nep-hea New Economics Papers
on Health Economics
Issue of 2010‒11‒20
nineteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. The message framing of health communications : how to elicit higher intention to get an annual pap test ? By L. Balbo
  2. Impact of Specialization on Health Outcomes – Evidence from U.S. Cancer Data By Frank R. Lichtenberg; Johannes Schoder
  3. The Weight of the Crisis: Evidence from Newborns in Argentina By Bozzoli, Carlos; Quintana-Domeque, Climent
  5. Measuring the external health cost of particulate matter from road traffic and other sources in Stockholm, Sweden. By Nerhagen, Lena; Bergström, Robert; Forsberg, Bertil; Johansson, Christer; Eneroth, Kristina
  6. Can sickness absence be affected by information meetings? Evidence from a social experiment By Johansson, Per; Lindahl, Erica
  7. Education and Obesity in Four OECD Countries By Franco Sassi; Marion Devaux; Jody Church; Michele Cecchini; Francesca Borgonovi
  8. Explaining Differences in Remuneration Rates of Nursing Homes in Germany By Roman Mennicken; Boris Augurzky; Heinz Rothgang; Jürgen Wasem
  9. Induced Abortion Potential Among Indian Women By U.S. Mishra; Mala Ramanathan; S. Irudaya Rajan
  10. Syphilis Cycles By David Aadland; David Finnoff; Kevin X.D. Huang
  11. Protecting child nutritional status in the aftermath of a financial crisis : evidence from Indonesia By Giles, John; Satriawan, Elan
  12. The distributional impact of reforms to disability benefits for older people in the UK By Hancock R; Pudney S
  13. The causal relationship between education, health and health related behaviour: Evidence from a natural experiment in England By Nils Braakmann
  14. Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms By Zack Cooper; Steve Gibbons; Simon Jones; Alistair McGuire
  15. Worker Absence and Productivity: Evidence from Teaching By Mariesa A. Herrmann; Jonah E. Rockoff
  16. Does Menstruation Explain Gender Gaps in Work Absenteeism? By Jonah E. Rockoff; Mariesa A. Herrmann
  17. Menthol Cigarettes and Smoking Cessation Behavior: A White Paper By Anderson, Stacey J PhD University of California - San Francisco
  18. Menthol’s Potential Effects on Nicotine Dependence: A White Paper By Yerger, Valerie B ND
  19. Potential Health Effects of Menthol: A White Paper By Salgado, Maria Victoria MD

  1. By: L. Balbo (CERAG - Centre d'études et de recherches appliquées à la gestion - CNRS : UMR5820 - Université Pierre Mendès-France - Grenoble II)
    Abstract: In an online experiment, women (N=209) were randomly exposed to a pamphlet promoting Pap test. The pamphlet was either gain- or loss-framed and emphasized either the prevention or detection function of the Pap. We hypothesized that the fit between framing and function (i.e. gain-prevention and loss-detection) will result in higher intention to follow the recommendation. Moreover, we predicted that under the non-fit condition (i.e. gain-detection and loss-prevention); people higher in perceived vulnerability will have higher intention to follow the recommendation. Analyses revealed that our hypotheses were partially supported
    Keywords: Marketing of health, health communication, message framing
    Date: 2010
  2. By: Frank R. Lichtenberg (Columbia University); Johannes Schoder (Socioeconomic Institute, University of Zurich)
    Abstract: There have been many studies of the volume-outcome relationship. In all of these, the unit of analysis is the hospital or physician. However, this level of analysis is mostly limited to the use of in-hospital mortality rates and is particularly sensitive to selective referral. Moreover, the literature on agglomeration economies highlights the importance of information spillovers within regions (Glaeser, 2010). To overcome these problems, our study is the first that examines the volume-outcome relationship on a regional (county or cancer registry) level. Using data from the National Cancer Institute’s Surveillance, Epidemiology and End Results program we find that regions with relatively more of the same cancer type exhibit relatively better health outcomes.
