nep-hea New Economics Papers
on Health Economics
Issue of 2010‒03‒13
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Teen overweight, weight stigma, and intimate relationship development from adolescence to young adulthood By Yen-hsin Alice Cheng; Nancy S. Landale
  2. The relative importance of shocks in a cohort's early and later life conditions on age-specific mortality By Mikko Myrskylä
  3. Does Drinking Impair College Performance? Evidence from a Regression Discontinuity Approach By Mark L. Hoekstra; Scott Carrell; James West
  4. On the Consumption Insurance Effects of Long-term Care Insurance in Japan: Evidence from Micro-level Household Data By Yasushi Iwamoto; Miki Kohara; Makoto Saito
  5. Preferences for Health Insurance in Germany and the Netherlands – A Tale of Two Countries By Peter Zweifel; Karolin Leukert; Stephanie Berner
  6. Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans? By Diane M. Harnak Hall; Juergen Jung; Thomas Rhoads
  7. Southwest Virginia Health Care Sector Economic Impact Analysis By Tanya Wanchek
  8. Economic Insecurity and the Spread of Obesity in Social Networks By Michael G. Barnes; Trenton Smith; Jonathan K. Yoder
  9. A closer look at child mortality among Adivasis in India By Das, Maitreyi Bordia; Kapoor, Soumya; Nikitin, Denis
  10. Time-driven activity-based costing in an outpatient clinic environment: development, relevance and managerial impact. By Demeere, Nathalie; Stouthuysen, Kristof; Roodhooft, Filip
  11. THE SKINNY ON OBESITY RATES AND THE U.S. ECONOMY By Paul Sommers; Dylan J. Fitzpatrick; Erin A. Toner
  12. Using Matched Survey and Administrative Data to Estimate Eligibility for the Medicare Part D Low Income Subsidy Program By Erik Meijer; Lynn A. Karoly; Pierre-Carl Michaud
  13. Prices and Cigarette Demand: Evidence from Youth Tobacco Use in Developing Countries By Deliana Kostova; Hana Ross; Evan Blecher; Sara Markowitz
  14. Family Status Transitions, Latent Health, and the Post-Retirement Evolution of Assets By James M. Poterba; Steven F. Venti; David A. Wise
  15. Health, Income, and the Timing of Education Among Military Retirees By Ryan D. Edwards

  1. By: Yen-hsin Alice Cheng (Max Planck Institute for Demographic Research, Rostock, Germany); Nancy S. Landale
    Abstract: With an emphasis on how weight stigma is manifested in social relationship context, this study explores two under-studied consequences of adolescent overweight, timing of first sex and subsequent intimate relationship development. The data employed come from Waves I to III of the National Longitudinal Study of Adolescent Health. The results indicate that overweight adolescents have significantly later onset of first sex and are more likely to enter early adulthood without any intimate relationship experience when compared to normal-weight youth. Overweight adolescents are vulnerable to discriminatory treatments such as being rejected by or having less close relationships with peers and are thus less likely to have any intimate relationship. The study contributes to the existing literature on overweight youth by revealing the critical role of prejudiced social encounters in peer relationships as the key context that hinders the development of intimate relationships from adolescence to early adulthood. Future studies should seek to understand the broader implications of poor social adjustments during adolescence for later development.
    JEL: J1 Z0
    Date: 2010–02
  2. By: Mikko Myrskylä (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: The relative importance of a cohort’s early life conditions, compared to later period conditions, on adult- and old-age mortality is not known. This paper studies how cohort-level mortality depends on shocks in the cohort’s early and later life (period) conditions. I use cohort’s own mortality as a proxy for the early life conditions, and define shocks as deviations from trend. Using historical data for five European countries I find that shocks in early life conditions are only weakly associated with cohort’s later mortality. This may be because individual-level health is robust to early life conditions, or because at the cohort-level scarring, selection and immunity cancel each other. Shocks in period conditions, measured as deviations from trend in period child mortality, are strongly and positively correlated with mortality at all older ages. The results suggest that at the cohort-level period conditions drive mortality change.
