nep-hea New Economics Papers
on Health Economics
Issue of 2010‒10‒30
seventeen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Height and well-being amongst older Europeans By Kevin Denny
  2. Prediction of the economic cost of individual long-term care in the Spanish population By Catalina Bolancé; Ramon Alemany; Montserrat Guillén
  3. Different effects of social capital on health status among residents: evidence from modern Japan By Eiji Yamamura
  4. Food Prices and Overweight Patterns in Italy By Luca Pieroni; Donatella Lanari; Luca Salmasi
  5. The Cultural Revolution, Stress and Cancer By Tilak Abeysinghe; Jiaying Gu
  6. Natural Experiment Evidence on the Effect of Migration on Blood Pressure and Hypertension By Gibson, John; Stillman, Steven; McKenzie, David; Rohorua, Halahingano
  7. Compensating the Dead? Yes we can! By Marc Fleurbaey; Marie-Louise Leroux; Grégory Ponthière
  8. The Role of Family in Suicide Rate in Italy By Claudio Detotto; V. Sterzi
  9. Favourable cost-benefit in an early defibrillation program using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest By Sund, Björn; Svensson, Leif; Rosenqvist, Mårten; Hollenberg, Jacob
  10. Why Junior Doctors Don’t Want to Become General Practitioners: A Discrete Choice Experiment from the MABEL Longitudinal Study of Doctors By Peter Sivey; Anthony Scott; Anthony Scott; Julia Witt; Catherine Joyce; John Humphreys
  11. Are You Well Prepared for Long-term Care? – Assessing Financial Gaps in Private German Care Provision By Matthias Keese; Annika Meng; Reinhold Schnabel
  12. Going Beyond Gender as Usual: Why and How Global HIV/AIDS Donors Can Do More for Women and Girls By Christina Droggitis; David Wendt; Nandini Oomman
  13. The Health Effects of Climate Change: A Survey of Recent Quantitative Research By Margherita Grasso; Matteo Manera; Aline Chiabai; Anil Markandya
  14. Is health status of elderly worsening in India:A comparison of successive rounds of National Sample Survey data By Husain, Zakir; Ghosh, Saswata
  15. Lead, Mortality, and Productivity By Karen Clay; Werner Troesken; Michael R. Haines
  16. Age of Pension Eligibility, Gains in Life Expectancy, and Social Policy By Frank T. Denton; Byron G. Spencer
  17. Examining the Gender, Ethnicity, and Age Dimensions of the Healthy Immigrant Effect: Implications for Health Care Policy By Karen M. Kobayashi; Steven G. Prus

  1. By: Kevin Denny (University College Dublin)
    Abstract: This paper uses a cross-country representative sample of Europeans over the age of 50 to analyse whether individuals’ height is associated with higher or lower levels of well-being. Two outcomes are used: a measure of depression symptoms reported by individuals and a categorical measure of life satisfaction. It is shown that there is a concave relationship between height and symptoms of depression. These results are sensitive to the inclusion of several sets of controls reflecting demographics, human capital and health status. While parsimonious models suggest that height is protective against depression, the addition of controls, particularly related to health, suggests the reverse effect: tall people are predicted to have slightly more symptoms of depression. Height has no significant association with life satisfaction in models with controls for health and human capital.
    Keywords: height, depression, well-being, life satisfaction, health
    Date: 2010–10–22
  2. By: Catalina Bolancé (Departament d'Econometria, Estadística i Economia Espanyola, RFA-IREA, Universitat de Barcelona); Ramon Alemany (Departament d'Econometria, Estadística i Economia Espanyola, RFA-IREA, Universitat de Barcelona); Montserrat Guillén (Departament d'Econometria, Estadística i Economia Espanyola, RFA-IREA, Universitat de Barcelona)
    Abstract: Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.
    Date: 2010–09
  3. By: Eiji Yamamura
    Abstract: This paper aims to explore how social capital is related to self-rated health status in Japan and how this relationship depends on the extent to which a person is embedded into the community. This study used data from 3079 adult participants in Japan’s Social Policy and Social Consciousness (SPSC) survey conducted in 2000. Controlling for unobserved city size- and area-specific fixed effects, I find through Ordered Probit estimations that social capital has a significantly positive effect on health status for long-time but not for short-time residents. Results also suggested that the experience of divorce is negatively associated with health status for long- time but not short-time residents. People can enjoy a social network, a kind of social capital, if they are a member of such a network. Nevertheless, people appear to be negatively influenced if they are excluded from networks. Such positive and negative effects of social capital are more obvious when people are more deeply integrated into a community. Empirical study provided evidence that social capital and socio-economic effects on health status are significantly influenced by the extent to which respondents are integrated into a community.
