nep-hea New Economics Papers
on Health Economics
Issue of 2010‒04‒04
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Do Food Stamps Contribute to Obesity in Low-Income Women? Evidence from the National Longitudinal Survey of Youth 1979 By Maoyong Fan
  2. Late-Life Decline in Well-Being across Adulthood in Germnay, the UK, and the US: Something is Seriously Wrong at the End of Life By Denis Gerstorf; Nilam Ram; Guy Mayraz; Mira Hidajat; Ulman Lindenberger; Gert G. Wagner; Jürgen Schupp
  3. Health-Insurance Coverage Rates for US Workers, 1979-2008 By Hye Jin Rho; John Schmitt
  4. Is There an Income Gradient in Child Health? It Depends Whom You Ask By Johnston, David W.; Propper, Carol; Pudney, Stephen; Shields, Michael A.
  5. Who Wants to Work in a Rural Health Post? The Role of Intrinsic Motivation, Rural Background and Faith-Based Institutions in Rwanda and Ethiopia By Serneels, Pieter; Montalvo, Jose G.; Pettersson, Gunilla; Lievens, Tomas; Butera, Jean Damascene; Kidanu, Aklilu
  6. The effect of compulsory schooling on health - evidence from biomarkers By Hendrik Jürges
  7. The social long-term care insurance in Germany: origin, situation, threats, and perspectives By Heinicke, Katrin; Thomsen, Stephan L.
  8. Moral Hazard in a Mutual Health-Insurance System: German Knappschaften, 1867–1914 By Timothy W. Guinnane; Jochen Streb
  9. Much Ado About Nothing? – Smoking Bans and Germany’s Hospitality Industry By Michael Kvasnicka; Harald Tauchmann
  10. Public Smoking Bans, Youth Access Laws, and Cigarette Sales at Vending Machines By Michael Kvasnicka
  11. Long-term Care Responsibility and its Opportunity Costs By Annika Meng
  12. Ghana’s National Health Insurance Scheme in the Context of the Health MDGs – An Empirical Evaluation Using Propensity Score Matching By Joseph Mensah; Joseph R. Oppong; Christoph M. Schmidt
  13. The Eff ect of Self-assessed Job Security on the Demand for Medical Rehab By Boris Augurzky; Arndt Reichert; Harald Tauchmann
  14. The Dutch system of long-term care By Esther Mot
  15. Interdependencies of Health, Education & Poverty in Egypt, Morocco and Turkey Using Demographic and Health Survey By Driouchi, Ahmed; Baijou, Ahmad

  1. By: Maoyong Fan (Department of Economics, Ball State University)
    Abstract: Does the Food Stamp Program (FSP), which provides in-kind transfers to low- income Americans, cause female participants to become obese? This question is particularly important because participants are substantially more likely to be obese than are nonparticipants. This paper estimates the effects of food stamp benefits on obesity, overweight and body mass index (BMI) of low-income women. Contrary to previous results, we find little evidence that the FSP causes obesity, overweight or higher BMI. Our analysis differs from previous research in three aspects. First, we exploit a rich longitudinal data set, the National Longitudinal Survey of Youth 1979, to distinguish between full-time and part- time participation. Second, instead of making parametric assumptions on outcomes, we employ a variety of difference-in-difference matching estimators to control for selection bias. Third, we estimate both short-term (one-year participation) and long-term (three-year participation) treatment effects. Empirical results show that after controlling for selection bias and defining the treatment and comparison groups carefully, there is little evidence that food stamps are responsible for higher BMI or obesity in female participants. Our estimates are robust to different definitions of the treatment and comparison groups, and to various matching algorithms.
    Keywords: Food Stamp Program, Obesity, Body Mass Index, Propensity Score Matching
    Date: 2010–03
  2. By: Denis Gerstorf; Nilam Ram; Guy Mayraz; Mira Hidajat; Ulman Lindenberger; Gert G. Wagner; Jürgen Schupp
    Abstract: Throughout adulthood and old age, levels of well-being appear to remain relatively stable. However, evidence is emerging that late in life well-being declines considerably. Using long-term longitudinal data of deceased participants in national samples from Germany, the UK, and the US, we examine how long this period lasts. In all three nations and across the adult age range, well-being was relatively stable over age, but declined rapidly with impending death. Articulating notions of terminal decline associated with impending death, we identified prototypical transition points in each study between three and five years prior to death, after which normative rates of decline steepened by a factor of three or more. The findings suggest that mortality-related mechanisms drive late-life changes in well-being and highlight the need for further refinement of psychological concepts about how and when late-life declines in psychosocial functioning prototypically begin.
