nep-hea New Economics Papers
on Health Economics
Issue of 2011‒10‒15
24 papers chosen by
Yong Yin
SUNY at Buffalo, USA

  2. Altruistically Unbalanced Kidney Exchange By Tayfun Sönmez; M. Utku Ünver
  3. Income Inequality and Health: Lessons from a Residential Assignment Program By Hans Grönqvist; Per Johansson; Susan Niknami
  4. Human Recognition among HIV-Infected Adults: Empirical Evidence from a Randomized Controlled Trial in Kenya By Tony Castleman
  5. Opt Out Or Top Up? Voluntary Healthcare Insurance And The Public Vs. Private Substitution By D. Fabbri; C. Monfardini
  6. The Causal Effect of Education on Health: What is the Role of Health Behaviors? By G. Brunello; M. Fort; N. Schneeweis; R. Winter-Ebmer
  7. Four decades of health economics through a bibliometric lens By Wagstaff, Adam; Culyer, Anthony J.
  8. The Income Body Weight Gradients in the Developing Economy of China By Tafreschi, Darjusch
  9. A Guide to the MEPS-IC Government List Sample Microdata By Alice Zawacki
  10. Copula bivariate probit models: with an application to medical expenditures By Rainer Winkelmann
  11. The Use of Effective Coverage in the Evaluation of Maternal and Child Health Programs: A Technical Note for the IDB's Social Protection and Health Division By Josh Colston
  12. Regulated Medical Fee Schedule of the Japanese Health Care System By Makoto Kakinaka; Ryuta Ray Kato
  13. The Impact of Marginal Tax Reforms on the Supply of Health Related Services in Japan By Ryuta Ray Kato
  14. Health Insurance Reform and Economic Growth: Simulation Analysis in Japan By Toshihiro Ihori; Ryuta Ray Kato; Masumi Kawade; Shun-ichiro Bessho
  15. Cleaning the Bathwater with the Baby: The Health Co-Benefits of Carbon Pricing in Transportation By Christopher R. Knittel; Ryan Sandle
  16. Superfund Cleanups and Infant Health By Janet Currie; Michael Greenstone; Enrico Moretti
  17. Caution, Drivers! Children Present: Traffic, Pollution, and Infant Health By Christopher R. Knittel; Douglas L. Miller; Nicholas J. Sanders
  18. Measuring change in health care equity using small area administrative data – evidence from the English NHS 2001-8 By Richard Cookson; Mauro Laudicella; Paolo Li Donni
  19. Does hospital competition harm equity? Evidence from the English National Health Service By Richard Cookson; Mauro Laudicella; Paolo Li Donni
  20. Modeling healthcare quality: life expectancy SURS in the G7 countries and Korea By Firl, Daniel J.
  21. Smoke Signals and Mixed Messages: Medical Marijuana & Drug Policy Signalling Effects By Niko De Silva; Benno Torgler
  22. Evidence on the Efficacy of School-Based Incentives for Healthy Living By Harold E. Cuffe; William T. Harbaugh; Jason M. Lindo; Giancarlo Musto; Glen R. Waddell
  23. Impatience, Incentives, and Obesity By Charles J. Courtemanche; Garth Heutel; Patrick McAlvanah
  24. Estimating Patients' Preferences for Medical Devices: Does the Number of Profile in Choice Experiments Matter? By John Bridges; Christine Buttorff; Karin Groothuis-Oudshoorn

  1. By: Vincenzo Carrieri; Maria De Paola (Dipartimento di Economia e Statistica, Università della Calabria)
    Abstract: Using a rich Italian survey, we investigate the effect of height on individual happiness. From our analysis it emerges that a large part of the effect of height on well-being is driven by a positive correlation between height and economic and health conditions. However, for young males the effect of height on happiness persists even after controlling for these variables, implying that height may produce some psycho-social direct effects on well-being. Consistent with this hypothesis, we find that males care not only about their own height but also about the height of people in their reference group. Well-being is greater for individuals who are taller than other subjects in their reference group. Results are robust to different definitions of reference group and controlling for a number of other reference group characteristics. We speculate that the beneficial effect of height on young males' well-being may be related to the fact that in some countries, such as Italy, and especially for men, height is considered as a proxy for handsomeness.
