nep-hea New Economics Papers
on Health Economics
Issue of 2011‒08‒15
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. A hybrid approach to efficiency measurement with empirical illustrations from education and health By Wagstaff, Adam; Wang, L. Choon
  2. Direct and Indirect Determinants of Obesity: The Case of Indonesia By Romling, Cornelia; Qaim, Matin
  4. Health and Economic Development - Evidence from the Introduction of Public Health Care By Strittmatter, Anthony; Sunde, Uwe
  5. Waiting times and socioeconomic status: does sample selection matter? By A. Sharma;; L. Siciliani;; A. Harris ;
  6. From social capital to health - and back By L. Rocco;; F. Elena;; M. Suhrcke;
  7. Measuring overfitting and mispecification in nonlinear models By Bilger M.;; Manning W.G;
  8. Structural social capital and health in Italy By D. Fiorillo;; F. Sabatini;
  9. Estimating the Impact of Health Programmes on the Anthropometric Indicators for Bangladeshi Women and Children Using Cross-Sectional Data By Hossain, M. I. ;
  10. Estimates of the asset-effect: The search for a causal effect of assets on adult health and employment outcomes By Abigail McKnight
  11. The Importance of the Meaning and Measurement of “Affordable” in the Affordable Care Act By Richard V. Burkhauser; Sean Lyons; Kosali I. Simon
  12. "Healthy, Wealthy and Wise?" Revisited: An Analysis of the Causal Pathways from Socio-economic Status to Health By Till Stowasser; Florian Heiss; Daniel McFadden; Joachim Winter

  1. By: Wagstaff, Adam; Wang, L. Choon
    Abstract: Inefficiency is commonplace, yet exercises aimed at improving provider performance efforts to date to measure inefficiency and use it in benchmarking exercises have not been altogether satisfactory. This paper proposes a new approach that blends the themes of Data Envelopment Analysis and the Stochastic Frontier Approach to measure overall efficiency. The hybrid approach nonparametrically estimates inefficiency by comparing actual performance with comparable real-life"best practice"on the frontier and could be useful in exercises aimed at improving provider performance. Four applications in the education and health sectors are used to illustrate the features and strengths of this hybrid approach.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Tertiary Education,Disease Control&Prevention,Education For All
    Date: 2011–08–01
  2. By: Romling, Cornelia; Qaim, Matin
    Abstract: Overweight and obesity are becoming serious issues in many developing countries. Since undernutrition is not completely eradicated yet, these countries face a dual burden that obstructs economic development. We analyze the nutrition transition in Indonesia using longitudinal data from the Indonesian Family and Life Survey, covering the period between 1993 and 2007. Obesity has been increasing remarkably across all population groups, including rural and low income strata. Prevalence rates are particularly high for women. We also develop a framework to analyze direct and indirect determinants of body mass index. This differentiation has rarely been made in previous research, but appears useful for policy making purposes. Regression models show that changing food consumption patterns coupled with decreasing physical activity levels during work and leisure time directly contribute to increasing obesity. Education, income, and marital status are significant determinants that influence nutritional status more indirectly. Change regressions underline that there are important path-dependencies. From a policy perspective, nutrition awareness and education campaigns, combined with programs to support leisure time exercise, seem to be most promising to contain the obesity pandemic. Women should be at the center of policy attention.
    Keywords: Obesity, Overweight, Nutrition Transition, Asia, Indonesia, Consumer/Household Economics, Food Consumption/Nutrition/Food Safety, Health Economics and Policy, I10, O12,
    Date: 2011–06
  3. By: Srinivasan, C. S.
    Abstract: Promotion of healthier eating choices and adherence to recommended dietary norms are important elements of the UK Governmentâs food strategy to combat the rising incidence of obesity. This paper explores the paradox of rising incidence of obesity over the last two decades even as consumers have moved towards healthier dietary choices. We analyse data from the UKâs National Diet and Nutrition Surveys over this period using quantile regression and counterfactual decompositions to identify the main elements underlying this paradox. We find that adherence to individual dietary norms in isolation has only very modest impacts on the obesity profile of the population. Efforts to promote compliance with some of the norms may have the unintended consequence of increasing excessive calorie consumption, leading to increased obesity. The effects of improved adherence to dietary norms may be offset by the changes in the impact of adherence to norms on excessive energy intake. Our results suggest that nutrition and policy and interventions need to focus on the simultaneous compliance with a range of dietary norms to have a significant impact on the incidence of obesity.
