nep-hea New Economics Papers
on Health Economics
Issue of 2010‒02‒13
fourteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Externalities in a Life-Cycle Model with Endogenous Survival By Michael Kuhn; Stefan Wrzaczek; Alexia Prskawetz; and Gustav Feichtinger; Michael Kuhn; Stefan Wrzaczek; Alexia Prskawetz; Gustav Feichtinger
  2. Are You What You Eat? Experimental Evidence on Health Habits and Risk Preferences By Matteo M. Galizzi; Marisa Miraldo
  3. Inhibitions and implications associated with celebrity participation in social marketing programs focusing on HIV prevention: an exploratory research By Beatriz Casais; João F. Proença
  4. Health Care Financing over the Life Cycle, Universal Medical Vouchers and Welfare By Juergen Jung; Chung Tran
  5. Work Out or Out of Work: The Labor Market Return to Physical Fitness and Leisure Sport Activities By Rooth, Dan-Olof
  6. Mental Health and Working Conditions in European Countries By Cottini, Elena; Lucifora, Claudio
  7. The Effects of Sick-Leaves on Earnings By Markussen, Simen
  8. Closing the Gates? Evidence from a Natural Experiment on Physicians' Sickness Certification By Markussen, Simen
  9. Human Resources for Health: Requirements and Availability in the Context of Scaling-Up Priority Interventions in Low-Income Countries By Christoph Kurowski; Anne Mills; Kaspar Wyss; N’Diekhor Yémadji; Salim Abdulla
  10. The Effects of Food Stamps on Obesity. By Charles L. Baum II
  11. The Effects of Food Stamps on Weight Gained by Expectant Mothers. By Charles L. Baum II
  12. Effect of a French Experiment of Team Work between General Practitioners and Nurses on Efficacy and Cost of Type 2 Diabetes Patients Care By Julien Mousquès; Yann Bourgueil; Philippe Le Fur; Engin Yilmaz
  13. Reducing the risks to health: the role of social protection: report of the Social Protection Task Group for the Strategic Review of Health Inequalities in England post 2010. By Glennerster, Howard; Bradshaw, Jonathan; Lister, Ruth; Lundberg, Olle
  14. The Male-Female Gap in Physician Earnings: Evidence from a Public Health Insurance System By Engelbert Theurl; Hannes Winner

  1. By: Michael Kuhn; Stefan Wrzaczek; Alexia Prskawetz; and Gustav Feichtinger; Michael Kuhn; Stefan Wrzaczek; Alexia Prskawetz; Gustav Feichtinger
    Abstract: We study socially vs. individually optimal lifecycle allocations of consumption and health care, when individual health expenditure curbs own mortality but also has a spillover effect on other persons' survival. Such spillovers arise, for instance, when health care activity at aggregate level triggers improvements in treatment through learningbydoing (positive externality) or a deterioration in the quality of care through congestion (negative externality). We combine an agestructured optimal control model at population level with a conventional lifecycle model to derive the social and private value of life. We then examine how individual incentives deviate from social incentives and how they can be aligned by way of a transfer scheme. The agepatterns of socially and individually optimal health expenditure and the transfer rate are derived. Numerical analysis illustrates the workings of our model.
    Keywords: Demand for health, externality, life-cycle-model, optimal control, tax-subsidy, value of life.
    Date: 2010–01
  2. By: Matteo M. Galizzi; Marisa Miraldo
    Abstract: We run an experiment to assess whether preferences for risk significantly differ for individuals with different health habits. We administrate a questionnaire followed by an experimental test to a sample of 120 subjects. The questionnaire measures health characteristics, habits and life style and assesses details about individual nutritional balance, drinking, smoking and physical exercise. We construct a number of individual health and nutritional indexes, including the Healthy Eating Index based on the USDA guidelines. We elicit preferences for risk using variants of the Holt and Laury (2002) paired lotteries test. Conditional on individual health habits and life style variables, we estimate the risk preferences for each subject, using Maximum Likelihood estimation. We observe that risk preferences significantly differ for subjects with different health habits and found some evidence of risk aversion. In particular, while smokers do not appear to be significantly more risk seeking, subjects with high scores of the Healthy Eating Index are characterized by higher degree of risk aversion.
    Date: 2010
  3. By: Beatriz Casais (Faculdade de Economia, Universidade do Porto); João F. Proença (Faculdade de Economia, Universidade do Porto)
    Abstract: This paper discusses celebrity participation in social marketing programs focusing on public health, especially on HIV programs. The research identifies the inhibitions of celebrity people and implications that this involvement may have upon their lives. The paper analysis data from in-depth interviews made to twenty-seven Portuguese celebrities from arts, show business and sports. The results show absence of prejudice against HIV. Famous people feel motivated to join public health and HIV cause because of the serious nature of the disease, as well as the social stigma attached to AIDS which can suggest positive discrimination. The paper also shows that celebrities expected a fee for their endorsement, despite the social role they consider celebrities should have, and the positive image they benefit for endorsing public health campaigns. The research discusses celebrity expectations and worries and, finally, shows several results that are helpful for negotiations between institutions and celebrities insofar as it may pave the way for celebrity involvement in social marketing programs.