    Keywords: Social capital; health status.
    JEL: I19 Z13 R58
    Date: 2010–09–29
  4. By: Luca Pieroni; Donatella Lanari; Luca Salmasi
    Abstract: In this paper we examine the role of relative food prices in determining the recent increase in body weight in Italy. Cross-price elasticities of unhealthy and healthy foods estimated by a demand system provide a consistent framework to evaluate substitution effects, when a close association is assumed between unhealthy (healthy) foods and more (less) energy-dense foods. We used a dataset constructed from a series of cross-sections of the Italian Household Budget Survey (1997-2005) to obtain the variables of the demand system, which accounts for regional price variability. The relative increase of healthy food prices was found to produce nontrivial elasticities of substitution towards higher relative consumption of unhealthy foods, with effects on weight outcomes. In addition, these changes were unevenly distributed among individuals and were particularly significant for those who were poorer and had less education.
    Keywords: Household Survey Data, Healthy and Unhealthy Foods, Overweight and Obesity, Elasticity of Substitution.
    JEL: D12 I10 I18
    Date: 2010–10–20
  5. By: Tilak Abeysinghe (Department of Economics, National University of Singapore); Jiaying Gu (Department of Economics, University of Illinois at Urbana-Champaign)
    Abstract: The link between mental stress and cancer is still a belief, not a well established scientific fact. Scientists have relied largely on opinions of cancer stricken patients to establish a link between stress and cancer. Such opinion surveys tend to produce contradictory statistical inferences. Although it is difficult to conduct scientific experiments on humans similar to those on animals, human history is replete with “experiments” that have caused enormous stress on some human populations. The objective of this exercise is to draw evidence from one such massive experiment, the Cultural Revolution in China. Cancer data from Shanghai analyzed through an age-period-cohort technique show very strong evidence in support of the hypothesis that mental stress causes cancer.
    Date: 2010–08–01
  6. By: Gibson, John (University of Waikato); Stillman, Steven (Motu Economic and Public Policy Research Trust); McKenzie, David (World Bank); Rohorua, Halahingano (University of Waikato)
    Abstract: Over 200 million people live outside their country of birth and experience large gains in material well-being by moving to where wages are higher. But the effect of this migration on health is less clear and existing evidence is ambiguous because of the potential for self-selection bias. In this paper, we use a natural experiment, comparing successful and unsuccessful applicants to a migration lottery to experimentally estimate the impact of migration on measured blood pressure and hypertension. Hypertension is a leading global health problem, as well as being an important health measure that responds quickly to migration. We use various econometric estimators to form bounds on the treatment effects since there appears to be selective non-compliance in the natural experiment. Even with these bounds the results suggest significant and persistent increases in blood pressure and hypertension, which have implications for future health budgets given the recent worldwide increases in immigration.
    Keywords: blood pressure, hypertension, lottery, migration, natural experiment
    JEL: C21 I12 J61
    Date: 2010–10
  7. By: Marc Fleurbaey (University Paris-Descartes, CORE, Sciences Po, LSE, IDEP.); Marie-Louise Leroux (CORE, Université Catholique de Louvain); Grégory Ponthière (Ecole Normale Supérieure, Paris School of Economics)
    Abstract: An early death is, undoubtedly, a serious disadvantage. However, the compensation of short-lived individuals has remained so far largely unexplored, probably because it appears infeasible. Indeed, short-lived agents can hardly be identified ex ante, and cannot be compensated ex post. We argue that, despite the above difficulties, compensation can be carried out by encouraging early consumption in the life cycle. In a model with heterogeneous preferences and longevities, we show how a specific social criterion can be derived from intuitive principles, and we study the corresponding optimal policy under various informational assumptions. We also study the robustness of our solution to alternative types of preferences and savings policies.
    Keywords: Compensation, Longevity, Mortality, Fairness, Redistribution.
    JEL: D63 D71 I18 J18
    Date: 2010–10–20
  8. By: Claudio Detotto; V. Sterzi
    Abstract: We use national panel data at provincial level to investigate the relationship between suicide rates and socio-economic factors in Italy. The role of family, drug and alcohol consumption, social conformism and population density are the main factors in explaining the suicide rate in Italy. In a further step, we check for the differences in the suicide determinants between southern and northern provinces. The findings show that the number and size of families as well as alcohol or drug abuse play a key role in the northern provinces, while density and social conformism appear to be the main factors in the South.
