nep-hea New Economics Papers
on Health Economics
Issue of 2010‒12‒18
twenty papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Impact of information on intentions to vaccinate in a potential epidemic : swine-origin Influenza A (H1N1) By Olivier Chanel; Stéphane Luchini; Sébastien Massoni; Jean-Christophe Vergnaud
  2. Get paid more, work more? Lessons from French physicians' labour supply responses to hypothetic fee increases By Olivier Chanel; Alain Paraponaris; Christèle Protière; Bruno Ventelou
  3. Palliative Care: A Novel Solution to the Healthcare Crisis. Syracuse Seminar Series on Aging. By R. Sean Morrison
  4. The Case for Presenteeism By Markussen, Simen; Mykletun, Arnstein; Røed, Knut
  5. Transitions to disability and rehabilitation By Leif Andreassen and Tom Kornstad
  6. Education-related Inequity in Health Care with Heterogeneous Reporting of Health By Teresa Bago d'Uva; Maarten Lindeboom; Owen O'Donnell; Eddy van Doorslaer
  7. On gender and growth : the role of intergenerational health externalities and women's occupational constraints By Agenor, Pierre-Richard; Canuto, Otaviano; da Silva, Luiz Pereira
  8. Body weight and socio-economic determinants: quantile estimations from the British Household Panel Survey By Pieroni L; Salmasi L
  9. The Effect of Breastfeeding on Children's Cognitive Development By Iacovou M; Sevilla sanz A
  10. Out-of-Pocket Maximum Rules under a Compulsatory Health Care Insurance Scheme: A Choice between Equality and Equity By Thierry Debrand; Christine Sorasith
  11. A Healthy Mix? Health Food Retail and Mixed Use Development: Mobility-related Analysis of Grocery Shopping Behavior in Irvine, California By Benjamin Heldt
  12. Optimal Aging and Death By Carl-Johan Dalgaard; Holger Strulik
  13. Data sets on pensions and health: Data collection and sharing for policy design By Jinkook Lee
  14. Improving long-term care provision: Towards demand-based care by means of modularity. By Blok, C. de; Luijkx, K.G.; Meijboom, B.R.; Schols, J.M.G.A.
  15. Smoking Behaviour and Life Satisfaction: Evidence from the UK Smoking Ban By Timothy Hinks and Andreas Katsaros; Andreas Katsaros
  16. Is foreign aid fungible? Evidence from the education and health sectors By Nicolas Van de Sijpe
  17. A study on occupational health hazards among women beedi rollers in Tamilnadu, India. By Nakkeeran, Senthil kumar; Pugalendhi, Subburethina Bharathi
  18. Health Shocks and Natural Resource Management: Evidence from Western Kenya By Joshua Graff Zivin; Maria Damon; Harsha Thirumurthy
  19. Accounting for Anticipation Effects: An Application to Medical Malpractice Tort Reform By Anup Malani; Julian Reif
  20. Patient Knowledge and Antibiotic Abuse: Evidence from an Audit Study in China By Janet Currie; Wanchuan Lin; Wei Zhang

  1. By: Olivier Chanel (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - CNRS : UMR6579); Stéphane Luchini (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - CNRS : UMR6579); Sébastien Massoni (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I); Jean-Christophe Vergnaud (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Panthéon-Sorbonne - Paris I)
    Abstract: Vaccination campaigns to prevent the spread of epidemics are successful only if the targeted populations subscribe to the recommendations of health authorities. However, because compulsory vaccination is hardly conceivable in modern democracies, governments need to convince their populations through efficient and persuasive information campaigns. In the context of the swine-origin A (H1N1) 2009 pandemic, we use an interactive study among the general public in the South of France, with 175 participants, to explore what type of information can induce change in vaccination intentions at both aggregate and individual levels. We find that individual attitudes to vaccination are based on rational appraisal of the situation, and that it is information of a purely scientific nature that has the only significant positive effect on intention to vaccinate.
    Keywords: France, experiment, interactive, information, vaccination, influenza A (H1N1), attitudes.
    Date: 2010–08
  2. By: Olivier Chanel (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - CNRS : UMR6579); Alain Paraponaris (SE4S - Sciences économiques et sociales, systèmes de santé, sociétés - INSERM : U912 - IRD - Université de la Méditerranée - Aix-Marseille II); Christèle Protière (SE4S - Sciences économiques et sociales, systèmes de santé, sociétés - INSERM : U912 - IRD - Université de la Méditerranée - Aix-Marseille II); Bruno Ventelou (GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - Université de la Méditerranée - Aix-Marseille II - Université Paul Cézanne - Aix-Marseille III - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - CNRS : UMR6579)
    Abstract: This paper is devoted to the analysis of the General Practitioners' (GPs) labour supply, specifically focusing on the physicians' labour supply responses to higher compensations. This analysis is mainly aimed at challenging the reality of a ‘backward bending' form for the labour supply of GPs. Because GPs' fees only evolve very slowly and are mainly fixed by the National Health Insurance Fund, we designed a contingent valuation survey in which hypothetical fee increases are randomly submitted to GPs. Empirical evidence from 1,400 French GPs supports the hypothesis of a negative slope for the GPs' labour supply curve. Therefore, increasing the supply of physicians' services through an increase in fees is not a feasible policy.
