nep-hea New Economics Papers
on Health Economics
Issue of 2009‒11‒27
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Health Savings Accounts for Small Businesses and Entrepreneurs: Shopping, Take-Up and Implementation Challenges By Susan M Gates; Pinar Karaca-Mandic; James R Burgdorf; Kanika Kapur
  2. Universal Health Insurance Coverage: Progress and Issues. Twenty-first Annual Herbert Lourie Memorial Lecture on Health Policy. By Jonathan Gruber
  3. HIV and mobility in the Lake Victoria Basin agricultural sector: A literature review By Drimie, Scott; Weinand, Julia; Gillespie, Stuart; Wagah, Margaret
  4. Identifying the Effects of Food Stamps on Child Health Outcomes When Participation is Endogenous and Misreported By Kreider, Brent; Pepper, John V.; Gundersen, Craig; Jolliffe, Dean
  5. Wives, husbands and wheelchairs: Optimal tax policy under gender-specific health By Marie-Louise Leroux; Grégory Ponthière
  6. Comparing condom use with different types of partners : evidence from national HIV surveys in Africa By de Walque, Damien; Kline, Rachel
  7. Mental health in the aftermath of conflict By Do, Quy-Toan; Iyer, Lakshmi
  8. The Public Health Costs of Job Loss By Kuhn, Andreas; Lalive, Rafael; Zweimüller, Josef
  9. Technological adoption in health care By Barros, Pedro Luis Pita; Martinez-Giralt, Xavier
  10. Cannabis Use and Mental Health Problems By van Ours, Jan C.; Williams, Jenny
  11. Does Leaving Welfare Improve Health? Evidence for Germany By Huber, Martin; Lechner, Michael; Wunsch, Conny
  12. Obesity and Price Sensitivity at the Supermarket By Gandal, Neil; Shabelansky, Anastasia
  13. Is Employer-Based Health Insurance a Barrier to Entrepreneurship? By Robert W. Fairlie; Kanika Kapur; Susan Gates

  1. By: Susan M Gates (RAND Corporation); Pinar Karaca-Mandic (University of Minnesota); James R Burgdorf (RAND Corporation); Kanika Kapur (University College Dublin)
    Abstract: A combination of high deductible health plans (HDHPs) and health savings accounts (HSAs) holds promise for expanding health insurance for small firms. We provide information on HSA take-up and shopping behavior from a 2008 survey of female small business owners, revealing that the HSA marketplace can be confusing for small firms. HSAs may have expanded access to health insurance for the smallest firms (under three employees), but not for small firms more generally. A sizable number of firms offering HSA-eligible insurance did not offer attached HSAs. Firms offering HSAs were satisfied with their experiences, but faced challenges in implementing them.
    Keywords: Health Savings Accounts, Health Insurance Costs, Small Business
    Date: 2009–11–01
  2. By: Jonathan Gruber (Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142)
    Abstract: Jonathan Gruber was a key architect of Massachusetts’ ambitious health reform effort, and in 2006 became an inaugural member of the Health Connector Board, the main implementing body for that effort. He delivered this lecture on October 2, 2009, and his references are to Congressional bills that were under consideration on that date. He laid out the universal coverage debate that’s gone on for a long time in the United States; described a new solution that he think they found for Massachusetts; described how the Massachusetts reform works; and how it can be extended nationally. Finally he spent time on the key issues that Congress is facing in fall 2009 trying to take this model to the national level.
    Keywords: health care reform, universal coverage, tax credits, minimum benefits, rationing, employer-sponsored insurance benefits, ESI, cost control, affordability, Massachusetts, employer responsibility, incremental universalism, individual mandate, shared responsibility, pooling, affordability, single payer, public option
    JEL: D14 H51 I11 I18 L33
    Date: 2009–11
  3. By: Drimie, Scott; Weinand, Julia; Gillespie, Stuart; Wagah, Margaret
    Abstract: The Lake Victoria region has the highest HIV prevalence in the East African Community, which comprises Kenya, Uganda, Tanzania, Rwanda, and Burundi. This region also has a significant concentration of commercial agricultural plantations, which rely on mobile workers, an extensive system of out-grower schemes, and linkages with neighboring communities and transportation routes. This paper reviews the relationships between the various components of the plantation system and the spread of HIV, which is a complex and dynamic process. There has been relatively little research on these dynamic interactions, and the relevant policies and programs are generally silent on mobility-induced vulnerability to HIV. As such, this review first examines how the conditions and structure of the migration process may increase HIV vulnerability for migrants, thereby illuminating key challenges. Second, the review considers what may be done to address these issues, particularly within the plantation system. A comprehensive response to HIV would require that the plantation companies engage in efforts against HIV/AIDS across its entire time line (that is, ranging from efforts to prevent infection to attempts to mitigate its full impact on both agricultural workers and the business as a whole). Despite the logic of this argument, we do not yet have strong financial evidence proving that companies should invest in a comprehensive strategy. This critical gap should be addressed. For example, pilot programs on select plantations could be used to show the cost-benefits of addressing HIV/AIDS through a well-designed set of interventions aimed at the different target groups.
