nep-hea New Economics Papers
on Health Economics
Issue of 2011‒05‒24
twenty-two papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Spillover Effects of Maternal Education on Child's Health and Schooling By Daniel Kemptner; Jan Marcus
  2. Catastrophic Health Expenditure and Household Well-Being By Ramses H. Abul Naga; Karine Lamiraud
  3. Recessions Are Bad for Workplace Safety By Boone, Jan; van Ours, Jan C.; Wuellrich, Jean-Philippe; Zweimüller, Josef
  4. Sense of coherence as a mediator between perceived neighborhood characteristics and health By Oshio, Takashi; Urakawa, Kunio
  5. Broke, Ill, and Obese: The Effect of Household Debt on Health By Matthias Keese; Hendrik Schmitz
  6. Governance in the health sector: a strategy for measuring determinants and performance By Savedoff, William D.
  7. Rationally Addicted to Cigarettes, Alcohol and Coffee? A Pseudo Panel Approach By Koksal, Aycan; Wohlgenant, Michael
  8. Incentive Design to Enhance the Reach of Weight Loss Program By You, Wen; Hashemi, Ali; Boyle, Kevin; Parmeter, Christopher F.; Kanninen, Barbara; Estabrooks, Paul A.
  9. How do Smoking Bans in Bars/Restaurants Affect Alcohol Consumption? By Koksal, Aycan; Wohlgenant, Michael
  10. The associations between early life circumstances and later life health and employment in the Netherlands and Spain By Manuel Flores; Adriaan Kalwij
  11. Measuring equity in health: a normative decomposition By Li Donni, P;; Peragine, V;; Pignataro G;
  12. Quality and quantity: the role of social interactions in individual health By Fiorillo, D;; Sabatini, F;
  13. Modelling life expectancy in Turkey By Halicioglu, Ferda
  14. Positive externalities of congestion on health: A case study of chronic illness in Japan for the period 1988–2009. By Yamamura, Eiji
  15. Contraceptive use among illiterate women in India: does proximate illiteracy matter? By Husain, Zakir; Dutta, Mousumi; Ghosh, Sriparna
  16. Disability Insurance and Labor Market Exit Routes of Older Workers in The Netherlands By Klaas de Vos; Arie Kapteyn; Adriaan Kalwij
  17. Disability and Social Security Reforms: The French Case By Luc Behaghel; Didier Blanchet; Thierry Debrand; Muriel Roger
  18. Disability Insurance, Population Health and Employment in Sweden By Lisa Jönsson; Mårten Palme; Ingemar Svensson
  19. Disability Pension Program and Labor Force Participation in Japan: A Historical Perspective By Takashi Oshio; Satoshi Shimizutani
  20. Pharmaceutical Use Following Generic Entry: Paying Less and Buying Less By Peter J. Huckfeldt; Christopher R. Knittel
  21. Health, Disability and Pathways to Retirement in Spain By Pilar García-Gómez; Sergi Jiménez-Martín; Judit Vall Castelló
  22. Disability, Health and Retirement in the United Kingdom By James Banks; Richard Blundell; Antoine Bozio; Carl Emmerson

  1. By: Daniel Kemptner; Jan Marcus
    Abstract: This is the first study investigating the causal effect of maternal education on child’s health and schooling outcomes in Germany. We apply an instrumental variables approach that has not yet been used in the intergenerational context. For that purpose, we draw on a rich German panel data set (SOEP) containing information about three generations. This allows instrumenting maternal education by the number of her siblings while conditioning on a set of variables describing the grandparents’ social status and the area where the mother grew up. Given these variables, the number of siblings generates exogenous variation in the years of education by affecting the household resources available per child. We present evidence for strong and significant effects on schooling outcomes for both sexes. And, we find substantial effects on health behaviour for adolescent daughters, but not for adolescent sons. We show that possible concerns for the validity of the instrument are unlikely to compromise these results. We also discuss assortative mating and household income as possible channels of causality.
    Keywords: Intergenerational mobility, returns to education, health, instrumental variables
    JEL: I12 I21 J62
    Date: 2011
  2. By: Ramses H. Abul Naga (IEMS - Institut d'économie et de management de la santé - Université de Lausanne); Karine Lamiraud (Economics Department - ESSEC Business School)
    Abstract: According to the catastrophic health expenditure methodology a house-hold is in catastrophe if its health out-of-pocket budget share exceeds a critical threshold. We develop a conceptual framework for addressing three questions in relation to this methodology, namely: 1. Can a budget share be informative about the sign of a change in welfare? 2. Is there a positive association between a households poverty shortfall and its health out-of-pocket budget share? 3. Does an increase in coverage of a health insurance scheme always result in a reduction of the prevalence of catastrophic ex-penditures?
