processes imply differences in the informal caregivers' satisfaction, with intensive caregivers being less likely to have greater satisfaction.
    Keywords: Informal Care; Informal Caregiver Satisfaction; Care Decision Process; Two-stage Sequential Game
    JEL: J10 C70 I10
    Date: 2009–10–08
  12. By: Moscone, Francesco; Tosetti, Elisa; Vittadini, Giorgio
    Abstract: In this paper we study the influence of social interaction on patients' hospital choice and its relationship with quality delivered by hospitals, using Italian data. We explore the impact on individual choices of a set of variables such as travel distance, individual- and hospital-specific characteristics, as well as a variable capturing the effect of the neighbourhood. The richness of our data allows us to disentangle contextual effects from the influence of information sharing on patients' hospital choices. We then use this framework to assess how such interaction is related to clinical hospital quality. Results show that network effect plays an important role in hospital choices, although it is less relevant for larger hospitals. Another empirical finding is the existence of a negative relationship between the degree of interaction among individuals and the quality delivered by hospitals. The absence of a source of information on the quality of hospitals accessible to all individuals, such as guidelines or star ratings, exacerbates the importance of information gathered locally in hospital choices, which may result in a lower degree of competition among hospitals and lower quality.
    Keywords: health care; social interaction; quality
    JEL: I11 H00 C21
    Date: 2009–10–09
  13. By: Janet Currie; Reed Walker
    Abstract: This paper provides evidence of the significant negative health externalities of traffic congestion. We exploit the introduction of electronic toll collection, or E-ZPass, which greatly reduced traffic congestion and emissions from motor vehicles in the vicinity of highway toll plazas. Specifically, we compare infants born to mothers living near toll plazas to infants born to mothers living near busy roadways but away from toll plazas with the idea that mothers living away from toll plazas did not experience significant reductions in local traffic congestion. We also examine differences in the health of infants born to the same mother, but who differ in terms of whether or not they were “exposed†to E-ZPass. We find that reductions in traffic congestion generated by E-ZPass reduced the incidence of prematurity and low birth weight among mothers within 2km of a toll plaza by 10.8% and 11.8% respectively. Estimates from mother fixed effects models are very similar. There were no immediate changes in the characteristics of mothers or in housing prices in the vicinity of toll plazas that could explain these changes, and the results are robust to many changes in specification. The results suggest that traffic congestion is a significant contributor to poor health in affected infants. Estimates of the costs of traffic congestion should account for these important health externalities.
    JEL: I12 Q51 Q53
    Date: 2009–10

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