nep-hea New Economics Papers
on Health Economics
Issue of 2010‒04‒11
seventeen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Where People Live and Die Makes a Difference: Individual and Geographic Disparities in Well-Being Progression at the End of Life By Denis Gerstorf; Nilam Ram; Jan Goebel; Jürgen Schupp; Ulman Lindenberger; Gert G. Wagner
  2. One Last Puff? Public Smoking Bans and Smoking Behavior By Silke Anger; Michael Kvasnicka; Thomas Siedler
  3. The impact of ambiguity on health prevention and insurance. By Johanna Etner; Sandrine Spaeter
  4. Does Education Reduce the Risk of Hypertension? Estimating the Biomarker Effect of Compulsory Schooling in England By Powdthavee, Nattavudh
  5. Timing of death and the repeal of the Swedish inheritance tax By Eliason, Marcus; Ohlsson, Henry
  6. Mandatory Sick Pay Provision: A Labor Market Experiment By Bauernschuster, Stefan; Duersch, Peter; Oechssler, Jörg; Vadovic, Radovan
  7. Size of economic activity and occurrence of fatal traffic accidents: a count panel data analysis on Fukuoka prefecture in Japan By Yoshitsugu Kitazawa
  8. Multi-partnered Fertility and Mental Health among Fragile Families By Kristin Turney; Marcia J. Carlson
  9. A Cost-benefit Analysis of Cataract Surgery based on the English Longitudinal Survey of Ageing By Martin Weale
  10. Comparison of long-term changes in teenage body mass index between urban and other areas in Japan from 1986 to 2003 By Yamamura, Eiji
  11. Effects of Female Labor Participation and Marital Status on Smoking Behavior in Japan By Yamamura, Eiji
  12. Diet, Health and Work Intensity in England and Wales, 1700-1914 By Bernard Harris; Roderick Floud; Robert W. Fogel; Sok Chul Hong
  13. Mental Health Treatment and Criminal Justice Outcomes By Richard Frank; Thomas G. McGuire
  14. One for the Road: Public Transportation, Alcohol Consumption, and Intoxicated Driving By C. Kirabo Jackson; Emily Greene Owens
  15. Estimation of a Dynamic Model of Weight By Shu Wen Ng; Edward C. Norton; David K. Guilkey; Barry M. Popkin
  16. The Trend of Mean BMI Values of US Adults, Birth Cohorts 1882-1986 Indicates that the Obesity Epidemic Began Earlier than Hitherto Thought By John Komlos; Marek Brabec
  17. Do Strikes Kill? Evidence from New York State By Jonathan Gruber; Samuel A. Kleiner

  1. By: Denis Gerstorf; Nilam Ram; Jan Goebel; Jürgen Schupp; Ulman Lindenberger; Gert G. Wagner
    Abstract: Lifespan psychological research has long been interested in the contextual embeddedness of individual development. To examine if and how regional factors relate to between-person disparities in the progression of late-life well-being, we applied three-level growth curve models to 24-year longitudinal data from deceased participants of the German Socio-Economic Panel Study (N = 3,427; age at death: 18 to 101 years). Results indicate steep declines in well-being with impending death, with some 8% of the between-person differences in both level and decline of well-being reflecting between-county differences. Exploratory analyses revealed that individuals living and dying in less affluent counties reported lower late-life well-being, controlling for key individual predictors including age at death, gender, education, and household income. The regional factors examined did not directly relate to well-being change, but were found to moderate (e.g., amplify) the disparities in change attributed to individual factors. Our results suggest that resource-poor counties provide relatively less fertile grounds for successful aging until the end of life and may serve to exacerbate disparities. We conclude that examinations of how individual and residential characteristics interact can further our understanding of individual psychological outcomes and suggest routes for future inquiry.
    Keywords: Neighborhoods; Selective mortality; successful aging; differential aging; psychosocial factors; well-being; longitudinal methods
    JEL: I12 J14 R23
    Date: 2010
  2. By: Silke Anger; Michael Kvasnicka; Thomas Siedler
    Abstract: This paper investigates the short-term effects of public smoking bans on individual smoking behavior. In 2007 and 2008, state-level smoking bans were gradually introduced in all of Germany’s sixteen federal states. We exploit this variation in the timing of state bans to identify the effect that smoke-free policies had on individuals’ smoking propensity and smoking intensity. Using rich longitudinal data from the German Socio-Economic Panel Study, our difference-in-differences estimates show that the introduction of smoke-free legislation in Germany did not change average smoking behavior within the population. However, our estimates also point to important heterogeneous effects. Groups that go out more often, and hence are more exposed to the constraints of public smoking bans in everyday life, did adjust their smoking behavior. Specifically, we find that young, unmarried individuals, and those living in urban areas are groups that are both less likely to smoke and smoke less intensively following the introduction of public smoking bans. Furthermore, effects on individual smoking habits proved stronger in states that had more strict smoking bans. Public smoking bans, therefore, have important health benefits over and above the reduction in exposure of non-smokers to second-hand smoke that is their immediate and prime objective.