    Keywords: height, social comparison, subjective well-being
    JEL: D6 I10 I30
    Date: 2011–10
  2. By: Tayfun Sönmez (Boston College); M. Utku Ünver (Boston College)
    Abstract: Although a pilot national live-donor kidney exchange program was recently launched in the US, the kidney shortage is increasing faster than ever. A new solution paradigm is able to incorporate compatible pairs in exchange. In this paper, we consider an exchange framework that has both compatible and in- compatible pairs, and patients are indifferent over compatible pairs. Only two-way exchanges are permitted due to institutional constraints. We explore the structure of Pareto-efficient matchings in this framework. The mathematical structure of this model turns out to be quite novel. We show that under Pareto-efficient matchings, the same number of patients receive transplants, and it is possible to construct Pareto-efficient matchings that match the same incompatible pairs while matching the least number of compatible pairs. We extend the celebrated Gallai-Edmonds Decomposition in the combinatorial optimization literature to our new framework. We also conduct comparative static exercises on how this decomposition changes as new compatible pairs join the pool.
    Keywords: Kidney Exchange, Market Design, Matching
    JEL: C78 D78 D02 D63
    Date: 2011–10–01
  3. By: Hans Grönqvist (SOFI, Stockholm University); Per Johansson (IFAU; Uppsala University; IZA); Susan Niknami (SOFI, Stockholm University)
    Abstract: This paper investigates how income inequality affects health. Although a large literature has shown that inhabitants in areas with greater income inequality suffer from worse health, past studies are severely plagued by inadequate data, non-random residential sorting and reverse causality. We address these problems using longitudinal population hospitalization data coupled with a settlement policy where Swedish authorities distributed newly arrived refugee immigrants to their initial area of residence. The policy was implemented in a way that provides a source of plausibly random variation in initial location. Our empirical analysis reveals no statistically significant effect of income inequality on the probability of being hospitalized. This finding holds also when investigating subgroups more vulnerable to negative health influences and when studying different types of diseases. There is however some indications of a detrimental effect on older persons’ health; but the magnitude of the effect is small. Our estimates are precise enough to rule out large effects of income inequality on health.
    Keywords: Income inequality; Immigration; Quasi-experiment
    JEL: I10 J15
    Date: 2011–10
  4. By: Tony Castleman (Institute for International Economic Policy, George Washington University)
    Abstract: This paper uses data from a randomized controlled trial to study the impacts of food supplementation and medical treatment on the receipt of human recognition by malnourished, HIV-infected adults in Kenya. Questions specially designed to measure human recognition were included in the trial, demonstrating how data on human recognition can be collected and analyzed as part of research or programs. The data are used to examine the impacts of interventions on human recognition, the determinants of human recognition receipt, and the role that human recognition plays in nutritional status and subjective well-being. Food supplementation has a significant, independent, positive impact on recognition received at completion of 6 months of food supplementation, but this effect does not persist 6 months after completion of the supplementation. The location of the study sites appears to play a significant role in the changes in human recognition, with smaller improvements among subjects at clinics in urban slums of Nairobi than among subjects in district and provincial hospitals outside of Nairobi, controlling for demographic, socio-economic, and health characteristics. Women receive lower levels of human recognition than men and also have worse mental health; further study is needed to better understand the relationship among gender, mental health, and human recognition. There is some evidence of an association between nutritional status and human recognition, but findings about the role human recognition plays in nutritional status and subjective well-being are mixed and further study is needed in this area, possibly over a longer timeframe than 12 months.
    Keywords: human recognition, respect, dehumanization, HIV, AIDS, malnutrition, nutrition, food supplementation, well being, randomized trial, stigma, Kenya
    JEL: I12 I31 O15
    Date: 2011–11
  5. By: D. Fabbri; C. Monfardini
    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.