    Keywords: Social marketing, Celebrity endorsement, HIV prevention
    JEL: H51 H52 H53 H75 I10 I18
    Date: 2010–02
  4. By: Juergen Jung (Department of Economics, Towson University); Chung Tran (Department of Economics, University of New South Wales)
    Abstract: In this paper we develop a general equilibrium overlapping generations (OLG) model with health shocks to analyze the life-cycle pattern of insurance choice and health care spending. We use data from the Medical Expenditure Panel Survey (MEPS) and show that our model is able to match the life-cycle trends of insurance take up ratios and average medical expenditures in the U.S. We then demonstrate how this model can be used to conduct health care policy analysis by evaluating the macroeconomic effects of a counter factual health care reform using a system of universal health insurance vouchers. Our results suggest that health insurance vouchers are able to extend insurance coverage to the entire population but they also increase aggregate spending on health. More importantly, we find that the positive insurance effect (efficient risk pooling) dominates the negative incentive effect (tax distortions and moral hazard) which results in significant welfare gains for all generations when a payroll tax is used to finance the voucher program. In addition, our results suggest that the choice of tax financing instrument and accounting for general equilibrium price adjustments are critical in determining the performance of the voucher program.
    Keywords: Public health insurance, private health insurance, vouchers, dynamic stochastic general equilibrium model, endogenous health production.
    JEL: H51 I18 I38 E6 E21 E62
    Date: 2010–02
  5. By: Rooth, Dan-Olof (Linneaus University)
    Abstract: This study is the first to present evidence of the return to leisure sports in the job hiring process by sending fictitious applications to real job openings in the Swedish labor market. In the field experiment job applicants were randomly given different information about their type and level of leisure sport being engaged in. Applications which signal sport skills have a significantly higher callback rate of about two percentage points for men, and this effect is about twice as large in physically demanding occupations. This indicates a health-productivity interpretation of the results. However, the result is mainly driven by the return to sports as soccer and golf, and not at all by more fitness related sports as running and swimming, which is indicative of alternative explanations for the labor market sports premium. One possible explanation emerges when analyzing register data on adult earnings and physical fitness when enlisting at age 18. The fitness premium, net of unobservable family variables, is in the order of 4-5 percent, but diminishes to 1 percent when controlling for non-cognitive skills. Hence, these results indicate that being engaged in leisure sports signals having important social skills.
    Keywords: leisure sports, physical fitness, cardiovascular fitness, correspondence testing, earnings
    JEL: J21 J64 J71
    Date: 2010–01
  6. By: Cottini, Elena (University of Milan); Lucifora, Claudio (Università Cattolica del Sacro Cuore)
    Abstract: Increased pressure for labour market flexibility and increasing demand over workers' performance have fostered the idea that working conditions, in most European countries, have progressively deteriorated with adverse effects on psychological well being and mental health. This paper investigates the links between contractual arrangements, working conditions and mental health using time-series cross-section data for 15 European countries. We use different waves of the European Working Conditions Survey (1995, 2000, 2005) to document recent patterns in mental health at the workplace and to assess how these are related to various job attributes. We find substantial heterogeneity in mental health incidence at the workplace both across workers, as well as between countries. Given population heterogeneity in responses to mental health questions, we implement a methodology for differential reporting in ordered response models which allows for threshold shifts. We show that a set of workplace attributes, such as: working in shifts, performing complex and intensive tasks and having restricted job autonomy lead to a higher probability of reporting mental health problems. We also provide evidence of a positive causal effect of adverse overall working conditions on mental health distress. We show that labour market institutions, and health and safety regulations can explain a significant part of cross-country differences.
    Keywords: working conditions, mental health, health and safety regulation, labour market institutions
    JEL: C25 I10 J81 J28
    Date: 2010–01
  7. By: Markussen, Simen (Ragnar Frisch Centre for Economic Research)
    Abstract: This paper assesses the causal effect of sick-leaves on subsequent earnings using an administrative dataset for Norway linking individual earnings, sick-leave records and primary care physicians. The leniency of a worker's physician - certifying sickness absence - is used as instrument for sick-leaves. Sick-leaves have a substantial impact on future earnings, reducing earnings by .3 percent per day of absence. When conditioning on full-time employment also two years after sickness the effect is .06 percent per day of absence. These effects are persistent over time and work mainly through wages not hours.
    Keywords: sickness absence; wage formation; IV estimation; wage regression
    JEL: C31 J22 J24 J31 J33 J71
    Date: 2009–06–30
  8. By: Markussen, Simen (Dept. of Economics, University of Oslo)
    Abstract: This paper exploits a Norwegian physician directed reform aimed to reduce sick-leave. Physicians were required to consider part-time sick-leave as the default treatment and – in the case of long lasting full-time sick-leave – to file a report documenting why the worker was unable to perform any work related activities. The reform had a large impact, reducing sick-leave by 18.8 percent. The main effect came from reduced spell duration – which can be directly linked to the extended documentation requirement laid on physicians within the first 8 weeks of a sick-leave spell. Physician-directed policies may be an (cost-) effective way of reducing sick-leave.
