nep-hea New Economics Papers
on Health Economics
Issue of 2011‒09‒22
fifteen papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Children of the Revolution: Fetal and Child Health amidst Violent Civil Conflict By Christine Valente
  2. Long-Term Care, Altruism and Socialization By Grégory Ponthière
  3. Measuring Poverty Without The Mortality Paradox By Mathieu Lefebvre; Pierre Pestieau; Grégory Ponthière
  4. Returns to Education and Smoking : Evidence from Germany By Julia Reilich
  5. Opt Out or Top Up? Voluntary Healthcare Insurance and the Public vs. Private Substitution By Fabbri, Daniele; Monfardini, Chiara
  6. Socioeconomic heterogeneity in the effect of health shocks on earnings: evidence from population-wide data on Swedish workers By Lundborg, Petter; Nilsson, Martin; Vikström, Johan
  7. Did the US Infertility Health Insurance Mandates Affect the Timing of First Birth? By Ohinata, A.
  8. Investing in Child Health and Development: The Impact of Breastfeeding on Children's School Performance By Layte, Richard; McCrory, Cathal
  9. Are health factors important for regional growth and convergence? An empirical analysis for the Portuguese districts By Ana Poças; Elias Soukiazis
  10. Patient Mobility, Health Care Quality and Welfare By Kurt R. Brekke; Rosella Levaggi; Luigi Siciliani; Odd Rune Straume
  11. The Socio-Economic Causes of Obesity By Charles L. Baum; Shin-Yi Chou
  12. Integration and Task Allocation: Evidence from Patient Care By Guy David; Evan Rawley; Daniel Polsky
  13. The FDA and ABCs: The Unintended Consequences of Antidepressant Warnings on Human Capital By Susan Busch; Ezra Golberstein; Ellen Meara
  14. Where Have All the Young Men Gone? Using Gender Ratios to Measure Fetal Death Rates By Nicholas J. Sanders; Charles F. Stoecker
  15. Electoral Accountability and Local Government Efficiency: Quasi-Experimental Avidence From the Italian Health Care Sector Reforms By Francesco Porcelli

  1. By: Christine Valente (Department of Economics, The University of Sheffield)
    Abstract: This paper considers the impact of exposure to civil conflict on health inputs and outcomes from conception to age five, using the recent Maoist insurgency in Nepal as a case study. Conflict intensity is measured by the number of conflict deaths by district and month and merged with pregnancy histories from the 2001 and 2006 Demographic and Health Surveys. Within-mother estimates show that civil conflict increases the likelihood of miscarriage, so that exposure to conflict in utero has not only a scarring effect but also a selection effect on survivors, most likely due to a combination of maternal stress and malnutrition.
    Keywords: civil conflict, child health, fetal loss, Nepal
    JEL: I10 J13 O15
    Date: 2011–09
  2. By: Grégory Ponthière (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: The public provision of long-term care (LTC) can replace family-provided LTC when adults are not sufficiently altruistic towards their elderly parents. But State intervention can also modify the transmission of values and reduce the long-run prevalence of family altruism in the population. That evolutionary effect questions the desirability of the LTC public provision. To characterize the optimal LTC policy, we develop a three-period OLG model where the population is divided into altruistic and non-altruistic agents, and where the transmission of (non) altruism takes place through a socialization process à la Bisin and Verdier (2001). The optimal short-run and long-run LTC policies are shown to differ, to an extent varying with the particular socialization mechanism at work.
    Keywords: long-term care ; altruism ; socialization ; optimal policy ; crowding out effect
    Date: 2011–09
  3. By: Mathieu Lefebvre (CREPP - Center of Research in Public Economics and Population Economics - Université de Liège); Pierre Pestieau (CREPP - Center of Research in Public Economics and Population Economics - Université de Liège, PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris, CORE - Center of Operation Research and Econometrics [Louvain] - Université Catholique de Louvain, CEPR - Center for Economic Policy Research - CEPR); Grégory Ponthière (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris - INRA, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)
    Abstract: Under income-differentiated mortality, poverty measures reflect not only the "true" poverty, but, also, the interferences or noise caused by the survival process at work. Such interferences lead to the Mortality Paradox: the worse the survival conditions of the poor are, the lower the measured poverty is. We examine several solutions to avoid that paradox. We identify conditions under which the extension, by means of a fictitious income, of lifetime income profiles of the prematurely dead neutralizes the noise due to differential mortality. Then, to account not only for the "missing" poor, but, also, for the "hidden" poverty (premature death), we use, as a fictitious income, the welfare-neutral income, making indifferent between life continuation and death. The robustness of poverty measures to the extension technique is illustrated with regional Belgian data.