    Keywords: Selective mortality, successful aging, differential aging, psychosocial factors, well-being, multiphase growth model
    Date: 2010
  3. By: Hye Jin Rho; John Schmitt
    Abstract: This study estimates rates of all forms of health insurance coverage for workers aged 18 to 64, by wage quintiles, over the past three decades. This analysis looks at health insurance from any source, while other reports (with rare exceptions) look at only employer-provided health coverage. This report provides trends from 1979 to 2008, while even the Census Bureau typically presents data starting from only either 1987 or 1999 (due to methodology changes made in those two years). The Census Bureau also does not publish data for workers, as this report does.
    Keywords: workers, health insurance, health care coverage
    JEL: J J3 J32 I I1 I18
    Date: 2010–03
  4. By: Johnston, David W. (Queensland University of Technology); Propper, Carol (University of Bristol); Pudney, Stephen (ISER, University of Essex); Shields, Michael A. (University of Melbourne)
    Abstract: A large literature uses parental evaluations of child health status to provide evidence on the socioeconomic determinants of health. If how parents perceive health questions differs by income or education level, then estimates of the socioeconomic gradient are likely to be biased and potentially misleading. In this paper we examine this issue. We directly compare child mental health evaluations from parents, teachers, children and psychiatrists for mental health problems, test whether these differences are systematically related to observable child and parent characteristics, and examine the implications of the different reports for the estimated income gradient. We find that respondents frequently evaluate children differently and while the sign of the income gradient is in the same direction across respondents, systematic differences in evaluations mean that the estimated magnitude and significance of the health-income gradient is highly dependent upon the choice of respondent and the measure of child health.
    Keywords: child health, income, reporting bias
    JEL: I12 J13
    Date: 2010–03
  5. By: Serneels, Pieter (University of East Anglia); Montalvo, Jose G. (Universitat Pompeu Fabra); Pettersson, Gunilla (University of Essex); Lievens, Tomas (Oxford Policy Management); Butera, Jean Damascene (Abt Associates, Inc.); Kidanu, Aklilu (Miz-Hasab Research Center)
    Abstract: Most developing countries face shortages of health workers in rural areas. This has profound consequences for health service delivery, and ultimately for health outcomes. To design policies that rectify these geographic imbalances it is vital to understand what factors determine health workers' choice to work in rural areas. But empirical analysis of health worker preferences has remained limited due to the lack of data. Using unique contingent valuation data from a cohort survey of 412 nursing and medical students in Rwanda, this paper examines the determinants of future health workers' willingness to work in rural areas, as measured by rural reservation wages, using regression analysis. These data are also combined with those from an identical survey in Ethiopia to enable a two-country analysis. We find that health workers with higher intrinsic motivation – measured as the importance attached to helping the poor – as well as those who have grown up in a rural area, and Adventists who participate in a local bonding scheme are all significantly more willing to work in a rural area. The main Rwanda result for intrinsic motivation is strikingly similar to that obtained for Ethiopia and Rwanda together. These results suggest that in addition to economic incentives, intrinsic motivation and rural origin play an important role in health workers' decisions to work in a rural area, and that faith-based institutions matter.
    Keywords: health care delivery, health workers, labour supply, public service
    JEL: J22 I11
    Date: 2010–03
  6. By: Hendrik Jürges (Mannheim Research Institute for the Economics of Aging (MEA))
    Abstract: Using data from the Health Survey for England and the English Longitudinal Study on Ageing, we estimate the causal effect of schooling on health. Identification comes from two nation wide increases in British compulsory school leaving age in 1947 and 1973, respectively. Our study complements earlier studies exploiting compulsory schooling laws as source of exogenous variation in schooling by using biomarkers as measures of health outcomes in addition to self-reported measures. We find a strong positive correlation between education and health, both self-rated and measured by blood fibrinogen and C-reactive protein levels. However, we find ambiguous causal effects of schooling on women's self-rated health and insignificant causal effects of schooling on men's self-rated health and biomarker levels in both sexes.