    Keywords: Europe, mortality
    JEL: J1 Z0
    Date: 2010–02
  3. By: Mark L. Hoekstra; Scott Carrell; James West
    Abstract: This paper examines the effect of alcohol consumption on student achievement by exploiting the discontinuity in drinking at age 21 at a college in which the minimum legal drinking age is strictly enforced. We find that drinking causes significant reductions in academic performance, particularly for the highest-performing students. This suggests that the negative consequences of alcohol consumption extend beyond the narrow segment of the population at risk of more severe, low-frequency, outcomes. Thus, our results indicate policies that combat drinking—particularly binge drinking that occurs around age 21—may well have large positive effects that are broader than previously known.
    JEL: I18 I21
    Date: 2010–03
  4. By: Yasushi Iwamoto; Miki Kohara; Makoto Saito
    Abstract: Using micro-level household data in the 2001 Comprehensive Survey of the Living Conditions of the People on Health and Welfare compiled by the Japanese Ministry of Health, Labor and Welfare, this paper examines how having a household member in need of long-term nursing care can result in welfare losses measured in terms of consumption. In so doing, this study evaluates the role of the public long-term care insurance scheme implemented in Japan in April 2000. The results indicate that when households include a disabled family member, household consumption net of long-term care costs do not decrease as much as before the introduction of long-term care insurance. Further, when compared with the surveys conducted in 1998, theadverse effects on consumption net of long-term care costs have become much weaker. These findings suggest that the introduction of social insurance in 2000 helped Japanese households to reduce the welfare losses associated with a disabled family member.
    Keywords: social insurance, consumption insurance, long-term care insurance
    JEL: E21 I18
    Date: 2009–12
  5. By: Peter Zweifel (Socioeconomic Institute, University of Zurich); Karolin Leukert (Polynomics, Olten); Stephanie Berner (Polynomics, Olten)
    Abstract: This contribution contains an international comparison of preferences. Using two Discrete Choice Experiments (DCE), it measures willingness to pay for health insurance attributes in Germany and the Netherlands. Since the Dutch DCE was carried out right after the 2006 health reform, which made citizens explicitly choose a health insurance contract, two research questions naturally arise. First, are the preferences with regard to contract attributes (such as Managed-Care-type restrictions of physician choice) similar between the two countries? Second, was the information campaign launched by the Dutch government in the context of the reform effective in the sense of reducing status quo bias? Based on random-effects Probit estimates, these two questions can be answered as follows. First, while much the same attributes have positive and negative willingness to pay values in the two countries, their magnitudes differ, pointing to differences in preference structure. Second, status quo bias in the Netherlands is one-half of the German value, suggesting that Dutch consumers were indeed made to bear the cost of decision making associated with choice of a health insurance contract.
    Keywords: preference measurement, willingness to pay, health insurance, discrete-choice experiments, health reform, Germany, Netherlands
    JEL: C25 D12 I18
    Date: 2010–02
  6. By: Diane M. Harnak Hall (Department of Family Studies and Community Development, Towson University); Juergen Jung (Department of Economics, Towson University); Thomas Rhoads (Department of Economics, Towson University)
    Abstract: The present study examines whether the college enrollment decision of young individuals (Student full-time, Student part-time, Non-student) depends on the availability of health insurance from their parents. Our findings indicate that the availability of parental health insurance has strong significant effects on the probability that a young individual enrolls as a full-time student. A young individual who has access to health insurance via a parent is up to 17.5 percent more likely to enroll as a full-time student than a student without parental health insurance.
    Keywords: Occupational choice, health insurance, educational choice, survey of income and program participation (SIPP).