    Keywords: Specialization, experience, cancer, survival
    JEL: I12
    Date: 2010–10
  3. By: Bozzoli, Carlos (DIW Berlin); Quintana-Domeque, Climent (Universidad de Alicante)
    Abstract: Argentina hit headlines around the world in 2002 on account of the largest debt default in history and a sudden economic collapse that generated statistics reminiscent of those from the Great Depression. In this article we focus on other consequences of the crisis that are not so obvious but that may linger for decades. Combining macroeconomic indicators with the Argentine national registry of live births (approximately 1.9 million from 2001 through 2003), we show that the crisis led to an average birth-weight loss of 30 grams. Our estimate is robust to different identification strategies. This deterioration in birth weight occurred in only about six months, and represents one-sixth of the difference in average birth weight between American and Pakistani babies. We also find that the crisis affected particularly the weight of babies born of mothers of low socioeconomic status. In an attempt to estimate the long-term economic costs of the crisis, we simulate the average loss of future individual earnings due to the reduction in average birth weight: about $500 per live birth.
    Keywords: economic crisis, birth weight, Argentina
    JEL: I1 J1
    Date: 2010–10
  4. By: Nerhagen, Lena (VTI); LI, Chuan-Zhong
    Abstract: Although the value of reducing mortality risks and that of reducing life year losses are closely related to each other, the valuation literature seems to treat them rather separately resulting in conflicting value estimates. While the former is more concerned with saved statistical lives from accidents, the latter is more directed to the lost life years due to air pollution etc. In this paper, we attempt to conduct an integrated valuation study for both types of values in the same choice experimental design. <p> We formulate an econometric model which simultaneously takes into account both mortality risk reduction and life year loss. The results indicates that conditional on given remaining life years upon survival, the marginal willingness to pay is constant for each statistical life saved, which indicates strong scope effect. The marginal value per extra life year, however, is a diminishing function of the number of life years. We have also examined the effect of other covariates such as the respondents’ characteristics (e.g. gender and age), their self-confidence in making choices, and possible categorical behavior on the final value estimates.
    Keywords: value of statistical life; value of life years; stated preference; choice experiment
    JEL: I18
    Date: 2010–11–11
  5. By: Nerhagen, Lena (VTI); Bergström, Robert; Forsberg, Bertil; Johansson, Christer; Eneroth, Kristina
    Abstract: This paper measures the external health cost due to emissions from different sources in the Stockholm area using the Impact pathway approach. The estimated health impact is the result of detailed dispersion modelling with high spatial resolution. We make separate calculations for the impact that occur within the Stockholm area, the surrounding region and the rest of Europe. The pollutants considered are combustion and secondary particulate matter (PM) from the burning of fuels and also road wear (non-exhaust PM) that makes a large contribution to measured concentrations of PM locally in Stockholm. We also investigate the influence of assumptions made regarding the exposure-response functions used in these calculations since PM of different origin are expected to have different health impacts. According to the results road traffic makes important contributions to the external health cost both on a local and a regional scale compared to other sources. This is in part due to emissions being released in close proximity to where people live but also because of the amount of pollutants emitted. Although non-exhaust PM makes a large contribution to local population exposure within Stockholm the external health cost is relatively small which is due to other health impact being relevant for this emission source. Residential heating also makes an important contribution to exposure and external health cost on a local scale while power plants have a large influence regionally.