    JEL: C34 C35 D12 H44 I11
    Date: 2011–09
  6. By: G. Brunello; M. Fort; N. Schneeweis; R. Winter-Ebmer
    Abstract: In this paper we investigate the contribution of health related behaviors to the education gradient, using an empirical approach that addresses the endogeneity of both education and behaviors in the health production function. We apply this approach to a multi-country data set, which includes 12 European countries and has information on education, health and health behaviors for a sample of individuals aged 50+. Focusing on self reported poor health as our health outcome, we find that education has a protective role both for males and females. When evaluated at the sample mean of the dependent variable, one additional year of education reduces self-reported poor health by 7.1% for females and by 3.1% for males. Health behaviors - measured by smoking, drinking, exercising and the body mass index - contribute to explaining the gradient. We find that the effects of education on smoking, drinking, exercising and eating a proper diet account for at most 23% to 45% of the entire effect of education on health, depending on gender.
    JEL: J1 I12 I21
    Date: 2011–09
  7. By: Wagstaff, Adam; Culyer, Anthony J.
    Abstract: This paper takes a bibliometric tour of the past 40 years of health economics using bibliographic"metadata"from EconLit supplemented by citation data from Google Scholar and the authors'topical classifications. The authors report the growth of health economics (33,000 publications since 1969 -- 12,000 more than in the economics of education) and list the 300 most-cited publications broken down by topic. They report the changing topical and geographic focus of health economics (the topics'Determinants of health and ill-health'and'Health statistics and econometrics'both show an upward trend, and the field has expanded appreciably into the developing world). They also compare authors, countries, institutions, and journals in terms of the volume of publications and their influence as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at the top on a variety of measures).
    Keywords: Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Rural Development Knowledge&Information Systems,Health Law
    Date: 2011–10–01
  8. By: Tafreschi, Darjusch
    Abstract: Though existing theories predict the income gradient of individual body weight to change sign from positive to negative in process of economic development, empirical evidence is scarce. This paper adds to the literature on that topic by investigating the case of China using data from the China Health and Nutrition survey. Using a one-dimensional measure to characterize the level of economic development of a region, regression analyses indicate that more income is related to larger future growth of individuals’ BMI in less developed areas whereas it lowers BMI growth in more developed areas. The switch is somewhat more pronounced for females. Finally, using concentration indices it is shown that overweight status is predominantly a problem of higher income ranks in less developed geographical areas and trickles down to lower income ranks throughout the course of economic development.
    Keywords: BMI, Bodyweight, Income, Development, China, CHNS, Concentration Index
    JEL: I18 O12
    Date: 2011–09
  9. By: Alice Zawacki
    Abstract: The Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) is conducted to provide nationally representative estimates on employer sponsored health insurance. MEPSIC data are collected from private sector employers, as well as state and local governments. While similar information is gathered from these two sectors, differences in the survey process exist. The goal of this paper is to provide details on the public sector including types of state and local government employers, sample design, general information on the data collected in the MEPS-IC, and additional sources of information.
    Keywords: employer sponsored insurance; state and local governments; Medical Expenditure Panel Survey-Insurance Component; public sector
    JEL: I1 J3
    Date: 2011–09
  10. By: Rainer Winkelmann
    Abstract: The bivariate probit model is frequently used for estimating the effect of an endogenous binary regressor (the "treatment") on a binary health outcome variable. This paper discusses simple modifications that maintain the probit assumption for the marginal distributions while introducing non-normal dependence using copulas. In an application of the copula bivariate probit model to the effect of insurance status on the absence of ambulatory health care expen- diture, a model based on the Frank copula outperforms the standard bivariate probit model.
    Keywords: Bivariate probit, binary endogenous regressor, Frank copula, Clayton copula
    JEL: C35 I12
    Date: 2011–09
  11. By: Josh Colston
    Abstract: Effective coverage is a measure of health system performance that combines three aspects of health care service delivery into a single measure: need, use, and quality. In this technical note, the concept of effective coverage is explained, methodological issues are discussed and the implications for the evaluation of SPH's projects in maternal and child health are presented.
    Keywords: Health :: Diseases, Health :: Health Care, Health :: Nutrition, maternal health, child health, health care, public health
    Date: 2011–07
  12. By: Makoto Kakinaka (International University of Japan); Ryuta Ray Kato (International University of Japan)
    Abstract: We present a theoretical framework for investigating the effect of the Japanese government-regulated medical fee schedule, 'Shinryo-Houshu-Seido,' on the behavior of medical providers. We also discuss the optimal rule of this fee schedule for the regulator, taking into account information asymmetry between the regulator and providers. Our simple model predicts that under the current fee schedule heterogeneous providers either under-provide or over-provide medical inputs, depending on the price. Furthermore, our analytical results show that when the allocated budget is reduced to a certain level, even the second-best outcome becomes unachievable, no matter how the fee schedule is regulated. While we demonstrate that the global budget caps or the limited budget size is shown to have a clear negative effect on social welfare, we suggest that the prospect of obtaining the second-best outcome without complete information on heterogeneous providers is left to negotiation between the regulator and the budget allocator.