    JEL: C35 I23 I10
    Date: 2010–02
  7. By: Tanya Wanchek
    Abstract: This study describes the contribution of the health care sector to the regional and local economies in Southwest Virginia (SWVA). The study uses an input-output model to identify the backward linkages from the health care sector to the overall economy. It provides information on how the health care sector affects employment and labor income in the region as a whole and in each of the seven localities in SWVA, including the counties of Buchanan, Dickenson, Lee, Russell, Scott, Tazewell, and Wise and the City of Norton. It also provides estimates of the impact of each component of the health care sector on regional and local economies. The results of the analysis provide a snapshot of the economic impact of the health care sector and serve as a baseline for future work on the economic impact of potential changes in the region.
    Keywords: Impact study, health sector
    JEL: H51 R34
    Date: 2009–11–16
  8. By: Michael G. Barnes; Trenton Smith; Jonathan K. Yoder (School of Economic Sciences, Washington State University)
    Abstract: A number of recent studies have provided evidence suggesting that increases in body weight may spread via social networks. The mechanism(s) by which this might occur have become the subject of much speculation, but to date little direct evidence has been available. We provide evidence for one such mechanism: economic insecurity. Using a sample of working-age men from the National Longitudinal Survey of Youth, we show that cohabitation with working (but not non-working) adults appears to be protective against weight gain. We address the potential endogeneity of the independent variable by employing instrumental variables in our regression analysis.
    Keywords: overweight, contagion, obesity, networks
    JEL: D12 I12
    Date: 2010–02
  9. By: Das, Maitreyi Bordia; Kapoor, Soumya; Nikitin, Denis
    Abstract: The authors use data from the National Family Health Survey 2005 to present age-specific patterns of child mortality among India's tribal (Adivasi) population. The analysis shows three clear findings. First, a disproportionately high number of child deaths are concentrated among Adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of Adivasis. Any effort to reduce child morality in the aggregate will have to focus more squarely on lowering mortality among the Adivasis. Second, the gap in mortality between Adivasi children and the rest really appears after the age of one. In fact, before the age of one, tribal children face more or less similar odds of dying as other children. However, these odds significantly reverse later. This calls for a shift in attention from infant mortality or in general under-five mortality to factors that cause a wedge between tribal children and the rest between the ages of one and five. Third, the analysis goes contrary to the conventional narrative of poverty being the primary factor driving differences between mortality outcomes. Instead, the authors find that breaking down child mortality by age leads to a much more refined picture. Tribal status is significant even after controlling for wealth.
    Keywords: Population Policies,Health Monitoring&Evaluation,Early Child and Children's Health,Adolescent Health,Early Childhood Development
    Date: 2010–03–01
  10. By: Demeere, Nathalie; Stouthuysen, Kristof; Roodhooft, Filip
    Abstract: Healthcare managers are continuously urged to provide better patient services at a lower cost. To cope with these cost pressures, healthcare management needs to improve its understanding of the relevant cost drivers. Through a case study, we show how to perform a time-driven activity-based costing of five outpatient clinic's departments and provide evidence of the benefits of such an analysis.
    Keywords: time-driven activity-based costing; cost control; outpatient clinic;
    Date: 2009–06–09
  11. By: Paul Sommers; Dylan J. Fitzpatrick; Erin A. Toner
    Date: 2010
  12. By: Erik Meijer; Lynn A. Karoly; Pierre-Carl Michaud
    Abstract: The 2003 Medicare Prescription Drug Improvement and Modernization Act added a new prescription drug benefit to the Medicare program known as Part D (prescription drug coverage), as well as the Low-Income Subsidy (LIS) program to provide "extra help" with premiums, deductibles, and copayments for Medicare Part D beneficiaries with low income and limited assets. In this paper, the authors report on the use of matched survey and administrative data to estimate the size of the LIS-eligible population as of 2006. In particular, they employ individual-level data from the Survey of Income and Program Participation (SIPP) and the Health and Retirement Study (HRS) to cover the potentially LIS-eligible noninstitutionalized and institutionalized populations of all ages. The survey data are matched to Social Security Administration (SSA) administrative data to improve on potentially error-ridden survey measures of income components (e.g., earnings and beneficiary payments from Supplemental Security Income and Old Age, Survivors, and Disability Insurance) and program participation (e.g., participation in Medicare or a Medicaid/Medicare Savings program). The administrative data include the Master Beneficiary Record/Payment History Update System, the Master Earnings File, and the Supplemental Security Record. The survey data are the source of information on asset components, as well as the income components (e.g., private pensions) and individual characteristics (e.g., health status) not covered in the administrative data. Their baseline estimate, based on the matched data, is that about 12 million individuals were potentially eligible for the LIS as of 2006. A sensitivity analysis indicates that the use of administrative data has a relatively small effect on the estimates but does suggest that measurement error is important to account for. The estimate of the size of the LIS-eligible population is more sensitive to the relative weight they place on the two survey data sources, rather than the choice of methods we apply to either data source.