    Keywords: suicide rate; socio-economic determinants; role of family
    JEL: D10 K00 R00
    Date: 2010
  9. By: Sund, Björn (Department of Business, Economics, Statistics and Informatics); Svensson, Leif (Department of Cardiology); Rosenqvist, Mårten (Department of Cardiology); Hollenberg, Jacob (Department of Cardiology)
    Abstract: <p> Aims: Out-of-hospital cardiac arrest (OHCA) is fatal without treatment and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden.<p> Methods and Results: A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real world implemented intervention and the monetary value of a life (€ 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, call-outs for the fire services, overhead resources and costs for the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be € 13 000 and the cost per saved life was € 60 000. <p> Conclusions: The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.
    Keywords: Cost-benefit analysis; cost-utility analysis; cost-effectiveness analysis; cardiac arrest; defibrillation; ambulance; fire services
    JEL: D61 H43 I18
    Date: 2010–10–19
  10. By: Peter Sivey (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Anthony Scott (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Anthony Scott (Melbourne Institute of Applied Economic and Social Research, The University of Melbourne); Julia Witt (Department of Economics, University of Manitoba); Catherine Joyce (Department of Epidemiology and Preventive Medicine, Monash University); John Humphreys (School of Rural Health, Monash University)
    Abstract: A number of studies suggest there is an over-supply of specialists and an undersupply of GPs in many developed countries. Previous econometric studies of specialty choice from the US suggest that a number of factors play a role, including expected future earnings, educational debt, and having predictable working hours. Given endogeneity issues in revealed preference studies, a stated-preference approach is warranted. This paper presents results from a discrete-choice experiment completed by a sample of 532 junior doctors in 2008 before they choose a specialty training program. This was conducted as part of the first wave of the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal survey of doctors. We include key job attributes such as future earnings and hours worked, but also allow the choice to be influenced by academic research opportunities, continuity of care and the amount of procedural work. Interactions of attributes with doctor characteristics, including gender, educational debt, and personality traits are also examined. We find the income/working hours trade-offs estimated from our discrete choice model are close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs’ earnings by $50,000, increasing opportunities for procedural or academic work can increase the number of junior doctors choosing General Practice by between 8 and 16 percentage points, approximately 212 to 376 junior doctors per year. The results can inform policymakers looking to address unbalanced supply of doctors across specialties.
    Keywords: Junior doctors, discrete choice experiment, specialty choice
    JEL: C9 I11 J24
    Date: 2010–10
  11. By: Matthias Keese; Annika Meng; Reinhold Schnabel
    Abstract: The development of expenditure for care services is one of the most intensively debated topics in public. However, studies calculating financial provision gaps only focus on the macro-level implications for the compulsory care insurance. In contrast, this paper examines the individuals’ micro-level perspective. We use survey as well as regional and national statistical data to calculate expected individual costs of long-term care on a very detailed care arrangement and care level basis. Afterwards, we compare these costs with the individuals’ total wealth. In our most conservative policy scenario, our results show that about a third of statutorily insured individuals will have to face a financial care provision gap. Among homeowners, an even higher share will have to liquidate the main residence. The privately insured are affected to a somewhat lower extent. In both groups, the situation will become much more severe if the development of public transfers does not keep up with future increases of long-term care costs. Furthermore, regression analyses show that provision gaps are more frequent among statutorily insured individuals, females, and individuals in single households.
    Keywords: Long-term care costs; care prevalence; life expectancy; provision gap
    JEL: D91 H75 J14
    Date: 2010–09
  12. By: Christina Droggitis; David Wendt; Nandini Oomman
    Abstract: This brief shows how three of the biggest donors to global HIV/AIDS programs can go beyond their stated commitments to address gender inequality and more effectively combat HIV and AIDS.
