nep-hea New Economics Papers
on Health Economics
Issue of 2010‒08‒14
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The Long-Term Care System in Germany By Erika Schulz
  2. The Long-Term Care System in Denmark By Erika Schulz
  3. Socioeconomic Environment and Mortality: A two-level Decomposition by Sex and Cause of Death By Martin Gächter; Engelbert Theurl
  4. Community based health insurance schemes in Africa: The case of Rwanda By Shimeles, Abebe
  5. Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries By Francesca Bettio; Giovanni Solinas
  6. An Examination of the Relationship between Health and Economic Growth By Garima Malik
  7. Ageing and asset prices By Elod Takats
  8. "The Effect of Child Health on Schooling: Evidence from Rural Vietnam" By Thuan Quang Thai; Evangelos M. Falaris
  9. Smoking persistence in Europe: A semi-parametric panel data analysis with selectivity By Dimitris Christelis; Anna Sanz-de-Galdeano
  10. Stochastic Mortality, Subjective Survival Expectations, and Individual Saving Behavior By Thomas Post; Katja Hanewald
  11. I feel good! Gender differences and reporting heterogeneity in self-assessed health By Pfarr, Christian; Schneider, Brit S.; Schneider, Udo; Ulrich, Volker
  12. The Trend of BMI Values of US Adults by Centiles, birth cohorts 1882-1986 By John Komlos; Marek Brabec
  13. Insurers' Negotiating Leverage and the External Effects of Medicare Part D By Darius N. Lakdawalla; Wesley Yin
  14. The Impact of Child Care Subsidies on Child Well-Being: Evidence from Geographic Variation in the Distance to Social Service Agencies By Chris M. Herbst; Erdal Tekin
  15. Effects of Welfare Reform on Illicit Drug Use of Adult Women By Corman, Hope; Das, Dhiman; Dave, Dhaval M.; Reichman, Nancy E.

  1. By: Erika Schulz
    Abstract: This document provides an overview of the long-term care system, the number and develop-ment of beneficiaries and the long-term care policy in Germany. The report 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). The first part of the project aims to facilitate structured comparison of the long-term care systems and policies in European Nations. Thus, this report is one of comparable reports provided for most European countries.
    Keywords: Long-term care system, long-term care policy, beneficiaries
    JEL: H51 I18 I19
    Date: 2010
  2. By: Erika Schulz
    Abstract: This document provides an overview of the long-term care system, the number and develop-ment of beneficiaries and the long-term care policy in Denmark. The report 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). The first part of the project aims to facilitate structured comparison of the long-term care systems and policies in European Nations. Thus, this report is one of comparable reports provided for most European countries.
    Keywords: Long-term care system, long-term care policy, beneficiaries
    JEL: H51 I18 I19
    Date: 2010
  3. By: Martin Gächter; Engelbert Theurl
    Abstract: Gender inequalities in longevity/mortality are a major area of research since the 1970s. Despite substantial insights, the questions posed and the research strategies used are still in a state of flux. In the present paper we shed some light on the question, to which extent socioeconomic variables determine the gender gap in mortality for important causes of death. Thereby we specifically focus on behavior-related causes of death. We follow an ecological approach based on aggregated mortality data from Austria both at the community and the district level covering the time period 1969 - 2004. By using weighted regression analysis (panel fixed effects, pooled and cross section) we find that higher income levels reduce male mortality in most causes of death (including malignant neoplasms and diseases of the circulatory system), while this indicator appear to be insignificant for female mortality in these causes. This indicates that the decreasing effect of the higher socioeconomic status on mortality might be canceled out by a gender role equalization effect for women due to the adoption of unhealthy life styles (e.g. smoking). This finding is also confirmed by the fact that female mortality does not decrease with increasing income levels for smoking-related diseases, ischaemic heart disease and lung cancer. Thus, our results suggest that the decreasing female mortality advantage is mainly caused by increased smoking among women, while in the case of alcohol, violence and accidents the gender equalization seems to work in the opposite direction. In a nutshell, we conclude that the examination of the gender-specific mortality rates and mortality gaps without a disaggregation between different causes of death might mask important patterns of the epidemiological transition and the underlying drivers.