    Keywords: General practitioners; contingent valuation; price of leisure; labour supply; backward bending curve
    Date: 2010–12–07
  3. By: R. Sean Morrison (Director, National Palliative Care Research Center; Vice-Chair for Research, Brookdale Department of Geriatrics and Palliative Medicine; Hermann Merkin Professor of Palliative Care, Mount sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574)
    Abstract: Palliative care is specialized healthcare for anyone who is diagnosed with a serious and life-threatening illness, starting when they get the diagnosis, regardless of the prognosis. Although hospice is a form of palliative care, most palliative care is not end-of-life care or hospice, a common misperception that deters many people from using palliative care when they would benefit from it. Palliative care improves quality of care, reduces hospital costs, and helps clinicians address the needs and wants of patients and their families, which is why I refer to it as a 'novel' solution to the longstanding healthcare crisis.
    Keywords: palliative care, hospice, patient autonomy, access to information, pain, distress, serious illness, cancer, depression, physical discomfort, medical education,
    JEL: H51 I12 J14
    Date: 2010–11
  4. By: Markussen, Simen (Ragnar Frisch Centre for Economic Research); Mykletun, Arnstein (Norwegian Institute of Public Health); Røed, Knut (Ragnar Frisch Centre for Economic Research)
    Abstract: Can activation requirements control moral hazard problems in public sickness absence insurance and accelerate recovery? Based on empirical analysis of Norwegian data, we show that it can. Activation requirements not only bring down benefit claims, they also reduce the likelihood that long-term sickness absence leads to inactivity. Our findings show that absentees who are issued graded (partial) absence certificates by their physician have shorter absences and higher subsequent employment rates than they would have had on regular sick leave. We conclude that the activation strategies that in recent years have permeated European and US welfare policy may fruitfully be carried over to sick leave insurance.
    Keywords: sick leave, disability, activation, workfare
    JEL: I18 I38 J48
    Date: 2010–11
  5. By: Leif Andreassen and Tom Kornstad (Statistics Norway)
    Abstract: The discrete choice model of McFadden (1973) is used to quantify the desire for going into rehabilitation or disability among fully employed married women in Norway. Predictions using the model indicate that as much as 60 percent of full-time employed married women going into disability or rehabilitation are not doing so entirely voluntarily. Using a set of identifying assumptions we decompose transitions into different components. Important findings are that decreasing unemployment has also played a significant role in increasing the number on disability and rehabilitation, while changes in disability benefits have not played a large role.
    Keywords: social security; disability; rehabilitation; discrete choice
    JEL: C35 H55 I12 I18
    Date: 2010–12
  6. By: Teresa Bago d'Uva (Erasmus University Rotterdam); Maarten Lindeboom (VU University Amsterdam); Owen O'Donnell (Erasmus University Rotterdam, and University of Macedonia, Thessaloniki, Greece); Eddy van Doorslaer (ESE, and iBMG, Erasmus University Rotterdam)
    Abstract: Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in health care utilisation. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of doctor visits in the direction of inequality favouring the better educated. There is a further, and typically larger, shift the same direction when correction is made for the tendency of the better educated to rate their health more negatively.
    Keywords: health care; health; equity; reporting heterogeneity; vignettes
    JEL: C35 C42 I12
    Date: 2010–12–06
  7. By: Agenor, Pierre-Richard; Canuto, Otaviano; da Silva, Luiz Pereira
    Abstract: This paper studies the growth effects of externalities associated with intergenerational health transmission, health persistence, and women's occupational constraints-- with particular emphasis on the role of access to infrastructure. The first part provides a review of the evidence on these issues. The second and third parts present an overlapping generations model of endogenous growth that captures these interactions, and characterize its properties. The model is then used to perform several gender-based or gender-related experiments -- a reduction in the cost of child rearing, improved wage equality in the market place, and better access to infrastructure. The last part draws together the implications of the analysis for promoting the role of women in growth strategies.