    Keywords: Public smoking bans; smoking, cigarette consumption, treatment effects
    JEL: I12 K32 I18 C33
    Date: 2010
  3. By: Johanna Etner; Sandrine Spaeter
    Abstract: In this paper, we analyze the choice of primary prevention made by individuals who bear a risk of being in bad health and an additive risk (of complications) that occurs after a disease has been diagnosed. By considering a two argument utility (depending on wealth and health), we show that the presence of a well-known (no ambiguity) additive risk of complications induces more investment in primary prevention by a risk-averse agent only if her preferences does not display some cross prudence in wealth (u122 < 0). If there is some ambiguity on the e¤ective probability of complication, an increase in ambiguity aversion increases prevention if the agent is a correlation lover (u12 > 0). We also show that full (partial) insurance can be optimal even if insurance premia are loaded (fair). These results hold with and without prevention and the individuals attitudes toward correlation help explain the impact of ambiguity on the optimal individual decisions.
    Keywords: health; utility; ambiguity; prevention; insurance.
    JEL: D81 I19
    Date: 2010
  4. By: Powdthavee, Nattavudh (University of York)
    Abstract: This paper estimates the exogenous effect of schooling on reduced incidence of hypertension. Using the changes in the minimum school-leaving age law in the United Kingdom from age 14 to 15 in 1947, and from age 15 to 16 in 1973, as sources of exogenous variation in schooling, the regression discontinuity and IV-probit estimates imply that completing an extra year of schooling reduces the probability of developing subsequent hypertension by approximately 7-12% points; the result which holds only for men and not for women. The correct IV-probit estimates of the LATE for schooling indicate the presence of a large and negative bias in the probit estimates of schooling-hypertension relationship for the male subsample.
    Keywords: hypertension, compulsory schooling, biomarker, regression discontinuity, health
    JEL: H1 I1 I2
    Date: 2010–03
  5. By: Eliason, Marcus (Institute of Labour Market Policy Evaluation); Ohlsson, Henry (Department of Economics)
    Abstract: Does taxation affect the timing of death? This is an interesting example of how behavior might be affected by economic incentives. We study how two changes in Swedish inheritance taxation 2003/04 and 2004/05 have affected mortality during the turns of the years. Our first main result is that deceased with estates taxable for legal heirs were 10 percentage points more likely to have died on New Year’s Day 2005, from when the inheritance tax was repealed, rather than on New Year’s Eve 2004, compared to deceased without taxable estates for legal heirs. The second main result is that deceased with estates taxable for a married spouse were 12 percentage points more likely to have died on New Year’s Day 2004, from when the inheritance tax between spouses was repealed, rather than on New Year’s Eve 2003, compared to deceased without taxable estates for a married spouse.
    Keywords: behavioral response to taxes; timing of death; estate tax; inheritance tax; tax avoidance; mortality
    JEL: H24 H31 I12
    Date: 2010–03–26
  6. By: Bauernschuster, Stefan; Duersch, Peter; Oechssler, Jörg; Vadovic, Radovan
    Abstract: Sick-pay is a common provision in labor contracts. It insures workers against a sudden loss of income due to unexpected absences and helps them smooth consumption. Therefore, many governments find sick-pay socially desirable and choose to mandate its provision. But sick-pay is not without its problems. Not only it suffers from moral hazard but more importantly it is subject to a potentially serious adverse selection problem (higher sick-pay attracts sicker workers). In this paper we report results of an experiment which inquires to the extend and the severity of the adverse selection when sick-pay is voluntary versus when it is mandatory. Theoretically, mandating sick-pay may be effective in diminishing adverse selection. However, our data provide clean evidence that counteracting effects are more salient. Mandatory sick pay exacerbates moral hazard problems by changing fairness perceptions and, as a consequence, increases sick pay provision far above the mandatory levels.
    Keywords: sick pay; sick leave; experiment; gift exchange.
    JEL: C9 C7 J3
    Date: 2010–03–30
  7. By: Yoshitsugu Kitazawa (Faculty of Economics, Kyushu Sangyo University)
    Abstract: In this paper, the investigation is conducted on the relationship between the number of fatalities by dint of traffic accidents and the gross municipal product, by using the panel data whose crosssectional units are composed of municipalities in Fukuoka Prefecture in Japan. It turns out that the conventional quasi-differenced GMM estimator gives unconvincing results, while some of the GMM estimators proposed by Kitazawa (2007) give convincing results. The convincing results suggest that the diseconomy of scale is recognized in the occurrence of traffic fatalities.