    Date: 2011–05–25
  3. By: Boone, Jan (Tilburg University); van Ours, Jan C. (Tilburg University); Wuellrich, Jean-Philippe (University of Zurich); Zweimüller, Josef (University of Zurich)
    Abstract: Workplace accidents are an important economic phenomenon. Yet, the pro-cyclical fluctuations in workplace accidents are not well understood. They could be related to fluctuations in effort and working hours, but workplace accidents may also be affected by reporting behavior. Our paper uses unique data on workplace accidents from an Austrian matched worker-firm dataset to study in detail how economic incentives affect workplace accidents. We find that workers who reported an accident in a particular period of time are more likely to be fired later on. And, we find support for the idea that recessions influence the reporting of moderate workplace accidents: if workers think the probability of dismissals at the firm level is high, they are less likely to report a moderate workplace accident.
    Keywords: workplace accidents, economic incentives, cyclical fluctuations
    JEL: I10 J60 J81
    Date: 2011–05
  4. By: Oshio, Takashi; Urakawa, Kunio
    Abstract: We examine how sense of coherence (SOC) mediates the association between perceived neighborhood characteristics and health, using micro data collected from a nationwide Internet survey in Japan conducted in 2011 (N = 9,940). We focus on the impact of neighborhood dissatisfaction, various aspects of perceived neighborhood characteristics, and trust in neighbors on self-rated health and four types of unhealthy behaviors: performing no exercise, sleeping for short periods, smoking, and eating no breakfast. After controlling for SOC, the direct relationship between subjective neighborhood assessment and health was less pronounced. At the same time, a mediation analysis reveals that the impact of neighborhood characteristics on health is highly mediated by SOC. Moreover, the extent of SOC mediation differs substantially across combinations of specific neighborhood characteristics and health variables. Among neighborhood characteristics, perceived safety tends to directly affect health with limited mediation. Among the unhealthy behaviors, performing no exercise is associated with a wide variety of neighborhood characteristics, the impacts of which are substantially mediated by SOC. We believe that this study presents a new aspect to the analysis of the association between one’s perception of his/her neighborhood and health.
    Keywords: Sense of coherence, self-rated health, perceived neighborhood characteristics, mediation analysis, Japan
    Date: 2011–03
  5. By: Matthias Keese; Hendrik Schmitz
    Abstract: We analyze the effect of household indebtedness on different health outcomes using data from the German Socio-Economic Panel from 1999–2009. To establish a causal effect, we rely on (a) fixed-eff ects methods, (b) a subsample of constantly employed individuals, and (c) lagged debt variables to rule out problems of reverse causality. We apply different measures of household indebtedness, such as the percentage shares of household income spent on consumer credit and home loan repayments (which indicate the severity of household indebtedness) and a binary variable of relative overindebtedness (which indicates a precarious debt situation). We find all debt measures to be strongly correlated with health satisfaction, mental health, and obesity. Controlling for unobserved heterogeneity and reversed causality we find evidence that household debt also causally deteriorates physical and mental health. However, there is no causal effect on being obese.
    Keywords: Debt; health satisfaction; mental health; obesity; fixed-effects
    JEL: D12 D14 I12
    Date: 2010–12
  6. By: Savedoff, William D.
    Abstract: Many different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.
    Keywords: Health Monitoring&Evaluation,Governance Indicators,National Governance,Health Systems Development&Reform,Health Economics&Finance
    Date: 2011–05–01
  7. By: Koksal, Aycan; Wohlgenant, Michael
    Abstract: In this paper, using pseudo panel data we analyze the relation between cigarette, alcohol, and coffee consumption within the rational addiction framework. Our purpose in this study is twofold. First, we want to get more insights about behavioral processes concerning cigarette, alcohol and coffee consumption. Second, we hope that our attempt to generalize rational addiction model to include three addictive goods will be useful to generate further research in the related literature. We found that cross price elasticity of cigarette with respect to alcohol price is negative, while cross price elasticity of alcohol with respect to cigarette price is positive. We believe that drinking works as a trigger for smoking especially in social settings like bars while it is also possible that people who want to cut cigarette consumption might increase alcohol consumption to cope with resulting stress, which induces an asymmetry in cross price elasticities. We did not find a strong relation between coffee consumption and the consumption of cigarette and alcohol. This finding does not rule out the possibility that coffee and cigarette are complements for certain people. However there is not a significant complementarity relationship when we look at the whole population.