    Keywords: Obesity incidence, adherence to dietary guidelines, impact assessment, Food Consumption/Nutrition/Food Safety,
    Date: 2011–04
  4. By: Strittmatter, Anthony; Sunde, Uwe
    Abstract: This paper investigates the causal effect of changes in health on economic development using a long panel of European countries. Identification is based on the particular timing of the introduction of public health care systems in different countries, which is the random outcome of a political process. We document that the introduction of public health care systems had a significant immediate effect on the dynamics of infant mortality and crude death rates. The findings suggest that a reduction in infant mortality or crude death rates exhibited a positive effect on growth in income per capita and increased population growth.
    Keywords: Mortality, Economic Development, Growth, Public Health Care.
    JEL: I10 J10 O11 N13
    Date: 2011–08
  5. By: A. Sharma;; L. Siciliani;; A. Harris ;
    Abstract: An increasing amount of empirical evidence suggests that patients with higher socioeconomic status wait less within publicly-funded hospitals to receive non-emergency (elective) surgery. Using data from Australia, we investigate the extent to which such gradient can be explained by sample selection, with richer patients being more likely to opt for treatment in the private sector when faced with waiting times in the public sector. We show that, once the potential biases introduced by sample selection are taken into account, the gradient between waiting times and socioeconomic status reduces significantly in size but does not disappear.
    Keywords: Hospital Waiting Times; Socio-economic Gradient; Quantile regression with sample selection; Heckman model
    JEL: I10 C14 C21
    Date: 2011–07
  6. By: L. Rocco;; F. Elena;; M. Suhrcke;
    Abstract: We assess the causal relationship between health and social capital, measured by generalized trust, both at the individual and the community level. The paper contributes to the literature in two ways: it tackles the problems of endogeneity and reverse causation between social capital and health by estimating a simultaneous equation model, and it explicitly accounts for mis-reporting in self reported trust. The relationship is tested using data from the first four waves of the European Social Survey for 26 European countries, supplemented by regional data from the Eurostat. Our estimates show that a causal and positive relationship between selfperceived health and social capital does exist and that it acts in both directions. In addition, the magnitude of the structural coefficients suggests that individual social capital is a strong determinant of health, while community level social capital plays a considerably smaller role in determining health.
    Date: 2011–07
  7. By: Bilger M.;; Manning W.G;
    Abstract: We start by proposing a new measure of overfitting expressed on the untransformed scale of the dependent variable, which is generally the scale of interest to the analyst.We then show that with nonlinear models shrinkage due to overfitting gets confounded by shrinkage—or expansion— arising from model misspecification. Out-of-sample predictive calibration can in fact be expressed as in-sample calibration times 1 minus this new measure of overfitting. We finally argue that re-calibration should be performed on the scale of interest and provide both a simulation study and a real-data illustration based on health care expenditure data.
    Keywords: overfitting, shrinkage, misspecification, forecasting, health care expenditure
    Date: 2011–08
  8. By: D. Fiorillo;; F. Sabatini;
    Abstract: This paper presents the first empirical assessment of the causal relationship between social capital and health in Italy. The analysis draws on the 2000 wave of the Multipurpose Survey on Household conducted by the Italian Institute of Statistics on a representative sample of the population (n = 50,618). Our measure of social capital is the frequency of meetings with friends. Based on probit and instrumental variables estimates, we find that higher levels of social capital increase perceived good health.
    Keywords: health, instrumental variables, income, social interactions, social capital, Italy.
    JEL: I12 I18 Z1
    Date: 2011–07
  9. By: Hossain, M. I. ;
    Abstract: In this paper we investigate the impact of health related programmes on health outcomes of women and children by applying the method of difference-in-differences on repeated cross-sectional datasets. Health outcomes are measured using an anthropometric indicator: weight-for-height z-score. We find a positive impact, due to financial protection and social safety net programmes in a seasonally famine-affected area in Bangladesh, on the health outcome of children. We also find that the BRAC Healthcare Programme (BHP), a healthcare programme run by a reputable NGO, BRAC, has a positive impact on the health outcome of its members living in urban slums. We apply a simple decomposition approach to measuring the contributions of the programmes in lowering or increasing the inequalities in the distribution of outcomes and find that none of the programmes analysed has made the inequalities in health worse. Our key objective in this study is to show that, in developing countries, where programme-specific data are rare, using broad data like the Demographic and Health Surveys (DHS) and the Multiple Indicators Cluster Surveys (MICS) etc. it is possible to identify relevant groups and periods in order to assess the performances of several government and non-government programmes.