    Keywords: Health cost; particulate matter; dispersion modelling; exposure-response functions; value of life year lost
    JEL: D62
    Date: 2010–11–10
  6. By: Johansson, Per (IFAU - Institute for Labour Market Policy Evaluation); Lindahl, Erica (IFAU - Institute for Labour Market Policy Evaluation)
    Abstract: During the last decade several empirical studies have stressed the importance of norms and social interactions for explaining sickness absence behavior. In this context public discussions about the intentions of the insurance, and of the rights and duties of the receivers, may be important for reducing the sickness absence. In this paper we study whether information meetings about the Swedish sickness insurance affect the length of sickness absence spells. The study is based on experimental data on individuals with weak labor market attachments. The displacement of when the call to the meeting was sent out was randomized. Comparing the survival functions of those called immediately with those whose calls were delayed (by about 30 days) makes it possible to study whether the length of sickness absence is affected by receiving the call earlier. The result suggests that the length is reduced by, on average, 20 percent. In the long term (12 months later) there is no effect of the information meeting. This suggests that attendance to the information meeting does not change individuals’ long-term behavior.
    Keywords: monitoring; moral hazard; public social insurance; survival analysis; instrumental variables
    JEL: C93 H51 H55 J22
    Date: 2010–10–28
  7. By: Franco Sassi; Marion Devaux; Jody Church; Michele Cecchini; Francesca Borgonovi
    Abstract: An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. Existing evidence provides strong suggestions that such epidemic has affected certain social groups more than others. In particular, education appears to be associated with a lower likelihood of obesity, especially among women. A range of analyses of health survey data from Australia, Canada, England and Korea were undertaken with the aim of exploring the relationship between education and obesity. The findings of these analyses show a broadly linear relationship between the number of years spent in full-time education and the probability of obesity, with most educated individuals displaying lower rates of the condition (the only exception being men in Korea). This suggests that marginal returns to education, in terms of reduction in obesity rates, are approximately constant throughout the education spectrum. The findings obtained confirm that the education gradient in obesity is stronger in women than in men. Differences between genders are minor in Australia and Canada, more pronounced in England and major in Korea. The causal nature of the link between education and obesity has not yet been proven with certainty; however, using data from France we were able to ascertain that the direction of causality appears to run mostly from education to obesity, as the strength of the association is only minimally affected when accounting for reduced educational opportunities for those who are obese in young age. Most of the effect of education on obesity is direct. Small components of the overall effect of education on obesity are mediated by an improved socio-economic status linked to higher levels of education, and by a higher level of education of other family members, associated with an individual’s own level of education. The positive effect of education on obesity is likely to be determined by at least three factors: (a) greater access to health-related information and improved ability to handle such information; (b) clearer perception of the risks associated with lifestyle choices; and, (c) improved self-control and consistency of preferences over time. However, it is not just the absolute level of education achieved by an individual that matters, but also how such level of education compares with that of the individual’s peers. The higher the individual’s education relative to his or her peers’, the lower is the probability of the individual being obese.
    Keywords: education, obesity
    JEL: I12 I21
    Date: 2009–12–10
  8. By: Roman Mennicken; Boris Augurzky; Heinz Rothgang; Jürgen Wasem
    Abstract: Remuneration rates of German nursing homes are prospectively negotiated between long-term care insurance (LTCI) and social assistance on the one side and nursing homes on the other. They diff er considerably across regions while there is no evidence for substantial differences in care provision. This paper explains the differences in the remuneration rates by observable characteristics of the nursing home, its residents and its region with a special focus on the largest federal state North-Rhine-Westphalia, in which the most expensive nursing homes are located. We use data from the German Federal Statistical Office for 2005 on all nursing homes that off er full-time residential care for the elderly. We find that differences in remuneration rates can partly be explained by exogenous factors. Controls for residents, nursing homes, and district characteristics explain roughly 30% of the price difference; 40% can be ascribed to a regionally different kind of negotiation between nursing homes and LTCI. 30% of the raw price difference remains unexplained by observable characteristics.