    Keywords: mortality, gender differential, causes of death, life expectancy, Austria
    JEL: I12 I18 J16
    Date: 2010–07
  4. By: Shimeles, Abebe (Development Research Department African Development Bank)
    Abstract: Community-based health insurance schemes (Mutuelles) in Rwanda are one of the largest experiments in community based risk-sharing mechanisms in Sub-Saharan Africa for health related problems. This study examines the impact of the program on demand for modern health care, mitigation of out-of-pocket catastrophic health expenditure and social inclusiveness based on a nationally representative household survey using traditional regression approach and matching estimator popular in the evaluation literature. Our findings suggest that Mutuelles have been successful in increasing utilization of modern health care services and reducing catastrophic health related expenditure. According to our preferred method, higher utilization of health care services was found among the insured non-poor than insured poor households, with comparable effect in reducing health-related expenditure shocks. This reinforces the inequity already inherent in the Mutuelles system.<p>
    Keywords: demand for health services; catastrophic health expenditure; average treatment effects; endogenous dummy variable; matching estimator
    JEL: I10
    Date: 2010–08–06
  5. By: Francesca Bettio; Giovanni Solinas
    Abstract: Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. Comparison between alternative types of provisions within each country suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. Comparison of home care provisions across the three countries suggests that the Italian and the Danish systems are the most cost effective, but the Danish system is more equitable, overall. These latter findings are partly explained by progressive replacement in Italy of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly, the migrant-in-the-family model of long term care. This new model has spread across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.
    Keywords: elderly care; long term care; cost-effectiveness; migration; welfare
    JEL: I12 I39 J14
    Date: 2009–02
  6. By: Garima Malik
    Abstract: This paper attempts to examine the relationship between health and economic growth. The rate of growth is measured using gross national income (GNI) and health status is measured using infant mortality rate and life expectancy rate. A theoretical framework has been developed to model this linkage between health and growth and this is further tested using a regression model which tests the causality between these variables of interest. We have also assumed in this analysis that these variables are affected by state-specific unobservable fixed effects, since there are other cultural, political and social factors at work here. [Working Paper No. 185]
    Keywords: Health, Economic Growth, Gross National Income (GNI), theoretical framework, cultural, political, social factors
    Date: 2010
  7. By: Elod Takats
    Abstract: The paper investigates how ageing will affect asset prices. A small model is used to show that economic and demographic factors drive asset, and in particular house, prices. These factors are estimated in a panel regression framework encompassing BIS real house price data from 22 advanced economies between 1970 and 2009. The estimates show that demographic factors affect real house prices significantly. Combining the results with UN population projections suggests that ageing will lower real house prices substantially over the next forty years. The headwind is around 80 basis points per annum in the United States and much stronger in Europe and Japan. Based on the analysis, global asset prices are likely to face substantial headwinds from ageing.
    Keywords: ageing, asset prices, house prices
    Date: 2010–08
  8. By: Thuan Quang Thai (Max Planck Institute for Demographic Research); Evangelos M. Falaris (Department of Economics,University of Delaware)
    Abstract: We study the relationship between long term child health and human capital. Child health may suffer if a child is inadequately nourished or is exposed to disease early in life and this may affect subsequent accumulation of human capital. We use data from rural Vietnam to examine the impact of child health on delay in starting school and schooling progress taking into account that choices of families affect children’s health and schooling. Our instrument is early life rainfall shocks that have differential effects arising from regional economic diversity. Our estimates indicate that better child health results in meaningfully improved schooling outcomes.
    Keywords: child health, z-score, school entry delay, schooling gap, rainfall shocks, Vietnam
    JEL: I12 J24 J13 O15
    Date: 2010
  9. By: Dimitris Christelis (Department of Economics, University Of Venice Cà Foscari); Anna Sanz-de-Galdeano (Department of Economics and Economic History, Universitat Autònoma de Barcelona)
    Abstract: We study smoking persistence, which can be due to both true state dependence and individual unobserved heterogeneity, in ten European countries. We distinguish between the two sources of persistence by using semi-parametric dynamic panel selection methods, applied to both smoking participation and cigarette consumption. We find that for both smoking decisions true state dependence is generally much smaller when unobserved individual heterogeneity is taken into account, and we also uncover large differences in true state dependence across countries. Finally, allowing for heaping in the reported number of cigarettes smoked considerably improves the fit of our model.
    Keywords: smoking, panel data, state dependence, selectivity
    JEL: C33 C34 D12 I10 I12
    Date: 2010
  10. By: Thomas Post; Katja Hanewald
    Abstract: Theoretical studies suggest that unexpected changes in future mortality and survival probabilities (stochastic mortality) are important determinants of individuals’ decisions about consumption, saving, asset allocation, and retirement timing. Using data on subjective survival expectations elicited in the Survey of Health, Ageing and Retirement in Europe (SHARE) and corresponding life table data from the Human Mortality Database (HMD), we find evidence of respondents’ awareness of stochastic mortality. We also find that respondents’ saving behavior is influenced by stochastic mortality perceptions.