    Keywords: cigarette, alcohol, coffee, rational addiction, pseudo panel, Demand and Price Analysis,
    Date: 2011
  8. By: You, Wen; Hashemi, Ali; Boyle, Kevin; Parmeter, Christopher F.; Kanninen, Barbara; Estabrooks, Paul A.
    Abstract: This study employed stated-preference methods to elicit individualsâ program participation preference towards different financial incentive attributes. The results of this study show promise for the use of carefully designed incentive programs to raise participation in weight loss programs. Results show that a fungible payment form is important for the incentive to be effective in reach (i.e., cash and grocery gift-cards are preferred over gym passes and waivers of insurance co-payments). Furthermore, immediate payment is preferred over delayed payment.
    Keywords: Financial Incentives, Program Reach, Random Parameter Logit, Health Economics and Policy, F10, F13,
    Date: 2011
  9. By: Koksal, Aycan; Wohlgenant, Michael
    Abstract: In this study, we employ a rational addiction framework to analyze the effects of smoking bans on alcohol consumption in bars/restaurants. We use pseudo panel data approach which has many advantages compared to panel data. Although cigarettes and alcohol are complements in consumption, our findings suggest that smoking bans in restaurants do not have a significant effect on the restaurant alcohol consumption. It is possible that smoking bans at restaurants cause a decrease in the restaurant alcohol consumption of smokers, but lead to an increase in the restaurant alcohol consumption of nonsmokers. If this is the case, the net effect of smoking bans on overall restaurant alcohol consumption would be zero. These results are just preliminary, and further analyses are required.
    Keywords: cigarette, alcohol, smoking ban, rational addiction, pseudo panel, Demand and Price Analysis,
    Date: 2011
  10. By: Manuel Flores; Adriaan Kalwij
    Abstract: Using data from the Survey of Health, Ageing and Retirement in Europe, this paper provides empirical evidence for the Netherlands and Spain on the associations between individuals' early life circumstances - measured by health and socioeconomic status (SES) during childhood - educational attainment, and later life health and employment (at ages 50-64). We find that for both men and women in the Netherlands and Spain, favorable early life circumstances (i.e., better childhood health and higher SES) are associated with a higher level of education, which is in turn associated with better health later in life. This latter is also linked to early life circumstances conditional on educational attainment. For men only, favorable early life circumstances are associated with a higher incidence of later life employment, primarily because of better later life health. Our findings thus suggest that policies aimed at improving children's s health and SES may have long-term benefits through increased individual educational attainment and later life health and employment.
    Keywords: Early life circumstances, health, employment
    JEL: D00 I10 J10 J20
    Date: 2011–04
  11. By: Li Donni, P;; Peragine, V;; Pignataro G;
    Abstract: This paper proposes a new approach to the measurement of equality of opportunity in health, based on the path independent Atkinson index of equality. The proposed decomposition is applied both to the ex-ante and the ex-post methodologies recently adopted by the literature. The approach is applied to the measurement of equality of opportunity in health using ten waves of the British Household Panel Survey. Results confirm that socioeconomic background is an important factor determining individual health in adulthood while the incidence of equality of opportunity is around one third of the overall equality according to a substantial stable pattern over years. Our findings also depict that differences in education, in social conditions and in the life style are crucial determinants of the shape of the observed health equalities in adulthood, explaining how potential differences can be derived by the combination of different circumstances.
    Keywords: Equality of opportunity; health inequalities; Atkinson index; responsibility;
    JEL: C52 D82 G22 I10
    Date: 2011–05
  12. By: Fiorillo, D;; Sabatini, F;
    Abstract: The public health literature focusing on the detrimental effects of social isolation has shown that the quantity of social connections is positively correlated with individual health. Drawing on pooled cross-sectional data, we test this hypothesis on a representative sample of the Italian population. Our findings show that, besides the quantity of interactions, it is their quality – as measured by subjective satisfaction derived from relationships with friends – that works as the best predictor of health. We point out the existence of health disparities based on socio-economic status. Poorer and less educated individuals are exposed to a higher probability of reporting poor health conditions. The risk is even worse for unemployed and retired workers. This paper contributes to the literature in two substantive dimensions. This is the first empirical study of the relationship between social interactions and health in Italy. Second, we add to previous studies by carrying out the first assessment of Tthe role of satisfaction in interpersonal relations.