    Keywords: Nursing homes; determinants of remuneration rates; regional price differences
    JEL: I11 I18
    Date: 2010–10
  9. By: U.S. Mishra; Mala Ramanathan; S. Irudaya Rajan
    Abstract: Information on abortion is limited and inaccurate especially in the developing world, which has led to several speculations on the prevalence of abortion in this region. A rise in prevalence of abortion is mostly accounted for in terms of increase in the prevalence of induced abortions, which reflects on the reproductive health of women. With the growing concern for reproductive health of women, the study of abortion phenomenon has drawn serious attention of researchers world wide. In such circumstances, this is an attempt to assess the induced abortion potential among Indian women by utilising information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India. [Working Paper No. 279]
    Keywords: induced abortion, unwanted pregnancy, ill-timed pregnancy, total pregnancy rate, total fertility rate
    Date: 2010
  10. By: David Aadland (Department of Economics and Finance, University of Wyoming); David Finnoff (Department of Economics and Finance, University of Wyoming); Kevin X.D. Huang (Department of Economics, Vanderbilt University)
    Abstract: Syphilis has re-emerged as a global public health issue. In lesser developed countries, millions of people are contracting the disease, which can be fatal without access to proper treatment. In developed countries, prevalence is on the rise and has cycled around endemic levels for decades. We investigate syphilis dynamics by extending the classic SIRS epidemiological model to incorporate forward-looking, rational individuals and the AIDS epidemic. The integrated economic-epidemiological model shows that human preferences over health and sexual activity are central to the nature of syphilis cycles. We find that low-activity individuals will behave in a manner that significantly dampen the cycles, while high-activity individuals will tend to exacerbate the cycles, a phenomenon we refer to as rational dynamic resonance. The model also provides insights into two failed attempts by the U.S. government to eradicate syphilis from the U.S. population.
    Keywords: syphilis, AIDS, disease, eradication, cycles, fatalism, dynamic resonance, SIRS
    JEL: D1 I1
    Date: 2010–05
  11. By: Giles, John; Satriawan, Elan
    Abstract: This paper exploits heterogeneity in program exposure to evaluate the effectiveness of a supplementary feeding program implemented in the wake of the 1997-1998 economic crises in Indonesia. The explicit aim of the program was to protect the nutritional status of infants and young children from adverse effects of the crisis. The use of heterogeneity in program exposure has several advantages for identifying the impact of the program. First, the analysis avoids the strong assumption that all targeted children experienced homogenous exposure to the program, and facilitates identification in a setting in which nearly all communities experienced some exposure. Second, by exploiting child age and program eligibility rules, the paper estimates models with community fixed effects and thus avoid bias introduced as a result of endogenous program placement. The analysis finds that the program improved the nutritional status of children 12 to 24 months of age at the time of the survey in 2000, and helped to avoid problems of severe malnutrition among young children.
    Keywords: Health Monitoring&Evaluation,Youth and Governance,Housing&Human Habitats,Population Policies,Social Cohesion
    Date: 2010–11–01
  12. By: Hancock R (School of Medicine, Health Policy and Practice, University of East Anglia); Pudney S (Institute for Social and Economic Research)
    Abstract: The UK Attendance Allowance (AA) and Disability Living Allowance (DLA) are non means-tested benefits paid to many disabled people aged 65+. They may also increase entitlements to means-tested benefits through the Severe Disability Premium (SDP). We investigate proposed reforms involving withdrawal of AA/DLA. Despite their present non-means-tested nature, we show that withdrawal would affect mainly low-income people, whose losses could be mitigated if SDP were retained at its current or a higher level. We also show the importance of the method of describing distributional impacts and that use of inappropriate income definitions in official reports has overstated recipientsÂ’ capacity to absorb the loss of these benefits.
    Date: 2010–11–08
  13. By: Nils Braakmann (Newcastle University, Business School – Economics, Newcastle upon Tyne)
    Abstract: I exploit exogenous variation in the likelihood to obtain any sort of academic degree between January- and February-born individuals for 13 academic cohorts in England. For these cohorts compulsory schooling laws interacted with the timing of the CGE and O-level exams to change the probability of obtaining an academic degree by around 2 to 3 percentage points. I then use data on individuals born in these two months from the British Labour Force Survey and the Health Survey for England to investigate the effects of education on health using being February-born as an instrument for education. The results indicate neither an effect of education on various health related measures nor an effect on health related behaviour, e.g., smoking, drinking or eating various types of food.
