nep-hea New Economics Papers
on Health Economics
Issue of 2011‒03‒26
thirteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. HIV, Risky Behavior and Ethno-Linguistic Heterogeneity By Miron Tequame
  2. Work Absenteeism Due to a Chronic Disease By Lacroix, Guy; Brouard, Marie-Ève
  3. Cigarette Taxes and the Social Market By Hansen, Benjamin; Sabia, Joseph J.; Rees, Daniel I.
  4. Wars and Child Health: Evidence from the Eritrean-Ethiopian Conflict By Akresh, Richard; Lucchetti, Leonardo; Thirumurthy, Harsha
  5. Prenatal Sex Selection and Girls' Well-Being: Evidence from India By Hu, Luojia; Schlosser, Analia
  6. Gender Differences, HIV Risk Perception and Condom Use By Judith Lammers; Sweder van Wijnbergen; Daan Willebrands
  7. Orphans at risk in Sub-Saharan Africa: Evidence on educational and health outcomes By Coneus, Katja; Mühlenweg, Andrea M.
  8. Body Mass Index, Participation, Duration of Work and Earnings under NREGS: Evidence from Rajasthan By Raghbendra Jha; Raghav Gaiha; Manoj K. Pandey
  9. Optimal productive size of hospital’s intensive care units By Hervé Leleu; James Moises; Vivian Valdmanis
  10. Workers’ Risk Underestimation and Occupational Health and Safety Regulation By Drakopoulos, Stavros A.; Theodossiou, Ioannis
  11. Differences in the effect of social capital on health status between workers and non-workers By Yamamura, Eiji
  12. The impacts of health care reforms on the efficiency of the Turkish public hospitals: Provincial markets By Sulku, Seher Nur
  13. Valuing Mortality Risk Reductions: Progress and Challenges By Cropper, Maureen; Hammitt, James K.; Robinson, Lisa A.

  1. By: Miron Tequame (Center for Research in the Economics of Development, University of Namur)
    Abstract: This paper studies the role of ethno-linguistic diversity on risky sexual behavior and HIV status of individuals. We compute three different measures of ethno-linguistic heterogeneity and show that ethno-linguistic heterogeneity is positively related to risky sexual behavior and HIV status of individuals. This effect, both on risky behavior and HIV status, is stronger for women than for men. Accordingly, we also find a positive association between ethno-linguistic heterogeneity and being in a discordant couple where the wife is HIV positive. Our findings have an implication for prevention policies as it identifies community level characteristics for implementing anti-HIV/AIDS policies.
    Keywords: HIV/AIDS, Risky Behavior, Ethno-Linguistic Diversity
    JEL: I18 J14 O12 O20 Z13
    Date: 2010–03
  2. By: Lacroix, Guy (Université Laval); Brouard, Marie-Ève (Gouvernement du Québec)
    Abstract: Research on health-related work absenteeism focuses primarily on moral hazard issues but seldom discriminates between the types of illnesses that prompt workers to stay home or seek care. This paper focuses on chronic migraine, a common and acute illness that can prove to be relatively debilitating. Our analysis is based upon the absenteeism of workers employed in a large Fortune-100 manufacturing firm in the United States. We model their daily transitions between work and absence spells between January 1996 up until December 1998. Only absences due to migraine and depression, its main comorbidity, are taken into account. Our results show that there is considerable correlation between the different states we consider. In addition, workers who are covered by the Blue Preferred Provided Organization tend to have shorter employment spells but also shorter migraine spells.
    Keywords: migraine, absenteeism, insurance policies, transition models, unobserved heterogeneity
    JEL: I10 J32
    Date: 2011–03
  3. By: Hansen, Benjamin (University of Oregon); Sabia, Joseph J. (U.S. Military Academy); Rees, Daniel I. (University of Colorado Denver)
    Abstract: Previous researchers have argued that the social market for cigarettes insulates its participants from policies designed to curb youth smoking. Using state Youth Risk Behavior Survey data, we examine whether recent changes in state cigarette taxes affected how young smokers obtained their cigarettes. Our estimates suggest that tax increases reduce youth smoking participation primarily through their effect on third-party purchase, although there is evidence that they are negatively related to borrowing among younger teenagers and negatively related to direct purchase among older teenagers.
    Keywords: youth smoking, cigarette taxes
    JEL: I10 I12
    Date: 2011–03
  4. By: Akresh, Richard (University of Illinois at Urbana-Champaign); Lucchetti, Leonardo (University of Illinois at Urbana-Champaign); Thirumurthy, Harsha (World Bank)
    Abstract: This is the first paper using household survey data from two countries involved in an international war (Eritrea and Ethiopia) to measure the conflict’s impact on children's health in both nations. The identification strategy uses event data to exploit exogenous variation in the conflict's geographic extent and timing and the exposure of different children's birth cohorts to the fighting. The paper uniquely incorporates GPS information on the distance between survey villages and conflict sites to more accurately measure a child’s war exposure. War-exposed children in both countries have lower height-for-age Z-scores, with the children in the war-instigating and losing country (Eritrea) suffering more than the winning nation (Ethiopia). Negative impacts on boys and girls of being born during the conflict are comparable to impacts for children alive at the time of the war. Effects are robust to including region-specific time trends, alternative conflict exposure measures, and an instrumental variables strategy.