    Keywords: Women, girls, HIV/AIDS, global programs, gender inequality, violence, men, family, community, donors, gender, world bank, Uganda
    Date: 2010
  13. By: Margherita Grasso; Matteo Manera; Aline Chiabai; Anil Markandya
    Abstract: In recent years there has been a large scientific and public debate on climate change and its direct as well as indirect effects on human health. According to World Health Organization (WHO, 2006), some 2.5 million people die every year from non-infectious diseases directly attributable to environmental factors such as air pollution, stressful conditions in the workplace, exposure to chemicals such as lead, and exposure to environmental tobacco smoke. Changes in climatic conditions and climate variability can also affect human health both directly and indirectly, via changes in biological and ecological processes that influence the transmission of several infectious diseases (WHO, 2003). In the past fifteen years a large amount of research on the effects of climate changes on human health has addressed two fundamental questions (WHO, 2003). First, can historical data be of some help in revealing how short-run or long-run climate variations affect the occurrence of infectious diseases? Second, is it possible to build more accurate statistical models which are capable of predicting the future effects of different climate conditions on the transmissibility of particularly dangerous infectious diseases? The primary goal of this paper is to review the most relevant contributions which have directly tackled those questions, both with respect to the effects of climate changes on the diffusion of non-infectious and infectious diseases. Specific attention will be drawn on the methodological aspects of each study, which will be classified according to the type of statistical model considered. Additional aspects such as characteristics of the dependent and independent variables, number and type of countries investigated, data frequency, temporal period spanned by the analysis, and robustness of the empirical findings are examined. <br />
    Keywords: Climate change; Health; Statistical models; Non-infectious diseases; Infectious diseases; Malaria; Cardiovascular diseases
    Date: 2010–10
  14. By: Husain, Zakir; Ghosh, Saswata
    Abstract: The increasing graying of India’s population raises concerns about the welfare and health status of the aged. One important source of information of health status of the elderly is the National Sample Survey Rounds on Morbidity and Health Care Expenditure. Using unit level data for 1995-96 and 2004 this paper has examined changes in reported health status of elderly in India and analyzed their relationship with living arrangements and extent of economic dependency. It appears that even after controlling for factors like caste, education, age, economic status and place of residence, there has been deterioration in self-perceived current health status of elderly. This paper argues that, although there have been changes in the economic condition and traditional living arrangements - with a decline in co-residential arrangements - this is not enough to explain the decline in reported health status and calls for a closer look at narratives of neglect being voiced in developing countries.
    Keywords: economic independence; co-residence; elderly; health status; ordered logit model; India
    JEL: J14 C35
    Date: 2010–09–05
  15. By: Karen Clay; Werner Troesken; Michael R. Haines
    Abstract: This paper examines the effect of water-borne lead exposure on infant mortality in American cities over the period 1900-1920. Infants are highly sensitive to lead, and more broadly are a marker for current environmental conditions. The effects of lead on infant mortality are identified by variation across cities in water acidity and the types of service pipes – lead, iron, or concrete – which together determined the extent of lead exposure. Time series estimates and estimates that restrict the sample to cities with lead pipes provide further support for the causal link between water-borne lead and infant mortality. The magnitudes of the effects were large. In 1900, a decline in exposure equivalent to an increase in pH from 6.7 to 7.5 in cities with lead-only pipes would have been associated with a decrease in infant mortality of 12.3 to 14.3 percent or about 22 fewer infant deaths per 1,000 live births. City-level evidence on wages in manufacturing suggests that the adverse health effects of lead may have extended beyond infants.
    JEL: I18 J24 N31 N32
    Date: 2010–10
  16. By: Frank T. Denton; Byron G. Spencer
    Abstract: Canadians are living longer and retiring younger. When combined with the aging of the baby boom generation, that means that the “inactive” portion of the population is increasing and there are concerns about possibly large increases in the burden of support on those who are younger. We model the impact of continued future gains in life expectancy on the size of the population that receives public pension benefits. We pay special attention to possible increases in the age of eligibility and the pension contribution rate that would maintain the publicly financed component of the retirement income security system.
    Keywords: age of pension eligibility, pension burden
    JEL: H55 J18 J26
    Date: 2010–10
  17. By: Karen M. Kobayashi; Steven G. Prus
    Abstract: Using data from the 2005 Canadian Community Health Survey, the current study expands on previous research on the healthy immigrant effect (HIE) in adult populations by considering the effects of both immigrant and visible minority status on health for males and females in mid- (45- 64) and later life (65+). The findings indicate that the HIE applies to recent immigrant men in midlife; that is, new male immigrants – those who immigrated less than 10 years ago – have better health compared to their Canadian-born counterparts, and that the effect is particularly strong for visible minorities. The picture is similar for older women who have recently immigrated, however this advantage largely disappears when a number of socio-demographic, socio-economic, and lifestyle factors are controlled. For older men and middle-aged women of color, however, the reality is strikingly different: both groups report health disadvantages compared to their Canadian-born counterparts, with both recent and longer-term midlife women having poorer health. Findings are discussed in terms of their implications for health care policy for immigrant adults.
    Keywords: healthy immigrant effect, gender, ethnicity, mid-life, later life, health care policy
    JEL: I18
    Date: 2010–10

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