    Keywords: Health, Compulsory schooling, Biomarkers, Regression discontinuity
    JEL: I12 I20
    Date: 2009–07–08
  7. By: Heinicke, Katrin; Thomsen, Stephan L.
    Abstract: This paper describes the Social Long-Term Care Insurance (SLTCI) in Germany. Based on a short review of the history of long-term care organization and the preceding laws in Germany, the implementation of the SLTCI as a self-standing pillar within the system of social insurances in Germany and its set-up with regard to eligibility criteria, service provision and financial budget are presented. Since SLTCI is a universal, contribution-financed insurance the ageing society and the corresponding shifts in the number of persons in need of care and the number of persons potentially providing informal care are challenges for its sustainability. Therefore, recently suggested reform options are discussed at the end of the paper showing potential pathways to a sufficient provision of care services in the future. --
    Keywords: Social Long-term Care Insurance,Germany,Financial Situation,Sustainability,Reform Options
    Date: 2010
  8. By: Timothy W. Guinnane; Jochen Streb
    Abstract: The Knappschaft underlies Bismarck’s sickness and accident insurance legislation (1883 and 1884), which in turn forms the basis of the German social-insurance system today and, indirectly, many social-insurance systems around the world. The Knappschaften were formed in the medieval period to provide sickness, accident, and death benefi ts for miners. By the mid-nineteenth century, participation in the Knappschaft was compulsory for workers in mines and related occupations, and the range and generosity of benefi ts had expanded considerably. Each Knappschaft was locally controlled and self-funded, and their admirers saw in them the ability to use local knowledge and good incentives to deliver benefi ts at low cost. This paper focuses on a problem central to any insurance system, and one that plagued the Knappschaften as they grew larger in the later nineteenth century: the problem of moral hazard. Replacement pay for sick miners made it attractive, on the margin, for miners to invent or exaggerate conditions that made it impossible for them to work. Here we outline the moral hazard problem the Knappschaften faced as well as the internal mechanisms they devised to control it. We then use econometric models to demonstrate that those mechanisms were at best imperfect.
    Keywords: Sickness insurance; moral hazard; malingering; Knappschaft; social insurance
    JEL: N33 N43 H55 H53 I18
    Date: 2010–01
  9. By: Michael Kvasnicka; Harald Tauchmann
    Abstract: Over the last years, public smoking bans have been introduced in most European countries. Unlike elsewhere, in Germany such bans were introduced at state level at diff erent points in time, which provides important intra-country regional variation that can be exploited to identify the eff ects of such bans on the hospitality industry. Using monthly data from a compulsory survey carried out by the German Federal Statistical Offi ce, we study the short-run eff ects that these bans had on establishments’ sales. In contrast to the largely US-based literature, we fi nd that smoke-free policies had a negative (yet moderate) eff ect on establishment sales. Closure rates of businesses in the hospitality industry, however, were not signifi cantly aff ected by the introduction of state smoking bans.
    Keywords: smoking bans; sales; intra-country regional variation
    JEL: L51 I12
    Date: 2010–03
  10. By: Michael Kvasnicka
    Abstract: Tobacco control policies have proliferated in many countries in recent years, in particular youth access laws and public smoking bans. The eff ectiveness of youth access laws is still disputed, however, as are the costs of public smoking bans to the hospitality industry. Using a unique data set on cigarette sales at more than 100k vending machines that provides fi rst objective evidence on the outgoing and customer behavior of smokers, we study both outcome dimensions by investigating several recent tobacco control measures in Germany. We fi nd a large negative eff ect on cigarette sales of a nation-wide introduction of devices for electronic age verifi cation in cigarette vending machines, particularly at machines placed outdoors and in localities that are strongly frequented by youths. In contrast, there is no evidence that a country-wide smoking ban in federal buildings aff ected cigarette sales in these premises and only weak evidence that a recent rise in the minimum legal smoking age aff ected cigarette purchases by youths. Finally, state-level smoking bans appear to have reduced indoor sales of cigarettes at vending machines, especially in bars. However, the magnitude of the estimated eff ect is rather modest, suggesting that businesses in the hospitality industry are unlikely to have been aff ected severely.