    Keywords: child health, conflict, economic shocks, Africa
    JEL: I12 J13 O12
    Date: 2011–03
  5. By: Hu, Luojia (Federal Reserve Bank of Chicago); Schlosser, Analia (Tel Aviv University)
    Abstract: In this paper, we study the impact of prenatal sex selection on the well-being of girls by analyzing changes in children's nutritional status and mortality during the years since the diffusion of prenatal sex determination technologies in India. We further examine various channels through which prenatal sex selection might affect girls’ outcomes. Using repeated cross-sections from a rich survey dataset, we show that high sex ratios at birth reflect the practice of sex selective abortion. We then exploit the large regional and time variations in the incidence of prenatal sex selection to analyze whether changes in girls' outcomes relative to boys within states and over time are associated with changes in sex ratios at birth. We find that an increase in the practice of prenatal sex selection appears to be associated with a reduction in the incidence of malnutrition among girls. The negative association is stronger for girls born in rural households and at higher birth parities. An examination of the various mechanisms linking between prenatal sex selection and children outcomes suggests that prenatal sex selection does not lead to a selection of girls into better endowed families, but there is some evidence of a larger reduction in family size for girls relative to boys. We also find an increase in girls' breastfeeding duration suggesting an improvement in parental care and treatment. On the other hand, prenatal sex selection does not appear to be associated with a reduction in excess female child mortality, or a reduction in son preference.
    Keywords: son preference, prenatal sex selection, ultrasound, sex ratio at birth, gender discrimination, child health
    JEL: J13 J16 I1 O12
    Date: 2011–03
  6. By: Judith Lammers (University of Amsterdam); Sweder van Wijnbergen (University of Amsterdam); Daan Willebrands (Amsterdam Institute for International Development (AIID))
    Abstract: We analyze how HIV-knowledge influences condom use across the sexes. The empirical work is based on a household survey conducted among 1,979 households of a representative group of market persons in Lagos in 2008. Last-time-condom-use is analyzed based on a Probit model while correcting for clustering effects. Next to socioeconomic characteristics, the data includes questions on knowledge of the existence of HIV, HIV prevention, HIV stigma, intended pregnancy, and risk perceptions of engaging in unprotected sex. We observe a large HIV knowledge gap between males and females. Moreover, across the sexes different type of knowledge are important in condom use. Low risk perceptions of engaging in unprotected sex and not knowing that condoms prevent HIV infection appear to be the best predictors for risky sexual behavior among men. The latter is also important in condom use among single females. Both factors, however, do not explain sexual behavior of married women, suggesting a lack of bargaining power in HIV prevention decisions among married females. Our results call for programmatic approaches to differentiate the focus of HIV prevention campaigns for males and females including a separate focus for married men and women. Moreover, the large predictive power of high-risk perceptions of engaging in unprotected sex (while correcting for other HIV knowledge indicators) calls for further exploration of influencing these risk perceptions in HIV prevention programs.
    Keywords: prevention; knowledge; HIV/AIDS; risk perception; gender; condom use
    JEL: I1 I2
    Date: 2011–03–11
  7. By: Coneus, Katja; Mühlenweg, Andrea M.
    Abstract: In this paper, we examine how orphanhood affects children's educational and health outcomes in eleven sub-Saharan African countries. Our analysis is based on a comparison of orphans and non-orphaned children living under the same conditions. We also examine the impacts of various family structures and compare social orphans (non-orphaned children not living with a biological parent) to orphans. Using household fixed-effects estimation, we provide evidence that children not living with a biological parent lag behind in education and are more often malnourished and stunted. Educational gaps are particularly evident among orphans and social orphans not living with a mother. The effect of paternal death or absence is rather modest in most countries. --
    Keywords: Orphans,family structure,human capital,sub-Saharan Africa,fixed-effects
    JEL: I12 I21 J24
    Date: 2011
  8. By: Raghbendra Jha; Raghav Gaiha; Manoj K. Pandey
    Abstract: Despite its evident importance relatively little is known about links between Body Mass Index (BMI) and participation in workfare programs, particularly in India. Using a unique data set for the Indian state of Rajasthan for 2009-10, this paper attempts to fill this void and examines the association between BMI and participation in, duration of employment in and earnings from employment in NREGs. Thus we go beyond the scope of the extant literature and model these links for both male and female workers with varied social and economic backgrounds. Further, we permit non-linearities in some impacts and allow for mutual endogenity, say, between BMI and earnings. To the best of our knowledge this is the first paper to examine this range of issues.