    Keywords: HIV/AIDS, Mobility, Migrant workers, Agricultural plantations,
    Date: 2009
  4. By: Kreider, Brent; Pepper, John V.; Gundersen, Craig; Jolliffe, Dean
    Abstract: The literature assessing the efficacy of the Food Stamp Program, now called the Supplemental Nutrition Assistance Program (SNAP), has long puzzled over positive associations between food stamp receipt and various undesirable health outcomes such as food insecurity. Assessing the impact of food stamps on outcomes is made difficult by endogenous selection into food stamp recipiency and extensive systematic misreporting of participation status. Using data from the National Health and Nutrition Examination Survey (NHANES), we apply and extend partial identification bounding methods to account for these two identification problems in a single unifying framework. Imposing relatively weak nonparametric assumptions on the selection and reporting error processes, we provide informative bounds on the impact of food stamps on child food insecurity, obesity, general health, and anemia. We find that commonly cited negative relationships between food stamps and health outcomes provide a misleading picture about the impact of the program. Without imposing any parametric assumptions, our tightest bounds identify modest favorable impacts of food stamps on child health.
    Keywords: Food Stamp Program, Supplemental Nutrition Assistance Program, food insecurity, health outcomes, partial identification, treatment effect, nonparametric bounds, classification error
    JEL: C1 C2 I3
    Date: 2009–11–13
  5. By: Marie-Louise Leroux; Grégory Ponthière
    Abstract: We study the optimal taxation problem in an economy composed of two-person households (men and women), where agents influence their own old-age dependency prospects through health spending. It is shown that the utilitarian social optimum can be decentralized by means of lump sum transfers from men to women, because women exhibit a higher disability-free life expectancy than men for a given level of health spending. Once self-oriented concerns for coexistence are introduced, the decentralization of the first-best requires also gender-specific subsidies on health spending aimed at internalizing the effect of each agent's health on the spouse's welfare. In the presence of singles in the population, the optimal policy requires also a differentiated subsidization of health spending for singles and couples. Finally, under imperfect observability of couples, the incentive compatibility constraints reinforce the need for subsidization of health spendings.
    Date: 2009
  6. By: de Walque, Damien; Kline, Rachel
    Abstract: Based on nationally representative samples from 13 Sub-Saharan African countries, this paper reinforces and expands previous findings that condom use in general is low in this region, men report using condoms more frequently than women, and unmarried individuals report they use condoms more frequently than married individuals with their spouse. Based on descriptive, bivariate, and multivariate analyses, the authors also demonstrate to a degree not previously shown in the current literature that married men from most countries report using condoms with extramarital partners about as frequently as unmarried men. However, married women from most countries included use condoms with extramarital partners less frequently than unmarried women. This result is especially troubling because marriage usually ensures regular sexual intercourse, providing more opportunities to pass HIV from extramarital partner to spouse than an unmarried person who may also have multiple partners but not as regular sexual intercourse.
    Keywords: Population Policies,Gender and Health,Adolescent Health,HIV AIDS,Gender and Law
    Date: 2009–11–01
  7. By: Do, Quy-Toan; Iyer, Lakshmi
    Abstract: The authors survey the recent literature on the mental health effects of conflict. They highlight the methodological challenges faced in this literature, which include the lack of validated mental health scales in a survey context, the difficulties in measuring individual exposure to conflict, and the issues related to making causal inferences from observed correlations. They illustrate how some of these issues can be overcome in a study of mental health in post-conflict Bosnia and Herzegovina. Mental health is measured using a clinically validated scale; conflict exposure is proxied by administrative data on war casualties instead of being self-reported. The analysis suggests that there are no significant differences in overall mental health across areas which are affected by ethnic conflict to a greater or lesser degree.
