nep-hea New Economics Papers
on Health Economics
Issue of 2011‒06‒25
ten papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Estimating Heterogeneous Take-up and Crowd-Out Responses to Marginal and Non-Marginal Medicaid Expansions By Ham, John C.; Ozbeklik, Serkan; Shore-Sheppard, Lara
  2. Quality and Quantity in Primary Care Mixed Payment Models: Evidence from Family Health Organizations in Ontario By Kantarevic, Jasmin; Kralj, Boris
  3. Antidepressants and Age By Blanchflower, David G.; Oswald, Andrew J.
  4. Use of Time and Value of Unpaid Family Care Work: A Comparison between Italy and Poland By Francavilla, Francesca; Giannelli, Gianna Claudia; Grotkowska, Gabriela; Socha, Mieczyslaw
  5. Delta and Gamma hedging of mortality and interest rate risk By Elisa Luciano; Luca Regis; Elena Vigna
  6. What Drives Inflows Into Disability?: Evidence from Three OECD Countries: Australia, Switzerland, United Kingdom By Ana Llena-Nozal; Theodora Xenogiani
  7. Malnutrition, Subsequent Risk of Mortality and Civil War in Burundi By Philip Verwimp
  8. The effect of coinsurance rate on the demand for healthcare: a natural experience in Japan By Galina Besstremyannaya
  9. Disability Programs, Health and Retirement in Denmark since 1960 By Paul Bingley; Nabanita Datta Gupta; Peder J. Pedersen
  10. Dimensions of Health in the Elderly Population By David M. Cutler; Mary Beth Landrum

  1. By: Ham, John C. (University of Maryland); Ozbeklik, Serkan (Claremont McKenna College); Shore-Sheppard, Lara (Williams College)
    Abstract: We use a linear probability model with interactions and a switching probit model (SPM) to estimate heterogeneous effects of Medicaid expansions on Medicaid take-up, private insurance coverage and crowd-out. Specifically, we estimate: i) LATEs; ii) ATETs for the currently eligible; and iii) ATETs for those made eligible by a non-marginal (counterfactual) expansion in Medicaid eligibility. Both estimation methods can control for observable differences across individuals, while SPM can also control for unobservable differences. For Medicaid take-up and private insurance coverage, the effects are precisely estimated and differ dramatically across demographic groups, but this is less true for the crowd-out estimates.
    Keywords: Medicaid expansions, take-up, crowd-out, treatment effects, switching probit model, linear probability model with interactions, counterfactual policy analysis
    JEL: I18 C21
    Date: 2011–06
  2. By: Kantarevic, Jasmin (Ontario Medical Assocation); Kralj, Boris (Ontario Medical Assocation)
    Abstract: We study the impact of a mixed capitation model known as the Family Health Organization (FHO) on selected quality and quantity outcomes relative to an enhanced fee-for-service model known as the Family Health Group (FHG) among primary care physicians in Ontario, Canada. Using a panel of administrative data that covers one year before and two years after the FHO model was introduced in 2007, we find that physicians in the FHO model provide about 6 percent fewer services and visits per day, but are between 8 and 15 percent more likely to achieve preventive care bonuses for senior flu shots, toddler immunizations, pap smears, and mammograms compared to physicians in the FHG model. These results are largely consistent with the hypothesis that the mixed payment model may reduce quantity and improve quality of health care relative to the fee-for-service model. We also find that the FHO physicians have lower referral rates and enroll patients of similar complexity compared to the FHG physicians.
    Keywords: physician remuneration, primary care, Family Health Organizations, Family Health Groups, Ontario, Canada
    JEL: I10 I12 I18
    Date: 2011–06
  3. By: Blanchflower, David G. (Dartmouth College); Oswald, Andrew J. (IZA)
    Abstract: Antidepressants as a commodity have been remarkably little-studied by economists. This study shows in new data for 27 European countries that 8% of people (and 10% of those middle-aged) take antidepressants each year. The probability of antidepressant use is greatest among those who are middle-aged, female, unemployed, poorly educated, and divorced or separated. A hill-shaped age pattern is found. The adjusted probability of using antidepressants reaches a peak – approximately doubling – in people’s late 40s. This finding is consistent with, and provides a new and independent form of corroboration of, recent claims in the research literature that human well-being follows a U-shape through life.