    Keywords: health; well-being; satisfaction; social interactions; social capital; family; Italy
    JEL: I12 I18 Z1
    Date: 2011–04
  13. By: Halicioglu, Ferda
    Abstract: This study is concerned with understanding the factors of life expectancy in Turkey for the period 1965-2005. The determinants of life expectancy in Turkey are related to selected social, economical and environmental factors. Bounds testing approach to cointegration is employed to compute the long-run elasticities of longevity with respect to the selected economic, social and environmental factors. There exists no previous study that estimates empirically the determinants of life expectancy in Turkey on the basis of time series data and cointegration framework. Empirical results suggest that nutrition and food availability along with health expenditures are the main positive factors for improving longevity whereas smoking seems to be the main cause for mortality. The results also draw a number of policy recommendations for improving longevity.
    Keywords: life expectancy; econometrics; cointegration; elasticities; Turkey.
    JEL: I12 C22
    Date: 2010
  14. By: Yamamura, Eiji
    Abstract: This paper explores, using Japanese panel data for the years 1988–2009, how externalities from congestion and human capital influence deaths caused by chronic illnesses. Major findings through fixed effects 2SLS estimation were as follows: (1) during the first-half period 1988-98, the number of deaths was proportionally smaller in areas where social capital was larger. Population density and human capital, however, did not affect number of deaths; (2) during the second-half period 1999–2009, the number of deaths was proportionally smaller in more densely populated areas. In addition, human capital contributed to decease the number of deaths. Social capital, on the other hand, did not influence number of deaths. These findings suggest that human capital and positive externalities stemming from congestion make greater contributions to improving lifestyle when chronic illness increases.
    Keywords: population density; education; chronic illness
    JEL: R58 I19
    Date: 2011–05–03
  15. By: Husain, Zakir; Dutta, Mousumi; Ghosh, Sriparna
    Abstract: Illiterate women comprise a particularly vulnerable section of the community. They lack empowerment, are unable to voice their choice with respect to contraceptive use, and also lack access to health services. However, their lack of literacy may be compensated if their partners are literate. Contraceptive use of such illiterate women (proximate literates), may be higher than that of illiterate women whose partners too are illiterates (isolate illiterates). The study uses the third wave of the Demographic Health Survey data for India (2005-2006).The 34,108 currently married illiterate women for whom data is available in the Individual file was divided into two groups, based on whether their partners were literate. Current use of modern contraceptives was compared between these two groups for socio-economic and demographic correlates. This was followed by multivariate analysis based on a logit model. Current use of modern methods was regressed on a dummy representing whether the partner was literate, along with relevant control variables. The results of the All-India (Rural+Urban) and All-India (Rural) models indicated that literacy of partners did lead to a significantly higher level of use of modern contraceptive methods. For the urban sub-sample, however, the study failed to find any significant transmission of information from the literate partner to the respondents. Disaggregate-level analysis also revealed that such transmission was restricted to only specific situations and communities. The study argued that the results may be explained by: [a] Reluctance of the male partner to share information; [b] Lack of information about family planning methods, even when there is communication; and [c] Presence of alternative channels of information reducing dependence of illiterate women on her partner. There should be an attempt to increase information of both partners through face to face interaction, rather than relying solely on public media. Simultaneously, women should be encouraged to develop contacts outside her household as this can reduce her dependence of partner for family planning related knowledge.
    Keywords: Contraceptives; Literacy; Reproductive Health; India
    JEL: J13 I20 C35
    Date: 2011–05–04
  16. By: Klaas de Vos; Arie Kapteyn; Adriaan Kalwij
    Abstract: This paper presents information on labor market participation of the elderly, mortality and health, pathways to retirement and rates of participation in various earnings replacing programs in the Netherlands. It presents an overview of reforms to Disability Insurance (DI) and other income maintenance and early retirement programs over the past few decades, and examines to what extent these reforms have affected labor market exit routes of older workers. The overall picture that emerges is that DI receipt appears unrelated to the general health of the population and that over the last two decades relatively fewer older workers exit the labor market through DI. This reduction may, arguably, in part be attributed to stricter DI eligibility rules.
    JEL: J26
    Date: 2011–05
  17. By: Luc Behaghel; Didier Blanchet; Thierry Debrand; Muriel Roger
    Abstract: The French pattern of early transitions out of employment is basically explained by the low age at “normal” retirement and by the importance of transitions through unemployment insurance and early-retirement schemes before access to normal retirement. These routes have exempted French workers from massively relying on disability motives for early exits, contrarily to the situation that prevails in some other countries where normal ages are high, unemployment benefits low and early-retirement schemes almost non-existent. Yet the role of disability remains interesting to examine in the French case, at least for prospective reasons in a context of decreasing generosity of other programs. The study of the past reforms of the pension system underlines that disability routes have often acted as a substitute to other retirement routes. Changes in the claiming of invalidity benefits seem to match changes in pension schemes or controls more than changes in such health indicators as the mortality rates. However, our results suggest that increases in average health levels over the past two decades have come along with increased disparities. In that context, less generous pensions may induce an increase in the claiming of invalidity benefits partly because of substitution effects, but also because the share of people with poor health increases.