    Keywords: Body Mass Index, National Rural Employment Guarantee, Participation, India
    JEL: C21 D31 D63 H53
    Date: 2011
  9. By: Hervé Leleu (CNRS-LEM (UMR 8179), IESEG School of Management); James Moises (Tulane University); Vivian Valdmanis (University of the Sciences in Philadelphia)
    Keywords: Hospital, Intensive Care Units, Returns to Scale, Optimal Size
    Date: 2011–03
  10. By: Drakopoulos, Stavros A.; Theodossiou, Ioannis
    Abstract: The standard treatment of occupational risk in the labour market is conducted in terms of the theory of compensating wage differentials, the basic characteristic of which is that workers can fully estimate actual occupational risks. However, research in cognitive psychology, and recent advances in economic psychology, suggest that individuals consistently underestimate risks associated with accidents. In this paper, we discuss the case when the workers systematically underestimate job risks. After presenting the standard treatment of occupational risks, and of health and safety at work regulation, we then proceed to incorporate the idea of job risk underestimation. The paper discusses the types and impact of regulation on health and safety effort in a simple framework in which workers’ beliefs concerning accident risks also play a role. The paper shows that a particular type of regulatory intervention is necessary for the risk underestimating workers not to suffer a welfare loss.
    Keywords: Job Risk; Occupational Health and Safety
    JEL: K32 J81 I18
    Date: 2011–03
  11. By: Yamamura, Eiji
    Abstract: This paper explores the relationship of social capital to self-rated health status in Japan, and how this is affected by the labor market. Data of 3075 adult participants in the 2000 Social Policy and Social Consciousness (SPSC) survey were used. Controlling for endogenous bias, the main finding is that social capital has a significant positive influence on health status for people without a job but not for those with. This empirical study provides evidence that people without a job can afford to allocate time to accumulate social capital and thereby improve their health status.
    Keywords: health status; social capital; labor market.
    JEL: I19 J22 Z13
    Date: 2011–03–06
  12. By: Sulku, Seher Nur
    Abstract: Turkey has implemented major health care reforms to improve the efficiency of the health care system since 2003. The objective of this study is to investigate the impact of these reforms, especially the performance-based payment system (P4P), on the efficiency of public hospitals. We employ the Data Envelopment Approach and the Malmquist index to comparatively examine before and after the reform years, 2001 and 2006 respectively. Our analyses compare the performances of public hospitals served in provincial markets. Inputs of number of beds, number of primary care physician, and number of specialists, and how they are used to produce outputs of inpatient discharges, outpatient visits, surgical operations are investigated. Indeed, as the quality indicators dead rate, hospital bed occupation rate and average length of stay are considered. We found that the P4P was successful in boosting productivity due to advancements in technology and technical efficiency. It is seen that the average technical efficiency gains took place because of the significantly improved scale efficiencies, but the average pure technical efficiency did not improve. The lower pure technical efficiencies compared to scale efficiencies affirms the lack adaptation of the hospital management to the renewed system. Additionally, our analysis indicates that in the socio-economically disadvantaged provinces productivity gains have not been achieved. Lastly, it is seen that the hospital quality indicators have not improved in the short run. In the international literature, P4P has been examined extensively for the developed countries. However there are a limited number of studies on developing countries. As it has been noted in the OECD health system review of Turkey: “Turkey is closing the performance gap with other OECD countries and, on a number of measures including overall costs, performs well relative to other comparable upper middle-income countries. Indeed, there may be much that other countries can learn from the recent health reforms in Turkey, especially in the use of performance-related pay to raise staff productivity”. Thus, our study would contribute to the existing literature with a comprehensive analysis of the health system efficiency in Turkey.
    Keywords: Turkey; Healthcare reform; Performance based supplementary payment system; Hospital efficiency
    JEL: I11 I12 I18 C33
    Date: 2011–03–14
  13. By: Cropper, Maureen (Resources for the Future); Hammitt, James K.; Robinson, Lisa A.
    Abstract: The value of mortality risk reduction is an important component of the benefits of environmental policies. In recent years, the number, scope, and quality of valuation studies have increased dramatically. Revealed preference studies of wage compensation for occupational risks, on which analysts have primarily relied, have benefited from improved data and statistical methods. Stated preference research has improved methodologically and expanded dramatically. Studies are now available for several health conditions associated with environmental causes, and researchers have explored many issues concerning the validity of the estimates. With the growing numbers of both types of studies, several meta-analyses have become available that provide insight into the results of both methods. Challenges remain, including better understanding of the persistently smaller estimates from stated preference than from wage differential studies and of how valuation depends on the individual’s age, health status, and characteristics of the illnesses most frequently associated with environmental causes.
    Keywords: value of a statistical life, mortality risk reduction, hedonic wage studies, stated preference studies
    JEL: Q50 Q51 Q58
    Date: 2011–03–17

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