    Keywords: well-being, aging, mental health, depression, happiness, Easterlin paradox
    Date: 2011–06
  4. By: Francavilla, Francesca (University of Westminster); Giannelli, Gianna Claudia (University of Florence); Grotkowska, Gabriela (Warsaw University); Socha, Mieczyslaw (Warsaw University)
    Abstract: This study provides a comparison of the size and value of unpaid family care work in two European member States, Italy and Poland. Using the Italian and Polish time use surveys, both the opportunity cost and the market replacement approaches are employed to separately estimate the value of family childcare and care of the elderly. The results show that, overall, in Italy the number of people performing family care work is higher, also due to the larger population. Italians participate somewhat less than Poles in child care, but substantially more in care of the elderly because of demographic factors. However, the huge difference in the value of unpaid family care work, which in Italy exceeds the value of Poland by about eight times, is largely to be attributed to the discrepancy in hourly earnings, average earnings of Poles being about one fifth of those of Italians. In GDP terms, instead, the value of unpaid family care work is more similar, ranging between 3.7 and 4.4 per cent of the Polish GDP and 4.1 and 5 per cent of the Italian GDP, depending on the estimation approach. The national values of these activities are discussed and an interpretation of the country differentials in the family care-taking gender gaps is given in terms of differences in culture, economic development and institutions.
    Keywords: unpaid work, time use, child care, care of the elderly, adult care, Poland, Italy, satellite accounts
    JEL: E01 E26 J13 J14 J16 J22
    Date: 2011–06
  5. By: Elisa Luciano; Luca Regis; Elena Vigna
    Abstract: This paper studies the hedging problem of life insurance policies, when the mortality and interest rates are stochastic. We focus primar- ily on stochastic mortality. We represent death arrival as the rst jump time of a doubly stochastic process, i.e. a jump process with stochastic intensity. We propose a Delta-Gamma Hedging technique for mortal- ity risk in this context. The risk factor against which to hedge is the dierence between the actual mortality intensity in the future and its "forecast" today, the instantaneous forward intensity. We specialize the hedging technique rst to the case in which survival intensities are ane, then to Ornstein-Uhlenbeck and Feller processes, providing actuarial justications for this restriction. We show that, without im- posing no arbitrage, we can get equivalent probability measures under which the HJM condition for no arbitrage is satised. Last, we ex- tend our results to the presence of both interest rate and mortality risk, when the forward interest rate follows a constant-parameter Hull and White process. We provide a UK calibrated example of Delta and Gamma Hedging of both mortality and interest rate risk.
    Date: 2011–01
  6. By: Ana Llena-Nozal; Theodora Xenogiani
    Abstract: This paper investigates the dynamic effects of health shocks on labour market transitions to disability, employment and other non-employment pathways. It uses longitudinal data to estimate time discrete duration models for three countries: Australia, Switzerland and the United Kingdom. Both current and lagged health status are important predictors of exit to disability benefits and the effect of health problems varies by age group, education and income across countries. The results are robust to the inclusion of different socio-demographic variables and to instrumenting health status.<BR>Ce papier analyse les effets dynamiques des chocs de santé sur les transitions du marché du travail vers des prestations d’invalidité, l’emploi et d’autres voies de non-emploi. Il utilise des données longitudinales pour estimer des modèles de durée à temps discret pour trois pays: l’Australie, la Suisse et le Royaume Uni. L’état de santé courante et celui de la période précédente ont un impact important sur la probabilité des sorties vers les régimes d’invalidité, et l’effet des problèmes de santé varie avec l’âge, l’éducation et le revenu à travers les pays. Les résultats sont robustes à l’inclusion des variables sociodémographiques et à l’instrumentation de l’état de santé.