    Keywords: asymmetric information, budget caps, regulated medical fee schedule, Japanese health care system
    Date: 2011–05
  13. By: Ryuta Ray Kato (International University of Japan)
    Abstract: This paper presents a computable general equilibrium (CGE) framework to numerically examine the effect of marginal tax reforms on the supply side of health related sectors. The generalized framework with the latest Japanese input-output table of year 2005 with 108 different production sectors provides the following results: An expansion of subsidies to the hospital sector creates the largest welfare gain when the government does not take into account its financing explicitly. The effect of such a policy on economic efficiency is more than ten times as much as the cost. However, such an expansion policy does necessarily not eventuate in the largest gain anymore if the government considers its balanced budget. The reduction of subsidies to the hospital sector reversely results in the largest welfare gain if the government uses its surplus induced by the reduction of subsidies, in order to decrease the tax imposed on the social welfare sector. Furthermore, if the hospital sector is compensated by lump-sum trasfers when its net subsidy rate is reduced, then a welfare gain could become larger. If the govenment uses its surplus not only for the reduction of the net tax rate of the social welfare sector but also for lump-sum transfers to the hospital sector in order to keep its income unchanged, then a larger welfare gain would be obtained, even if the government implements a balanced budget policy. This implies that a welfare enhancing tax reform within health related sectors is plausible as long as the net subsidy rate of the hospital sector can be reduced. Such a reform does not create any new government deficits either.
    Keywords: Computable General Equilibrium (CGE) Model, Marignal Tax Reform, Health Sectors, Taxation, Subsidy, Simulation
    JEL: C68 H51 H53
    Date: 2011–09
  14. By: Toshihiro Ihori (The University of Tokyo); Ryuta Ray Kato (International University of Japan); Masumi Kawade (Nihon University); Shun-ichiro Bessho (Hitotsubashi University)
    Abstract: This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations. Our simulation produced the following results: First, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior following the increase in co-payment rates, however, reduces economic growth. Third, Japanfs trend of increasing the future public health insurance benefits can mainly be explained by its aging population, and increasing the co-payment rate does little to reduce future payments of public health insurance benefits. Fourth, the effect on future economic burdens of reducing medical costs through efficiencies in public health insurance, emphasis on preventive medical care, or technological progress in the medical field is small. Finally, a policy of maintaining public health insurance at a fixed percentage of GDP will require reducing public health insurance benefits, perhaps up to 45% by 2050. Such a policy also reduces economic growth until approximately 2035. Our simulation indicates that the reform does not significantly reduce future public health insurance benefits, but it can enhance economic growth and welfare by encouraging private saving.
    Keywords: public health insurance; Japan; national medical expenditure; economic growth; aging population; dynamic CGE model
    JEL: C68 D58 E17 E62 H51 H55 H62 I18 O40
    Date: 2011–09
  15. By: Christopher R. Knittel; Ryan Sandle
    Abstract: Efforts to reduce greenhouse gas emissions in the US have relied on Corporate Average Fuel Economy (CAFE) Standards and Renewable Fuel Standards (RFS). Economists often argue that these policies are inefficient relative to carbon pricing because they ignore existing vehicles and do not adequately reduce the incentive to drive. This paper presents evidence that the net social costs of carbon pricing are significantly less than previous thought. The bias arises from the fact that the demand elasticity for miles travelled varies systematically with vehicle emissions; dirtier vehicles are more responsive to changes in gasoline prices. This is true for all four emissions for which we have data—nitrogen oxides, carbon monoxide, hydrocarbon, and greenhouse gases—as well as weight. This reduces the net social costs associated with carbon pricing through increasing the co-benefits. Accounting for this heterogeneity implies that the welfare losses from $1.00 gas tax, or a $110 per ton of CO2 tax, are negative over the period of 1998 to 2008 even when we ignore the climate change benefits from the tax. Co-benefits increase by over 60 percent relative to ignoring the heterogeneity that we document. In addition, accounting for this heterogeneity raises the optimal gas tax associated with local pollution, as calculated by Parry and Small (2005), by as much as 57 percent. While our empirical setting is California, we present evidence that the effects may be larger for the rest of the US.