    Keywords: stochastic mortality, subjective survival expectations, forecast dispersion, savings behavior
    JEL: D14 D84 D91 H31 J11
    Date: 2010–07
  11. By: Pfarr, Christian; Schneider, Brit S.; Schneider, Udo; Ulrich, Volker
    Abstract: For empirical analysis and policy-oriented recommendation, the precise measurement of individual health or well-being is essential. The problem with variables based on questionnaires such as self-assessed health is that the answer may depend on individual reporting behaviour. Moreover, if individual‟s health perception varies with certain attitudes of the respondent reporting heterogenei-ty may lead to index or cut-point shifts of the health distribution, causing estimation problems. We analyse the reporting behaviour of individuals on their self-assessed health status, a five-point categorical variable. We explore observed heterogeneity in categorical variables and include unob-served individual heterogeneity using German panel data. Estimation results show different im-pacts of socioeconomic and health related variables on the five subscales of self-assessed health. Moreover, the answering behaviour varies between female and male respondents, pointing to gen-der specific perception and assessment of diseases. Reporting behaviour on self-assessed health questions in surveys is problematic due to a possible heterogeneity. Hence, in case of reporting heterogeneity, using self-assessed measures in empirical studies may be misleading or at least ambiguous.
    Keywords: reporting heterogeneity; generalized ordered probit; self-assessed health
    JEL: I12 C21
    Date: 2010–08–03
  12. By: John Komlos; Marek Brabec
    Abstract: Trends in BMI values are estimated by centiles of the US adult population by birth cohorts 1886-1986 stratified by ethnicity. The highest centile increased by some 18 to 22 units in the course of the century while the lowest ones increased by merely 1 to 3 units. Hence, the BMI distribution became increasingly right skewed as the distance between the centiles became increasingly larger. The rate of change of BMI centile curves varied considerably over time. The BMI of white men and women experienced upsurges after the two World Wars and downswings during the Great Depression and again after 1970. However, among blacks the pattern is different during the first half of the century with men's rate of increase in BMI values decreasing substantially and that of females remaining unchanged at a relatively high level until the Second World War. However, after the war the rate of change of BMI values of blacks resembled that of the whites with an accelerating phase followed by a slow down around the 1970s. In sum, the creeping nature of the obesity epidemic is evident, as the technological and lifestyle changes of the 20th century affected various segments of the population quite differently.
    JEL: I10
    Date: 2010–08
  13. By: Darius N. Lakdawalla; Wesley Yin
    Abstract: Public financing of private health insurance may generate external effects beyond the subsidized population, by influencing the size and bargaining power of health insurers. We test for this external effect in the context of Medicare Part D. We analyze how Part D-related insurer size increases impacted retail drug prices negotiated by insurers for their non-Part D commercial market. On average, Part D lowered retail prices for commercial insureds by 5.8% to 8.5%. The cost-savings to the commercial market amount to $3bn per year, which approximates the total annual savings experienced by Part D beneficiaries who previously lacked drug coverage.
    JEL: H57 I11 I18 L11 L51
    Date: 2010–08
  14. By: Chris M. Herbst; Erdal Tekin
    Abstract: In recent years, child care subsidies have become an integral part of federal and state efforts to move economically disadvantaged parents from welfare to work. Although previous empirical studies consistently show that these employment-related subsidies raise work levels among this group, little is known about the impact of subsidy receipt on child well-being. In this paper, we identify the causal effect of child care subsidies on child development by exploiting geographic variation in the distance that families must travel from home in order to reach the nearest social service agency that administers the subsidy application process. Using data from the Kindergarten cohort of the Early Childhood Longitudinal Study, our instrumental variables estimates suggest that children receiving subsidized care in the year before kindergarten score lower on tests of cognitive ability and reveal more behavior problems throughout kindergarten. However, these negative effects largely disappear by the time children reach the end of third grade. Our results point to an unintended consequence of a child care subsidy regime that conditions eligibility on parental employment and deemphasizes child care quality.
    JEL: I18 I2 J13
    Date: 2010–08
  15. By: Corman, Hope; Das, Dhiman; Dave, Dhaval M.; Reichman, Nancy E.
    Abstract: Exploiting changes in welfare policy across states and over time and comparing relevant population subgroups within an econometric difference-in-differences framework, we estimate the causal effects of welfare reform on adult women’s illicit drug use from 1992 to 2002, the period during which welfare reform unfolded in the U.S. The analyses are based on all available and appropriate national datasets, each offering unique strengths and measuring a different drug-related outcome. We investigate self-reported illicit drug use (from the National Surveys on Drug Use and Health), drug-related prison admissions (from the National Corrections Reporting Program), drug-related arrests (from the Uniform Crime Reports), drug-related treatment admissions (from the Treatment Episode Data Set), and drug-related emergency room episodes (from the Drug Abuse Warning Network). We find robust and compelling evidence that welfare reform led to declines in illicit drug use and increases in drug treatment among women at risk for relying on welfare, and some evidence that the effects operate, at least in part, through both TANF drug sanctions and work incentives.
    Date: 2010–06

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