    JEL: H55 I10 J14
    Date: 2011–03–28
  7. By: Philip Verwimp
    Abstract: The paper investigates the effect of child malnutrition on the risk of mortality in Burundi, a very poor country heavily affected by civil war. We use anthropometric data from a longitudinal survey (1998-2007). We find that undernourished children, as measured by the height-for-age z-scores (HAZ) in 1998 had a higher probability to die during subsequent years. In order to address the problem of omitted variables correlated with both nutritional status and the risk of mortality, we use the length of exposure to civil war prior to 1998 as a source of exogenous variation in a child’s nutritional status. Children exposed to civil war in their area of residence have worse nutritional status. The paper finds that one year of exposure translates into a 0.15 decrease in the HAZ, resulting in a 10% increase in the probability to die for the whole sample as well as a 0.34 decrease in HAZ per year of exposure for boys only, resulting in 25% increase in the probability to die. We show the robustness of our results. Food and income transfer programs during civil war should be put in place to avoid the long-term effects of malnutrition.
    Keywords: malnutrition; mortality; children; war; Africa; instrumental variables
    Date: 2011–06
  8. By: Galina Besstremyannaya (CEFIR)
    Abstract: The paper measures the effect of coinsurance rate on the demand for healthcare in Japan. We construct the control group of consumers and estimate the average treatment effect of the April 2003 rise in coinsurance rate of heads of households on their healthcare expenditure. Another approach assesses the impact of the nominal coinsurance rate on the probability of having healthcare expenditure. Individual heterogeneity is exploited with the help of a latent class model. The analysis employs the 2000-2006 data of the Japanese Panel Survey of Consumers. The estimations demonstrated a negative and significant effect of the coinsurance rate on the demand for healthcare. The elasticity of total healthcare expenditure with respect to nominal coinsurance rate was -0.51. The rise in nominal coinsurance rate from 20% to 30% decreased the probability of having healthcare expenditure by 4.2%. The estimates justify the reliance on coinsurance rate as an instrument to contain costs in Japanese health insurance system. Yet, enhancing the efficiency of healthcare provision may offer alternative means to dealing with the burden of healthcare costs in Japan.
    Keywords: healthcare demand, social health insurance, coinsurance rate, price elasticity
    JEL: I10 I18 G22 R22
    Date: 2011–05
  9. By: Paul Bingley; Nabanita Datta Gupta; Peder J. Pedersen
    Abstract: This paper investigates the interaction between measures of health, disability pension take up and labor market performance in Denmark by charting their development over time and by examining how they are affected by key policy reforms in the area of early retirement. The main emphasis is on the long-run development of the Social Disability Pension (SDP) program, and whether it concurs with trends in population health based on mortality indicators (both overall and cause-specific) and with self-reported health. A strong relationship is found between labor force activity measures and non-health related programs for early retirement for those 60 and older. However, no clear relationship is evident between SDP take up and the health indicators. One reason for the lack of a correlation is most probably that SDP is “on its own track” due to program innovations and reforms creating competing risks or program substitution especially for the 50+ population.
    JEL: H51 H55 I18 J26
    Date: 2011–06
  10. By: David M. Cutler; Mary Beth Landrum
    Abstract: In this paper, we characterize the multi-faceted health of the elderly and understand how health along multiple dimensions has changed over time. Our data are from the Medicare Current Beneficiary Survey, 1991-2007. We show that 19 measures of health can be combined into three broad categories: a first dimension representing severe physical and social incapacity such as difficulty dressing or bathing; a second dimension representing less severe difficulty such as walking long distances or lifting heavy objects; and a third dimension representing vision and hearing impairment. These dimensions have changed at different rates over time. The first and third have declined rapidly over time, while the second has not. The improvement in health is not due to differential mortality of the sick or a new generation of more healthy people entering old age. Rather, the aging process itself is associated with less rapid deterioration in health. We speculate about the factors that may lead to this.
    JEL: I1 I12
    Date: 2011–06

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