    Date: 2011–08
  16. By: Janet Currie; Michael Greenstone; Enrico Moretti
    Abstract: We are the first to examine the effect of Superfund cleanups on infant health rather than focusing on proximity to a site. We study singleton births to mothers residing within 5km of a Superfund site between 1989-2003 in five large states. Our “difference in differences” approach compares birth outcomes before and after a site clean-up for mothers who live within 2,000 meters of the site and those who live between 2,000- 5,000 meters of a site. We find that proximity to a Superfund site before cleanup is associated with a 20 to 25% increase in the risk of congenital anomalies.
    Date: 2011–02
  17. By: Christopher R. Knittel; Douglas L. Miller; Nicholas J. Sanders
    Abstract: Since the Clean Air Act Amendments of 1990 (CAAA), atmospheric concentration of local pollutants has fallen drastically. A natural question is whether further reductions will yield additional health benefits. We further this research by addressing two related research questions: (1) what is the impact of automobile driving (and especially congestion) on ambient air pollution levels, and (2) what is the impact of modern air pollution levels on infant health? Our setting is California (with a focus on the Central Valley and Southern California) in the years 2002-2007. Using an instrumental variables approach that exploits the relationship between traffic, ambient weather conditions, and various pollutants, our findings suggest that ambient pollution levels, specifically particulate matter, still have large impacts on weekly infant mortality rates. Our results also illustrate the importance of weather controls in measuring pollution’s impact on infant mortality.
    Date: 2011–07
  18. By: Richard Cookson (Centre for Health Economics, University of York, UK); Mauro Laudicella (Healthcare Management Group, Imperial College Business School, London, UK); Paolo Li Donni (Department of Economics, Finance and Business, University of Palermo, Italy)
    Abstract: This study developed a method for measuring change in socio-economic equity in health care utilisation using small area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1,500 and combined with other small area administrative data. Regression models of utilisation were used to examine year-on-year change in the small area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003-8) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006-8) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement.
    Date: 2011–10
  19. By: Richard Cookson (Centre for Health Economics, University of York, UK); Mauro Laudicella (Imperial College Business School, London, UK); Paolo Li Donni (Department of Economics, Finance and Business, University of Palermo, Italy)
    Abstract: Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market dispersion and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity.
    Date: 2011–10
  20. By: Firl, Daniel J.
    Abstract: In this study I have made efforts towards investigating healthcare in two arenas. First, can a model with life expectancy as a proxy for healthcare quality be used to objectify the study of efficiency in the G7 countries and Korea? Table 1 and the results section have illuminated many factor variables which vary between countries and characterize the environments in which different healthcare systems have developed. The analysis also illuminates an inherent structural difference in the mechanism of delivering healthcare throughout the developed world. Secondly, can these aggregate data be used to show us anything new about the studies performed by Peter Zweifel and Friedrich Breyer? Did the SISYPHUS Syndrome disappear in the early 1990s as Zweifel suggested in 2002? No, in Table 2 I have demonstrated through SURS that over the time period 1990-2009 there are clear statistically significant SISYPH variables in at least Canada, Germany, Korea, and Britain. Lastly, can I confirm Breyer’s model of HCE in Germany and can it be useful in other countries? Yes to extent possible the methodologies were replicated in a SURS fashion in an effort to simultaneously test and examine different variables in different countries. I was unable to confirm the results of Breyer in his 2011 examination of the sickness fund members for Germany. However, I was able to offer primitive characterizations of the other G7 countries and Korea and how their HCE move.