    Keywords: education, health, socio-economic gradient, education gradient
    JEL: I12 I20
    Date: 2010–11
  14. By: Zack Cooper; Steve Gibbons; Simon Jones; Alistair McGuire
    Abstract: This paper examines whether or not hospital competition in a market with fixedreimbursement prices can prompt improvements in clinical quality. In January 2006, theBritish Government introduced a major extension of their market-based reforms to theEnglish National Health Service. From January 2006 onwards, every patient in England couldchoose their hospital for secondary care and hospitals had to compete with each other toattract patients to secure their revenue. One of the central aims of this policy was to createfinancial incentives for providers to improve their clinical performance. This paper assesseswhether this aim has been achieved and competition led to improvements in quality. For ourestimation, we exploit the fact that choice-based reforms will create sharper financialincentives for hospitals in markets where choice is geographically feasible and that prior to2006, in the absence of patient choice, hospitals had no direct financial incentive to improveperformance in order to attract more patients. We use a modified difference-in-differenceestimator to analyze whether quality improved more quickly in more competitive marketsafter the government introduced its new wave of market-based reforms. Using AMI mortalityas a quality indicator, we find that mortality fell more quickly (i.e. quality improved) forpatients living in more competitive markets after the introduction of hospital competition inJanuary 2006. Our results suggest that hospital competition in markets with fixed prices canlead to improvements in clinical quality.
    Keywords: Health Care, Quality, Competition, Choice, Incentives, Reimbursement
    JEL: I1 L1 R0
    Date: 2010–01
  15. By: Mariesa A. Herrmann; Jonah E. Rockoff
    Abstract: A significant amount of work time is lost each year due to worker absence, but evidence on the productivity losses from absenteeism remains scant due to difficulties with identification. In this paper, we use uniquely detailed data on the timing, duration, and cause of absences among teachers to address many of the potential biases from the endogeneity of worker absence. Our analysis indicates that worker absences have large negative impacts: the expected loss in daily productivity from employing a temporary substitute is on par with replacing a regular worker of average productivity with one at the 10th–20th percentile of productivity. We also find daily productivity losses decline with the length of an absence spell, consistent with managers engaging in costly search for more productive substitutes and temporary workers learning on the job. While illness is a major cause of absenteeism among teachers, we find no evidence that poor health also causes lower on-the-job productivity.
    JEL: J22 J24 J45
    Date: 2010–11
  16. By: Jonah E. Rockoff; Mariesa A. Herrmann
    Abstract: Ichino and Moretti (2009) find that menstruation may contribute to gender gaps in absenteeism and earnings, based on evidence that absences of young female Italian bank employees follow a 28-day cycle. We analyze absenteeism of teachers and find no evidence of increased female absenteeism on a 28-day cycle. We also show that the evidence of 28-day cycles in the Italian data is not robust to the correction of coding errors or small changes in specification. We show that five day workweeks can cause misleading group differences in absence hazards at multiples of 7, including 28 days.