    Keywords: traffic accident, number of fatalities, gross municipal product, count panel data, GMM, diseconomy of scale
    JEL: C23 I12 R41
    Date: 2010–03
  8. By: Kristin Turney (University of Michigan); Marcia J. Carlson (University of Wisconsin-Madison)
    Abstract: This paper uses data from the Fragile Families and Child Wellbeing Study to examine the association between multi-partnered fertility (MPF) when parents have children with more than one partner and parents‘ mental health, including Major Depressive Disorder, heavy episodic drinking, and illicit drug use. Random-effects models provide some evidence that mothers‘ and fathers‘ MPF is linked to adverse mental health. However, these associations mostly disappear when we use the more conservative fixed-effects models that estimate changes in MPF as a function of changes in individual mental health. We also find evidence that social selection may account for the link between MPF and mental health, as depressed mothers and fathers, as well as mothers who report heavy episodic drinking, are more likely to have a child by a new partner. Ultimately, MPF and mental health may be reciprocally related and part of broader processes of social disadvantage.
    Keywords: depression, parenting, mental health, Fragile Families and Child Wellbeing Study, social disadvantage
    JEL: C80 D02 D60 I32
    Date: 2010–03
  9. By: Martin Weale
    Abstract: This paper uses the English Longitudinal Survey of Ageing to explore the selfreport effect of cataract operations on eyesight. Calibrating the results to an existing study of the effect of imperfect eyesight on qualty of life, the impact of cataract operations on quality-adjusted life-years is found to be very similar to that established in specific studies and well above the costs of cataract operations. The implications of this for the treatment of medical care in the national accounts are discussed.
    Date: 2009–11
  10. By: Yamamura, Eiji
    Abstract: Japanese prefecture level panel data for the period 1986–2003 was used to analyze and compare the determinants of teenage body mass index (BMI) by sex and geographical area. Major findings through random effects estimation were as follows: (1) BMI consistently increased during the period in males aged 10–16 and in females aged 10–13 years, but not in 16-year-old females; (2) there was no difference in this trend between urban and other areas in most cases. However, the BMI of 16-year-old females was markedly lower in urban areas than in other areas. These findings suggest that girls who reach adolescence have a greater incentive to go on a diet and this tendency is more distinct in urban areas than in other areas.
    Keywords: BMI; Diet.
    JEL: I30 I11 R11
    Date: 2010–04–03
  11. By: Yamamura, Eiji
    Abstract: Using individual level data (the Japanese General Social Survey), this paper aims to explore how interaction between genders contributes to the cessation of smoking in Japan, where females are distinctly less inclined to smoke than males. Controlling for various socioeconomic factors and selection bias, I find through a Heckman-type selection estimation that proportions of female employees in workplaces are negatively associated with male smoking but not with female smoking. Furthermore, married males are less likely to smoke than single males, whereas there is no difference in smoking rates between married and single females. These results suggest that smokers are more inclined to cease smoking when they are more likely to have contact with opposite sex nonsmokers. Overall, this empirical study provides evidence that the psychological effect of the presence of people in one’s surroundings has a direct significant effect upon smoking behavior; however, this effect is observed only among males and not females.
    Keywords: social pressure; female labor participation; marital status; smoking behavior
    JEL: D12 I12 Z13
    Date: 2010–03–31
  12. By: Bernard Harris; Roderick Floud; Robert W. Fogel; Sok Chul Hong
    Abstract: In their different ways, both Thomas Malthus and Thomas McKeown raised fundamental questions about the relationship between food supply and the decline of mortality. Malthus argued that food supply was the most important constraint on population growth and McKeown claimed that an improvement in the population’s capacity to feed itself was the most important single cause of mortality change. This paper explores the implications of these arguments for our understanding of the causes of mortality decline in Britain between 1700 and 1914. It presents new estimates showing changes in the calorific value and composition of British diets in 1700, 1750, 1800 and 1850 and compares these with the official estimates published by the Royal Society in 1917. It then considers the implications of these data in the light of new arguments about the relationship between diet, work intensity and economic growth. However the paper is not solely concerned with the analysis of food-related issues. It also considers the ways in which sanitary reform may have contributed to the decline of mortality at the end of the nineteenth century and it pays particular attention to the impact of cohort-specific factors on the pattern of mortality decline from the mid-nineteenth century onwards.