    Keywords: healthcare expenditures ; healthcare factor variables ; sisyphus syndrome
    JEL: I11 I12 I1
    Date: 2011–06–15
  21. By: Niko De Silva (QUT); Benno Torgler (QUT)
    Abstract: Liberal drug policy reform is often criticized for 'sending the wrong message', particularly to youth. Reform opponents argue that liberal policies such as decriminalisation and medical marijuana laws will cause marijuana to be perceived as less risky and lead to an increase in use. We seek to test this claim empirically, exploiting the timing and unique properties of state level medical marijuana laws in the US to isolate policy signalling effects. We use survey-derived state-level estimates of youths' marijuana risk-perceptions and use prevalence, and find evidence of signalling effects on aggregate risk-perceptions of marijuana use that correspond to the introduction of medical marijuana laws. These effects, however, do not conform to what reform opponents predict - medical marijuana provisions appear to send the 'right' message. Further, we find no robust effects on non-medical marijuana use.
    Keywords: Medical marijuana, drug policy, ballot initiatives, policy signalling
    JEL: K14 K42 I18 Z19
    Date: 2011–09–12
  22. By: Harold E. Cuffe; William T. Harbaugh; Jason M. Lindo; Giancarlo Musto; Glen R. Waddell
    Abstract: We analyze the effects of a school-based incentive program on children's exercise habits. The program offers children an opportunity to win prizes if they walk or bike to school during prize periods. We use daily child-level data and individual fixed effects models to measure the impact of the prizes by comparing behavior during prize periods with behavior during non-prize periods. Variation in the timing of prize periods across different schools allows us to estimate models with calendar-date fixed effects to control for day-specific attributes, such as weather and proximity to holidays. On average, we find that being in a prize period increases riding behavior by sixteen percent, a large impact given that the prize value is just six cents per participating student. We also find that winning a prize lottery has a positive impact on ridership over subsequent weeks; consider heterogeneity across prize type, gender, age, and calendar month; and explore differential effects on the intensive versus extensive margins.
    JEL: I12
    Date: 2011–10
  23. By: Charles J. Courtemanche; Garth Heutel; Patrick McAlvanah
    Abstract: This paper explores the relationship between time preferences, economic incentives, and body mass index (BMI). Using data from the 2006 National Longitudinal Survey of Youth, we first show that greater impatience increases BMI and the likelihood of obesity even after controlling for demographic, human capital, occupational, and financial characteristics as well as risk preference. Next, we provide evidence of an interaction effect between time preference and food prices, with cheaper food leading to the largest weight gains among those exhibiting the most impatience. The interaction of changing economic incentives with heterogeneous discounting may help explain why increases in BMI have been concentrated amongst the right tail of the distribution, where the health consequences are especially severe. Lastly, we model time-inconsistent preferences by computing individuals' quasi-hyperbolic discounting parameters (beta and delta). Both long-run patience (delta) and present-bias (beta) predict BMI, suggesting obesity is partly attributable to rational intertemporal tradeoffs but also partly to time inconsistency.
    JEL: D9 I10
    Date: 2011–10
  24. By: John Bridges; Christine Buttorff; Karin Groothuis-Oudshoorn
    Abstract: Background: Most applications of choice-based conjoint analysis in health use choice tasks with only two profiles, while those in marketing routinely use three or more. This study reports on a randomized trial comparing paired with triplet profile choice formats focused on measuring patient preference for hearing aids. Methods: Respondents with hearing loss were drawn from a nationally representative cohort, completed identical surveys incorporating a conjoint analysis, but were randomized to choice tasks with two or three profiles. Baseline differences between the two groups were explored using ANOVA and chi-square tests. The primary outcomes of differences in estimated preferences were explored using t-tests, likelihood ratio tests, and analysis of individual-level models estimated with ordinary least squares. Results: 500 respondents were recruited. 127 had no hearing loss, 28 had profound loss and 22 declined to participate and were not analyzed. Of the remaining 323 participants, 146 individuals were randomized to the pairs and 177 to triplets. The only significant difference between the groups was time to complete the survey (11.5 and 21 minutes respectively). Pairs and triplets produced identical rankings of attribute importance but homogeneity was rejected (P<0.0001). Pairs led to more variation, and were systematically biased toward the null because a third (32.2%) of respondents focused on only one attribute. This is in contrast to respondents in the triplet design who traded across all attributes. Discussion: The number of profiles in choice tasks affects the results of conjoint analysis studies. Here triplets are preferred to pairs as they avoid non-trading and allow for more accurate estimation of preferences models.
    JEL: C91 I11 I18
    Date: 2011–10

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