    JEL: H55 H63 J14 J26
    Date: 2011–05
  18. By: Lisa Jönsson; Mårten Palme; Ingemar Svensson
    Abstract: This paper describes the development of population health and disability insurance utilization for older workers in Sweden and analyzes the relation between the two. We use three different measures of population health: (1) the mortality rate (measured between 1950 and 2009); (2) the prevalence of different types of health deficiencies obtained from Statistics Sweden’s Survey on Living Conditions (ULF, 1975-2005); (3) the utilization of health care from the inpatient register (1968–2008). We also study the development of the relative health between disability insurance recipients and non-recipients. Finally, we study the effect of the introduction of less strict eligibility criteria for older workers in 1970 and 1972 as well as the subsequent abolishment of these rules in 1991 and 1997, respectively.
    JEL: H51 H55 I18 J26
    Date: 2011–05
  19. By: Takashi Oshio; Satoshi Shimizutani
    Abstract: This paper utilizes historical information to explore the relationship between labor force participation of middle aged and old people and the disability program in Japan. In particular, we explore the time series dimension to identify what has determined the trend in disability program participation over time and relate it with the labor supply. We find that mortality and health measures have been largely unrelated to the disability program participation rates. While major revisions to the disability program have slightly expanded the eligibility for DI programs, the program participation is still very low; thus, the effect on labor force participation is very limited in Japan, which is in contrast with some European countries that have high take up rates, inducing early retirement.
    JEL: H55 J26
    Date: 2011–05
  20. By: Peter J. Huckfeldt; Christopher R. Knittel
    Abstract: We study the effects of generic entry on prices and utilization using both event study models that exploit the differential timing of generic entry across drug molecules and cast studies. Our analysis examines drugs treating hypertension, high blood pressure, type 2 diabetes, and depression using price and utilization data from the Medical Expenditure Panel Survey. We find that utilization of drug molecules starts decreasing in the two years prior to generic entry and continues to decrease in the years following generic entry, despite decreases in prices offered by generic versions of a drug. This decrease coincides with the market entry and increased utilization of branded reformulations of a drug going off patent. We show case study evidence that utilization patterns coincide with changes in marketing by branded drug manufacturers. While the reformulations---often extended-release versions of the patent-expiring drug---offer potential health benefits, the FDA does not require evidence that the reformulations are improvements over the previous drug in order to grant a patent. Indeed, in a number of experiments comparing the efficacies of the patent-expiring and reformulated drugs do not find statistical differences in health outcomes calling into question the patent-extension policy.
    JEL: I18 L11 M3 O31 O38
    Date: 2011–05
  21. By: Pilar García-Gómez; Sergi Jiménez-Martín; Judit Vall Castelló
    Abstract: In this paper we analyze the trends in labor force participation and transitions to benefit programs of older workers in relation to health trends as well as recent Social Security reforms. Our preliminary conclusions are pessimistic regarding the effect of health improvements on the labor market attachment of older workers since we show that despite the large improvements in the mortality rates among older individuals in Spain, the employment rates of individuals older than fifty-five remain lower than the ones observed in the late 1970s. Some caution should remain in our conclusions as the evidence on health trends is inconclusive. Regarding the effect of Social Security reforms, we find that both the 1997 and the 2002 reform decreased the stock into old-age benefits at the cost of an increased share of the participation into disability. Finally, we find that there was a significant increase in the outflow from employment into disability after the 2002 reform.
    JEL: H55 I18 J11
    Date: 2011–05
  22. By: James Banks; Richard Blundell; Antoine Bozio; Carl Emmerson
    Abstract: Over the last thirty years pathways to retirement have changed substantially in the UK. They have been dominated by spells of unemployment in the late 1970s, with then an increased importance of disability spells from the mid-1980s onwards. At the end of the period the direct route from work to retirement was increasingly more common. General economic conditions seem to have been important driving forces during the entire period. In contrast changes in health do not seem to provide convincing explanations for these trends: mortality has been falling over the period without any apparent link to the share of the population reporting ill health or disability or to the number claiming benefits. We also find evidence that recent reforms have had some impact. The halting of the previous growth in the rate of in-flow onto disability benefits in the mid-1990s coincided with the implementation of a major reform. Evidence from the pilots of the Pathways-to-Work programme in 2003-2005 suggests that those moving onto disability benefits moved off these benefits faster than they would otherwise have done as a direct result of the programme.
    JEL: H55 I1 I38
    Date: 2011–05

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