    Keywords: Health Monitoring&Evaluation,Disease Control&Prevention,Population Policies,Gender and Health,Health Systems Development&Reform
    Date: 2009–11–01
  8. By: Kuhn, Andreas; Lalive, Rafael; Zweimüller, Josef
    Abstract: We study the short-run effect of involuntary job loss on comprehensive measures of public health costs. We focus on job loss induced by plant closure, thereby addressing the reverse causality problem of deteriorating health leading to job loss as job displacements due to plant closure are unlikely caused by workers' health status, but potentially have important effects on individual workers' health and associated public health costs. Our empirical analysis is based on a rich data set from Austria providing comprehensive information on various types of health care costs and day-by-day work history at the individual level. Our central findings are: (i) overall expenditures on medical treatments (hospitalizations, drug prescriptions, doctor visits) are not strongly affected by job displacement; (ii) job loss increases expenditures for antidepressants and related drugs, as well as for hospitalizations due to mental health problems for men (but not for women); and (iii) sickness benefits strongly increase due to job loss.
    Keywords: Health; Job loss; Plant closure; Social cost of unemployment
    JEL: I12 I19 J28 J65
    Date: 2009–08
  9. By: Barros, Pedro Luis Pita; Martinez-Giralt, Xavier
    Abstract: This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients' benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients' benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems.
    Keywords: health care; payment systems; technology adoption
    JEL: I11 I12 Q33
    Date: 2009–11
  10. By: van Ours, Jan C.; Williams, Jenny
    Abstract: This paper investigates whether cannabis use leads to worse mental health. To do so, we account for common unobserved factors affecting mental health and cannabis consumption by modeling mental health jointly with the dynamics of cannabis use. Our main finding is that using cannabis increases the likelihood of mental health problems, with current use having a larger effect than past use. The estimates suggest a dose response relationship between the frequency of recent cannabis use and the probability of currently experiencing a mental health problem.
    Keywords: cannabis use; discrete factor models; duration models; mental health
    JEL: C41 D12 I19
    Date: 2009–07
  11. By: Huber, Martin; Lechner, Michael; Wunsch, Conny
    Abstract: Using exceptionally rich linked administrative and survey information on German welfare recipients we investigate the health effects of transitions from welfare to employment and of assignments to welfare-to-work programmes. Applying semi-parametric propensity score matching estimators we find that employment substantially increases (mental) health. The positive effects are mainly driven by males and individuals with bad initial health conditions and are largest for males with poor health. In contrast, the effects of welfare-to-work programmes, including subsidized jobs, are ambiguous and statistically insignificant for most outcomes. Robustness checks that include a semi-parametric instrumental variable approach do not provide reasons for concern.
    Keywords: health effects; welfare programs
    JEL: I10 I38 J68
    Date: 2009–08
  12. By: Gandal, Neil; Shabelansky, Anastasia
    Abstract: In this paper, we employ a rich data set at the individual level in order to examine which factors are most highly correlated with obesity. Our main result is that, even after controlling for income levels and other factors, we find that high 'price-sensitivity' for food products is associated with high obesity rates. We find that a woman who stated that prices were 'not important at all' when purchasing food products had a Body Mass Index (BMI) that was 1.3 units below those who stated that price was 'very important.' This suggests that the price effect is not trivial and obesity is a problem that is not limited to those with low income levels. A 1.3 unit reduction in the BMI would move approximately 28% of women who are in the 'overweight' category to the 'normal weight' category and 25% of women who are in the 'obese' category to the 'overweight' category.
    Keywords: Obesity; Price Sensitivity
    JEL: D12 I18
    Date: 2009–09
  13. By: Robert W. Fairlie (Department of Economics, University of California, Santa Cruz and RAND); Kanika Kapur (School of Economics and Geary Institute, University College Dublin and RAND); Susan Gates (RAND)
    Abstract: The focus on employer-provided health insurance in the United States may restrict business creation. We address the limited research on the topic of “entrepreneurship lock” by using recent panel data from matched Current Population Surveys. We use difference-in-difference models to estimate the interaction between having a spouse with employer-based health insurance and potential demand for health care. We find evidence of a larger negative effect of health insurance demand on the entrepreneurship probability for those without spousal coverage than for those with spousal coverage. We also take a new approach in the literature to examine the question of whether employer-based health insurance discourages entrepreneurship by exploiting the discontinuity created at age 65 through the qualification for Medicare. Using a novel procedure of identifying age in months from matched monthly CPS data, we compare the probability of business ownership among male workers in the months just before turning age 65 and in the months just after turning age 65. We find that business ownership rates increase from just under age 65 to just over age 65, whereas we find no change in business ownership rates from just before to just after for other ages 55-75. Our estimates provide some evidence that "entrepreneurship lock" exists, which raises concerns that the bundling of health insurance and employment may create an inefficient allocation of which or when workers start businesses.
    Keywords: Self-employment, entrepreneurship, health insurance
    Date: 2009–11–17

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