    Keywords: Difference-in-differences; Weight-for-height z-scores; Decomposition.
    Date: 2011–07
  10. By: Abigail McKnight
    Abstract: In this paper we seek to determine the effect of assets held in early adult life on later outcomes. We specifically look at wages, employment prospects, general health and Malaise. The identification of an asset-effect throws up a number of statistical challenges as asset holding is not random. We employ a number of statistical techniques in our search for the causal effect of assets on adult health and employment outcomes. We find that simple Ordinary Least Squares and probit estimates of the asset effect are indeed biased in many cases. However, after applying a battery of techniques to remove such biases, the conclusion is that within the cohort examined (born in 1958), early asset holding does have positive effects on later wages, employment prospects, excellent general health and in reducing malaise.
    Keywords: asset effect, wealth, asset-based welfare
    Date: 2011–06
  11. By: Richard V. Burkhauser; Sean Lyons; Kosali I. Simon
    Abstract: This working paper highlights the practical importance of two critical but under-explored assumptions behind existing estimates of the Affordable Care Act (ACA)’s potential impact on the mix of employees and families who may have employer-sponsored health insurance (ESI) in the future or may receive subsidies in the new health insurance exchanges. The first assumption is whether ACA’s affordable coverage rule will be interpreted to mean that employers must provide affordable single coverage or that they must provide affordable family coverage policies to workers with families to avoid paying a fine. The second assumption is how much employers and employees will cooperatively agree in the future to designing new compensation contracts to take advantage of the way “affordability” is determined. We show that depending on these assumptions, the ACA could lead to far more lower to moderate income families gaining access to affordable coverage through exchanges or, conversely, to far fewer of these families being covered by ESI, even if no employers drop their health insurance plans as a result of the new law. Using our stylized models, we find at one extreme that the share of private sector workers covered by ESI would fall by as much as 12.7 percentage points, relative to a case of full compliance with the law, if the ACA affordability coverage rule is interpreted to apply to family coverage and employees directly pay 100 percent of the cost of the ESI in premiums, with compensating higher wages making them no worse off. At the other extreme, we find no changes in the share of private sector workers covered by ESI along this margin if employee contribution shares do not change in the future and affordability is interpreted to refer to single coverage. What constitutes a realistic point between these two extremes depends on exactly how the affordability coverage rule will be interpreted and the degree that employers and employees will actually be able to make these adjustments because of labor market rigidities. This working paper’s contribution is to point out the importance of these hitherto unexplored factors for future consideration in research that uses more sophisticated micro simulation models. In our stylized model, most of the effect of the movement onto the subsidized exchanges occurs when employees directly pay less than 50 percent of the ESI family premium. We conclude by discussing the limitations of stylized calculations relative to full simulation models, and directions for future research.
    JEL: I0
    Date: 2011–08
  12. By: Till Stowasser; Florian Heiss; Daniel McFadden; Joachim Winter
    Abstract: Much has been said about the stylized fact that the economically successful are not only wealthier but also healthier than the less affluent. There is little doubt about the existence of this socio-economic gradient in health, but there remains a vivid debate about its source. In this paper, we review the methodological challenges involved in testing the causal relationships between socio-economic status and health. We describe the approach of testing for the absence of causal channels developed by Adams et al. (2003) that seeks identification without the need to isolate exogenous variation in economic variables, and we repeat their analysis using the full range of data that have become available in the Health and Retirement Study since, both in terms of observations years and age ranges covered. This analysis shows that causal inference critically depends on which time periods are used for estimation. Using the information of longer panels has the greatest effect on results. We find that SES causality cannot be ruled out for a larger number of health conditions than in the original study. An approach based on a reduced-form interpretation of causality thus is not very informative, at least as long as the confounding influence of hidden common factors is not fully controlled.
    JEL: C33 C52 I0 I12 I30 J0 J20
    Date: 2011–08

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