    Keywords: premature mortality ; income-differentiated mortality ; poverty measurement ; censored income profile
    Date: 2011–09
  4. By: Julia Reilich
    Abstract: Looking at smoking-behavior it can be shown that there are differences concerning the time-preference-rate. Therefore this has an effect on the optimal schooling decision in the way that we appear a lower average human capital level for smokers. According to a higher time-preference-rate additionally we suppose a higher return to education for smokers who go further on education. With our empirical findings we can confirm the presumptions. We use interactions-terms to regress the average rate of return with IV. Therefore we obtain that smokers have a significantly higher average return to education than non-smokers.
    Date: 2011–09
  5. By: Fabbri, Daniele (University of Bologna); Monfardini, Chiara (University of Bologna)
    Abstract: We investigate whether people enrolled into voluntary health insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption, without reducing reliance upon public provisions (top up). We study the case of Italy, where a mixed insurance system is in place. To this purpose, we specify a joint model for public and private specialist visits counts, and allow for different degrees of endogenous supplementary insurance coverage, looking at the insurance coverage as driven by a trinomial choice process. We disentangle the effect of income and wealth by going through two channels: the direct impact on the demand for healthcare and that due to selection into VHI. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for-profit VHI. These results imply that the market for VHI eases the redistribution from high income (doubly insured) individuals to low income (not doubly insured) ones operated by the Italian National Health Service (NHS). Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.
    Keywords: public provision of private goods, health insurance, bivariate count data model, endogenous multinomial treatment, simultaneous equation modeling
    JEL: C34 C35 D12 H44 I11
    Date: 2011–09
  6. By: Lundborg, Petter (Lunds University); Nilsson, Martin (IFAU - Institute for Labour Market Policy Evaluation); Vikström, Johan (Institute for Labout Market Policy Evaluation)
    Abstract: In this paper, we test for the existence of socioeconomic heterogeneity in the effect of health shocks on labor market outcomes using register data on the total population of Swedish workers. We estimate fixed effect models and use unexpected hospitalizations as a measure of health shocks. Our results suggest large heterogeneity in the effects, where low educated individuals suffer relatively more from a given health shock. This result holds across a wide range of different health shocks and our results suggest that the heterogeneity increases by age. We test several potential explanations to these results. Extensive sensitivity analyses, including a difference-in-differences matching model, show that our estimates are robust to a number of potential threats. We conclude that socioeconomic heterogeneity in the effect of health shocks offers one explanation to why the socioeconomic gradient in health widens during middle ages.
    Keywords: Health; health shocks; socioeconomic status; life-cycle
    JEL: I10 I12
    Date: 2011–08–31
  7. By: Ohinata, A. (Tilburg University, Center for Economic Research)
    Abstract: From 1977-2001, 15 US states mandated health insurance providers to offer coverage for infertility treatment. Although the majority of the past literature has studied impacts on older women who are likely to seek treatment, this paper proposes that the mandates may have had a wider impact on the US population. Specifically, it may have given an option for younger women to delay birth since these policies reduced the opportunity cost of having a child in the future. Results suggest a significant delay of 1-2 years in the time of first birth among highly educated white women.
    Keywords: Infertility;Insurance mandates;Fertility;Timing of birth.
    JEL: I18 J13 J18
    Date: 2011
  8. By: Layte, Richard; McCrory, Cathal
    Keywords: children
    Date: 2011–09
  9. By: Ana Poças (Polytechnic Institute of Guarda and UDI); Elias Soukiazis (Faculdade de Economia/GEMF, Universidade de Coimbra)
    Abstract: The aim of this study is to analyze the impact of health factors on economic growth and convergence across the Portuguese regions at the district level. Like education, health factors could be important for explaining the growth performance of regions through the increase in labour productivity. Therefore, human capital can be seen in a broader perspective encompassing not only educational qualifications but also health conditions. Although this is not a new idea, empirical evidence at a regional level is not robust supporting this issue, with few exceptions. With this study we try to fill this gap and bring additional evidence of the relevance of health on regional growth considering the Portuguese districts. We employ a panel data approach for the period 1996-2006 taking into account specific regional differences. We also analyze whether there are differences between the littoral (coastal) and the interior (in-land) districts in what concerns health conditions and how they affect their convergence process.
    Keywords: : Regional growth, health and human capital, panel data.
    JEL: R11 O18
    Date: 2011–08
  10. By: Kurt R. Brekke (Department of Economics and Centre and Health Economics Bergen, Norwegian School of Economics); Rosella Levaggi (Department of Economics, University of Brescia); Luigi Siciliani (Department of Economics and Centre for Health Economics, University of York, Heslington); Odd Rune Straume (Department of Economics, University of Minho)
    Abstract: Patient mobility is a key issue in the EU who recently pased a new law on patients`right to EU-wide provider choice. In this paper we use a hotelling model with txo regions that differ in technology to study the impact of patient mobility leads to too low (higt) quality and two few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient mobility implements the first best, but the low - skill region would not be willing to trnsfer authority as its welfare is lower than without mobility. In a decentralised solution, the effects of pacient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a "race-to-the-bottom" in quality and lower welfare in both regions. In the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region benefits. For a socially optimal payment, wich is higher than marginal cost, quality levels in the two regions are closer to (but not at) the first best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unles an appropriate transfer payment scheme is implemented.