    Keywords: Health Monitoring&Evaluation,Population Policies,Gender and Health,Gender and Law,Rural Development Knowledge&Information Systems
    Date: 2010–12–01
  8. By: Pieroni L (Department of Economics Finance and Statistics, University of Perugia); Salmasi L (Department of Economics, University of Verona)
    Abstract: This work examines the socio-economic determinants of body weight in UK by means of two recent waves from the British Household Panel Survey. Our results support some findings in the literature, but also point to new conclusions and show that quantile regression estimates are quite different from OLS ones. Among obese people, our results reveal that they are less so as male that do not spend extra-time at work or female increasing physical activity. Furthermore, smoking cessation may lead to moderate effects on weight increases only for underweight or normal-weight subjects but are not significant for obese ones.
    Date: 2010–12–13
  9. By: Iacovou M (Institute for Social and Economic Research); Sevilla sanz A (Department of Economics, University of Oxford)
    Abstract: This paper uses Propensity Score Matching to investigate the causal effect of breastfeeding on childrenÂ’s cognitive development. There is a strong association between breastfeeding and cognitive outcomes; however, it is notoriously difficult to establish whether this is causal, or whether it arises because mothers who breastfeed tend to be those whose children would do better anyway. Using PSM, we find that breastfeeding for four weeks has a positive and significant effect on test scores, in the order of one tenth of a standard deviation. Thus, interventions which increase breastfeeding rates may improve not only childrenÂ’s health, but also their cognitive skills.
    Date: 2010–12–10
  10. By: Thierry Debrand (IRDES institut for research and information in health economics); Christine Sorasith (IRDES institut for research and information in health economics)
    Abstract: Using the microsimulation model ARAMMIS, this study attempts to measure the impacts of introducing an out-of-pocket (OOP) maximum threshold, or a safety net threshold, on consumer copayments for health care financed by the abolition of the Long-term Illness Regime (ALD) in France. The analysis is based on a comparison of different safety net threshold rules and their redistributive effects on patients’ OOP payments. We attach particular importance to indicators that bring to light changes in OOP payment levels and measure their impact on the equity of OOP distribution. The first section outlines the French National Health System to provide a better understanding of the stakes involved in reforming the health care reimbursement rules under the Compulsory Health Care Insurance scheme. In the second section, we describe the hypotheses retained, the database and the microsimulation model. The final section presents key findings, measuring the impact of the reform at both individual and system levels.
    Keywords: Microsimulation, Health expenditure, Out-of-pocket payment.
    JEL: I18 H51 D63
    Date: 2010–11
  11. By: Benjamin Heldt
    Date: 2010–12–07
  12. By: Carl-Johan Dalgaard; Holger Strulik
    Abstract: This study introduces physiological aging into a simple model of optimal in- tertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal health investments. At the same time, physiological aspects of the aging process influence optimal savings and health investment. We calibrate the model for the average US male in 2000 and proceed to show that the calibrated model accounts well for the cross-country link between labor productivity and life expectancy in the same year (\the Preston curve"); cross-country income dierences can explain dierences in life expectancy at age 20 of up to a decade. Moreover, techno- logical change in health care of about 1.1% per year can account for the observed shift in the Preston curve between 1980 and 2000.K
    Keywords: Aging, Longevity, Health Investments, Savings, Preston Curve
    Date: 2010–07
  13. By: Jinkook Lee
    Abstract: A growing number of countries are developing or reforming pension and health policies in response to population ageing and to enhance the welfare of their citizens. The adoption of different policies by different countries has resulted in several natural experiments. These offer unusual opportunities to examine the effects of varying policies on health and retirement, individual and family behaviour, and well-being. Realizing these opportunities requires harmonized data-collection efforts. An increasing number of countries have agreed to provide data harmonized with the Health and Retirement Study in the United States. This article discusses these data sets, including their key parameters of pension and health status, research designs, samples, and response rates. It also discusses the opportunities they offer for cross-national studies and their implications for policy evaluation and development.
    Keywords: data analysis, comparison, old age risk, health status, quality of life, social policy, demographic aspect, international
    Date: 2010–09
  14. By: Blok, C. de (Tilburg University); Luijkx, K.G. (Tilburg University); Meijboom, B.R. (Tilburg University); Schols, J.M.G.A. (Tilburg University)
    Date: 2010
  15. By: Timothy Hinks and Andreas Katsaros (University of the West of England); Andreas Katsaros (University of Bath)
    Abstract: We use three waves of the British Household Panel Survey to examine whether changes in smoking behaviour are correlated with life satisfaction and whether the recent ban on smoking in public places in England, Wales and Northern Ireland has affected this relationship. We find that smokers who reduced their daily consumption of cigarettes after the ban report significantly lower levels of life satisfaction compared to those who did not change their smoking habits, with heavy smokers particularly affected. No such finding is reported for previous years.