    JEL: I1 I3 N3
    Date: 2010–04
  13. By: Richard Frank; Thomas G. McGuire
    Abstract: Are many prisoners in jail or prison because of their mental illness? And if so, is mental health treatment a cost-effective way to reduce crime and lower criminal justice costs? This paper reviews and evaluates the evidence assessing the potential of expansion of mental health services for reducing crime. Mental illness and symptoms of mental illness are highly prevalent among adult and child criminal justice populations. The association between serious mental illness and violence and arrest is particularly strong among individuals who are psychotic and do not adhere to medication. Two empirical studies augment the empirical research base relating mental illness to crime. In a recent community sample of adults, we find higher rates of arrest for those with serious mental illness and with substance abuse. Among youth, even with family fixed effects, antisocial personality scores predict future school problems and arrests. A large body of research tracks mental health and criminal justice outcomes associated with treatments and social policies. Reviews of the cost-effectiveness of treatments for children with behavioral problems, mental health courts, and mandatory outpatient treatment are inconclusive.
    JEL: I18
    Date: 2010–04
  14. By: C. Kirabo Jackson; Emily Greene Owens
    Abstract: We exploit arguably exogenous train schedule changes in Washington DC to investigate the relationship between public transportation provision, the risky decision to consume alcohol, and the criminal decision to engage in alcohol–impaired driving. Using a triple differences strategy, we provide evidence that overall there was little effect on DUI arrests, alcohol related fatal traffic and alcohol related arrests. However, we find that these overall effects mask considerable heterogeneity across geographic areas and spatial shifting. Specifically, we find that areas close to bars that are within walking distance to Metro stations experience increases in alcohol related arrests and decreases in DUI arrests.
    JEL: I18 R49
    Date: 2010–04
  15. By: Shu Wen Ng; Edward C. Norton; David K. Guilkey; Barry M. Popkin
    Abstract: The ongoing debate about the economic causes of obesity has focused on the changing relative prices of diet and exercise. This paper uses a model that explicitly includes time and spatially varying community-level urbanicity and price measures as instruments to obtain statistically correct measures for the endogenous effects of diet, physical activity, drinking, and smoking on weight. We apply a dynamic panel system GMM estimation model to longitudinal (1991–2006) data from China to model weight and find that among adult men in China, about 6.1% of weight gain was due to declines in physical activity and 2.9-3.8% was due to dietary changes over this period. In the long run, physical activity can account for around 6.9% of weight gain, while diet can account for 3.2-4.2% of weight gain.
    JEL: I12
    Date: 2010–04
  16. By: John Komlos; Marek Brabec
    Abstract: The trend in the BMI values of the US population has not been estimated accurately because time series data are unavailable and because the focus has been on calculating period effects. In contrast to the prevailing strategies, we estimate the trend and rate of change of BMI values by birth cohorts stratified by gender and ethnicity born 1882-1986. We use loess additive regression models to estimate age and trend effects of BMI values of US-born black and white adults measured between 1959 and 2006. We use all the NHES and NHANES survey data and find that the increase in BMI was already underway among the birth cohorts of the early 20th century. The rate of increase was fastest among black females; for the three other groups under consideration, the rates of increase were similar. The generally persistent upward trend was punctuated by upsurges, particularly after each of the two World Wars. That the estimated rate of change of BMI values increased by 71% among black females between the birth cohorts 1955 and those of 1965 is indicative of the rapid increases in their weight. We infer that transition to post-industrial weights was a gradual process and began considerably earlier than hitherto supposed.
    JEL: I00
    Date: 2010–04
  17. By: Jonathan Gruber; Samuel A. Kleiner
    Abstract: Concerns over the impacts of hospital strikes on patient welfare led to substantial delay in the ability of hospitals to unionize. Once allowed, hospitals unionized rapidly and now represent one of the largest union sectors of the U.S. economy. Were the original fears of harmful hospital strikes realized as a result? In this paper we analyze the effects of nurses’ strikes in hospitals on patient outcomes. We utilize a unique dataset collected on nurses’ strikes over the 1984 to 2004 period in New York State, and match these strikes to a restricted use hospital discharge database which provides information on treatment intensity, patient mortality and hospital readmission. Controlling for hospital specific heterogeneity, patient demographics and disease severity, the results show that nurses’ strikes increase in-hospital mortality by 19.4% and 30-day readmission by 6.5% for patients admitted during a strike, with little change in patient demographics, disease severity or treatment intensity. This study provides some of the first analytical evidence on the effects of health care strikes on patients, and suggests that hospitals functioning during nurses’ strikes are doing so at a lower quality of patient care.
    JEL: I12 I23 J52 J62
    Date: 2010–03

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