    Keywords: Labor market policies; sick-leave; physicians’ gate keeping
    JEL: H53 I18 J28
    Date: 2009–03–30
  9. By: Christoph Kurowski; Anne Mills; Kaspar Wyss; N’Diekhor Yémadji; Salim Abdulla
    Abstract: The purpose of this study was to explore the role and importance of human resources for the scaling up of health services in low income countries. In the case studies, the following have been analyzed: (i) investigated the size, composition and structure of the current health work force; (ii) produced estimates of future human resource availability; (iii) estimated the quantity of human resources required significantly to scale up priority interventions towards 2015; and (iv) compared human resource availability and human resource requirements. [HEFP WP No 01/04]
    Keywords: nurses, medical staff, human resources, MACROECONOMICS, Millennium Development Goals, case studies, employment, population ratio, Tanzania, health services, low income countries,
    Date: 2010
  10. By: Charles L. Baum II
    Abstract: Poverty has historically been associated with a decrease in food consumption. This at least partially changed in 1964 when the Food Stamp Act began guaranteeing food for those in poverty. Since the Act’s passage, the prevalence of obesity has increased dramatically, particularly among those with low incomes. This paper examines the effects of the Food Stamp Program on the prevalence of obesity using 1979 National Longitudinal Survey of Youth data. Results indicate food stamps have significant positive effects on obesity and the obesity gap for females, but these effects are relatively small and such benefits, consequently, are approximated to have played a minor role in increasing obesity at the aggregate level.
    Keywords: Food stamps; weight; obesity; BMI
    JEL: I18
    Date: 2010–02
  11. By: Charles L. Baum II
    Abstract: With over 66 % of Americans overweight, expectant mothers are unusual because they are encouraged to gain weight while pregnant. Food stamp receipt (FSR) may facilitate recommended weight gain for pregnant women by providing additional resources for food and nutrition. I examine the effects of FSR on the amount of weight gained by low-income expectant mothers using NLSY79 data. Results indicate FSR decreases the probability gaining an insufficient amount of weight but does not exacerbate the probability of gaining too much weight. Examining the effects of FSR on pregnancy weight gain is important because low birth weight is more likely when expectant mothers gain an insufficient amount of weight.
    Keywords: Food stamps, weight, weight gain
    JEL: J1
    Date: 2010–02
  12. By: Julien Mousquès (IRDES institut for research and information in health economics); Yann Bourgueil (IRDES institut for research and information in health economics); Philippe Le Fur (IRDES institut for research and information in health economics); Engin Yilmaz (DREES direction de la recherche des études de l'évaluation et des statistiques)
    Abstract: This study aims to assess the efficacy and the cost of a French team work experiment between nurses and GPs for the managing of type 2 diabetes patients. Our study was based on a case control study design in which we compare the evolution of process (standard follow-up procedures) and final outcomes (glycemic control), and the evolution of cost. The study is realized for two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After 11 months of follow-up, we showed that patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 to 6.8, p<=5%) and under glycemic control (with OR comprise between 1.8 to 2.7, p<=5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled groups. Finally, this experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiments to be launched by French health authorities.
    Keywords: Primary health care, Diabetes mellitus, Health care team, Comparative study, Outcome and process assessment, Cost analysis
    JEL: I12
    Date: 2010–01
  13. By: Glennerster, Howard; Bradshaw, Jonathan; Lister, Ruth; Lundberg, Olle
    Abstract: We demonstrate that the introduction of social protection systems as well as their generosity and coverage have significant impacts on health. Who receives the benefits within the household affects the health outcomes for the family. The eligibility for and administration of benefits matters. We examine the growth of means testing in the UK and its recent modifications. We find serious difficulties facing those with long term medical conditions who are on the margins of the labour force. Collaboration between the health and social protection systems is poor. We give particular attention to gender and health and the implications this has for the social protection system. We also consider the fate of groups like asylum seekers who are excluded from its normal working.
    Date: 2009–06
  14. By: Engelbert Theurl (Department of Economics and Statistics, University of Innsbruck, Austria); Hannes Winner
    Abstract: Empirical evidence from U.S. studies suggests that, on average, female physicians earn less than their male counterparts. This gap in earnings does not disappear when individual and market characteristics are con- trolled for. This paper investigates whether a gender earnings difference can also be observed in a health care system predominantly financed by public insurance companies. Using a unique data set of physicians' earn- ings recorded by a public social security agency in an Austrian province between 2000 and 2004, we find a gender gap in average earnings of about 32 percent. A substantial share of this gap (20 to 47 percent) cannot be explained by individual and market characteristics, leaving labor market discrimination as one possible explanation for the observed gender earn- ings difference of physicians.
    Keywords: Health care financing; physician earnings; wage composition
    JEL: I11 I18 J31 J71
    Date: 2010–01

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