    Keywords: Life Satisfaction Smoking ban
    JEL: D6
    Date: 2010–12
  16. By: Nicolas Van de Sijpe
    Abstract: This paper takes a fresh look at the issue of foreign aid fungibility. Unlike the bulk of existing empirical studies, I employ panel data that contain information on the specific purpose for which aid is given. This allows me to link aid given for education and health purposes to recipient public spending in these sectors. In addition, I attempt to distinguish between aid flows that are recorded on the recipient’s budget and those that are off-budget, and illustrate how a failure to differentiate between on- and off-budget aid produces biased estimates of fungibility. Sector programme aid is the measure of on-budget aid, while technical cooperation serves as a proxy for off-budget aid. In both sectors, across a range of specifications, technical cooperation leads to at most a small displacement of recipient public expenditure, implying limited fungibility for this type of aid. In static fixed effects models sector programme aid shows an almost one-for-one correlation with recipient public expenditure, again suggesting low fungibility, but this effect becomes imprecise and volatile in dynamic models estimated with system GMM.
    Keywords: foreign aid, fungibility, public education expenditure, public health expenditure
    JEL: E62 F35 H50 O23
    Date: 2010
  17. By: Nakkeeran, Senthil kumar; Pugalendhi, Subburethina Bharathi
    Abstract: The beedi industry occupies a prominent place in rural development in terms of its capacity to offer potential employment opportunities to a large number of people. For the beedi industry Tamilnadu is one of the major hub in India. It is estimated that around one million workers mostly woman and children are employed in Beedi making. It is an ardu¬ous, labour intensive task because each beedi is rolled individually. Beedi industry is almost an unorganized sector hence even the government officials finding it difficult to enforce the various legal requirements. Apart from the other legal implications the health hazards which the women employees who are rolling the beedis are enormous. This study aims to explore the level of health hazards experienced by the woman beedi rollers in Tamilnadu. A total of 388 usable responses obtained from women beedi rollers comprising from the beedi rollers concentrated districts i.e., Tirunelveli, Tuticorin, Tiruchirappalli & Vellore are used for this study. The study found that more than 70% of the beedi rollers suffered from eye, gastrointestinal and nervous problems while more than 50% of the respondents suffered from respiratory problems, mostly throat burning and cough. More than 75% of the respon¬dents faced osteological problems. From the study is it understood that the health hazards level is very high. This study proposes a framework to be implemented with the Government agencies, NGOs and Welfare organizations for the welfare of the beedi rollers.
    Keywords: Beedi rollers; Health Hazards; Welfare measures; Tamilnadu.
    JEL: K32 I18
    Date: 2010–09–18
  18. By: Joshua Graff Zivin; Maria Damon; Harsha Thirumurthy
    Abstract: Poverty and altered planning horizons brought on by the HIV/AIDS epidemic can change individual discount rates, altering incentives to conserve natural resources. Using longitudinal data from household surveys in western Kenya, we estimate impacts of health status on labor productivity and discount rates. We find that household size and composition are predictors of whether the effect on productivity dominates the discount rate effect, or vice-versa. Since households with more and younger members are better able to reallocate labor to cope with productivity shocks, the discount rate impact dominates for these households and health improvements lead to greater levels of conservation. In smaller families with less substitutable labor, the productivity impact dominates and health improvements lead to greater environmental degradation.
    JEL: I1 O13 O55 Q27 Q5 Q56
    Date: 2010–12
  19. By: Anup Malani; Julian Reif
    Abstract: While conducting empirical work, researchers sometimes observe changes in behavior before the adoption of a new treatment program or policy. The conventional diagnosis researchers make is that the treatment is endogenous. Observing behavioral changes prior to treatment is also consistent, however, with anticipation effects. In this paper we provide a framework for comparing the different methods for estimating anticipation effects and propose a new set of instrumental variables that can address the problem that subjects' expectations are unobservable. We use our framework to analyze the effect of tort reform on physician supply. We find that accounting for anticipation effects doubles the estimated effect of tort reform.
    JEL: C50 I18 J20 K13
    Date: 2010–12
  20. By: Janet Currie; Wanchuan Lin; Wei Zhang
    Abstract: We ask how patient knowledge of appropriate antibiotic usage affects both physicians prescribing behavior and the physician-patient relationship. We conduct an audit study in which a pair of simulated patients with identical flu-like complaints visits the same physician. Simulated patient A is instructed to ask a question that showcases his/her knowledge of appropriate antibiotic use, whereas patient B is instructed to say nothing beyond describing his/her symptoms. We find that a patient’s knowledge of appropriate antibiotics use reduces both antibiotic prescription rates and drug expenditures. Such knowledge also increases physicians’ information provision about possible side effects, but has a negative impact on the quality of the physician-patient interactions.
    JEL: I11 I12 I18
    Date: 2010–12

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