nep-hea New Economics Papers
on Health Economics
Issue of 2011‒08‒29
twelve papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Causal Effects of Health Shocks on Consumption and Debt: Quasi-Experimental Evidence from Bus Accident Injuries By Manoj Mohanan
  2. Quality of work and health status: a multidimensional analysis By Tindara Addabbo; Marco Fuscaldo; Anna Maccagnan
  3. The Causal Impact of Fear of Unemployment on Psychological Health By Arndt Reichert; Harald Tauchmann
  4. The impact of recall periods on reported morbidity and health seeking behavior By Das, Jishnu; Hammer, Jeffrey; Sanchez-Paramo, Carolina
  5. International portability of health-cost coverage : concepts and experience By Werding, Martin; McLennan, Stuart
  6. Child mental health and educational attainment: multiple observers and the measurement error problem By David Johnston; Propper, Carol; Pudney, Stephen; Shields, Michael
  7. Adolescent pregnancies and health issues in Uttar Pradesh: Some policy implications By Rode, Sanjay
  8. Vertical Integration and Optimal Reimbursement Policy By Christopher Afendulis; Daniel Kessler
  9. Is the Foreclosure Crisis Making Us Sick? By Janet Currie; Erdal Tekin
  10. Health and Mortality Delta: Assessing the Welfare Cost of Household Insurance Choice By Ralph Koijen; Stijn Van Nieuwerburgh; Motohiro Yogo
  11. Was What Ail'd Ya' What Kill'd Ya'? By Robert W. Fogel; Louis Cain; Joseph Burton; Brian Bettenhausen
  12. Do Hospitals Cross Subsidize? By Guy David; Richard Lindrooth; Lorens A. Helmchen; Lawton R. Burns

  1. By: Manoj Mohanan
    Abstract: Endogeneity in the health-wealth relationship presents a challenge for estimating causal effects of health shocks. Using a quasi-experimental study design, comprising exogenous shocks sustained as bus accident injuries in India, with, "controls," drawn from travelers on the same bus routes one year later, I present new evidence of causal effects of health shocks on household consumption and debt. Using primary household survey data, I find that households faced with the health shock-related expenditures, which were on average equal to two months of household income, are able to smooth consumption on food, housing, and festivals, with small reductions in education spending. Debt was the principal mechanism used by households to mitigate effects of the shock, leading to significantly larger levels of indebtedness among the exposed.
    Keywords: Health Shocks, Causal Effects, Quasi-experimental, Health Expenditure, Consumption Smoothing, Debt, Road Traffic Accidents
    JEL: D91 I30
    Date: 2011
  2. By: Tindara Addabbo; Marco Fuscaldo; Anna Maccagnan
    Abstract: Quality of work has been found to significantly affect health outcomes. In this paper we analyse the extent to which the quality of the work done in the past affects the health of the elderly in Italy. For this purpose, we use data drawn from the Italian sample of the Survey of Health, Ageing and Retirement in Europe (SHARE) and focus on individuals aged over 60. Using different types of factor analysis, we identify three dimensions of quality of work and five factors of health status. In particular, as regards the former, we distinguish among the physical dimension, the control dimension and the socioeconomic dimension of work quality. As regards health, using a nested factor model we obtain a factor of global health problems and four residual factors of cognitive problems, mobility problems, affective problems and motivational problems. These factors are then analysed by gender using a multivariate analysis. Our findings suggest that good quality of work in terms of the socioeconomic and control dimensions significantly decreases the probability of being globally unhealthy during the elder phase of one’s life cycle as well as of displaying motivational problems, the effect being similar in both genders. We also find that a higher level of control in men’s work increases their affective problems when they are older and have left the labour force, suggesting a loss in men’s social sphere after retirement from a rewarding job and a likely underdevelopment of their relational dimension outside their work activity.
    Keywords: Quality of work, health status, elderly.
    JEL: J14 J28
    Date: 2011–08
  3. By: Arndt Reichert; Harald Tauchmann
    Abstract: We analyze the eff ect of job insecurity on psychological health. We extend the group of people being aff ected to employees who have insecure jobs to account for a broader measure of the mental health consequences of potential unemployment. Using panel data with staff reductions in the company as an exogenous source of job insecurity, we fi nd that an increase in fear of unemployment substantially decreases the mental health status of employees. Quantile regression results yield particularly strong eff ects for individuals of already poor mental health.