    Keywords: Patient Mobility, Health Care Quality; Regional an global welfare
    JEL: H51 H73 I11 I18
    Date: 2011
  11. By: Charles L. Baum; Shin-Yi Chou
    Abstract: An increasing number of Americans are obese, with a body mass index of 30 or more. In fact, the latest estimates indicate that about 30% of Americans are currently obese, which is roughly a 100% increase from 25 years ago. It is well accepted that weight gain is caused by caloric imbalance, where more calories are consumed than expended. Nevertheless, it is not clear why the prevalence of obesity has increased so dramatically over the last 30 years. We simultaneously estimate the effects of the various socio-economic factors on weight status, considering in our analysis many of the socio-economic factors that have been identified by other researchers as important influences on caloric imbalance: employment, physical activity at work, food prices, the prevalence of restaurants, cigarette smoking, cigarette prices and taxes, food stamp receipt, and urbanization. We use 1979- and 1997-cohort National Longitudinal Survey of Youth (NLSY) data, which allows us to compare the prevalence of obesity between cohorts surveyed roughly 25 years apart. Using the traditional Blinder-Oaxaca decomposition technique, we find that cigarette smoking has the largest effect: the decline in cigarette smoking explains about 2% of the increase in the weight measures. The other significant factors explain less.
    JEL: I1 I12
    Date: 2011–09
  12. By: Guy David; Evan Rawley; Daniel Polsky
    Abstract: We develop a formal model to show how integration solves task allocation problems between organizations and test the predictions of the model, using a large and rich patient-level dataset on hospital discharges to nursing homes and home health care. As predicted by the theory, we find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower cost delivery systems by discharging patients earlier and in poorer health, and integration leads to greater post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks, health outcomes are no worse when patients receive care from an integrated provider. The evidence suggests that by improving the allocation of tasks, integration solves coordination problems that arise in market exchange.
    JEL: I12 L23
    Date: 2011–09
  13. By: Susan Busch; Ezra Golberstein; Ellen Meara
    Abstract: Using annual cross-sectional data on over 100,000 adolescents aged 12-17, we studied academic and behavioral outcomes among those who were and were not likely affected by FDA warnings regarding the safety of antidepressants. Just before the FDA warnings, adolescents with probable depression had grade point averages 0.14 points higher than adolescents with depression just after the warnings. The FDA warnings also coincided with increased delinquency, use of tobacco and illicit drugs. Together, our results stress the importance of mental health and its treatment as an input into cognitive and non-cognitive aspects of human capital.
    JEL: I12 J18 J24
    Date: 2011–09
  14. By: Nicholas J. Sanders; Charles F. Stoecker
    Abstract: Fetal health is an important consideration in the formation of health-based policy. However, a complete census of true fetal deaths is impossible to obtain. We present the gender ratio of live births as an under-exploited metric of fetal health and apply it to examine the effects of air quality on fetal health. Males are more vulnerable to side effects of maternal stress in utero, and thus are more likely to suffer fetal death due to pollution exposure. We demonstrate this metric in the context of the Clean Air Act Amendments of 1970 (CAAA) which provide a source of exogenous variation in county-level ambient total suspended particulate matter (TSPs). We find that a standard deviation increase in annual average TSPs (approximately 35 μg/m<sup>3</sup>) decreases the percentage of live births that are male by 3.1 percentage points. We then explore the use of observed differences in neonatal and one-year mortality rates across genders in response to pollution exposure as a metric to estimate total fetal losses in utero. These calculations suggest the pollution reductions from the CAAA prevented approximately 21,000-134,000 fetal deaths in 1972.
    JEL: I12 Q51 Q53
    Date: 2011–09
  15. By: Francesco Porcelli (University of Bari)
    Abstract: This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system; second a process of fiscal decentralisation. The electoral system was changed in 1995 and replaced a pure proportional system by a majoritarian system, fostering the transition of regional governments towards a presidential regime. The process of fiscal decentralisation took effect in 1998, when intergovernmental grants earmarked for the health care sector were replaced by regional taxes. The Italian context offers a unique source of data to test the predictions of recent theoretical models that support a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralisation. The paper provides two main contributions: 1) a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s; 2) the evaluation of the impact of the electoral reform in a quasi-experimental setting. The final results provide empirical evidence in line with the findings of the theoretical models.
    Keywords: electoral accountability, DEA, decentralisation, efficiency, health
    JEL: D71 D91 I32
    Date: 2011–09

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