    Date: 2010–02
  13. By: Deliana Kostova; Hana Ross; Evan Blecher; Sara Markowitz
    Abstract: This paper estimates the impact of cigarette prices on youth smoking in lower-income countries using data from the Global Youth Tobacco Survey (GYTS). Country-level heterogeneity is addressed with fixed effects and by directly controlling for confounding environmental factors such as local anti-smoking sentiment, cigarette advertising, anti-smoking media messages, and compliance with youth access restrictions. We find that cigarette price is an important determinant of both smoking participation and conditional demand. The estimated price elasticity of participation is -0.63. The likelihood of participation decreases with anti-smoking sentiment and increases with exposure to cigarette advertising. The estimated price elasticity of conditional cigarette demand is approximately -1.2. Neither anti-smoking sentiment, cigarette advertising, nor access restrictions have an impact on the intensity of smoking among current smokers, but exposure to anti-smoking media may reduce the number of cigarettes smoked.
    JEL: I1 O1
    Date: 2010–02
  14. By: James M. Poterba; Steven F. Venti; David A. Wise
    Abstract: We consider the evolution of assets after retirement. We ask whether total assets--including housing equity, personal retirement accounts, and other financial assets--tend to be husbanded for a rainy day and drawn down primarily at the time of precipitating shocks, or whether they are drawn down throughout the retirement period. We focus on the relationships between family status transitions, “latent” health status, and the evolution of assets. Our analysis is based primarily on longitudinal data from the HRS and AHEAD cohorts of the Health and Retirement Study. We find that the evolution of assets is strongly related to family status transitions. For both single individuals and married couples who do not experience a death or divorce, total assets increase well into old age. In contrast, individuals in married couples that experience a family status transition, either a death or a divorce, exhibit much slower asset growth and often experience a large decline in asset values at the time of the transition. In addition, the level and evolution of assets is very strongly related to health, measured by a latent health index. For example, for continuing two-person HRS households between the ages of 56 and 61 in 1992 the ratio of assets of households in the top health quintile to the assets of those in the bottom quintile was 1.7 in 1992. It had increased to 2.2 by the end of 2006.
    JEL: E21 J14
    Date: 2010–02
  15. By: Ryan D. Edwards
    Abstract: There is a large and robust correlation between adult health and education, part of which likely reflects causality running from education into health. Less clear is whether education obtained later in life is as valuable for health as are earlier years of schooling, or whether education raises health directly or through income or wealth. In this paper, I examine how the timing of educational attainment is important for adult health outcomes, income, and wealth, in order to illuminate these issues. Among military retirees, a subpopulation with large variation in the final level and timing of educational attainment, the health returns to a year of education are diminishing in age at acquisition, a pattern that is less pronounced for income and wealth. In the full sample, the marginal effects on the probability of fair or poor health at age 55 of a year of schooling acquired before, during, and after a roughly 25-year military career are –0.025, –0.016, and –0.006, revealing a decline of about half a percentage point each decade. These results suggest that education improves health outcomes more through fostering a lifelong accumulation of healthy behaviors and habits, and less through augmenting the flow of income or the stock of physical wealth.
    JEL: I12 I20 J24
    Date: 2010–02

This nep-hea issue is ©2010 by Yong Yin. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.