    Keywords: Smoking; tobacco control; youth and second-hand smoking; hospitality industry
    JEL: I18 K32 L51
    Date: 2010–03
  11. By: Annika Meng
    Abstract: This paper analyzes the relationship between long-term care provision and the average individual wage rate. In addition, the eff ects of the number of hours spent on caregiving on the probability of employment as well as on the number of hours worked are examined. Data from the Survey of Health, Ageing and Retirement (SHARE) of 2004 and 2006 is used to analyze caregiving eff ects on the European labor market. Descriptive statistics show a positive correlation between hours of care and the wage rate for those working. In the regression analysis, sample-selection models combined with instrumental-variable estimation are used to estimate the causal eff ects of hours of care on wages. The results illustrate that care for parents has a large negative impact on the individual’s wage rate. Test results show that controlling for sample selection is reasonable. Finally, the probability of employment is only decreased in the female sample. Although the hours worked are not signicantly affected.
    Keywords: Informal care; labor-market outcomes; sample selection
    JEL: J11 J22 C01
    Date: 2010–02
  12. By: Joseph Mensah; Joseph R. Oppong; Christoph M. Schmidt
    Abstract: In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS) to improve health care access for Ghanaians and eventually replace the cashand- carry system. This study evaluates the NHIS to determine whether it is fulfi lling its purpose in the context of the Millennium Development Goals #4 and #5 which deal with the health of women and children. We use Propensity Score Matching techniques to balance the relevant background characteristics in our survey data and compare health outcomes of recent mothers who are enrolled in the NHIS with those who are not. Our fi ndings suggest that NHIS women are more likely to receive prenatal care, deliver at a hospital, have their deliveries attended by trained health professionals, and experience less birth complications. We conclude that NHIS is an eff ective tool for increasing health care access, and improving health outcomes.
    Keywords: Health insurance, prenatal care, Millennium Development Goals, Propensity Score Matching
    JEL: I18 O12 C21
    Date: 2009–12
  13. By: Boris Augurzky; Arndt Reichert; Harald Tauchmann
    Abstract: The interdependence of labor market conditions and the demand for health care has been addressed by several theoretical and empirical analyses. We contribute to the debate by empirically examining the eff ect of a decrease in self-perceived job security on health care utilization. That is, employees at risk of losing their job might postpone or even try not to use non-acute rehab measures in order to reduce their individual risk of being laid off by avoiding absenteeism and signaling good health. We use individual-level data from the German Socioeconomic Panel for the years 2003, 2004, and 2006. The identifi cation strategy rests on an instrumental variable approach where the county unemployment rate and its relative change compared to the previous year serve as instruments for the employees’ self-assessed risk of losing their jobs. Contrary to the hypothesis, we have evidence for job insecurity increasing the demand for medical rehab. This finding is robust to various model variants.
    Keywords: Rehab; unemployment; health care utilization; job worries; absenteeism; sick leave
    JEL: I11
    Date: 2010–01
  14. By: Esther Mot
    Abstract: This document describes the Dutch system of long-term care (LTC) for the elderly. An overview of LTC policy is also given. This document is part of the first stage of the European project ANCIEN (Assessing Needs of Care in European Nations), commissioned by the European Commission under the Seventh Framework Programme (FP7). Since the first stage of the project aims to facilitate structured comparisons of the organisation of LTC for the elderly in different countries, comparable reports have been written for most other European countries (including new member states). Future analyses in subsequent work packages within the project will build on these country reports.
    Keywords: long-term care; elderly; institutions; healthcare
    JEL: H51 I18
    Date: 2010–03
  15. By: Driouchi, Ahmed; Baijou, Ahmad
    Abstract: The interdependencies of health, education and poverty that are common knowledge to individuals are also present at the aggregate levels of countries and internationally. The assessment of these interdependencies is the central task of this research but based on the Demographic Health Surveys (DHS) of Egypt, Morocco and Turkey. The results attained through dependency tests and probit models, confirm the existence of major interdependencies at the levels of households. These findings support the need for accelerating and developing further integrated and transversal economic and social policies.
    Keywords: Interdependencies; Health; Education; Poverty; Egypt; Turkey; Morocco.
    JEL: D31
    Date: 2009–11–28

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