    JEL: I19 J16 J22
    Date: 2010–11
  17. By: Anderson, Stacey J PhD University of California - San Francisco
    Abstract: Publicly available internal tobacco industry documents were analyzed to explore questions regarding menthol cigarettes and cessation behavior, using the following as initial questions: 1) Compared to non-menthol smokers, do menthol smokers have a harder time quitting, report more or fewer quit attempts, and/or have higher or lower quit rates? 2) Compared to non-menthol smokers, are menthol smokers more or less likely to relapse or delay quitting, and/or to experience different odds of maintaining abstinence long-term? Tobacco companies largely considered reviews of the academic literature on these questions; therefore, documentary evidence was employed to refine research questions. More than 500 relevant documents were identified on 1) perceived sensory and taste rewards of menthol and potential relation to quitting; 2) motivation or desire to quit among menthol users; and 3) socio-demographic correlates of both menthol usage and cessation patterns. Menthol’s cooling and anesthetic effects mask the short-term negatives of smoking such as throat pain, burning, and cough. This may provide superficial physical relief as well as psychological assurance against concerns about health that would otherwise motivate smokers to quit. Menthol smokers, particularly women, also perceive the minty aroma of menthol cigarettes to be more socially acceptable than non-menthol cigarettes, a perception that lessens the impact of smoking denormalization on quitting motivation. Relative to the overall smoking market, menthol smokers tend to be younger, female, and non-white; this description also fits those smokers who have a harder time of quitting and staying quit. Document analysis suggests that menthol in cigarettes may encourage experimenters who find non-mentholated cigarettes too harsh, including young or inexperienced users, to progress to regular smoking rather than quitting, and may inhibit the desire to quit among established menthol smokers who have become accustomed to the taste and sensation of menthol cigarettes.
    Date: 2010–10–07
  18. By: Yerger, Valerie B ND
    Abstract: Publicly available internal tobacco industry documents were analyzed to answer the following questions regarding menthol’s role in nicotine dependence: 1) What are the addiction and exposure measures and what are their relationships to menthol cigarette use? 2) Do menthol smokers show different signs or levels of nicotine dependence compared to non-menthol smokers? 3) Does menthol affect cigarette consumption (cigarettes per day) and do menthol smokers smoke more or fewer cigarettes per day compared to non-menthol smokers? 4) What is menthols’ effect on nicotine metabolism (i.e. glucuronide formation) and do menthol smokers experience different nicotine exposure and/or altered nicotine metabolism as compared to non-menthol smokers? (i.e. serum cotinine levels) 5) Does menthol have an effect on nicotine delivery? 6) Does menthol alter the addictiveness of smoking through sensory stimulation? Tobacco industry documents reveal at least two important reasons for menthol’s use in cigarettes. A final collection of 309 documents was analyzed for this report, of which 72 were deemed relevant to one or more of the research questions and cited in this paper. Our analyses of these documents indicate 1) menthol is used in cigarettes to override the harsh taste of tobacco; 2) menthol has physiological effects, and it synergistically interacts with nicotine; 3) menthol makes low tar, low nicotine tobacco products that would otherwise be tasteless and unsatisfactory acceptable to smokers. Tobacco manufacturers manipulated menthol levels to produce tobacco products that would be easier to consume, especially for new and inexperienced smokers.
    Date: 2010–10–07
  19. By: Salgado, Maria Victoria MD
    Abstract: The objective of this paper is to assess tobacco industry views and research on potential health effects of menthol and menthol cigarettes. A search was conducted among the documents included in the Legacy Tobacco Documents Library. An initial set of words was used, followed by snowball design search. Relevant documents addressed the following subject areas: (1) pharmacology of menthol; (2) menthol’s effect on nicotine metabolism; (3) short and long-term effects of menthol and menthol cigarette use, including carcinogenesis; (4) role of menthol on disease risk; and (5) menthol’s effects on biomarkers of smoking exposure. It is important to underscore that, regarding the health effects of menthol, most of the information tobacco companies used and based their decisions on came from the biomedical literature and not from studies carried out by the companies themselves, who seem to have conducted very little in-house research on the subject. Although menthol pharmacology is well documented, the effect of menthol on levels of biomarkers of smoke exposure is less well examined; however, results collected in the present white paper suggest that menthol does not seem to modify them. In addition, menthol itself appears to be non-carcinogenic, though no documents related to in-house studies analyzing its role in absorption of other carcinogens were found. Reported short-term effects were rare. The tobacco industry documents did not discuss long term long term studies on menthol’s health effects, making it difficult to assess any link to disease risk. We conclude that the tobacco industry works under the assumption that menthol is an innocuous and widely use additive without adverse effects.
    Date: 2010–10–07

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