    Keywords: Fear of unemployment; mental health; job insecurity; labor market dynamics
    JEL: I10 I18 J28
    Date: 2011–07
  4. By: Das, Jishnu; Hammer, Jeffrey; Sanchez-Paramo, Carolina
    Abstract: Between 2000 and 2002, the authors followed 1621 individuals in Delhi, India using a combination of weekly and monthly-recall health questionnaires. In 2008, they augmented these data with another 8 weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. This paper shows that the length of the recall period had a large impact on reported morbidity, doctor visits, time spent sick, whether at least one day of work/school was lost due to sickness, and the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures such that the poor use health care providers more than the rich in the weekly recall surveys but less in monthly recall surveys. The authors hypothesize that illnesses -- especially among the poor -- are no longer perceived as"extraordinary events"but have become part of"normal"life. They discuss the implications of these results for health survey methodology, and the economic interpretation of sickness in poor populations.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Disease Control&Prevention,Gender and Health,Housing&Human Habitats
    Date: 2011–08–01
  5. By: Werding, Martin; McLennan, Stuart
    Abstract: Social insurance and other arrangements for funding health-care benefits often establish long-term relationships, effectively providing insurance against lasting changes in an individual's health status, engaging in burden-smoothing over the life cycle, and entailing additional elements of redistribution. International portability regarding this type of cover is, therefore, difficult to establish, but at the same time rather important both for the individuals affected and for the health funds involved in any instance of an international change in work place or residence. In this paper, full portability of health-cost cover is taken to mean that mobile individuals can, at a minimum, find comparable continuation of coverage under a different system and that this does not impose external costs or benefits on other members of the systems in the source and destination countries. Both of these aspects needs to be addressed in a meaningful portability framework for health systems, as lacking or incomplete portability may not only lead to significant losses in coverage for an individual who considers becoming mobile which may impede mobility that is otherwise likely to be beneficial. It may also lead to financial losses, or windfall gains, for sources of health-cost funding which can ultimately lead to a detrimental process of risk segmentation across national health systems. Against this background, even the most advanced sets of existing portability rules, such as those agreed upon multilaterally at the EU-level or laid down in bilateral agreements on social protection, appear to be untargeted, inconsistent and therefore potentially harmful, either for migrants or for health funds operated at both ends of the migration process, and hence for other individuals who are covered there.
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Health Law,Insurance Law
    Date: 2011–07–01
  6. By: David Johnston; Propper, Carol; Pudney, Stephen; Shields, Michael
    Abstract: We examine the effect of survey measurement error on the empirical relationship between child mental health and personal and family characteristics, and between child mental health and educational progress. Our contribution is to use unique UK survey data that contains(potentially biased) assessments of each childs mental state from three observers (parent, teacher and child), together with expert (quasi-)diagnoses, using an assumption of optimal diagnostic behaviour to adjust for reporting bias. We use three alternative restrictions toidentify the e ect of mental disorders on educational progress. Maternal education and mental health, family income, and major adverse life events, are all signi cant in explaining child mental health, and child mental health is found to have a large in uence on educationalprogress. Our preferred estimate is that a 1-standard deviation reduction in `true latent child mental health leads to a 2-5 months loss in educational progress. We also nd a strong tendency for observers to understate the problems of older children and adolescents compared to expert diagnosis.
    Date: 2011–08–16
  7. By: Rode, Sanjay
    Abstract: In the globalization era, adolescent pregnancies have become an important health issue. Teenage mothers have bigger disadvantage in terms of socio-economic factors. In Uttar Pradesh teenage mothers are found in the poorer households with less education. The logistic regression shows that odd ratio for the teenage mothers are more in rural area. The odd is higher for scheduled caste, tribe and other backward caste as compare to other caste households. The adolescent mothers of low standard of living index has higher odd ratio as compare to the adolescent mothers of higher standard of living index. Teenage mothers do not use the family planning methods and prenatal care. They do not deliver the baby in the health care facility and breastfeed their baby immediately after the delivery. The odd ratio is higher for no breastfeeding after child birth. In order to reduce the teenage pregnancy, government of Uttar Pradesh must generate more self employment opportunities to women and girls. The vocational training will improve the employment possibilities among adolescent girls. Government must provide the health care facilities to the poorer households. Such policies will reduce the adolescent pregnancies in the state.
    Keywords: Pregnancies; fertility; employment
    JEL: J13 J1
    Date: 2011–03–04
  8. By: Christopher Afendulis; Daniel Kessler
    Abstract: Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that subjecting integrated providers to higher-powered reimbursement incentives, i.e., less cost-sharing, may enhance medical productivity. More generally, we conclude that it may be efficient for purchasers of health services (and other services subject to agency problems) to consider the organizational form of their suppliers when choosing a reimbursement mechanism.
    JEL: I1 I11 I18 L2
    Date: 2011–08
  9. By: Janet Currie; Erdal Tekin
    Abstract: We investigate the relationship between foreclosure activity and the health of residents using zip code level longitudinal data. We focus on Arizona, California, Florida, and New Jersey, four states that have been among the hardest hit by the foreclosure crisis. We combine foreclosure data for 2005 to 2009 from RealtyTrac with data on emergency room visits and hospital discharges. Our zip code level quarterly data allow us to control for many potential confounding factors through the inclusion of fixed effects for each zip code as well as for each combination of county, quarter, and year. We find that an increase in the number of foreclosures is associated with increases in medical visits for mental health (anxiety and suicide attempts), for preventable conditions (such as hypertension), and for a broad array of physical complaints that are plausibly stress-related. They are not related to visits for cancer morbidity, which arguably should not respond as rapidly to stress. Foreclosures also have a zero or negative effect on elective procedures, as one might expect. Age specific results suggest that the foreclosure crisis is having its most harmful effects on individuals 20 to 49. We also find that larger effects for African-Americans and Hispanics than for whites, consistent with the perception that minorities have been particularly hard hit.
    JEL: I12
    Date: 2011–08
  10. By: Ralph Koijen; Stijn Van Nieuwerburgh; Motohiro Yogo
    Abstract: We develop a pair of risk measures for the universe of health and longevity products that includes life insurance, annuities, and supplementary health insurance. Health delta measures the differential payoff that a policy delivers in poor health, while mortality delta measures the differential payoff that a policy delivers at death. Optimal portfolio choice simplifies to the problem of choosing a combination of health and longevity products that replicates the optimal exposure to health and mortality delta. For each household in the Health and Retirement Study, we calculate the health and mortality delta implied by its ownership of life insurance, annuities including private pensions, supplementary health insurance, and long-term care insurance. For the median household aged 51 to 58, the lifetime welfare cost of market incompleteness and suboptimal portfolio choice is 28 percent of total wealth.
    JEL: D14 D91 G11 G22 I10
    Date: 2011–08
  11. By: Robert W. Fogel; Louis Cain; Joseph Burton; Brian Bettenhausen
    Abstract: Making use of those Union Army veterans for whom death certificates are available, we compare the conditions with which they were diagnosed by Civil War pension surgeons to the causes of death on the certificates. We divide the data between those veterans who entered the pension system early because of war injuries and those who entered the pension system after the 1890 reform that made it available to many more veterans. We examine the correlation between specific conditions and death causes to gauge support for the hypothesis that death is attributable to something specific. We also examine the correlation between the accumulation of rated conditions to time until death to gauge support for the “insult hypothesis.” In general, we find support for both hypotheses. Examining the hazard ratios for dying of a specific condition, there is support for the idea that what ail’d ya’ is what kill’d ya’.
    JEL: I1 N11
    Date: 2011–08
  12. By: Guy David; Richard Lindrooth; Lorens A. Helmchen; Lawton R. Burns
    Abstract: Cross-subsidies are often considered the principal mechanism through which hospitals provide unprofitable care. Yet, hospitals’ reliance on and extent of cross-subsidization are difficult to establish. We exploit entry by cardiac specialty hospitals as an exogenous shock to incumbent hospitals’ profitability and in turn to their ability to cross-subsidize unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry, we find that the hospitals most exposed to entry reduced their provision of services considered to be unprofitable (psychiatric, substance- abuse, and trauma care) and expanded their admissions for neurosurgery, a highly profitable service.
    JEL: I11 L21 L23
    Date: 2011–08

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